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In the Clinic |

Smoking Cessation

Manish S. Patel, MD; and Michael B. Steinberg, MD, MPH
[+] Article, Author, and Disclosure Information

CME Objective: To review current evidence for health consequences of smoking, prevention of smoking-related disease, treatment, and practice improvement of smoking cessation.

Funding Source: American College of Physicians.

Disclosures: Dr. Patel, ACP Contributing Author, has disclosed no conflicts of interest. Dr. Steinberg, ACP Contributing Author, reports personal fees from Arena Pharmaceuticals and major league baseball outside the submitted work. Disclosures can also be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M15-2670.

Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that she has no financial relationships or interests to disclose. Darren B. Taichman, MD, PhD, Executive Deputy Editor, reports that he has no financial relationships or interests to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Deborah Cotton, MD, MPH, Deputy Editor, reports that she has no financial relationships or interest to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Catharine B. Stack, PhD, MS, Deputy Editor for Statistics, reports that she has stock holdings in Pfizer.

With the assistance of additional physician writers, the editors of Annals of Internal Medicine develop In the Clinic using MKSAP and other resources of the American College of Physicians.

In the Clinic does not necessarily represent official ACP clinical policy. For ACP clinical guidelines, please go to https://www.acponline.org/clinical_information/guidelines/.


Ann Intern Med. 2016;164(5):ITC33-ITC48. doi:10.7326/AITC201603010
© 2016 American College of Physicians
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This issue provides a clinical overview of smoking cessation, focusing on health consequences of smoking, prevention of smoking-related disease, treatment, and practice improvement. The content of In the Clinic is drawn from the clinical information and education resources of the American College of Physicians (ACP), including MKSAP (Medical Knowledge and Self-Assessment Program). Annals of Internal Medicine editors develop In the Clinic in collaboration with the ACP's Medical Education and Publishing divisions and with the assistance of additional science writers and physician writers.

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Smoking cessation and oral cavity cancer – a dentist’s view
Posted on March 22, 2016
Delphine Maret (1), Emmanuelle Vigarios (2)
1 Faculté de Chirurgie Dentaire, UPS, CHU, laboratoire AMIS, 2 Oral Oncology Department, Institut Universitaire du Cancer
Conflict of Interest: None Declared
We read Patel and Steinberg’s article entitled “Smoking cessation” (1) with great interest. In the part dealing with the health consequences of smoking, Patel and Steinberg reported that “tobacco use is associated with cancer of the lungs, oropharynx and larynx,…, acute myeloid leukemia” (1). However, because tobacco is the most commonly known etiologic factor (2), cancer of the oral cavity should be listed separately rather than being included in oropharynx cancer. Oral cavity and oropharynx tumors are distinct and unique (3) and it is important for clinicians to be aware of this difference.

According to Chi et al., the different anatomic parts of the oral cavity include the labial and buccal mucosa, floor of mouth, alveolar ridge and gingiva, anterior two-thirds of the tongue, hard palate, and retromolar trigone (3). Cigarette smoking is responsible for one fourth of all oral cavity cancer cases (4). The risk clearly increases when smoking lasts for over 20 years and more than 20 cigarettes are smoked per day (4). The most common malignancy of the head and neck (excluding nonmelanoma skin cancer) is Oral Cavity Squamous Cell Carcinoma (OC-SCC) (3). Oral lesions precede these OC-SCC (5). According to Patel and Steinberg (1), a broad range of health care providers, including dentists, can reduce the impact of tobacco use in our society. We would like to focus on the crucial role of the dentist in the prevention and treatment of smoking-related diseases (including referral to another health professional), which involves not only maintaining teeth and gums in optimal condition but also the early identification of OC-SCC, oral potentially malignant disorders screening and effective care during malignant disease. Dentists should know their patients’ smoking status and routinely closely examine the whole oral mucosa during dental visits. We feel strongly that the evident close connection between dentistry and medicine is essential. The topic of prevention and treatment of tobacco abuse is atypical example of the imperative need for cooperation among health care professionals.

Delphine Maret (1), Emmanuelle Vigarios (2)
1 Faculté de Chirurgie Dentaire, UPS, CHU, laboratoire AMIS Toulouse, France
2 Oral Oncology Department, Institut Universitaire du Cancer, Toulouse, France. 

References
1. Patel MS, Steinberg MB. Smoking Cessation. Ann Intern Med. 2016;164:33‑48.
2. Ernani V, Saba NF. Oral Cavity Cancer: Risk Factors, Pathology, and Management. Oncology. 2015;89:187‑95.
3. Chi AC, Day TA, Neville BW. Oral cavity and oropharyngeal squamous cell carcinoma--an update. CA Cancer J Clin. 2015;65:401‑21.
4. Hashibe M, Brennan P, Benhamou S, Castellsague X, Chen C, Curado MP, et al. Alcohol drinking in never users of tobacco, cigarette smoking in never drinkers, and the risk of head and neck cancer: pooled analysis in the International Head and Neck Cancer Epidemiology Consortium. J Natl Cancer Inst. 2007;99:777‑89.
5. Tilstone C. Dentists: a crucial part to play in oral cancer. Lancet Oncol. 2007;8:575.
A new tobacco quit kit to enhance smoking cessation efforts
Posted on May 10, 2016
Justin List, MD, MAR, MSc, Michelle Dresser, MPH, Shadi Chamany, MD, MPH, Hang Pham-Singer, PharmD
New York City Department of Health and Mental Hygiene
Conflict of Interest: None Declared
We appreciated the update to In the Clinic’s smoking cessation topic by Patel and Steinberg (1). We read the section on smoking cessation counseling with particular interest. The New York City Department of Health and Mental Hygiene recently released its new Tobacco Quit Kit (2) as part of its public health detailing program, a provider outreach initiative to increase uptake of best practices on public health priorities (3). As part of this kit, we developed a clinical tool, the Tobacco Use Treatment Guide, which distills the “5 As” into ask, assist, and follow-up and included sample medication regimens to simplify decision making (4). Additionally, we posed questions to consider when designing a clinical workflow to streamline treatment as part of ask, assist, and follow-up. This guide, along with other clinician- and patient-facing materials, can be found online as part of the Tobacco Quit Kit (2). The Department of Health and Mental Hygiene invites clinicians and practices to use and share these materials as part of a tobacco cessation strategy.

Justin List, MD, MAR, MSc
New York City Department of Health and Mental Hygiene, Long Island City, NY

Michelle Dresser, MPH
New York City Department of Health and Mental Hygiene, Long Island City, NY

Shadi Chamany, MD, MPH
New York City Department of Health and Mental Hygiene, Long Island City, NY

Hang Pham-Singer, PharmD
New York City Department of Health and Mental Hygiene, Long Island City, NY

References:
1. Patel MS, Steinberg MB. Smoking Cessation. Ann Intern Med. 2016;164:33 48.
2. New York City Department of Health and Mental Hygiene. Tobacco Quit Kit. Accessed at: http://www1.nyc.gov/site/doh/providers/resources/public-health-action-kits-smoking-cessation.page on 21 April, 2016.
3. Dresser MG, Short L, Wedemeyer L, et al. Public Health Detailing of Primary Care Providers: New York City’s Experience, 2003-2010. Am J Public Health. 2012;102:Suppl3:S342-52.
4. New York City Department of Health and Mental Hygiene. Tobacco Treatment Guide. Accessed at: http://www1.nyc.gov/assets/doh/downloads/pdf/csi/tobacco-workflow-brochure.pdf on 21 April, 2016.
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