Where are cigarettes made?
"People smoking the U.S. brand cigarettes [we tested] received a level of this carcinogen in their mouth and lungs that was three times higher compared to smokers in Canada and Australia, " says Dr. James Pirkle, deputy director for science at the CDC's National Center for Environmental Health.
"This is important information, I'm confident the FDA will pay a lot of attention to it, " Pirkle says.
But American smokers shouldn't run out to buy the foreign brands just yet, tobacco experts say.
"This study should not be taken lightly, " says Dr. John Spangler, director of tobacco intervention programs at Wake Forest University School of Medicine, but it only looks at nitrosamines - "not the two dozen other cancer causing toxins" in cigarettes.
"People might think that by switching brands, they will improve their health outcomes, " he says, but it's too early in the research to know whether this might the case.
Smokes Around the World
Why do cigarettes made abroad tend to have lower levels of nitrosamines, or more accurately, tobacco-specific nitrosamines?
According to the study, Australian, Canadian, and U.K. cigarette brands were made from "bright" tobacco, which has a lighter color and uses different curing processes than the U.S. variety.
This means that changes in the variety and preparation of cigarettes can lower the levels of nitrosamine, something Philip Morris, the maker of Marlboro has been aware of for a number of years.
David Sutton, spokesperson for Philip Morris USA, says that the company was able to reduce the levels of this chemical by 80 to 90 percent in the 2002 crop by changing the heating system used.
Unfortunately, making a healthier cigarette is not as simple as lowering the levels of nitrosamines, tobacco researchers note.
"Tobacco smoke contains about 4, 000 chemicals, " Spangler says, and while lowering carcinogens is likely a step in the right direction, this would not improve "your risk for other tobacco-related diseases [such as] heart disease, stroke, emphysema and many other[s]."
What's more, whether lower-nitrosamine cigarettes translate into fewer cancers and fewer cancer deaths among smokers is till "a question mark" in the research, says Dr. Edwin Salsitz, attending physician in the division of Chemical Dependency at Beth Israel Medical Center.
Nonetheless, this study, which is the first to compare nitrosamine levels among cigarettes around the globe, provides important insight into what makes cigarettes bad for you and how that can be tweaked in production, Pirkle says.
This kind of insight becomes all the more essential, thanks to new regulation that allows the Food and Drug Administration to regulate the production of cigarettes.
The Tobacco Act and FDA Control
The CDC's findings have added weight considering the new regulatory power granted to the FDA by last year's Family Smoking Prevention and Tobacco Control Act, tobacco policy experts say.
"This study shows why the authority to issue product standards - which the FDA now has - is so critically important, " says McGoldrick. "This is a dramatic change from the times when tobacco companies alone determined product design."
In the past, campaigns on ways to make cigarettes "healthier" by adding filters or by reducing the tar content turned out to be "shams, " says Salsitz, but in this case, the FDA would monitor whether any production changes could actually impact public health.
Though this study alone does not prove that lower the nitrosamine levels in cigarettes will actually mean fewer cases of cancer for smokers, adds Mitch Zeller, a lawyer who specializes in tobacco policy, but if the research reveals that it does, "the FDA now has the power to make that change."
Unfortunately, that change is a long time in the making, Spangler notes, as this research is young yet.
Until an FDA-sanctioned "healthier" cigarette can be made, the best option for lowering the health risks of smoking, of course, is to kick the habit.
"As of today, there is not cigarette on the market that public health organizations endorse as offering 'reduced risk, '" says Sutton, so "if smokers are concerned about the risks of cigarette smoking, the best thing to do is quit."