Tobacco Documents Online

, s THE POSITION OF THE AMFRICAN CANCER SOCIETY REGARDING TOBACCO AND LUNG CANCER As early as 1936, Dr. Alton Ochsner, former President and now an honorary Life Member of the American Cancer Society, called attention t'o the growing.increase in lung cancer. The distinguished surgeon from New Orleans speculated that cigarettes might be the major cause of the dramatic increase in lung cancer noted in his surgical experience. He observed that ; . mast of his lung cancer patients were cigarette smokers. Since that time, Dr. Ochsner has"been a strong advocate of realistic research action on the possible link between cigarettes 'and lung cancer. From the time he became a member of the National Board of Directors-of the Society in 1 941, he became an advocate of a thorough study of the alarming increase in lung cancer that he had ob'sPrved in his practice of surg.ory. Dr. OchsnPr was not alone in his suspicion about cigarettes and lung cancer. In 1944, Dr. Clarence C. Little, then-Managing Director of the American Cancer Society$-wrote in a pamphlet entitled, "Cancer, A Study for Laymeri:" "Although no definite evidence exists concerning the relation betwpen the use of tobacco and the incidence of lung cancer, it would seem unwise to fill the lungs repeatedly with a suspension of fine particles of tobacco product of which smoke consists. It is-difficult to see how such particles can be prevented from becominPp lodged in the walls of the lungs and when so located how they can avoid producinp a cei^tain amount of 1/7/64

-2- irritation. One might also question the ultimate results of ' continued inhalation of the type of atmosphere which characterizes the lower levels of city streets. Experimental work with animals involving these matters is still inconclusive but it seems probable that the lung as an organ is not immune of the effects of chronic- irritation and it will in this respect resemble*the other organs of the body. Such being the-case, wisdom in avoiding unnecessary ';lung' irritation seems to be established." Dr. Little -is now Scientafic Director of the Tobacco xndustry Research Committee. The American Cancer Society became increasingly concerned about the alarming increase in ~eath rates from lung cancer in 3.949, When Dr. E. Cuyler Hammond, Director of the Statistical Aesearch Section of the Society, made a study of "trends in cancer mortali.ty." He reported to the'Cancer Prevention Committee of the Society: "The lung-bronchus category is the only site category which has shown a steady and tremeridous increase in age-corrected death rates from 1933 to the present time." He pointed out that in 1948 in the U.S., cancer of the lung and tho bronchus daused 12,891 male deaths and 3,440 fPmal.e deaths compared with some 2,000 male death's and 1,000 female deaths in 1933, and that "only a relatively small proportion of the increase can be attributed to the growth and the aging of our population, and it Is hard to relievP that it can be attributed entirely to improvemont in diaRnosis.°°

c -3- It was noted that the increase in cancer of the lung had occurred in all sections of the U.S. and in most other countries from which reliable statistics were abailable. "Therefore," Dr. Hammond's report-said, "it may be assumed that it is due to r. some factor or factors operating over wide areas and in very different types of,communities." Furthermore, the report added, "it would seem_ to be a reasonable hypothesis' thdt tkiere .has been j a corresponding increase in.one or more of the major;factors, at, present unknown, which are responsible for lung cancer. ., . "xf it is discovered that lung cancer is indeed caused by . some carcinog-en1c substance or substances of widespread and increasing use .., there is reason to hope that we may be able ~ to control the disease by eliminating the cause." Dr:; Hammond's,1949 report strongly recommended that the f~ Cancer Prevention Committee of the Society and other "groups' , , "give high priority to the problem of cancer of the 1'ung." The Hammond report did not suggest cigarette smok ing'as a possible factor,•but as a result,of it, the American Cancer Society's concern in pinpointing the factor began.• Out of it the cigarette-lung cancer link emerged. One of the first actions taken by the Society was a grant. to Washington University, St. Louis, Missouri, for a study.on cigarette smoking as an etilogic factor in lung cancer. The late Dr. Evarts A. Graham and Dr. Frnest-L. Wynder (who is

