Warren Graham W, Cummings K Michael
From the Department of Radiation Oncology, Department of Cell and Molecular Pharmacology and Experimental Therapeutics, Department of Psychiatry and Behavioral Sciences, Hollings Cancer Center, Medical University of South Carolina, Charleston SC.
Am Soc Clin Oncol Educ Book. 2013:359-64. doi: 10.14694/EdBook_AM.2013.33.359.
Tobacco use, primarily associated with cigarette smoking, is the largest preventable cause of cancer mortality, responsible for approximately one-third of all cancer deaths. Approximately 85% of lung cancers result from smoking, with an additional fraction caused by secondhand smoke exposure in nonsmokers. The risk of lung cancer is dose dependent, but can be dramatically reduced with tobacco cessation, especially if the person discontinues smoking early in life. The increase in lung cancer incidence in different countries around in the world parallels changes in cigarette consumption. Lung cancer risks are not reduced by switching to filters or low-tar/low-nicotine cigarettes. In patients with cancer, continued tobacco use after diagnosis is associated with poor therapeutic outcomes including increased treatment-related toxicity, increased risk of second primary cancer, decreased quality of life, and decreased survival. Tobacco cessation in patients with cancer may improve cancer treatment outcomes, but cessation support is often not provided by oncologists. Reducing the health related effects of tobacco requires coordinated efforts to reduce exposure to tobacco, accurately assess tobacco use in clinical settings, and increase access to tobacco cessation support. Lung cancer screening and coordinated international tobacco control efforts offer the promise to dramatically reduce lung cancer mortality in the coming decades.
烟草使用，主要与吸烟相关，是癌症死亡的最大可预防原因，约占所有癌症死亡人数的三分之一。大约85%的肺癌由吸烟导致，另有一部分是由非吸烟者接触二手烟引起的。肺癌风险与吸烟量有关，但戒烟可显著降低风险，尤其是在早年就戒烟的情况下。世界各国肺癌发病率的上升与香烟消费量的变化同步。改用过滤嘴香烟或低焦油/低尼古丁香烟并不能降低肺癌风险。在癌症患者中，确诊后继续吸烟与不良治疗结果相关，包括治疗相关毒性增加、患第二原发性癌症的风险增加、生活质量下降和生存率降低。癌症患者戒烟可能改善癌症治疗结果，但肿瘤学家通常不提供戒烟支持。减少烟草对健康的影响需要协同努力，以减少烟草接触、在临床环境中准确评估烟草使用情况，并增加获得戒烟支持的机会。肺癌筛查和协调一致的国际烟草控制努力有望在未来几十年大幅降低肺癌死亡率。
