小测试：吸电子烟真的比吸烟好嘛？ - FT商学院
近年来，电子香烟成为那些渴望健康生活却又不能戒除烟瘾的人们的新选择。电子香烟的推广使其成为了一个新兴的研究领域。然而电子香烟真的如同宣传的那样对人体危害更小吗？最新的研究结果将为我们揭晓这个答案。
v.吞云吐雾（特指电子水烟）
Exhalation
n.蒸发，呼气；散发物 [eks?'le??(?)n]
Combustible
adj.可燃的，易燃的
[k?m'b?st?b(?)l]
n.危险；冒险；vt.危及 ['per?l]
Carcinogen
n. 致癌物质 [kɑ:'s?n?d?(?)n]
vt.使模糊；使混乱
['?bf?ske?t]
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Is it better to vape than to smoke?（842 words）By Anjana Ahuja-----------------------------------------------------They seem most visible when the wind blows in from the Arctic — small clusters punctuating the empty streets, white sticks clasped between blue fingers and their exhalations drifting across No Smoking signs.Smokers are, in all respects, a dying breed. In England in
per cent of people described themselves as smokers, compared with 19.3 per cent in 2012. About a third tried to give up in the past 12 months.Those who carry on puffing suffer higher rates of cancer, heart disease, respiratory disease and stroke than non-smokers. The National Health Service estimated that 78,000 deaths in 2014 were attributable to the habit.Many smokers have considered turning to electronic cigarettes, which are “vaped” rather than smoked, in order to quit. Ecigarettes are a recent development in tobacco harm-reduction and are marketed as a less harmful alternative to smoking. But a stream of conflicting stories about their benefits, or otherwise, has left consumers confused.Last month, for example, several newspapers including the Daily Mail, The Times and The Sun, reported research that suggested certain flavours of ecigarettes may harm sperm. The findings were presented at a British Fertility Society conference but are yet to be published in a journal.There is, however, a strong scientific consensus that vaping is far better for health than smoking (although it is best to neither vape nor smoke). This consensus was reinforced by a study published this week in the Annals of Internal Medicine.Ecigarettes have been barely regulated until recently, meaning that their ingredients are not always known. In the past, e-liquid and vapour have been found to contain toxins such as carbonyls, tobacco-specific N-nitrosamines (TSNAs) and heavy metals, which can also be found in tobacco smoke.This similarity constitutes one reason why their risk level has been a concern. The new study suggests vapers have a lower exposure to these toxins than smokers and hence are subject to a lower risk to health.Researchers led by Dr Lion Shahab at University College London looked at five groups of long-term nicotine users. They were: former smokers who now o former smokers who only used nicotine replacement therapy su smokers who also used ecigarettes, and smokers using nicotine replacements.There were 181 participants, and their saliva and urine were tested for biomarkers of nicotine, carcinogens and other toxins.Dr Shahab found that those who used only ecigarettes received a similar nicotine hit to smokers, while benefiting from substantially lower exposure to toxins and carcinogens. By extrapolation, lower exposure suggests lower levels of eventual harm.The dual users who smoked and vaped were subject to exposures as high as smokers, for reasons that are as yet unclear. Thus smokers who want to improve their health are advised to completely give up combustible cigarettes rather than mix them with ecigarettes or nicotine patches.The work, funded by Cancer Research UK, confirms that “full cessation of all nicotine products remains the best option to avoid harm”.The finding echoes other analyses, such as a 2014 systematic review in the journal Therapeutic Advances in Drug Safety, which concluded “electronic cigarettes are by far a less harmful alternative to smoking . . .” and that considerable health benefits accrue from switching. Public Health England states that vaping is 95 per cent safer than smoking.Put simply, there is a spectrum of peril: smoking regular cigarettes exposes you to cons ecigarettes and nicotine patches offer lower exposure and by implication less harm. And of course, steer clear of all nicotine products if you know what is best for you.At a briefing at the Science Media Centre in London last week, Professor Robert West, editor-in chief of the journal Addiction, offered an insightful précis of how the clear, simple message that vaping is safer than smoking had become lost in the haze: “We see a constant drip-drip of them [studies into ecigarettes]: small studies, studies without cigarettes as a comparator, studies looking at risk where the level of risk isn’t quantified.”The novelty of the products means that long-term surveys of vaping are decades away, leaving the knowledge gap ripe for filling by the kind of studies alluded to by Professor West.In addition, the “to vape or not to vape” dilemma is coloured by an association with the absurdly powerful tobacco industry, which has long obfuscated and dissembled over the sheer deadliness and addictiveness of its products.This has led to another criticism of vaping: it lures people into smoking. Research is trying to elucidate whether children who vape and then smoke would have ended up smoking anyway. The hotly contested “gateway” argument is separate and important but should not be conflated with the issue of relative toxicity.And what if you have not tried any form of tobacco? Just say no, full stop, to both vaping and smoking — to the unpleasant smell, to the unnecessary expense, to the raised risks of disease (whatever they turn out to be) and, of course, to being forced out into the cold.
