Dependence of oncological diseases on mother's smoking. Impact of smoking on cancer occurrence

Oncological diseases rank first among the ailments of the modern human body. The increase in the number of oncology diagnoses has become an acute health problem in all countries of the world.

Cancer does not spare any of the body systems, including the respiratory system.

But is there a real connection between smoking and the occurrence of cancers in the human lungs? How does addiction affect the functioning of the respiratory system?

Over the past few years, medical scientists have been conducting research on the influence of a person's lifestyle on the occurrence of oncological diseases... Based on the results of the observations and experiments, today we can confidently state that the habit of smoking really provokes the formation of cancer cells. What is the reason? The fact is that any cigarettes contain harmful carcinogenic substances. Accumulating in the last part of the cigarette, they freely enter the human body when inhaling cigarette smoke.

Despite the increased popularity in recent years, electronic cigarettes also have a lot of subtleties of use. Of course, compared to conventional cigarettes, electronic devices have less impact on the body due to the absence of harmful tar, reduced content of nicotine and other harmful substances.

But the main danger from electronic cigarettes conceal the liquids and impurities used in them. Regardless of the brand and manufacturer of products, each of them still includes toxic substances, carcinogens and heavy metals in its composition.

Cancer provoking by smoking, causes and statistics of diseases

With regular smoking, substances enter the smoker's body, gradually destroying the structure of the epithelium in the bronchi. This process provokes substitutions in the columnar epithelium for flat and multilayered tissue structures. It is these tissue changes that lead to the appearance of malignant tumors.

Cancer in the lungs caused by smoking is caused by exposure to tobacco smoke, which contains harmful components such as tar and nicotine.

The habit of smoking is one of the most common, well-founded and researched reasons for the development of malignant tumors. Smoking is the undisputed cause of tissue destruction in the respiratory system.

In addition to the proliferation of cancer cells in the lung area, tobacco smoking is the cause of diseases such as:

• cancers in the lip area and oral cavity generally;
• oncological diseases of the esophagus;
• cancer that affects the liver, stomach, and pancreas;
• cancerous growths in the trachea, bronchi;
• cancer can affect the kidneys, bladder, cervix and human blood.

The risk of oncological diseases in a smoker is much higher, which has been proven by repeated scientific medical research.

The experiments were carried out both on animals and by the method of statistical analysis of morbidity in various populations. The results of experiments carried out on animals proved that due to direct contact of a living creature and tobacco smoke, the probability of formation cancerous tumors, undoubtedly increases at times.

Excessive smoking is called the main cause of lung cancer. In the statistics of patients, an important fact is noted that the cases of the disease among the male half of the population are ten times higher than the diagnoses of oncology among women.

People who are in direct contact with tobacco smoke are at the highest risk of developing cancer. At the same time, cancerous tumors that affect the area of \u200b\u200bthe human mouth are formed 2-3 times more often in heavy smokers than in people without such a pernicious habit. Special attention should be paid to cases in which the consumption of the number of cigarettes reaches one pack per day or more. The risk of getting cancer in such patients increases 10 times.

The development of cancerous tumors directly depends on such factors:

• frequency of cigarette smoking during the day;
• the age at which the patient started smoking;
• the quality of the tobacco used;
• lifestyle of a person in general.

For example, those who smoke up to 10-15 cigarettes per day are 8 times more likely to get cancer than non-smokers. At that time, the risk of cancer in those who use 20 to 25 cigarettes a day, compared to non-smokers, is 20 times higher.

The risk of developing the disease also depends on the age of the patient, and also his experience as a smoker. For example, if a person has joined an addiction before reaching the age of eighteen, then the likelihood of the manifestation of the disease increases 13 times compared to statistics among nonsmokers.

The risk of developing cancer, depending on the age of the patient, is as follows:

• smoking started by a person between the ages of 20 and 24 increases the likelihood of cancerous growths by 10 times;
• but the addiction to smoking, started at the age of 25 and older, increases the chances of getting sick 3 times.

According to the results of the simplest statistical studies, the habit of smoking can be the cause of cancer in 90% of cases among the male population, from 60% to 80% of diagnoses among women.

Also, from 40% to 60% of cases of malignant tumors are noted in cases where tobacco smoking is accompanied by excessive alcohol consumption.

Primary signs of cancerous lesions

It should be noted that cancerous lesions do not manifest themselves immediately. At the initial stage of development, they are preceded by long-term precancerous changes in the mucous tissues of the bronchi and lungs. Often, tumor formations develop in the bronchial mucosa, thereby closing its lumen as it develops. At the same time, breathing is gradually hampered, the flow of oxygen into the body is disrupted.

