By Norra MacReady
SEOUL, SOUTH KOREA -- September 5, 2007 -- Lung cancer risk is higher with hand-rolled cigarettes than with the standard manufactured kind, according to findings presented here at the 12th World Conference on Lung Cancer (WCLC).
These data suggest that taxes that make standard cigarettes more expensive could be misguided, as they might encourage more people to start smoking the homemade kind, one expert warned.
In this prospective, epidemiological study, Heidi B. Rolke, MD, Senior Physician, Department of Pulmonology, Sorlandet Hospital, Kristiansand, Norway, and her associate Frode Gallefoss, MD, PhD, submitted questionnaires about smoking habits to everyone who developed lung cancer in Southern Norway between June 14, 2002, and June 13, 2005.
During the study period, 355 people developed lung cancer, of whom 296 (83%) had used hand-rolled cigarettes and 37 (10.4%) used fabricated cigarettes. The remaining patients had never smoked. Smokers who rolled their own consumed 32.3 pack-years of tobacco, compared with 40 pack-years consumed by smokers of standard cigarettes (P =.023), and smoked 15 cigarettes per day, compared with 20 smoked by users of manufactured cigarettes (P <.0001).
Norway is "a bit special" in its wide use of hand-rolled cigarettes, said Dr. Rolke, who presented the findings on September 3. One-third of all the tobacco sold there is in the form of tobacco packed for hand rolling, and of people who smoke, 44% of the men and 28% of the women say they use the hand-rolled kind. In southern Norway, the proportion is even higher: fully 90% of smokers prefer to roll their cigarettes themselves.
The fact that smokers of hand-rolled cigarettes smoked fewer cigarettes per day and consumed fewer pack-years of tobacco supports the hypothesis that those cigarettes are more dangerous than the pre-fabricated kind, Dr. Rolke said. This is not surprising, given that hand-rolled cigarettes have a much higher concentration of carcinogenic compounds. They contain, on average, 1 to 3 mg of nicotine, compared with 0.1 to 1.5 mg in fabricated cigarettes, and 22 to 35 mg of tar, versus 1 to 15 mg in their fabricated counterparts.
The levels of tar and nicotine in fabricated or manufactured cigarettes are fairly standard around the world, while those in hand-rolled cigarettes vary widely, said Jonathan M. Samet, MD, Chairman, Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States.
Many governments tax manufactured cigarettes, not only to increase revenues but also with the aim of discouraging people to smoke. However, "one concern is that, as manufactured cigarettes become increasingly expensive, people will roll their own," explained Dr. Samet, who was not involved in this study. "These findings suggest that perhaps the risk [of lung cancer] is higher among those who roll their own."
The solution, he said, is to make tobacco prices consistent, so that smokers have less incentive to favor the hand-rolled kind over manufactured cigarettes -- and, of course, to keep encouraging people to quit.
[Presentation title: Relationship Between Hand-Rolled Cigarettes and Primary Lung Cancer: A Norwegian Experience. Abstract C8-01]
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