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An epidemic of smoking-related cancer
and disease in women
In March 2001, the Office of the US Surgeon General released a
long-awaited, detailed report called Women and Smoking,
along with this statement:
When calling attention to public
health problems, we must not misuse the word "epidemic." But there is
no better word to describe the 600-percent increase since 1950 in
women’s death rates for lung cancer, a disease primarily
caused by cigarette smoking. Clearly, smoking-related disease among
women is a full-blown epidemic.
-- David Satcher, MD, PhD
Smoking is the most preventable cause of early death in this
country. According to the Centers for Disease Control and Prevention
(CDC), smoking-related diseases caused the deaths of about 174,000
women in each year from 2000 to 2004. On average, these women died 14.5
years earlier because they smoked.
The most recent CDC survey (from 2007) showed that more than 1
in 6 American women aged 18 years or older (17%) smoked cigarettes. The
highest rates were seen among American-Indian and Alaska-Native women
(36%), followed by white (20%), African-American (16%), Hispanic (8%),
and Asian women (4%). The less education a woman has, the more likely
it is she will smoke. For instance, women with less than a high school
education are more than twice as likely to smoke as college graduates.
Overall, women are less likely to smoke than men. But it has
been found that smoking is more popular among younger than older women.
This is an alarming trend that will affect the future health of these
young women. About 20% of women ages 25 to 44 smoke; only about 8% of
women 65 and over do. If these younger women continue to smoke as they
get older, they will have more smoking-related illness and disability.
Smoking rates are slightly lower among women aged 18 to 24, a little
more than 19%.
Women who smoke nearly always begin as teenagers -- usually
before high school graduation. And the younger a girl is when she
starts, the more heavily she is likely to use tobacco as an adult.
Teenage girls are just as likely to smoke as boys. The most recent CDC
surveys showed that 19% of female high school students and 6% of middle
school girls had smoked at least one cigarette in the past 30 days.
More than 9% of 12th grade girls reported that they had smoked at least
one cigar in the past month (see also Cigar Smoking).
Nearly 29% of the senior girls had used some form of tobacco in the
past month.
How can smoking affect your health?
Cancers
Tobacco use accounts for nearly 1 in 3 cancer deaths. Tens of
thousands of women will die this year from lung cancer, which has shot
past breast cancer as the leading cause of cancer death among women.
Almost 90% of these deaths will be due to smoking.
Not only does smoking increase the risk for lung cancer, it's
also a risk factor for other cancers:
- cervix
- mouth
- larynx (voice box)
- pharynx (throat)
- esophagus
- kidney
- bladder
- pancreas
- stomach
Smoking is also linked to some forms of leukemia.
Smoking raises your risk of heart disease
and stroke
Women who smoke greatly increase their risk of heart disease
(the leading killer among women) and stroke. Risk goes up with the
number of cigarettes smoked and the length of time a woman has been
smoking. Even though most of the women who die of heart disease are
past menopause, smoking increases the risk more in younger women than
in older women. Some studies suggest that smoking cigarettes increases
the risk of heart disease even more among younger women who are also
taking birth control pills.
Smoking damages your lungs
Smoking damages the airways and small air sacs in the lungs.
It is related to chronic coughing and wheezing. More than 75% of deaths
due
to chronic bronchitis and emphysema -- together these are known as
chronic obstructive pulmonary disease (COPD) -- are caused by smoking.
The risk goes up both with the number of cigarettes smoked each day and
with the length of time a woman has been smoking. Female smokers aged
35 or older are almost 13 times more likely to die from emphysema or
bronchitis than those who don't smoke. Smoking "low tar" or "light"
cigarettes does not reduce these risks, or any of the other health
risks of tobacco.
The lungs grow more slowly in teenage girls who smoke. Adult
women who smoke start losing lung function in early adulthood.
