Lung Cancer In Smokers Research Articles

Risks Advantages and Early Workability Diagnosis of CT Lung Cancer of Smokers Contaminated with HIV

Risks Advantages and Early Workability Diagnosis of CT Lung Cancer of Smokers Contaminated with HIV

P54.04 A Study to Determine the Association of Trace Eelments and Heavy Metals with Lung Cancer and their Correlation with Smoking

P54.04 A Study to Determine the Association of Trace Eelments and Heavy Metals with Lung Cancer and their Correlation with Smoking

P43.02 A Multiplex Plasma Protein Panel for Detection of Lung Cancer in Ever Smokers Not Currently Eligible for Screening

P43.02 A Multiplex Plasma Protein Panel for Detection of Lung Cancer in Ever Smokers Not Currently Eligible for Screening

P09.51 Lung Adenocarcinoma in Morocco

Lung cancer is the most common cancer and the leading cause of cancer death worldwide. Adenocarcinoma has become the most prevalent histological type. It represents about 60% of non-small cell lung cancers, and mainly related to changes in cigarette composition. This study aims to describe the epidemiological characteristics of lung adenocarcinoma in Rabat (capital of Morocco). This is a descriptive retrospective study of 162 cases of primary lung adenocarcinoma diagnosed and treated at Ibn Sina University Hospital Center in Rabat between January 2016 and December 2017. Of the 265 cases of primary lung cancer reported during the period of study, 162 (61.1%) were diagnosed with adenocarcinoma. Of these, 88.3% were men, with a male-female ratio of 7.5. The average age at diagnosis of lung cancer was 59.2 years (range 31-80 years). Nearly one-fifth (19.6%) of patients were aged less than 50 years, 54.2% were between 50 and 65 years and 26.2% were older than 65 years. According to the results, 86.7% of men and 15.8% of women were smokers. Immunohistochemistry was performed on 132 cases. All patients were considered positive for cytokeratin 7 (CK7) but negative for cytokeratin 20 (CK20) and 82.3% were positive for Thyroid Transcription Factor-1 (TTF-1). The majority of cancer cases (81.5%) were diagnosed with locally advanced or metastatic disease. The increasing incidence of lung adenocarcinoma is alarming. Most cases were diagnosed with metastatic disease and occurred among smokers,highlighting the need for smoking cessation and lung cancer early detection programs.

Development and psychometric testing of the self-regulatory questionnaire for lung cancer screening (SRQ-LCS)

Background: Research implicates psychological factors in low uptake of lung cancer screening. We developed and psychometrically tested a standardised measure of these psychological determinants in preparation for a prospective, longitudinal cohort study of screening uptake. Methods: Leventhal’s Common-Sense Model of Self-Regulation of Health and Illness provided the theoretical framework to generate the initial item pool. Items were refined during expert review and cognitive interviews which tested for face validity, redundancy, acceptability and comprehensibility. An online survey piloted the refined pool with 1500 current and former (quit ≤ 15 years) smokers aged 55–80. The response distributions, internal reliability and factor structure determined the final retained constructs. Regression analyses examined these constructs’ associations with screening intention, smoking status and demographics. Results: The final measure included seven factor-derived subscales (consequences, personal control, treatment control, illness coherence, emotional representation, behavioural response and appraisal, risk perception) with Cronbach’s alphas ranging from 0.59 to 0.91 and four single-item questions (response efficacy for smoking cessation, treatment intention, perceived stigma and lung cancer survival). Most constructs were associated with smoking status and screening intention (p’s < .05). Conclusions: The Self-Regulatory Questionnaire for Lung Cancer Screening (SRQ-LCS) is an acceptable, reliable and valid measure for investigating the psychological determinants of screening uptake.

Chr15q25 genetic variant (rs16969968) independently confers risk of lung cancer, COPD and smoking intensity in a prospective study of high-risk smokers

ImportanceWhile cholinergic receptor nicotinic alpha 5 (CHRNA5) variants have been linked to lung cancer, chronic obstructive pulmonary disease (COPD) and smoking addiction in case–controls studies, their corelationship is not well...

Lung cancer in women: is gynecological and obstetrical history important?

