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"The message is that there is no safe level of smoking," said Maki Inoue Choi, NCI researcher and lead author of the study, which was published in JAMA Internal Medicine

Measures that are identified as topped out for 3 consecutive performance periods may still be proposed for removal through notice-and-comment rulemaking and extremely topped out measures, those with an average mean performance within the 98th to 100th percentile range, can also still be proposed for removal in the next rulemaking cycle, regardless of whether or not they are in the midst of the topped out measure lifecycle (83 FR 59763)

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