Cumulative exposure is used for exposure assessment in epidemiological studies where absolute risk is used for risk assessment. Absolute risk is also used for risk appraisal from an evidence based health perspective as it helps to estimate the numbers needed to harm or numbers needed to treat. However, when it comes to risk appraisal using relative risk estimate, a better estimate of exposure is exposure rate. In a previous paper, Smith et al (xxxx) used data from smoking and cancer studies to show that while cancer risks are similar with increased cumulative exposure in years of smoking, they tend to show dose response variability when packs smoked were used (cite). In this paper, we examine this concept further with respect to cumulative exposure in other studies and study the association between cumulative versus exposure rates.