The first signs of lung cancer and cancerous lesions respiratory tract it is generally accepted to consider:

• frequent bouts of dry cough;
• accumulation of phlegm and mucus when coughing up;
• painful sensations both day and night in the area of \u200b\u200bthe sternum and bronchi.

When further development diseases, along with sputum discharge, blood splashes can also be observed. In the case when the development of cancer is characteristic of the middle bronchi, then the patient's condition may deteriorate sharply due to additional infection.

In the event that small bronchi are affected, then the first symptoms will be:

• persistent chest pain;
• severe cough with pain;
• less pain in the lungs;
• rapid fatigability, increasing weakness and a decrease in the level of performance.

It is important that changes in tissues can be stopped at an early stage.

This process is completely reversible if the patient does not just reduce the number of cigarettes used per day, but completely quits the smoking habit.

The fact that smoking even five cigarettes a day still remains at the same level of cancer risk as smoking a whole pack should make smokers think about the real dangers of addiction. In addition, inhalation of tobacco smoke while smoking influences the occurrence of 1/3 of tumors of all diagnosed tumors.

Smoking kills the body of any person, which leads to inevitable diseases or even death due to the developed ailments. To the question of what percentage of smokers develop cancer in the lung tissues, the answer has long been received: in the case of every second smoker, a lethal outcome was recorded due to the development of diseases provoked by tobacco dependence.

Quitting smoking completely allows you to lower your cancer risks. Active promotion of sports, healthy and active lifestyles can call on the population to refuse or revise their own habits.

In addition to this general rule, there are several more recommendations:

If desired, every smoker can take advantage of the help of specialists who can not only choose an effective program to eliminate addiction, but also help in the fight against dangerous addiction with special techniques and regular examinations.

Smoking is the most significant preventable cause of cancer. Years of research have proven that the link between smoking and cancer is clear. Smoking is responsible for about a quarter of cancer deaths and one fifth of all cancer cases.

Smoking is responsible for over 100 million deaths worldwide during the 20th century. WHO experts argue that in the 21st century, while maintaining modern look on this problem, the number of deaths can reach one billion.

Most importantly, most of these premature deaths were preventable by smoking cessation.

What types of cancer does smoking cause?

Smoking is the cause of 4 out of 5 cases. Lung cancer is a cancer with a low survival rate and one of the most unfavorable cancers. He is the most common reason deaths from cancer in the world.

Smoking also increases the risk of at least 13 types of cancer, including cancer of the larynx, esophagus, oral cavity and pharynx, pancreas, kidney, liver, stomach, intestine, cervix, ovary, nose and sinuses, as well as some ...

Why is it so hard to quit smoking?

Smoking is highly addictive because tobacco contains nicotine. Cigarettes provide a quick dose of nicotine - it takes about 20 seconds for the nicotine from the absorbed smoke to reach the brain. Nicotine is a drug, the strength of addiction to which is comparable to such "hard" drugs as heroin and cocaine. This is the main reason that quitting smoking can be very, very difficult.

How exactly does tobacco smoke cause cancer?

The most important mechanism of cancer caused by smoking is DNA damage, including key genes that protect us from cancer. Many chemicals found in cigarette smoke have been shown to cause DNA damage - including benzene, polonium-210, benzopyrene, and nitrosamines.

The effect of these toxic substances is aggravated when they work together with other substances contained in cigarette smoke. For example, chromium allows poisons like benzopyrene to form stronger bonds with DNA molecules, thereby increasing the likelihood of serious damage. Chemical elements such as arsenic and nickel interact with the mechanisms of repair (restoration) of the damaged DNA molecule. As a result, the likelihood that the damaged cell will turn into malignant increases significantly.

How long does it take to smoke for cancer to develop?

It usually takes many years or even decades from the moment you start smoking to the development of cancer. Human body able to cope with a certain amount of DNA damage, however, it is very difficult to restore all molecules damaged by tobacco smoke.

Each cigarette is capable of damaging the DNA in a large number of lung cells, in addition, damage in the same cells accumulates over time. One recent study has shown that every 15 cigarettes smoked can cause enough DNA changes for a cell to turn from normal to. That is why it is better to quit smoking sooner or later.

What else does smoking harm?

It is also more difficult for smokers to cope with harmful environmental factors than people with healthy lungs and blood vessels... Each person has special enzymes that can neutralize harmful substances and turn them into non-toxic compounds. But the neutralization of chemicals contained in tobacco smoke, such as cadmium, can exhaust the reserves of this “purification”.

