Impact ofCigarette Smoking on Ovarian Cancer inSulaimani City

Impact ofCigarette Smoking on Ovarian Cancer inSulaimani City

DOI: 10.33899/mjn.2021.168291 ©2020, College of Nursing, University of Mosul.

Creative Commons Attribution 4.0 International License
https://mjn.mosuljournals.com/article_168291.html

AmaniFadhil Abbas[1]HadeelAbdulelah Ibrahim[2]

Abstract

Background—Smoking is a risk factor for mucinous ovarian cancer, but its effects on other ovarian cancer subtypes and on overall ovarian cancer risk are unclear.

Methods— This study was a case control study; it was conducted in Hiwa  hospital for oncology in Sulaimani city. This study conducted from the 1st of June, 2019 to 1st of April 2020,  involving 100  ovarian cancer  patients and 100 female appeared normal without ovarian cancer as a controls. All  subjects who agreed to participate signed a consent form, answered a data  collection sheet about personal information as age, education, marital state ,education, economic status , physical activity and special habits especially exposure to passive smoking.

Results— The mean age of the examined subjects wss 44.9 ± 13.9 and 37.9 ± 13.7 for both cases and control groups respectively, with a significant difference (p< 0.001) Most cases were house wife 65% and 32% were illiterate with high significant difference (p< 0.001). 40 % of cases were Sufficient economic state .  About cigarette smoking (5% , 3%)of women were active, (2%, 0%) quit, and (31%, 16%) passive smokers and the remaining( 62%, 81%) were never smokers in case and control groups respectively . So passive women more prone to ovarian cancer with a significant difference p =0.02  Especially those with  > 5 years passive smoker (87.1%) comparing with 5 years and less in cases group  and compared to control groups p< 0.001 .

This study revealed that  passive smoking was associated with serous ovarian cancer(15.5%). Majority of the patients complained  from abdominal pain and abdominal distension (76%) as the first presenting symptom .

Conclusions— the mean age of Ovarian cancer woman was 44.9 ± 13.9 and most of the age of patients had ovarian cancer were between 40-50 Years. Passive smoker women more prone to ovarian cancer especially those with  > 5 years passive smoker . Passive cigarette smoking may be associated with serous ovarian cancer.

 Keywords: Age, Cigarette smoking, sign &symptom

Introduction

Ovarian cancer is the most lethal gynecologic  malignancy and is the fifth most common cause of  cancer-related death among women (ZohreMomenimovahed et al., 2019). Although ovarian cancer has a lower prevalence incomparison with breast cancer, it is three times more lethal,The highmortality rate of ovarian cancer is caused by asymptomatic and secret growth of thetumor, delayed onset of symptoms, and lack of proper screening that result in itsdiagnosis in the advanced stages (Badgwell & Bast, 2007 ; Yoneda et al., 2012)There are three forms of ovarian tumors,each originating from a different cell type; epithelial tumors (90%of cases), germ cell tumors (5% of cases), and stromal tumors (5% of cases) (Sumanasekera et al., 2018; Torre et al., 2018).  Epithelial tumors are the most usually diagnosed OC in women  (Goff et al., 2013;  Humans 2004). The etiology of ovarian cancer  is still unclear (Gharwan et al., 2015). multiple factors, such as genetic/ hereditary factors, high levels of estrogens, gonadotropins, exposure to a number of environmental toxicants can increase risk for ovarian cancer. Choosing healthy lifestyles such as diets rich in glutathione and other antioxidants, maintaining a healthy weight, and regular exercise may provide protective measures against ovarian cancer (Sumanasekera et al., 2018). It is believed that ovarian cancer is a multifactorial disease and it is  a result of the interaction of hereditary, reproductive, hormonal, dietary  factors and smoking (Hunn  & Rodriguez , 2012).

 Methods— This study was a case control study; it was conducted in Hiwa  hospitalfor oncology in Sulaimani city. This study conducted from the 1^st of June, 2019 to 1^st of April 2020,  involving 100  ovarian cancer  patients and 100 female appeared normal without ovarian cancer as a controls. All  subjects who agreed to participate signed a consent form, answered a data  collection sheet about personal information as age, education, marital state ,education, economic status , physical activity and special habits especially exposure to passive smoking. 

 Results---The mean age of the examined subjects that ranged from 15 to 72 years old is 44.9 ± 13.9 and 37.9 ± 13.7 for both cases and control groups respectively, with a significant difference (p< 0.001) ,and most of the age of patients had ovarian cancer were between40-50 Years (29% vs. 19%)  with high significant difference (p = 0.004), Figure 1, Table 1. Most cases were house wife 65% and 32% were illiterate with high significant difference (p< 0.001). 40 % of cases were Sufficient economic state which is less than  control group were 69 % Sufficient economic state with high significant difference (p< 0.001). marital status  p=0.13 and physical activity p=0.06  did not differ significantly between cases and controls.

 Figure 1: Distribution of age between cases and control

 Table 1: Socio-demographics characteristics of cases and control groups.

Table 2 shows that (5% , 3%)of women were active, (2%, 0%) quit, and (31%, 16%) passive smokers and the remaining( 62%, 81%) were never smokers in case and control groups respectively . So passive women more prone to ovarian cancer with a significant difference p =0.02  Especially those with  > 5 years passive smoker (87.1%) comparing with 5 years and less in cases group  and compared to control groups p< 0.001 table 3.

