Grant Number:	1R21CA301405-01 Interpret this number
Primary Investigator:	Bover Manderski, Michelle
Organization:	Rutgers Biomedical And Health Sciences
Project Title:	Influence of Menthol Cigarette Smoking on Lung Cancer Screening Eligibility in a National Prospective Study
Fiscal Year:	2025

PROJECT SUMMARY/ABSTRACT Lung cancer is the leading cause of cancer death among US men and women and accounted for more than 125,000 deaths in 2023—more than 20% of all cancer deaths. An important strategy to reduce mortality is lung cancer screening by low-dose computed tomography (LDCT), which has been estimated to reduce lung cancer mortality by up to 20%. In 2013, the US Preventive Services Task Force (USPSTF) began recommending LDCT lung cancer screening for people aged 55–80 years with a 30 pack-year history of smoking who currently smoke or had quit within 15 years; in 2021, these criteria were revised to include adults aged 50–80 with a 20 pack- year smoking history. Although uptake has been slow, there have been favorable shifts in diagnoses towards earlier stages. Still, nearly half of lung cancers today are diagnosed at distant stages, and inequities in lung cancer screening and mortality persist for several groups such as African Americans, women, and people with lower income, many of whom smoke menthol vs non-menthol cigarettes and at increasing rates. Menthol in cigarettes is associated with increased smoking initiation, propensity to progress to regular smoking, increased nicotine dependence, and decreased cessation success. Paradoxically, people who smoke menthol cigarettes have comparable levels of nicotine and carcinogen exposure biomarkers yet consume fewer cigarettes per day than people who smoke non-menthol cigarettes. Prior studies have concluded that menthol cigarette type need not be considered when estimating risk for lung cancer. However, these studies predated growth in the menthol cigarette market and the introduction of LDCT lung cancer screening, for which eligibility is determined largely by cigarettes smoked per day. This raises new questions about the potential indirect impact of menthol cigarette smoking on lung cancer screening and outcomes: if people who smoke menthol consume fewer cigarettes per day, are they less likely to meet screening eligibility criteria, despite having the same exposure to carcinogens? If true, people who smoke menthol face greater risk for later-stage diagnosis, and subsequently, mortality. This application will utilize the Tobacco Use Supplement to the Current Population Survey (TUS-CPS) and the Tobacco Longitudinal Mortality Study (TLMS) to evaluate the influence of menthol in cigarettes on lung cancer screening eligibility and outcomes. Under Aim 1, we will compare lung cancer screening eligibility for people who smoke menthol vs nonmenthol cigarettes, hypothesizing that menthol smoking will be associated with decreased probability of meeting screening eligibility criteria. We will also examine changes over time and differences by race/ethnicity, sex, and income through stratified analyses. Under Aim 2 we will evaluate lung cancer screening eligibility and menthol smoking exposure among individuals who have died of lung cancer using a case-case approach. We hypothesize that adjusted odds of menthol smoking will be higher for ineligible vs eligible cases and will evaluate heterogeneity by time (< 2013 vs after), race/ethnicity, sex, and income. We will also investigate the reasons for ineligibility among those not eligible (e.g., pack-years vs age) and if this differs by menthol status.





None