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:.: a > , • , . : , . c . ' _: • • , • . . . Com;ents on Article by Niels Duagal entitled: "Lung Cancer published in Laz.icet, December 16,1961, P• 1350: rtr '~~ r •.i in Iceland, This is a very brief article containing data which coutd be +?~ subject to criticism, however, it is one of the papers which may be ,.:'. : ~.-.: :'.` 'j..~;F.: y5~. ,:_;,- ,;.... :., . -. l.l;?. ..il:.iSCr .}.l r-c'.,-d i~:'., ,.• '•. „ quoted to claim a causal relationship between smoking and lung cancer. `3 .. , ., .:.~ ~,.. ~..• . . <.l:'6.~ . - ~f~ r-,' ..fRYf~S iii ^'tr '~ ~;/, .'~ `.-~; . ... . S . 1^ ~ ~ , ~ :+i~.~ K ~'t.f '~«~r. • +~~~'.1,(',}I~,~~ ~` Hriefly, Dr. Dungal claims that with the increasedecigarette conswnp W -7`'~'iy-~'~~a~2 ,r 3 tion in Iceland there has been a rise in lung cancer which is not y A. :. -. r ,., .. . . .: ... , ~`fi .; .. : _ . ,, . attributable to atmospheric pollution since in Reykjavik (the capital) ; : ..a _ , , .,.. ,. ..,; •,:.._ „ ~ .., . ~;..r~.• ~:; the heating is from natural hot springs and the air is exceptiona11y ~ ..._, _ : . . .. . . . . .,:..... r+. ::...:_, , ~ : : ~. , P .... rt . : ?=-. ~m. .,,..•;.:. -. ~_. • .... , _ . . i "-iy rT~ .... ; .. , . ~ .... . :.:~.. .. . ~..,,. :pure. Comments on this paper will be directed toward criticisms .; ~- :' " ..;:.e..' -:... ~. . .. .._. ~. ,. . . . . . . . . . .. . ~ .: •. .. ' sr .. • . :. ._ ... . -. , ~. . . ..". . ..... .- :.- . .. ...•.' . , s.~-_:r :'~`a~dF~.~i~~;n+i;•. which could be used in the event $hat it is raised in testimony, and ., , , •', : ' :. ; . . ; _ .- : .. , , - • < ::-~•a :~.t~ :: ~,~ secondly, to point out how it illustrates the confusion and variability . .. . . _ . .. , .. . , . . .. ., . r~~ .. ~ . ~ -. .., ~ ... . . r in diagnosis as well as the confusion over the type of lung cancer .. ~ .. , which is said to be increasing with smoking. . , . .. ..... ... ~. . , . _ - -,....•~ ... ~ ~,..~: The results of this stud,y are based on autopsies which have • _ ,,~ ,;; ,. , involved are too small to be meaningful since there were only 62 cases of lung cancer in a period of nearly 30 years. Although the atmosphere in the capital city Reykjavik may be pure, the autopsied individ'ca]..s came from various parts of Iceland, in some of which there is said to be considerable smoke in the huts in the winter time. Since the author claims that the alveolar cell tumors were caused by a viral agent, why does he not think that other types of tumors were caused by a viral agent instead of by smoking?' Since apparently there is said many limitations including errors in selection of cases. The numbers ;w,.. ~k'!Fg%3fa :

to be a marked increase in smoking in recent years, this would not appear to provide a sufficient latent period according to those who - ,,, ._ k . , a r ,1 :r• , . , r. <,. claim it takes 20 to 40 Yyears to produce an increase in lung cancer from an increase in smoking. In the period 1956 to 1960, there*were ...- , .. . .. ... . -19 cases of cancer of the lung in men and 12 in women, which is ari un- _ usuallJ,y high ratio of cancer of the lung in Women. It is of interest, .~~ '3.''i.. . . , - . i, ~i•+s.,.~ ,'.. but admittedly questionable significance, that Iceland has'an ~j. ~~4f. Fr:.s. ~~ Jc~<~.' f7.s yti,i~'F~~q~x a~.~:, X" • , ~c~•' . . _ ..... r _. . @ t s.... i~ ~ ..~1 ~ ~~s~ r ~ . :.'~.• :G', ~N .'~F Ys' unusually high rate of cancer of the stomach, the increase in which may be leveling off while the rate for cancer of the lung is increas - - This apparent rec .the lung and stomach has been noted in other squamous cell carcinomas, whereas 25 were adenocarcinomas. "In ms,n,,y other countries, squamous-cell carcinomas are common among smokers, but in Iceland smoking seems to produce a more undifferen- .tiated and perhaps more malignant type of tumor of the oat-cell type." ~~•; ;7his paper apparently illustrates the confusion as to what type of ;cancer is supposed to be increasing,from smoking and also probably the inconsistencies on the part of pathologists in their classification of types of cancer of the lung. Attachment: Copy of reprint INCI,OSik3E NO. 1, page 2