Health Risks of Smoking
Health Risks of Smoking
60
7.5 years
40 33
20 12
0
40 55 70 85 100
Age
Doll et al BMJ 1994
Health benefits of smoking cessation
• Increased longevity
• Stabilisation of lung cancer risk (but not
absolute decline)
• Heart disease risk declines towards non-
smoker level over 10 years
• Accelerated decline in lung function reduced
• Improved reproductive health
• Improved recovery from surgery
Effects of quitting
80 80
% Alive
% Alive
60 60
40 40 Former smokers
Former smokers
20 stopped 35-44 20 stopped 45-54
0 0
40 55 70 85 100 40 55 70 85 100
Age Age
100 100
80 80
% Alive
% Alive
60 60
40 40
Former smokers Former smokers
20 stopped 55-64 20 stopped 65+
0 0
40 55 70 85 100 40 55 70 85 100
Age Age
Doll et al BMJ 1994
Effects of cessation on cancer
• At age 60, 1 in 17 men or 1 in 24 women that
stop smoking may avoid lung cancer
(BMJ 2000;321:323-9)
• At age 50, 1 in 10 men or 1 in 14 women that
stop smoking avoid lung cancer
• At age 40, 1 in 8 men; at age 30, 1 in 7 men
that stop smoking avoid lung cancer
• Former smokers reduce their incidence of
laryngeal, oral cavity & oesophagus,
pancreatic, colorectal, and urinary tract cancer
Lung cancer risk by age and smoking
20.0
habit
17.9
Rate per 1000 person years
16.0
13.2 45-54
12.0 55-64
9.2
65-74
8.0 7.0 7.1
75-84
4.5
3.9
4.0
2.7
1.7
1.1
0.6
0.3 0.6 0.6
0.1
0.0
0.0
Nonsmokers 1-14 cigs 15-24 25 +
Smoking habit
CPS2
Lung cancer risk by age of quitting
Current
smokers
Lung cancer deaths per 100,000
Never
1500
smokers
quit 30-39
1000
quit 40-49
quit 50-54
500
quit 55-59
0 quit 60-64
40 50 60 70 80
Age Halpern JNCI 1993: CPS2 data
Smoking cessation and CHD
“Healthy” smokers Smokers with CHD
• Mortality risk may • Cessation halves risk
take up to 10 years during 1-13 years of
after cessation to follow-up (Eur Heart J
reach that of non- 1999;20:1773)
smoker; • One of every five
• Acute myocardial smokers that quits
infarction (heart avoids CHD event
attack) risk declines during 10 years
in only 3-4 years
Blood pressure, stroke, renal
function
• Blood pressure increased (independently of body weight) after
cessation in several long-term studies
• 24-hour BP monitoring showed daytime lowering of BP after 1
week of cessation (Hypertension 1999;33:586)
• Former smokers have decreased carotid artery stenosis
compared to current smokers
• Cessation reduces risk of stroke to non-smoker level after 5
years
• Drug treatment of hypertension is less effective in smokers
• Former smokers have less renal function abnormalities than
continuing smokers
Pulmonary function
2.9
Postbronchodilator FEV1
2.7
Continuing smokers
2.6
2.5
2.4
Screen 1 2 3 4 5
JAMA 1994;272(19):1497-505 Years of follow-up
depqumch.tc
Effects of cessation on reproductive
health
• Women who stop before pregnancy: no adverse
effects of smoking on infants
• Stopping between the 1st prenatal care visit and
week 32 prevents deficits in infant birth weight,
head circumference and brain:body weight ratio
but does not completely prevent deficits in
crown-heel length or increased ponderal index
(Am J Epidemiol 2000;152:219)
• Former smokers have the same prevalence of
erectile dysfunction (impotence) as non-smokers
Postoperative complications
400
300
220
200
100 70
0
1950 1975 2000 2025 2050
Year
Source: Peto et al
Cumulative deaths from tobacco (millions)
Scenarios: impact of prevention
520
500 500
Trend
If smoking
uptake halves
400
by 2020
300
220
200
100 70
0
1950 1975 2000 2025 2050
Year
Source: Peto et al
Cumulative deaths from tobacco (millions) Scenarios: impact of cessation
520
500 500
Trend
If smoking
uptake halves
400
by 2020
300 340
220 If adult smoking
200 halves by 2020
190
100 70
0
1950 1975 2000 2025 2050
Year
Source: Peto et al