Steven Stellman - Influence of type of cigarette on peripheral versus central lung cancer

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      Brooks, D. R., Austin, J. H., Heelan, R. T., Ginsberg, M. S.,   Shin, V., Olson, S. H., Muscat, J. E., Stellman, S. D.   14 (3) 576-81-

      Abstract: OBJECTIVES: Adenocarcinoma has   replaced squamous cell carcinoma as the most common cell type of   lung cancer in the United States. It has been proposed that this   shift is due to the increased use of filter and lower-tar   cigarettes, resulting in increased delivery of smoke to   peripheral regions of the lungs, where adenocarcinoma usually   occurs. We reviewed radiologic data to evaluate the hypothesis   that tumors in smokers of cigarettes with lower-tar yield are   more likely to occur peripherally than tumors in smokers of   higher-yield cigarettes. METHODS: At two urban academic medical   centers, we reviewed computed tomographic scans, chest   radiographs, and medical records to assign tumor location   (peripheral or central) for 330 smokers diagnosed with carcinoma   of the lung between 1993 and 1999. We compared the proportion of   tumors in a peripheral versus central location by lifetime filter   use and average lifetime tar rating (< 21 and > or = 21   mg). RESULTS: Tumor location (69% peripheral and 31% central) was   unrelated to cigarette filter use. Smokers of cigarettes with   lower-tar ratings were more likely than those with higher ratings   to have peripheral rather than central tumors (odds ratio, 1.76;   95% confidence interval, 0.89-3.47). When restricted to subjects   with adenocarcinoma or squamous cell carcinoma, the odds ratio   (95% confidence interval) was 2.31 (1.05-5.08). CONCLUSIONS:   Among cigarette smokers with lung cancer, use of cigarettes with   lower-tar yield was associated with preferential occurrence of   tumors in peripheral sites. Our findings support the hypothesis   that changes in smoking associated with lower-tar cigarettes have   led to a shift in the location of smoking-related lung cancer.

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