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• CARCINOGEN EXPOSURE WITH WATER PIPE SMOKING
  Mohamed F. Allam
  Published on: 13 May 2016

• Published on: 13 May 2016

  CARCINOGEN EXPOSURE WITH WATER PIPE SMOKING

  • Mohamed F. Allam, Research Fellow

  NOT PEER REVIEWED To the Editor: The habit of water pipe smoking is rapidly extending in all occidental countries. This rise in popularity appears to be correlated with the advent on store shelves of an array of fruit-flavored tobacco mixtures, which list ''molasses'' as a primary ingredient. Also there is a widespread misperception among smokers that the water through which the smoke bubbles acts as a filter, rendering...

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  NOT PEER REVIEWED To the Editor: The habit of water pipe smoking is rapidly extending in all occidental countries. This rise in popularity appears to be correlated with the advent on store shelves of an array of fruit-flavored tobacco mixtures, which list ''molasses'' as a primary ingredient. Also there is a widespread misperception among smokers that the water through which the smoke bubbles acts as a filter, rendering it considerably less harmful than that of cigarettes [1]. A recent systematic review showed that the main motives for water pipe tobacco smoking were socializing, relaxation, pleasure and entertainment. Peer pressure, fashion, and curiosity were additional motives for university and school students [2]. However, the habit of smoking tobacco in water pipes is an old practice in the Eastern Mediterranean countries like Egypt, Jordan, Syria, Lebanon and Iraq [3]. Recently, Jaboc and collaborators (2013) published a crossover study about biomarkers of toxicant exposure with water pipe compared with cigarettes. The study included 13 volunteers from San Francisco (USA) who smoked both cigarettes and water pipes. The results showed that water pipe was associated with greater exposure to carbon monoxide, polycyclic aromatic hydrocarbons and benzene compared with cigarette smoking. Finally, the authors concluded that water pipe smoking is associated with a high risk of leukemia related to high levels of benzene exposure [4]. If Jaboc and collaborators' (2013) conclusions were right, we would expect higher prevalence of leukemia in the Eastern Mediterranean region compared with the Occidental Countries. Reviewing cancer registries in GLOBOCAN 2008, we can notice that adjusted standardized mortality rates of leukemia in males are comparable in the European Region (5.0 per 100.000) to the Eastern Mediterranean Region (4.7 per 100.000). A similar rate is noticed in the Americas Region (5.0 per 100.000) [5]. Deficient registration systems could not be the explanation. Neoplasms principally attributed to smoking like lung, laryngeal and oro-pharyngeal cancers have similar prevalence in Egypt like many of the occidental countries [5]. Water pipe tobacco brands used in the study of Jacob and collaborators (2013) were Nakhla and Al-Waha. These are the same brands usually consumed in the Eastern Mediterranean countries, like Egypt. On examining the box of Nakhla Double Apple brand, widely consumed in Spain, we can find a clear notice that it contains 0% tar. During the smoking process cigarette tobacco burns directly, whereas water pipe tobacco does not burn in a self-sustaining manner and requires an external heat source such as charcoal. I think that the high level of polycyclic aromatic hydrocarbon and benzene in the urine samples of water pipe smokers in the study of Jaboc and collaborators (2013) could be attributed to the charcoal disks used in many occidental countries. These quick lighting charcoal disks are impregnated in gasoil rich in polycyclic aromatic hydrocarbons and benzene. Smoke from these impregnated charcoal disks is inhaled by water pipe smokers [1]. In Eastern Mediterranean countries like Egypt, natural charcoal is used and is burned slowly in special clay or metallic receptacles [1,3]. This could explain the comparable prevalence of leukemia in Egypt and Occidental Countries. Examining quick lighting charcoal disk tubes available in Spain, we can notice that they lack labeling about the hazards of their use for water pipe smoking. Regulations and control for the use of these impregnated charcoal disks in the European Countries are urgently needed.

  REFERENCES 1. Shihadeh A. Investigation of mainstream smoke aerosol of the argileh water pipe. Food Chem Toxicol 2003;41(1):143-52. 2. Akl EA, Jawad M, Lam WY, Co CN, Obeid R, Jihad Irani J. Motives, beliefs and attitudes towards waterpipe tobacco smoking: a systematic review. Harm Reduct J 2013;10:12. 3. Chaouachi K. The medical consequences of narghile (hookah, shisha) use in the world. Rev Epidemiol Sante Publique 2007;55(3):165-170. 4. Jacob P 3rd, Abu Raddaha AH, Dempsey D, Havel C, Peng M, Yu L, Benowitz NL. Comparison of nicotine and carcinogen exposure with water pipe and cigarette smoking. Cancer Epidemiol Biomarkers Prev 2013;22(5):765-72. 5. International Agency for Research on Cancer. GLOBOCAN 2008. Available at: http://globocan.iarc.fr/ (Accessed 31 August 2013).

  Conflict of Interest:

  None declared

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  Conflict of Interest:
  None declared.

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