June 10, 2019
3 min read

Smoking unfiltered cigarettes doubles risk for lung cancer mortality

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DALLAS — In an analysis of the National Lung Screening Trial, adults who reported smoking unfiltered cigarettes had a 30% higher risk for all-cause mortality and were nearly twice as likely to die of lung cancer.

The data, presented at the American Thoracic Society International Conference, also determined that smokers of light or ultralight cigarettes share similar risks for all-cause mortality and lung cancer mortality compared with individuals who smoke regular cigarettes. Additionally, these smokers were less likely to quit smoking.

“Since the late 1960s, tobacco companies have made enormous changes in efforts to reduce ‘tar-yield’ of cigarettes as a surrogate to reducing the health risks of cigarettes. However, still 80% of lung cancer is related to smoking, and it remains the leading cause of cancer-related death in the U.S.,” Nina Thomas, MD, from the department of pulmonary and critical care medicine at the Medical University of South Carolina, told Healio Pulmonology. “Now, with lung cancer screening, we have been able to reduce lung cancer mortality by 20%, and if we can successfully help participants quit smoking and remain abstinent for 7 years, then there is an additional 20% reduction in mortality.”

For this secondary analysis of the National Lung Screening Trial, researchers evaluated clinical outcomes including lung cancer incidence, lung cancer-related mortality, all-cause mortality, tobacco abstinence and dependence. The researchers used Cox and logistic proportional models to define the effect of cigarette type on the clinical outcomes and also utilized the Fagerström Test for Nicotine Dependence, Heaviness of Smoking Index and time to first cigarette scores to uncover the effect of each type of cigarette.

“These data help inform us in clinical practice on how to better risk stratify our patients and individualize tobacco-cessation counseling based on the type of cigarettes they smoke,” Thomas said.

According to data presented at the ATS International Conference, adults who reported smoking unfiltered cigarettes were 40% more likely to develop lung cancer (HR = 1.37; P = .0051), twice as likely to die of lung cancer (HR = 1.96; P < .0001) and 30% more likely to die of any cause (HR = 1.28; P = .0033). Those who smoke unfiltered cigarettes were also more heavily nicotine dependent compared with those who smoke filtered cigarettes (OR = 1.32; P < .01).

The researchers also analyzed outcomes among smokers of light and ultralight cigarettes. They found that smokers of these types of cigarettes appeared to have lower nicotine dependence (OR = 0.76; P < .0001), but there was no difference in lung cancer incidence, lung cancer mortality or all-cause mortality compared with regular cigarette smokers. In addition, those who reported smoking light or ultralight cigarettes were less likely to quit smoking than those who smoke regular or unfiltered cigarettes (OR = 0.82; P < .0001), according to the findings presented here.


“The results were startling not only in how much more dangerous unfiltered cigarettes are, but also that light and ultralight cigarettes are just as harmful despite how they have been marketed for so many years,” Thomas told Healio Pulmonology.

Thomas and colleagues reported no difference in clinical outcomes among smokers of menthol vs. unflavored cigarettes.

“The results have already changed my clinical practice, in that I now ask my patients about the type of cigarette they smoke, why and about their dependence,” Thomas said. “An easy way to assess dependence is to ask them, ‘How soon after you wake up in the morning do you smoke your first cigarette?’”

Looking ahead, future investigations might focus on developing a patient-centered personalized tobacco treatment intervention to individualize tobacco cessation, Thomas said. It will also be important in future trials to evaluate the effect of different types of cigarettes on lung cancer outcomes in subsets of higher-risk individuals, such as those with lower socioeconomic status and black individuals, as “certain cigarette types have been marketed selectively to these groups in the past,” she told Healio Pulmonology. by Scott Buzby


Thomas N, et al. Abstract 5894. Presented at: American Thoracic Society International Conference; May 17-22, 2019; Dallas.

Disclosure: Thomas reports no relevant financial disclosures.