Changes In Cigarette Design Research Articles

Possible Explanations for the Observed Rise in the Incidence of Lung Adenocarcinoma relative to that of Lung Squamous Cell Carcinoma

The observed rise in the incidence of lung adenocarcinoma relative to lung squamous cell carcinoma has been claimed to result from changes in cigarette design associated with the shift to lower tar filter cigarettes. We present evidence that tends to undermine this claim. In particular, a recently published review based on extensive data has shown that there has been a substantial rise in the relative frequency of adenocarcinoma compared to squamous cell carcinoma in those who have never smoked.

Time trends in never smokers in the relative frequency of the different histological types of lung cancer, in particular adenocarcinoma

The increasing proportion of lung cancers classified as adenocarcinoma has been a topic of interest and research. The main objective of the analyses reported here is to summarize how the proportion of adenocarcinoma varies in never smokers by time, sex and region based on published evidence on the distribution of lung cancer types available from epidemiological studies. Based on 219 sex- and period-specific blocks of data drawn from 157 publications, there appears to be a clear time-related increase in the proportion of lung cancers in never smokers that are adenocarcinoma, which is evident in both sexes, and not specific to any region. It is seen whether the denominator of the proportion is made up of adenocarcinoma plus squamous cell carcinoma cases, cases of the four major types combined, or all lung cancer cases. The ratio of adenocarcinoma to squamous cell carcinoma rose continuously from 1950 to 69 to be almost 4 times higher for the data from 2000 onwards. We discuss factors that may have contributed to the observed findings, including changes in lung cancer classification. Our findings argue against the hypothesis that increases in the ratio arise from changes in cigarette design and composition.

Creation of an Epidemic: The Tobacco Industry and the Rise of Smoking-Related Adenocarcinoma of the Lung: Surveillance-Epidemiology and End Results (SEER) Analysis, 1973-2011

SESSION TITLE: Lung Cancer Posters SESSION TYPE: Original Investigation Poster PRESENTED ON: Wednesday, October 28, 2015 at 01:30 PM - 02:30 PM PURPOSE: When epidemiologic research first established a definitive association between cigarette smoking and lung cancer in the early 1950s, adenocarcinoma comprised about 5% of lung cancers and appeared to be unrelated to smoking. In the 1960s and 1970s, adenocarcinoma increased sharply, and became strongly related to cigarette smoking. METHODS: We analyzed time trends in lung cancer histology with changes in cigarette design and Tobacco Industry actions over six decades. We utilized SEER data on 419,941 lung cancers diagnosed between 1973 and 2011 to analyze time trends of age-standardized incidence rates of five histologic subtypes: adenocarcinoma, squamous cell, small cell, large cell, and adenosquamous carcinoma RESULTS: As time progressed, the percentage of lung cancers that were adenocarcinomas dramatically increased from 29% (in 1973-1974) to 55% (in 2010-2011). During this 38-year period, the percentage of lung cancers that were squamous cell carcinomas decreased from 41% to 26%. Among all patients, adenocarcinoma incidence surpassed squamous cell carcinoma by 1985-1989 to become the most common histologic subtype. Adenocarcinoma surpassed squamous cell carcinoma in 1990-1994 in men, while it was already most common in women by 1973-1974. Adenocarcinoma rose 77% in men from 1973-1974 to 1990-1994, while it rose 197% in women between 1973-1974 and 2005-2006. Among whites, adenocarcinoma surpassed squamous cell carcinoma by 1985-1989, while this occurred among blacks by 1990-1994. It was already most common among other race individuals in 1973-1974. Adenocarcinoma was already most common among patients < 50 yrs of age by 1973-1974, while adenocarcinoma rapidly increased and surpassed squamous carcinoma in all other age groups by 1990-1994. CONCLUSIONS: The frequency of adenocarcinoma of the lung has dramatically increased over the last six decades from that of an uncommon lung cancer subtype comprising about 5% of lung cancers to its current status as the most common form of lung cancer. Since inception of the SEER database in 1973, adenocarcinoma rose from 29% to 55% of lung cancers in the US. Adenocarcinoma incidence is higher that that of all other lung cancer subtypes combined. It is the most common histology in men and women, in whites, blacks, and other-races, and in all age groups. CLINICAL IMPLICATIONS: The role of Big Tobacco in leading to creation of the current epidemic of smoking-related adencarcinoma of the lung will be addressed in a companion presentation submitted to this meeting. DISCLOSURE: The following authors have nothing to disclose: Gary Strauss, Alejandro Moreno-Koehler, Matthew Finkelman No Product/Research Disclosure Information

Changes in tar yields and cigarette design in samples of Chinese cigarettes, 2009 and 2012.