Other chemicals, such as formaldehyde and acrolein, kill the cilia that clear harmful substances from the airways.

Cigarette smoke also affects the immune system by suppressing cells that can recognize and destroy a malignant cell soon after it appears.

Second hand smoke

Secondhand smoke can also cause cancer - by a quarter increases the likelihood of lung cancer in
a non-smoker may also increase the likelihood of occurrence and pharynx.

Secondhand smoke can also increase the risk of other diseases, such as illness of cardio-vascular system, strokes, breathing problems.

Secondhand smoke is especially harmful for children. They are at increased risk of developing respiratory infections, asthma, bacterial meningitis and sudden death. Most importantly, children are usually exposed to passive exposure to tobacco smoke at home, where one or both parents smoke. Tobacco smoke spreads through the apartment, even if the windows are open. Almost 85% of tobacco smoke is invisible and particles of smoke accumulate on surfaces and clothing.

For the same reasons, driver's smoking has a harmful effect on the health of car passengers, especially children. Some countries have introduced a liability to smoke in a car if the passenger is under 18.

Oncological diseases occupy one of the first places among other human ailments. Lung cancer is the world's biggest public health problem. Cancer kills all internal organs and systems, and the respiratory system is no exception.

Statistical information

According to statistics, today the number of smokers is more than 1.2 billion worldwide, that is, a third of the world's population smokes.

More than 60% of men smoke, and 15% of women. Many people start smoking at school.

Tobacco smoke contains a large number of toxins and poisons, including polycyclic carbohydrates. Poisonous substances such as aromatic amines, benzopyrene, naphthylamine, aminobiphenyl, benzene, phenol, and many others are found in cigarettes, so smoking and lung cancer are closely related.

Causes of oncology

To understand why cancer occurs, it is necessary to understand what cancer is and what causes the development of malignant tumors.

The human body is a living system that consists of cells. Cells in our body are constantly growing and dividing to replace damaged or aged cells. In about 7–10 years, all cells of the body are completely renewed. And if this mechanism breaks down, uncontrolled cell division and growth occurs, which leads to cancer.

All known factors that provoke cancer can be combined into three groups:

• physical (radiation, ultraviolet radiation, etc.);
• chemical (carcinogens);
• biological (viruses).

There are also internal causes of cancer, which primarily include a hereditary predisposition.

All of them initially lead to damage to the DNA structure, which usually results in the activation of the oncogene.

If the immune system ok, then it will resist the growth of tumor cells for a long time and will not let it get out of control for a long period. And more often than not, bad cells die due to the active struggle of the body. But sometimes the immune system stops recognizing defective cells or simply does not have time to cope with their number. It is impossible to say completely why the immune system is failing, but you can be sure that the wrong cells multiply, which provokes the development of a malignant neoplasm, and the tumor leads to cancer.

Risk factors

All diseases have factors that provoke the development of the disease. Basically, oncology from smoking provokes the development of cancer of the internal organs.

People who smoke are at risk because their body is exposed to the following factors:

1. Influence of carcinogens. Mutations in DNA do not start just like that, but under the influence of mutagenic factors. The list is long: radiation from the sun, exhaust fumes, and so on. However, the environment does not influence the formation of diseases as much as smoking and exposure to tobacco smoke. In addition to nicotine, tobacco smoke contains several dozen toxic and carcinogenic substances that poison the smoker's body.
2. Weak immunity. The stronger the immune system, the more chances that the body will defeat the tumor, therefore oncology is a disease of the elderly. But since smokers weaken their immunity with the help of cigarettes, they have every chance of contracting lung cancer and other oncological diseases. Smoking experience and the number of cigarettes smoked per day play an important role in the development of diseases.
3. Hereditary predisposition in lung cancer does not play a big role. The disease develops in 90% of cases only due to the addiction of smoking. 10% of the sick are those people who work in hazardous industries. The hereditary factor acts only in cases of breast, intestinal and genitourinary systemand lung cancer develops only due to smoking.

There are a number of cancer-causing diseases. These include:

• alcoholism is accompanied by the formation in the body of the drinker of a large amount of acetaldehyde, which is a potential carcinogen. People who abuse alcohol often develop cancerous tumors of the gastrointestinal tract;
• the herpes virus provokes cervical cancer;
• epstein-Barr virus provokes the development of lymphogranulomatosis, throat and nose cancer.

