Less tar is not necessarily safer

People who switch to low-tar or light cigarettes from regular cigarettes are likely to inhale the same amounts of cancer-causing toxins and remain at high risk for developing smoking-related cancers and other diseases. Millions of people smoke low-tar, mild or light cigarettes, believing that they are less harmful than other cigarettes. But in a recent report from the United States National Cancer Institute (NCI), entitled Risks associated with smoking cigarettes with low machine-measured yields of tar and nicotine, experts conclude that changes in cigarette design and manufacturing over the past 50 years have not made smoking any safer.

Epidemiologists predicted in the late 1960s and 1970s that as more smokers used lower-yield products for longer periods of time, death rates from lung cancer would fall. Now, the NCI reports that choosing lower-yield cigarettes is not likely to reduce tar intake or disease risks. Furthermore, there is no evidence that switching to light or ultra-light cigarettes assists smokers in quitting. This might be because smokers who switch to low-tar or low-nicotine cigarettes from regular cigarettes compensate for the lower nicotine level by inhaling more deeply, taking larger or more frequent puffs, or increasing the number of cigarettes smoked per day. In 2001, about 172,000 Americans died of cancer because of their use of tobacco products (31% of all cancer deaths). This NCI report is the 13th volume in their 'Smoking and Tobacco Control Monograph Series', which began in 1991 to provide ongoing information about emerging public health issues in smoking.

Revising renal cancer therapy

A combination of surgery and immunotherapy might provide a desperately needed means of prolonging survival of metastatic renal-cell cancer patients. Renal cancer has poor prognosis and resists chemotherapy, leading many physicians to advocate aggressive surgery. The value of removing the affected kidney, however, has been debated for many years. Several studies have reported that cytokine treatment can improve renal cancer outcome. The authors combined these approaches by treating metastatic renal-cell cancer patients with radical nephrectomy followed by therapy with the cytokine interferon-α-2b. They found that the median survival of 120 patients who received surgery followed by interferon-α-2b was 11.1 months, whereas the average survival time for 121 patients who received interferon-α-2b therapy alone was only 8.1 months. Although the statistical significance of this study is debatable, the results do support those of a recent, smaller trial. The authors conclude that the combined treatment should be considered the standard of care in future Phase III trials.

ORIGINAL RESEARCH PAPER Flanagan, R. C. et al. Nephrectomy followed by interferon α-2b compared with interferon α 2b alone for metastatic renal-cell cancer. N. Engl. J. Med. 345, 1655–1659 (2001) [content page]

FURTHER READING Tannock, I. F. Removing the primary tumor after the cancer has spread. N. Engl. J. Med. 345, 1699–1700 (2001) [content page] | Mickisch, G. H. J. et al. Radical nephrectomy plus interferon-α-based immunotherapy compared with interferon α alone in metastatic renal-cell carcinoma: a randomised trial. Lancet 358, 966–970 (2001) [PubMed]