Published in Cancer Detection and Prevention 1993; 17(1).

Black and blond tobacco and cancer: a review

S Benhamou, MSC, H Sancho-Garnier MD

INSERM U351, Institut Gustave Roussy, 94805 Villejuif Cedex FRANCE

Few epidemiological studies have compared the risk of tobacco- related cancers incurred by smokers of black tobacco to the risk incurred by smokers of blond tobacco. The small number of studies can be explained by the geographical distribution of black and blond tobacco use all over the world: the majority of studies were conducted in countries where blond tobacco was mainly used, such as United States or England, whereas black tobacco was common mainly in Southern Europe and Latin America. Several relevant papers recently reviewed the carcinogenic effect of black and blond tobacco. A summary of these papers is presented here. A 2-fold risk of lung cancer among smokers of black tobacco compared to smokers of blond tobacco was consistently reported in Cuba, in France, in Italy and in Uruguay. For cancers of the bladder, the increase was 2 to 3-fold in Argentina, in France, in Italy and in Uruguay. For cancer of the larynx, a 2 to 2.5-fold increase among black tobacco users compared to blond tobacco users was reported in one study including four European countries and in Uruguay. Increases in risks were also reported for cancers of the oropharynx in Uruguay, for oesophageal cancer in southern Thailand and in Uruguay, and for cancers of the mouth in Brazil. Overall, all the studies are fairly consistent in showing that black tobacco may be more carcinogenic than blond tobacco. Biochemical and molecular studies confirmed the epidemiological evidence. For example, levels of N-Nitrosamines and of aromatic amines are greater in smoke produced by black tobacco compared with blond tobacco, and urines of smokers of black tobacco contain substances that are twice mutagenic compared with urines of smokers of blond tobacco.

Paper presented at the International Symposium on Cofactor Interactions and Cancer Prevention; Nice, France; March 17-19, 1993; in the section on Avoidable Risk Factors.