The number of lung cancer patients in the world has grown from less than 100 cases at the beginning of the 20th century to almost 2.2 million today. The main reason for the development of the disease is smoking, which also complicates therapy. Meanwhile, about 50% of patients do not give up this habit even after surgery.

Lung cancer is one of the most common oncological diseases, which accounts for a significant number of deaths. Unlike other malignant neoplasms, it is rarely associated with genetic factors and is among the diseases of a predominantly exogenous nature.

In most cases, lung cancer is associated with smoking. Non-smokers account for only 10-15% of detected cases, and about 60% of them are women. Among women suffering from lung cancer, 20% have never smoked, and in Asia their share among the diseased reaches 30%.

“People who smoke are usually diagnosed with small cell carcinoma, squamous cell carcinoma and adenocarcinoma. In cases where the disease is not associated with smoking, it is adenocarcinoma or neuroendocrine cancer, ”said Sergey Orlov, Senior Researcher at the First St. Petersburg State Medical University named after Academician I.P. Pavlov.


Non-small cell lung cancer is directly related to smoking and is one of the most aggressive types. As a rule, it progresses rapidly and gives metastases, and the effectiveness of chemotherapy in this type of disease quickly decreases.

Among the main causes of death from smoking, along with lung cancer, are cardiovascular diseases and chronic obstructive pulmonary disease (COPD).

“Cardiovascular diseases are associated with the effects of tobacco smoke on vascular coagulation and blood vessel walls, lung cancer is associated with direct exposure to tobacco smoke carcinogens on the lungs,” he explained. Head of the Department of Thoracic Oncology, N.N. N. N. Petrova, Professor of the Department of Oncology, N.N. I. I. Mechnikov Evgeny Levchenko. — In COPD, it is caused by an irritant and inflammatory action.”

Tobacco smoking is also associated with other dangerous diseases. “Smoking can also cause cancer of the mouth, esophagus, bladder,” adds Head of the Department of Biology of Tumor Growth, N.N. N. N. Petrova Evgeny Imyanitov. “If people stopped smoking today, then oncological incidence in general would decrease by about 30%, of which the lion’s share would be lung cancer,” the doctor explains.

There are dopamine receptors in the nervous system that ensure the activity of the reward center, Evgeny Imyanitov explains. Stimulants of the dopamine system are alcohol, stimulants, fatty and sugary foods, and smoking.

With respect to smoking, it should be understood that humans stimulate the reward center by delivering nicotine. Cigarette smokers get nicotine from tobacco smoke. Tobacco smoke tar contains a huge amount of substances that cause various types of cancer, including lung cancer. Delivery of nicotine can be done in a less harmful way. A new innovative approach and scientifically based solution in this matter are alternative nicotine-containing products, such as electronic cigarettes and tobacco heating systems. That is why a number of developed countries have policies that encourage smokers to stop using traditional cigarettes. Smokers are being encouraged to switch to electronic tobacco heating systems that deliver nicotine in a less harmful way, the specialist says.

The risk of developing most smoking-related neoplasms declines within 5 years of quitting the habit, although the level and speed of risk reduction may vary depending on the type of neoplasm. “If a patient under the age of 75 has never quit smoking, then the risk of death from lung cancer by the age of 75 is about 16%. But if you quit smoking at the age of 50, it drops to about 10%, ”says Evgeny Levchenko. “Smoking cessation is associated with increased five-year overall survival, five-year relapse-free survival, and reduced overall mortality,” he explains.

Smoking also affects the cellular response to platinum therapy, as components of tobacco smoke can block targeted apoptosis or increase cell proliferation.

“Many of the compounds found in tobacco smoke are hematotoxic,” adds Sergey Orlov. “Continued smoking during anticancer therapy negatively affects the results of treatment.”

In this regard, therapy in the treatment of lung cancer should include smoking cessation. “The results of lung cancer treatment can be improved by quitting smoking between 8 and 10 weeks before surgery, improving the environmental situation, using organ-preserving tracheobronchoplastic surgery techniques, and quitting smoking after surgery,” emphasized Evgeny Levchenko. “However, about 50% of those who quit smoking before surgery then return to this habit again.”

In cases where it is not possible to completely stop smoking cigarettes, doctors may recommend less harmful, lower-risk alternatives, such as smokeless nicotine products, to patients.

“Smoking cessation should become an essential component of cancer treatment in all cancer programs, from prevention and diagnosis to treatment and palliative care,” said Sergey Orlov. “For those patients who cannot give up a bad habit, it is advisable to consider using the concept of harm reduction in the form of switching to alternative sources of nicotine delivery – electronic tobacco heating systems.”

Due to the absence of combustion, the amount of harmful and potentially harmful substances in the aerosol of electronic tobacco heating systems is significantly reduced (by 95%) compared to the smoke from a traditional cigarette.

In addition to smoking, modifiable cancer risk factors include poor diet, sedentary lifestyle, ultraviolet radiation, alcohol use, and being overweight. Their influence can be corrected through lifestyle changes.