Tobacco Documents Online

BOOK 53 TAB# 1-53 LOW TAR AND DISEASE 2063628OOO t

TABLE OF CONTENTS 2063628001

Tab # Author's Name TABLE OF CONTENTS Title 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 Lee, P.N. Stellman, S.D. Peto, R. ' Koziowski, L.T. Peto, R. Benowitz, N. Winkelstein, W. Peto, R. Hoffmann, D. Horm, J.W. Schmidt, F. Holland, W.W. Int Agency Res Cancer Work Group Eval Carcino Peto, R. Kozlowski, L.T. Bross, T.D. Weisberg, R.L. Parkin, D. Brown, C.C. Frogatt, P. Stephen, A. Benowitz, N.L. Froggatt, P. Hecht, S.S. Darby, S.C. Ebi-Kryston, K.L. Jarvis, M.J. Kozlowski, L.T. Shiffmann, S.M. Harris, J.E. Speizer, F.E. Kozlowski, L.T. Lung Cancer and the 'Safer' Cigarette Tobacco (A Major International Health Hazard (Cigarette Yield and Cancer Risk (Evidence from Case-Control and Prospective Studies))) Tobacco-Related Diseases Less Hazardous Tobacco Use as a Treatment for the 'Smoking and Health' Problem Lung Cancer (Causes and Prevention (Chapter 1 Keynote Address (The Control of Lung Cancer) Is There a Future for Lower-Tar-Yield Cigarettes Some Ecological Studies of Lung Cancer and Ischaemic Heart Disease Mortality in the United States The Value of Preventive Medicine (Control of Tobacco-Related Disease) Tobacco (A Major International Health Hazard (V Smoking. Current Research Issues...)) Falling Rates of Lung Cancer in Men in the United States Smoking (The Position in the Federal German Republic) Low-Tar Cigarettes Put to the Test Tobacco Smoking (Tobacco Smoking (Epidemiology Studies of Cancer in Human (1 Introduction (2 Cancer of the Lung))))) Tobacco ( A Major International Health Hazard (IV Health Effects of Low-Tar, Low-Nicotine...)) Less Hazardous Smoking and the Pursuit of Satisfaction Crimes of Official Science (A Casebook) Smoking and Health 1987 ( A World Report (Trends in Cigarette Consumption in the USA)) Surveillance in Health and Disease (Part 2 Practical Applications of Surveillance (13 Surveillance of Cancer)) Projections of Lung Cancer Mortality in the United States... Nicotine, Smoking and the Low Tar Program Nicotine, Smoking and the Low Tar Programme (111 Smoking Yields and Consumption (8 Estimating the Extent of Compensatory Smoking)) Health and Public Policy Implications of the 'Low Yield' Cigarette Determinants of Policy on Smoking and Health The Relevance of Tobacco-Specific Nitrosamines to Human Cancer Nicotine, Smoking, and the Low Tar Programme (11 Smoking Habits and Related Mortality in the UK...)) Predicting 15 Year Chronic Bronchitis Mortality in the Whitehall Study Comment on the Hunter Committee's Second Report Have Tar and Nicotine Yields of Cigarettes Changed A Safe Cigarette (Session 5 Behavioral and Economic Issues (Diminished Smoking, Withdrawal Symptoms, and Cessation))) A Safe Cigarette (Session 5: Behavioral and Economic Issues (Public Policy Issues in the Promotion of Less Hazardous...) Epidemiology of Respiratory Diseases (Task Force Report (Smoking)) Smokers, Non-Smokers, and Low-Tar Smoke

