Tobacco Documents Online

j I A ~ ~ C~ AN.C.EL 19mly- NEWS ~ SERVICE 219 EAST 42nd STREET ~ NEW YORK, N. Y. 10017 1 MURRAY HILL 6•4300 -+~ - lY 4, January 7, 1964 TO THE CITY EDITOR: Attached is a compilation of the history of "The Position of the American Cancer Society Regarding Tobacco and Lung Cancer". Your writers may find this useful as a background and for feature material in connection with the issuance of the forthcoming report of the Surgeon General. MAR 3 0 1981

T HE POSITION OF THE AMERICAN CANCER SOCIETY REGARDING TOBACCO AND LUNG CANCER As early as 1936, Dr. Alton Ochsner, former President and now an honorary Life Member of the American Cancer Society, called attention to the growing increase in lung cancer. The distinguished surgeon from New Orleans speculated that cigarettes might be the major cause of the dramatic increase in lung cancer noted in his surgical experience. He observed that most of his lung cancer patients were cigarette smokers. Since that time, Dr. Ochsner has been a strong advocate of realistic research action on the possible link between cigarAttes 'and lung cancer. From the time he became a member of the National Board of Directors of the Society in 1941, he became an advocate of a thorough study of 'thP alarming inci^ease in lung cancer that he had observed in his practice of surgery. Dr. Ochsner was not alone in his suspicion about cigarettes and lung cancer. In 1944, Dr. Clarence C. Little, then Managing Director of the American Cancer Society, wrote in a pamphlet entitled, "Cancer, A Study for Laymen:" "Although no definite evidence exists concerning the relation between the use of tobacco and the incidence of lung cancer, it would seem unwise to fill the lungs repeatedly with a suspension of fine particles of tobacco prbduct of which smoke consists. It is difficult to see how such particles can be prevented f rom becominp lodged in the walls of the lungs and when so located how they can avoid producinP a certain amount of 1/7/64

-2- irritation. One might also question the ultimate results of continued inhalation of the type of atmosphere which characterizes the lower levels of city streets. Experimental work with animals involving these matters is still inconclusive but it seems probable that the lung as an organ is not immune of the effects of chronic irritation and it will in this respect resemble the other organs of the body. Such being the case, wisdom in avoiding unnecessary lung irritation seems to be established." Dr. Little is now Scientific Director of the Tobacco Industry Research Committee. The American Cancer Society became increasingly concerned about the alarming increase in death rates from lung cancer in- ],949, when Dr. E. Cuyler Hammond, Director of the Statistical Research Section of the Society, made a study of "trends in cancer mortality." He reported to the Cancer Prevention Committee of the Society: "The lung-bronchus category is the only site category which has shown a steady and tremeridous increase in age-corrected death rates f rom 1933 to the present time." He pointed out that in 1948 in the U.S., cancer of the lung and the bronchus caused 12,891 male deaths and 3,440 female deaths compared with some 2,000 male deaths and 1,000 female deaths in 1933, and that "only a relatively small proportion of the incrPase can be attributed to the growth and the aging of our population, and it is hard to relievP that it can bP attributed entirely to tn ~ ;~. .~ improvemnnt In diapnosis."

It was noted that the increase in cancer of the lung had occurred in all sections of the U.S. and in most other countries from which reliable statistics were abailable. "Therefore," Dr. Hammond's report said, "it may be assumed that it is due to some factor or factors operating over wide areas_and in very different types of communities." Furthermore, the report added, "it would seem to be a reasonable hypothesis that there.has been a corresponding increase in one or more of the major factors, at present unknown, which are responsible for lung cancer. "If it is discovered that lung cancer is indeed caused by some carcinogenic substance or substances of widespread and increasing use ... there.is reason to hope that we may be able to control the disease by eliminating the cause." Dr. Hammond's 191+9 report strbngly recommended that the Cancer Prevention Committee of the Society and other groups "give high priority to the problem of cancer of the lung." The Hammond report did not suggest cigarette smoking as a possible factor, but as a result.of it, the American Cancer Society's concern in pinpointing the factor began. Out of it the cigarette-lung cancer link emerged. One of the first actions taken by the Society was a grant to Washington University, St. Louis, Missouri, for a study on cigarette smoking as an etilogic factor in lung cancer. The late Dr. Evarts A. Graham and Dr. Ernest L. Wynder (who is « ~ ~ ~ ~,.~

-4- presently associated with Sloan-Kettering Institute, New York) began studying the smoking habits of lunP cancer patients. The Society continued to make grants to the team and by 1953 Graham and Wynder reported that they had produced skin cancer in mice by the application of cigarette smoke concentrate. On October 26, 1951, the Board of Directors of the American Cancer Society directed "that a field study on smoking in relation to cancer of the lung be approved and the necessary funds be made available." This was the beginning of the American Cancer Society -- Drs. Hammond and Daniel Horn study which linked cigarettes to lung cancer. The'Society undertook this study without any preconceived conviction that cigarette smoking might be the major cause of the increase in lung cancer. The Hammond-Horn study diff Pred from others in that it was prospective. It looked forward instead of backward, studying people as they lived and died. Even before Drs. Hammond and Horn were ready to report their first evidence linking cigarettes to lung cancer, significant facts had developed abroad. Drs. Doll-and Hill had concluded f rom a study of physicians in England that there was an association between cigarette smoking and the increase in lung cancer. The Hammond-Horn study, begun in November 1951, was one y ~ ~ L_~ ° of the largest ever undertaken in the field of health. It in- ~ volved more than 187,000 men between the ages of 50 and 70 i.n 394 counties in ninP states across the country. Some 22,000 volunteers assnmblAd data on the smoking and non-smoking habits of this vast group of mpn -- men in the age Proup in which lung cancer is

