Is the risk for developing respiratory, upper digestive, and bladder cancer among smokers different for those who smoke menthol cigarettes? A historical cohort study
Abstract
Introduction and Objective. Cigarette smoking is linked to several different forms of cancer. Menthol cigarettes have gained significant attention as lawmakers battle to outlaw them to reduce smoking. Menthol flavoring is added to cigarettes to improve tolerance by mitigating the harsh sensation experienced while smoking non-menthol cigarettes. The menthol flavor itself provides a cooling sensation, which attracts younger smokers. Through false advertising, many companies have misled consumers to believe menthol smoking is less dangerous. The purpose of this study is to challenge the belief that smoking menthol cigarettes decreases the risk for smoking associated cancer incidence. Therefore, the objective is to compare the odds of developing cancer between menthol and non-menthol cigarette smokers in a representative sample. Methods. A retrospective cohort study using data from the National Health and Nutrition Examination Survey performed by the National Center for Health Statistics between 2000 and 2018 was performed. Outcome of interest was incidence of cancer occurring after a significant cumulative cigarette smoking exposure of at least 15 pack-years in which there is information about menthol vs. non-menthol cigarette smoking in smokers older than 20 years old and free from cancer diagnosis before 15 pack-year exposure. Covariates that were analyzed include gender, race, education level, and income. Bivariate analyses were used to compare the distributions of control variables according to exposure, and to contrast the distribution of cancer incidence between levels of all the independent variables considered, including the exposure of interest. To control for confounders, a multiple logistic regression model was fitted. Results. As compared to non-menthol smokers, menthol smokers are more frequently females, non-white and less educated (p<0.01). Prior to adjusting for confounders, the odds for cancer were higher among non-menthol smokers (OR 1.31 95% CI 1.04-1.65). After adjustment for gender, race, education level, and income the OR decreased and became not different from 1 (OR 1.23 95% CI 0.97-1.57). Conclusions-Implications. It is well known that cigarette smoking is linked to several cancers, however the relationship between menthol smoking and cancer is less clear. Our findings supports that smoking menthol cigarettes is as harmful as non-menthol ones regarding risk of cancer. In the FDA’s decision regarding the ban of menthol cigarettes it will be important to look at variables in addition to cancer such as cardiovascular risk, substance use disorders, and societal factors.
Keywords
cigarette smoking, menthol cigarette, cancer incidence
Presentation Type
Oral Presentation
Is the risk for developing respiratory, upper digestive, and bladder cancer among smokers different for those who smoke menthol cigarettes? A historical cohort study
Introduction and Objective. Cigarette smoking is linked to several different forms of cancer. Menthol cigarettes have gained significant attention as lawmakers battle to outlaw them to reduce smoking. Menthol flavoring is added to cigarettes to improve tolerance by mitigating the harsh sensation experienced while smoking non-menthol cigarettes. The menthol flavor itself provides a cooling sensation, which attracts younger smokers. Through false advertising, many companies have misled consumers to believe menthol smoking is less dangerous. The purpose of this study is to challenge the belief that smoking menthol cigarettes decreases the risk for smoking associated cancer incidence. Therefore, the objective is to compare the odds of developing cancer between menthol and non-menthol cigarette smokers in a representative sample. Methods. A retrospective cohort study using data from the National Health and Nutrition Examination Survey performed by the National Center for Health Statistics between 2000 and 2018 was performed. Outcome of interest was incidence of cancer occurring after a significant cumulative cigarette smoking exposure of at least 15 pack-years in which there is information about menthol vs. non-menthol cigarette smoking in smokers older than 20 years old and free from cancer diagnosis before 15 pack-year exposure. Covariates that were analyzed include gender, race, education level, and income. Bivariate analyses were used to compare the distributions of control variables according to exposure, and to contrast the distribution of cancer incidence between levels of all the independent variables considered, including the exposure of interest. To control for confounders, a multiple logistic regression model was fitted. Results. As compared to non-menthol smokers, menthol smokers are more frequently females, non-white and less educated (p<0.01). Prior to adjusting for confounders, the odds for cancer were higher among non-menthol smokers (OR 1.31 95% CI 1.04-1.65). After adjustment for gender, race, education level, and income the OR decreased and became not different from 1 (OR 1.23 95% CI 0.97-1.57). Conclusions-Implications. It is well known that cigarette smoking is linked to several cancers, however the relationship between menthol smoking and cancer is less clear. Our findings supports that smoking menthol cigarettes is as harmful as non-menthol ones regarding risk of cancer. In the FDA’s decision regarding the ban of menthol cigarettes it will be important to look at variables in addition to cancer such as cardiovascular risk, substance use disorders, and societal factors.