Tobacco Documents Online

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LIST OF TABLES (Continued) (A indicat'estables located in appendix at endd of chapter). PageA2J. Experimental studies concerning oral carcino- genesis .................................... 371 30. Esophageall cancermortal.ity ratios-prospective studies .................................... 290 A31. Summary of methods usedl in retrospective studies of tobacco use and cancer of the esophagus ...... 3,75 A31a.. Summary of results of retrospective studies of to- bacco use and cancer of the esophagus ............. 378' A32. Atypical nuclei in basal cell~ of epithelium of esoph- agus of males,, byy smoking habits.and age ...... 379 A33. Atypical nuclei in basall cells ofl' epithelium of esoph- agus of males, by-amomit of smoking and age .... 380 34. Il;idtrteyy and urinary bladder cancer-prospective studies ...................................... 294 A35. Summary of methods used in retrospective studies of. smoking, and cancer of the bladder ............ 381 A35a. Summary of results of retrospective studies of smok- ing and cancer of the bladder ................. 383, 36. Pancreatic cancer mortality ratios-prospective studies ........................................ 298 236

TABLE A15.-Sh/dios omteevlaiup tka rcAetiolestlip aJsnlyd:hif~ fo iu/ c6r usrrsln+Frlnr?1 ctisenesaa )!+.u...n. ( ~.a (ACtum nun,bnr of ca. sLawu !n pm.eutno., S61-Swukers NS=Nnnmaokcrs Author, year, Number and euuntry, type of r;fSrence popnlatiun. Bonke. 1965, U.S.A. (33). 3hah ctaf., 1969, India (E05). Data collection Resulte Contntents Parents of 59 femilies. lnterview Pereon- h`u~nber of raspiratory Iline.ve.! Nn etatistiralb eign!fie.m t yeare sllneeseepsrson-yeors _ d~Rere . nc NS .........................(24) 120 624 5.2 noted. Cig.rettea/day: 1-10 ..........(19) 99 829 5.3 11-20 ...................(26) 108 486 4.5 >20 ......................(19) 99 424 4.3 Pipe, eiger .................. (14) 72 804 4.2 Tuberculosle 3urvey, X-rgg TuLe.culoue Nnrma! nr institute and - by X-ray +ontubcrcu(ove emplarees. interview. NS ........................ }10 (19.7) 118 (168.8) SM ........................ 36 (26.3) 215 (224.7) t Numbers in narentheeea ceprespntfigures --expected" by use of 2 x 2 contingency table. Tuberculoua mPLuYee9 w2re ronnd to have eigniflannety fewee nnsmokere and moker

60 50 40 30-! 20- ~ 10~ 4- 2~ 1934-36 1939~1 1944-46 1949-51 1954i56 1959-61 1963-64 Celentlar Years FIGURE1.-I6ung.cancer, Finland and Norwag.. $OURCE: $'lteybergJ,Ii. (154).. . land after 1950 and found a correlation between that increase and the increasing salee ofeigarettes in.thatcountry. Iireyberg (Y54) analyzed the lung cancer deathi rates of both -N'orn°ay and Finland in relation tothe use of tobacco in those two countries over the past 100 years: Figure 1 shows the.substantial difference in lung cancer mortality between the two countries. Kreybergobserved thatcigarettes,came.intouse in Norway in 11886~6 while the Finnish population (more closely allied to Russia socio- economically) was consuming more than 100 million cigarettes per Year dhring the decade of the 1880's. Cigarettes remained scarce in Vorway until after World: War I, and this 30-year lag in consump- us , M

T.tBLE A16.-Comp[ications developing en the. postoperative period in patients undeygoing a7idominal'.operqttions Men over 20 Percent Percent broneho- Percent Group, C4ees chest Percent Pnee.moniea total: clear 6runebitisand complication atelectasis rate Smoken .................... 300 41;1 63.0. 6a 58.3 Light Smukers .............. 180 68.4 2P:9' 3:9 31.6'. Nonsmokers . ................ 66 92.5 6:0I 1.5 9.6 Women. over 20 Smnkers ................... ... 2339.1 43.5' lYd. 60.9 Light Smoken ................ 62' 77,5 20.9~. 1.6. 22.5 Nonsmoken.................. 618'~ 88.8 8.1 3.1 LL2 SOnRCg: Mortbn, D..I. V. (1yY') TaeLE A17:-Arterial oxggen.satur¢tiion before and.after'operatian A[LCrinll oxygen saturetiGn (percentage) Group Case u nber Defore operation Day 1. Day.2 Day.B 1 94 93 94. .. 2 94 93 94 Nansmokera ......................... 3 96 93 94~ ... 4' 55 90 94. ... 5' 94 90 93 ,., 6'. 95 91 89 91' 9 92 89 81 89'. 3mokera ................................ 8 91 89 86 89 9: 93 91 89 92' 10 90 87 88 92 9onRCa: Maxton„ A. (1!2).. 230

