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This increases the formation of certain carcinogens such as nicotine-derived nitrosamine ketone (NNK), known to promote adenocarcinoma.[14] Added to this are the more intense inhalations taken by the smoker to compensate for the filtration effect, which cause the smoke to penetrate deep into the lungs, reaching the distal respiratory tract where cells are particularly conducive to adenocarcinoma.[15] In 2014, the surgeon general in the United States concluded that the increase in adenocarcinoma recorded in the country since the 1960s was largely due to the introduction of ventilated filters

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