Risk Of Tobacco-related Cancers Research Articles

Tobacco‐specificN‐nitrosamines andARECA‐derivedN‐nitrosamines: Chemistry, biochemistry, carcinogenicity, and relevance to humans

Nicotine and the minor tobacco alkaloids give rise to tobacco-specific N-nitrosamines (TSNA) during tobacco processing and during smoking. Chemical-analytical studies led to the identification of seven TSNA in smokeless tobacco (< or = 25 micrograms/g) and in mainstream smoke of cigarettes (1.3 micrograms TSNA/cigarette). Indoor air polluted by tobacco smoke may contain up to 24 pg/L of TSNA. In mice, rats, and hamsters, three TSNA, N'-nitrosonornicotine (NNN), 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK), and 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL), are powerful carcinogens; two TSNA are moderately active as carcinogens; and two TSNA appear not to be carcinogenic. The TSNA are procarcinogens, agents that require metabolic activation. The active forms of the carcinogenic TSNA react with cellular components, including DNA, and with hemoglobin (Hb). The Hb adducts in chewers and smokers serve as biomarkers for the uptake and metabolic activation of carcinogenic TSNA and the urinary excretion of NNAL as free alcohol and as glucuronide for the uptake of TSNA. The review presents evidence that strongly supports the concept that TSNA contribute to the increased risk for cancer of the upper digestive tract in tobacco chewers and for the increased risk of lung cancer, especially pulmonary adenocarcinoma, in smokers. The high incidence of cancer of the upper digestive tract especially among men on the Indian subcontinent has been causally associated with chewing of betel quid mixed with tobacco. In addition to the TSNA, the betel quid chewers are exposed to four N-nitrosamines that are formed during chewing from the Areca alkaloids, two of these N-nitrosamines are carcinogens. The article also reviews approaches toward the reduction of the carcinogenic potency of smokeless tobacco, betel quid-tobacco mixtures, and cigarette smoke. Although the safest way to reduce the risk for tobacco-related cancers is to refrain from chewing and smoking, modifications of smokeless tobacco and of cigarettes are indicated to lead to less toxic products. Another more recent approach for reducing the carcinogenic effect of tobacco products is the application of chemopreventive agents, primarily of micronutrients. Future aspects in tobacco carcinogenesis, especially as it relates to TSNA, are expected in the field of molecular biochemistry and in biomarker studies, with the goal of identifying those tobacco and betel quid chewers and tobacco smokers who are at especially high risk for cancer.

Potential inhibitors of tobacco carcinogenesis.

Tobacco smoking is causally associated with cancer of the lung, upper aerodigestive tract, pancreas, renal pelvis and urinary bladder. Tobacco chewers and especially snuff dippers face an increased risk for cancer of the oral cavity and pharynx. Although cessation of the tobacco habits is the only sure way to avoid an increased risk of tobacco-related cancers, certain modified products should be available to lower the incidence rates for cancer among those tobacco chewers and smokers who are unable to give up their tobacco habits. The modified cigarette has been the first approach toward the reduction of cancer risk. In the case of cancer of the lung, the long-term smoker of low-yield filter cigarettes has a risk reduction of 30-50% over that of the smoker of nonfilter cigarettes; however, the risk of filter cigarette smokers for cancer of the lung and cancer at other sites is still many times higher than that of the nonsmoker. A second modality is the application of natural or synthetic chemopreventive agents. Clinical studies with tobacco users have been primarily limited to the application of beta-carotene and retinoids. Although the data appear encouraging in respect to reducing early lesions in the oral cavity of tobacco chewers and smokers and in respect to second primaries in smokers, the benefits of beta-carotene and retinoids are gradually reversed upon withholding these micronutrients. It is understandable that activities in respect to chemopreventive agents in clinical trials on smokers are limited, since cessation of smoking alone leads within only a few years to a significant reduction of the cancer risk. Another reason for the limited interest in clinical trials on smokers may relate to the lack of laboratory data on the actual effects of chemopreventive agents in animals induced with tobacco-specific carcinogens. However, during the last few years, a number of natural or synthetic chemopreventive agents in animals induced with tobacco-specific carcinogens. However, during the last few years, a number of natural or synthetic chemopreventive agents have been tested in mice and rats which were treated with carcinogenic, tobacco-specific N-nitrosamines (TSNA). The results appear most encouraging in respect to lung tumor reduction. It is hoped that this type of research will gain in interest. Human data suggest that the fat content of the diet influences the cancer risk of smokers.(ABSTRACT TRUNCATED AT 400 WORDS)

Tobacco-specific nitrosamines, an important group of carcinogens in tobacco and tobacco smoke.

Tobacco-specific nitrosamines are a group of carcinogens that are present in tobacco and tobacco smoke. They are formed from nicotine and related tobacco alkaloids. Two of the nicotine-derived nitrosamines, NNK and NNN, are strong carcinogens in laboratory animals. They can induce tumors both locally and systemically. The induction of oral cavity tumors by a mixture of NNK and NNN, and the organospecificity of NNK for the lung are particularly noteworthy. The amounts of NNK and NNN in tobacco and tobacco smoke are high enough that their total estimated doses to long-term snuff-dippers or smokers are similar in magnitude to the total doses required to produce cancer in laboratory animals. These exposures thus represent an unacceptable risk to tobacco consumers, and possibly to non-smokers exposed for years to environmental tobacco smoke. The permission of such high levels of carcinogens in consumer products used by millions of people represents a major legislative failure. Indeed, the levels of tobacco-specific nitrosamines in tobacco are thousands of times higher than the amounts of other nitrosamines in consumer products that are regulated by government authorities. Although the role of tobacco-specific nitrosamines as causative factors in tobacco-related human cancers cannot be assessed with certainty because of the complexity of tobacco and tobacco smoke, several lines of evidence strongly indicate that they have a major role, especially in the causation of oral cancer in snuff-dippers. Epidemiologic studies have demonstrated that snuff-dipping causes oral cancer. NNK and NNN are quantitatively the most prevalent known carcinogens in snuff, and they induce oral tumors when applied to the rat oral cavity. A role for NNK in the induction of lung cancer by tobacco smoke is likely because of its organospecificity for the lung. Tobacco-specific nitrosamines may also be involved in the etiology of tobacco-related cancers of the esophagus, nasal cavity, and pancreas. Because they are derived from nicotine, and therefore should be associated only with tobacco, tobacco smoke and other nicotine-containing products, tobacco-specific nitrosamines as well as their metabolites and macromolecular adducts should be ideal markers for assessing human exposure to, and metabolic activation of, tobacco smoke carcinogens. Ongoing research has demonstrated the formation of globin and DNA adducts of NNK and NNN in experimental animals. Sensitive methods for the detection and quantitation of these adducts in humans would provide an approach to assessing individual risk for tobacco-related cancers.(ABSTRACT TRUNCATED AT 400 WORDS)