Researchers find ‘clear relationship’ between light cigarettes and lung adenocarcinomas

Peter G. Shields

A Surgeon General’s report issued in 2014 linked the increased prevalence of lung adenocarcinomas in the United States to changing cigarette designs, specifically the small filter ventilation holes in “light” cigarettes adopted in the mid-1960s.

To support a potential FDA regulatory action on the ventilation holes in cigarette filters, a research team led by Peter G. Shields, MD, deputy director of The Ohio State University Comprehensive Cancer Center — Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, conducted a weight-of-evidence review to examine why rates of lung adenocarcinomas increased unexpectedly relative to those for other lung cancer subtypes.

Results suggested the placement of small ventilation holes in cigarette filters allows for filter ventilation and enables a smoking machine to report lower tar yields than what actually occurs for smokers. The researchers, therefore, concluded filter ventilation has contributed to the rise in lung adenocarcinoma cases, and that the FDA should consider regulating its use, up to and including a ban.

“Our data suggest a clear relationship between the addition of ventilation holes to cigarettes and increasing rates of lung adenocarcinoma seen over the past 20 years,” Shields said in a press release. “What is especially concerning is that these holes are still added to virtually all cigarettes that are smoked today.”

HemOnc Today spoke with Shields about the weight-of-evidence review, the implications of the findings and why the FDA should consider banning cigarette filter ventilation holes.

Question: What prompted this review?

Answer: Our review is a reflection of the consensus in the field. The 2014 Surgeon General’s report on smoking and health concluded that adenocarcinoma of the lungs — now the most common type of lung cancer — has steadily increased. Conversely, squamous cell carcinoma has steadily declined, a decrease associated with the reduced prevalence of cigarette smoking among the U.S. population. For some reason, adenocarcinomas did not follow suit. Another conclusion in the report stated that adenocarcinomas resulted from changes in cigarette designs, once of which led to the introduction of ‘light’ cigarettes in the 1960s. This is remarkable because light cigarettes were, at the time, considered healthier. According to the report, the increase in lung adenocarcinomas appeared associated with the cigarette design; however, there was limited evidence that suggested filter ventilation had something to do with this increase or with the increase in the amount of tobacco-specific nitrosamines in the tobacco — an important cause of lung cancer.

We took these data, conducted a weight-of-evidence review and put it into regulatory context. In our opinion, there is now enough data for the FDA to consider banning the placement of small ventilation holes in cigarette filters, which may not be noticeable to smokers. To be clear, we are not suggesting taking off the filters, but taking the holes out of the filters. Most cigarettes on the U.S. market have these holes. All cigarettes should have the same amount of ventilation so cigarette smokers cannot take advantage of what we call ‘the elasticity of the cigarette’ due to those small holes.

Q: What did you find?

A: We found no beneficial reason for having the small holes and many reasons to think the holes are causing a problem. However, although the evidence for these conclusions appeared highly suggestive, it was not conclusive. To be conclusive, we would need to look at smokers who use one type of cigarette vs. another type of cigarette for 4 years duration. Because all cigarettes have had increasing amounts of ventilation over the last 30 years or so, this study cannot be done.

Q: What are the implications of the findings?

A: We now have a scientific consensus with data on which the FDA can act. In terms of counseling smokers, it is not as though we needed more reasons to try to get smokers to quit; yet we have another reason, which is that the cigarettes today are much more dangerous than cigarettes 20 or more years ago.

Q: Based on these findings, should the FDA ban use of the small ventilation filter holes?

A: The FDA could ban use of ventilation filter holes right now, but it may question whether there would be any unintended consequences for taking the holes out. The tobacco industry would likely file a lawsuit to stop any regulation set by the FDA. Therefore, the FDA might demand better data for unintended consequences. Technically, removing holes from ventilation in cigarettes is an easy thing to do for the tobacco industry, because there already are some cigarettes — menthol cigarettes — on the market with no ventilation.

Q: Do you have plans for additional research?

A: We do. In fact, we submitted a large grant to the NCI and are hoping to be funded. There are three different projects that are all looking not at whether the ventilation holes are worse, but the FDA needs to know that we are not wrong in suggesting that taking the holes out of cigarettes is safer. We have to make sure that smokers will not get more carcinogen exposure when these holes are taken out. These projects will take about 5 years to complete.

Q: Is there anything else that you would like to mention?

A: The FDA has the authority to regulate tobacco products to improve public health, except for banning cigarettes entirely or mandating 100% removal of nicotine. It has started to regulate products, and we hope that filter ventilation will be considered. Separately, for cigarette smokers, some people still think that switching to a ‘light’ cigarette is healthier. All efforts need to be made to help smokers quit — including patients with cancer, whatever their stage of disease. – by Jennifer Southall

References:

U.S. Department of Health and Human Services. The Health Consequences of Smoking — 50 Years of Progress: A Report of the Surgeon General. Available at: www.surgeongeneral.gov/library/reports/50-years-of-progress/full-report.pdf. Accessed on July 11, 2017.

Song MA, et al. J Natl Cancer Inst. 2017;doi:10.1093/jnci/djx075.

For more information:

Peter G. Shields, MD, can be reached at The Ohio State University Comprehensive Cancer Center — Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, 460 W. 10th Ave., Columbus, OH 43210; email: peter.shields@osumc.edu.