Contents Page I'ntrndaction ........................................... 237 Lur.g C:nucer ....................................... 239! F'nfiiaminlnc*i~rtaT Studke9. .......................... ,... ... 240 Prospective Studies .......................... 240 Retrospective Studies ........................ 240 i.i;nm (',imcer Trend4~~ in Other Countries~............. ,. .... 244! Ilistology of Lung Tumors ........................ 246 LungCancer Relationships in Wumen, .............. 251 Lung Cancer, the Urban Factor, and Air Pollution .... 252 Lung Cancer and Occupational Hazards ............ 256. Uranium Mining ............................ 256 Other Occupations ............................ 256 -Nickel ............................................ 256 Asbestos .................................... 257 Arsenic ..................................... 257 Chrnmin~rn.-..--- ..................`---........,...,.. 257 P:ahological S'tudies. . . . . ........... . .......... ,. .. 258 ['nlmonary Carcinogenesis ........................ 258 General Aspects of Careinogenesis ............. 258 Polynuclear Aromatic Hydrocarbons ....... , 264 Nitrosamine Compounds................... ..~,....~ 264 Pesticides and Fungicides ................. 266 Radioactive Isot'opes ..................... 266, Inhibitors of Ciliarg. bZovementl ........... 267 Experimental Studies ................ ........ 267 Skin Painting and Subcutaneous Injection. .. 267 Tissue and Organ Culture ................ 267 Tra ch eo.S ron ch ia1 Imp lantation anrl Tnctillatinn .. 268~' Tnh~alatinn ... ............ 26$~~ 275 R'eduetion in Turnor geni¢ity . .............. ..... 276 Summary and Conclusions . .. ............. ... .. Cancer of the Larynx ................................ 277 Epidemiologieal Studies .......................... 277 P2thological Study .............................. 280 Experimental Study ......................................... 281. Sltmmary.y and Conclusions.. ........................ .. ...281 Oral C'ancer ......................................... 2841 Epid'emiolbgical Studies .......................... 285 Experimental Studies ............................. 288' Summary and Conclusions ........................•. 289. 233 '

Page Cancer of the Esophagus ............................. 289 Epidemiological Studies .......................... 289 Pathological Study .............................. 292 Experimental Studies ............................ 292' Summary and-Conclusions ........................ 293 Cancer of the Urinary Bladder and Kidney .............. 293 Epidpmiological:Studies (Bladder) ................... 293' EpidemiologicaI Studies (Kidney)' ................. 296 Experimental Studies ............................ 296 Summary andi Conclusions ........................ . 299' Cancer ofthe Pancreas ............................... 299 Summary and Conclusions ........................ . 299 References ......................................... 299'. FIGURES 1. Lung cancer, Finland and Norway ................... 245. 21 Percent of smoking,dogs with tumors ................ .. 274 3.. Percent of lung lobes with tumors inn smoking dbgs ..... .. . 274 4. Effects of chronic cigarette smoke inhalation on the hamsterlhrynx ................................. 284 LIST OF TABLES 1. Lung cancer mortality ratios .................... 2411 2. Lung cancer. mortality ratios for males by duration of cigarette smoking ........................... 244!. A3. Outline of inethods' used in retrospective studies of smoking in relation to lung cancer ............. .323 A4. Group characteristics in retrospective studies onihmg eancer and tobacco use .................... ..., 329' 5. Annual', means of total lungca.ncer mortality and.sex ratios for selected periods in Finland and Norway 246 6. Epidemiologic and pathologic investigations concern ing smoking and histology of lung cancer ....... 247 A7. Grouping of pu:lmonarycar.cinomas .............. 334 &, Tumor prevalence among males and~ females 35-69 years of age;, by type of tumor and smoking category ................................... 250 9: Epidemiologic investi'gat!ions ¢oncerningthe relation- ship of lung cancer to snrokingy air pollution, and urban or rurallresidence ...................... 2'53 10. Pathologic and cytologic findings in ttie tracheo- bronchialitree of smokers and nonsmokers ...... 259 234 .;.... _,~...d:..~::~_

TABLE A15s fitudies concemrng the relationship of smoking to infectious respiratory disease in humans (Actual numberof casea ehown in pamnlheses) SM - Smnkece NS = Nonsmokers Author, ycae. Numberand Data cdunCry, type.of " collection Reaulta Comments reference population Mine. _11_8 male end 1950, female patienta U.S.A. with pneumonia (167). and4'I2healthy individuals from d °e l ran om mp e. Hn pital Interview. Mean age ........................~..... Caeee 49.@ C_ one.ole 49.6 NS ............................. ..... 16.26 25.21 Cigarettes only .......................... 63.56 62.33 Mixed ...........................~.... 21.19 22-46 Lnwe. 62Umaleand Inter.cie.wby 1956, 185temale trained England tuberculoeia eocial (i5Yi. petientsand419 worker. male and 249 female control outpatienta. Dowling, lndividuala at al., expased to 1969, "infgctloue U.S.A. oold agent" (YS}L andplacebo. Malea Caeee Cont*ota The author stated that thecewasa eignifcantdiRerenee in tobacco vaage between the two. gmupe. Femnlee Cigarette emakere Caeee C_ ontro7w include pipe smokers. NS ....... ............. 2.5 8.1 37.3 51.4 Cigarettee/dsy: 1-9 ...... 9.2 12.9 20.5 25.7 10-19 ............... 38.1 35.6 30.8 20.5 20 29 ............... 23.4 27.4 30 39 .. 11.3 9.3 1 11.4 2.4 >40 . . ... 9.4 6.7 The author noted s eignificantdeflciency o,non- and light smokers and an e cess of heavy smokers emong the caeea Interriew and Exposed to plaeebo Expoaed to inJectioua o0ent No ortatistteally medical Percent Percent significant examinat/on. developinG deveinpinc diRerenees Number ^cold" Number "co(8" noted. . NS ................. ]11 10 328 ... 34 SM ................. 78 14 249 35

