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Benefits and risks of smoking cessation

Author: Nancy A Rigotti, MD


Section Editors: James K Stoller, MD, MS, Mark D Aronson, MD
Deputy Editor: Judith A Melin, MA, MD, FACP

All topics are updated as new evidence becomes available and our peer review process is complete.
Literature review current through: Oct 2017. | This topic last updated: Dec 07, 2016.

INTRODUCTION Cigarette smoking is the leading preventable cause of mortality, responsible for nearly
six million deaths worldwide and over 400,000 deaths in the United States annually [1,2]. If current trends
continue, tobacco will kill more than eight million people worldwide each year by the year 2030. The three
major causes of smoking-related mortality are atherosclerotic cardiovascular disease, lung cancer, and
chronic obstructive pulmonary disease (COPD) [2].

Smokers who stop smoking reduce their risk of developing and dying from tobacco-related illnesses [3,4].
Screening all patients for tobacco use and providing smokers with behavioral counseling and
pharmacotherapy to stop smoking are among the most valuable preventive services that can be offered in
health care [5].

This topic will discuss the benefits and risks of smoking cessation. Management of smoking cessation,
including the use of behavioral and pharmacologic therapies, is discussed in detail separately. (See
"Overview of smoking cessation management in adults" and "Behavioral approaches to smoking cessation"
and "Pharmacotherapy for smoking cessation in adults".)

BENEFITS OF SMOKING CESSATION Smoking cessation is associated with substantial health benefits
for all smokers [6]. The extent of benefit partly depends on the intensity and duration of prior tobacco smoke
exposure. Smokers who stop smoking can be expected to live longer and are less likely to develop tobacco-
related diseases, including coronary heart disease, cancer, and pulmonary disease. Smokers also benefit
from quitting smoking even after the development of smoking-related diseases, such as coronary heart
disease or chronic obstructive pulmonary disease (COPD).

All-cause mortality Up to one-half of all smokers can be expected to die from a tobacco-related illness [1].
In one population-based cohort of nearly 50,000 people aged 40 to 70 years in Norway, the years of life lost
were 1.4 years in women and 2.7 years in men among those who smoked 20 cigarettes daily, compared with
those who never smoked [7].

Smoking cessation is associated with a mortality benefit for both men and women of all ages [4,7-10].
Stopping smoking at younger ages, especially before age 40, is associated with a larger decline in premature
mortality than stopping at a later age [3,7,11]. However, quitting smoking after age 60 years is still associated
with a lower risk of death compared with older adults who continue to smoke [7,10,12,13]. Even in smokers
over age 80, quitting smoking appears to reduce mortality [12].

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