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    2 Comments for this article
    Not only cigarettes, but other forms of smopking like sheesha, midwah,hookah are more pernicious
    Rajeev Gupta, MBBS, MD, DM (Cardiology) | Mediclinic Al Jowhara Hospital, Al Ain, UAE
    I congratulate the authors for dispelling the common myth: filtered cigarettes are less harmful. That said, other forms of smoking, common in some countries and cultures like sheesha, midwakh (sometimes spelled medwakh and also known as dokha), beedis, and hookah are more harmful. As per one estimate, smoking 1 time midwakh is equivalent to smoking 4-5 cigarettes, and smoking sheesha for 30-minute is equivalent to smoking 20-cigarettes over 30 minutes. Some people think, these forms of smoking are less harmful. Education is required about the much more pernicious nature of these non-cigarettes smokes.
    CONFLICT OF INTEREST: None Reported
    Effect of Socioeconomic Class on Mortality
    John Clark, MD | ANMC
    My clinical experience is patients most likely to smoke unfiltered cigarettes are poor, more likely to have significant co-morbidities, and less likely to receive routine medical care. Was any attempt made to adjust this analysis for health and socio-economic status between groups? It may be true that smoking unfiltered cigarettes identifies a cohort of patients at higher risk for lung cancer. However, the statement that "unfiltered cigarettes are the most dangerous" cannot be supported unless the patients were matched for co-morbidities, access to health care, and socioeconomic status.
    CONFLICT OF INTEREST: None Reported
    Research Letter
    October 21, 2019

    Association of Cigarette Type With Lung Cancer Incidence and Mortality: Secondary Analysis of the National Lung Screening Trial

    Author Affiliations
    • 1Health Equity and Rural Outreach Innovation Center (HEROIC), Ralph H. Johnson Veterans Affairs Hospital, Charleston, South Carolina
    • 2Thoracic Oncology Research Group, Medical University of South Carolina, Charleston
    • 3Hollings Cancer Center, Medical University of South Carolina, Charleston
    • 4Department of Public Health Sciences, Medical University of South Carolina, Charleston
    JAMA Intern Med. 2019;179(12):1710-1712. doi:10.1001/jamainternmed.2019.3487

    In response to increasing evidence implicating cigarette smoking as a cause of lung cancer in the 1950s, tobacco manufacturers introduced filtered and “lower-tar” cigarettes to allay consumer concerns, knowing they did not actually reduce health risks. Puncturing ventilation holes of varying sizes and numbers into the filter to dilute inhaled smoke became the optimum way to reduce tar yield.1

    Despite these changes, smoking remains responsible for 80% to 90% of lung cancer diagnoses and 5-year survival is 18%, highlighting the importance of prevention.2 Lung cancer screening with low-dose computed tomography has been shown to improve mortality, and tobacco treatment is a required component of effective screening. We investigated the association of filter status, tar level, and menthol flavor with lung cancer outcomes in the National Lung Screening Trial.

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