Why and how to quit 

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There are just over 10 million cigarette smokers in England, which is about a quarter of the adult population, and in 2005, there were over 95,000 smoking-related deaths. This is almost one in five of all deaths.

Smoking is linked to an increased risk of several cancers including lung, head and neck, oesophagus, stomach, liver, breast, bowel , bladder, kidney and skin. Patients who give up after a diagnosis of cancer have a much better chance of cure than those who do not. This section describes the risks of smoking, the underlying mechanisms of harm and practical tips to help you, a friend or relative to give up. 

What makes smoking harmful?

Tobacco smoke contains over 4000 different chemicals, many of which are carcinogenic including Benzene, Formaldehyde, Ammonia, Hydrogen cyanide, Acetone and Arsenic. The 3 components of smoke which we know are particularly damaging are:

  • Nicotine
  • Carbon monoxide
  • Tar

Nicotine is a powerful, fast acting and addictive drug. Most people who smoke are dependent on the nicotine in cigarettes. When a smoker inhales, nicotine is absorbed into their bloodstream and the effects are felt on their brain seven to eight seconds later. Nicotine also has many complex effects on the rest of the body. In small amounts nicotine stimulates nerve impulses in the central and the autonomic nervous system but, in large amounts nicotine inhibits these nerve impulses. The immediate effects of nicotine:-

  • Increased heart rate
  • Constriction of the small blood vessels in the skin
  • Increase blood pressure
  • Increased metabolism
  • Effects on mood and behaviour
  • Causes anxiety & tremor

Carbon monoxide is a poisonous gas found in relatively high concentrations in cigarette smoke. It combines readily with haemoglobin, the oxygen-carrying substance in blood, to form carboxyhaemoglobin. In fact it combines more readily with haemoglobin than oxygen does, so up to 15% of a smokers blood may be carrying carbon monoxide round the body instead of oxygen. Oxygen is essential for body tissues and cells to function efficiently. If the supply of oxygen is reduced for long periods, this can cause problems with growth, repair and absorption of essential nutrients. Carbon monoxide can also affect the ‘electrical’ activity of the heart and, combined with other changes in the blood associated with smoking and diet, may encourage fatty deposits to form on the walls of the arteries.

Tar. When a smoker inhales, the cigarette smoke condenses and about 70% of the tar contained in the smoke is deposited in the lungs. Many of the substances in tar are already known to cause cancer (see below). Irritants in tar can also damage the lungs by causing narrowing of the bronchioles, coughing, an increase in bronchiole mucus and damage (ciliostasis) to the small hairs which help protect the lungs from dirt and infection.

Why give up smoking?

Smoking is the single most harmful, freely available environmental factor which mankind inflicts on itself. Despite being the greatest cause of ill health and premature death there are billions of smokers in the western world contributing to one in five of all deaths.

Smokers are at greater risk of illness and early death compared to non-smokers. Those who smoke more than 25 cigarettes a day are 25 times more likely to die from cancer and almost twice as likely to die of flow coronary heart disease and if they also suffer flow high blood pressure and high cholesterol when there is an eight-fold increase in risk.

  • Coronary heart disease - Smokers double their risk of dying from heart attack or heart failure
  • Atherosclerosis - this is the build up of fatty deposits and loss of elasticity in the artery walls 
  • Strokes  and dementia
  • Peripheral vascular disease and gangrene and aortic and other aneurysms
  • Cancerof the lung, mouth, nose and throat, larynx, oesophagus, pancreas, bladder, stomach, leukaemia, lymphoma, kidney
  • Chronic bronchitis, emphysema and other lung diseases such as recurrent infections in the airways and general loss of efficiency in the lungs
  • Peptic ulcers (these are ulcers in the stomach and duodenum) —increase both in incidence and the time they take to heal
  • Tobacco amblyopia (defective vision)
  • Increased risk of osteoporosis; the loss of bony tissue, resulting in brittle bones that are liable to fracture.
  • Increase risk of erectile function and vaginal dryness
  • Parkinson's disease ad other neurodegenerative conditions
  • Infertility and earlier menopause.
  • In pregnancy, spontaneous abortion, low birth weight babies, perinatal mortality.
  • Blood clots – deep vein thrombosis, pulmonary embolism, strokes.
  • Greater risk of a second cancer forming

Passive smoking

Breathing the smoke from other people’s cigarettes is called passive smoking. It consists of smoke from the burning end of the cigarette — called sidestream smoke — and smoke inhaled and exhaled by the smoker. The US Environmental Protection Agency has declared passive smoking, or exposure to environmental tobacco smoke (ETS), to be a ‘Class A Carcinogen’ which means that it is capable of causing cancer in humans. Passive smoking may cause the following: adults babies and young children irritation to the eyes, nose and throat; increased acute respiratory illness in early childhood (including infections); headaches, dizziness and sickness; chronic cough, phlegm and wheeze; aggravation of asthma and allergies; chronic middle ear lesions (glue ear); increased risk of coronary heart disease; reduced levels and capacity of lung functions; 10%  to 30% increased risk of lung cancer for non-smokers increased prevalence of asthma; who are exposed to passive smoking over long periods

