New results appear to undercut the longstanding notion that individuals who smoke menthol cigarettes have a higher risk of lung cancer than those who smoke nonmenthol cigarettes. The data, drawn from an analysis of adults enrolled in a large community cohort study, showed that smokers of menthol cigarettes actually have a slightly lower lung cancer risk than nonmenthol smokers and are also less likely to die of the disease.

“Cigarette smoking remains the leading cause of premature death in the United States, but undue emphasis on reduction of menthol relative to other cigarettes may distract from the ultimate health prevention message that smoking of any cigarette is injurious to health,” said William J. Blot, PhD, with Vanderbilt-Ingram Cancer Center in Nashville, Tennessee, and colleagues.

They also noted that their observations are timely given that the FDA is currently deliberating about a possible nationwide ban on the sale of menthol cigarettes. The investigators compared quitting rates in 12,373 menthol and nonmenthol smokers after an average follow-up of 4.3 years.

Participants were drawn from the prospective Southern Community Cohort Study (SCCS) between March 2002 and September 2009. The SCCS is exploring disparities in cancer and other chronic diseases in 85,806 individuals aged 40 to 79 years who reside in 12 southern states, two-thirds of whom are black and the rest mostly non-Hispanic whites. The research group also identified 440 patients with lung cancer in the SCCS cohort and compared them with 2213 matched controls.

William J. Blot, PhD

Blot and associates said the incidence rates of lung cancer have long been established to be higher in black men than white men, although the reasons for the gap are not clear. Smoking prevalence has also been reported to be somewhat higher in black men than in white men. However, black men smoke fewer cigarettes per day, which makes it difficult to argue that differential smoking accounts for the racial gap in lung cancer risk. The much higher use of menthol cigarettes by black men has been proposed as a factor in this disparity, although there have been scarce data to support such a claim.

In their study, the Vanderbilt investigators documented a lower lung cancer incidence in menthol smokers than nonmenthol smokers. Of individuals who smoked ≥20 cigarettes per day, menthol smokers had 12.2 times the risk of lung cancer as individuals who had never smoked. Nonmenthol smokers were 21.1 times as likely to develop lung cancer as those who have never smoked.

Of current smokers, 86% of blacks reported a preference for menthol cigarettes compared with only 23% of whites. The results are in line with a recent national survey that found that 83% of blacks used menthol cigarettes versus 23% of whites. The analysis also showed that both black and white menthol smokers reported smoking fewer cigarettes per day than nonmenthol smokers. Overall, 21% of individuals who were smokers at baseline had quit at follow-up, with menthol and nonmenthol smokers equally likely to quit.

Blot and associates cited the use of a prospective design, in particular, as an important study strength. With a prospective design, data on smoking and other variables were obtained before the onset of lung cancer, which minimized the possibility of the recall bias that plagues retrospective case-control studies. Additional study strengths include its size and the enrollment of a large number of both blacks and nonblacks with a similar socioeconomic status.

The authors emphasized that they did not have detailed information on individuals’ use of menthol versus nonmenthol cigarettes, which may caused a misclassification of cigarette type.