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Philip Morris

Smoking and Health 640000 - 790000 the Continuing Controversy

Date: 19790110/P
Length: 133 pages
2060460623-2060460756
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Author
Kornegay, H.R.
Type
PUBL, PUBLICATION, OTHER
BIBL, BIBLIOGRAPHY
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LEGAL DEPT
Litigation
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PARE, PARENT
Site
N28
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Afl Cio
Agriculture
Air Force
Amed, American Medical Association
American Academy of Allergy
American Assn for Thoracic Surgery
American Cancer Society
American Chemical Society
American Heart Journal
American Petroleum Inst
American Statistical Assn
Annals of the Ny Academy of Sciences
Appropriations Comm
Archives of Environmental Health
British Medical Journal
Business Week
Chemical Inst of Canada
Columbia Univ
Congress
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FDA, Food and Drug Administration
Federal Aviation Administration
Hew, Dept of Health Education and Welfare
House
Hri, Health Research Inst, Roswell Park
Intl Agency for Research on Cancer
Intl Archives of Occupational + Environm
Johns Hopkins
Journal of the Irish Medical Assn
Karolinska Inst
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Los Angeles Times
Mayo Clinic
Medical World News
Mount Sinai School of Medicine
Natl Heart Lung + Blood Inst
Natl Inst of Neurological + Communicativ
NCI, Natl Cancer Inst
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Niehs, National Institute of Environmental Health Services/Sciences
NIH, Natl Inst of Health
Ny Times
OSHA, Occupational Safety & Health Administration
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TI, Tobacco Inst
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Who, World Health Org
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Author (Organization)
TI, Tobacco Inst
Named Person
Aronow, W.S.
Astrup, P.
Barnard, C.
Becker, C.
Belcher, J.R.
Bridbord
Burch, P.
Califano
Churg, J.
Devees
Fisher, R.
Framingham
Fraumeni, J.F., J.R.
Gilliam, A.E.
Gori, G.B.
H, W.
Hammond, E.C.
Higgins, I.
Hirayama, T.
Jones
Phillips, G.B.
Rueper, W.
Russell, Mae
Salvaggio, J.
Scamlar
Selikoff, I.
Silverman
Stedman, R.
Surgeon General
Terry, L.
Tower, D.B.
Vandenberg, S.
Vest, T.C.
Vincent, R.G.
Yerushalmy, J.
Master ID
2060460229/0756

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29 May 2000
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jxz45d00