Smoking causes other health problems
Smoking can cause or worsen poor blood flow in the arms and
legs (peripheral vascular disease or PVD.) This can limit everyday
activities such as walking. Even worse, surgery to improve the blood
flow often fails in people who keep smoking. Because of this, many
doctors who operate on blood vessels (vascular surgeons) won't do
certain surgeries on patients with PVD unless they stop smoking.
Stopping smoking lowers the risk of PVD. In people who already have
PVD, quitting smoking improves the odds that treatment will work.
Women who smoke, especially after going through menopause,
have lower bone density (thinner bones) and a higher risk for broken
bones, including hip fracture, than women who do not smoke. They may
also be at higher risk for getting rheumatoid arthritis and cataracts
(clouding of the lenses of the eyes), as well as age-related macular
degeneration, which can cause blindness.
Smoking affects your reproductive health
Tobacco use can damage a woman's reproductive health. Women
who smoke are more likely to have trouble getting pregnant. Smokers are
younger at menopause than non-smokers and may have more unpleasant
symptoms while going through menopause.
Smoking can also cause problems during pregnancy that can hurt
both mother and baby. Smokers have a higher risk of the placenta (the
organ that protects and nourishes the growing fetus) growing too close
to the opening of the uterus. Smokers are also more likely to have
early membrane ruptures and placentas that separate from the uterus too
early. Bleeding, early delivery (premature birth), and emergency
Caesarean section (C-section) may result from these problems. Smokers
are more likely to have miscarriages and stillbirths, too.
Smoking can affect your baby’s
health
First of all, up to 5% of infant deaths would be prevented if
pregnant women did not smoke.
More than 10% of women smoke throughout their pregnancies --
some studies put the number at 16% or higher. Smoking is linked to an
increased risk of early delivery and infant death. Research also
suggests that infants of mothers who smoke during and after pregnancy
are 2 to 3 times more likely to die from sudden infant death syndrome
(SIDS) than babies born to non-smoking mothers. The risk of SIDS is
somewhat less for infants whose mothers stop smoking during pregnancy,
even if they start smoking again after delivery.
Of the women who are able to stop smoking during pregnancy,
only 1 out of 3 stay quit a year after the delivery. But infants of
non-smoking mothers have the lowest risk of SIDS.
Smoking during pregnancy causes low birth weight in at least 1
in 5 infants. Smoking during pregnancy slows fetal growth. This often
causes babies to have health problems as a result of being born
underweight. Women who stop smoking before they get pregnant reduce
their risk of having a low birth weight baby to that of women who never
smoked. Even women who quit during the first 3 to 4 months of pregnancy
have much healthier babies than those who keep smoking.
Many women are able to quit smoking during early pregnancy.
But women who have mood disorders, such as depression, often find it
much harder to quit. Researchers have learned that between one-third
and one-half of women who smoke during pregnancy have a mood disorder.
It can be harder to treat pregnant women for depression, anxiety, or
nicotine withdrawal with medicines because of concerns about the drugs
hurting the fetus. Counseling or mental health therapy may help some of
these women. If the woman is unable to quit smoking with therapy, she
may want to talk with her doctor about medicines that she can take
during pregnancy.
After a baby is born, some harmful chemicals in tobacco smoke
can also be passed on through breast milk. This can affect a baby right
away. For instance, infants who were breast-fed by mothers who smoked
slept for a full half-hour less than when the mothers didn't smoke
(this was measured over 3½ hours right after breast
feeding).
If you managed to quit smoking while you were pregnant, don't
pick up the habit again after the baby is born. When you find yourself
tempted to start back, get help right away. And keep in mind that
parents who smoke are more likely to have children who smoke. So if you
stay quit your child stands a better chance of never starting.
Secondhand smoke can affect your children's
health
Almost 3 million children in the United States under the age
of 6 breathe secondhand smoke at home at least 4 days per week. Studies
show that older children whose parents smoke get sick more often. Their
lungs grow less then children who do not live around smokers. They have
bronchitis and pneumonia more often. They cough and wheeze more.