Disclosure: Shields reports no relevant financial disclosures.

Peter G. Shields

A Surgeon General’s report issued in 2014 linked the increased prevalence of lung adenocarcinomas in the United States to changing cigarette designs, specifically the small filter ventilation holes in “light” cigarettes adopted in the mid-1960s.

To support a potential FDA regulatory action on the ventilation holes in cigarette filters, a research team led by Peter G. Shields, MD, deputy director of The Ohio State University Comprehensive Cancer Center — Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, conducted a weight-of-evidence review to examine why rates of lung adenocarcinomas increased unexpectedly relative to those for other lung cancer subtypes.

Results suggested the placement of small ventilation holes in cigarette filters allows for filter ventilation and enables a smoking machine to report lower tar yields than what actually occurs for smokers. The researchers, therefore, concluded filter ventilation has contributed to the rise in lung adenocarcinoma cases, and that the FDA should consider regulating its use, up to and including a ban.

“Our data suggest a clear relationship between the addition of ventilation holes to cigarettes and increasing rates of lung adenocarcinoma seen over the past 20 years,” Shields said in a press release. “What is especially concerning is that these holes are still added to virtually all cigarettes that are smoked today.”

HemOnc Today spoke with Shields about the weight-of-evidence review, the implications of the findings and why the FDA should consider banning cigarette filter ventilation holes.

Question: What prompted this review?

Answer: Our review is a reflection of the consensus in the field. The 2014 Surgeon General’s report on smoking and health concluded that adenocarcinoma of the lungs — now the most common type of lung cancer — has steadily increased. Conversely, squamous cell carcinoma has steadily declined, a decrease associated with the reduced prevalence of cigarette smoking among the U.S. population. For some reason, adenocarcinomas did not follow suit. Another conclusion in the report stated that adenocarcinomas resulted from changes in cigarette designs, once of which led to the introduction of ‘light’ cigarettes in the 1960s. This is remarkable because light cigarettes were, at the time, considered healthier. According to the report, the increase in lung adenocarcinomas appeared associated with the cigarette design; however, there was limited evidence that suggested filter ventilation had something to do with this increase or with the increase in the amount of tobacco-specific nitrosamines in the tobacco — an important cause of lung cancer.

We took these data, conducted a weight-of-evidence review and put it into regulatory context. In our opinion, there is now enough data for the FDA to consider banning the placement of small ventilation holes in cigarette filters, which may not be noticeable to smokers. To be clear, we are not suggesting taking off the filters, but taking the holes out of the filters. Most cigarettes on the U.S. market have these holes. All cigarettes should have the same amount of ventilation so cigarette smokers cannot take advantage of what we call ‘the elasticity of the cigarette’ due to those small holes.

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Q: What did you find?

A: We found no beneficial reason for having the small holes and many reasons to think the holes are causing a problem. However, although the evidence for these conclusions appeared highly suggestive, it was not conclusive. To be conclusive, we would need to look at smokers who use one type of cigarette vs. another type of cigarette for 4 years duration. Because all cigarettes have had increasing amounts of ventilation over the last 30 years or so, this study cannot be done.

Q: What are the implications of the findings?

A: We now have a scientific consensus with data on which the FDA can act. In terms of counseling smokers, it is not as though we needed more reasons to try to get smokers to quit; yet we have another reason, which is that the cigarettes today are much more dangerous than cigarettes 20 or more years ago.

Q: Based on these findings, should the FDA ban use of the small ventilation filter holes?

A: The FDA could ban use of ventilation filter holes right now, but it may question whether there would be any unintended consequences for taking the holes out. The tobacco industry would likely file a lawsuit to stop any regulation set by the FDA. Therefore, the FDA might demand better data for unintended consequences. Technically, removing holes from ventilation in cigarettes is an easy thing to do for the tobacco industry, because there already are some cigarettes — menthol cigarettes — on the market with no ventilation.

Q: Do you have plans for additional research?

A: We do. In fact, we submitted a large grant to the NCI and are hoping to be funded. There are three different projects that are all looking not at whether the ventilation holes are worse, but the FDA needs to know that we are not wrong in suggesting that taking the holes out of cigarettes is safer. We have to make sure that smokers will not get more carcinogen exposure when these holes are taken out. These projects will take about 5 years to complete.

Q: Is there anything else that you would like to mention?

A: The FDA has the authority to regulate tobacco products to improve public health, except for banning cigarettes entirely or mandating 100% removal of nicotine. It has started to regulate products, and we hope that filter ventilation will be considered. Separately, for cigarette smokers, some people still think that switching to a ‘light’ cigarette is healthier. All efforts need to be made to help smokers quit — including patients with cancer, whatever their stage of disease. – by Jennifer Southall

References:

U.S. Department of Health and Human Services. The Health Consequences of Smoking — 50 Years of Progress: A Report of the Surgeon General. Available at: www.surgeongeneral.gov/library/reports/50-years-of-progress/full-report.pdf. Accessed on July 11, 2017.

Song MA, et al. J Natl Cancer Inst. 2017;doi:10.1093/jnci/djx075.

For more information:

Peter G. Shields, MD, can be reached at The Ohio State University Comprehensive Cancer Center — Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, 460 W. 10th Ave., Columbus, OH 43210; email: peter.shields@osumc.edu.

Disclosure: Shields reports no relevant financial disclosures.