选择正确答案
What is the percentage of people in England would describe themselves as smokers in 2016?
2015年英国有16.9%的人是吸烟者，19.3%是2012年的数据，而有三分之一的吸烟者表示在过去的一年内曾经尝试戒烟
选择正确答案
What is the result of Dr Lion Shahab’s research?
Dr Shahab的实验发现电子烟可以带来和普通香烟一样的吸烟效果，但是却能减少吸烟者对于毒素和致癌物质的摄入。
Vapers were subject to exposures as high as smokers
The risk level of vaping is unknown due to the uncertainty of the ingredients
It’s better to mix combustible cigarettes with ecigarettes or nicotine patches
Vaping is much safer than smoking.
选择正确答案
Which answer is not one of the groups used as the experiment subject in Dr Lion Shahab’s research?
实验对象包括：使用普通香烟的吸烟者；以前是吸烟者现在只使用电子香烟的人；过去的吸烟者现在使用尼古丁替代产品的人；同时使用普通香烟和电子烟以及同时使用普通香烟和尼古丁替代产品的人，没有提到已经完全戒烟的人
Regular smokers
Former smokers who now gave up smoking
Former smokers who now used ecigarettes or nicotine replacement therapy
Smokers who also used ecigarettes or nicotine replacements
选择正确答案
What is the criticism of vaping mentioned in the article?
有批评指出，电子香烟对人体的较小危害性很可能会导致更多没有吸烟习惯的人成为吸烟者。其他答案是文中提到的一些观点但并不是明确表示的对于电子香烟的批评
Promoting vaping may do harm to the tobacco industry
Vaping could lead to other kind of diseases to human body
Vaping lures people into smoking
Vaping cause unpleasant smell and unnecessary expense电子烟和普通烟哪个危害更大_百度文库
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&　　点燃一根烟，在飘逸的烟雾里你忘记了烦恼，看着那一闪一闪的红火头，就像是我们凡人的人生，在一种不知道什么的力量下沉浮，戒烟确实是不容易的。吸烟与肺癌的关系这个是获得广泛认可的，但是非吸烟的肺癌患者也在逐步增加。（百度知道日报）
&　　对于非小细胞肺癌这个癌种类型，非吸烟的患者与吸烟的患者有什么差异呢，最近韩国做了一项研究，从中我们可以看到一些差异。
&　　这一项研究统计了 2011 年 6 月至 2014 年 12 月新诊断的非小细胞肺癌患者，涉及到的患者人数是 1860 名。区分吸烟和非吸烟的标准是整个生命周期是否接触了 100 支以上的香烟。
&　　1、707 名患者是从未吸烟的患者（占比 38.%）：女性在非吸烟的患者群里比例更高，83.7% 的非吸烟患者是女性，吸烟的患者里这一数据是 5.6%，非吸烟的患者有 89.8% 的比例是肺腺癌，而吸烟的患者只有 44.9% 是肺腺癌。
&　　我们知道非小细胞肺腺癌的靶向药物最多，如易瑞沙、特罗凯和克唑替尼，因此非吸烟的患者相比吸烟的患者有一半的可能性是肺腺癌，能从比较成熟的靶向药物治疗里获益。