-4- presently associated with S1oan-~Kettering Institute, New York) began studying thp smoking habits of lune; cancer patients. The Society continued to make grants to the team and by 1953 Graham and Wynder reported that they had produced skin cance'r in mice by the application of cigarette smoke concentrate. On October 26, 1951, the Board of Directors of the American Cancer Society directed " that a field study on smoking in relation to cancer of the.lung be approved and the nPcessary funds be made available." This was the beginning of the American Cancer Society -- Drs. Hammond and Daniel Horn study which linked cigarettes to lung cancer. The`Society undertook this study without any preconceived conviction that cigarette smoking might be the major cause off the increase in lung cancer. The Hammond-Horn study diff Pred f rom others in that it was prospective. It looked forward instead off backward, studying people as they lived and died. F,ven before Drs. Hammond and Horn were ready to report their first evidence linking cigarettes to lung cancer, significant facts had developed abroad. Drs. Doll 'and" Hill, had concluded from a study of physicians in'England that there was an, association ' between cigarette smoking and the increase in lung, cancer. The Hammond -Horn study, begun in November 1951, was one . of the largest ever undertak en in the field of health. It in- volved more than 187,000 men between the ages of 50 and 70 in 394 counties in nine states across the country. Some 22,000 volunteers asspmbled data on the smoking and non-smoking habits of this vast group of men -- men in the age group in which lung cancer is

-5_ <. most common. Each year for ta period of four years the volunteers Qheck ed on the status of the men originally interviewed. When a death occurred in the group interviewed, the cause of death was established through official death certificates, doctors Veports, and for somp, autopsy findings and biopsy reports. t . Phile the study was still underway the American Cancer . ~.~ . Society devoted its 1953 Scientific Session to "Cancer 'of the Lung -- An Evaluation' of the Problem." In opening the `session, Dr. Charles S,. Cameron, then Medical and Scientific Director of the Society, described lung cancer as "a disease that is well, on its way-toward the proportions..of a national epidemic." Scientists participating in the two-day session expressed widely divergent views on the possible relationship between cigarettes and lung cancer. Dr. Hammond, then in the midst off his; massive American Cancer Society smoking study, had doubts. He wanted, he said, "very strong- proof indeed before I would be willing to state as an absolute fact that I know cigarettes to be responsible" for the major increase in lung cancer. The significance of the meeting was that many'physicians were made more aware of a possible cigarette-lung cancer link. At the end of two-and-a-half years, thelmerican Cancer Society was ready to make a preliminary report. The report was made by Drs. Hammond and Horn on June 12, 19~+, before the American Medical Association's annual-convention in San Francisco. 1

On the basis of the deaths that had occurred since the beginning of the study among the more than 187,000 men, the report concluded that among men between the age of 50 and 70, cigarette smokers have a death rate higher than non-smokers of the same age by as much as 75 per cent. While the report made clear that the findings were only preliminary, it said "the authors are of the opinion that the association found between regular cigarette smoking and diseases, of the coronary arteries and between smoking and cancer reflect ~ . cause-and-effect relationship." The American"Cancer Society Hammond-Horn report received front page news,coverage.' Radio and television treated it as important news. Magazines became more actively interested in the possible link between cigarette smoking and lung cancer. The Hammond-Horn revelations were listed as one of the major news events of 1954. Between the Hammond, Graham Wynder reports in 1949 and , 1950, and the preliminary r eport of the American Cancer Society's smokinp study in June 1954, much evidence had developed to point to cigarette smoking as one of the major factors in lung cancer. Several American Cancer Society sponsored conferences had been held on the problem of lung cancer, including the question of cigarettes as the possible cause of the great increase. In 1952, the American Cancer Society had formed the National Lunr Cancer Committee, which stated at its first meeting: "While work should be continued on whether or not smoking is a ma,jor cause of lung cancer, other possible causative agents

must not be overlooked." It pointed to such inhaled substances as soot, motor fumes, dust from roads, etc. As a spokesman of thP Society said,.cit,r,arettes in relation to~lung cancer had been placed at the scene of the crime but their guilt had yet to be proven. After the Society's preliminar,y smokinp; report in 1954, its Board of Directors established a fund of $500,000 for the sppcial study of cancer of the lung and cigarettes. Since that tirioe, the Society has spent millions of dollars on research related to smoking and lung cancer. A_t its annual meeting in October 1954, the Board of Directors took,its first action on a.lekinr the public about the possible. hazards involved in cigarette smoking. The Board . .. . resolved "that the American Cancer Society emphasize to the American people that presently availablP evidence indicates an association between smoking, particularly cigarette smoking, and lunr cancer, and to a lesser degree, other forms of cancer ..., and heart disease." Also, in 1954, the Third National Lung Cancer Conf erence, voted that "since the presently available evidence ind_icates an association between. smoking and lung cancer, be it resolved that the American Cancer-Society and the U.S. Public Health Service .., devise and pursue public health education and other m eawxres designed to control the risinf, incidence of lung cancer, especially as it relates to cigarette ;smoking®1°

