1. True or False: Among 4.5 million worldwide 2019 cancer deaths, the leading cancer risk factor for both males and females was tobacco use.

True. An August 2022 Lancet study analyzed risk factors associated with 4.5 million 2019 cancer deaths. It found that the leading risk factor among men was tobacco use, accounting for 33.9 percent of life-years lost, 4.5 times higher than the second leading risk factor, alcohol use (7.4 percent).

Tobacco use was also the leading female cancer death risk factor at 10.7 percent, with unsafe sex being the second leading factor (8.2 percent). Worthy of note is that for both sexes the top two risk factors were behavioral, not environmental, occupational or metabolic.

2. True or False: Among 23 different types/categories of cancer, lung cancer (cancer of the lung, bronchus or trachea) is by far the leading cancer killer of both male and female tobacco users.

True. This is a finding of the 2022 Lancet study.

3. True or False: Four types/categories of cancer account for nearly all tobacco use cancer deaths: mouth cancer, throat cancer, larynx cancer (voice box) and lung cancer.

False. While accounting for roughly half of life-years lost by tobacco users in the Lancet study, in addition to cancer of the mouth, throat, larynx and lungs, tobacco use has been proven to cause cancer of the bladder, kidney, liver, stomach, pancreas, colon, rectum, and cervix, as well as acute myeloid leukemia (National Cancer Institute).

4. True or False: Tobacco and tobacco smoke contain a complex mixture of over 9,500 chemical compounds, many of which are hazardous to human health. A total of 83 cancer-causing chemicals (carcinogens) have so far been identified in tobacco products – 37 in unburned tobacco and 80 in tobacco smoke.

True. This is the primary finding of a May 25, 2022 review published in Food and Chemical Toxicology. It also found that “No clear decreasing trends were observed for any of these carcinogens in recent years.”

5. True or False: Nicotine, the most abundant chemical in cigarettes, smokeless tobacco products, and e-cigarette liquid, is not a factor associated with the development or spreading (metastasis) of cancer.

False: As detailed in a June 2022 WhyQuit study review, nicotine has been found to induce carcinogenic effects (June 2022) including the development of gastric (May 2022) and breast cancer (May 2022), to promote metastatic colonization of lung cancer cells (April 2022), and is the source for tobacco-specific nitrosamines (TSNAs) including NNA, NNK and NNN (May 2022).

While the overall health risks associated with e-cigarette use are believed to be orders of magnitude less than those associated with cigarette smoking, in that it normally takes roughly three decades before most smokings health risk consequences become noticeable, it could take another decade or so before science develops a basic appreciation of the most pronounced long-term vaping consequences.

Even then, given the tremendous variation in devices, flavorings, ingredients, and impurities, we could see a risk spectrum so broad as to make risk generalizations dangerous.

As detailed by a 2003 IARC report, how many of the following 81 cancer-causing chemicals identified in mainstream cigarette smoke could you have named?

1. Acetaldehyde
2. Acetamide
3. Acrylamide
4. Acrylonitrile
5. 2-Amino-3,4-dimethyl-3H-imidazo[4,5-f]quinoline (MeIQ)
6. 3-Amino-1,4-dimethyl-5H-pyrido [4,3-b]indole (Trp-P-1)
7. 2-Amino-l-methyl-6-phenyl-1H-imidazo [4,5-b]pyridine (PhlP)
8. 3-Amino-l-methyl-5H-pyrido [4,3-b]indole (Trp-P-2)
9. 2-Amino-3-methyl-9H-pyrido[2,3-b]indole (MeAaC)
10. 2-Amino-6-methyldipyrido [1,2-a:3',2'-d] imidazole (Glu-P-1)
11. 2-Amino-9H-pyrido[2,3-b]indole (AaC)
12. 4-Aminobiphenyl
13. 2-Aminodipyrido[1,2-a:3',2'-d]imidazole (Glu-P-2)
14. 0-Anisidine
15. Arsenic
16. Benz[a]anthracene
17. Benzene
18. Benzo[a]pyrene
19. Benzo[b]fluoranthene
20. Benzo[j]fluoranthene
21. Benzo[k]fluoranthene
22. Benzo[b]furan
23. Beryllium
24. 1,3-Butadiene
25. Cadmium
26. Catechol (1,2-benzenediol)
27. p-Chloroaniline
28. Chloroform
29. Cobalt
30. p,p'-DDT
31. Dibenz[a,h]acridine
32. Dibenz[a,j]acridine
33. Dibenz(a,h)anthracene
34. 7H-Dibenzo[c,g]carbazole
35. Dibenzo(a,e)pyrene
36. Dibenzo(a,i)pyrene
37. Dibenzo(a,h)pyrene
38. Dibenzo(a,i)pyrene
39. Dibenzo(a,l)pyrene
40. 3,4-Dihydroxycinnamic acid (caffeic acid)
41. Ethylbenzene
42. Ethylene oxide
43. Formaldehyde
44. Furan
45. Glycidol
46. Heptachlor
47. Hydrazine
48. Indeno[1,2,3-cd]pyrene
49. IQ 92-Amino-3-methyl-3H-imidazo[4,5-f]quinoline)
50. Isoprene
51. Lead
52. 5-Methyl-chrysene
53. 2-Naphthylamine
54. Nitrobenzene
55. Nitrogen mustard
56. Nitromethane
57. 2-Nitropropane
58. N-Nitrosodi-n-butylamine (NDBA)
59. N-Nitrosodi-n-propylamine (NDPA)
60. N-Nitrosodiethanolamine (NDELA)
61. N-Nitrosodiethylamine (DEN)
62. N-Nitrosodimethylamine (DMN)
63. N-Nitrosoethylmethylamine (NEMA, MEN)
64. 4-(N-Nitrosomethylamino)-1-(3-pyridinyl)-1-butanone (NNK)
65. N'-Nitrosonornicotine (NNN)
66. N-Nitrosopiperidine (NPIP, NPP)
67. N-Nitrosopyrrolidine (NPYR, NPY)
68. Polonium-210
69. Propylene oxide
70. Radon 222
71. Safrole
72. Styrene
73. Tetrachloroethylene
74. o-Toluidine (2-methylaniline)
75. Trichloroethylene
76. Urethane - carbamic acid
77. Urethane - ethyl ester
78. Vinyl acetate
79. Vinyl chloride
80. 4-Vinylcyclohexene
81. 2,6-Xylidine (2,6-dimethylaniline)

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John R. Polito received his JD from the University of South Carolina School of Law in 1985, where he graduated Wig & Robe. He is a former 3-pack-a-day thirty-year smoker and the 1999 founder of WhyQuit. A nicotine cessation educator since 2000, John mentored under Joel Spitzer for two decades, presenting more than 100 live nicotine dependency recovery programs modeled after Joel's programs. He is the author of "Freedom from Nicotine - The Journey Home," "Smart Turkey," and 6 peer-reviewed journal articles. John is the founder and director of Turkeyville, a 15,000-member Facebook support group exclusively for cold turkey quitters. Email: johnpolito54@gmail.com

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