The FDA needs to tighten regulations on filtered cigarettes
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As an oncologist specializing in lung cancer, it has been encouraging to see more of my patients defeat this disease every year. And yet for one type of tumor — lung adenocarcinoma, which strikes the deepest parts of the lung — the opposite is happening. 

After a half century of U.S. progress reducing smoking-related illnesses, cigarettes have gotten more dangerous, and we see that today in the most common type of lung cancer that patients develop: adenocarcinomas.

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We understand what one of the reasons why cigarettes are more dangerous — and fixing that problem — is well within the jurisdiction of the U.S. Food and Drug Administration (FDA) if the agency chooses to act.

 

Clearing the air

In a study published this week by my colleagues and five other cancer centers across the United States, it seems the rise in cancers correlates to a rise in the popularity of "light" cigarettes over the last half century. We did not draw that conclusion lightly — we examined countless studies as well as internal tobacco company research documents and reports to explore the connection.

The conclusion is clear: the dangerous rise in adenocarcinoma could be countered by something as simple as a return to a more classic cigarette design.

Cigarettes today are more dangerous because the tobacco companies started putting tiny holes in the paper filters. Cigarette manufacturers conducted studies using a smoking machine (versus human subjects) to test how exposures differed with the new filters.

But the study design was flawed and allowed manufacturers to mix air with the resulting smoke to dilute and skew measurements of actual human exposure. The result? Cigarettes with more filter holes appeared to have lower tar yields, fooling smokers and scientists into thinking that cigarettes with more holes are safer.

These filtration holes are on almost every cigarette sold in the United States today. Smokers have been fooled because the smoother smoke made them think that the so-called “light” cigarettes were healthier, and they were advertised as being healthier. Today, the cigarette companies are not allowed to advertise cigarettes as “lights” or “ultralights”, but the holes are still there.  

Study after study has revealed why those ventilation holes make the cigarettes more dangerous. They cause the cigarette to burn more slowly and at a lower temperature. The result is more smoldering and more incomplete combustion, which produces a higher amount of toxic substances.

They also allow for the cigarette to be smoked differently and deliver nicotine at lower amounts, so that smokers inhale more smoke, which contains those higher amounts of toxic substances. Higher puffs let more smoke into the lungs. These chemicals get into the areas where adenocarcinomas are more likely to develop. There are other reasons why cigarettes are more dangerous, but this research focused on the holes and the FDA has the authority and right now to ban them.

Closing the holes

The 2009 Family Smoking Prevention and Tobacco Control Act (TCA) gives the FDA the authority to regulate tobacco products and issue “product standards” when evidence shows that it is necessary to protect public health.

Based on the findings in our study, such evidence is impossible to ignore — cigarette ventilation provides no public health benefit and appears to have added to cigarettes' well-known dangers.

The FDA now has an opportunity to ask cigarette manufacturers to clarify what potential public health benefit may exist for filter ventilation, and whether or not those benefits outweigh the clear risks. In the absence of benefit, the FDA should consider banning filter ventilation.

Despite progress reducing smoking rates, and some advances in earlier detection of lung cancer, more than 150,000 Americans will die from the disease this year. Lung cancer remains the leading cancer killer in this country — any action that can reduce that tragic loss of life must be taken.

When visiting with patients misled by the promise of a safer smoking experience, the impact of light cigarettes is obvious to me. In almost any form, smoking is toxic, and that message could not be clearer. It is time for federal regulation to remove any doubt. Smokers need to know that cigarettes have gotten more dangerous over the last 40 to 50 years, so if they are still smoking now, they need to quit. They have plenty of reasons to quit, and this is one more.

 

Dr. Peter Shields is a medical oncologist who focuses on the treatment of lung cancer and research into prevention of lung and breast cancer at The Ohio State University Comprehensive Cancer Center — Arthur G. James Cancer Hospital and Richard J. Solove Research Institute. His studies investigate the causes of cancer and develop biomarkers of cancer risk.


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