To date, statistics do not provide accurate evidence that smoking causes breast cancer. Tobacco smoke does not directly interact with this organ. But women who smoke, this disease manifests itself much more often than those who do not have this addiction. The lovers of the smoking process undermine their immune system.

The first signal that a woman is sick is the presence of a lump in the breast. If symptoms are found, it is necessary to urgently seek help from specialists. The most susceptible to breast cancer are women over 40.

Lung cancer is caused by smoking and is the most common disease in the world. It is formed on the epithelium of the bronchi. It is practically impossible to recognize the disease at the initial stage, since it proceeds without visible signs. Fluorography must be done once a year. As the disease progresses, coughing appears, sometimes with blood and severe chest pain.

There are several types of lung cancer.

1. Central - the neoplasm appears in the large bronchi. Over time, the neoplasms move into the next, peripheral, form that cannot be cured. Symptoms of the central form of lung cancer are shortness of breath, cough, may be bloody. As well as chest pains, weakness and fever.
2. Peripheral lung cancer appears in the small bronchi and lung tissue. As a result, a large number of foci are formed on the lungs. In the initial stage, peripheral cancer goes away without symptoms. Over time, coughing, fever, chest pains, darkening of the eyes and shortness of breath appear.

Both types are fatal, there is practically no chance of curing the disease.

Bowel and genitourinary cancer

Colon cancer and bladder cancer have nothing to do with smoking. However, such diseases can be found to a greater extent in people who smoke. The mucous membranes of these organs collect all the poisons and toxins that are contained in tobacco smoke. Poisonous substances cause cell mutation, as a result, the cells die. A malignant tumor can develop in any organ of a person.

The symptoms of bowel and bladder cancer depend on the stage of the tumor lesion. At the initial stage, the disease goes away without any visible signs.

More people die from lung cancer in the world than from any other type of cancer. This disease is insidious in that it may not manifest itself in the early stages. But when the disease is discovered, it is already at the stage where nothing can be done. Therefore, unlike some other cancers, lung cancer is usually fatal.

As a prevention of lung cancer and other diseases at the state level, long-term programs are being developed and implemented to combat air pollution, improve work and life. And there is also a fight against smoking: restricting places where smoking is allowed, banning advertising of tobacco products. A healthy lifestyle is being promoted among young people, and programs for the development of physical education and sports are being implemented.

If a person can quit smoking, they have a chance to reduce the risk of developing cancer cells. Sport, proper nutrition and healthy image life will help the individual to live normally and not get sick. In addition to all that has been said, there are several more recommendations:

• It is undesirable to quit smoking abruptly, since the person is experiencing severe stress. At any moment he can break loose and smoke again, but the number of cigarettes can greatly increase.
• In the period of gradual cessation of cigarettes, it is necessary to choose tobacco products with a minimum content of nicotine and tar - such information is on every pack of cigarettes.
• If a person decides to quit smoking, he should be more often in the fresh air, play sports, jogging or walking.
• It is necessary to eat right, preferably to eat foods with natural fats.
• Regularly monitor body weight: if the weight begins to increase, you need to go on a diet.

If a person has a desire to stop smoking, but there is no willpower, then you can use the help of experienced doctors. They will examine the patient and select the appropriate treatment for addiction.

Conclusion

Smoking is bad habit, which is present in almost every second. Everyone knows about the consequences of smoking, but not everyone has the willpower to quit smoking. Not all cancers end in failure, but the insidiousness of lung cancer lies in the fact that it is practically incurable and does not manifest itself in the early stages. Smokers should keep this in mind, reconsider their lifestyle and take action before it's too late.

Lung cancer is one of the most difficult and intractable diseases arising, primarily in smokers. According to statistical studies, smoking lung cancer develops in ninety cases out of a hundred, and emphysema and bronchitis from eighty and above. The blame is cigarette smoke, which contains several thousand chemical components that contribute to the occurrence of malignant neoplasms.

Possible reasons

The main and reliably confirmed cause of lung cancer is tobacco smoking. Among the more than four thousand carcinogenic substances released during the combustion of the leaves of this plant, several especially dangerous poisons are emitted, such as: benzopyrene, toluidine, naphthalamine, nickel, polonium.

Long-term exposure to the body of these carcinogens irritates the mucous membrane, disrupts the structure and function of the bronchial epithelium, causes metaplasia of the columnar epithelium, which contributes to the occurrence of malignant tumors. Promotes the development of cancerous tumors and greatly weakened by smoking immunity.

