A systematic review of health effects of electronic cigarettes.

OBJECTIVE: To provide a systematic review of the existing literature on health consequences of vaporing of electronic cigarettes (ECs). METHODS: Search in: PubMed, EMBASE and CINAHL. INCLUSION CRITERIA: Original publications describing a health-related topic, published before 14 August 2014. PRISMA recommendations were followed. We identified 1101 studies; 271 relevant after screening; 94 eligible. RESULTS: We included 76 studies investigating content of fluid/vapor of ECs, reports on adverse events and human and animal experimental studies. Serious methodological problems were identified. In 34% of the articles the authors had a conflict of interest. Studies found fine/ultrafine particles, harmful metals, carcinogenic tobacco-specific nitrosamines, volatile organic compounds, carcinogenic carbonyls (some in high but most in low/trace concentrations), cytotoxicity and changed gene expression. Of special concern are compounds not found in conventional cigarettes, e.g. propylene glycol. Experimental studies found increased airway resistance after short-term exposure. Reports on short-term adverse events were often flawed by selection bias. CONCLUSIONS: Due to many methodological problems, severe conflicts of interest, the relatively few and often small studies, the inconsistencies and contradictions in results, and the lack of long-term follow-up no firm conclusions can be drawn on the safety of ECs. However, they can hardly be considered harmless.

[Lung cancer screening with low dose CT requires careful consideration].

Results from the American National Lung Screening Trial (NLST) show a significant reduction in lung cancer and all-cause mortality in a high risk population screened with annual low-dose CT. Handling of pulmonary nodules, false positive tests, overdiagnosis, psychosocial consequences and cost-efficiency etc. are all aspects that require careful consideration. This paper gives an overview of the current knowledge on these issues. Before a recommendation can be made, we need an overall evaluation of both the benefits and harms in CT screening for lung cancer.

[Lung cancer screening with low-dose CT - Danish and international results].

Lung cancer is the cancer type that causes the largest number of deaths in Denmark. With advances in medical imaging and widespread use of computed tomography (CT), it is possible to detect even small abnormalities in lung tissue. This has led to a great interest in lung cancer screening with low-dose CT and launching of randomised screening trials worldwide. This paper gives an overview of the current lung cancer screening trials in Denmark and internationally and focuses on main lung cancer findings and mortality results.

Smoking habits in the randomised Danish Lung Cancer Screening Trial with low-dose CT: final results after a 5-year screening programme.

BACKGROUND: We present the final results of the effect of lung cancer screening with low-dose CT on the smoking habits of participants in a 5-year screening trial. METHODS: The Danish Lung Cancer Screening Trial (DLCST) was a 5-year screening trial that enrolled 4104 subjects; 2052 were randomised to annual low-dose CT (CT group) and 2052 received no intervention (control group). Participants were current and ex-smokers (≥4 weeks abstinence from smoking) with a tobacco consumption of ≥20 pack years. Smoking habits were determined annually. Missing values for smoking status at the final screening round were handled using two different models. RESULTS: There were no statistically significant differences in annual smoking status between the CT group and control group. Overall the ex-smoker rates (CT + control group) significantly increased from 24% (baseline) to 37% at year 5 of screening (p<0.001). The annual point prevalence quit rate increased from 11% to 24% during the five screening rounds; the ex-smokers' relapse rate remained stable, around 11%, across the same period. CONCLUSIONS: Screening with low-dose CT had no extra effect on smoking status compared with the control group, but overall the screening programme probably promoted smoking cessation. CLINICAL TRIAL REGISTRATION: The DLCST is registered in Clinical Trials.gov Protocol Registration System (identification no. NCT00496977).

CT screening for lung cancer brings forward early disease. The randomised Danish Lung Cancer Screening Trial: status after five annual screening rounds with low-dose CT.

BACKGROUND: The effects of low-dose CT screening on disease stage shift, mortality and overdiagnosis are unclear. Lung cancer findings and mortality rates are reported at the end of screening in the Danish Lung Cancer Screening Trial. METHODS: 4104 men and women, healthy heavy smokers/former smokers were randomised to five annual low-dose CT screenings or no screening. Two experienced chest radiologists read all CT scans and registered the location, size and morphology of nodules. Nodules between 5 and 15 mm without benign characteristics were rescanned after 3 months. Growing nodules (>25% volume increase and/or volume doubling time<400 days) and nodules >15 mm were referred for diagnostic workup. In the control group, lung cancers were diagnosed and treated outside the study by the usual clinical practice. RESULTS: Participation rates were high in both groups (screening: 95.5%; control: 93.0%; p<0.001). Lung cancer detection rate was 0.83% at baseline and mean annual detection rate was 0.67% at incidence rounds (p=0.535). More lung cancers were diagnosed in the screening group (69 vs. 24, p<0.001), and more were low stage (48 vs 21 stage I-IIB non-small cell lung cancer (NSCLC) and limited stage small cell lung cancer (SCLC), p=0.002), whereas frequencies of high-stage lung cancer were the same (21 vs 16 stage IIIA-IV NSCLC and extensive stage SCLC, p=0.509). At the end of screening, 61 patients died in the screening group and 42 in the control group (p=0.059). 15 and 11 died of lung cancer, respectively (p=0.428). CONCLUSION: CT screening for lung cancer brings forward early disease, and at this point no stage shift or reduction in mortality was observed. More lung cancers were diagnosed in the screening group, indicating some degree of overdiagnosis and need for longer follow-up.

