IASLC: Hand-Rolled Cigarettes More Carcinogenic than Store Bought

SEOUL, South Korea, Sept. 4 -- Hand-rolled cigarette smokers appear to be at higher risk of lung cancer than those who smoke commercially manufactured brands, researchers found.
Onset of lung cancer was earlier among Norwegian smokers who primarily rolled their own cigarettes-at an average of 7.7 fewer pack-years of smoking history-compared with those who bought cigarettes at the store.
This despite the fact that hand-rolled users smoked substantially fewer cigarettes a day (P<0.0001) according to results of the lung cancer cohort study reported here at the International Association for the Study of Lung Cancer meeting.
The findings may not be directly applicable to other countries because Norway is one of the only strongholds of hand-rolled cigarette use in the developed world, said Heidi B. Rolke, M.D., of the Sorlandet Hospital in Kristiansand, Norway, who presented the results.
However, "hand-rolled cigarettes are going to be increasing in the United States," commented Carolyn Dresler, M.D., of the Arkansas Department of Health in Little Rock, Ark.
"As you increase taxes [on cigarettes]," she said, "it's been shown in other parts of the world that people will . . . go to more hand-rolled cigarettes."
But, there has been little study done on cigarettes beyond manufactured products, commented Jonathan M. Samet, M.D., of John Hopkins University.
The researchers conducted a prospective epidemiologic study in which they sent a questionnaire on smoking habits to all 479 patients with a first diagnosis of primary lung cancer living in southern Norway. Among them, 21% had small cell lung cancer and 70% had non-small cell lung cancer while the remainder had unknown histology.
Six percent of respondents had never smoked. Among smokers, the vast majority (88%) smoked hand-rolled rather than commercially manufactured cigarettes.
Compared with smokers of commercially prepared cigarettes, hand-rolled cigarette smokers reported:
Fewer cigarettes per day on average (14.9 versus 19.8, P<0.0001).
Fewer maximum cigarettes per day on average (20.3% versus 25.5%, P<0.05).
Fewer pack-years of smoking in their lifetime (32.3 versus 40.0, P=0.018).
Notably, though, more smokers who rolled their own cigarettes started smoking at an early age (55% started by age 16 versus 36%, P=0.04). The mean age at "smoking debut" was about a year earlier (17.2 versus 18.5).
"Early smoking debut increases the carcinogenic risk," Dr. Rolke said. "This might, of course, be seen as a confounder."
But, at diagnosis, age was similar between groups (66.8 hand-rolled cigarettes versus 66.6 manufactured).
The reason for elevated carcinogenicity may be that individuals pack cigarettes tighter with more tobacco than do manufacturers, Dr. Rolke said. Hand-rolled cigarettes have been shown to contain about 10 times as much nicotine as manufactured cigarettes (1 to 3 mg versus 0.1 to 0.5 mg) and substantially more tar as well (22 to 35 mg versus 1 to 15 mg).
"So there's an indication here that we should be concerned if rising prices for manufactured cigarettes would lead to substitution," Dr. Samet concluded, "and [the findings] may give us a clue that some of the kinds of hand-rolled cigarettes used in other places like India are important."
In Norway, the price for hand-rolled cigarettes was lower than for commercially manufactured cigarettes, Dr. Rolke said.
This may also hold a lesson for other countries, Dr. Samet said.
"If there is a lack of uniformity of prices across tobacco products then there may be switching," he said. "I think the Norway example points to what must be done, which is to make sure that per cigarette smoke the price is the same for different products."
Nevertheless, "the message is going to be the same that the patient needs to stop smoking … hand-rolled or manufactured," Dr. Dresler said.
Drs. Rolke, Samet, and Dresler reported no conflicts of interest. Primary source: International Association for the Study of Lung Cancer meetingSource reference: Rolke HB, Gallefoss F "Relationship between hand rolled cigarettes and primary lung cancer: a Norwegian experience" IASLC meeting 2007; C8-01.