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372 STATEMENT OF JACK MATTHEWS FARRIS, M.D. My name is Jack Matthews Farris. I am Emeritus Professor' of Surgery at the University of California at San Diego. I practiced surgery in the Los Angeles area for more than 25 years as Staff Surgeon at the Good Samaritan Hospital, Los Angeles; Chief of Surgical Service at the Harbor General Hospital, Torrance, California; and Chief of Surgical Services at the California Hospital Medical Center, Los Angeles. I also served as Senior Consultant to Surgery for the Veterans Administration, for whom I directed the surgical activities at several of their institutions in California. I am on the Board of Directors and Board of Trustees of the Scripps Clinic and Research Foundation, and was on the Board of Directors for the Medical Research Association of California. I am a member of numerous medical societies where I have served on advisory committees. I have published approximately 73 papers in scientific journals and have contributed several chapters for surgical textbooks. My full Curriculum Vitae and list of publi- cations are submitted with this statement. Throughout the past 25 years, I have followed with interest the evidence for and against the thesis that cigarette smoking has 3 a causal relationship with cancer has been stimulated by my operati< many of whom suffered from cancer including lung cancer. In 1965, I submitted staten sentatives and the Senate in which that lung cancer had been shown to and that any conclusion to the con My opinion today remains fi: numerous complexities in the behav parts of the body. I believe that causes cancer, we might well lind t little or nothing to do with the ger That the smoking and health trated by many studies and findings smoking causation hypothesis. I wc few of these. 1. Persons who have never s that is indistinguishable from thos in smokers. A recent study has sho incidence of cancer of the lung in : 2. In the early 1960's resec smoking in the population, predictec cancer would level off in the next c then have supported their predictior -2-

r R t M 373 a causal relationship with cancer of the lung. This interest has been stimulated by my operation on more than 8,000 patients, many of whom suffered from cancer in various parts of the body, including lung cancer. In 1965, I submitted statements to the House of Repre- sentatives and the Senate in which I said that I did not believe that lung cancer had been shown to be caused by cigarette smoking, and that any conclusion to the contrary was not justified. J1y opinion today remains firmly the same. There are aumerous complexities in the behavior and cause of cancer in all parts of the body. I believe that, when we learn how and what causes cancer, we might well find that cigarette smoking has little or nothing to do with the genesis of carcinoma of the lung. That the smoking and health controversy continues is demon- trated by many studies and findings that cannot be explained by a smoking causation hypothesis. I would like to mention just a few of these. 1. Persons who have never smoked get cancer of the lung that is indistinguishable from those cancers that are reported in smokers. A recent study has shown a significant and increasing incidence of cancer of the lung in non-smokers. 2. In the early 1960's researchers, without regard to smoking in the population, predicted that the death rate in lung cancer would level off in the next decade or so. Studies since then have supported their prediction. -2- I

374 3. Cancer is rarest in those parts of the body most in contact with cigarette smoke, for example, lip, tongue, trachea and larynx. Tracheal cancer continues to be an extremely rare disease, even though the trachea, which is part of the respiratory tract, is more exposed to tobacco smoke than the lung. The larynx is also more exposed to tobacco smoke than the lung; nevertheless, the incidence of laryngeal cancer has remained relatively stable duriag the last quarter century and has not followed the reported increase in lung cancer. 4. Lung cancer often originates in areas of the lung that have little or no contact with tobacco smoke, that is, in the peripheral areas of the lung, rather than in the hilar, or central, region. 5. Although there is no reason to suppose that there is greater exposure of tobacco smoke at the site of any given cancer in the lung, lung cancer usually appears as a solitary lesion. Metastatic cancer, on the other hand, such as that which spreads in the lung field. Moreover, once a lobe containing cancer of the lung has been removed, a second primary cancer of the lung rarely develops, although the lung fields have been exposed to the same cancer. One theory that is being investigated is that the immune ~ system has a lot to do with the development of this disease. -3- ME 7. Efforts have failed to p: reported to be statistically assoc: animals exposed to smoke. 'One stuc hamsters exposed to cigarette smokE exposed. 8. Some studies find that i chemicals the smokers have a lower non-smokers. For example, chloromethyl ethers. this has It is clear that the smoking not been resolved. It is also clea be the total answer to cancer of th All of us who are interested have one thing in common - we are a for the prevention of cancer, which lives today. The problem won't be : of disease. The problem can only bc Of the various theories and factors date. -4-

® I 375 7. Efforts have failed to produce the kind of lung cancer reported to be statistically associated with smoking in tests on animals exposed to smoke. One study has shown that a group of hamsters exposed to cigarette smoke lived longer than those not exposed. 8. Some studies find that in workers exposed to certain chemicals the smokers have a lower incidence of cancer than the non-smokers. For example, this has occurred in workers exposed to chloromethyl ethers. It is clear that the smoking and health controversy has not been resolved. It is also clear that cigarette smoke cannot be the total answer to cancer of the lung. All of us who are interested in this controversial subject, have one thing in common_- we are all anxious to see a discovery for the prevention of cancer, which inexplicably claims so many lives today. The problem won't be solved by legislating the cause . of disease. The problem can only be solved by continued exploration of the various theories and factors suggested by the research to date. -4- 1