China is home to the greatest number of smokers as well as the greatest number of smoking-related deaths. An active and growing market of cigarettes marketed as 'light' or 'low tar' may keep health-concerned smokers from quitting, wrongly believing that such brands are less harmful. This study sought to observe changes in cigarette design characteristics and reported tar, nicotine and carbon monoxide (TNCO) levels in a sample of cigarette brands obtained in seven Chinese cities from 2009 to 2012. Cigarettes were purchased and shipped to Roswell Park Cancer Institute, where 91 pairs of packs were selected for physical cigarette design characteristic testing and recording of TNCO values. Data analysis was conducted using SPSS, and was initially characterised using descriptive statistics, correlations and generalised estimating equations to observe changes in brand varieties over time. Reported TNCO values on packs saw mean tar, nicotine and CO levels decrease from 2009 to 2012 by 7.9%, 4.5% and 6.0%, respectively. Ventilation was the only cigarette design feature that significantly changed over time (p<0.001), with an increase of 31.7%. Significant predictors of tar and CO yield overall were ventilation and per-cigarette tobacco weight, while for nicotine tobacco moisture was also an independent predictor of yield. The use of ventilation to decrease TNCO emissions is misleading smokers to believe that they are smoking a 'light/low' tar cigarette that is healthier, and is potentially forestalling the quitting behaviours that would begin to reduce the health burden of tobacco in China, and so should be prohibited.

Changing rates of adenocarcinoma of the lung.

Over the past several decades, adenocarcinoma of the lung has been increasing as a fraction of all lung cancer. Examination of the available evidence led the 2014 Report of the Surgeon General to conclude that the increases in the rates of adenocarcinoma among smokers in the U.S. were a result of changes in cigarette design and composition over the past 6 decades. While a causal link to design and composition changes as a whole is clear, the changes that have been implemented over the past several decades are not uniformly applied across all cigarette brands in the current market, raising questions about differences in risks among users of different cigarette brands. Recognition of the increased risks resulting from design and composition changes offers a corollary opportunity to reduce current disease risks by identifying and regulating the specific compositional and design changes that produced the increase in risk.

Has the lung cancer risk from smoking increased over the last fifty years?

BackgroundWe examine whether the lung cancer risk due to smoking has increased over time.MethodsLung cancer risk equations based on prospective mortality data collected from 1960 to 1972 were applied to 5-year birth-cohort-specific estimates of smoking behaviors among white males to estimate lung cancer mortality rates for U.S. white males from 1960 to 2000. These estimated rates were compared to U.S. white male mortality rates for the same birth cohorts.ResultsObserved birth-cohort-specific U.S. lung cancer mortality rates are substantially higher than those expected from changes in smoking behaviors, and the proportional difference increases with advancing calendar year. This trend persisted even when the duration term was increased in the risk equation. However, adjusting for changes in cigarette design over time by adding a term for the duration of smoking after 1972 resulted in the predicted rates closely approximating the observed U.S. mortality rates.ConclusionLung cancer risk estimates observed during the 1960s under predict current lung cancer mortality rates in U.S. white males. Adjustment for the duration of smoking after 1972 results in estimates that reasonably approximate the observed U.S. lung cancer mortality, suggesting that lung cancer risks from smoking are increasing in the United States coincident with changes in cigarette design.

Do changes in cigarette design influence the rise in adenocarcinoma of the lung?

BackgroundIncidence rates for adenocarcinoma of the lung are increasing and are higher in the United States than in many other developed countries. We examine whether these trends may be associated with changes in cigarette design.MethodsLung cancer risk equations based on observations during 1960–1972 from the American Cancer Society Cancer Prevention Study I are applied to 5-year birth cohort–specific estimates of changes in smoking behaviors to predict birth cohort–specific rates of squamous cell carcinoma and adenocarcinoma of the lung among US White men for the period 1973–2000. These expected rates are compared to observed rates for the same birth cohorts of White men in the US Surveillance, Epidemiology and End Results (SEER) data.ResultsChanges in smoking behaviors over the past several decades adequately explain the changes in squamous cell carcinoma rates observed in the SEER data. However, predicted rates for adenocarcinoma do not match the observed SEER data without inclusion of a term increasing the risk for adenocarcinoma with the duration of smoking after 1965.ConclusionThe risk of developing squamous cell carcinoma from smoking appears to have remained stable in the United States over the past several decades; however, the risk of adenocarcinoma has increased substantially in a pattern temporally associated with changes in cigarette design.

