Patients benefit from a comprehensive program that focuses on cancer treatment and addresses their tobacco addiction

1.How does tobacco use fuel cancer development at the cellular level, and what lesser-known cancers linked to tobacco should clinicians be more aware of?

When tobacco smoke is inhaled, it delivers a mix of harmful chemicals that damage DNA and interfere with the body’s ability to repair these changes. Over time, this damage builds up, leading to uncontrolled cell growth—a hallmark of cancer. While lung cancer is the most well-known, tobacco use is also strongly linked to several lesser-known cancers. These include cancers of the bladder, pancreas, kidney, cervix, and even certain types of leukaemia. Oral cancers and cancers of the throat and oesophagus are also commonly tied to tobacco, including smokeless tobacco.  In addition to cancer, smoking also causes heart disease, stroke, and lung diseases, like emphysema.

2. With the rise of lung cancer in nonsmoking women, particularly in Asia, how do genetic mutations like EGFR play a role, and what are the latest strategies for addressing this challenge?

As a result of tobacco control policies, the rapid increase in new diagnoses of lung cancer has slowed, but among people who get lung cancer, an increasing proportion never smoked cigarettes. As we try to understand this, we see that many of these patients’ tumours have mutations in some cancer-associated genes like EGFR (epidermal growth factor receptor) or many others. These mutations occur in the tumour and are NOT something patients inherited from their parents.  These mutations can drive cancer growth even without traditional risk factors like smoking. The good news is that understanding these mutations has helped us personalise treatment. Instead of using one-size-fits-all chemotherapy, we now often turn to targeted therapies—drugs designed to specifically block the abnormal EGFR signals that fuel cancer. These treatments tend to have fewer side effects and can be more effective in the right patients. We can now find these tumour mutations using blood tests as well as advanced genomic testing. So, while the rise in cases is concerning, our ability to tailor treatment has greatly improved, offering real hope for better outcomes.

3. What does research say about the long-term effects of second-hand smoke, especially on vulnerable populations like children and women, and how can these risks be communicated more effectively in clinical settings?

Research has consistently shown that long-term exposure to cigarette smoke can lead to serious health issues, including lung cancer, heart disease, and respiratory problems, even in nonsmokers. Children are particularly vulnerable because their lungs are still developing, and women may be more biologically susceptible to the harmful effects of tobacco smoke. What’s challenging is that many people still see second-hand smoke as “harmless” if they’re not the ones smoking. We encourage families to create smoke-free environments at home and in cars, especially around kids. Ultimately, it’s about raising awareness and empowering people to take small but meaningful steps to protect themselves and their loved ones.

4. How critical is early detection in tobacco-related cancers, and what signs should clinicians be vigilant about, particularly in high-risk groups?

Early detection of cancer can be critically important! It can make the difference between a curable condition and one we cannot cure with current treatments. Routine screenings like low-dose CT scans for high-risk individuals can catch lung cancer early, when it’s still curable. Symptoms often appear when it’s too late, especially in cancers like lung or oral cancer. That’s why clinicians need to be extra vigilant, particularly when dealing with high-risk groups like people who have smoked for a long time. Persistent cough, hoarseness, unexplained weight loss, sores in the mouth that don’t heal, or coughing up blood—these are all red flags that shouldn’t be ignored. At the end of the day, it’s about giving patients their best shot at beating cancer.

5. How is MSK leveraging precision screening tools and genomics to personalise cancer prevention strategies, particularly for high-risk groups like former smokers or those with a family history of cancer

At MSK, in addition to proven techniques like CT scan screening for lung cancer, we’re taking a more personalised approach to cancer prevention, especially for high-risk groups like people who have already quit smoking or individuals with a family history of cancer. Through precision screening tools and genomic testing, we can better understand a person’s unique risk profile. For instance, we don’t just look at smoking history—we also examine genetic markers that could signal a higher cancer risk. This allows us to tailor screening recommendations and catch issues early, often before symptoms even appear. For people who quit smoking as well as those who continue to smoke, programs like MSK’s Tobacco Treatment Program offer ongoing support, including behavioural counselling and medications, to help them quit and reduce relapse risk. It’s not just about quitting—it’s about not using tobacco for good. When we combine this kind of personalised prevention with advanced screening tools, we give patients a stronger chance of staying ahead of cancer. It’s a big step toward smarter, more targeted care that truly puts the individual first.

6. What strategies, including behavioural support and pharmacotherapy, have proven most effective in helping cancer patients quit tobacco use, and what outcomes have been observed?

Quitting tobacco is crucial for cancer patients, as it can significantly improve treatment outcomes and reduce the risk of recurrence. Successful strategies typically combine behavioural support with pharmacotherapy. Behavioural support helps patients navigate triggers and cravings by offering counselling and coping techniques, making the quitting process more manageable. When paired with pharmacotherapy, like nicotine replacement therapies (NRTs) or medications such as varenicline or bupropion, the success rate increases significantly. In addition, there are new medicines, like cytisinicline, that may be approved for use in the future. These medications reduce withdrawal symptoms and cravings, helping patients stay on track. The combination of these two approaches has been shown to double or even triple the chances of quitting successfully. The outcomes are promising; patients who quit smoking, even after diagnosis, often experience better responses to cancer treatments, fewer complications, and live longer. This comprehensive approach to tobacco cessation doesn’t just help patients quit; it gives them the tools to maintain a tobacco-free lifestyle, which can lead to better overall health and quality of life.

7. How are specialised treatment programmes at centres like MSK improving clinicians’ ability to manage tobacco-related cancers and impacting patient outcomes? 

The treatment programs at major cancer centres, like MSK, often combine cutting-edge cancer care with targeted tobacco cessation support. The cutting-edge care for cancer at MSK includes advanced genomic techniques to allow identification of the drivers of cancer for most patients with lung cancers, as well as some with other tobacco-related cancers. While we’ve made dramatic advances in the care of people with cancer, we know we have an opportunity to improve outcomes and cure more patients by applying the best science to the care of our patients. To do this, we offer clinical trials to many patients, providing an opportunity for next-generation care today. For clinicians, having a structured support system that integrates behavioural counselling, pharmacotherapy, and personalised cessation plans allows for a more tailored treatment strategy. Patients benefit from a comprehensive program that not only focuses on their cancer treatment but also addresses their tobacco addiction, one of the leading risk factors for cancer progression. Studies show that when patients quit smoking, they tend to have better responses to cancer treatments, fewer complications, and improved recovery rates. The expertise of these specialised programs also helps clinicians provide continuous monitoring, early intervention for relapse, and long-term support, which leads to higher success rates in quitting and ultimately enhances patient quality of life.