BMJ -- Press Releases

Releases Saturday 10 January 2004
No 7431 Volume 328

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(1) LOW TAR CIGARETTES DO NOT CUT LUNG
CANCER RISK

(2) MEDICALLY SUPERVISED INJECTING
CENTRES SHOULD BE PILOTED IN THE UK

(1) LOW TAR CIGARETTES DO NOT CUT LUNG
CANCER RISK

(Cigarette tar yields in relation to mortality from lung
cancer in the cancer prevention study II prospective
cohort 1982-8.)
http://bmj.com/cgi/content/full/328/7431/72

The risk of lung cancer is no different in people who
smoke medium tar cigarettes, low tar cigarettes, or very
low tar cigarettes, concludes new research from the
United States.

Researchers analysed the relation between the tar rating
of the brand of cigarette smoked in 1982 and death from
lung cancer over six years among 364,239 men and
576,535 women aged 30 years or more.

Irrespective of the tar level of their current brand, all
current smokers had a far greater risk of lung cancer
than people who had never smoked or who had quit.

Men and women who smoked very low tar (7 mg or
less) and low tar (8-14 mg) brands had risks of lung
cancer indistinguishable from those who smoked medium
tar (15-21 mg) brands. This pattern did not change after
demographic factors, dietary habits, and occupational
and medical histories were taken into account.

Men and women who smoked non-filtered cigarettes
with tar ratings of 22 mg or more had even higher risks
of lung cancer.

These findings are consistent with other evidence that
people smoke low tar cigarettes more intensively, and
challenge the assumption that the link between tar rating
and lung cancer risk is necessarily linear, say the authors.

They suggest that reducing the use of high tar non-filter
cigarettes may provide limited public health benefits in
those countries where these products are commonly
used.

Contacts:

Dr. Jeffrey Harris, Internal Medicine Associates,
Massachusetts General Hospital, Boston,
Massachusetts, USA
Email: jeharris{at}partners.org

Dr. Michael Thun, Epidemiology and Surveillance
Research, American Cancer Society, Atlanta, Georgia,
USA
Email: mthun{at}cancer.org

(2) MEDICALLY SUPERVISED INJECTING
CENTRES SHOULD BE PILOTED IN THE UK

(Supervised injecting centres.)
http://bmj.com/cgi/content/full/328/7431/100

A programme of medically supervised injecting centres
should be piloted in the UK, as part of an integrated
public health strategy, say the authors of an article in this
week's BMJ.

Injecting centres�"designed to reduce the health and
public order problems associated with illegal injection
drug use" �have been set up in Australia, Germany, and
the Netherlands, and a pilot programme for the UK was
recently recommended by the Home Affairs Select
Committee. Home Secretary David Blunkett rejected
this advice however�a decision which should now be
reconsidered say the article's authors, as fresh evidence
has emerged from an Australian pilot study regarding the
effectiveness of such initiatives.

Medically supervised injecting centres allow drug users
to inject 'street drugs' in a clinical environment, with
resuscitation equipment and nursing staff on hand in case
of overdose or other complications. Trained staff can
offer safer injecting advice�including help to move away
from intravenous drug use�but are not permitted to
assist users with injecting.

The article's authors argue that pilot studies in other
countries have shown positive results. An
eighteen-month project in Sydney, Australia showed that
clients attending the centre were more likely to start
treatment for their addiction, and half the users reported
their injecting practices had become less risky. Local
residents and businesses complained of fewer sightings
of public drug injecting, and discarded syringe counts
dropped.

Criticisms that such centres promote drug use is not
supported by the evidence, say the article's authors.
Similar charges were levelled at needle exchange
programmes in the 1980s�a strategy which has been
shown to improve public health. The Home Secretary's
support of a different initiative�prescribable heroin
centres�in preference to injecting centres should now
be reconsidered, say the authors, since they are largely
appropriate only for long term heroin addicts. Medically
supervised injecting centres are targeted instead at
homeless and socially excluded drug users, and are an
essential part of a successful public health strategy.