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The consequences of the unregulated cigarette

Correspondence to:
Dr Nigel Gray
International Agency for Research on Cancer, 150 Cours Albert Thomas, 69008 Lyon, France; nigel{at}uicc.org

ABSTRACT
This article considers changes in cigarette design in relation to the concept of "dose", drawing attention to the observation that there is not one smoking related epidemic of lung cancer, but at least two. Squamous carcinoma is declining in parallel with smoking prevalence while adenocarcinoma is increasing in the face of declining smoking prevalence. It is concluded that the adenocarcinoma epidemic is unnecessary and is due substantially to cigarette design changes, including increases in tobacco specific nitrosamines, manipulation of droplet size and ventilated filters. The need for regulation of smoke constituents is emphasised.

Abbreviations: FTC, Federal Trade Commission; NNK, 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone; PAHs, poly aromatic hydrocarbons; TSNAs, tobacco specific nitrosamines

Keywords: tobacco; regulation; nitrosamines; dose; adenocarcinoma