Meanwhile, other research studies in the U.S. found evidence that cigarette smoking was related to the increase in lung cancer. In Juney1955,.Dr. Oscar Auerbach, now Senior Medical Investigator, Veterans Administration Hospital, East Orange, New Jersey, and Associate- Professor of Pathology, New York Medical College, applied to the American Cancer Society for a research grant to pursue his suggestive biologic findings of the relationship between cigarette smoking and lung cell changes. His preliminary evidence was based n``microscopic PxaminPtion of human bronchial tubes and lung tissue. As.a resurit the American Cancer Society made a grant to Dr. Auerbach to help continue the study and a research team was formed wY}ich . ` .. includ9d not only Dr. Auerbach, but Dr. Hammond'and Lawrence Garfinkel, both'epidemiologists from the Society, and Dr. Arthur Purdy Stout, the distinguished pathologist of Columbia.Presbyterian Medical Center and formerly Profes:;or of 1?athology at Columbia University College of Physicians and'Surgeons. Several r.eports have been issued since on this research, all-adding.new evidehce onn the link between cigarette smoking and lung cancer. In 19'56, Drs. Hammond and Horn made a second report on the Society's smoking study to the American Medical Association's annual convention in Atlantic City. They concluded that'cancer of the lung is a rare disease among men who have never smoked; that lung cancer is an important cause of death among men smoking two or more packs a day; that the death rate from lung cancer increases with the amount of cigarettes smoked,'and that evidence indicates that riving up cigarette smoking reduces the risk of lung cancer.

The report also linked-cigarette smoking to cardio-vascular diseases. Also in 1956, the American Cancer Society, the American ~ieart Association,. the National Cancer Institute and the National Heart Institute joined in establishing a Study Group on Smoking and Health, consisting of seven scientists. They were charged with reviewing all of the evidence so far developed on the problem of smoking and health. After months of study, they reported in. March 195? "The sum total of scientific evidence establishes beyond reasonable doubtthat cigarette smoking is a causative factor in : the rapidly increasing incidence of:human epidermoid carcinoma of the lung and that smoking of tobacco, particularly in the form of cigarettes, is an important health hazard. The implications of this statement are clear in terms of the need for thorough con- sideration of appropriate control measures by the official and voluntary agencies concerned with the health of the people." This Study Group report was widely publicized by press, radio and television. The scientists making the report were: Dr..Richard J. Bing, Washington University Medical School, St. Louis, Mo.; Dr. Rolla E. Dyer, Emory University Medical School, Atlanta, Ga.; Dr. Abraham M. Lilienfeld, Roswell Park Memorial Institute, Buffalo, N. Y.; Dr. Norton NPlson,-Postgraduate Medical School, New York University, New York City; Dr. Michael B. Shimkin, National Cancer Institute, Bethesda, Md.; Dr. David M. Spain, Peth-E1 Hospital, Erooklyn, N. Y.; and.Dr. Frank M. Strong, University of Wisconsin, Madison,Wisc. Dr. Dean F.

-10- Daviesz.of the American Cancer Soc.iety served as executive ~ secretary of the' Group. ; Drs. Hammond and Horn presented their f inall r eport on the American Cancer Society's four-year smoking studyuin June ~ 1957, before the American Medical Association's annual convention in New York City. This 'paper 'confirmed findings'in `the pre- . liminary liminary reports. They pointed out that the annual lung death• rates were t~en times as high among regular smokers as'among those who never smoked. Among two-pack-a-day cigarette smokers the rate was more than 20 times as high as among.non-smokers. Men who sto-pped smoking had a lower cancer death ratP: Those who once smoked a pack or more a day, but who had given up smoking for at least one year, had a death rate less that of those who cont,:iniied smoking. than half Significantly,'the U.S. Surgeon General, Dr. Leroy E. Burney, in July 1957, issued a public warning in which he said, "it is clear that there is an'increa sing and consistent body of evidence that excessive cigarette smoking is one of the causative factors in lung cancer." The Surgeori General's statement was based on a revie:: of data thusr far assembled on cigarette smoking and lung cancer made by the U.S. Public Health Service. "To help disseminate the facts," the Surgeon General said, `tbe Public Health Service is sending copies of this statement, the Study Group report and the report of Drs. Hammond and Horn to State , Health Officers and to the American MPdi.cal Association with the rpqnest that they consider distributing copies to local health