Smoking even ultralight cigarettes does not reduce lung cancer risk and death, finds JAMA Study

USA: Smoking “lower-tar” light or ultralight cigarettes versus regular cigarettes made no difference in reducing mortality from lung cancer, a recent study published in the JAMA Internal Medicine has found. Additionally, the study found that unfiltered cigarettes posed the greatest risk for lung cancer incidence and death compared with filtered cigarettes.

In the 1950s tobacco manufacturers introduced filtered and “lower-tar” cigarettes, in response to increasing evidence suggesting cigarette smoking as a cause of lung cancer. This was done to allay consumer concerns, knowing they did not actually reduce health risks.

Nichole T. Tanner, an associate professor in the department of medicine at the Medical University of South Carolina, and colleagues conducted a secondary analysis of the National Lung Screening Trial. Specifically, they examined the association between baseline cigarette tar level, menthol flavour and filter status and lung cancer incidence and mortality. NLST is a large randomized controlled trial that demonstrated that CT lung cancer screening could reduce mortality 20% in high-risk smokers.

"Despite the creation of low-tar alternatives and filtered cigarettes, “smoking remains responsible for 80% to 90% of lung cancer diagnoses, and 5-year survival is 18%, highlighting the importance of prevention," wrote the authors.

The researchers examined data from 14,123 participants in NLST, looking at baseline tar level of cigarettes (regular, light, or ultralight) and whether the cigarettes were filtered or unfiltered. They then matched this information with outcomes data like lung cancer diagnosis, mortality, and all-cause mortality.

Key findings include:

• Smoking light or ultralight cigarettes did little to reduce risk: These individuals had a hazard ratio of 0.91 for lung cancer mortality compared with smokers of regular cigarettes, but the difference was not statistically significant.


• Smoking a menthol brand also didn't help.


• But the 11.4% of participants in the study population who smoked unfiltered cigarettes were living dangerously: With a hazard ratio of 1.96, they had nearly twice the risk of mortality compared with those who smoked filtered brands.


• Their all-cause mortality was also higher, at a hazard ratio of 1.28, and their lung cancer incidence hazard ratio was 1.37.

Tanner et al pointed out that the study results indicated that it was important to find individuals who smoked unfiltered cigarettes because they would benefit most from aggressive tobacco treatment. But smoking remains deadly, even with filtered cigarettes: Lung cancer mortality in those who smoked filtered cigarettes was 1,600 lung cancer deaths per 100,000 individuals, compared with 34 deaths per 100,000 in those who never smoked.

"Evidence suggests that despite the adoption of new cigarette designs, cigarette smoking continues to pose an enormous health risk," the authors concluded.

More Information: "Association of Cigarette Type With Lung Cancer Incidence and Mortality: Secondary Analysis of the National Lung Screening Trial" published in the JAMA Internal Medicine.

DOI:10.1001/jamainternmed.2019.3487

Journal Information: JAMA Internal Medicine