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Since Dickens had reacted to the chewing and expectorating of tobacco as abhorrent social practices common in "the public places of America," Nast's hyperbole in this illustration of the gigantic receptacle for saliva complements Dickens's sentiments precisely

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They can bleed easily at times

Overall, the evidence supports that quitting smoking significantly lowers esophageal cancer risk and enhances survival prospects, reinforcing smoking cessation as a critical intervention in esophageal cancer control