&　　2、非吸烟的患者相比吸烟的患者更年轻（65 岁 vs 68 岁），临床分期也更早一些，处于临床 I-II 期的非吸烟患者比例是 44.5%，而吸烟的患者诊断时在 I-II 期的比例是 38.9%。
&　　由于处于临床早期，这样更能获得较好的治疗机会，甚至争取手术治疗的机会，因此这一点上，不吸烟的患者是明显受益的。
&　　3、从可靶向治疗的基因突变来看，非吸烟的非小细胞肺癌患者明显受益。
&　　非吸烟的患者 EGFR 基因突变比例是 57.8%（353/611），吸烟的患者 EGFR 的突变比例只有 24.4% ( 164/673 ) 。
&　　非吸烟的患者 ALK 基因重排突变比例是 7.8% ( 47/605 ) 。吸烟的患者 ALK 基因重排的突变比例是 2.8% ( 19/683 ) 。
&　　吸烟的患者有 9.6%（57/592）是 KRAS 基因突变，而非吸烟患者只有 5.8% ( 29/497 ) 的比例是 KRAS 突变。
&　　我们知道 EGFR 和 ALK 是靶向药物比较多治疗比较成熟的两个驱动基因，易瑞沙、特罗凯、克唑替尼都是靶向这两个驱动基因的。
&　　同样的 EGFR 基因突变，非吸烟患者更多的是 EGFR 基因的 19 外显子缺失和 21 号外显子的 L858R 突变，几乎没有 18 和 20 外显子的突变。
&　　KRAS 基因突变没有成熟的靶向药物，是比较棘手的一个驱动基因突变。
&　　这个差别太明显了，简直是不能直视，各位烟友或者身边有吸烟的人赶紧转发此数据，劝慰戒烟。
&　　4、对于 1153 名非小细胞肺腺癌来说，也就是本研究的一个细分亚群。非吸烟患者的 EGFR 突变频率是 59.8%（341/570）,ALK 重排的频率是 8.1% ( 46/566 ) ,KRAS 的突变频率是 6.2%（29/466）。但是对于吸烟的患者而言，EGFR 突变频率是 35.3%（153/434）,ALK 重排的频率是 4.1% ( 18/436 ) ,KRAS 的突变频率则高达 13.3%（50/377）。见下图。
&　　图 1：非小细胞肺腺癌的吸烟和非吸烟患者驱动基因突变频率
&　　5、非吸烟的非小细胞肺癌患者的总生存期（OS）明星长于吸烟的非小细胞肺癌患者见下图 2。非吸烟的患者中位 OS 尚未达到，吸烟的患者的中位 OS 为 23.9 个月。总生存期超过 2 年的非吸烟患者比例是 75.8%，对于吸烟的患者而言这一数据仅为 49.8%，差距非常明显。
&　　图 2：非吸烟患者的总生存期 OS（绿色曲线）优于吸烟患者（蓝色曲线）
&　　既然吸烟引发了如此严重的问题，不只是增加了肺癌的发病率，还导致肺癌难以治疗，那么是否可以将香烟换成电子烟呢。据悉全球控烟的大环境下，电子烟发展迅速，已经有 500 多种电子烟品牌，最新的第四代电子烟也打出了"定制化和个性化"的大旗。
&　　但是研究表明电子烟仍然产生尼古丁，气化烟雾里还有丙二醇和丙三醇。几百项研究表明，电子烟所产生的有害物质包括与肺癌和哮喘相关的超细颗粒，致癌性烟草特异性亚硝胺，致癌性羰基化合物。虽然这些成分的浓度明显低于普通香烟，但在部分电子烟产品中浓度较高。细胞学实验也证明电子烟可影响到基因突变、表达。因此电子烟可能会和吸烟一样造成健康风险。
&　　所以要戒烟，就要不留余地，不要存在什么侥幸心理，要知道电子烟如果要达到或模拟吸烟的那种状态，也不可能是干干净净的。
&　　癌度有话说：
&　　吸烟患者在生存获益上不如非吸烟患者，这个是早就有研究。不过这篇韩国人的研究，包含的患者人群也不少，还是给我们了一些提示。尤其是在肺腺癌的比例、有靶向药物控制的驱动基因突变比例，这些因素直接影响了患者的生存获益，通过数据我们可以看到，即便是肺癌患者，非吸烟的患者治疗和总生存期明显优于吸烟的患者。
&　　因此，还是戒烟吧，为了健康和更好的治疗可能，需要把戒烟当成一件重要的事情来抓，而且要戒掉就彻底戒掉，不要跳到电子烟，这个目前缺乏监管的东西，目前的研究证明仍然是影响健康的。
&　　原创文章，转载请注明来源：癌度微信公众号
&　　癌度 APP 是专注于癌症相似病友检索、为用户推荐病情和治疗相似的病友，相互交流治疗和康复经验。癌小度能够搜索关于肿瘤治疗的任何问题，"有了癌小度，你也可以做自己的肿瘤医生！"
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