Smokers of mentholated cigarettes are no more likely to develop lung cancer than other smokers, according to a new, very large, prospective study of black and white smokers published online March 23 in the Journal of the National Cancer Institute. In fact, contrary to a popular hypothesis, menthol smokers in this study had a somewhat lower risk of developing and dying from lung cancer than non-menthol smokers.
Lung cancer rates are higher among blacks than whites, and use of mentholated cigarettes, also higher among blacks, has been suggested as a possible explanation. Some studies have raised the possibility that menthol influences smoking behavior, causing deeper inhalation for instance, or that it increases dependency or affects the biology of the lung. Others have suggested that menthol makes it harder to quit smoking.
To explore these issues, William J. Blot, Ph.D., of the Vanderbilt-Ingram Cancer Center in Nashville, Tenn., and the International Epidemiology Institute, Rockville, Md., and colleagues conducted a prospective study among 85,806 people enrolled in the Southern Community Cohort Study, an ongoing multiracial study in 12 southern states. Within this cohort, they identified 440 lung cancer patients and compared them with 2,213 matched controls (other people in the study with the same demographics, such as race, age, and sex, but without lung cancer).
They found that menthol cigarettes were associated with a lower lung cancer incidence and fewer lung cancer deaths than regular cigarettes. For instance among people smoking 20 or more cigarettes a day, menthol smokers were about 12 times more likely to have lung cancer than never-smokers while non-menthol smokers were about 21 times more likely to have the disease. The differences were statistically significant.
The researchers also collected information on smoking behavior, including quitting smoking, among 12,373 participants who smoked and who responded to a follow-up questionnaire. Among both blacks and whites, menthol smokers reported smoking fewer cigarettes per day than non-menthol smokers. After an average 4.3 years of follow up, 21% of those who smoked at the beginning of the study had quit; the quit rate was about the same for menthol and non-menthol smokers.
The authors conclude that mentholated cigarettes are no more, and perhaps less, harmful than non-mentholated cigarettes. They note that the findings are timely, as the U.S. Food and Drug Administration is now considering whether to ban or regulate mentholated cigarettes.
"Cigarette smoking remains the leading cause of premature death in the United States, but undue emphasis on reduction of menthol relative to other cigarettes may distract from the ultimate health prevention message that smoking of any cigarettes is injurious to health," they write.