What happens in the body

When smoking, tobacco smoke enters the lungs, then into the bloodstream, from where, overcoming the blood-brain barrier, enters the central nervous system... Its main component is nicotine, an alkaloid found in the leaves and stems of tobacco. In the process of smoking, it, as part of the smoke, is absorbed into the smoker's blood.

In addition to nicotine, tobacco smoke contains carbon monoxide (carbon monoxide), ammonia and tobacco tar. These substances interfere with the normal delivery of oxygen to tissues and organs, irritate the mucous membranes, leading to increased mucus production .. Ammonia, for example, when it enters the mucous membranes of the upper respiratory tract, turns into ammonia, causing tissue edema and chronic bronchitis.

All of the above substances do not dissolve over time and do not disappear anywhere, they remain forever in the smoker's body, gradually forming clusters and covering his lungs with black bloom. As the experience of the smoker increases, the condition of the addicted person becomes worse and worse. Constant exposure to hot tobacco smoke and the ingress of a large amount of carcinogens with it into the lungs and other soft tissue leads to chronic inflammatory processes membranes and an increased risk of tumors. There is a significant decrease in the level of local immunity in the lungs and bronchi, as well as deterioration general condition, which also contributes to the formation of malignant tumors.

How to deal with it

The most important part of the prevention and treatment of lung cancer is complete cessation of tobacco use. There are many methods to quit smoking: nicotine gum, patches, various medications... Passive smoking should also be avoided, as it further promotes the formation of tumors.

The next step in fighting lung cancer is correct, healthy eating... A diet rich in fruits and vegetables can significantly reduce the risk of disease, while drinking alcohol has the opposite effect.

An active lifestyle, high-quality and balanced nutrition, regular medical commissions with mandatory visits to a specialist - oncologist, playing sports and avoiding foods containing GMOs reduce the risk of developing the disease by fifty percent. Understanding, controlling, and minimizing risk factors for disease is the first step towards lung cancer prevention.

DO YOU WANT TO QUIT SMOKING?

Then download a smoking cessation plan.
It will make it much easier to quit.

V.F. Levshin

RONTS them. N.N. Blokhin, Moscow

The prevention of malignant neoplasms by helping to quit smoking (TC) is based on the following scientifically based principles:

- tobacco is the most widespread of the proven human carcinogens;

- TC is the leading proven cause of cancer death.

A number of special studies have convincingly confirmed the ability of components of tobacco smoke to form mutagenic adducts with DNA, which can lead to mutations or other damage to cellular genes and the development of cancer in the future. Tobacco carcinogenesis is well understood. IARC many years ago, based on the analysis and generalization of numerous experimental and epidemiological data, came to the conclusion that TC is carcinogenic to humans. It should also be borne in mind that tobacco smoke and its compounds can play the role of a co-carcinogen or modify the action of other known carcinogens according to the principle of synergy: radon, asbestos, arsenic, ionizing radiation and others.

The main pathogenetic features of tobacco intoxication and tobacco carcinogenesis:

- versatility;

- long-term delay clinical manifestations and consequences;

- the reversibility of tobacco intoxication and its consequences in case of cessation of TC.

The versatility of TI is due to the fact that tobacco smoke is a cocktail that contains more than a hundred toxic, mutagenic and carcinogenic compounds with different affinity to different organs and tissues and with a wide range of consequences. In particular, the presence of about 50 carcinogenic compounds was found in the composition of tobacco smoke. To date, a direct causal relationship has been established between MC and more than 40 diseases and disorders in humans, including 12 forms of malignant neoplasms.

Table 1 shows the average results of numerous analytical epidemiological studies to study the relationship of MC with the risk of development different forms malignant neoplasms; lists those forms of cancer for which a causal relationship with MC is proven: cancers of the lung, oral cavity, larynx, pharynx, esophagus, pancreas, stomach, liver, cervix, bladder, kidney, and acute myeloid leukemia.

It is important to note that for most of these cancers, a dose-response relationship has been established for the risk of their development on MC, that is, the risk of developing these forms of cancer naturally increases with an increase in the duration and strength of exposure to tobacco smoke or the duration and intensity of MC. Establishment of a dose-effect relationship is the most convincing evidence of a direct etiological relationship between MC and the development of the corresponding forms of malignant neoplasms.

It is important to note that in recent years, a number of studies have shown that both secondhand smoke and exposure to tobacco smoke from the environment can also significantly increase the risk of developing certain forms of malignant neoplasms in non-smokers.

With secondhand smoke, the degree and frequency of exposure to tobacco smoke can vary significantly. Nevertheless, some authors believe that any more or less significant exposure to tobacco smoke may, to a greater or lesser extent, increase the risk of developing, in particular, tumors of the upper respiratory-alimentary tract.

