Recent Smoking Habit, Packs Per Day

Evaluating Risk Factors: Smoking Cigarettes

Evaluating your likely current (and near future) state of health means taking into account the risk factors — such as recent smoking habit, packs per day — that affect you.   Our medical diagnosis tool, The Analyst™, identifies major risk factors by asking the right questions.

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If you indicate history of tobacco use, The Analyst™ will ask further questions including this one:
How much have you smoked in the past 8 years? Multiply the number of years you smoked by the average number of packs smoked per day. For example, 4 years x half a pack daily = roughly 2 pack-years. (1 pack of cigarettes equals 5 cigars or 8 pipes.)
Possible responses:
→ I have not smoked during the past 8 years
→ Under 1 pack-year
→ 1-5 pack-years
→ 5-15 pack-years
→ Over 15 pack-years

The Diagnostic Process

Based on your response to this question, which may indicate no recent tobacco smoking, recent light tobacco smoking, recent moderate tobacco smoking or recent heavy tobacco smoking, The Analyst™ will use differential diagnosis to consider possibilities such as:
Cigarette Smoke Damage

Cigarette Smoke Damage also suggests the following possibilities:

Acute Bronchitis

If you smoke or are around damaging fumes (such as those in certain kinds of factories), you are more likely to get acute bronchitis and to have it longer because your bronchial tree is already damaged.

Acute Lymphocytic Leukemia (ALL)

Cigarette smoking is associated with increased risk for leukemia and may lead to leukemias of specific morphologic and chromosomal types.  The association varies with age.  In one study, smoking was associated with only a modest increase in overall risk for leukemia, but among participants aged 60 and older, smoking was associated with a twofold increase in risk for AML and a threefold increase in risk for ALL.  Among older persons, risks increased with amount and duration of smoking. [J Natl Cancer Inst. 1993 Dec 15;85(24): pp.1994-2003]

Acute Myelogenous Leukemia (AML)

There is a growing body of evidence linking smoking and cancer of the hematopoietic system.  Between 20% and 30% of leukemia cases are related to smoking.  In one study, smoking was associated among participants aged 60 and older with a twofold increase in risk for AML. [J Natl Cancer Inst. 1993 Dec 15;85(24): pp.1994-2003]

Aneurysm / Rupture

278 consecutive patients with aneurysmal subarachnoid hemorrhage were compared with 314 hospitalized control patients.  Regression analysis showed that recent alcohol intake and smoking were significant independent risk factors for hemorrhage. [Stroke 24: pp.639-46, 1993]

Studies have consistently found a 50% decrease in mortality from abdominal aortic aneurysms among former smokers compared with current smokers. [Medical Clinics of North America, March 1992;76(2): pp.333-53]


Smokers have on average 33% more angina attacks than do non-smokers.


Tobacco smoke contains more than 4,000 chemicals, more than 50 of which have been identified as carcinogens.  These chemicals are extremely damaging to the cardiovascular system.  Specifically, these chemicals are carried in the bloodstream on LDL cholesterol, where they either damage the lining of the arteries directly or they damage the LDL molecule which then damages the arteries.  High cholesterol levels compound the risks.

Basal Cell Cancer

Smoking is a risk factor for non-melanoma skin cancer.

Bladder Cancer

Close to 50% of all bladder and kidney cancer deaths in men are caused by smoking.  Among women, 37% of bladder and 12% of kidney cancer deaths are directly attributable to smoking.  The risk of developing these cancers is two to three times greater for both male and female smokers than that of the nonsmoking population.  Cigarette smoke can interact with chemicals (especially aromatic amines) in the work place to produce bladder and kidney cancer.  Workers exposed to organic chemicals in the dye, rubber, leather and paint industries that also smoke have a greater bladder cancer rate than would be predicted from either smoking or chemicals alone.

Buerger's Disease

Smoking is the cause of Buerger's disease: there is no documentation of occurrence in nonsmokers, implicating cigarette smoking as the primary cause.  Recent work suggests that Buerger's disease may be a reaction to tobacco of persons with a specific genetic type or an autoimmune disorder with immune cell sensitivity to some collagen types, which are constituents of blood vessels.

Cancer, General

Cigarette smokers have total, overall cancer death rates twice that of nonsmokers.  The greater the number of cigarettes smoked, the greater the risk.

