Cigarette Filter Ventilation and its Relationship to Increasing Rates of Lung Adenocarcinoma

Abstract

The 2014 Surgeon General's Report on smoking and health concluded that changing cigarette designs have caused an increase in lung adenocarcinomas, implicating cigarette filter ventilation that lowers smoking machine tar yields. The Food and Drug Administration (FDA) now has the authority to regulate cigarette design if doing so would improve public health. To support a potential regulatory action, two weight-of-evidence reviews were applied for causally relating filter ventilation to lung adenocarcinoma. Published scientific literature (3284 citations) and internal tobacco company documents contributed to causation analysis evidence blocks and the identification of research gaps. Filter ventilation was adopted in the mid-1960s and was initially equated with making a cigarette safer. Since then, lung adenocarcinoma rates paradoxically increased relative to other lung cancer subtypes. Filter ventilation 1) alters tobacco combustion, increasing smoke toxicants; 2) allows for elasticity of use so that smokers inhale more smoke to maintain their nicotine intake; and 3) causes a false perception of lower health risk from "lighter" smoke. Seemingly not supportive of a causal relationship is that human exposure biomarker studies indicate no reduction in exposure, but these do not measure exposure in the lung or utilize known biomarkers of harm. Altered puffing and inhalation may make smoke available to lung cells prone to adenocarcinomas. The analysis strongly suggests that filter ventilation has contributed to the rise in lung adenocarcinomas among smokers. Thus, the FDA should consider regulating its use, up to and including a ban. Herein, we propose a research agenda to support such an effort.

Buccal Epithelium, Cigarette Smoking, and Lung Cancer: Review of the Literature

“…This change may account for the recent increase in lung adenocarcinoma rates relative to other lung cancer subtypes [46] , suggesting that the deep inhalation of cigarette smoke results in a larger carcinogenic effect on the peripheral lung compared to the rest of the respiratory tree. A large body of evidence supports the field effect in cigarette smokers and novel screening methods (i.e., exfoliated buccal cells, liquid biopsy, electric nose, and blood RNA, etc.)…”

FGL2 is positively correlated with enhanced antitumor responses mediated by T cells in lung adenocarcinoma

“…The extrapulmonary manifestations include hypercalcemia of the malignancy and hypertrophic pulmonary osteoarthropathy. Tobacco smoking is a risk factor for lung adenocarcinoma (Song et al, 2017). In addition to smoking, gene mutations are also important mutagenic factors of lung adenocarcinoma (Ding et al, 2008).…”

Associação entre tabagismo e a síndrome da fragilidade

“…Em um estudo sobre a força muscular do joelho, Kok, Hoekstra e Twisk (2012) observaram que o fumo de 100g de tabaco por semana reduz 2,9% da força muscular em homens e 5,0% em mulheres.…”

“…Esta redução do peso é decorrente de um aumento da taxa metabólica concomitante a uma supressão do apetite (CHIOLERO et al, 2008 Alguns estudos também sugerem que o monóxido de carbono piora a visão, percepção do tempo e coordenação motora (SONG et al, 2017).…”

“…Segundo Zaitune et al (2012), os fatores que contribuem para essa redução tabagismo conforme o avançar da idade são: o surgimento de agravos que levam à recomendação de cessação do consumo de cigarros, a maior probabilidade de óbito precoce dos fumantes, a atual e crescente preocupação com a saúde levando a adotar comportamentos mais saudáveis.…”