Benefits of quitting

It is never too late to stop even after a diagnosis of cancer. Quitting smoking is the greatest single step smokers can do at any stage in their life. When the daily assault of nicotine, carbon monoxide, tar and other poisons has stopped, the body begins to repair the damage. In terms of the successful treatments of cancer, there is now strong evidence that smokers have a significantly lower chance of being cured from their cancer. This applies to both the chance of getting it into remission in the first place and a higher chance of it returning after initial treatment has finished. Smokers are inflicting a wide range of added problems on themselves during their treatments and in the long term:

Extra risk for smokers during and after cancer therapies

  • Greater risk of acute side effects of chemotherapy and radiotherapy.
  • Increase risk of thrombosis (blood clots) in the superficial and deep veins
  • Worse mood, a higher incidence of anxiety and a lower ability to cope.
  • Higher risk of indigestion which is common with some chemotherapy regimens
  • Greater risk of long term radiotherapy damage such as skin thinning, fibrosis, rectal damage.
  • Persistent smokers have a major increased risk of second cancers caused by the chemo & radiotherapy.
  • Greater risk of osteoporosis which is already at higher risk after chemo and some hormone therapies.
  • Poorer tolerance to long term hormones such tamoxifen, the aromatase inhibitors or zoladex particularly abdominal discomfort, joint pains and hot flushes.
  • Earlier menopause and higher risk of menopausal symptoms such as hot flushes and vaginal dryness independent of hormone therapy.
  • Increases the risk of heart damage from herceptin or some chemotherapy drugs.
  • Lower chance of the cancer being cured
  • Higher chance of the cancer returning after successful initial therapy

In addition to the cancer effects there are enormous benefits in quitting relating to general wellbeing which indirectly is vital in the overall fight against any serious disease. Smokers who quit notice their body systems start to return to normal, resulting in the following general benefits, many of which can be experienced within a few weeks:-

  • breathing improves
  • improved ability to cope with sudden exertion
  • loss of smoker's cough and reduction in phlegm
  • sense of taste and smell improves
  • hair, skin and breath no longer smell of tobacco smoke
  • the natural decline in lung efficiency slows down to a rate similar to non-smokers
  • exercising gets easier, energy levels increase
  • feeling good about themselves for having stopped
  • improved mood and lower anxiety

In conclusion quitting smoking increases the chances of surviving cancer, living a longer and healthier life. It improves the tolerance to treatments, saves a great deal of money, improves sexual function, stops harming other people, makes you more attractive and will gain the admiration of your friends, family and colleagues.

How to quit smoking?

There is no quick and easy way to quit. Up to half of smokers continue to light up cigarettes after being diagnosed with cancer. You have to want to stop smoking. Most smokers want to stop smoking and it’s the single most important thing a smoker can do to help their cancer and live longer. At any one time, one in six smokers are trying to quit. Despite the strong addiction of cigarettes more than 11 million people in Britain alone have become successful ex-smokers. Most of those who stop do so by themselves. Being determined is the vital ingredient. Deciding to quit and really wanting to succeed are important steps in becoming a non-smoker. It is helpful for smokers to have a plan to quitting smoking. The following suggestions have helped some people to quit successfully.

10 tips to quit:

1. Make a date and stick to it - Making a commitment to quit and sticking to it. Make a time and date. Most people who successfully quit smoking do so by stopping altogether, and not by gradually cutting down. Make a promise to yourself and a punishment if you fail (e.g. give money to you an organisation you despise).

2. Keep busy - Keep busy to help take your mind off cigarettes. Throw away all your ashtrays, lighters and unopened cigarette packets.

3. Drink plenty of fluids. - Keep a glass of water or juice by you and sip it steadily. Try different flavours.

4. Get more active - Walk instead of using the bus or car. Try the stairs instead of the lift. Physical activity helps you relax and can boost your morale.

5. Think positive - Withdrawal can be unpleasant but it is a sign that your body is recovering from the effects of tobacco. Irritability, urges to smoke and poor concentration are common. Don’t worry. They usually disappear after a couple of weeks.

6. Change your routine - Try to avoid the shop where you usually buy cigarettes. Perhaps you should avoid the pub or the break room at work if there are lots of smokers around you. Try doing something totally different. Surprise yourself!

7. No excuses - Don’t use a crisis, or even good news, to be an excuse for ‘just one cigarette’. There is no such thing. You will soon want the next and the next…

8. Treat yourself - This is important. If you can, use the money you are saving by not smoking to buy yourself something special – big or small – that you wouldn’t usually have.

9. Be careful what you eat - Try not to snack on fatty foods. If you do need to snack, try fruit, raw vegetables or sugar-free gum or sweets.

10. Take one day at a time - Each day without a cigarette is good news for your heart, your health, your family and your pocket.

The quitting program

Cutting down or stopping outright? Cutting down is less likely to work than simply stopping outright. Unfortunately, even if you do manage to cut down, the numbers tend to creep back up again. So once you have planned ahead and chosen your date it is better to stop outright.

