Regardless of Cigarette Type, Smoking Associated With Increased Lung Cancer Risk, Mortality

smoking, chest x ray
This study confirms that smoking any type of cigarette (regular, light, or ultralight; unflavored or menthol; filtered or unfiltered) is associated with an increased risk for lung cancer and mortality.

Individuals who smoked light or ultralight cigarettes had similar mortality rates to those who smoked regular cigarettes, according to a research letter published in JAMA Internal Medicine.

Data from patients in the Lung Screening Trial were re-analyzed to determine whether baseline cigarette tar level (regular, light, or ultralight), flavor (unflavored or menthol), and filter status (filtered or unfiltered) was associated with lung cancer diagnosis, mortality, or all-cause mortality.

Among the 14,123 participants, 50% were current smokers throughout the study. Furthermore, 55% smoked regular cigarettes, 33% smoked light cigarettes, and 11.1% smoked ultralight cigarettes. In addition, 88.4% of participants smoked filtered cigarettes, while 11.4% smoked unfiltered cigarettes. After adjustment, unfiltered cigarette smokers were nearly 40% more likely to develop lung cancer and nearly twice as likely to die of lung cancer compared with individuals who smoked filtered cigarettes.

There was no difference in mortality outcomes between light/ultralight or flavored vs regular cigarette smokers. Furthermore, while individuals who smoked filtered cigarettes fared better than unfiltered cigarettes, these findings demonstrated that lung cancer mortality in filtered cigarette smokers to be 1600 per 100,000 persons compared with 34 lung cancer deaths per 100,000 persons in a never-smoking cohort. The difference, the researchers noted, most likely reflects the design features in filtered vs unfiltered cigarettes including the amount, density, blends of tobacco in the column, additives, and filter paper porosity. Yet, despite new cigarette designs, cigarette smoking continues to pose a tremendous health risk.

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“This study confirms that smoking filtered and unfiltered cigarettes is associated with increased risk of lung cancer incidence and mortality and is consistent with other studies in the literature,” The researchers wrote. “Tobacco companies marketed low-tar cigarettes to consumers as an alternative to quitting, suggesting that this improved health risks. Unfortunately, most smokers believe light/ultralight cigarettes reduce risk, and this misconception may dissuade them from quitting.”


Tanner NT, Thomas NA, Ward R, et al. Association of cigarette type with lung cancer incidence and mortality: secondary analysis of the National Lung Screening Trial [published online October 21, 2019]. JAMA Intern Med. doi:10.1001/jamainternmed.2019.3487