International Epidemiology Institute, 1455 Research Blvd, Ste 550, Rockville, MD 20850, USA.
J Natl Cancer Inst. 2011 May 18;103(10):810-6. doi: 10.1093/jnci/djr102. Epub 2011 Mar 23.
Menthol cigarettes, preferred by African American smokers, have been conjectured to be harder to quit and to contribute to the excess lung cancer burden among black men in the Unites States. However, data showing an association between smoking menthol cigarettes and increased lung cancer risk compared with smoking nonmenthol cigarettes are limited. The Food and Drug Administration is currently considering whether to ban the sale of menthol cigarettes in the United States.
We conducted a prospective study among 85,806 racially diverse adults enrolled in the Southern Community Cohort Study during March 2002 to September 2009 according to cigarette smoking status, with smokers classified by preference for menthol vs nonmenthol cigarettes. Among 12,373 smokers who responded to a follow-up questionnaire, we compared rates of quitting between menthol and nonmenthol smokers. In a nested case-control analysis of 440 incident lung cancer case patients and 2213 matched control subjects, using logistic regression modeling we computed odds ratios (ORs) and accompanying 95% confidence intervals (CIs) of lung cancer incidence, and applied Cox proportional hazards modeling to estimate hazard ratios (HRs) of lung cancer mortality, according to menthol preference.
Among both blacks and whites, menthol smokers reported smoking fewer cigarettes per day; an average of 1.6 (95% CI = 1.3 to 2.0) fewer for blacks and 1.8 (95% CI = 1.3 to 2.3) fewer for whites, compared with nonmenthol smokers. During an average of 4.3 years of follow-up, 21% of participants smoking at baseline had quit, with menthol and nonmenthol smokers having equal odds of quitting (OR = 1.02, 95% CI = 0.89 to 1.16). A lower lung cancer incidence was noted in menthol vs nonmenthol smokers (for smokers of <10, 10-19, and ≥ 20 cigarettes per day, compared with never smokers, OR = 5.0 vs 10.3, 8.7 vs 12.9, and 12.2 vs 21.1, respectively). These trends were mirrored for lung cancer mortality. In multivariable analyses adjusted for pack-years of smoking, menthol cigarettes were associated with a lower lung cancer incidence (OR = 0.65, 95% CI = 0.47 to 0.90) and mortality (hazard ratio of mortality = 0.69, 95% CI = 0.49 to 0.95) than nonmenthol cigarettes.
The findings suggest that menthol cigarettes are no more, and perhaps less, harmful than nonmenthol cigarettes.
薄荷醇香烟受到非裔美国吸烟者的青睐，据推测，它们更难戒掉，并导致美国黑人的肺癌负担过重。然而，与吸非薄荷醇香烟相比，显示吸薄荷醇香烟与肺癌风险增加之间存在关联的数据有限。美国食品和药物管理局目前正在考虑是否在美国禁止销售薄荷醇香烟。
我们根据吸烟状况，对参加 2002 年 3 月至 2009 年 9 月期间南方社区队列研究的 85806 名不同种族的成年人进行了一项前瞻性研究，吸烟者分为喜欢薄荷醇与非薄荷醇香烟的人群。在回答了随访问卷的 12373 名吸烟者中，我们比较了薄荷醇和非薄荷醇吸烟者之间的戒烟率。在对 440 例肺癌新发病例患者和 2213 例匹配对照进行嵌套病例对照分析中，我们使用逻辑回归模型计算了肺癌发病率的优势比（OR）及其 95%置信区间（CI），并应用 Cox 比例风险模型估计了肺癌死亡率的风险比（HR），这是根据薄荷醇偏好来确定的。
在黑人和白人中，薄荷醇吸烟者报告的每天吸烟量较少；黑人每天少吸 1.6 支（95%CI = 1.3 至 2.0），白人每天少吸 1.8 支（95%CI = 1.3 至 2.3），与非薄荷醇吸烟者相比。在平均 4.3 年的随访期间，有 21%的基线吸烟者已经戒烟，薄荷醇和非薄荷醇吸烟者戒烟的几率相同（OR = 1.02，95%CI = 0.89 至 1.16）。与从不吸烟者相比，吸薄荷醇香烟的肺癌发病率较低（对于每天吸烟<10、10-19 和≥20 支的吸烟者，OR=5.0 比 10.3、8.7 比 12.9 和 12.2 比 21.1）。肺癌死亡率也呈现出类似的趋势。在调整吸烟包年数的多变量分析中，薄荷醇香烟与较低的肺癌发病率（OR = 0.65，95%CI = 0.47 至 0.90）和死亡率（死亡率的风险比= 0.69，95%CI = 0.49 至 0.95）相关，而非薄荷醇香烟。
研究结果表明，薄荷醇香烟并不比非薄荷醇香烟更有害，甚至可能危害更小。