Diet and physical activity.  Both of these have an important effect on your body. Stopping smoking is a major change for your body to adapt to, and a healthy diet and regular physical activity suitable to your level of fitness.

Helping other people. When you smoke cigarettes other people around you are being exposed to its risk – this is called passive smoking. It consists of smoke from the burning end of the cigarette (called side stream smoke) and smoke inhaled and exhaled by the smoker. The US Environmental Protection Agency has declared passive smoking, or exposure to environmental tobacco smoke (ETS), to be a ‘Class A Carcinogen’ which means that it is capable of causing cancer in humans. Passive smoking may cause the following: adults babies and young children irritation to the eyes, nose and throat; increased acute respiratory illness in early childhood (including infections); headaches, dizziness and sickness; chronic cough, phlegm and wheeze; aggravation of asthma and allergies; chronic middle ear lesions (glue ear); increased risk of coronary heart disease; reduced levels and capacity of lung functions; 10%  to 30% increased risk of lung cancer for non-smokers increased prevalence of asthma; who are exposed to passive smoking over long periods. 

Products to help you quit 

There are many different smoking cessation aids (products to help you stop smoking) on the market. It is important to check whether the product is safe and effective before you spend your time, energy and money on it. If you are ever in any doubt as to whether it is safe for you to use a product, check first with your doctor or pharmacist.

Some manufacturers claim very high success rates for their products, promising between 80% and 90% effortless success. But there is no magic solution. To be certain that a product or method works it has to be put through proper tests (clinical trials). If the product has an effect, it can then be compared to that achieved with another product. Not all the products available have been tested in this way.

Nicotine replacement products

These methods replace some of the addictive nicotine that you used to get from smoking. Nicotine replacement therapy has been well researched and tests have shown that, if used correctly, it will double your chance of success – which is good news if you found withdrawal very hard on previous attempts. If you smoke your first cigarette within 30 minutes of waking, then you are particularly likely to benefit from nicotine replacement therapy.

Nicotine replacement products are generally safer than smoking but if you have, or have had, a heart problem you must check with your doctor or pharmacist before starting to use it. It is also important to use the product properly, so always follow the manufacturer’s instructions. Ask your pharmacist or doctor if you are not sure. In particular, you must stop smoking completely while taking nicotine replacement therapy. Nicotine replacement products may also affect the action of some drugs such as warfarin and beta-blockers. There forms of nicotine replacement commonly available include patches, gum, nasal sprays and inhalators. Your family doctors may be able to give you a prescription for nicotine replacement patches and gum but they are also available over the counter without prescription.

The patch gives you a continual supply of nicotine at a low dose while you are wearing it – so you can’t respond quickly to a craving or a stressful moment. The gum, nasal spray and inhalator deliver a higher dose quickly so you can respond to a craving with a ‘quick fix’, as with cigarettes. Side effects of nicotine replacement products include nausea, indigestion, headaches, dizziness and palpitations. The most popular nicotine replacement device is now affectionately termed vaping:

Vaping: E-cigarettes are battery-powered devices that heat a liquid, usually containing nicotine mixed with the chemicals propylene glycol and glycerin, and flavourings into a vapor that users can inhale. Every day we see the stories, in newspapers and on television, about vaping health risks. Public Health England and the Royal College of Physicians have concluded that the potential of serious vaping danger is probably very low. The RCP says vaping is “unlikely to exceed five percent of the harm from smoking tobacco. On the other hand, the U.S. Food and Drug Administration announced that its authority to regulate tobacco products will now extend to include e-cigarettes. The devices, along with cigars, hookah and pipe tobacco, will now be regulated in a similar way to conventional cigarettes. The new rules, which take effect on Aug. 8, also banned the sale of these products to people under age 18 both in stores and online.

One trial has already linked their exclusive use to an increased risk of lung cancer and further trials are likely to find risks with e-cigarettes in view of the carcinogens they contain and the number of people using them. Nevertheless, they they are a short term useful tool to help you stop especially if you smoke mainly in response to cravings or stress and you miss the ‘hand to mouth’ action of smoking.

Non-nicotine replacement products

Acupuncture: These are many and varied. They are easily available through mail order, newsagents, health shops or pharmacists. Often they do not require a license under the Medicines Act. Generally there is not enough firm evidence to say how effective they are. Be wary of claims of very high success rates. Non-nicotine replacement products include nicobrevin capsules, scented inhalers, dummy cigarettes, tobacco-flavoured chewing gum, herbal cigarettes and filters.

Other complementary therapies: These undoubtedly help some people. However, the results of research are not clear, so overall their effectiveness remains unproven. The two most popular forms of complementary therapies for stopping smoking are hypnotherapy and acupuncture. If you decide to try these therapies, it is important to find a practitioner registered with the directory of UK hypnotherapist.

Support groups: Joining a ‘stop smoking’ support group can help you feel less alone in your attempt to quit. Being with other people who are also stopping can provide all-important mutual support, a sense of being understood and a sense of competition! They are usually run over a period of weeks and take you through the different stages of stopping. Specialist smoker’s clinics, using nicotine replacement products, can improve your chances of stopping by between three and four times.

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