Chapters Index (French) French Version Welcome page Contact

Why should we set up a prevention policy?

For most cancer types with a specific tobacco origin as described in the previous pages (mainly in relation to tobacco and alcohol)

• either the cancer is still localised but major mutilation is necessary to save the patient (pneumonectomy for lung cancer which can be carried out in only 10% of cases, total laryngectomy which cures about 50% of patients, but with voice loss and the risk of social isolation, oesophagectomy which cures only 10% of patients and radical cystectomy with an external derivation in about half of cases),
  
• or the cancer is no longer localised: only palliative measures can be taken in order to win time (palliative radiotherapy, chemotherapy with a few short-lived responses and pain sedation).

In most cases, diagnosis is late and cancer is no longer localised.

In our Cancer Centre in Caen, cancers due to tobacco and alcohol represent half of hospital admissions: lung cancer, head and neck tumours, oesophageal cancer and bladder carcinoma.

These two toxic products also have effects on the cardio-vascular system, the liver, the stomach and nerves.

Contrary to common belief, stopping tobacco or alcohol consumption leads to a rapid and significant reduction in the risk either for cancer or the other related diseases.

The following diagram shows the significant reduction in the risk of lung cancer in relation to stopping smoking and the influence of stopping duration.

Effect of stopping smoking on the relative risk of cancer (from Doll and Peto studies).

It is relatively easy to put together a prevention policy, but strong political action is necessary.

Tobacco consumption

1. Tobacco consumption is a social reality which can be studied scientifically. In France, like in many other countries, tobacco consumption can be measured, thus allowing a statistical study of the effects of advertisement campaigns paid by the tobacco industry as well as the real impact of prevention propaganda. The economical interest (in French) is colossal. For the French speaking population, two sites are of great interest and defend the interests of the tobacco industry: CDIT and SEITA . For English speakers, the Philip Morris site is also very interesting. These sites are the proof of the difficulty to fight against tobacco consumption.

2. Tobacco smoking sociology (in French) has been described in many papers and we have taken the data from a consensus conference in France held in October 1998.(see website Tabac-Net).  

3. Tobacco smoking is a health problem like many others. Thus, the physician (or the nurse) should treat this problem like any other: personal history of the smoking habit (beginning, quantities of tobacco smoked, attempts to stop), family and social history (smoking habits of family and friends), disease symptoms (head and neck, lung, heart, vascular disease), physical and psychological dependency, emotional relationships and personal conceptions concerning his (her) own smoking habit. The Swiss website Stop-Tabac (with its English text) is very interesting and helps understand what kind of health problem smoking is.

4. The physician is a scientist and has a great deal of epidemiological and experimental proof of the toxicity of tobacco (see studies by Doll et Peto).For the long term benefit of his (her) patient, stopping smoking is very important. Thus, as demanded by ethical principles, the physician (or the nurse) should set aside his (her) own philosophy and attitude towards tobacco in order to act as a genuine health professional. Cigarette smoking by the physician or the nurse (and worse so if done in front of the patient) is a counter-example for adolescents or fragile patients.
   
5. Despite many technical progresses like the new chemotherapies or target therapies, . For instance, the diagnosis of lung cancer or oesophageal cancer is almost always done at an advanced stage when an efficient therapy is no more feasible. Only prevention is efficient.Despite great technical progress such as new chemotherapies or target therapies, most tobacco cancers kill their host. For instance, the diagnosis of lung cancer or oesophageal cancer is almost always at an advanced stage when efficient therapy is no longer feasible. Only prevention is efficient.
   
6. Tobacco smoking is like a drug habit (in French), with its physical and psychological dependency. It is totally wrong to believe that one can stop smoking without any major difficulty. Young people get the habit through multiple and repeated experiences: on the other hand, the social role of smoking is very important.
   
7. Advertising of tobacco links cigarettes to success at work, power of seduction and team spirit. In our times of loneliness and unemployment, cigarettes allow distancing from real situations. This false protection may explain the increasing number of women smokers (at least in France). Fighting advertisement for tobacco smoking (in French) is a very efficient preventive measure.

There is no magic formula to help our patients stop smoking: the worst example that can be given is to let them observe doctors’ and nurses’ smoking habits!