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Every year more than 400,000 deaths in the United States are attributed to cigarette smoke. With more than 4,000 chemical substances, there is a plethora of ways cigarette smoke can poison a person. And it's not just smokers who are at risk, some studies have shown that people who inhale second hand smoke may be even more at risk that the person smoking the cigarette. Cigarettes cause cancer, lung disease, heart disease, reproductive problems, and developmental problems.

Cancer is the most obvious cause of death related to cigarette smoke. With more than 40 known carcinogens, cigarette smoke is the cause of more than 85% of lung cancer cases, and is also associated with cancers of the mouth, pharynx, larynx, esophagus, stomach, pancreas, uterine cervix, kidney, ureter, bladder and colon. The primary carcinogens in cigarette smoke are Polycyclic Aromatic Hydrocarbons, N-nitrosaminous compounds, aromatic amines, and trace metals.

Polycyclic Aromatic Hydrocarbons (PAH) found in cigarette smoke, such as Benzo[a]pyrene, Dibenz[a,h]anthracene and Benz[a]anthracene are reactive compounds that when metabolized they become extremely genotoxic epoxides, or tumor initiators.

N-nitrosaminous compounds have been shown to cause brain tumors in tests on animals, and some studies have linked brain tumors in children to exposure to second-hand smoke. It is a metabolically activated carcinogen, which disrupts DNA, and its effects seem to be augmented by the consumption of alcohol. There has been a significant increase in cases of cancer in the mouth and esophagus in people who smoke and drink large amounts of alcohol.

Aromatic amines have been associated with an elevated risk of bladder cancer. There is also some evidence in their having a role in breast cancer. Mothers who smoke also pass aromatic amines to their children through breast milk.

Trace metals such as Nickel, Cadmium, Arsenic, and Polonium-210 can also be found in cigarette smoke. These elements have not been proven to contribute to cancer because of the small amounts present in smoke, but there has not been enough research to show the effects of them as they accumulate in the body over the years. It is possible that they are a co-factor to other causes of cancer.

In addition to cancer, cigarette smoke also causes other forms of lung disease. Chemicals and particles in cigarette smoke cause alterations to the number, types, and functions of the respiratory epithelial and

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