FIVE. Associated Conditions

What are the medical consequences of tobacco use?

Tobacco use kills an estimated 440,000 U.S. citizens each year, which is more than alcohol, cocaine, heroin, homicide, suicide, car accidents, fires, and AIDS combined. Since 1964, more than 12 million Americans have died prematurely from tobacco, and another million U.S. tobacco users alive today will most likely die of a tobacco-related illness. Tobacco use harms every organ in the body. It accounts for about one-third of all cancer-related deaths and for a host of other diseases such as leukemia, cataracts, lung diseases of all types, vascular disease, and the body's ability to successfully heal and fight infections of all types.

The overall rates of death from cancer are twice as high among smokers as nonsmokers. Foremost among the cancers caused by tobacco use is lung cancer. Cigarette smoking has been linked to about 90% of all lung cancer cases and is the number one cancer killer of both men and women. Today, the rate of lung cancer in women exceeds breast cancer. Smoking is also associated with cancers of the lips, mouth, pharynx, larynx, esophagus, stomach, colon, pancreas, cervix, kidney, and bladder.

Gender Differences in Diseases Found in Smokers


Tobacco use harms every organ in the body.

Men have been smoking since the Virginia colony started growing tobacco for American and European consumption. The overall rate of men who smoke is higher than women, as are the death rates. However, currently the rates of male smokers and deaths due to smoking have declined since the Surgeon General's Report was published in 1964 (see Question 21). Older men are more likely to be former smokers than older women, who have difficulty quitting.


Because women find it harder to quit than men, the incidence of lung cancer in women has been increasing both in North America and Europe. A Swiss research team concluded that the rate of smoking and deaths due to smoking among women has yet to reach its peak. In time, female smokers will outnumber male smokers.

Differences in Gender-Specific Health Risks

The risks for males who smoke are decreased fertility and erectile dysfunction. Women over 35 who are smokers and are on birth control pills are at a greater risk for developing blood clots, which may cause a heart attack or a stroke. It is strongly advised that women who are on birth control pills should stop smoking. Other risks include potential physical problems, which are related to reproduction, pregnancy, and mothering. Smoking causes premature aging. Many women who smoke are prone to ectopic pregnancies. Smoking may cause early menopause.

Men and Women

Smoking is the leading cause of death among both American and European men and women. Diseases related to smoking are preventable. Smoking causes about 90% of the early deaths in men and about 80% of female deaths.

Can you list all of the specific diseases associated with smoking?


Ischemic heart disease


Peripheral vascular disease

Abdominal aortic aneurysm

Microvascular disease affecting end organs (examples include exacerbation of Raynaud syndrome, poor wound healing after major surgery, erectile dysfunction)


Chronic obstructive pulmonary disease (COPD)

Community acquired pneumonia

Poor asthma control

Emphysema Cancer:

Lung cancer

Cancer of the mouth, throat, and esophagus; pancreatic cancer, colon cancer

Cervical cancer, vulvar cancer, and contributes to abnormal Pap smears

Renal cell carcinoma, bladder cancer

Leukemia Reproductive:

Erectile dysfunction (via micro vascular disease)

Lowered sperm counts


Ectopic pregnancies Other:

Macular degeneration

Periodontal disease


Peptic ulcers


Hepatic: Stimulation of liver metabolism of other drugs resulting in a loss of their effectiveness; acceleration of fibrosis in hepatitis

All of these diseases and conditions are a result of tobacco use and not nicotine. Nicotine is merely the major chemical involved in forming the addiction to tobacco. It is the cause of the disease of dependency. While it also exacerbates the cardiovascular effects of underlying vascular disease, because of its stimulatory effects on heart rate and blood pressure by constricting the blood vessels and stimulating the sympathetic nervous system, it does not directly cause vascular disease. It is all of the other ingredients, which are not in themselves addictive that lead to the long list of other diseases mentioned above. These other ingredients are discussed in greater detail in Questions 12 and 13.

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