March 23, 2011 -- People who smoke menthol cigarettes are no more likely -- and may actually be less likely -- to develop lung cancer than people who smoke non-menthol cigarettes, a study suggests.
The study, published online in the Journal of the National Cancer Institute, comes out nearly a week after an FDA advisory panel stated that removing menthol cigarettes from the market may improve public health because menthol cigarettes may be more difficult to quit than non-menthol cigarettes and may be more enticing to young smokers because of their minty taste.
Menthol cigarettes are also more popular with African-American smokers, who have a higher incidence of lung cancer.
Menthol Cigarettes and Lung Cancer
But “the new study information almost closes the door on the lung cancer issue,” says study researcher William J. Blot, PhD, of the Vanderbilt-Ingram Cancer Center in Nashville. “The main message is that cigarettes are harmful, regardless of whether they are menthol or non-menthol, and the best action is to quit smoking.”
“I don’t think there is enough scientific evidence to justify a ban of menthol cigarettes in comparison with non-menthol cigarettes,” Blot says.
In the study, researchers identified 440 people with lung cancer among 85,806 study participants from 12 Southern states. They compared the smoking status and cigarette preferences of lung cancer patients with those of 2,213 people without lung cancer.
They found that smoking menthol cigarettes was actually associated with a significantly lower rate of lung cancer and lung cancer deaths than smoking non-menthol cigarettes.
Among pack-a-day smokers, menthol smokers were 12 times more likely to develop lung cancer compared to never smokers; those who smoked non-menthol cigarettes were 21 times more likely to develop lung cancer than those who never smoked.
What’s more, smokers who chose menthol cigarettes also smoked fewer cigarettes per day than those who smoked non-menthol cigarettes, and the quitting rate was similar between both menthol and non-menthol smokers. Previous studies have suggested that it may be harder to quit if you smoke menthol cigarettes.
Now Blot and colleagues plan to look at biochemical markers of tobacco smoke to see if there are any important differences between African-American and white smokers and menthol and non-menthol smokers. “Menthol is off the table, but the reason why African-American men have higher rates of lung cancer is still not clear,” he says.
All Cigarettes Pose Health Risks
All cigarettes are created equal when it comes to health risks, says Len Horovitz, MD, a pulmonary specialist at Lenox Hill Hospital in New York City. “Menthol cigarettes are as dangerous as non-menthol cigarettes and cigarettes are the No. 1 cause of heart disease, lung cancer, chronic obstructive pulmonary disease (COPD), and other diseases.”
Regardless of whether you smoke menthol or non-menthol, “set a date after which you will be an ex-smoker,” he says. There are many smoking-cessation tools available today, including nicotine-replacement systems such as patches and gum.
Amy V. Lukowski, PsyD, clinical director of the Health Initiatives Programs at National Jewish Health in Denver, says that the study should not be interpreted to mean that menthol cigarettes are any safer than non-menthol cigarettes.
“Lung cancer is only part of the picture and smoking is known to cause heart disease, stroke, COPD, and so many other diseases,” she says. “Tobacco kills and we really need to focus our efforts on cessation for smokers and stopping people from starting in the first place.”
Debate Over a Ban on Menthol Cigarettes
Lukowski is in favor of a ban on menthol cigarettes. “Almost half of young people use menthol cigarettes due to their minty taste so this is an important product to not have on the market,” she says.
The new findings dovetail nicely with the FDA panel’s recent recommendation, says David Abrams, PhD, the executive director of the Steven A. Schroeder National Institute for Tobacco Research and Policy Studies at Legacy, a public health group that aims to stamp out tobacco smoking.
The FDA panel stated that it was not clear that menthol cigarettes caused any additional risks at the individual level to the individual smoker, he says.
Although the new study did not show that there was any difference in quitting success rates among menthol vs. non-menthol smokers, “other research suggests very strongly that menthol smokers want to quit more and have more difficulty with quitting and succeeding,” he says.
“More kids start with menthol cigarettes, and adults have more trouble quitting when they smoke menthol,” Abrams. “This evidence is consistent and strong enough to warrant a ban on menthol.”
Gilbert Ross, MD, medical director for the American Council on Science and Health, a New York City-based consumer education group, sees the issue differently. “Menthol smokers have no increased risk of lung cancer or any other cigarette-related disease as compared to non-menthol smokers,” he says.
“It is well-known that menthol smokers smoke fewer cigarettes per day than regular cigarette smokers [and this is] but one reason why it is highly unlikely that banning menthol cigarettes will lead to a decrease in cigarette smokers,” Ross says. “In fact, I believe such a ban may actually increase the number of cigarettes smoked because few menthol smokers will actually quit, [instead] fleeing to illicit menthols and/or regulars,” he says. “More minors will find illicit cigarettes that are easily available from sellers who neither check ID's nor pay taxes.”