A prominent cancer expert encouraged Filipino doctors to rethink their strategies to address the smoking problem as the current policies mostly failed to help smokers quit, leaving millions of smokers exposed to diseases.
Dr. David Khayat, a renowned French oncologist who was a resource speaker in a virtual scientific meeting of the Philippine Medical Association (PMA), said health professionals should look at science and innovation in reducing the exposure of smokers to harm caused by tobacco smoke, noting that nicotine does not cause cancer as previously misperceived.
“In a perfect world, the dream is to eliminate smoking and therefore all smoking-related diseases. If not possible, I think we have to take decision based on science, and not on emotion or opinion,” Dr. Khayat said in a virtual presentation on the topic “Smoking, Cancer and Tobacco Harm Reduction” during the 115th PMA Annual Convention and Scientific Meetings held on May 19 to 22, 2022.
The scientific meeting was chaired by Dr. Ricardo A. Batac with Dr. Annielyn Beryl Ong-Cornel, Dr. Bu Castro, Dr. Guia Tan, Dr. Maria Encarnita Limpin, and Dr. Rizalina Raquel also as speakers.
Dr. Khayat, who has devoted himself to the fight against cancer for more than three decades, said if the elimination of smoking is not possible, smokers should be given the opportunity to reduce their exposure to toxicants and carcinogens from tobacco smoke. He said many smokers would not quit even when afflicted with cancer.
A professor of Oncology at Pierre et Marie Curie University and head of Medical Oncology at La Pitié-Salpétrière Hospital in Paris, Dr. Khayat said the fight against cancer should involve reducing exposure to known carcinogens, as the current anti-smoking policies, which revolve around bans and increases in taxes, failed to address the problem of smoking cigarette, which contains more than 6,000 chemicals and ultrafine particles, including 80 carcinogens or potential carcinogens.
He said that if prohibition or ban on smoking was not working, it is the responsibility of medical professionals to provide alternatives that reduce the harm from smoking, and these should include innovative products such as e-cigarettes, heated tobacco products and snus.
“The greater amount of carcinogens you are exposed to, the higher the risk of cancer,” said Dr. Khayat. “Although 80 percent of all lung cancers occur in smokers, only 8 percent of all smokers will develop lung cancer.”
He said among the strategies to fight cancer is the reduction of exposure to carcinogens. Harm reduction is not a new concept, but a term that arose in the context of drug addiction, he said. “People make poor lifestyle choices despite suffering negative health effects,” he said.
He said it was the late Prime Minister Margaret Thatcher who pioneered the focus on harm reduction during the AIDS epidemic in the UK, which resulted in the lowest rates of HIV among drug users in the word.
Over the past 12 years, UK think tank Centre for Social Justice led the change in drug policy in favor of abstinence. The outcome from such shift is that drug-related fatalities doubled since 2011, and one in three drug-related deaths in Europe are now in the UK, he said.
Dr. Khayat encouraged Filipino medical professionals to look at smoke-free alternatives as harm reduction tool that will help address smoking-related diseases in the Philippines.
“All of these alternatives such as snus, electronic cigarettes (vapes) and heated tobacco products (HTPs) are showing very significant efficacy in helping people switch from real cigarettes that are very bad to health,” he said.
He also asked the medical community to look at nicotine as part of the solution. He said that nicotine, while addictive, is not a source of cancer, and health experts even prescribe nicotine replacement therapy (NRT) to help smokers quit.
“If you want to reduce exposure to carcinogens, you must identify the nature, production and exposure source of carcinogens,” said Dr. Khayat.
“Smokers commonly misperceive that nicotine is a major carcinogen,” he said, adding that it is contrary to the conclusion of Cancer Research UK, which found that nicotine is not responsible for the harmful effects of smoking.
“Nicotine does not cause cancer, and people have used nicotine replacement therapy safely for many years. NRT is safe enough to be prescribed by doctors,” the Cancer Research UK said.
He said while the best thing for patients is to completely quit smoking, most fail to do so, with studies showing that as many as 64 percent of people with lung cancer continue to smoke, even though they know that it is bad for their health.
“The fact is 80 percent of smokers would never leave smoking. And 64 percent of people smoking will not stop even if they have cancer,” he said. “So we have to find a way. Knowing that smoking was bad, they continue to smoke even if they have cancer. So we have to provide them with a solution, if not they are going to be desperate.”
Dr. Khayat said these solutions now include snus, vapes and HTPs, all of which “are showing very significant efficacy in helping people switch from real cigarettes that are very bad to their health.”
He said doctors also have a role to play to help remove the stigma among smokers. He said this is where tobacco harm reduction comes in. “Accepting that some levels of bad behaviors are inevitable, therefore, we should target to minimize the harm people suffer as a consequence,” he said.
He said innovation in tobacco smoking with the use of vapes, HTPS and snus provide alternatives to reduce exposure to carcinogens. Dr. Khayat said different scientific bodies confirmed that using snus instead of cigarettes puts individuals at a lower risk of mouth cancer, heart disease, lung cancer, stroke, emphysema and chronic bronchitis.
In Japan, a study found reduced formation of harmful and potentially harmful constituents in HTPS compared to cigarettes. A study on the effects of switching to HTP concluded in 2021 that consistent improvements in respiratory symptoms, exercise tolerance, quality of life and rate of disease and exacerbations were observed in patients with COPD who abstained from smoking or substantially reduced their cigarette consumption by switching to HTP use.
In July 2020, the US FDA determined that the exposure modification order for IQOS would be appropriate to promote the public health and is expected to benefit the health of the population as a whole.
A 2021 study suggested that the use of e-cigs could be a third as harmful to health as smoking especially in high-income country settings. The estimate is based on a number of biomarker studies.
He said that on a country level, Japan experienced a 34-percent decline in cigarettes sales in four years following the introduction of heated tobacco products.
