Lessons to be Learned About Menthol from Lung Cancer Mortality Rates

 

For years we have seen a battle over the banning of menthol cigarettes.  On one side are prohibitionists, who believe that society’s ills can be cured by proscribing specific behaviors and products.  Opposing a ban are libertarians and those civil rights advocates who fear that prohibition would promote illegal sales and consumption, particularly in the African-American community. 

I have commented several times on who smokes menthols (here, here, here and here); this column was precipitated by a March 22 New York Times article by Sheila Kaplan, “Menthol Cigarettes Kill Many Black People.”

The best way to look at smoking-related deaths is to examine lung cancer mortality rates (LCMRs), expressed as deaths per 100,000 people per year.  The CDC Wonder website provides tools for investigating deaths for the period 1968-2022, including age-standardized rates, so that researchers can compare all of these years, which had different population distributions.

The chart shows LCMRs for Black and White men and women in the U.S.  Keep in mind that these mortality rates are latent with respect to smoking, stemming from smoking rates 20 years earlier.  For example, when LCMRs peaked for both Black and White men around 1990, that reflected high smoking rates from around 1970.

The most striking finding here is that while the LCMR for Black men was similar to that of White men in 1968, the rate for the former skyrocketed, peaking in 1989-90 at 367.  However, after that, the rate plummeted every year except one.  If menthol was the cause of smoking among Black men, then it didn’t persist.  By 2022, the LCMR among Black men was still higher than that among White men, but the gap was much narrower. 

It’s hard to specify menthol as a major factor, as the LCMR decline was just as impressive as the LCMR increase.  If, as prohibitionists claim, menthol is easier to start and harder to quit, we wouldn’t see this impressive reversal.

LCMRs were very similar among Black and White women until around 2000, after which rates among White women were somewhat higher.  

Also, note that LCMRs did not peak among women until over a decade after they peaked among men, and women experience much more of a plateau, from around 2000 to 2003.  And we still haven’t seen a sharp decline among women yet.

In 2012, FDA Center for Tobacco Products scientist Brian Rostron published a study finding “evidence of lower lung cancer mortality risk among menthol smokers compared with nonmenthol smokers at ages 50 and over in the U.S. population.” (here).  These results were in agreement with two previous studies (here and here).

FDA officials consistently portray a menthol ban as a corrective response to the tobacco industry’s presumptive targeting of African-Americans.  But, as I wrote previously, far more Whites smoke menthol.  As for who has been “disproportionately impacted,” Black men have the highest LCMRs of all four groups, but Black women have the lowest.

 

 

 

Campaign For Tobacco-Free Kids Amplifies False Claim from the Council on Foreign Relations

 

A recent Campaign For Tobacco-Free Kids newsletter touting its crusade to rid the world of tobacco products put the spotlight on menthol cigarettes:

“Due in large part to the tobacco industry’s targeted marketing of menthol cigarettes, Black Americans die at higher rates from cancer and other tobacco-related diseases. A new analysis from the Council on Foreign Relations [CFR] finds a U.S. ban on menthol cigarettes would quickly close disparities in lung cancer death rates among Black Americans.”

As that statement didn’t ring true, I fact-checked the CFR report and confirmed that it stated, “Both incidence and mortality from lung cancer is higher among Black Americans than their white counterparts,” citing CDC data. 

The CDC Wonder Website is the premier authority for U.S. mortality statistics.  Using their numbers, I analyzed deaths from cancers of the larynx, trachea, bronchus and lung (hereafter lung cancer mortality rate, or LCMR) among persons age 35+ years from 2012 to 2016, the latest years in the dataset.  Results are age-adjusted, comparable and expressed as deaths per 100,000 persons per year (or 100,000 person-years, p-y).

It is true that Black men have the highest LCMR, at 126 deaths per 100,000 p-y; white men are next, at 104.  Women have lower LCMRs in general because they smoke at lower rates.  The LCMR among white women is 70, but the rate among Black women is even lower, at 64.  

CFR’s causal statement is wrong anyway, as these facts remain: 1) Burning tobacco and inhaling the smoke for decades produces lung cancer and other smoking-related fatal illnesses; 2) the same cannot be said of either nicotine or menthol.