Fellowship in Head and Neck Surgery (USA)Fellowship in Neurotology & Skull Base Surgery

(USA)Senior Consultant in ENT-Head and Neck

and NeurotologyApollo Hospitals, Bangalore

In IndiaIt is estimated that around 40% of the men

and 15% of the women use tobacco on a regular basis.

However, in certain areas of the country regular use increases to over 85% in men and over 65% in women (including smoking and chewing).

Facts and FiguresMost prevalent age - 25-44 yearsAverage age to start smoking is 14.6 years Tobacco is the most preventable cause of head

and neck cancer deaths. Use of tobacco (cigarettes, paan, chewing

tobacco or snuff) is closely linked with cancers of the mouth, throat, voice box and tongue.

There are 4,000 substances found in cigarettes and 43 of them are known to cause cancer .

Ingredients in cigarettesPolonium210 (nuclear

waste)Acetaldehyde (irritant)Lead (nerve poison)Formaldehyde

(embalming fluid)Cadmium (found in

batteries)N-Nitrosamines (known

carcinogen)Benzopyrene (known

carcinogen)Uranium 235 (nuclear

waste)Nicotine (addictive

substance)

Health Consequences of Nicotine ExposureAccelerated coronary and peripheral vascular

diseaseIncrease in heart rate (30% higher)StrokeHypertensionSmokeless tobacco users had 2.5 times

increase in cholesterol

Effect of Tobacco on Pregnancy/BirthHypoxemia of fetusSpontaneous abortionPlacental disruptionPreterm deliveryDecreased milk productionBirth defects (cleft lip or palate)low birth weight.

If you smoke or are around second-hand smoke while you are pregnant, you are more likely to:

deliver earlyexperience problems during labourif you’re breast-feeding -> some chemicals are

passed directly from breast milk to the baby.baby has higher risk of dying during childbirth

or dying of SIDS (sudden infant death syndrome).

What is second-hand smoke?Second-hand smoke is the smoke from a

burning cigarette, pipe or cigar. Also known as environmental tobacco smoke ETS contaminates the air and is retained in

clothing, curtains and furniture. Cigarettes produce about 12 minutes of smoke,

yet the smoker may inhale only 30 seconds of smoke from their cigarette. The rest of the smoke lingers in the air for non-smokers to breathe.

When someone smokes inside a home or car, everyone inside breathes second-hand smoke.

Effects of ETSIt is unpleasant, annoying, and irritating to

the eyes and nose headaches, coughing and wheezing, nausea

and dizziness. colds, bronchitis and pneumonia.Long term exposure heart problems,

breathing problems and lung cancer.

Effect of ETS on Childrencoughing and wheezingasthma and other breathing problemsbronchitis and pneumoniahigher risk of heart disease

increases both the number and the duration of ear infections - the most common cause of children's hearing loss

take up smoking themselves.impairment in school performance and

intellectual achievement has also been demonstrated.

World Health Organization’s International Agency for Research on Cancer (IARC) have all classified secondhand smoke as a known human carcinogen—a category reserved for agents for which there is sufficient scientific evidence that they cause cancer

the risk of developing cancer from ETS is about 100 times greater than from outdoor cancer-causing pollutants

Did you know that ETS causes more than 3,000 non-smokers to die of lung cancer each

year!

Facts about Smokeless Tobacco: A Dangerous Alternative

Smokeless tobacco is highly addictiveIt is the leading cause of oral cancerIt kills at a younger age than cigarettesIt has 100 times higher concentration of

cancer-causing agents than cigarettes Most commonly used by 18-25 age 28 substances in this are known to cause

cancer

Statistics show that every year 8,00,000 new cancer cases are registered

3,20,000 of which are suffering from Head and Neck cancers largely attributed to tobacco habits.

While, tobacco claims about 4.9 million deaths annually globally, an alarming 1 million of them are from India.

Head and neck cancers are common in India and account for about 30% of cancers in males and about 13% in females.

In the Western world in general, it accounts for less than 10% of all cancers

The primary reason for this unusually high incidence is the indiscriminate use of tobacco in its various forms

The overall survival rate for head and neck cancer in the general population is only 52%, a rate which is worse than uterine, breast, cervical and colon cancersWith early detection and treatment, the 5-year survival rate can increase up to 85%.

Warning Signs A sore on the lip or in the mouth that does not heal A lump on the lip or in the mouth or throat   A white (leukoplakia) or red patch on the gums,

tongue or lining of the mouth Unusual bleeding, pain or numbness in the mouth A sore throat or a feeling that something is caught

in the throat   Difficulty or pain with chewing or swallowing  Swelling of the jaw that causes dentures to fit

poorly or become uncomfortable

A change in the voice or hoarseness   Pain in the ear without evidence of local ear

problems  Slurred speech  Loose teeth not associated with any gum problems  Swelling, numbness, paralysis of the muscles in

the face Chronic sinus infections that do not respond to

treatment with antibiotics Bleeding through the nose, frequent headaches,

swelling or other trouble with the eyes.

Tips to quit tobaccoRemember, most people don’t start on their

own, so don’t try quitting on your own.

Ask for help and positive reinforcement from your friends, parents, coaches, teachers, whomever...

Tips to quit tobaccoThink of reasons why you want to quit. Pick a quit date and throw out all your

tobacco and ashtray. Tell yourself out loud every day that you’re

going to quit.Find alternatives to tobacco. A few good

examples are sugarless gum, fruits, raisins or dried fruit.

Notice when and where you use tobacco. Plan other things to do at those times.

Delay the act, count till 100 Substitute stimulus associated with tobacco

i.e. tea can be replaced by milk or juice.

Tips to quit tobaccoFind activities to keep your mind off tobacco.

You could ride a bike, talk or write a letter to a friend, work on a hobby, or listen to music.

Do something else when you feel the urge to smoke/ chew tobacco. This will help you keep your mind off tobacco.

Exercise can help relieve tension caused by quitting.

Set realistic goals and achieve them.Don't give in to cravings. These usually last

for only 3-5 minutes.

Tips to quit tobaccoDeep breathing: When you were smoking,

you breathed deeply as you inhaled the smoke. When the urge strikes now, breathe deeply and picture your lungs filling with fresh, clean air.

Increase your water intake.Take small sips of water when the urge to

smoke/chew is high.Reward yourself. You could save the money

that would have been spent on tobacco products and buy something nice for yourself.

Motivating Patients to Quit

Improved healthFood tastes betterImproved sense of

smellSave moneyFeel better about

yourselfHome, car, breath

will smell betterCan stop worrying

about quitting

Set a good example for children

Healthier babies and children

Not worry about exposing others to smoke

Feel better physicallyFreedom from addictionPerform better in sports

Nicotine Withdrawal Symptoms

Withdrawal peaks in 2 days and lasts up to 1-2 weeks (on average)

Depressed mood, sadnessInsomniaIrritability, frustration, angerAnxietyImpaired concentrationRestlessnessIncreased appetite

Once You Quit:

Learn to say no to tobacco offers from others. Don’t take even one puff. Try to remain in smoke free areas. Avoid

company of smokers and chewers. Make a group of people who have quit tobacco. Try alternative ways to deal with stresses —

Relaxation, deep breathing, listening to music, exercises, taking a walk, talking to someone over telephone etc

Even if you fail in your attempt- Try again

Are you ready to Quit?