I was recently asked to address a group of female legislators on the subject of smoking and women’s health. While there were public health and cancer experts who spoke about the more familiar consequences of smoking — high and early incidence of lung cancer, heart disease and death among women who smoke — I focused my comments on the lesser known female health complications.
Let me start with the mind-numbing number of chemicals in cigarette smoke: So far researchers have found 4,000! These chemicals damage the DNA in every cell that is exposed to them and hence increase the risk of advanced cellular destruction and/or cancer.
So let’s follow the trail of smoke to see where it causes this damage: First, when you smoke, you suck all 4,000 chemicals into your mouth and throat — increasing your risk for some extremely malignant tumors. Inhaling then gets the smoke to your bronchi and lungs — and damages the DNA of these cells (far more quickly in women than in men). This leads to the well known risk of cancer, even 15 or 20 years after the smoking insult has ceased (albeit at a lesser rate than if smoking continues). The chemicals then get absorbed into your gastrointestinal tract, increasing esophageal, stomach, colon and pancreatic cancer. Next up, these toxins are metabolized in your liver and collected as byproducts in your lymph nodes — causing an increased risk for liver cancer and lymphomas. They pass on to your reproductive organs, and, you guessed it, increase your risk of ovarian and cervical cancer. And finally, you excrete these malevolent substances through your bladder — and here too they do their thing, increasing the incidence of bladder cancer.
Women who smoke have four times the risk of heart attack and stroke as female nonsmokers, and that number rises to more than nine times the risk if a woman started smoking before age 15 ( which is when many women form the habit). When you smoke, blood vessels are damaged, platelets get stickier, clotting factors increase and there is an elevation in bad cholesterol and a decrease in good cholesterol — and voila your heart and brain "go a long way baby" (to tissue death) from the chemicals in that prettily packaged and sexily portrayed white weapon.
When it comes to women’s reproductive health, I have some additional scary statistics. It’s common knowledge that cervical cancer is actually a sexually transmitted disease, due to infection with human papillomavirus (or HPV). Although 70 percent of sexually active adults get this virus at some point in their lives (it’s very contagious and often causes no symptoms), the good news is that viral shedding ceases within two years in most young women.
However, the chemicals in smoke seem to promote viral growth; the body’s immune system is less likely to stop the viral shedding. The longer the virus is present and capable of entering the DNA of cervical cells, the more likely it will cause mutations and result in cervical cancer. Women who smoke have a higher risk of on-going HPV infection, growth of venereal warts and development of cervical pre-cancer and cancer. When one of my patients is found to have an abnormal Pap with an HPV infection, my first question is “Are you smoking?” and if she replies (often reluctantly) that she is; I advise her that in order to help her body get rid of the offending virus she most stop smoking.
And the smoke insult to our reproductive system continues. The chemicals in cigarettes destroy follicles, affect ovulation and cause irregular bleeding and make it more difficult to get pregnant. Moreover, they may also hamper the function of the fallopian tubes and double the risk for ectopic or tubal, pregnancy.
Once a woman who smokes does get pregnant (and it implants normally in her uterus), she is twice as likely to miscarry, and if she continues to smoke the chemicals retard fetal growth and increase her risk for premature delivery and pregnancy complications. And if she or her husband smokes in the house, they expose their infant to an elevated risk of sudden infant death syndrome (SIDS).
Recent studies have also shown that children of women who smoked during pregnancy have a greater incidence of learning disabilities and behavioral disorders such as attention deficit disorder. These harmful affects are evident even among adolescents as old as 14 whose mothers were smokers during pregnancy.
For those looking to prevent pregnancy, a word on contraception: One of the most convenient and effective forms has and continues to be birth control pills, as well as birth control patches and vaginal rings. All of these have very minimal risk for heart attack and stroke, but when combined with smoking, especially in women over 35, that risk may be more than 13 times greater. Based on that figure, I feel that birth control pills should be available over the counter, while smoking should be by prescription only.
As we get beyond the need for contraception, know that female smokers are likely to go through menopause at an earlier age, and, once they are menopausal, their symptoms tend to be more severe than nonsmokers. Even if estrogen is given to these women, it is less likely to be effective in correcting these symptoms; smoking causes the release of substances that bind up estrogen and render it inactive.
Diminished estrogen production encourages bone-eating cells, a recipe for osteoporosis. The chemicals in smoke also have a direct effect on bone, increasing bone loss at a young age. In fact, smoking increases your bone age by about 10 years. That means that if you have smoked for 20 years, by the age of 40 you’ll have at least 10 percent less bone mass than nonsmokers, which translates to a 40 percent increase in risk of future hip fracture. (And that’s a conservative estimate — some say your risk of bone fracture increases as much as 250 percent!)
For those who think it’s what’s on the outside that counts, there’s the cosmetic issue: Like your bones, cigarette smoke ages your skin by 10 years or more.
I always surprise new patients by asking them how long they’ve smoked, before they’ve admitted to doing so. I can tell just by looking at the skin around their eyes and lips; the chemicals of smoke destroy the fine blood vessels that provide nutrients to the skin, causing the skin to age prematurely.
If you’ve been smoking for a long time, you may no longer want to look in the mirror, but let me point out one final woe: Smoking increases your risk of glaucoma and macular degeneration, so not only does smoke get in your eyes, it also blinds you.
Dr. Reichman’s Bottom Line: You know by now that smoking is bad for you. But if after taking a look at this chilling list, you are still among that 20 percent of women who smoke, talk to your doctor, look on Web sites and seek help. You too can kick the habit and make a huge difference in your future health and well-being.
Dr. Judith Reichman, the “Today” show's medical contributor on women's health, has practiced obstetrics and gynecology for more than 20 years. You will find many answers to your questions in her latest book, "Slow Your Clock Down: The Complete Guide to a Healthy, Younger You," which is now available in paperback. It is published by William Morrow, a division of .