Special studies and calculations show that in China every year about 11,500 non-smoking women die of lung cancer due to secondhand smoke, in the United States - more than 3,000. The possibility of increasing the risk of developing certain forms of cancer in children of smoking parents, as well as in offspring mothers who smoked during pregnancy.

Thus, the carcinogenic effect of MC in the population is significantly expanding. Special calculations show that in developed countries, tobacco is responsible for about 30% of all deaths from cancer, while alcohol consumption and low consumption of vegetables and fruits each account for 5% of deaths from cancer. In Russia, 43% of all deaths in men aged 35-69 years from malignant tumors and 89% of all deaths from lung cancer are associated with MC.

As you can see from the table. 1, the degree of association of MC with different forms of cancer is different (indicators of relative risk). Accordingly, different proportions of all cases of diseases with a certain form of cancer are associated with TC (indicators of attributive risk).

It is possible to distinguish forms of cancer that have:

- a strong connection with TC (cancer of the lung, larynx, bladder);

- middle connection (cancer of the esophagus, nasopharynx, cervix);

- relatively weak, but reliable connection (liver cancer, stomach cancer, myeloid leukemia).

Table 1

Smoking and the risk of developing various forms of cancer

With regard to several forms of malignant neoplasms, the data on their connection with MC are contradictory, in some epidemiological studies this connection is shown, in others it is not confirmed (colorectal cancer, breast cancer, melanoma). For most other forms of malignant neoplasms, the relationship between their development and exposure to tobacco has not been established. There are also tumors, the risk of which, according to individual studies, is even significantly reduced in smokers in comparison with non-smokers (endometrial cancer, acoustic neuroma).

The multifactorial and multistage process of carcinogenesis, in many respects, different complexes of factors that determine the development of malignant tumors, explain the different participation and different role of MC in the development of not only different forms of cancer, but also different histological types of tumors of the same localization. Thus, in a number of studies it was found that an increase in the risk of lung cancer due to MC was more pronounced in relation to squamous and small cell lung cancer than in adenocarcinoma. In a retrospective study conducted on the material of the case histories of patients with malignant neoplasms who were treated at the N. N.N. Blokhin in 1995–2000, it was convincingly shown that the risk of developing small cell and squamous cell lung cancer in smokers was many times higher than that of adenocarcinoma of the lung. Similarly, in the group of patients with cervical cancer, the association of MC with the risk of developing squamous cell carcinoma was noticeably more pronounced than with adenocarcinoma. At the same time, the connection between MC and the risk of adenocarcinoma development was minimal or absent altogether. It has also been established that the relationship between tumor development and MC may depend both on the genotypic characteristics of the individual and on the phenotype of the tumor itself.

In the case of multifactorial etiology of malignant neoplasms, it is important to take into account the relationship and joint influence of various risk factors on the risk of developing tumors. It is known that the combined effect of TC with other risk factors can have a multiplier effect in terms of increasing the risk of certain forms of cancer. Thus, the risk of stomach cancer in smokers infected with H. pylori increases dramatically compared to those with a history of only one of these risk factors. The most pronounced multiplier effect in the combination of TC with alcohol abuse in relation to an increase in the risk of head and neck tumors, stomach cancer and esophageal cancer. Thus, the relative risk of squamous cell carcinoma of the esophagus can increase by more than 50 times in people who are heavy smokers and abuse alcohol in comparison with non-smokers and non-drinkers.

It should be recognized that tobacco smoke is by far the most common carcinogen proven for humans. At the same time, such characteristics of tobacco intoxication and carcinogenesis as the delayed effects and their reversibility open up significant opportunities for prevention, in particular, the prevention of cancer. WHO named tobacco as the leading preventable cause of death for the world's population, and "tobacco control" is recognized in the world as the most effective way to prevent cancer. The prophylactic efficacy of avoiding TC has been convincingly proven by numerous scientific studies and programs. According to the criteria of efficiency and cost, the prevention of TC and assistance in the rejection of TC are recognized as the "gold standard" of preventive medicine.

When protecting the population from tobacco intoxication and its consequences, including the prevention of malignant neoplasms, it is necessary to use both measures to prevent the onset of TC and measures to terminate TC by people who already smoke. Only a comprehensive and long-term application of appropriate measures to control the spread of MC, educational, medical, economic, legislative and administrative, gives a significant effect to reduce the spread of MC in the population and the subsequent decrease in morbidity and mortality in these populations. This, first of all, is shown by the experience of developed Western countries, most of which have been carrying out special national programs to reduce the spread of TC among the population for several decades. Due to the decrease in the prevalence of MC in these countries, there is an increasing decrease in mortality from lung cancer, bladder cancer, primarily among men.

