al., 1999; Ryberg et al., 1997; Tang et al., 1998). Separately, gastrin-releasing peptide has been shown to be more highly expressed in women than men for the same level of smoking (Shriver et al., 2000). The gene for this peptide is located on the X chromosome, so a double copy might result in increased levels that in turn trigger growth stimulation. Therefore, assessment of PREPs also should consider possible effects on hormonal status and differences in the effects of individual tobacco constituents in women.

Racial and Ethnic Differences in Lung Cancer Risk

Lung cancer rates differ by race and ethnicity (U.S. DHHS, 1998). Lung cancer incidence rates are highest among African-American males (112.3 per 100,000), followed by Caucasian males (73.1 per 100,000). African-American and Caucasian females have similar rates (46.2 and 43.3 per 100,000, respectively). Asian-American males and females have relatively lower rates (52.4 and 22.5, respectively), while Hispanics have the lowest rates (38.8 and 19.6, respectively). In the United States, smoking rates differ; African Americans, Hispanics, Chinese Americans, and Hawaiians tend to smoke fewer cigarettes per day than European Americans (Le Marchand et al., 1992). In the United States, Hispanic males and females tend to smoke less than nonHispanic whites, but the risks within smoking levels are similar (Humble et al., 1985). Hawaiians have a greater risk of smoking compared to Filipinos and Caucasians living in Hawaii (Le Marchand et al., 1992). The differences in lung cancer rates within smoking categories may be due to smoking topography, types of cigarettes smoked, differences in the frequencies of heritable traits, and/or environmental, lifestyle, and dietary differences. For example, Japanese have lower rates of lung cancer than persons from other countries, which may be due to the use of tobacco with lower TSNAs, more frequent use of charcoal filters, or lifestyle differences. However, the effects of these factors on lung cancer rates are small compared to the overall increased risk for use of cigarettes.

There are some data to suggest that lung cancer risk is higher in African Americans than Caucasians for a given level of smoking (Harris et al., 1993; Schwartz and Swanson, 1997). For example, Harris et al. reported an RR of 1.8 for African Americans compared to Caucasians at the same level of tobacco consumption calculated as cumulative tar intake (Harris et al., 1993). African Americans tend to smoke menthol cigarettes, while the opposite is true for Caucasians (Cummings et al., 1987). Menthol cigarettes provide cooler smoke that helps anesthetize airways (Sant’Ambrogio et al., 1991), so smoking topography might be affected (Orani et al., 1991). The greater use of mentholated cigarettes among African Americans (Cummings et al., 1987; Wagenknecht et al., 1990) is



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