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Letter to the Editor

Re: Roman Sosnowski, Paolo Verze, Cosimo De Nunzio,

and Marc A. Bjurlin’s Letter to the Editor re: Marcus G.

Cumberbatch, Matteo Rota, James W.F. Catto, Carlo La

Vecchia. The Role of Tobacco Smoke in Bladder and

Kidney Carcinogenesis: A Comparison of Exposures

and Meta-analysis of Incidence and Mortality Risks.

Eur Urol 2016;70:458–66: Smoking Cessation and

Urology: A New Domain for Prevention and Treatment

We read with great interest the letter by Sosnowski et al



who authors highlighted the role of urologists in providing

smoking cessation counseling. We agree with the authors

that urologists should play an essential role in informing

patients of the relationship between smoking and urologic

diseases and in helping them to cease smoking. However,

urologists themselves should quit smoking first.

In China, tobacco control has remained a difficult issue

for a long time. According to the 2015 Chinese Adults

Tobacco Survey Report, more than 316 million Chinese

adults were current smokers with average daily consump-

tion of approximately 14.2 cigarettes


. The prevalence

of tobacco use among men is one of the highest

worldwide: 52.9% of men were smokers in 2010 and

52.1% in 2015



More concerning, however, is the issue of tobacco

smoking among Chinese doctors, including urologists.

According to a survey in Changzhou (Jiangsu Province) in

2013, 27.6% of doctors were current smokers and almost

half of the surgeons surveyed were smokers

[3] .


study showed that the prevalence of smoking was 23%

among Chinese doctors, and 41% for men


. The smoking

rate among doctors is considerably higher in China than in

the USA, which is approximately 5%

[5] .

The smoking behaviors of urologists could have effects

on both themselves and their patients. Patients usually

place a lot of faith in advice from their doctors. Studies have

revealed that patients who received smoking cessation

advice from their urologist were significantly more likely to



. However, being smokers themselves, many

urologists may neglect the importance of smoking cessation

and may not advise their patients to quit smoking. Only 29%

of Chinese doctors surveyed believed that most smokers

would take their smoking cessation advice


. Further-

more, a survey revealed that 37% of doctors who smoke

have smoked in front of their patients


. This behavior

may compromise patient belief in quitting smoking and

increase patient exposure to secondhand smoke. Cigarette

smoking is the leading preventable cause of disease and

death that doctors face. Urologists should be more aware of

the danger that smoking can do to their health and be at the

forefront of efforts not to smoke and to help patients to quit


To better fight against urologic diseases linked to

smoking, urologists themselves should cease smoking, not

only to set a good example for their patients but also for their

own health. The Chinese government should establish strict

tobacco control legislations, including provisions with

regard to smoking among medical professions. Only 30%

of Chinese doctors surveyed believed that good smoking

bans were implemented in their hospitals


. This indicates

that there is still much work to do for Chinese hospitals to

strengthen tobacco control efforts and create a tobacco-free

environment for doctors. In addition, specific education and

training programs on smoking cessation need to be targeted

at urologists.

Smoking by doctors is an important issue that needs to

be addressed immediately in China. Promotion of smoking

cessation among urologists is as important as helping

patients to cease smoking.

Conflicts of interest:

The authors have nothing to disclose.


[1] Sosnowski R, Verze P, Nunzio C, Bjurlin MA. Re: Marcus G.

Cumberbatch, Matteo Rota, James W.F. Catto, Carlo La Vecchia.

The role of tobacco smoke in bladder and kidney carcinogenesis:

a comparison of exposures and meta-analysis of incidence and

mortality risks. Eur Urol 2016;70:458–66: smoking cessation and

urology: a new domain for prevention and treatment. Eur Urol

2016;70:e102–3. eururo.2015.09.035 .

[2] Li S, Ma C, Xi B. Tobacco control in China: still a long way to go. Lancet

2016;387:1375–6. .

[3] Zhang H. Cigarette smoking among Chinese medical staff. Lancet



E U R O P E A N U R O L O G Y 7 1 ( 2 0 1 7 ) e 1 5 2 – e 1 5 3

available at


journal homepage:

DOIs of original articles: ,




2016 European Association of Urology. Published by Elsevier B.V. All rights reserved.