Table 2: Distribution of  smoking in both cases and control groups

Table 3  Duration (years) of passive smoker between cases and patient

This study revealed that passive smoking was associated with serous ovarian cancer(15.5%) then Mucinous(5.1%),Endometriod  (3.4%), adult granulosa, Teratoma (2.9%)and Dysgerminoma(1.2%) ovarian cancer figure (2 )

 Figure 2: Relationship between Passive smoker and Type of ovarian cancer

 Figure 3 :Signs and symptoms among cases of ovarian cancer.

Majority of the patients complained  from abdominal pain and abdominal distension (76%) as the first presenting symptom followed by Indigestion (58 %), Change in bowel habit (56%), urinary complaints  (dysuria, retention ,frequency of micturition) (48%), weight lose (33%), Extreme fatigue (10%) and postmenopausal bleeding (9 %) .

Discussion

In this study, the mean age of Ovarian cancer woman was 44.9 ± 13.9and most of the age of patients had ovarian cancer were between 40-50 Years.

The epithelial ovarian cancer is an age-related disease, and is considered primarily a postmenopausal disease(Chornokuret al., 2013; Chan et al., 2006). Increased incidence of this cancer is more pronounced in women over 65 years of age(Mohammadian  et al., 2012)According to previous studies, median age atdiagnosis is 50–79 years.( Chan et al., 2006; Arora et al.,2018; Zheng et al.,2018) The relationship between age and the outcome of ovarian cancer is uncertain. Although many researchers have pointed out that the younger age of ovarian cancer is associated with the improved outcome(Arora et al.,2018;, Chan et al., 2003; Chan et al., 2004), other stated age is not an independent prognostic factor(Chan et al., 2004).Older age in this disease is associated with more advanced disease and lower survival rate(Chan et al., 2006; Massi et al., 1996).Older women are treated less aggressively in contrast with younger ovarian cancer patients, and, thus, survival is lower in these group(Poole et al., 2013)An age of over 64 years is one of the predictors of mortality in people with ovarian cancer(Ørskov et al.,2016)

Most cases were house wife and illiterate with Barely Sufficientor insufficient economic state, because job strain may capture facets of psychosocial stress that affect health as demonstrated by consistent associations with cardiovascular disease risk and mortality among individuals mostly from the U.S. and Europe (Huang et al.,2015; Kivimaki & Kawachi, 2015), and because ovarian cancer seems susceptible to stress-related biological alterations, we hypothesized stress-related house wife, low education, insufficient economic state characteristics would be associated with increased risk of incident ovarian cancer

Another variable in the life style characteristics is performing physical activity and the results of present study most patients were not performing any physical activity.    

Physical activity may decrease risk of ovarian cancer by decreasing exposure to estrogen. Physical activity inhibits ovulation temporarily,. In addition, regular physical activity may lengthen ovulatory cycles, thereby decreasing lifetime exposure to endogenous estrogens. Physical activity also leads to decreased body fat, which may cause lower levels of extra glandular estrogen production, Moreover, increased physical activity may reduce chronic inflammation, which may play a role in the development of ovarian cancer (Lindsay et al., 2004)

the present study shows that most participant  were never smokers in case and control groups then passive smoker ovarian cancer women were double the passive smoker control with significant difference, So passive women more prone to ovarian cancer, especially those with  > 5 years passive smoker.Also  passive smoking was associated with serous ovarian cancer more  than Mucinous , Endometriod , adult granulosa, Teratoma  and Dysgerminoma ovarian cancer .this result which in line with other studywhich conclude that Cigarette smoking may be associated with serous ovarian cancer among AA(Kelemen et al., 2017), which differs from associations reported among Caucasians(Faber et al., 2013).

In contrary to present study Literatures reported that passive smoking is associated with decreased risk of ovarian cancer among individuals with daily ETS (Environmental tobacco smoke) exposure. This effect may be due to the immunosuppressive effects of nicotine as well as the role of tobacco smoke as an up regulator of metabolism (Baker et al., 2006).

Chemicals in tobacco smoke are a mixed bag of directly genotoxic DNA damaging compounds (initiators), compounds that enhance the action of these initiators (promoters), and compounds that do both. Some of these substances are more abundant in side stream smoke, which comes off the tip of the cigarette, than the smoke inhaled by smokers themselves (McCarty et al., 2009).

This side stream smoke is a major source of secondhand smoke (SHS). Many studies have reported that toxicants from cigarette smoke can form the DNA adducts which is believed to represent the first step of carcinogenesis. Which, if not repaired or if repaired incorrectly, these modifications may lead to mutations and cancer (Jenkins et al., 2000).

This study revealed that majority of the patients complained  from abdominal pain and abdominal distension as the first presenting symptom followed by Indigestion , Change in bowel habit , urinary complaints  (dysuria, retention ,frequency of micturition) , weight lose , Extreme fatigue and postmenopausal bleeding , Similarly, (Khan &Sultana, 2010) showed that abdominal pain as the most common symptom followed by abdominal distension, urinary complaints, vaginal discharge, and postmenopausal bleeding. a study conducted in Nigeria (Odukogbe et al., 2004) stated abdominal distension to be the most common presenting feature with a higher proportion of patients presented with advanced stage disease which is similar to our study. Others also reported abdominal distension as a common feature in their study (Gaughan et al., 2006; Petignat et al., 1997) .

(Khan & Sultana)  no specific sign or symptom for early stage or for late stage disease In early as well as in late stage (Khan &Sultana, 2010).

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