33 34 35 36 37 38 39 4O 41 42 43 44 45 46 47 48 49 5O 51 52 53 Holbrook, J.H. Holbrook, J.H. Kannel, W.B. Jaffe, J.H. Hirayama, T. Richmond, J.B. Hoffmann, D. Benowitz, N.L. Luoto, J. Lenfant, C. Rickert, WoS. The Changing Cigarette National Conference on Smoking and Health (Developing a Blueprint for Action) Update on the Role of Cigarette Smoking in Coronary Artery Disease Low Tar Cigarettes Flunk the Test Epidemiological Aspects of Lung Cancer in the Orient Ending the Cigarette Pandemic Human Carcinogenesis (VIII Laboratory Epidemiology Studies (33 Tobacco Carcinogenesis (Metabolic Studies in Humans))) Smokers of Low-Yield Cigarettes Do Not Consume Less Nicotine Reducing the Health Consequences of Smoking - A Progress Report Are 'Low-Yield' Cigarettes Really Safer A Comparison of the Yields of Tar, Nicotine, and Carbon Monoxide of 36 Brands of Canadian Cigarettes Tested Under Three Conditions Rickert, W.S. Wynder, E.L. Wald, N.J. Devesa, S.S. Loeb, L.A. Samet, J.M. Wald, N.J. Tomatis, L. Diamond, L. Gillis, C.R. Yields of Tar, Nicotine, and Carbon Monoxide in the Sidestream Smoke from 15 Brands of Canadian Cigarettes Demographic Aspects of the Low-Yield Cigarette (Considerations in the Evaluation of Health Risk) Relative Intakes of Tar, Nicotine, and Carbon Monoxide from Cigarettes of Different Yields Lung Cancer (Causes and Prevention (Chapter 3 Trends in Lung Cancer Incidence and Mortality in the U.S.) Smoking and Lung Cancer (An Overview) Less Hazardous Cigarettes and Disease of the Lung Cancer Risks and Prevention (3: Smoking) Tobacco (A Major International Health Hazard (Foreword)) Augmentation of Elastase-lnduced Emphysema by Cigarette Smoke (Effects of Reducing Tar and Nicotine Content) Cigarette Smoking and Male Lung Cancer in an Area of Very High Incidence (11 Report of a General Population Cohort...)

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CONTROVERSY Lung cancer and the 'safer' cigarette PETER N LEE MA Consultant in Statistics and Honorary Research Fellow, Divison of Epidemiology, Institute of Cancer Research, London years ago, when the evidence relating cigarette smoking to lung ~cer first started to appear, nearly all British smokers Smoked unripped (plain) Narettes with a tar yield of Today, more than of cigarettes smoked have and average tar yields are 15rag. Even the tar yields cigarettes have declined ~y so that hardly any garettes nowadays are above le 'middle tar' (17 to 22rag) ~nge while 'low tar' (0 to 10mg) lter cigarettes have captured rare than 15% of the market in ~last ten years. Similar trends ~e OCcurred in most developed .a developing countries (Lee, ~3). Although this suggests a ~uCtion in 1~ r'~neer c~uld l~u~(the tar ~ cffrcinouenic) it is ~h Considering a ~mber of .~ ~i,Rant~N points "sk of lung ~.~N~~ ~-$i~t, since the n dent on ~r is strongly depen ~--~d2tion of smoking (Doll and ~~, 1981), past exposure to ~~ettes is relevant, so that the ~~i~re of the effect of lower tar cigarettes is likely to take many years to emerge; early findings are likely to under- estimate the true benefit. Second, it does not necessarily follow that halving the dose of tar received by the smoker from each cigarette has the same effect on risk as halving the number of cigarettes smoked per day. Only for the. latter dose-response relationship is good evidence available. Third, changes in cigarette de- sign have resulted in chang6s in tar 'quality' as well as tar quanti- ty. Studies by Wynder and Hoff- man (1979) have shown that the mouse skin carcinogenicity of tar per unit dose has been steadily reducing. Fourth, reductions in risk will only be expected if smokers do not increase the number of cigarettes they smoke to 'com- pensate' for the reductions in nicotine yield that tended, at least until about ten years ago (Lee, 1976), to occur con- comitantly with the reductions in tar. Although consumption of .cigarettes per smoker has in- creased nationally, some studies suggest that changes in con- sumption are in fact essentially independent of changes in the tar/nicotine yield of the brand smoked (Garfinkel, 1979; Wald et al., 1980). Given that people currently smoking low tar cigarettes consume ten to 15% fewer cigarettes than middle tar smokers (Lee, 1983), the rise in consumption seems di~e to other causes such as lighter smokers giving up, or changes in price. Smokers may possibly compensate by altering the way they smoke their cigarettes, so the amount of tar they receive may bear little relation to the published yields, which are based on machine smoking under stan- dard conditions. A number of studies have investigated the relationship between machine nicotine yield and nicotine up- take. None of these studies is of the large, long-term 'within- smoker' type needed to provide reliable conclusions, and there is considerable variation in their findings, but all are consistent .with the theory of 'partial corn- September 1983 Vol. 227 1459 0 0