Introduction. Lung cancer remains the most frequent cause of death related to cancers, reaching 1.8 mln worldwide. We observe globally that the incidence of lung cancer in the never smokers affects women disproportionately more often than men. Material and methods. The aim of the study was to analyse the data about women suffering from lung cancer, with particular emphasis on their gynecological and obstetrical history. Women with confirmed primary lung cancer were evaluated (n = 29). Information about smoking, gynecological and obstetrical history was obtained from a self-administered questionnaire. Demographic data were also collected. Results. The most frequent lung cancer was adenocarcinoma (51.7%), followed by squamous-cell carcinoma (31.0%) and small-cell lung cancer (17.2%). Epidermal growth factor receptor (EGFR) mutations were present in 3 cases. The vast majority of women were smokers (89.7%) with median 30 pack years (IQR 20–48). Evaluating the TNM classification, the highest number of patients was classified to stage III (44.8%). The median age of menarche was 14 years, menopause — 50 years, the number of days with bleeding in the menstrual cycle — 4 and the length of the menstrual cycle — 28 days. An overwhelming majority of women have given birth to a child. Women reported extended menstrual cycles as the most frequent menstrual disorder (6 cases, 20.7%). Hormone replacement therapy and intrauterine contraceptive device use were declared in 10.3%. Conclusions. The results based on the small group of patients did not reveal any significant gynecological dysfunctions in our sample group with lung cancer.

Smoking cessation and shared decision-making practices about lung cancer screening among primary care providers.

ObjectiveWe describe primary care providers’ current practice patterns related to smoking cessation counseling and lung cancer screening (LCS).MethodsFamily, internal medicine, and pulmonary medicine providers from two medical centers were asked to complete an electronic survey to report their practice patterns.ResultsOf 52 participating providers, most reported initiating three major components of a smoking cessation intervention often or very often: advise to quit (50, 96%), assess willingness to quit (47, 90%), and assist with counseling or pharmacotherapy (49, 94%). However, other components were less commonly initiated such as arranging follow‐ups (only 11 providers indicated recommending them often or very often, 21%) and less than half of providers reported that they often or very often recommend cessation counseling or pharmacotherapy of any type (except varenicline), though family medicine providers were more likely to recommend pharmacotherapy compared to the other specialists (p < 0.01). The majority of providers (47, 92%) reported that they engage in informed/shared decision‐making about LCS, although only about one‐third (17, 33%) indicated using a patient decision aid. Pulmonary medicine providers were more likely to use decision aids than providers from internal or family medicine (p < 0.04).ConclusionsWithin the context of LCS, primary care providers report often having conversations about smoking cessation with their patients who smoke, have no clear preference for type of treatment, and rarely use follow‐up calls or visits pertaining to quitting smoking. While many providers report engaging in shared decision‐making about LCS, few use a decision aid for this conversation.

Inference of Sojourn Time and Transition Density using the NLST X-ray Screening Data in Lung Cancer.

The aim of this study is to provide statistical inference of the sojourn time and the transition probability from the disease free to the preclinical state of lung cancer for male and female smokers using lung cancer data from the National Lung Screening Trial (NLST). We applied a likelihood function to the lung cancer data, to obtain Bayesian inference of the transition probability and the sojourn time distribution. A log-normal distribution was used for the transition probability density function multiplied by 30%, and a Weibull distribution was used to model the sojourn time in the preclinical state. The estimate of screening sensitivity is 0.61 for males and 0.62 for females. Early transition happened before age 50 and lasted until after age 90. The transition probability from the disease free to the preclinical state has a single maximum at around age 73 for males and 72 for females. For male, the Bayesian posterior mean, and median sojourn time are 1.33 and 1.27 years, respectively. For female, the corresponding posterior mean, and median sojourn time are 1.23 and 1.21 years, respectively. Our estimation showed that male smokers are more vulnerable to lung cancer, because they have a higher transition probability density than the same aged female smokers. The female smokers have a slightly shorter mean sojourn time than the male, meaning that they are quicker to develop clinical symptom of lung cancer.

