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Stephen Sidney, MD, MPH; Irene S. Tekawa, MA; Gary D. Friedman, MD; Marianne C. Sadler, MPH; Donald P. Tashkin, MD

Arch Intern Med. 1995;155(7):727-732.

Abstract
Background
Menthol combustion produces carcinogenic compounds such as benzo[a]pyrenes. Mentholated cigarettes are much more commonly smoked by black individuals than by white individuals. The incidence of lung cancer is much higher (60%) in black men than in white men, but it differs little by race in women. We examined the association of mentholated cigarette use with lung cancer in men and women because mentholated cigarette use could help to explain the higher incidence rate of lung cancer in black men than in white men.

Methods
The study population consisted of 11 761 members of the Northern California Kaiser Permanente Medical Care Program, Oakland (5771 men and 3990 women), aged 30 to 89 years, who underwent a multiphasic health checkup in 1979 through 1985 and reported that they were current cigarette smokers who had smoked for at least 20 years. Data were collected about current cigarette brand, duration of mentholated cigarette use, and other smoking characteristics. Follow-up for incident lung cancer cases (n=318) was carried out through 1991.

Results
The relative risk of lung cancer associated with mentholation compared with nonmentholated cigarettes was 1.45 in men (95% confidence interval, 1.03 to 2.02) and it was 0.75 in women (95% confidence interval, 0.51 to 1.11), adjusted for age, race, education, number of cigarettes smoked per day, and duration of smoking. Further adjustment for tar content and self-reported smoking intensity characteristics did not substantially alter the estimate of relative risk. A graded increase in risk of lung cancer with increasing duration of mentholated cigarette use was present in men.

Conclusion
This study suggests that there is an increased risk of lung cancer associated with mentholated cigarette use in male smokers but not in female smokers.

(Arch Intern Med. 1995;155:727-732)

Author Affiliations
From the Division of Research, Kaiser Permanente Medical Care Program, Oakland, Calif (Drs Sidney and Friedman and Mss Tekawa and Sadler); Pulmonary Division, University of California-Los Angeles, Medical Center (Dr Tashkin).

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