A cluster randomized trial in general practice with referral to a group-based or an Internet-based smoking cessation programme.

BACKGROUND: Reviews state that there is a room for improvements of smoking cessation (SC) intervention in general practice. METHODS: In 2005, all 61 general practitioners (GPs) in four municipalities in Copenhagen, Denmark, were invited to participate. Twenty-four GPs accepted and were cluster randomized to one of three groups: Group A, referral to group-based SC counselling (national model), n = 10; Group B, referral to internet-based SC programme (newly developed), n = 8; or Group C, no referral ('do as usual'), n = 6. A total of 1518/1914 smokers were included, and 760 returned a questionnaire at 1-year follow-up. RESULTS: The participating GPs reported significantly more SC counselling than GPs who refused participation (P = 0.04). Self-reported point abstinence was 6.7% (40/600), 5.9% (28/476) and 5.7% (25/442) in Groups A, B and C, respectively. Only 40 smokers attended group-based SC counselling, and 75 logged in at the internet-based SC programme. In cluster analyses, we found no significant additional effect of referral to group-based (OR: 1.05; 95% CI: 0.6-1.8) or internet-based SC programmes (OR: 0.91; 95% CI: 0.6-1.4). CONCLUSIONS: We found no additional effect on cessation rates of GPs' referring to group-based SC counselling or internet-based SC programme. This finding might, to some degree, be explained by the short time used by the GPs on SC counselling and the selection of the participating doctors.

[Water-pipe smoking--a survey of a Cochrane review]. / Vandpiberygning--en gennemgang af et Cochrane-review.

More than half the younger population in Denmark have tried water-pipe smoking, but very few smoke daily or weekly. Water-pipe smoke contains approximately the same harmful substances as cigarette smoke. Accordingly, it is expected that water-pipe smoking will have the same harmful effect on health and be as addictive as other forms of tobacco smoking. The limited epidemiologic evidence seems to indicate that water-pipe smoking is as damaging to health as other forms of tobacco smoking. A Cochrane-review did not find a single study of water-pipe smoking cessation.

The Danish randomized lung cancer CT screening trial--overall design and results of the prevalence round.

INTRODUCTION: Lung cancer screening with low dose computed tomography (CT) has not yet been evaluated in randomized clinical trials, although several are underway. METHODS: In The Danish Lung Cancer Screening Trial, 4104 smokers and previous smokers from 2004 to 2006 were randomized to either screening with annual low dose CT scans for 5 years or no screening. A history of cigarette smoking of at least 20 pack years was required. All participants have annual lung function tests, and questionnaires regarding health status, psychosocial consequences of screening, smoking habits, and smoking cessation. Baseline CT scans were performed in 2052 participants. Pulmonary nodules were classified according to size and morphology: (1) Nodules smaller than 5 mm and calcified (benign) nodules were tabulated, (2) Noncalcified nodules between 5 and 15 mm were rescanned after 3 months. If the nodule increased in size or was larger than 15 mm the participant was referred for diagnostic workup. RESULTS: At baseline 179 persons showed noncalcified nodules larger than 5 mm, and most were rescanned after 3 months: The rate of false-positive diagnoses was 7.9%, and 17 individuals (0.8%) turned out to have lung cancer. Ten of these had stage I disease. Eleven of 17 lung cancers at baseline were treated surgically, eight of these by video assisted thoracic surgery resection. CONCLUSIONS: Screening may facilitate minimal invasive treatment and can be performed with a relatively low rate of false-positive screen results compared with previous studies on lung cancer screening.

[Treatment of nicotine addiction. Drug therapy for smoking cessation]. / Behandling af nikotinafhaengighed. Medikamentel rygeafvaenning.

Most Danish smokers are addicted to nicotine. Treatment with nicotine replacement therapy or bupropion doubles the one-year success rate after cessation of smoking. Pregnant smokers who are unable to stop smoking without medical treatment can safely be offered nicotine replacement therapy. The health risk of smoking is particularly high in patients with cardiovascular disease. Reluctance to use nicotine products for patients with heart disease is not supported by scientific evidence, and either bupropion or nicotine products can safely be administered to them.