Compensation as a risk factor for lung cancer in smokers who switch from nonfilter to filter cigarettes

The likelihood of increasing the number of cigarettes per day (cpd), a common method of compensation, in smokers who had switched from nonfilter to filter cigarettes was examined in newly diagnosed and histologically confirmed lung cancer cases including all cell types. There were a total of 1,242 lung cancer cases and 2,300 sex and age matched hospital controls interviewed in twenty hospitals from nine United States cities between 1969 and 1984. Lung cancer cases compensated more (as increased cpd after switching) than the controls. The mean increase in cpd for cases was about twice that of controls. Using switchers who did not increase cpd as the referent group, switchers who increased cpd showed a clearcut dose-response relationship for lung cancer with increasing levels of compensation. The odds ratio increased from 1.2 to 2.4 in males and 1.7 to 3.8 in females corresponding to increases of 1-10 to 21+ cpd after switching. Findings from this study suggest that increasing cpd after switching to filter cigarettes is an important risk factor for lung cancer that needs to be stressed in epidemiologic studies. Proponents of the idea that switching cigarettes is of some benefit, should also advocate that individuals who continue smoking should avoid compensation after switching.