There is irrefutable evidence linking cigarette smoking and cancer of various sites.  The urine of cigarette smokers has been found to be strongly mutagenic in bacterial test systems.  There are at least 43 carcinogens described in cigarette smoke which include polyaromatic hydrocarbons, heterocyclic hydrocarbons, N-nitrosamines, aromatic amines, aldehydes, volatile carcinogens, inorganic compounds, and radioactive elements.

Cigarette smoke contains substances that act at every stage of cancer formation and growth.  Organs that have direct contact with smoke (lung, oral cavity and esophagus) are at the greatest risk of developing cancer.  As the substances delivered in cigarette smoke are absorbed and spread through the human body, smoking causes cancer at various distant sites.  For example, cigarette smoking is a risk factor for the development of cervical cancer.  Samples from the cervix of women smokers show components of tobacco smoke that contain mutagenic activity.


The risk of being diagnosed with cardiomyopathy goes up with the number of cigarettes smoked per day.  Although there is room for controversy, all doctors recommend that smokers with DCM quit smoking.

Cervical Cancer

Cigarette smoking accounts for approximately 30% of cervical cancers deaths in the USA, with women smokers having a two-fold increase in the incidence of this disease over never-smokers.  Cessation appears to have an immediate effect, with former smokers having no increased risk of developing cervical cancer.

A 9-year prospective study of over 6,000 women found a dose-response relationship between smoking cigarettes and the risk of cervical cancer.  Those who smoked 15 or more cigarettes per day were 80% more likely to develop cancer or precancerous lesions than nonsmokers.  Those who smoked for 10 or more years were 80% more likely to develop cancer.  Starting smoking younger than age 16 produced twice the risk of nonsmokers for developing cervical pathology.  Smoking is one co-factor that makes HPV-infected cells more likely to turn cancerous.

Cervical Dysplasia

Women who smoke may be 50% more likely than nonsmokers to develop cervical cancer or precancerous lesions.

Chronic Thyroiditis

A study of 132 pairs of twins (264 subjects) showed that smoking can have negative effects on the endocrine system, causing a 3- to 5-fold increase in the risk of all types of thyroid disease.  The association was most pronounced in autoimmune disorders (Graves' disease and autoimmune thyroiditis), although there was still a strong association for non-autoimmune thyroid disorders.

COPD (Chronic Obstructive Pulmonary Disease)

Smoking is the single most important risk factor in the development of COPD, contributing to 81.5% of all COPD deaths.  People who smoke or have chronic bronchitis have an increased risk of emphysema.  Chronic coughing and shortness of breath are symptoms of these diseases.  Studies involving over one million men and women have shown that the death rate for chronic bronchitis and emphysema is six times as high for smokers as for non-smokers.

Esophageal Cancer

Nearly 80% of all deaths from esophageal cancer are attributable to cigarette smoking.  Smokers have an 8- to 10-fold greater risk of developing esophageal cancer than nonsmokers.

Gastric/Peptic/Duodenal Ulcers

Smoking is associated with the development, delayed healing and recurrence of peptic ulcers, as well as resistance to treatment.

Heavy Metal Toxicity

Tobacco smoking is the most important single source of cadmium exposure in the general population.  It has been estimated that about 10% of the cadmium content of a cigarette is inhaled through smoking.  The absorption of cadmium from the lungs is much more effective than that from the gut, and as much as 50% of the cadmium inhaled via cigarette smoke may be absorbed.

On average, smokers have 4-5 times higher blood cadmium concentrations and 2-3 times higher kidney cadmium concentrations than non-smokers.  Despite the high cadmium content in cigarette smoke, there seems to be little exposure to cadmium from passive smoking.  No significant effect on blood cadmium concentrations could be detected in children exposed to environmental tobacco smoke.

Hypertension (High Blood Pressure)

Malignant hypertension and renovascular hypertension are more common in people who smoke.  Approximately 15% of hypertension is attributable to smoking.  Smoking interferes with the metabolism of multiple anti-hypertensive medications, neutralizing their effectiveness.

Intermittent Claudication

Cigarette smoking is the most important risk factor for vascular disease bar none.

Kidney Cancer

Close to 50% of all bladder and kidney cancer deaths in men are caused by smoking.  Among women, 37% of bladder and 12% of kidney cancer deaths are directly attributable to smoking.  The risk of developing these cancers is two to three times greater for both male and female smokers than that of the nonsmoking population.  Cigarette smoke can interact with chemicals (especially aromatic amines) in the work place to produce bladder and kidney cancer.  Workers exposed to organic chemicals in the dye, rubber, leather and paint industries that also smoke have a greater bladder cancer rate than would be predicted from either smoking or chemicals alone.

