Tobacco Documents Online

1 . HEALTH CC,{ncer? Dn't blame srnokA By BRIAN HOAD CANBERRA'S latest tar and nicotine ratings of Australian cicarettes have just been released throu_eh the Australian Cancer Societr with the warning that "cigarette smoking causes approximately 11.500 dcaths,a year in Australia from vascular discase. lung cancer. bronchitis and emphysema."' Cigarette smokins! CAUSES nothine of the sort: savs Dr Hiram Langston. onc of the leadine thoracic surgeons in the US,pow based in Chicago. In particular. Langston would like to emphasise that, cigarette smokine does not CAUSE cancer of th'e lun e. Langston is here at the invitation of the local tobacco indusm to discuss the latest developments: in his,view- on this controversial subject. lis the frist, time he has aeccpted such an invitation to travel abroad. He's usually too busc operating on cancerous lunes back in Chicago. ~ He first started airing his views in 1962, well before the subject reached the market place. It all started because he is rather suspicious of statistics: "1 don'n know what they mean. Different people can draw, different eonclusions from the same statistics_ I did not even try to alter alli the statistical conclusions relating, eigarctte smokine to lung cancer by further statistical manipulation. Even if I succeeded the end'result would merelj invalidate the method. So I ignored them and eoncentrated instead on studying the clinical behaviour of the disease in patients." Witli seeminslv unshakeable logic and a rare ability to, admit what he knows and what he does not know, L'an,-sto^ has persisted with his arguments in the face of often fierce resistance. Quite simply he believes in them: "If wc have convictions properly arrived at!wrmust also aave the courage to stand up,and be counted." He also finds it rather depressing to hear his medical peers parrotine on about cigarette smoking causing lung cancer when they know that, nobody knows what causescancer of the lung or anything else - "but perhaps they don't have as much time to think about these things as I do." And although he doesnh approve of the current "fear tactics" being practised bs anti-smoking bodies and governments alike. he also doesn't .approve of smoking either -•9 used to smoke two packs a day but gace it up in 1954. !t irritates the lungs. Why mistreat them?" After, years of' being grilled, on the chords. Cancer ofi the larvnx ~ and cancer of the lung are both , said to be caused by smoking., ~ However, cancer of.the 1ar'enx has shown very 9ittle inereasein incidence while lune tancerihas become a disease of epidemic proponions. i~ If i k c garette smo e crere the cause of cancevof the lung it would be reasonable tn , t expect to find the disease infecting both sides of the litng simultaneouslj•: But this is rare - an incidence of about five perccnt, If' smoke is evenly distributed durine smoking, why should ithis be so? 'Even more curious is'the fact that among patients who have undereone the successful removal of one lung for cancer' the incidence of a second cancer occurring later, is most uncommon - an incidence of 1-2 percent. "Ifsmoking were the cause you would expect people who ` started smoking early or tho 'se who smoke very heavily to i develop sueh cancers earliec In ~ fact it has been elearly ~ demonstratedthatregardlessof • tlte amount or duration ~ Dr.Hi'ram Langston: diflerent people can draw.dilHerenteoncluslons Irom the same statistics subject by assorted commissions in the US and Canada. Langston expresses hiss ideas succinctly. "The first point is that lung canceris predominantly a male disease. The incidence ratio is about seven males to one female. Even though it has been claimed in recent yrars that the incidence in females has been rising, this preponderance formales persists. And the increase in female incidence is nondue to the type of tumors normally, associated with smoking. "The disease also has a elearlv defined age incidence.,The peak occurs between 55•70' years of age in the generallpopulation, There are few cases on either side of this,peak. Contrary to most other cancers the incidence of the disease does not, continue to rise with increasing age. After 60-70 years,of age it tends to decline. 'Another intetesting point is that the incidence of lung cancer was rising well before cigarettes became popular. German pathologists showed this disease to be incrcasine around'1890~ "If smokine causes cancer of the lung :t should also cause cansnr of the AUSTRALIA NATIONAL "BULLETIN" August 1, 1978 trachea - the wiud'pipe. All tno smoke I goes in and out through the trach'ea. the matcrialidepositedlb~ the smoke in,thc mucous lining of the aii pa,sages e.cit.that way , too. The trachea pets it coming andgoingd yet it is a rare site for cancer, "Similarh•. even thinZ rnter, and exits through the Ian nx. the narrow -"- -• -^"^'119 portal between the vocal of smoktng, the disease develbps i at approximately 60' years of age as ` expected . So I have come to view the rise of lung cancer as a cyclical biological phenomenon of unknown causes. It appears that the generation principallc ~ affected by this disease is the one born around 1890-1900.,1 base this opinion on a personal' review of over 4000 lung ;, cancer patients covering a period of 40 years in the Veterans' Administration { Hospital at Hines. Illinois. For example. patients treated! during the period 1939-43 had a peak age of 45-49: That peak age has ritcreased~ steadily since then. During the years 1964-68'the peak ' { aee had reached 70-74. And I believ le that when this generation IInadly, passes j into history, the incidence of this ! dreadful diseasewn be expected to turn 1 down. "]h fact such a tum-down was notcd last year in Britain by Sir Richard'Doll;. regius nrofessor of medicine at Oxford;. Scotland. Wales an&Eneland have had the hiehesr incidence of lune cancer in the world so you would expect the turn-down to aeeur there first. The US is about 10th in the incidence ratings list and I believe Australia is about 13th. 1 would expect this welcome turn-dbwn in the incidence of the disease to occur in the US around 1980. But why tliiss biological phenomenon should bare occurred in the first place we jusndon't know, nor why itishould'now be show•inc signs, of declining - allhoueh scme people havr suggested genctic atlaptation .1 to the unknow•n causes."

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