Elsevier

Lung Cancer

Volume 54, Issue 1, October 2006, Pages 11-18
Lung Cancer

Effects of type of smoking (pipe, cigars or cigarettes) on biological indices of tobacco exposure and toxicity

https://doi.org/10.1016/j.lungcan.2006.06.016Get rights and content

Summary

Although all forms of smoking are harmful, smoking pipes or cigars is associated with lower exposure to the lethal products of tobacco products and lower levels of morbidity and mortality than smoking cigarettes. Cytochrome P-450-1A (CYP1A) is a major pathway activating carcinogens from tobacco smoke. Our primary aim was to compare CYP1A2 activity in individuals smoking pipes or cigars only, cigarettes only and in non-smokers. We studied 30 smokers of pipes or cigars only, 28 smokers of cigarettes only, and 30 non-smokers male subjects matched for age. CYP1A2 activity was assessed as the caffeine metabolic ratio in plasma. One-day urine collection was used for determining exposure to products of tobacco metabolism. Nitrosamine and benzo[a]pyrene DNA adducts were measured in lymphocytes. CYP1A2 activity was greater (p < 0.0001) in cigarette smokers (median: 0.61; interquartile range: 0.52–0.76) than in pipe or cigar smokers (0.27; 0.21–0.37) and non-smokers (0.34; 0.25–0.42) who did not differ significantly. Urinary cotinine and 1-hydroxypyrene levels were higher in cigarette smokers than in pipe or cigar smokers and higher in the later than in non-smokers. DNA adducts levels were significantly lower in pipe or cigar smokers than in cigarette smokers. In multivariate analysis, cigarette smoking was the only independent predictor of CYP1A2 activity (p < 0.0001) and of 1-hydroxypyrene excretion in urine (p = 0.0012). In this study, pipe or cigar smoking was associated with lower exposure to products of tobacco metabolism than cigarette smoking and to an absence of CYP1A2 induction. Cigarette smoking was the only independent predictor of CYP1A2 activity in smokers. However, inhalation behaviour, rather than the type of tobacco smoked, may be the key factor linked to the extent of tobacco exposure and CYP1A2 induction. Our results provide a reasonable explanation for the results of epidemiological studies showing pipe or cigar smoking to present fewer health hazards than cigarette smoking.

Section snippets

Subjects and procedures

The study was approved by the Committee for the Protection of Human Subjects of Paris—Pitié Salpêtrière. All subjects gave written informed consent for participation. Three groups of subjects were recruited from volunteers registered at the Clinical Investigation Center of Paris Saint-Antoine and in response to public advertisements: exclusive non-smokers (no tobacco use for at least 1 year and no passive exposure to tobacco at home or office), exclusive pipe or cigar smokers (smokers for more

Results

Eighty-eight subjects participated in the study: 30 non-smokers, 30 exclusive pipe or cigar smokers and 28 exclusive cigarette smokers. All subjects were male, although attempts were made to recruit female cigar smokers. Among the 30 non-smokers, 19 had never ever smoked, 7 had smoked less than five cigarettes/day and quit smoking more than 16 years before inclusion, three had smoked at least 20 cigarettes/day and quit smoking 5, 5 and 2 years before inclusion and one did not mention how many

Discussion

In this selected sample of exclusive, mostly non-inhaling, pipe or cigar smokers, we observed no significant induction of CYP1A2 activity – a major pathway of carcinogenesis related to smoking [19], [21], [22], [23], [24] – in comparisons with non-smokers. As expected [25], [38], much higher levels of CYP1A2 activity were found in exclusive, mostly inhaling, cigarette smokers. Pipe and cigar smokers had lower level of exposure to tobacco metabolism products (urinary cotinine and

Acknowledgements

We thank Vanessa Niot-Mansart for the analysis of DNA adducts.

Funding: The study was funded by an unrestricted grant from the “Association pour la Recherche des Nicotianées” (A.R.N). This association was not involved in the design, carrying out or analysis of the study, or in the preparation of the manuscript. The study was also supported by the “Institut National de la Santé et de la Recherche Médicale” and the “Assistance Publique-Hôpitaux de Paris” at the Clinical Investigation Centre of

References (50)

  • S.J. Henley et al.

    Association between exclusive pipe smoking and mortality from cancer and other diseases

    J Natl Cancer Inst

    (2004)
  • A.G. Shaper et al.

    Pipe and cigar smoking and major cardiovascular events, cancer incidence and all-cause mortality in middle-aged British men

    Int J Epidemiol

    (2003)
  • P. Boffetta et al.

    Cigar and pipe smoking and lung cancer risk: a multicenter study from Europe

    J Natl Cancer Inst

    (1999)
  • J.H. Lubin et al.

    Risk of lung cancer among cigarette and pipe smokers in southern China

    Int J Cancer

    (1992)
  • P. Lange et al.

    Relationship of the type of tobacco and inhalation pattern to pulmonary and total mortality

    Eur Respir J

    (1992)
  • S. Benhamou et al.

    Lung cancer risk associated with cigar and pipe smoking

    Int J Cancer

    (1986)
  • F. Baker et al.

    Health risks associated with cigar smoking

    JAMA

    (2000)
  • M.P. Stany

    Health risks of cigar smoking

    JAMA

    (2000)
  • N.J. Wald et al.

    Prospective study of effect of switching from cigarettes to pipes or cigars on mortality from three smoking related diseases

    BMJ

    (1997)
  • R. Mulcahy

    Cigar and pipe smoking and the heart

    BMJ

    (1985)
  • T.F. Pechacek et al.

    Smoke exposure in pipe and cigar smokers. Serum thiocyanate measures

    JAMA

    (1985)
  • S.G. Wannamethee et al.

    Associations between cigarette smoking, pipe/cigar smoking, and smoking cessation, and haemostatic and inflammatory markers for cardiovascular disease

    Eur Heart J

    (2005)
  • H. van der Vaart et al.

    Acute effects of cigarette smoke on inflammation and oxidative stress: a review

    Thorax

    (2004)
  • A. Nishikawa et al.

    Cigarette smoking, metabolic activation and carcinogenesis

    Curr Drug Metab

    (2004)
  • D.H. Phillips

    Smoking-related DNA and protein adducts in human tissues

    Carcinogenesis

    (2002)
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