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CONTROVERSY that is a person smok- a reduced nicotine brand ~educes his nicotine intake, t~0ugh not proportionately by so large a factor. Russell et al. 11980) claimed support for the mnflicting viewpoint of corn- but re-analy- by Kozlowski et al. I1982) showed a clear trend to- wards reduced blood nicotine Nels in those smoking lower arettes. ~, now at the epidemiol- 0gy, four prospective and five ~ective studies have speci- investigated the relation- between lung cancer and smoked. Of the Separate comparisons made studies and sexes, 19 smokers of lower tar or clgarettes to have a lower lung cancer than smokers ~er tar or plain cigarettes, eXception being a non-sig- increase based on a re- small sample. Overall, reduction in mortal- 25 to 30%. It should be that in all these studies COmparison was between of the old high tar plain and smokers of filter of the middle or mid- tar group, typical of some vears ago. bach et a'l. (1979) com- legree of lung changes dying in 1955-60 dying in 1970-77 and the results show a marked differ- ence. If the lesions he studied are directly related to lung cancer, one cigarette of the past seems to be equivalent {o perhaps three or four modern cigarettes and life- time exposure to lower tar cigarettes may involve markedly tess risk than lifetime exposure to higher tar cigarettes. The changes in national mor- tality rates seem superficially rather unpromising, with male rates fairly static and female rates rising quickly. However, study of trends in total lung cancer rates gives a deceptive picture because in old men and in old and middle-aged women the average number of years smoking is sub- stantially greater now than for men and women of comparable age in earlier years. Since risk is related to the fourth or fifth power of duration of smoking, this increased duration will over- whelm any reduction in risk per cigarette smoked. To gain a more valid picture of potential benefits of tar re- ductions it is necessary to look at young and middle-aged men and young women, where changes in duration of smokir~g will not confound the picture. Over the last 20 years risk in men has fallen at all ages below 60 and has been halved in those aged 45 or less, and risk in women has fallen at ages below 45, and has been halved in the 30 to 34 age group. Although it is possible that reductions in air pollution fol- lowing the Clean Air Act are partly responsible, the magni- tude of the fall is too large to-be wholly due to this. Since average cigarette consumption per head has changed relatively little over the period, the trends are all consistent with tar reduction being the major factor. The fall in the lung cancer rate could be greater in years to come with cigarettes having even lower tar levels. References Auerbach O, Hammond EC, Garfinkel L. (1979): 'Changes in bronchial epithelium in relation to cigarette smoking 1955-1960 vs. 1970-1977". N Engl J Med. 300, 381-386. Doll R, Peto R. ( 1981 ): 'The causes of cancer: quantitative estimates of avoidable risks of cancer in the United States today', J Natl Cancer lnsr 66, 1191-1308. Garfinkel L. (1979): "Changes in the cigarette consumption of smokers in relation to changes in tar'nicotine content of cigarettes smoked', Am J Pub Hlth. 69, 1274-1276. Kozlowski LT, Frecker RC, Lei H. (1982): "Nicotine yields of cigarettes, plasma nico- tine in smokers and public health'. Prev Med, I1,240-244. Lee PN. (1976): Statistics of smoking in the United Kingdom. Tobacco Research Coun- cil Research Paper I, 7th ed. Lee PN. (1983): Lung cancer incidence and o'pe of cigarette smoked. Int Lung Cancer Update Conference, New Orleans. Russell MAH, Jarvis M, Iyer R, Feyerabend C. (1980): 'Relation of nicotine yield of cigarettes in blood nicotine level of smok- ers', Br Med J. 280, 972-976. Wald N J, Idle M, Boreham J, Bailey A. (1980): 'Inhaling habits among smokers of different types of cigarette', Thorax, 35, 925-928. Wynder EL, Hoffmann D. (1979): 'Tobacco and health: a societal challenge', New Engl J Med, 30t1, 854-903. 0 The Practitioner 1461 ~0 o 0~ o~ o o

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WORLD HEALTH ORGANIZATION INTERNATIONAL AGENCY FOR RESEARCH ON CANCER A TOBACCO: MAJOR INTERNATIONAL HEALTH HAZARD Proceedings of an International Meeting organized by the IARC and co-sponsored by the All-Union Cancer Research Centre of the Academy of Medical Sciences of the USSR, Moscow, USSR held in Moscow, 4-6 June 1985 EDITORS D. G. ZARIDZE R. PETO IARC Scientific Publications No. 74 INTERNATIONAL AGENCY FOR RESEARCH ON CANCER LYON 1986