Hookah smoking and cancer: carcinoembryonic antigen (CEA) levels in exclusive/ever hookah smokers

Abstract

BackgroundWe have recently published some work on CEA levels in hookah (also called narghile, shisha elsewhere) and cigarette smokers. Hookah smokers had higher levels of CEA than non-smokers although mean levels were low compared to cigarette smokers. However some of them were also users of other tobacco products (cigarettes, bidis, etc.).ObjectivesTo find serum CEA levels in ever/exclusive hookah smokers, i.e. those who smoked only hookah (no cigarettes, bidis, etc.), prepared between 1 and 4 times a day with a quantity of up to 120 g of a tobacco-molasses mixture each (i.e. the tobacco weight equivalent of up to 60 cigarettes of 1 g each) and consumed in 1 to 8 sessions.MethodsEnhanced chemiluminescent immunometric technique was applied to measure CEA levels in serum samples from 59 exclusive male smokers with age ranging from 20–80 years (mean = 58.8 ± 14.7 years) and 8–65 years of smoking (mean = 37.7 ± 16.8). 36 non-smokers served as controls. Subjects were divided into 3 groups according to the number of preparations; the number of sessions and the total daily smoking time: Light (1; 1; ≤ 20 minutes); Medium (1–3; 1–3; >20 min to ≤ 2 hrs) and Heavy smokers (2–4; 3–8; >2 hrs to ≤ 6 hrs). Because of the nature of distribution of CEA levels among our individuals, Wilcoxon's rank sum two-sample test was applied to compare the variables.ResultsThe overall CEA levels in exclusive hookah smokers (mean: 3.58 ± 2.61 ng/ml; n = 59) were not significantly different (p ≤ 0.0937) from the levels in non-smokers (2.35 ± 0.71 ng/ml). Mean levels in light, medium and heavy smokers were: 1.06 ± 0.492 ng/ml (n = 5); 2.52 ± 1.15 ng/ml (n = 28) and 5.11 ± 3.08 ng/ml (n = 26) respectively. The levels in medium smokers and non-smokers were also not significantly different (p ≤ 0.9138). In heavy smokers, the CEA levels were significantly higher than in non-smokers (p ≤ 0.0001567).ConclusionOverall CEA levels in exclusive hookah smokers were low compared to cigarette smokers. However, heavy hookah smoking substantially raises CEA levels. Low-nitrosamines smokeless tobacco of the SNUS Swedish type could be envisaged as an alternative to smoking for this category of users and also, in a broad harm reduction perspective, to the prevalent low-quality moist snuff called naswar.

Reply to the letter to the editor by Chaouachi and Sajid: cancer risks of hookah (shisha, narghile) tobacco use require further independent sound studies

“…smokers in remote villages of the Punjabi countryside who have been smoking only hookah), are in agreement with this chemical fact. 10,11 They are also in agreement with numerous historic studies and recent measurements of biomarkers in body fluids of shisha smokers in Germany. 12 At an international anti-tobacco conference this year, a not yet published study on the levels of many toxic and carcinogenic substances (namely cadmium, lead, chromate, arsenic, metabolites of benzene, polycyclic aromatic hydrocarbons, acrolein, and acrylamide) was announced.…”

The Prevalence, Attitudes, and Correlates of Waterpipe Smoking Among High School Students in Iran: a Cross-Sectional Study

“…Other factors that attract WP smokers, especially adolescents, are its aromatic and condensed smoke, attractive pipe design, availability, inexpensive tobacco, and social acceptance because of traditional associations and it being less stigmatized than cigarette smoking [22]. WP smoking is a new challenge for global public health efforts [23], and recent studies have shown that WP smoke is more harmful than cigarette smoke, because one session of WP smoking expose it's users to a larger amount of smoke and higher level of tobacco toxicants such as tar, carbon monoxide, nicotine, and arsenic compared with one cigarette [24][25][26][27][28][29].WP smoking is considered to be associated with lung cancer, esophageal cancer, low birth weight, periodontal diseases, and pulmonary dysfunction [30].…”

Antioxidant and Chemotherapeutic Potential of Curcuma Amada Rhizome Extract on Benzo(a)pyrene Induced Cervical Carcinoma in Sprague Dawley Rats

“…With this concept, the cancer specific markers CEA, CA 125 and GGT were evaluated in the present study. CEA is a glycoprotein, the elevated levels of which are found in smokers [70] and cervical cancer patients [71]. The enhanced marker level in BaP induced animals indicates the correlation that exists between CEA and tumor burden.…”