Tobacco Control 2000;9:351–354 351 Tob Control: first published as 10.1136/tc.9.3.352a on 1 September 2000. Downloaded from animals. The methods used have been Dr P Bjucher (France), Professor I Plesko (Slovakia), described by HoVmann.56 Professor LJ Denis (Belgium), Professor H Senn (Switzerland), Professor H Zur Hausen (Germany), LETTERS TO The cigarettes were purchased in 29 coun- Professor H Hansen (Denmark), Professor U tries by volunteers (the International Veronesi (Italy), Dr K Bjartveit (Norway), THE EDITOR Cigarette Variation Group), who purchased Mr S Woodward (Australia), Dr V Tkeshelashvili (Georgia), Mr B De Blij (Netherlands), Professor M the premium example available, which were, Dicato (Luxembourg), Professor S Eckhardt in most cases, filtered. No “light”, “mild”, (Hungary), Mr T Hudson (Ireland), Dr J Mackay “menthol” or other variants were purchased. (Hong Kong), Professor Niu Shiuru (China), Dr I Letters intended for publication should be a Forty cigarettes of each brand were analysed Tannock (Canada), Dr H Vertio (Finland), Dr Zakelj maximum of 500 words, 10 references, and one (Slovenia), Professor W Zatonski (Poland), Ms M at the Institute of Carcinogenesis in Moscow. Ziv (Israel), Mr M Pertschuk (USA), Dr Estevez table or figure, and should be sent to the editor at Not all brands were available in each country (Argentina), Dr A Junquiera (Brazil), and Professor the address given on the inside front cover. Those and it is not known whether those purchased Abdrakhmanov (Kasakhstan).This work was con- responding to articles or correspondence published ducted within the framework of support from the were locally produced, imported or Italian Association for Cancer Research (Associazone in the journal should be received within six weeks smuggled, or how long they had been stored of publication. per la Ricerca sul Cancro). before sale. This is not a representative sample—the cigarettes were acquired as they NIGEL GRAY DAVID ZARIDZE* Variation within global cigarette brands would be by the person in the street. Our aim in tar, nicotine, and certain nitro- CHRIS ROBERTSON was to investigate international variation. L KRIVOSHEEVA* samines: analytic study The results of the tar and nicotine testing N SIGACHEVA* were unremarkable. Generally they con- PETER BOYLE EDITOR,—While the content of food, formed to the packet statement (where AND THE INTERNATIONAL CIGARETTE pharmaceutical products, drugs, and many present). Tar yield ranged from 10.6 mg/cig VARIATION GROUP other consumer goods are tightly regulated to 15.7 mg/cig for Camel, 11.8 mg/cig to Division of Epidemiology and Biostatistics, by governments, tobacco products, surpris- 20.4 mg/cig for Lucky Strike, and 8.4 mg/cig European Institute of Oncology, ingly, are not. to 15.9 mg/cig for Marlboro. Nicotine yield Via Ripamonti 435, 20141, Milan, Italy Tar and nicotine yields of cigarettes have ranged from 0.85 mg/cig to 1.3 mg/cig for *Institute of Carcinogenesis, progressively, but not universally, appeared on Camel and Lucky Strike, and 0.68 mg/cig to Cancer Research Centre, cigarette packets and advertising since 1967. Russian Academy of Medical Sciences, 1.25 mg/cig for Marlboro. Kashirskoye Sh. 24, Moscow 115478, Russian Federation These figures have been used to justify terms DiVerences in nitrosamine yields were such as “light” and “mild” in descriptive substantial. There is a threefold diVerence Correspondence to: Professor Boyle advertising. In 1981 a US public health report between the lowest and highest yields of [email protected] concluded: “the preponderance of scientific NNK for Camel, a fivefold diVerence for evidence strongly suggests that the lower the Lucky Strike, and ninefold for Marlboro (fig 1 US Department of Health and Human Serv- “tar” and nicotine content of the cigarette, the ices. The health consequences of smoking: the 1 1). NNK and NNN yields are highly less harmful would be the eVect.” correlated (correlation 0.88, 95% confidence changing cigarette. A report of the Surgeon Some early reports concluded, plausibly, General, 1981. Rockville, Maryland: Public interval 0.83 to 0.93), so only NNK is shown Health Service, OYce of the Assistant Secre- that a decrease in lung cancer mortality could in the figure. tary for Health, OYce on Smoking and be ascribed to smoking reduced tar We have shown that a three- to ninefold Health, 1981. (DHHS Publication No (PHS) cigarettes, although more recent data2 suggest 81–50156.) variation in carcinogen dose can be given to 2 Thun MJ, Heath CW Jr. Changes in mortality that there is little if any diVerence in the long the smoker, without any warning, in products from smoking in two American Cancer term outcome of smoking “low tar” as that are trademarked and globally advertised. Society prospective studies since 1959. Prev 1997; :422–6. against “regular” cigarettes. Further there has In 19987 some of us proposed the setting of Med 26 been an increase in adenocarcinoma relative 3 Thun MJ, Lally CA, Flannery JT, Calle EE, http://tobaccocontrol.bmj.com/ upper limits on such carcinogens by Flanders WD, Heath CW Jr. Cigarette smok- to squamous