Studies and Concepts Under Review

A Food and Drug Administration scientist has found a lower risk of dying from lung cancer among menthol smokers compared to non-menthol smokers at ages 50 and over.

The scientist, Brian Rostron of the FDA’s Center for Tobacco Products, studied data of 6,074 smokers from 1987 to 2006, including 1,417 who smoked only menthol cigarettes.

The lower risk of dying from lung cancer was found in all age groups, in men and women, and with black smokers compared with white smokers.

“These results agree with expectations that any association between lung cancer and menthol smoking would be greatest at ages in which smokers have smoked longer and accumulated more pack-years of smoking,” Rostron said in a study published in the journal Nicotine & Tobacco Research.

The report adds another layer of complexity to the public-health debate over menthol cigarettes, which are mint-flavored and one of the few growth sectors of the shrinking cigarette business.

The FDA in June began an independent review of research following a report from its Tobacco Products Scientific Advisory committee that recommends a ban of menthol cigarettes.

The committee said the flavoring has led to an increase in smokers — particularly among teens, African-Americans and those with low incomes. It also said menthol flavoring makes it harder for them to quit.

A menthol ban or other restrictions on the cigarettes would fall heavily on Lorillard Inc., whose Newport brand is the top-selling U.S. menthol cigarette at 35 percent of the market.

“The public-health implications of any decreased lung cancer risk of menthol smoking compared with non-menthol smoking, if ever conclusively demonstrated, are inevitably problematic,” Rostron said. “Smoking of any kind of cigarette is known to profoundly harm individual and population health.

“Further study is needed into possible explanations for the observed association and the public-health impact of potential reasons for it. This research could potentially identify ways to decrease the individual risk of cigarettes.”

Rostron said one possible cause could be greater smoking cessation among menthol smokers compared with non-menthol smokers during the follow-up period.

“Some research has suggested that menthol smokers have lower cessation than non-menthol smokers,” he wrote. “Cigarette ventilation is one possible cause of differences in risk for menthol cigarettes, given that the delivery of carcinogenic constituents can be altered by ventilation.”

Rostron’s research finding is similar to those reported in March 2011 by William Blot of the International Epidemiology Institute of Rockville, Md., as well as by Steven Stellman at the American Health Foundation in 2003.

Blot’s group studies 85,806 racially diverse adults enrolled in the Southern Community Cohort Study during March 2002 to September 2009.

“The findings suggest that menthol cigarettes are no more, and perhaps less, harmful than non-menthol cigarettes,” Blot concluded in his study.

John Spangler, a professor of family and community medicine at Wake Forest School of Medicine, said there are “two opposite takeaway messages” from the Rostron study considering overall mortality did not change significantly.

“In other words, you might be less likely to die of lung cancer if you smoke menthol cigarettes, but any smoking — menthol or non-menthol — gives the same risk of dying,” Spangler said. “We know that the risk of dying prematurely among smokers is much greater than among non-smokers.”

Brad Rodu, a professor of medicine at the University of Louisville, said he finds it interesting that the FDA’s committee downplayed the Blot research in its report and did not mention the Stellman research.

“The importance of this newest research should not be underestimated,” Rodu said.

“Last year, FDA Commissioner Margaret Hamburg emphasized that ‘science underlies everything we do at this agency.’ Rostron and the Center for Tobacco Products should be commended for producing this analysis.

“One hopes it will be used appropriately by the FDA in development of science-based tobacco regulation.”

Bill Godshall, executive director of SmokeFree Pennsylvania, said the Rostron research demonstrates that the FDA committee “exaggerated the health risks of menthol in its ideological zeal to demonize and ban flavorings.”

“But the new study shouldn’t be misinterpreted as indicating that menthol cigarettes are less hazardous than other cigarettes, as outlier findings should simply be viewed as outlier findings,” Godshall said.