Impact of filter cigarette smoking on lung cancer histology

Stellman, Steven D.; Muscat, Joshua E.; Hoffmann, Dietrich; Wynder, Ernst L.

Background. The rates of lung adenocarcinoma cancer have risen more rapidly than the rates of lung squamous cell cancer over the past 2 decades.

Methods. A case–control study was carried out to assess the impact of long-term filter cigarette smoking on the risk of squamous cell carcinoma (SCC) and adenocarcinoma (AC) of the lung.

Results. Odds ratios for SCC among subjects who had smoked only filter cigarettes were reduced relative to lifetime nonfilter cigarette smokers by 30% for men and by 60% for women, but no risk reduction was observed for AC of the lung.

Conclusion. The predominance of AC over SCC may be due in part to the fact that smokers of very low yield cigarettes tend to compensate for the lower nicotine levels by inhaling more deeply and frequently, leading to greater exposure of the peripheral lung to the carcinogens in tobacco smoke, and in part to the increased concentration of nitrosamines that preferentially produce AC in laboratory animals.


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Preventive Medicine

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November 11, 2014


One of the great unresolved paradoxes of smoking and lung cancer is the massive shift in histology over 50 years from squamous cell carcinoma, principally affecting the central trachea and bronchi, and adenocarcinoma, appearing more often in the peripheral lung. This study provided evidence for the hypothesis that the shift in histology was due in part to marketplace changes in cigarette filtration and tar/nicotine content. We were subsequently able to test this hypothesis using CT scans and other clinical data in over 300 lung cancer cases diagnosed at Columbia and Memorial Sloan-Kettering (Brooks et al., Cancer Epidemiol Biomarkers Prev 2005; 14(3):576-81). We did in fact find peripheral tumor location to occur more often in smokers of lower-tar cigarettes. The long-term histology shift, however, remains unexplained.