Smoking can also trigger a child's asthma attack. More than 40% of
children who go to the emergency room for asthma live with smokers. A
severe asthma attack can be deadly.
Children who live with parents who smoke also get more ear
infections. This often causes fluid to build up in their ears and they
may need surgery to have ear tubes placed for drainage. Some of these
problems may seem small, but they add up quickly: think of the
expenses, doctor visits, medicines, lost school time, and often lost
work time for the parent who must take the child to the doctor. And
this doesn't include the discomforts that the child must go through.
The Surgeon General's report: Secondhand
smoke kills people who don't smoke, and makes others sick
Environmental tobacco smoke (ETS), also known as secondhand
smoke, has also been shown to increase the risk of lung cancer. The
2006 Surgeon General's report on secondhand smoke stated that:
- Secondhand smoke causes premature death and disease in
children and adults who do not smoke.
- Children exposed to secondhand smoke are at an increased
risk for sudden infant death syndrome (SIDS), respiratory infections,
ear problems, and more severe asthma. Smoking by parents causes
breathing (respiratory) symptoms and slows lung growth in their
children.
- Secondhand smoke immediately affects the heart and blood
circulation in a harmful way. Over a longer time it also causes heart
disease and lung cancer.
- The scientific evidence shows there is no safe level of
exposure to secondhand smoke.
- Many millions of Americans, both children and adults, are
still exposed to secondhand smoke in their homes and workplaces, even
though there has been a great deal of progress in tobacco control.
- The only way to fully protect non-smokers from exposure to
secondhand smoke indoors is to prevent all smoking in that indoor space
or building. Separating smokers from non-smokers, cleaning the air, and
ventilating buildings cannot keep non-smokers from being exposed to
secondhand smoke.
Kicking the habit
More than 75% of women say they want to quit smoking. Almost
half report having tried to quit in the past year. The chance of
quitting and staying quit is about the same for both men and women,
although there may be some ways women are different (see the section
below, "Differences
between women and men").
Quitting can help reduce the risk of many of the health
effects listed above. The risk of heart disease is greatly reduced just
1 to 2 years after quitting. The risk of stroke returns to normal 10 to
15 years after quitting.
Many women are afraid to quit for fear of gaining weight. Some
women who quit smoking do add a few pounds, mostly in the first year.
Although figures vary, women gain an average of around 10 pounds after
quitting. This amount of weight gain can usually be controlled through
diet and exercise. But the health benefits of quitting are much greater
than any problems posed by a small weight gain.
Differences
between women and men
Some studies have shown there may be differences in men and
women who are trying to quit smoking. A few studies, for instance,
found that nicotine replacement therapies seemed to help men more than
women. Studies of other medicines, such as bupropion (Zyban®)
and varenicline (Chantix®) have not
found such a difference --
men and women had the same success rates. Some of these studies used
counseling or group support, which seemed to help both men and women
quit and stay quit.
There is also a question about how monthly hormone changes can
affect pre-menopausal women as they are quitting smoking. Studies have
been mixed about whether it works better for women to try and quit
during the first or last parts of their menstrual cycles. Most of the
studies seem to support the idea that women may have stronger urges to
smoke just before their menstrual periods are due to start. This is
about the same time women may have pre-menstrual symptoms. Because of
this, some experts recommend that women quit smoking after the
pre-menstrual symptoms have passed. If you choose to do this, you may
want to make a plan to deal with any pre-menstrual urges to smoke that
may show up 2 or 3 weeks later.
Get help to quit
You don't have to do it alone. In fact, quitting tools such as
phone-based quitting programs,
support groups, and medicines can double your chances of quitting and
staying quit. For more information, see our Guide to Quitting Smoking,
as well as the other Society publications listed below. Or call us at
1-800-ACS-2345 (1-800-227-2345).