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Page 101: jxz45d00
645 ocher cancere etY's yearly reports to Congress have cited various prospeetive and retrospective popuL tfon surveys to support claias of atatiatical relationahipa between ciga[ette smoking sad cancers of the oral cavfty. bladder. esophagus. laryn and pancreaa (1, 2). [ovevat, close eta.inatlon of the tnci- desce rates of these diseases reveals .any unaaplafnable patterna that are almost iupossible to reconcile with the kypotheais that ct{arette smoking causes the.. The incidence rates usually cited for these cancere, aad tbair ti.e patterns, have been derived fro data'collected The establishment of any relationship betveeo seok- kini and cantece of the laryn:, esophagus and bladder ust involve considerable auessvork, because of the vastly different incidence patterns and trends of these diseases and ultlple suspected eaases. is two large-aeals studiea, conducted 25 years apart, by the pablic 8u ltb Service: The Second National Cancer Survey (itCS). 1967-t9, and the Third National Cancer Survey (TNCS), 19il-71. Source daca froa the rirat National Cancer Survey. 1937-)9, ara no longer available, but conparative daca fro• eke Seeond sad Third, for the seven geographic araaa that Ckap kad Ss eoaaos, were published by the National Caneer 8aatltats last ysat (3). More than 20,000 cancer c-asea were Aaelodpd to tha.ifC6, .ote than 124,000 in the TNCS. 103 20sQ4so724
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646 Figure 1 Incidence Rat.s• par 100,000 Populat/on from Second National Cancer Survey (SNCS) (1947•q) and Third National Cancer Survey (TNCS) (196f}71) SNCS TNCS SNCS TNCS SNCS TNC° % 0 C1INCER ORAL CAVITY SITE a PMARVNX q BLADDER { 0 - WhM mab p- nonwnur male ESOPHAGUS p- whib famala Q- nonwhlta Nmata 'Aya aAjaate0 to the 10l0 U.S. Ooouunon atanaara. ioarer.OMw ano Sllramun 1976 I(3) 104 2060460725
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647 Ths graphs in piture 1 illuatrvice such inconsruiriee ns incidence rates rialnR, fa111n1 oi reaalnin{ stable depend- ing eo diauaa. lender and tate. [ven when one eou lders the no~called '1a{ period° -- the tiee between the action of the nlie{ed causal agent (acarctu` saokint) and the diagnosis of the disease -- the Rraphs atill do not support the claie that cigarette saokln{ is the cauaal a pot. For e:aeple,'ooerhlte uale rates for caaeers of the orsl cavity and phar7a: .era up by almoet 40 percent in 25 yeara, while the rates for white sen aad so.an were down by approai.ately 30 percent. The rates for ueanhlte feaales decreased, coo, but not so sharply. Turther, ulfilar peculiarities in the rate paccerns cao be obssrved for ca.eer of the bladder. The rates for sales, both white and aevhitev increased aarkedly -- especially the nonwhite sale raee, which nearl7 doubled. The rates for both groups of feaales were sharply down. Soaa critics of cl6arettes have clalaed that blacks 824 ether nonuhites •a7 have been slower to take up rlgarette asakin{ in any nuabers and are therefore later in shoriaa teereaaes in the °el{arette-ralaced" diseases. Thle contention f sot supported by the daca, as illuatrated in Figure 1. On the other hand, the ationa: Cancer Institute researchers have sa{peted another explanation for these trends in nenvhitee, aNel] that other factors such aa ac ues to sedlcal care and laprs.ad d1a{aosie say partially aeplain the increased inci- daaea ts aase of these dlsa.aes ln blacks. 105 2060460726 '
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648 Sut chaes factors cao hardly aceount far tha Ju.p to o.ophap al eocar is nonrhite salea while white .ale iscidasca va dropping. tha incresae in bladdar tanear ia sos.bica . ua• while [t dropped !n nonwhite vesen or tha dacrease Sa orsl/pharpageal canc.r in nonvhlce •osan rhile it cltsbed ataqlp in noe+hita .ta. Othar published studies and survqa indicate that no Lir• stat ueets of causality correctly eao be adn about s.okin{ snd any of th.ss esneara which have bsen tatia- tieall7 linksd vitb e1{arattes. Oral/pharv ual 6ancere Although claioa have baan aade that eaokin{ causes oral aod pbar7ngsa1 esaears, such eontaetiona are not supported by sa eaanination of the available literature. A oa.Nr of stadies, for e:uple, hava failed to establish a relatioaahlp betwaen s.okins and oral cancer (4. S) sad a.oktns and pharys- pal caeeer (S). laeant studies on tobacco and oral and pharyniaal easesrs have e:ulned the possibility of a substaatia117 kighar risk for developoent of chaaa caneara Sn indlvlduals who bstb s.eke and drink. One study in 1977 reportad suck a• t.erausad risk in patlants ssasinad in 20 hospitals Sa e1gbt Au rica• titias (6)• Yn.evur, this raa nec ceaftr.ed by tro 206Q460727