Laryngeal Cancer

Smoking is the major cause of this cancer with approximately 82% of cases attributed to it.  The risk of developing laryngeal cancer is approximately 10-fold greater for a male and 8-fold greater for a female as compared to never-smokers.  The risks are directly proportional to the number of cigarettes smoked.  People who stop smoking can greatly reduce their risk of developing cancer of the larynx, as well as cancer of the lung, mouth, pancreas, bladder, and esophagus.

Lung Cancer

Lung cancer is the leading cause of cancer death among both men and women.  Some 90% of lung cancer in men and 79% of lung cancer in women is directly attributed to smoking.  In fact, smoking increases the chance of developing lung cancer 22-fold for males and 12-fold for females.  The relative risk of developing lung cancer is directly proportional to the amount and duration of smoking.  The 250% increase in the occurrence of lung cancer between 1960 and 2000 followed the rise in cigarette smoking 20 years earlier.

Smoking causes lung cancer of all the principal histologic types: squamous cell, large cell, small cell and adenocarcinoma.  Small cell cancer is the most aggressive type of lung cancer and has the worst prognosis.  This kind of cancer tends to grow rapidly spread to other parts of the body early.  Large cell cancer spreads to lymph nodes of the chest and it enters the blood stream where it gets carried to other organs such as the liver, bone, brain, and spinal cord.  Among men there is an increased proportion of squamous cell carcinoma, while in women there is an increased proportion of adenocarcinoma.

Macular Degeneration

Any type of smoking or exposure to tobacco smoke can accelerate the development of the 'wet' type of macular degeneration.  Smokers on average exhibit only half the density of yellow macular pigment (lutein and zeaxanthin) and develop macular degeneration 7 years sooner than non-smokers.

Mouth Cancer

Smoking is a major cause of oral cancer (tongue, cheeks, lips, gums), accounting for 92% of these cancers in men and 61% in women.  The increased risk attributed to smoking is of 27-fold in men and 6-fold in women.  As with laryngeal cancer, alcohol consumption significantly increases the risk of oral cancer.

Multiple Sclerosis

A study at the University of Bergen in Norway, reported October 28th, 2003 in the journal Neurology, found that smoking can more than double a person's chances of developing multiple sclerosis.  The risk was higher even if people had given up cigarettes.  The authors, Dr. Trond Riise and colleagues, examined 22,312 people aged between 40 and 47.  Of those, 87 had MS.  The smokers were 1.81 times more likely to get MS than the non-smokers and men had a higher (2.75 times more likely) risk than women (1.61) who had smoked.

Osteoporosis - Osteopenia

The evidence is overwhelming: smoking boosts bone loss and is therefore a risk factor for osteoporosis and for bone fractures in general.

Pancreatic Cancer

Cigarette smoke contains a large number of carcinogens and therefore it should come as no surprise that cigarette smoking is one of the biggest risk factors for developing pancreatic cancer.  For example, smoking during college has been associated with a 2 to 3-fold increased risk of pancreatic cancer.

Approximately 30% of all deaths from pancreatic cancer are attributable to cigarette smoking.  Historically, males have had a much higher incidence of cancer of the pancreas.  However, this difference is steadily decreasing as women smoke earlier and more heavily.  There is approximately a 2-fold increase in the risk of developing pancreatic cancer with smoking and this risk is dose-dependent.

Phlebitis / Thrombophlebitis

Smoking increases the risk of phlebitis.


Smoking is a risk factor for the development of pneumonia.

Squamous Cell Cancer

Smoking is a risk factor for non-melanoma skin cancer.

Stomach Cancer

About 20% of the mortality from stomach cancer is attributable to smoking.  There is approximately a 50% increase in the risk of stomach cancer in smokers compared to never-smokers.

Collapsed Lung

Smoking increases the risk of a collapsed lung.

Panic Attacks

Female patients with panic disorder had a significantly higher smoking prevalence at the onset of their illness than did control subjects 10 years previously (54% vs. 35%).  Current smoking prevalence was also higher in those patients with panic attack versus controls (40% vs. 25%).  Male smoking rates did not differ between the groups. [Psychiatric Research, 1992;43: pp.253-62]

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