Risks Advantages and Early Workability Diagnosis of CT Lung Cancer of Smokers Contaminated with HIV

Aim: Cellular breakdown in the lungs screening with Chest registered Tomography (CT) is gainful in smokers matured 55 to 74 years. Methods: We considered the dangers, advantages and achievability of ahead of schedule cellular breakdown in the lung’s analysis with CT in HIV-contaminated smokers. French, multicenter, single round chest CT concentrate in France, acknowledged between May 2019 and April 2020. Our current research was conducted at Mayo Hospital, Lahore from October 2019 to September 2020. Patients were HIV-contaminated smokers at any rate 40 years, in any event 23 pack years, with a CD4 þ T-lymphocyte nadir check under 360 cells/ml. Our current research was conducted at Jinnah Hospital, Lahore from May 2019 to April 2020. Single chest CT with a proposed normalized workup calculation of positive pictures. Fundamental result measure: The result was the quantity of histologically demonstrated lung malignancies determined by CT to have a 2-year development. Results: Median age of the 442 included patients was 49.8 years, 81.6% were under 55 a long time, 84% were men, middle smoking was 30 pack-years, middle nadir and last CD4 þ cell tallies were 168 and 574 cells/ml, separately, and 93% of patients had a plasma HIV RNA under 50 duplicates/ml. A positive picture at standard was accounted for in 95 (23%) patients, and 18 (4.5%) patients had 19 intrusive methodologies with no genuine unfriendly occasions. Cellular breakdown in the lungs was analyzed in 12 patients (six at beginning phases), of which nine (3.1%, 96% certainty span: 0.9- 3.9) were CT recognized, and eight in patients under 57 years. Conclusion: Early cellular breakdown in the lung’s analysis with CT in HIV-contaminated smokers was plausible, safe, and yielded a critical number of tumors. Cellular breakdown in the lungs screening of HIV infected smokers with a significant history of immunodeficiency uncovered a considerable number of tumors at more youthful ages than the focused-on reach in everybody

Study of genetic variants in chromosome 5p15.33 region in non-smoker lung cancer patients.

Genome-wide association studies have identified that genetic polymorphisms in the telomerase reverse transcrip-tase (TERT) and cleft lip and palate transmembrane 1-like (CLPTM1L) genes may play important roles in the development of lung cancer in never smokers. This study was aiming to evaluate the associations between the risk of lung cancer in never smokers and single nucleotide polymorphisms in these genes by Real-Time Taqman assay, in forty lung cancer patients and forty apparently healthy age-matched controls selected from the chest department, Kasr Al-Ainy hospital from June 2018 to January 2019. Adenocarcinoma was the most common histopathological subtype of lung cancer in the study patients. Also, the prevalence of females having adenocarcinoma was more common than males. The heterozygous form of the CLPTM1L occurred more frequently in the subjects aged above 46 years (P=0.019). There was a significant association between (rs 2730100) (c. 1574-3777C>A) TERT and CLPTM1L (rs 451360) (c.1532+ 1051C>A) genotypes and the incidence of lung cancer in never smokers, especially adenocarcinoma, a subtype of non-small cell lung carcinoma (NSCLC). Polymorphism in the telomerase reverse transcriptase (TERT) and cleft lip and palate transmembrane 1 like (CLPT-M1L) genes may play an important role in the development of NSCLC, especially adenocarcinoma subtype. The two genes are located in the chromosome 5p15.33.

The molecular basis of gender disparities in smoking lung cancer patients

AimsGender disparities exist in smoking-related lung cancer epidemiology, but the molecular basis has not been explored so far. We aimed at identifying genes with gender-bias expression pattern in smoking lung cancer patients for understanding the molecular basis of gender bias in smokers using meta-analysis of microarray gene expression data. Materials and methodsTranscriptome of around 1100 samples from 13 studies were used in the meta-analysis to identify ‘Lung Cancer genes specific to Female-Smokers’ (LCFS) and ‘Lung Cancer genes specific to Male-Smokers’ (LCMS). The expression profiles of these genes were validated with an independent microarray report and TCGA-RNA-sequencing data. The molecular interactions, pathway, and other functional annotations were portrayed for the key genes identified. Key findingsWe identified 1159 gender-biased genes in smoking lung cancer patients. Of these, 400 and 474 genes showed differential expression in cancerous compared to normal lung of women (LCFS) and men (LCMS), respectively. While many up-regulated LCFS were involved in ‘immune responses’ including T-cell activation, leukocyte cell-cell adhesion, the LCMS were mainly involved in ‘positive regulation of gene expression’, signaling pathways including RAS, VEGF, insulin-receptor signaling, and ‘cell cycle’. SignificanceThe strategic-method identified genes, particularly, SNX20, GIMAP6, MTMR2, FAM171B, IDH1, MOBP, FBXO17, LPXN and WIPF1, which were consistently differentially expressed in at least 4 studies, and in agreement with RNA-Seq data. Exploring their functions could be beneficial to the gender-based diagnosis, prognosis, and treatment of lung cancer in smokers. The current meta-analysis supports existing knowledge of sexual-dimorphism of immune responses in cancer.

