3.24 Genetic influences on tobacco-caused disease

Last updated: 2011
Suggested citation: Winstanley, MH. 3.24 Genetic influences on tobacco-caused disease. In Scollo, MM and Winstanley, MH [editors]. Tobacco in Australia: Facts and issues. Melbourne: Cancer Council Victoria; 2011. Available from http://www.tobaccoinaustralia.org.au/3-22-genetic-influences-on-tobacco-caused-disease


There is evidence that the development of tobacco-caused disease may be mediated by the influence of an individual's genetic make-up.1–4 If confirmed, this means that someone with a genetic susceptibility to heart disease (or lung cancer or any of the other many diseases caused by smoking) could be at higher risk of developing these diseases if they smoke, and conversely, that some individuals may theoretically be at less risk of developing certain diseases. These findings have given rise to some debate about whether genetic screening might usefully contribute to the prevention of tobacco-caused disease,5–7 but the concept of genetic screening to ascertain individual risk of developing tobacco-related disease is considered to be impractical for the following three reasons:

Firstly, it is likely that many different genes, each contributing only a small portion of the overall risk, influence a smoker's individual risk of developing a particular disease which is caused by smoking. As discussed throughout this chapter, it is already well understood that smokers have a much higher risk than non-smokers of developing many conditions. Given this, it may be that being able to assess an individual smoker's personal risk of developing disease is in fact not much more informative than predicting risk simply on the basis of being a smoker.6

Secondly, smoking is the cause of many different diseases. Even to test smokers for susceptibility to the most commonly-caused diseases such as cardiovascular disease, lung cancer and chronic obstructive pulmonary disease, would mean screening for a large number of polymorphisms (common, naturally occurring variations in a gene, DNA sequence or chromosome).6

Finally, even if all these processes are eventually elucidated and genetic pathways identified for each kind of disease, it is probable that virtually everybody will have at least one susceptibility gene for one or more smoking-related disease.5,8

Screening for susceptibility to tobacco-caused diseases therefore cannot be regarded as a viable tool for smoking prevention, and from a public health perspective, the only workable message is that smoking is not safe for anyone.8,5

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1. Talmud P, Stephens J, Hawe E, Demissie S, Cupples L, Hurel S, et al. The significant increase in cardiovascular disease risk in APOE ε4 carriers is evident only in men who smoke: potential relationship between reduced antioxidant status and ApoE4. Annals of Human Genetics 2005;69:613-22. Available from: http://www.ncbi.nlm.nih.gov/pubmed/16266401

2. Devereux TR, Taylor JA and Barrett JC. Molecular mechanisms of lung cancer. Interaction of environmental and genetic factors. Giles F. Filley Lecture. Chest 1996;109(3):14S-19. Available from: http://www.chestjournal.org/cgi/reprint/109/3/14S

3. Amos C, Xu W and Spitz M. Is there a genetic basis for lung cancer susceptibility? Recent Results Cancer Research 1999;151:3-12. Available from: http://www.ncbi.nlm.nih.gov/pubmed/10337715

4. Kaprio J. Genetic epidemiology of smoking behavior and nicotine dependence. Chronic Obstructive Pulmonary Disease 2009;6(4):304-6. Available from: http://www.ncbi.nlm.nih.gov/pubmed/19811391

5. Hall W, Madden P and Lynskey M. The genetics of tobacco use: methods, findings and policy implications. Tobacco Control 2002;11:119-24. Available from: http://tobaccocontrol.bmj.com/cgi/reprint/11/2/119.pdf

6. Hall W. A research agenda for assessing the potential contribution of genomic medicine to tobacco control. Tobacco Control 2007;16:53-8. Available from: http://tobaccocontrol.bmj.com/cgi/reprint/16/1/53.pdf

7. Hall W, Mathews R and Morley K. Being more realistic about the public health impact of genomic medicine. PLoS Medicine 2010;7(10):pii: e1000347. Available from: http://www.ncbi.nlm.nih.gov/pubmed/20967240

8. Wang X and Mahaney M. Genotype-specific effects of smoking on risk of CHD [Editorial]. The Lancet 2001;358:87-8. Available from: http://www.ncbi.nlm.nih.gov/pubmed/11463406