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649 otk.r atudfas of oral eaaeer patieeta publishad th• aaaa year (7, •). Istarsstiatl7 anouth, eu (7) pointed to another tatter -- poor dantitioa or tooth spaclai -- as a.ora laper- taot risk faeter than either eitarettas or alcohol. •ttaapts to atud7 the possible tafluaeess. of cita- rattas aad alcohol in the development of aral and phar7apal caaears are cosplleatad, because lodi.ldoals who s.oks also are •ero likal7 cn driak. 7harafora, it is diffSeait ce dataraioo shat -- if any -- rola th ue social hablts play. taoobataal Caac.r • kiostatistitian fron the tetareatiosal Agency for Su u reh on Cancer la prsoca recencl7 reeisaed worldwide pattsr4a of ssoshagul cancer aol certain epidsnlologleal data (p). a conclud.d that "tbo data_stroatl7 aottoat that factor associated with povsrt7 ead specific llsitations of dietary intake incrauo auseaptibtift7 for this dtaauo." This rea.archer noted "aaceptiona117 high ratns 1• a..a arus,• and "a bitber iacideact anont tha lower aoe1o- asaaonis `roaps," ont .arkedlr t females. a aaid tkat althoegh thnte ta a statistical aaanccation vtth tebaeeo aad baavy als.hol use !a the 0.6. ud dastera ioropa, is oek at 944 reat at the world they ra not "facters of major 1oper- taaea.a 107 2060460728
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ss0 "• coaaiderahle array of etternal factors have baaa aasoclated with the disease," he said, "but none strongly e.ongh ar with sefflcisnt conslstency between countries for tkair etiological role to be basic." Is aaother recent atudy, rse.archers ecasininp the Sncldence of eeophaSaal Canter in Southern lran found that the risk of this cancer in sales and feaalu •as "at Laast nearly equl," evea though cigaretts smoking and alcohol consuq tioa are "al.ost saclusl.ely ala" habits la this region (10). This obaer.atlon led the to speculate that "it ssus probable that the etiology of the dis.esee in th1 region is sot eaplainable by association with tobacco smoking and/or alcohol ssa, since these habits do not correspond with the epidemiology of the disease as found ln this study." Lar.osaal Cineer •fter examining nearly 200 patients with laryngeal carciaoaa, an inSllsh otolaryntolo{ist questioned the claf• that aaokiag easses this cancer (11). te obsar.ed that "the laeidanes of laryngeal cancer has rs.ainN •ora or lose caaataut for 70 years -- e periad in which tobacco cosss.ptioa .•.(ku) rises sbarply." •a alss .araed that " uy data aleNiat a eortalatio between heavy elaarett• s.okin-q asd larfs{eal eartiaama aust be interprated with tautioo because 1 the e.tlrs population the incldence of larysaeal earclseu 108 2060460729
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651 has beta reaark•bl) constant." The tritish physici.n"s conclusions •re supported by ths •ork of •a •r{sntinien who eraained the efoking habits of Igf cancer patients in three cities (12). gtatistical asalyais of the data, he said, revealed "r•luas [fer saakiag) that are net significaot, consequently not inditating • depen- dsacy between the prasence of the studied cancer and the saokiag habit." ie said, "de can therefore hypothetically assuaa that other factors, besid u the significance af the •asking h•bit, aust logically affect the etiology of thass patholagiss." Saoking apparentl7 also aa discounted as a causal factor by •ritiah scientist who investigated the possible relationship betasen alcohol and tobacco use and lar)ogtal cautar by sasainina disease and death rate patterns (13). 0as problsas he aaid, is that trenda in aortality tatss Sn different •g• group show contru tin{ charactaristies. e foead, after drawing up ti.e trend charts by five-year •ga gr•aps, that the sort or less consistent fall in dtath-rata is both sexes -- rSile per capita consuaption of alcohol aad cigarette use rost So both sexes -- "would aeaa to be iaesapacihl• with the hTpothesis that tobacco and/or alcohol srs MJor caasal agoaa." 7sfora Yia discuasion of the dsta oa larTagsal casear. k• bad teaasatsd an the nsed to usa all a.aiLble data 109 206a460730
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652 Sn att.nptint to deter-ntee diae u e c.usation: "7here cae be eo doubt that epld.aloloatsts have the profe.aional re.po..- ibility for elucidatin{ the causes of disease with all [he ingenuity aed thoroujhness they cao coa und." lut vlth a rr)naas" rsr. in adical journals, he •lso nated that "cr)leS wolf lo the abaeuce of the earsuder fs generally held to be counterproducti.e." )ladder Cancer A nuaber of studies era.lnin; the incldenee of bladder cancer have found no uaoclation betveeo cigarette smoking and the occurrence of bladder tumors (14-16). Iocou- siatencies 1u the coacluslcns of reports eaaslnin{ the rele- tlonship between s.ekcn` and bladder cancer and "the relative seakneas of the evidence for an sssociacion in feualea^ led the journal Lancet to "suggest the need for caution in lnterprets- ciea• of such studies (17). Aajor paper on bladder cancer uaa published by the ational Cencer Institute in late 1978 (18). The tro so.ereuest epldealolegisca looked at the geographic pattatna idssctfled in their 1nstltute's "cancer atlas" (19) (..a Cancer I Workplace ebapt.r). iladdar cancer saps, according to th.sa resurchera, sksred "s!{siflcan[1y higher" rates among aales in the Porth- 110 2060460731
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JNCI ,.: CifFARTPAfNP QF (+EAt'H FpuC.Aii(ita A•4li r41 .~ • 653 Figure 2 Journal of the National Cancer Institute Oclooer 978 voiume 61 M,mcer 4 a1,n r..y.ltr. - .r~aY NdISYW inyltyft a F~ 2060460732
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JNCI 653 Figure 2 Journal of the National Cancer Institute Oc1oDP, 1978 vowme 61 N,mDer 4 „'. bEFAFT~AENT Of nEWH FpULAh(jr. ANl. y..f . i• , ' t... 1n•nAr• ..~K.• Ydfar~ .ny~l,lp.~ .y ~bMn 111 2060460733

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