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 .
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% .
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
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
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.
 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.http://dx.doi.org/10.1016/j. eururo.2015.09.035 .
 Li S, Ma C, Xi B. Tobacco control in China: still a long way to go. Lancet
 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 atwww.scienced irect.com
DOIs of original articles:http://dx.doi.org/10.1016/j.eururo.2015.06.042 , http://dx.doi.org/10.1016/j.eururo.2015.09.035
2016 European Association of Urology. Published by Elsevier B.V. All rights reserved.