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Tobacco and cancer kiran
- 1. TOBACCO and CANCER DR. KIRAN Dr KIRAN KUMAR BR
- 4. BURDEN OF THE PROBLEM
- 5. Its not all BAD….....
- 8. What is TOBACCO? • Tobacco is a product prepared from the leaves of the tobacco plant by curing them. • The plant is part of the genus Nicotiana • While more than 70 species of tobacco are known, the chief commercial crop is N. tabacum
- 9. Types of tobacco products • Smokeless tobacco • Loose leaf • Pellets • Plug • Guṭkha is a preparation of crushed areca nut, tobacco, catechu, parafin wax, slaked lime and sweet flavourings • Zarda consists of tobacco, lime, spices and vegetable dyes • Khaini is made from sun-dried or fermented coarsely cut tobacco leaves
- 10. Smoked Tobacco • Cigars • Blunts • Cigarillos • Little cigars • Cigarettes • Flavoured Cigarettes • Filter cigarettes • Pipe smoking • Bidis
- 11. EPIDEMIOLOGY OF TOBACCO AND CANCER • Definitive recognition for tobacco use as a causative factor in the seminal 1964 U.S. Surgeon General’s Report (SGR) on Smoking and Health by Doll and Hill and Wynder and Graham • Common index of cancer risk is pack-years- • the number of packs of cigarettes smoked per day multiplied by the number of years smoked in the lifetime.
- 13. NEUROBIOLOGY OF TOBACCO DEPENDENCE • The primary driver of smoking behavior is ? • What is the ‘Estrogen of Lung Cancer’? • • NICOTINE—the major addictive substance and primary reinforcer of continued smoking. • NICOTINE IS NOT CARCINOGENIC
- 14. What is smoking topography? • Smokers can affect the amount of nicotine (and accompanying toxicants) they draw from a cigarette by altering the number of puffs taken, puff size, frequency, duration, and velocity.
- 15. Is there science behind QUITTING? • Nicotine is metabolized primarily to cotinine, which is further metabolized to trans-3′-hydroxycotinine (3HC), catalyzed by the liver cytochrome P450 2A6 enzyme. • The ratio of 3HC to cotinine in plasma or saliva can be used as a reliable noninvasive phenotypic marker for CYP2A6 activity. • Clinical trial data clearly show that the metabolite ratio can be used to predict success in quitting, and that the likelihood of quitting decreases as the ratio increases, such that slower metabolizers are more successful at achieving abstinence.
- 16. Evolution of Tobacco Products • TAR- tar is not a specific substance, but simply the collected particulate matter from cigarette smoke, without water and nicotine • Introduction of low tar and filtered cigarettes actually increased risk • promoting deeper inhalation and higher rates of addiction with no reductions in cancer risk, resulting in subsequent changes in lung cancer from centrally located squamous cell cancers to peripherally located nonsquamous cell cancers
- 17. Evolution of Tobacco Products • What is ENDS? •
- 18. • Electronic nicotine delivery system or e-cigarettes or e-cigs. • It is a handheld electronic device that simulates the feeling of tobacco smoking. It works by heating a liquid to generate an aerosol, commonly called a "vapor", that the user inhales. • Using e-cigarettes is sometimes called vaping. The liquid in the e- cigarette, called e-liquid.
- 19. CARCINOGENS IN TOBACCO PRODUCTS • The International Agency for Research on Cancer (IARC) • Identified 72 measurable carcinogens in cigarette smoke • Group 1 (carcinogenic to humans), • 2A (probably carcinogenic to humans), or • 2B (possibly carcinogenic to humans).
- 22. The most important carcinogens • 1. N-nitrosamines • 2. Benzene • 3. PAH (polyclyclic aromatic amines), • 4. 1,3- butadiene, and • 5. Cadmium. • Most of these carcinogens are formed during the ‘CURING’ process of tobacco. • Possible to reduce carcinogens by changing curing and storage practices. • Smokeless tobacco products, although they are not burned, nonetheless contain substantial levels of carcinogens, most prominently the N- nitrosamines.
- 23. HOW TOBACCO USE LEADS TO CANCER?
- 24. HOW TOBACCO USE LEADS TO CANCER? • Ciliatoxic, inflammatory, and oxidizing compounds, such as acrolein and ethylene oxide in smoke, may also impact the likelihood of cancer development. • Epigenetic changes such as hypermethylation, particularly at P16, may also play a role in lung cancer development
- 25. TOBACCO USE BY THE CANCER PATIENT • A cancer diagnosis can be used as a window of opportunity, or teachable moment, to intervene and provide assistance in the quitting process. • Never smoker • having smoked less than 100 cigarettes in a person’s lifetime and no current cigarette use. • Former smoker • is typically defined as no current cigarette use, usually within the past year. • Recent smoker (or recent quit) • is generally defined as having stopped smoking within the recent past, typically for a period of 1 week to 1 year. • Current smoker • is typically defined as smoking one or more cigarettes per day every day or some days
- 26. THE CLINICAL EFFECTS OF SMOKING ON THE CANCER PATIENT • The recently released 2014 SGR now provides substantial evidence behind the effects of smoking by cancer patients with the following conclusions: • 1. In cancer patients and survivors, the evidence is sufficient to infer a causal relationship between cigarette smoking and adverse health outcomes. Quitting smoking improves the prognosis of cancer patients. • 2. In cancer patients and survivors, the evidence is sufficient to infer a causal relationship between cigarette smoking and increased all-cause mortality and cancer-specific mortality. • 3. In cancer patients and survivors, the evidence is sufficient to infer a causal relationship between cigarette smoking and increased risk for second primary cancers known to be caused by cigarette smoking, such as lung cancer. • 4. In cancer patients and survivors, the evidence is suggestive but not sufficient to infer a causal relationship between cigarette smoking and the risk of recurrence, poorer response to treatment, and increased treatment-related toxicity.
- 33. What is NTCP? • The National Tobacco Control Programme (NTCP) was launched by the Ministry of Health and Family Welfare (MoHFW), Government of India in 2007- 08, during the 11th five year plan
- 34. What is COTPA? • COTPA stands for the “Cigarettes and Other Tobacco Products (Prohibition of Advertisement and Regulation of Trade and Commerce, Production, Supply and Distribution) Act, 2003”. The Act is applicable to all products containing tobacco in any form as detailed in the Schedule to the Act.