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Cigarette Filter Ventilation and its Relationship to Increasing Rates of Lung Adenocarcinoma

Year: 2017

Type: article

Abstract: The 2014 Surgeon General's Report on smoking and health concluded that changing cigarette designs have caused an increase in lung adenocarcinomas, implicating cigarette filter ventilation that lowers smoking machine tar yields.The Food and Drug Administration (FDA) now has the authority to regulate cigarette design if doing so would improve public health.To support a potential regulatory action, two weight-of-evidence reviews were applied for causally relating filter ventilation to lung adenocarcinoma.Published scientific literature (3284 citations) and internal tobacco company documents contributed to causation analysis evidence blocks and the identification of research gaps.Filter ventilation was adopted in the mid-1960s and was initially equated with making a cigarette safer.Since then, lung adenocarcinoma rates paradoxically increased relative to other lung cancer subtypes.Filter ventilation 1) alters tobacco combustion, increasing smoke toxicants; 2) allows for elasticity of use so that smokers inhale more smoke to maintain their nicotine intake; and 3) causes a false perception of lower health risk from "lighter" smoke.Seemingly not supportive of a causal relationship is that human exposure biomarker studies indicate no reduction in exposure, but these do not measure exposure in the lung or utilize known biomarkers of harm.Altered puffing and inhalation may make smoke available to lung cells prone to adenocarcinomas.The analysis strongly suggests that filter ventilation has contributed to the rise in lung adenocarcinomas among smokers.Thus, the FDA should consider regulating its use, up to and including a ban.Herein, we propose a research agenda to support such an effort.Cigarette smoke is the major cause of lung cancer, containing numerous carcinogens, mutagens, and other toxicants (1-3).When the incidence of lung cancer began to rapidly increase in the 1950s through the 1970s, squamous cell lung cancers were the most common sub type for men, but these decreased over the next 40 years with the decreasing smoking prevalence (1,4-10).However, the incidence of lung adenocarcinomas did not similarly decrease for men and women, exceeding squamous cell cancers in about 1990 and currently comprising about 60% of non-small cell lung cancers (Figure 1A).In 2014, the Surgeon General's Report (SGR) on the Health Consequences of Smoking concluded: "The evidence is sufficient to conclude that the increased risk of adenocarcinoma of the lung in smokers results from changes in the design and composition of cigarettes since REVIEW

Source: JNCI Journal of the National Cancer Institute

DOI: 10.1093/jnci/djx075