Congress report: 12th World Conference on Lung Cancer – a step forward in lung cancer treatment. Seoul 2007

The present report gives a scope on relevant abstracts presented at the 12th World Conference of Lung Cancer held in Seoul, South Korea, in September 2007. Some data will directly influence the daily routine of thoracic oncologists. The most important is the intention of the International Association for the Study of Lung Cancer IASLC to modify the staging system. For example, T4 tumours with satellite nodules will be reclassified as T3, and nodules in the ipsilateral lung from M1 to T4. In the first-line treatment of stage IIIB/IV patients the combination of cisplatin/pemetrexed was equally effective as the control arm applying cisplatin/gemcitabine with a lower rate of side effects. Interestingly, patients with adenocarcinomas and large cell carcinomas showed a significant survival benefit using the new combination which might be explained by divergent enzymatic activity between the histological subtypes. Gefitinib, applied in the second line setting, showed similar efficacy when compared with docetaxel, even in a non-Asian population. Maybe, the gefitinib story has now to be discussed again. The knowledge on predictive markers for an individualised application of targeted therapies is improving, but at the moment this does not influence our daily practice. The role of smoking in lung cancer was discussed in the presidential session. It was stated that the dramatic increase of adenocarcinomas in relation to other NSCLC subtypes is consistent with the hypothesis that changes in cigarette design and composition were the major factors responsible for this development. The use of filter vents reduced the resistance to draw allowing smokers to take bigger, deeper puffs thus facilitating the delivery of smoke particles deep into the airways. In conclusion one can say that the international effort to improve lung cancer outcome is effective, however, the clinically relevant steps are still small.

Creation of an epidemic: The tobacco industry (TI) and smoking-related adenocarcinoma (AD) of the lung

7583 Background: When epidemiologic research first demonstrated an association between cigarette smoking (CS) and lung cancer (LC) in the 1950s, AD comprised about 5% of LCs and was only weakly related to CS. In the 1960s and 1970s, AD increased sharply, and became strongly related to CS. Methods: We conducted an epidemiological and ecological analysis correlating time trends in LC histology with changes in cigarette design and TI actions over the past 30 yrs. We utilized SEER data on 307,797 LCs diagnosed from 1975 to 2003 to analyze time trends of age-standardized incidence rates of each LC subtype: AD, squamous (SQ), small cell, and large cell. Comparisons were drawn based on sex, race, and age. Because SEER contains no data on CS, other sources were utilized to correlate changing histology to time trends in smoking prevalence, the changing cigarette, and TI actions. Results: Among all pts, AD surpassed SQ by 1980–84 to become the most common histology. AD increased 62% from 1975–79 to 1995–99, but fell 8% in 2000–03. SQ peaked in 1980–84 and dropped 35% by 2000–03. AD surpassed SQ in 1985–89 in men, while AD was already most common in women by 1975–79. AD rose 38% in men from 1975–79 to 1995–99, while it doubled in women during this interval. Among whites, AD surpassed SQ by 1980–84, although this did not occur among blacks for another decade. Nonetheless, AD incidence has consistently been higher in black men than in other subgroups. AD was already most common in pts &lt;50 yrs by 1975–79, while AD rapidly increased and surpassed SQ in all other age groups by 1990–94. By 2000–03, AD comprised 47% of all LCs (42% in men; 52% in women; 59% in pts &lt;50 yrs). Currently, AD is the most common histology in both sexes, races, and in all age groups. Trends in AD correlate with the wide-scale adoption by smokers of filtered and low tar cigarettes, and with increasing nitrosamine levels in cigarettes. Conclusions: The rise of AD, particularly in women and younger persons, is consistent with the hypothesis that changes in cigarette design and composition was responsible for this rise. These changes were introduced by the TI in response to mounting evidence that CS caused other forms of LC. While low tar cigarettes do not reduce LC risk, their adoption appears to be responsible for creating an epidemic of smoking-related lung AD. No significant financial relationships to disclose.

Worldwide trends in lung cancer pathology

Molecular profiling studies serve to remind us that lung cancer is a complex disease, with different phenotypes that are characterized by variation in morphology as well as molecular composition. Over recent decades, there appear to be worldwide shifts in the relative frequencies of various phenotypic patterns of lung cancer, which are even more striking than changes in the overall incidence of lung cancer. This review summarizes major worldwide trends in lung cancer pathology, which can be explained in part, but not entirely, by changes in cigarette design. Characterizing these trends will be important for recognizing contributions of carcinogens other than tobacco smoke to the worldwide problem of lung cancer.

