Cigarette smoking and male lung cancer risk with special regard to type of tobacco

Background The mortality rate from lung cancer (LC) increased sharply in Spain between 1957 and 1986. This increase has been related to a previous increase in cigarette smoking. Certain features of cigarette smoking which were frequent among Spanish smokers (use of black tobacco and use of cigarettes without filter) have been related to a higher risk of LC. Methods A hospital-based case-control study was conducted between December 1986 and June 1990. The 325 male patients with lung cancer included in the study (cases) were compared with 325 age-matched male controls without LC. Occupation and lifetime tobacco consumption were requested using a structured questionnaire. The LC odds ratios (OR) and 95% CI were estimated with multiple logistic regression. Results Lung cancer risk increased with cigarette consumption and duration of the habit. After adjusting for lifetime cigarette consumption and for socioeconomic level, LC risk was greater among black tobacco smelters than among exclusive blond tobacco smokers (OR = 5.0, 95% CI : 2.0-12.7); LC risk among long-term (greater than or equal to 20 years) filter-tipped cigarette users was lower compared to all other smokers (OR = 0.4, 95% CI : 0.2-0.7). Conclusions The main results of the study (a higher LC risk among black tobacco users than in exclusive blond tobacco users, and a lower LC risk among long-term filter-tipped cigarette smokers than all other smokers) have been consistent with previous case-control studies and with ecologic studies which took into account past exposure levels.