Review Suggests FDA Should Tighten Regulations on Filtered Cigarettes

A recent review has found evidence suggesting that the inclusion of ventilation in cigarette filters has contributed to the increased rate of lung adenocarcinoma among smokers. The review was published in the Journal of the National Cancer Institute.

“The smoke from cigarettes with ventilated filters provides false perceptions to the smoker of reduced harmfulness,” wrote Min-Ae Song, PhD, of the Ohio State University and James Cancer Hospital in Columbus, Ohio, and colleagues. “Filter ventilation affects how the tobacco burns, smoking behavior, and how the lung is exposed to carcinogens, so that it plausibly contributes to the increased adenocarcinomas by a cigarette that the smoker falsely believes is less harmful.”

The US Food and Drug Administration (FDA) now has authority to regulate cigarette design, and a 2014 Surgeon General’s Report concluded that changing the design of cigarettes has caused increases in the incidence of lung adenocarcinoma. Song and colleagues provided a weight-of-evidence review that included 3,284 citations from published scientific literature and internal tobacco company documents.

According to the review, filters were initially introduced to allow cigarettes to taste smoother. At the end of the 1960s, about 7% of marketed cigarettes had filter ventilation, but this rate increased to 94% to 100% by 1982.

Prior studies have shown that filter ventilation alters tobacco combustion, increasing smoke toxicants; allows for elasticity of use so that smokers inhale more smoke to maintain their nicotine intake; and causes a false perception of lower health risk.

Based on their review, the researchers believe that the addition of filter ventilation to cigarettes has contributed, at least in part, to the increased risk for lung adenocarcinomas. They used the Surveillance, Epidemiology, and End Results 9 database to calculate yearly age-adjusted incidence rates for adenocarcinoma, squamous cell carcinoma, and total lung cancer cases for men from 1975 to 2012. In addition, they used the Centers for Disease Control and Prevention WONDER Population Projections to compute the number of new adenocarcinoma and squamous cell carcinoma cases in US men from 2008 to 2012. They found an excess of 32,400 adenocarcinoma cases compared with squamous cell carcinoma cases.

“Based on the findings from this weight-of-evidence review, we would recommend that the FDA ask cigarette manufacturers to provide clear and convincing evidence that there is a public health benefit gained by filter ventilation in filter design and that the benefits outweigh any health risks,” the researchers concluded. “Absent such clear and convincing evidence from any source, the FDA should consider adopting a standard to prohibit filter ventilation.”