carcinoma, more pronounced in establishing the market median as an initial ing and changes in the histopathology of lung women than men, and this may be caused by upper limit. Clearly lower nitrosamine cancer. J Natl Cancer Inst 1997;89:1580–6. the increases in tobacco specific nitrosamines 4 Levi F, Franceschi S, LaVecchia C, Randimbi- cigarettes can be, and are, produced, and son L, Te VC. Lung carcinoma trends by in cigarettes plus more intense (compensa- there is no excuse for the wide, within brand, histologic type in Vaud and Neuchatel, tory) smoking and deeper inhalation variations described here. Switzerland, 1974–1994. Cancer 1997; 34 :906–14. associated with modern cigarettes. We see these results as a compelling and 79 We decided to test three global brands 5 Brunnemann KD, Genoble L, HoVmann D. urgent argument for government regulation Identification and analysis of a new tobacco- (Camel, Lucky Strike, and Marlboro) for of carcinogen concentrations in cigarettes. specific N-nitrosamine - 4-(methylnitros- consistency of tar and nicotine yields and Obviously such regulation should go beyond amino)-1-(3-pyridyl)-1-butanone. Carcinogen- for two tobacco specific nitrosamines, esis 1987;8:465–9. carcinogens to other toxic, modifiable 6 Djordjevic MV, Brunnemann KD, HoVmann 4 - (methylnitrosamino)-1-(3-pyridyl)-1- substances, and to nicotine. D, Identification and analysis of a nicotine- butanone (NNK), and N-nitrosonornicotin derived N-nitrosamino acid and other nitro- (NNN). The former is a powerful lung samino acids in tobacco. Carcinogenesis 1989; adenocarcinogen, regardless of route of We thank the members of the International Cigarette 10:1725–31. on September 29, 2021 by guest. Protected copyright. Variation Group, who purchased and supplied the 7 Gray N, Boyle P, Zatonski W. Tar concentra- administration, and the latter is an cigarettes at their own expense. They are: Professor tions in cigarettes and carcinogen content. established oesophageal carcinogen in JG McVie (UK), Dr AK Kubik (Czech Republic), Lancet 1998;352:787–8. Camel Lucky Strike Marlboro 300 300 300 250 250 250 200 200 200 150 150 150 NNK (ng/cig) 100 NNK (ng/cig) 100 NNK (ng/cig) 100 50 50 50 0 0 0 UK UK UK Italy Italy Italy Peru USA USA USA Israel Israel Israel Brazil China Russia Russia France France France Poland Ireland Ireland Mexico Mexico Finland Finland Finland China 2 China 1 Holland Norway Norway Norway Belgium Belgium Belgium Portugal Slovakia Slovakia Hungary Hungary Slovenia Slovenia Slovenia Australia Australia Australia Denmark Denmark Denmark Lithuania Germany Germany Germany Argentina Argentina Argentina Czech Rep. Czech Rep. Czech Rep. Kazakhztan Hong Kong Hong Kong Hong Kong Switzerland Switzerland Switzerland Netherlands Netherlands South Africa Luxembourg Luxembourg Figure 1 Results of testing for NNK yields from three brands of cigarettes in various countries. www.tobaccocontrol.com 352 Letters, Books Tob Control: first published as 10.1136/tc.9.3.352a on 1 September 2000. Downloaded from Carbon monoxide in the expired air of Light cigarettes smokers who smoke so-called “light” Usual cigarettes brands of cigarettes 50 BOOKS 45 40 EDITOR,—Tobacco smoke is an important 35 source of carbon monoxide (CO). Smokers Book reviews and books of interest to with expired CO values of 11–21 parts per 30 million (ppm) are defined as mild smokers, % 25 “Tobacco Control” should be sent to the 20 whereas those with expired CO values of editor at the address given on the inside 15 more than 21 ppm are defined as heavy front cover. 10 smokers.1 We report on the expired CO read- 5 ings of smokers who smoke “light” brands 0 Tobacco war compared to those who smoke regular 0–10 11–20 21–30 31–40 41–50 > 50 brands. The approach chosen was designed Mean CO value (ppm) Tobacco war: inside the California to reflect real smoking habits, and was not battles. Stanton A Glantz, Edith D Figure 1 Distribution of carbon monoxide laboratory based. Many health agencies Balbach. Berkeley, California, measure tar and CO values using smoking (CO) readings of “light” cigarette smokers and regular cigarette smokers. University of California Press, 2000. machines under standardised laboratory conditions.2 However, cigarettes are not ISBN 0-520-22285-7. 469 pages. smoked by machines, and smokers may The method used in this study was very For a decade, since voters there approved a titrate their nicotine intake by varying their much related to the situation in real life, referendum question raising the state’s smoke inhalation and cigarette where consumers might be attracted by cigarette excise tax and assigning a portion of consumption.34 Here we show that there is “light” cigarettes because they assume these the revenue to a campaign to reduce tobacco no diVerence in CO concentrations in the will reduce their health risk.9 Other variables use, California has been a cockpit of conflict expired air of smokers who smoke “light” may aVect the present results, but it is likely between public health forces and the tobacco brands versus smokers who smoke regular that further studies will confirm the present industry.