Adherence to Prudent and Mediterranean Dietary Patterns Is Inversely Associated with Lung Cancer in Moderate But Not Heavy Male Polish Smokers: A Case-Control Study.

Lung cancer is the most commonly diagnosed cancer in men worldwide. Studies regarding dietary patterns (DPs) and lung cancer are limited, with results remaining inconclusive, and the association of DPs with lung cancer in smokers is unclear. This study analyzed the associations between DPs, including the Polish-adapted Mediterranean diet (Polish-aMED) score, and lung cancer risk in Polish adult male smokers. This case-control study involved 439 men aged 45–80 years from northeastern Poland, including 187 newly diagnosed lung cancer cases. Dietary data was collected with a 62-item food frequency questionnaire (FFQ-6). Two approaches were applied to identify dietary patterns. The Polish-aMED score was calculated (hypothesis-driven approach) and a principal component analysis (PCA) was used to identify PCA-driven DPs (data-driven approach). A logistic regression analysis was performed to estimate the odds ratio (OR) and 95% confidence interval (95% CI) of the lung cancer risk associated with the adherence to DPs overall as well as for moderate (2.5–11 pack-years) and heavy (>11 pack-years) smokers. Among moderate smokers, the risk of lung cancer was lower by 41% (OR: 0.59; 95% CI: 0.39–0.90; p < 0.05; adjusted model) in the higher adherence to the prudent DP when compared to the lower adherence, and by 66% (OR: 0.34; 95% CI: 0.15–0.76; p < 0.05; adjusted model) in the high adherence (7–9 points) to the Polish-aMED score when compared to the low adherence (0–3 points). No significant association between the westernized traditional DP or the sweet dairy DP and lung cancer was revealed. In conclusion, the current study suggests that pro-healthy dietary patterns, including the Mediterranean pattern, may favour lower risk of lung cancer in moderate smokers, although it was not confirmed in heavy smokers.

Update on Safety Profiles of Vitamins B1, B6, and B12: A Narrative Review.

The neurotropic B vitamins B1 (thiamine), B6 (pyridoxine), and B12 (cobalamin) are essential for proper functioning of the nervous system. Deficiencies may induce neurological disorders like peripheral neuropathy (PN) and mainly occur in vulnerable populations (eg, elderly, diabetics, alcoholics). As epidemiologic cohort studies raised safety concerns about vitamin B6/B12 intake being potentially associated with increased risks of hip fracture (HF) and lung cancer (LC), we explored these aspects and performed comprehensive literature searches. However, we suggest not to neglect actual high-risk factors (eg, smoking in LC, higher age in HF) by focusing on individual nutrients, but to examine the complex interaction of numerous factors involved in disease development. Because it warrants continued consideration, we also provide an update on neurotoxicity associated with vitamin B6. We consider that neurological side effects due to vitamin B6 intake are rare and only occur with high daily doses and/or longer treatment duration. The benefit-risk ratio of high-dose treatment with neurotropic B vitamins in indications like PN is therefore considered advantageous, particularly if dosing recommendations are followed and serum levels monitored.

Addressing Disparities in Lung Cancer Screening Eligibility and Healthcare Access. An Official American Thoracic Society Statement

Background: There are well-documented disparities in lung cancer outcomes across populations. Lung cancer screening (LCS) has the potential to reduce lung cancer mortality, but for this benefit to be realized by all high-risk groups, there must be careful attention to ensuring equitable access to this lifesaving preventive health measure.Objectives: To outline current knowledge on disparities in eligibility criteria for, access to, and implementation of LCS, and to develop an official American Thoracic Society statement to propose strategies to optimize current screening guidelines and resource allocation for equitable LCS implementation and dissemination.Methods: A multidisciplinary panel with expertise in LCS, implementation science, primary care, pulmonology, health behavior, smoking cessation, epidemiology, and disparities research was convened. Participants reviewed available literature on historical disparities in cancer screening and emerging evidence of disparities in LCS.Results: Existing LCS guidelines do not consider racial, ethnic, socioeconomic, and sex-based differences in smoking behaviors or lung cancer risk. Multiple barriers, including access to screening and cost, further contribute to the inequities in implementation and dissemination of LCS.Conclusions: This statement identifies the impact of LCS eligibility criteria on vulnerable populations who are at increased risk of lung cancer but do not meet eligibility criteria for screening, as well as multiple barriers that contribute to disparities in LCS implementation. Strategies to improve the selection and dissemination of LCS in vulnerable groups are described.