Additional resources
More information from your American Cancer
Society
The following information may also be helpful to you. These
materials may be ordered from our toll-free number, 1-800-ACS-2345.
- Living Smoke-free for You and Your Baby (also available in
Spanish)
- Set Yourself Free: Deciding How to Quit--A Smoker's Guide
(also available in Spanish)
National organizations and Web sites*
In addition to the American Cancer Society, other sources of
patient information and support include:
American Heart Association & American Stroke
Association
Toll-free number: 1-800-AHA-USA-1 (1-800-242-8721)
Web site: www.americanheart.org
Toll-free number: 1-888-4-STROKE (1-888-478-7653)
Web site: www.strokeassocation.org
American Lung Association
Toll-free number: 1-800-548-8252 for the ALA helpline
Web site: www.lungusa.org
Centers for Disease Control and Prevention
Office on Smoking and Health
Toll-free number: 1-800-232-4636 (1-800-CDC-INFO)
Web site: www.cdc.gov/tobacco/quit_smoking/index.htm
National Cancer Institute
Toll-free number: 1-877-448-7848 for help quitting smoking
1-800-4-CANCER (1-800-422-6237) for cancer information
Web site: www.cancer.gov
U.S. Department of Health and Human Services
Office on Women's Health
National Women's Health Information Center
Toll-free number: 1-800-994-9662
Web site: www.womenshealth.gov
Smokefree.gov
(Info on state phone-based quitting programs)
Toll-free number: 1-800-QUITNOW (1-800-784-8669)
Web site: www.smokefree.gov
*Inclusion on
this list does not imply endorsement by the
American Cancer Society.
No matter who you are, we can help. Contact us anytime, day or
night, for information and support. Call us at 1-800-ACS-2345
(1-800-227-2345)
or visit www.cancer.org.
References
Allen SS, Bade T, Center B, et al. Menstrual phase effects on
smoking relapse. Addiction.
2008 May;103(5):809-821.
American Cancer Society. Cancer
Facts & Figures 2008.
Atlanta, GA: American Cancer Society, 2008.
Bohadana A, Nilsson F, Rasmussen T, Martinet Y. Gender
differences in quit rates following smoking cessation with combination
nicotine therapy: influence of baseline smoking behavior. Nicotine Tob
Res. 2003 Feb;5(1):111-116.
California Environmental Protection Agency. Proposed
Identification of Environmental Tobacco Smoke as a Toxic Air
Contaminant. 2005. Available at:
www.arb.ca.gov/toxics/ets/finalreport/finalreport.htm. Accessed October
10, 2007.
Campaign for Tobacco Free Kids. Smoking and Pregnancy: The
harms of continued smoking and the benefits of quitting.
Available at:
http://tobaccofreekids.org/research/factsheets/pdf/0288.pdf. Accessed
October 12, 2007.
Carpenter MJ, Saladin ME, Leinbach AS, et al. Menstrual phase
effects on smoking cessation: a pilot feasibility study. J Womens
Health. 2008 Mar;17(2):293-301.
Centers for Disease Control and Prevention (CDC). Cigarette
smoking among adults --- United States, 2007. Morb Mort Wkly Rep.
2008;57(45):1221-1226. Available at:
www.cdc.gov/mmwr/preview/mmwrhtml/mm5745a2.htm. Accessed November 13,
2008.
Centers for Disease Control and Prevention (CDC). Deaths from
Chronic Obstructive Pulmonary disease --- United States, 2000--2005.
Morb Mort Wkly Rep.
2008;57(45):1229-1232. Available at:
www.cdc.gov/mmwr/preview/mmwrhtml/mm5745a4.htm. Accessed November 13,
2008.
Centers for Disease Control and Prevention (CDC). Smoking and
Tobacco Use: National Youth Tobacco Survey, 2006 NYTS Data and
Documentation. Available online at:
www.cdc.gov/tobacco/data_statistics/surveys/NYTS/#NYTS2006. Accessed
September 9, 2008.
