Myths about smoking and vaping

Prof. Berghmans

Interview with Prof. Dr. Berghmans

If you quit smoking, does this completely eliminate the risk of lung cancer? How dangerous is vaping for your lungs? And what about the treatments available for lung cancer patients?

In our country, 19.4% of the population smokes and 15.4% of people smoke daily. Between 85 and 90% of lung cancers are caused by smoking. Although the number of men smoking has declined in recent years, the number of women smoking has increased. Lung cancer is therefore the second most common cancer among both sexes.

"In our country, 19.4% of the population smokes and 15.4% of people smoke daily."

How does tobacco smoke affect the lungs? We put this question to Professor Thierry Berghmans, head of the functional thoracic oncology unit, affiliated with the Jules Bordet Institute in Brussels.

“As tobacco smoke spreads inside the lungs via branches called bronchi, it causes changes in cells that lead to the development of lung cancer. Tobacco smoke contains many toxic substances, such as benzene, acetaldehyde, acrolein, ammonia and others. The substances in tobacco smoke affect lung tissue and can cause lung cancer, as well as other diseases such as COPD and pulmonary emphysema.”

Studies show that quitting smoking does not eliminate the risk of lung cancer overnight. Can you explain why that is?

"The risk of lung cancer increases proportionally with the number of cigarettes smoked per day and as the smoking habit is maintained over the course of many years. Once you quit smoking, the risk slowly decreases. It takes many years before you can say that the risk has been significantly reduced, but it will always be higher compared to non-smokers. On the other hand, if you continue to smoke, the risk of lung cancer will only increase."

"There are other effects as well. It is normal for your pulmonary function to decline. But smoking only accelerates this process. And when you quit smoking, you won't get that loss of pulmonary function back. However, the subsequent decline in lung function gradually returns to the rate of a non-smoker."

“Smoking also leads to cardiovascular problems. The risk of problems with the cardiac arteries and peripheral arteries, and therefore also the risk of heart attack, increases, for example. When you quit smoking, you also reduce this risk.” 

"When you quit smoking, you won't get that loss of pulmonary function back."

Smoking is the leading cause of lung cancer, but it is not the only one. What are the other causes?

"We certainly must not disregard the risk associated with passive smoking – this relates to people who do not smoke themselves but are exposed to tobacco smoke on a daily basis because their partner smokes, for example. It is therefore important to discourage smoking for these people.”

"Other causes include exposure to asbestos, which is sometimes present in the environment. Radon is also a risk factor. This gas is found in our regions, for example in the region south of the Sambre and the Meuse."

“There are also many risks associated with professional life. The IARC - International Agency for Research on Cancer - has listed them. In any case, the risk of lung cancer is doubled, or even multiplied, if two risk factors are combined, such as smoking and exposure to asbestos, for example."

E-cigarettes are marketed to help people quit smoking. But today, more and more young people are vaping, according to a recent survey by the University of Antwerp: 11% vape every week, 8% every day, and the majority of them believe the risks are low. Is this true? Or will vaping lead to more lung cancer in the long run?

“It is very difficult to answer this question. The topic has been debated within the medical community for some time. There are two short-term risks. There are young people who start vaping and then move on to smoking. Especially if they vape with a liquid containing nicotine, it can lead to nicotine addiction, just like smoking. There is also a risk of serious lung disease if you change the composition of your vaping liquid yourself. Fortunately, this rarely happens.”

“As far as vaping is concerned, it is too soon to assess the risks. As we don't yet know what problems this will cause in 20 or 30 years - a reasonable time frame to consider the occurrence of chronic pathologies - I advise young people not to start vaping."

“We also do not have enough quality data on vaping as a smoking cessation method to say that e-cigarettes work adequately. According to a recent study they could help, but if you use an e-cigarette, you still risk addiction to nicotine. Currently, I do not advocate the routine use of e-cigarettes for smoking cessation."

"As far as vaping is concerned, it is too soon to assess the risks."

Lung cancer is a very complex disease. What does this mean for patient care?

"We started with two main types of lung cancer: small cell and non-small cell lung cancer. Today, thanks to molecular biology, we can distinguish many more types of diseases. This impacts the choice of treatment, regardless of the stage of the disease.”

“One of the big advances is immunotherapy. We know that this therapy is less effective in patients with certain mutations within the tumor. On the other hand, we have very effective small-molecule treatments that can be administered orally for some of the tumor mutations. But today, we need a lot of input and many analyses to arrive at the right treatment. This requires more time and more tissue samples. These biopsies can be taxing on patients and also lead to a longer lead time before the treatment can start. Fortunately, techniques are evolving rapidly and will certainly make it possible to shorten this lead time. So, patients will be able to benefit from an effective treatment allowing the disease to be controlled for a long period or leading to a curative strategy, as in perioperative treatments."