Differential expression profiling of transcripts of IDH1, CEA, Cyfra21-1, and TPA in stage IIIa non-small cell lung cancer (NSCLC) of smokers and non-smokers cases with air quality index

Smoking tobacco is the major hazard for lung cancer in Indian subcontinent especially men, compare to woman where, other important risk factors such as air pollutions are responsible. So, the aim of the study is to compare chronic smokers (CS) and non-smokers living in areas with air quality categorized as poor (AQI 201–300) or moderate (AQI 101–200). We measured the expression of non-small cell lung cancer (NSCLC) biomarkers;. IDH1, CEA, Cyfra21-1, and TPA through quantitative Real-Time PCR (qRT-PCR) and compared the levels of upregulation of the transcripts in stage IIIa NSCLC over control benign tissues among the smoking and AQI settings. Though the all biomarkers were significantly up-regulated in tumor tissues compared to control benign tissues, the fold change increase of IDH1 and CEA was highest in CS-poor/moderate AQI, followed by non-smokers-poor AQI and non-smokers moderate AQI. This indicates the aggressiveness and poor prognosis in CS living in either poor or moderate AQI areas. The level of Cyfra21-1 was lower in in the CS groups in comparison to non-smokers in the poor AQI area. This suggest higher Lung Squamous cell carcinoma histology in non-smokers living areas with poor AQI. Hence, we conclude that poor air quality can be as injurious for lung cancers as chronic smoking.

Physical Activity Does Not Lower the Risk of Lung Cancer.

Observational studies have suggested that physical activity might lower the risk of lung cancer in former and current smokers, but not in never-smokers. Using genetic instruments for self-reported and accelerometer-measured physical activity traits implemented through two-sample Mendelian randomization (MR), we sought to strengthen the evidence for causality. We used 18 genome-wide significant (P < 5 × 10-8) single-nucleotide polymorphisms (SNP) for self-reported moderate-to-vigorous physical activity and seven SNP for accelerometer-measured ("average acceleration") physical activity from up to 377,234 UK Biobank participants and evaluated these in relation to risk using 29,266 lung cancer cases (including 11,273 adenocarcinomas, 7,426 squamous cell carcinoma, and 2,664 small-cell carcinoma cases) and 56,450 controls. MR analysis suggested no effect of self-reported physical activity [OR (95% confidence interval (CI)) = 0.67 (0.42-1.05); P = 0.081; Q-value = 0.243] and accelerometer-measured activity [OR (95% CI) = 0.98 (0.93-1.03); P = 0.372; Q-value = 0.562] on lung cancer. There was no evidence for associations of physical activity with histologic types and lung cancer in ever and never smokers. Replication analysis using genetic instruments from a different genome-wide study and sensitivity analysis to address potential pleiotropic effects led to no substantive change in estimates. Collectively, these findings do not support a protective relationship between physical activity and the risk of lung cancer. SIGNIFICANCE: A new genetic study provides little evidence that recommending physical activity would help prevent lung cancer.

Antiseizure drugs and risk of developing smoking-related chronic obstructive pulmonary disease or lung cancer: A population-based case-control study.

To determine whether enzyme-inducing antiseizure drugs (ASDs) affect the risk of developing chronic obstructive pulmonary disease (COPD) or lung cancer in smokers. Cases of COPD and lung cancer and matched controls without these conditions were identified from a population of smokers with ≥1 prescription for any type of ASD in the Clinical Practice Research Datalink UK database of patients managed in primary care (1995-2016). A matched case-control study was performed utilising multivariate logistic regression analyses of exposure to enzyme-inducing ASDs compared to non-enzyme-inducing ASDs. The duration of ASD exposure and level of tobacco exposure were also assessed. We identified 5952 incident COPD and 1373 incident lung cancer cases, and 59 328 and 13 681 matched controls, respectively. Compared with never use, ever use of enzyme-inducing ASDs was associated with slightly decreased risk estimates of COPD (adjusted odds ratio: 0.85, 95% confidence interval: 0.81-0.89) and lung cancer (adjusted odds ratio: 0.82, 95% confidence interval: 0.73-0.92). These risk estimates were attenuated in heavy smokers. We found slightly decreased risk estimates of COPD and lung cancer among smokers taking enzyme-inducing ASDs and hypothesise that this may be related to induction of detoxification of tobacco-specific lung toxins.