Centers for Disease Control and Prevention (CDC).
Smoking-attributable mortality, years of potential life lost, and
productivity losses, United States, 2000--2004. Morb Mort Wkly Rep.
2008;57(45):1226-1228. Available at:
www.cdc.gov/mmwr/preview/mmwrhtml/mm5745a3.htm. Accessed November 13,
2008.
Centers for Disease Control and Prevention (CDC). Youth Risk
Behavior Surveillance --- United States, 2007. Morbidity and Mortality
Weekly Report. 2008; 57(SS-04);1-31. Available at:
http://www.cdc.gov/mmwr/preview/mmwrhtml/ss5704a1.htm. Accessed
September 3, 2008.
Chakravarthy U, Augood C, Bentham GC, et al. Cigarette smoking
and age-related macular degeneration in the EUREYE Study.
Ophthalmology.
2007;114:1157-1163.
Gonzales D, Bjornson W, Durcan MJ, White JD, et al. Effects of
gender on relapse prevention in smokers treated with bupropion SR. Am J
Prev Med. 2002 May;22(4):234-239.
Gonzales D, Rennard SI, Nides M, Oncken C, et al, for the
Varenicline Phase 3 Study Group.
Varenicline, an alpha4beta2 nicotinic acetylcholine receptor partial
agonist, vs sustained-release bupropion and placebo for smoking
cessation: a randomized controlled trial. JAMA. 2006 Jul
5;296(1):47-55.
Goodwin RD, Keyes K, Simuro1 N. Mental disorders and nicotine
dependence among pregnant women in the United States. Obstetrics
& Gynecology. 2007;109:875-883.
Environmental Protection Agency. Fact Sheet: Respiratory
Health Effects of Passive Smoking. EPA document #
43-F-93-003. January
1993. Available at: www.epa.gov/smokefree/pubs/etsfs.html. Accessed
October 10, 2007.
Mennella JA, Yourshaw LM, Morgan LK. Breastfeeding and
smoking: short-term effects on infant feeding and sleep. Pediatrics.
2007 Sep;120(3):497-502.
National Women’s Health Information Center, Office
on Women’s Health. Why
It’s Important for Women to
Quit. 2007. Available at
www.4women.gov/quitsmoking/important/.
Accessed October 10, 2007.
Office of the US Surgeon General. The Health Consequences of
Smoking: A Report of the Surgeon General. Centers for
Disease Control
and Prevention (CDC), Office on Smoking and Health. 2004. Available at:
www.surgeongeneral.gov/library/smokingconsequences/. Accessed October
10, 2007.
Office of the US Surgeon General. The Health Benefits of
Smoking Cessation: A Report of the Surgeon General.
Centers for Disease
Control and Prevention (CDC), Office on Smoking and Health. 1990.
Available at: http://profiles.nlm.nih.gov/NN/B/B/C/T. Accessed October
1, 2008.
Office of the US Surgeon General. The Health Consequences of
Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General.
June 27, 2006. Office on Smoking and Health. Available at:
http://www.cdc.gov/tobacco/data_statistics/sgr/sgr_2006/index.htm.
Accessed October 10, 2007.
Office of the US Surgeon General. Women and Smoking: A Report
of the Surgeon General. Centers for Disease Control and
Prevention
(CDC), Office on Smoking and Health. 2001. Available at:
www.surgeongeneral.gov/library/womenandtobacco/. Accessed October 8,
1008.
O'Hara P, Connett JE, Lee WW, et al. Early and late weight
gain following smoking cessation in the Lung Health Study. Am J
Epidemiol. 1998;148:821-830.
Salihu HM, Aliyu MH, Pierre-Louis BJ, Alexander GR. Levels of
excess infant deaths attributable to maternal smoking during pregnancy
in the United States. Matern
Child Health J. 2003 Dec;7(4):219-27.
Last Medical Review: 10/30/2008
Last Revised: 05/21/2009
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