Elsevier

Annals of Epidemiology

Volume 9, Issue 2, February 1999, Pages 114-120
Annals of Epidemiology

Original reports
Mentholated Cigarette Smoking and Lung-Cancer Risk

https://doi.org/10.1016/S1047-2797(98)00042-8Get rights and content

Abstract

PURPOSE: Menthol smoking may lead to a greater increase in lung-cancer risk than smoking of nonmentholated cigarettes. Mentholation of cigarettes adds additional carcinogenic components to cigarette smoke and increases retention times for cigarette smoke in the lungs. Only two epidemiologic studies have been conducted on menthol smoking and lung cancer, and their results are conflicting. Of note, African American males have much higher rates of lung cancer than Caucasian males despite smoking fewer cigarettes per day. Because the consumption of menthol cigarettes is much more frequent among African Americans, it is of interest to examine the possible association between menthol smoking and lung-cancer risk in this population.

METHODS: We examined the association between menthol cigarette smoking and lung-cancer risk among smokers by comparing 337 incident cases of lung cancer with 478 population controls enrolled in a case-control study of lung cancer. Information on smoking history and other known and potential risk factors for lung cancer, including dietary intake, was obtained by in-person interviews.

RESULTS: The adjusted odds ratios did not differ appreciably between smokers of mentholated cigarettes versus exclusive nonmentholated cigarette smokers in the overall study group of smokers. The odds ratio (OR) for 32 pack-years or more of mentholated vs. nonmentholated cigarettes was 0.90 (95% confidence interval (CI) = 0.38–2.12) in African Americans and 1.06 (95% CI = 0.47–2.36) in Caucasians, and did not differ for either ethnic group (p = 0.98).

CONCLUSIONS: Our results suggest that the lung-cancer risk from smoking mentholated cigarettes resembles the risk from smoking non-mentholated cigarettes. Our data do not support the hypothesis that the increased risk of lung cancer among African Americans is due to the increased prevalence of menthol smoking.

Introduction

It has been hypothesized that smoking menthol cigarettes leads to a greater increase in the risk of lung cancer than smoking of nonmentholated cigarettes (1). The hypothesis is supported by the observation that mentholation of cigarettes adds additional carcinogenic components to cigarette smoke (2). In addition, laboratory studies have shown longer air-retention time in the lungs for guinea pigs (3), dogs (4), and indirectly in humans (5), under conditions of exposure to menthol. There have been two studies of menthol smoking in relation to lung-cancer risk in humans 6, 7.

African Americans are much heavier consumers of mentholated cigarettes than Caucasians 1, 8. The lung-cancer incidence in African-American males exceeds that of U.S. Caucasians (9). African-American men have a higher prevalence of smoking 8, 10, 11, but they smoke on the average, fewer cigarettes per day 8, 10, 12 than Caucasian smokers. Thus it is reasonable to speculate that the higher prevalence of menthol smoking among African Americans may partially account for the excess lung cancer incidence.

We therefore examined the association between mentholated cigarette smoking and lung-cancer risk among African Americans and Caucasians enrolled in a study of genetic markers for lung-cancer risk in Los Angeles County.

Section snippets

Methods

Data from a population based case-control study designed to examine genetic markers for lung-cancer risk were used to study the association between menthol smoking and lung cancer. Details of this study have been presented elsewhere (13), but are summarized below.

Incident cases of lung cancer were identified between 1991 and 1994 from 35 hospitals in Los Angeles County. These hospitals were chosen because they could provide the study with approximately equal numbers of African-American and

Results

Table 1 describes the study population. The age distributions for the cases (mean = 63.5) and controls (mean = 62.3) were similar, while gender and race proportions were matched in frequency within 13%. As expected, the smoking histories differed substantially between cases and controls. In this study, relative to never smoking, and adjusting for the matching factors only, the odds ratio (OR) for a current smoker with a smoking history of 40 pack-years was 19.42 (95% confidence interval (CI) =

Discussion

The lung-cancer risk associated with mentholated smoking was similar to that for exclusive nonmentholated cigarette smoking both in the total sample and within ethnic groups. Two previous studies have been conducted on menthol smoking and lung cancer risk. Kabat and colleagues (6) found no difference between menthol and nonmenthol smoking associations with lung cancer risk in a study using hospital controls. The study may have had low precision due to the small percentage of exclusive menthol

Acknowledgements

Funding for the research was provided by grants 1RT-87, 1RT-140, and 3RT-0403 from the State of California Tobacco-Related Disease Research Program, and a pre-doctoral fellowship from the National Institute on Drug Abuse, DA07272. Case ascertainment was supported in part by the California Public Health Foundation, subcontract 050-F-8709, which is supported by the California Department of Health Services as part of its statewide cancer-reporting program, mandated by Health and Safety Code

References (31)

  • P.I. Clark et al.

    Effect of menthol cigarettes on biochemical markers of smoke exposure among black and white smokers

    Chest.

    (1996)
  • M.E. Jarvik et al.

    Mentholated cigarettes decrease puff volume of smoke and increase carbon monoxide absorption

    Physiol Behav

    (1994)
  • S. Sidney et al.

    Mentholated cigarette use among multiphasic examinees 1979–86

    Amer J Publ Health.

    (1989)
  • I. Schmeltz et al.

    Benzo(a)pyrene, phenols, and other products from pyrolysis of the cigarette additive, (dl)-menthol

    Nature.

    (1968)
  • G.P. Orani et al.

    Upper airway cooling and l-menthol reduce ventilation in the guinea pig

    J Appl Physiol.

    (1991)
  • F.B. Sant’Ambrogio et al.

    Effect of l-menthol on laryngeal receptors

    J Appl Physiol.

    (1991)
  • B. McBride et al.

    A physiological stimulus to upper airway receptors in humans

    J Appl Physiol Respirat Environ Exerc Physiol.

    (1981)
  • G.C. Kabat et al.

    Use of mentholated cigarettes and lung cancer risk

    Cancer Research.

    (1991)
  • S. Sidney et al.

    Mentholated cigarette use and lung cancer

    Arch Intern Med.

    (1995)
  • United States Department of Health and Human Services. Report of the 1986 Adult Use of Tobacco Survey. United States...
  • Miller BA, Kolonel LN, Bernstein L, Young JL, Jr, Swanson GM, West D, et. al. (eds). Racial/Ethnic Patterns of Cancer...
  • G.A. Giovino et al.

    Surveillance for selected tobacco-use behaviors—United States, 1900–1994

    MMWR CDC Surveill Summ.

    (1994)
  • A.C. Marcus et al.

    Prevalence of cigarette smoking in the United StatesEstimates from the 1985 current population survey

    J Natl Cancer Inst.

    (1989)
  • S.D. Stellman et al.

    Smoking habits and tar levels in a new American Cancer Society prospective study of 1.2 million men and women

    J Natl Cancer Inst.

    (1986)
  • S.J. London et al.

    Polymorphism of glutathione S-transferase M1 (GSTM1) and the risk of lung cancer among African Americans and Caucasians in Los Angeles County

    J Natl Cancer Inst.

    (1995)
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