Resveratrol Nanoemulsion; A Promising Inhibitor against Mitogen-Activated Protein Kinase - Dependent Inflammation and Ameliorates Nicotine induced-lung Toxicity in Rats

Background: Nicotine, a major component of cigarette smoke, plays an important role in the development of cardiovascular disease and lung cancer in smokers. The aim of the present article was to investigate protective activity of resveratrol nanoemulsion (RENE) against lung toxicity induced by nicotine in adult rats as compared to basic resveratrol. Materials and Methods: RENE was prepared using bovine serum albumin method, then characterized for their particle size and zeta potential. Furthermore, Adult albino rats weighing around 150 ±10 g were used for the evaluation of lung protective activity of RENE (50 mg/k.b.w.) against nicotine-induced lung toxicity in rats. Results: The mean particle size of RENE was 49.5 ± 0.05 nm and zeta potential of +15.75 with the observed shapes of nanoparticle was spherical. The daily oral administration of the RENE at a concentration of 39.75 mg/kg body weight for 30 days to rats treated with nicotine (2.5 mg/kg.b.w.) resulted in a significant improve plasma cholesterol, triglyceride, HDL-cholesterol, LDL-cholesterol as well as serum tumor necrosis factor alpha (TNF-α), interleukin 6 (IL-6) and growth factor (TGF)-β1 in nicotine treated groups rats. On the other hand, oral administration of RENE elevated the activity of superoxide dismutase (SOD), glutathione peroxidase (GPx) and total protein kinase-1 (Akt-1) as well as reduced the level malondialdehyde (MDA) in lung rats treated with nicotine. In addition, RENE reduced the expression of lung inducible nitric oxide synthase (iNOS) and mitogen-activated protein kinase (p38-MAPK) levels as compared to nicotine treated control group. Also, RENE and resveratrol almost normalized these effects in the histoarchitecture of the lung. Conclusion: The obtained biochemical, molecular biology and histological results of our study proved the lung protective activity of RENE against nicotine induced lung toxicity in rats.

Dissecting the genetic overlap of smoking behaviors, lung cancer, and chronic obstructive pulmonary disease: A focus on nicotinic receptors and nicotine metabolizing enzyme.

Smoking is a major contributor to lung cancer and chronic obstructive pulmonary disease (COPD). Two of the strongest genetic associations of smoking-related phenotypes are the chromosomal regions 15q25.1, encompassing the nicotinic acetylcholine receptor subunit genes CHRNA5-CHRNA3-CHRNB4, and 19q13.2, encompassing the nicotine metabolizing gene CYP2A6. In this study, we examined genetic relations between cigarettes smoked per day, smoking cessation, lung cancer, and COPD. Data consisted of genome-wide association study summary results. Genetic correlations were estimated using linkage disequilibrium score regression software. For each pair of outcomes, z-score-z-score (ZZ) plots were generated. Overall, heavier smoking and decreased smoking cessation showed positive genetic associations with increased lung cancer and COPD risk. The chromosomal region 19q13.2, however, showed a different correlational pattern. For example, the effect allele-C of the sentinel SNP (rs56113850) within CYP2A6 was associated with an increased risk of heavier smoking (z-score = 19.2; p = 1.10 × 10-81 ), lung cancer (z-score = 8.91; p = 5.02 × 10-19 ), and COPD (z-score = 4.04; p = 5.40 × 10-5 ). Surprisingly, this allele-C (rs56113850) was associated with increased smoking cessation (z-score = -8.17; p = 2.52 × 10-26 ). This inverse relationship highlights the need for additional investigation to determine how CYP2A6 variation could increase smoking cessation while also increasing the risk of lung cancer and COPD likely through increased cigarettes smoked per day.