A method for comparing the impact on carcinogenicity of tobacco products: a case study on heated tobacco versus cigarettes

Wout Slob, Lya G Soeteman-Hernández, Bil Wieneke , Yvonne C M Staal*, William E Stephens, Reinskje Talhout

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

6 Citations (Scopus)


Comparing the harmful health effects related to two different tobacco products by applying common risk assessment methods to each individual compound is problematic. We developed a method that circumvents some of these problems by focusing on the change in cumulative exposure (CCE) of the compounds emitted by the two products considered. The method consists of six steps. The first three steps encompass dose‐response analysis of cancer data, resulting in relative potency factors with confidence intervals. The fourth step evaluates emission data, resulting in confidence intervals for the expected emission of each compound. The fifth step calculates the change in CCE, probabilistically, resulting in an uncertainty range for the CCE. The sixth step estimates the associated health impact by combining the CCE with relevant dose‐response information. As an illustrative case study, we applied the method to eight carcinogens occurring both in the emissions of heated tobacco products (HTPs), a novel class of tobacco products, and tobacco smoke. The CCE was estimated to be 10‐ to 25‐fold lower when using HTPs instead of cigarettes. Such a change indicates a substantially smaller reduction in expected life span, based on available dose‐response information in smokers. However, this is a preliminary conclusion, as only eight carcinogens were considered so far. Furthermore, an unfavorable health impact related to HTPs remains as compared to complete abstinence. Our method results in useful information that may help policy makers in better understanding the potential health impact of new tobacco and related products. A similar approach can be used to compare the carcinogenicity of other mixtures.
Original languageEnglish
Number of pages12
JournalRisk Analysis
VolumeEarly View
Early online date1 May 2020
Publication statusE-pub ahead of print - 1 May 2020


  • Tobacco products
  • Carcinogenicity
  • Heated tobacco
  • Cumulative exposure
  • Relative potency


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