Refusal from TC in the overwhelming majority of smokers leads to the rapid activation of detoxification processes in their body, as a result of which the body of former smokers is effectively cleansed of tobacco toxins accumulated over many years or decades of TC, and overall recovery occurs. When assessing the effectiveness of refusal from TC, it was found, in particular, that mortality from cardiovascular diseases among those who quit smoking decreases to the level among non-smokers 5-10 years after quitting MC, mortality from malignant diseases decreases to the level among non-smokers after 10 20 years.

The preventive effect of refusal from TC depends on the timing of the termination of TC.

For instance:

- refusal of TC at the age of 50 years reduces the risk of developing tumors of the upper respiratory-digestive tract by half;

- refusal from TC up to 30 years reduces this risk by more than 90%.

Special calculations of the cumulative risk of developing lung cancer during life until the age of 75 show that for those who continue to smoke this risk is 16%, and for those who quit smoking by age 60; 50; 40 and 30 years of age, the risk decreases to 10, respectively; 6; 3 and 2%.

The same pattern is illustrated in Fig. 1 (data from Doll R., Peto R., 1994, on tracking a cohort of people who quit smoking are presented). A significant decrease in the risk of death from lung cancer with an increase in the period from the moment of refusal from TC is clearly shown.

Deaths per 1000 people

1,4

1.2

1,0

0,8

0,6

0,4

0,2

Figure: 1. Reducing the risk of death from lung cancer after discontinuation of TC (Doll & Peto, 1994).

Reducing the number of cigarettes smoked or switching to light cigarettes, even with a minimal content of tobacco tar, carbon monoxide, other toxic compounds and nicotine, do not give the desired preventive effect. The reason is that these half measures do not eliminate tobacco addiction and the smoker, who reduces the number of cigarettes or switches to light cigarettes, often, as a rule, unnoticed for himself, changes smoking behavior, taking more frequent and deeper puffs to satisfy his addiction, and in As a result, tobacco intoxication does not decrease or decreases minimally. Therefore, only a complete rejection of TC can provide a full preventive effect.

Over the past decade, a number of studies have found that TC and tobacco intoxication not only increase the risk of developing a number of malignant neoplasms, but can also affect the prognosis and survival of cancer patients and, accordingly, the effectiveness of their treatment. So, in prospective follow-up of patients with different forms of cancer at the same stages of the disease and treatment methods, it was found that the prognosis, quality of life and survival were noticeably better in patients who never smoked in comparison with smokers, as well as in patients who quit smoking before starting treatment in comparison with those who continue to smoke. This pattern has been confirmed in patients with malignant neoplasms of the head and neck, lung cancer, cervical cancer, bladder cancer, esophageal cancer, squamous cell carcinoma of the anus, breast cancer, non-Hodgkin's lymphoma, and acute leukemia. In fig. 2 presents data from one of the studies of a cohort of patients with head and neck tumors who had the same stage and received the same treatment. The survival curves of patients with head and neck tumors after treatment, depending on their smoking status, clearly show that the survival rate of those who quit smoking long before treatment or even at the time of treatment was significantly higher than in patients who continued to smoke.

Figure: 2. The survival rate of patients with head and neck tumors depending on the fact of smoking (NEJM 328: 159-63; 1993).

Some studies have shown that smoking behavior can significantly affect the effectiveness of chemotherapy, postoperative radiation therapy, and the risk of developing other primary tumors after radical treatment head and neck tumors, the risk and severity of complications of radiotherapy in patients with laryngeal cancer. In one study, it was found that TC removed the prophylactic effect of beta-carotene intake to prevent recurrence of colorectal polyps in patients after removal of primary intestinal polyps.

Many studies have established that the prognosis and treatment results for a number of diseases, including some forms of malignant neoplasms, depend, first of all, on the smoking status at the time of diagnosis and on whether the smoker succeeds in quitting smoking in the future. Therefore, the rejection of TC has long been recognized as one of the components of therapy for a number of cardiovascular and pulmonary diseases. At the moment, it is clear that the cessation of TC should be included in the complex of therapeutic and prophylactic measures in the treatment of cancer patients. The very fact of the diagnosis of cancer often motivates smoking patients to quit TC, but only a minority manage to stop smoking completely, the majority cannot quit smoking or they quit only temporarily. The main reason for the difficulty of quitting TC is tobacco dependence, for overcoming which most patients need qualified medical care... Indicative data were obtained by American researchers during the examination of more than 1000 treated cancer patients. It was found that 44% of patients with malignant neoplasms who smoked before starting treatment succeeded in completely quitting smoking. At the same time, only 62% of smokers with cancer received qualified help in quitting smoking. In another recent survey in the United States, which covered about 2,000 people with a diagnosis of cancer, it was found that 72.2% of smokers with cancer patients received clear recommendations from doctors to abandon TC after diagnosis of their tumor disease.

