BEIRUT: Environmental pollutants may be a main contributor to lung cancer in Lebanon, in addition to the usual suspects, nargileh, cigarettes and other tobacco products, according to new research by local scientists.
Lebanese researchers mapped the most dangerous risk factors contributing to lung cancer in the country, which they say are frightening because of their prevalence in daily urban life.
Their study is the latest in a slew of research linking nargileh or water pipe smoking to a variety of lung diseases, which also shows that frequent users can develop both a chemical and psychological dependence similar to that of cigarettes.
“I find these results very alarming,” said Pascale Salameh, the head of the Faculty of Pharmacy at Lebanese University and one of the study’s authors.
There are few reliable statistics of cancer patients in the country. The latest data compiled by the Public Health Ministry is in its cancer registry of 2003, which shows that lung cancer is the second most common cancer type in both men and women in Lebanon.
The scientists of the later study looked at 100 lung cancer patients in their pilot study, the results of which were published this summer in the Journal of Epidemiology and Global Health.
They collected details including social and demographic status, such as age, sex, education and marital status, past smoking habits, jobs, living area, nutrition and family medical history.
They found the most common risks associated with lung cancer to be cigarette and nargileh smoking and pollution caused by electricity generators as well as traffic.
Cigarette smoking and fuel used for heating were the more common risk factors for women. For men, they were cigarette smoking and living near a generator. Water pipe smoking was correlated with lung cancer for both.
Former cigarette smokers had a 17-times higher risk of developing lung cancer compared with nonsmokers. The risk for nargileh smokers was seven times higher than nonsmokers.
People living in urban areas, or near a busy road or generator, were also more at risk. Men were more likely to develop the disease than women because they were more exposed to the risk factors.
The scientists identified other factors that they believe contribute to the risk of developing lung cancer, including passive smoking, low consumption of fruits and vegetables, a family history of lung cancer and a work environment that contains materials such as asbestos.
The authors said the study is the first attempt at finding a pattern to the causes of lung cancer in Lebanon. A broader study will be needed to verify whether these risk factors do, indeed, cause the disease.
The findings confirm an emerging trend in local research on the effects of nargileh smoking, which is increasingly being linked to a plethora of lung diseases, now including lung cancer.
Over the past few years, Salameh published a series of papers examining the links between nargileh smoking, lung disease and addiction.
She found links between water pipe smoking and chronic lung problems like bronchitis and obstructive pulmonary disease, a condition that limits airflow in the lungs by damaging their airways.
Her findings also showed that nargileh smokers had elevated levels of carbon monoxide and cotinine in their blood and saliva. Cotinine is a substance produced in the body when nicotine from cigarettes or water pipes enters the body.
In addition, Salameh’s research established that it was possible for smokers to develop a chemical and psychological dependence on nargileh.
“We found out that almost half of people who smoke a water pipe are dependent on it,” she said.
She found that the water bowl in the nargileh only marginally reduces the level of nicotine in the smoke that is inhaled, which contributes to the physical dependence. This dependence is a result of habitual use in social situations or to relieve stress.
She is convinced that the latest research points to nargilehs contributing to lung cancer.
“The association of water pipe to respiratory diseases is showing up more and more,” she said. “It seems that water pipe smoking may also increase the risk of lung cancer”
Salameh estimates that, in terms of increasing the risk of lung disease, smoking two water pipes per week is the equivalent to smoking about one pack of cigarettes a day.
But, she said, the comparison is inaccurate since there are different toxins in cigarette and nargileh smoke.
She is particularly alarmed by water pipe smoking’s contributing to lung cancer because it is still thought to be harmless by young people, who use it more than the elderly and will therefore spend many more years smoking.
Women also appear to be more in danger as a result of nargileh smoking, since they tend to smoke it exclusively whereas men tend to occasionally smoke nargileh and often as a substitute for cigarettes.
Unfortunately, it may not be possible to conclusively determine whether water pipe smoking causes lung cancer until the younger adults who have been smoking it for years grow older and develop cancer.
“We may need to wait a little bit longer for young people to pass a longer duration of smoking in order to find out,” Salameh said.
On smoking, she said new, innovative ways to discourage the behavior among the youth need to be found, and existing laws against smoking should be enforced.
But in terms of pollution caused by electricity generators, there is no quick fix.
“It’s a whole, integrative issue that is not easy to apply with just a small decision,” she said. “You need to have a long-term policy where laws are generated, applied and reinforced.”
These measures would include developing a public transport system and improving the electricity supply.
But smokers, she said, can take action now. An early halt to smoking can reverse the damage to the body.
“The sooner the better,” she said.