EPIDEMIOLOGIGAL. $TUDIE& Numerous epidemiologicall studies, both retrospective and pros- pective, have been carried out in.different parts of the world to investigate the relationship between smoking and cancer of the lung. These studies are outlined in tables 1„ 2,, A3, and A4L. those of cigarette smokers (table 1). ies to have lung cancer mortality rateshigher than those of non- smokers, although. these are generally substantially lower than Pipe and cigar smokers have been shown in the prospective stud- ( H~d ) ., England and Wales during the period from 1953'-57 through 1961- 65s the rates for male. doctors of the same ages fell by 38' percent. deathxates,from lung cancer rose by 7 percent among all men from Ex-smokers show significantly lower lung cancer death ratesthan continuing smokers. Tnitheir study of more than 40',000I British physicians, Doll and Hill (9'4, 75), noted a.d'ecrease in lung cancer mortality rateswith increasing,time since smoking stopped (table 1). During the past 20' years„ half of all the physicians in Britain who used to smoke cigarettes have stopped smoking. While thee duration of smoking (table 2)1. ciatedl with increased inhalation (table 1) as well as,with increasedi inithe mortalityfrom ]hngcancer with increasing amounts of cigar- ettes smoked perr day.. Other measures of exposure show similar trends. Hammond (118) reported increased mortalityy ratios asso- investigations have studied more than, a million persons from a number of different populations for up to 10 years, These studies show increased lung cancer mortality ratios for cigarette smokers of all amounts ranging from 7.61 to 14.20 among male smokers as compared to nonsmoking males. The one major prospective study of female cigarette smokers reveals an overall mortality ratio of2'.20 (118). Also~uniforrnlypresent.in these studies is a dose.related increase Prospective Studies The major prospective studies concerning,the relationship of smoking andlung cancer are presented in table 1. In allll thesee and. controls as well as the relative risk. ratios for all smokers. ported coneerningthe relhtionship~of smokingand lung:caneer.. These studies are outlined in tables A,' and A4. Table A4 presents's the percent of'nonsmokers and of heavy smokers among both cases. More than 30retrospective(ease-comtrol) 0 studies have been. re- Retrospecta've Stzdies 24'0

LIST OF TABLES (Continued) (A ibdicatestableslocatedlin appendix at.end.of chapter) Page SL Identified or suspected'' tumorigeneticagentsinc cigarette smoke ............................. 265 AT2'. Autopsy studies concerning the presence of radio- activity in the lungs of smokers ............... .335 AL:.,. Experiments cancerningthe effects of the skin paint, ing,or subcutaneous injection of cigarette smoke condensate or its constituents upon andmals ..... 337 Al-4l Experiments coneerning,,thee effect of cigarette.smoke or its constituents.an tissue and organ cultures .. 343 At a.. Experiments concerning the effect of the instillation or implantation: of cigarette smoke.orits constitu- ents into the tracheobronchial tree of animals .... 346 .a7Gi Experiments concernsngthe effect of the inhalatilonn ofi cigarette smoke or its constituents upon the respiratory tract of animals ................... 349 171.. Data on pedigreed male beagle dogs of groups F, L„ 18. H,h and N ................................. 270 Summary of principal cause of death (days No:, 57 through No. 875 ) in dogs of groups F, L,,H, h and NI 271 19. Data, on dogs with lung tumors indicating type of tumor and lobe iin.which the tumor was found .... 272 20, Laryngeal cancer mortality ratios - prospective studies .................................... 278 A'71,. Outline of retrospective studies of tobacco use and. cancer of thelarynx ......................... 354 A22. Summaryy of results of retrospective studies of tobacco~ use andlcancerofthelarynx .................... 358 A2'3: Numtier and percent distribution by relative fre- quencyr ofatypicall nuclei among true vocal cord cells, of men classified by smoking category ..... 359 :a'?4. Number and'. percent distribution, by highest num- ber of'cell rows, in. the basall layer of'the true vocal cord, of men elassifiedd by smoking category ..,. . 360 25:, Deposition of "C-labeled smoke particles in particu- lar regions of the respiratory tract ............ 282 26: Classification ofthe five registered stages of epithe- lial changes; at thelarynx.............. ......... . 283 27. Oral cancer mortality ratios-prospective studies.. 286 A28: Outline of retrospective studies of tobacco use and cancer of the oral'.cavity ..................... 361 A28a. Summary of'results of retrospective studies of smok- ing by type and.oral cancer of the detailed sites.. 368 235