Changing trends in incidence of lung cancer by histologic type in Scotland.

Lung cancer is a major public health concern worldwide. Our study aims to examine trends in incidence of lung cancer in Scotland during 1959-97 and by histologic type for 1975-97. In Scotland, lung cancer is the most commonly diagnosed cancer in men and is the second most commonly diagnosed cancer in women. Due to poor survival rates, trends in incidence and mortality display similar patterns. Within the United States and many parts of Europe, falls in the incidence of squamous cell carcinoma have occurred whilst the incidence of adenocarcinoma has increased. Data were extracted from the Scottish Cancer Registry. Trends in incidence were examined by standardising rates to the World Standard Population. Age-specific rates were examined by year of diagnosis and mid year of birth. In Scotland the incidence of lung cancer in men has fallen since the late 1970s, whereas incidence in women has continued to increase. Incidence rates of adenocarcinoma have increased over time but squamous cell carcinoma remains the predominant type of lung cancer in Scotland. The quality of lung cancer registration data has improved over time, although a large proportion of lung cancers (>20%) are not microscopically verified. Changes in histologic types are unlikely to be solely due to diagnostic advances. Rates of adenocarcinoma have increased steadily over time, and this may be due to changes in cigarette design during the 1950s.

Health impact of “reduced yield” cigarettes: a critical assessment of the epidemiological evidence

Cigarettes with lower machine measured “tar” and nicotine yields have been marketed as “safer” than high tar products over the last four decades, but there is conflicting evidence about the...

Lung cancer mortality rates in birth cohorts in the United States from 1960 to 1994

We sought to describe the changing death rates from lung cancer in the US white population in sequential birth cohorts, adjusting for cohort smoking prevalence and duration. We searched the US mortality database (1960–1994) for all deaths among whites in which lung cancer was listed as the underlying cause of death. To determine the population at risk for lung cancer, we used the 1970, 1978–1980, and 1992 National Health Interview Surveys to estimate the annual number of current and recent smokers (those who had quit within 5 years) in 11 5-year birth cohorts, starting in 1901. We then determined annual lung cancer mortality rates for each birth cohort, stratified by sex and adjusting for the prevalence and duration of smoking. The population-based rates of lung cancer mortality were much higher among men than among women across all ages and birth cohorts, reflecting higher smoking rates among men. These differences decreased after we controlled for current and recent smoking within the cohorts and were slightly increased in women after we controlled for duration of smoking. Differences in lung cancer death rates across birth cohorts of US men and women primarily reflect differences in the prevalence and duration of smoking in these birth cohorts. Changes in cigarette design that have greatly reduced tar yields have a relatively small effect compared with that of people's smoking status and duration of smoking.

Cigarette smoking and changes in the histopathology of lung cancer.

Adenocarcinoma of the lung, once considered minimally related to cigarette smoking, has become the most common type of lung cancer in the United States. The increased incidence of this cancer might be explained by advances in diagnostic technology (i.e., increased ability to perform biopsies on tumors in smaller, more distal airways), changes in cigarette design (e.g., the adoption of filtertips), or changes in smoking practices. We examined data from the Connecticut Tumor Registry and two American Cancer Society studies to explore these possibilities. Connecticut Tumor Registry data from 1959 through 1991 were analyzed to determine whether the increase in lung adenocarcinoma observed during that period could be best described by birth cohort effects (i.e., generational changes in cigarette smoking) or calendar period effects (i.e., diagnostic advances). Associations between cigarette smoking and death from specific types of lung cancer during the first 2 years of follow-up in Cancer Prevention Study I (CPS-I), initiated in 1959) and Cancer Prevention Study II (CPS-II, initiated in 1982) were also examined. Adenocarcinoma incidence in Connecticut increased nearly 17-fold in women and nearly 10-fold in men from 1959 through 1991. The increases followed a clear birth cohort pattern, paralleling gender and generational changes in smoking more than diagnostic advances. Cigarette smoking became more strongly associated with death from lung adenocarcinoma in CPS-II compared with CPS-I, with relative risks of 19.0 (95% confidence interval [CI] = 8.3-47.7) for men and 8.1 (95% CI = 4.5-14.6) for women in CPS-II and 4.6 (95% CI = 1.7-12.6) for men and 1.5 (0.3-7.7) for women in CPS-I. The increase in lung adenocarcinoma since the 1950s is more consistent with changes in smoking behavior and cigarette design than with diagnostic advances.