Relevant studies carried out in the Russian Federation show that in our country, the knowledge and preparedness of doctors of various specialties, including oncologists, regarding the control of MC in their patients are at a very low level. In particular, in one of the studies that covered 399 cancer patients, it was found that 42% of them are smokers. At the same time, they rarely received recommendations, and even more qualified assistance in refusing TC from oncologists. At the same time, the increased motivation of cancer patients to refuse TC contributes to the good effectiveness of the treatment of their tobacco dependence.

Taking into account all of the above, on the basis of the prevention department of the RCRC, more than 5 years ago, an assistance service was organized in refusing TC. The specialized reception combines group and individual consultations.

The group lesson methodology includes the following activities:

- an interactive survey of group members about smoking behavior and past experience of refusal from TC;

- a short lecture on tobacco intoxication, tobacco dependence, their consequences for health and the health-improving effect of refusing TC;

- training in psychobehavioral and medication methods of treating tobacco dependence and tactics of refusal from TC;

- instructions for the prevention of recurrence of TC.

The duration of a group lesson is 1.5 hours on average. The size of the group can be from 5 to 15 smokers. All persons attending group classes undergo a minimum medical examination including:

- a survey regarding smoking history and behavior according to the questionnaire;

- assessment of the level of tobacco dependence and motivation to quit TC;

- a survey in relation to possible complaints and diseases in history;

- general inspection and measurement blood pressure, heart rate, weight and height;

- measurement of CO in exhaled air.

All who attended the group sessions are subsequently monitored to assess the results of care and changes in smoking behavior, as well as the possible correction of the refusal plan and the prevention of TC recurrence. Tracking is carried out during repeated visits of persons who have attended group classes or through contacts with them by phone in 1 mode; 3; 6 and 12 months after attending a group lesson. Over the past 3 years of work of the help service in the refusal of the TC, more than 1500 people have attended the consultative reception. The necessary data to analyze the effectiveness of group exercises were obtained for 1432 people. The age of those who attended the group sessions varied between 18 and 74 years. At the same time, the majority, 67%, were over the age of 40, and only 17% were under 30. This ratio of age groups is due to the fact that the proportion of smokers motivated to quit TC naturally increases with age. The percentage of men and women in the study cohort was 59 and 41, respectively. This ratio differs markedly from the ratio of men and women in the general population of adult smokers, which is approximately 5 to 1. Women are more likely and more motivated to quit TC compared to men.

More or less complete tracking with an assessment of the effectiveness of assistance in refusing TC was carried out in relation to 76.6% (1097) of persons, with the remaining 23.4% (335) of any contacts when tracing various reasons failed to install. In general, most smokers have achieved some kind of results. So 42% stopped TC for different terms and 19% reduced the number of cigarettes smoked per day by at least 25%. A relatively large proportion of smokers, 28%, did not make any attempts to quit TC at all. A special survey of the last group of smokers showed that the main reasons for the absence of attempts to quit TC after attending a counseling appointment were: postponing the attempt to quit TC for the future; disbelief in the effectiveness of the proposed methods of refusal from TC; changing the decision to refuse the TC. A special analysis showed that the main factors determining the effectiveness of counseling in quitting TC are the past experience of quitting TC, the degree of tobacco dependence, the level of motivation and psychological readiness to quit TC, and the use of those proven in relation to their effectiveness. medications for the treatment of tobacco addiction. At the same time, the experience and intensity of TC did not significantly affect the effectiveness of assistance in refusing TC.

In conclusion, it should be emphasized once again that the organization and implementation of medical care in the rejection of TC is extremely promising, but practically unrealized in our country, direction of prevention and treatment of diseases, including many forms of malignant neoplasms. IARC, on behalf of its leading experts, emphasizes the special role and responsibility of oncologists in the development and implementation of methods for the prevention and termination of MC. Measures for the prevention and termination of MC among the population are currently the main positions in all anti-cancer programs aimed at reducing the incidence and mortality from malignant neoplasms.