Original reportsMentholated Cigarette Smoking and Lung-Cancer Risk
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
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