most common. Each year for a period of four years the volunteers checked on the status of the men originally interviewed. When a death occurred in the group interviewed, the cause of death was established through official death certificates, doctors reports, and for some, autopsy findings and biopsy reports. While the study was still underway the American Cancer Society devoted its 1953 Scientific Session to "Cancer of the Lung -- An Evaluation of the Problem." In opening the session, Dr. C harles S. Cameron, then Medical and Scientific Director of the Society, described lung cancer as "a disease that is well on its way toward the proportions of a national epidemic." Scientists participating in the two-day session expressed widely divergent views on the possible relationship between cigarettes and lung cancer. Dr. Hammond, then in the midst of his massive American Cancer Society smoking study, had doubts. He wanted, he said, "very strong-proof indeed before I would be willinR to state as an absolute fact that I know cigarettes to be responsible" for the major increase in lung cancer. The significance of the meeting was that many physicians were made more aware of a possible cigarette-lung cancer link. At the end of two-and-a-half years, the American Cancer Society was ready to make a preliminary report. The report was made by Drs. Hammond and Horn on June 12, 1954, before the American Medical Association's annual convention in San Francisco. Ln ~

On the basis of the deaths that had occurred since the beginning of the study among the more than 187,000 men, the report concluded that among men between the age of 50 and 70, cigarette smokers have a death rate higher than non-smokers of the same age by as much as 75 per cent. While the report made clear that the findings were only preliminary, it said "the authors are of the opinion that the association found between regular cigarette smoking and diseases of the coronary arteries and between smoking and cancer reflect cause-and-effect relationship." The American Cancer Society Hammond-Horn report received front page news•coverage.' Radio and television treated it as important news. Magazines became more actively interested in the possible link between cigarette smoking and lung cancer. The Hammond-Horn revelations were listed as one of the major news events of 195+. Between the Hammond, Graham-Wynder reports in 1949 and 1950, and the preliminary r eport of the American Cancer Society's smokinp study in June 1951+, much evidence had developed to point to cigarette smoking as one of the major factors in lung cancer. Several American Cancer Society sponsored conferences had been held on the problem of lung cancer, including the question of cigarettes as the possible cause of the great increase. In 1952, the American Cancer Society had formed the National LunP Cancer Committee, which stated at its first meeting: "While work should be continued on whether or not smoking is a ma ior cause of lunP cancer, other possible causative agents tn ca ~

must not be overlooked.". It pointed to such inhaled substances as soot, motor fumes, dust from roads, etc. As a spokesman of the Society said, cigarettes in relation to lung cancer had been placed at the scene of the crime but their guilt had yet to be proven. After the Society's preliminary smoking report in 19 !N, its Board of Directors established a fund of S500,000 for the special study of cancer of the lung and cigarettes. Since that time, the Society has spent millions of dollars on research related to smoking and lung cancer. At its annual meeting in October 19~+, the Board of Directors took,its first action on elertinrp the public about thP possible hazards involved in cigarette smoking. The Board resolved "that the American Cancer Society emphasize to the American people that presently availablP evidence indicates an association between smoking, particularly cigarette smoking, and lung cancer, and to a lesser degree, other forms of cancer .... and heart disease." Also in 1954, tthe Third National Lung Cancer Conf erence, voted that "since the presently available evidence indicates an association between.smoking and lung cancer, be it resolved that the American Cancer Society and the U.S. Public Health Service ... devise and pursue public health education and other measiires designed to control the rising incidence of lung cancer, especially as it relates to cigarette smoking."

Meanwhile, other research studies in the U.S. found evidence that cigarette smoking was related to the increase in lung cancer. In June 1955, Dr. Oscar Auerbach, now Senior Medical Investigatorg Veterans Administration Hospital, East Orange, New Jersey, and Associate Prof essor of Pathology, New York Medical College, applied to the American Cancer Society for a research grant to pursue his suggestive biralogic findings of the relationship between cigarette smoking and lung cell changes. His preliminary evidence was based on microscopic examination of human bronchial tubes and lung tissue. As a result the American Cancer Society made a grant to Dr. Auerbach to help continue the study and a research team was formed which included not only Dr. Auerbach, but Dr. Hammond and Lawrence Garfinkel, both'epidemiologists from the Society, and Dr. Arthur Purdy Stout, the distinPuished pathologist of Columbia.Presbyterian Medical Center and formerly Professor of Pathology at Columbia University College of Physicians and*Surgeons. Several reports have been issuPd since on this research, all•adding new evidehce on the'link between cigarette smoking and lung cancer. In 19569 Drs. Hammond and Horn made a second report on the Society's smoking study to the American Medical Association's annual convention in Atlantic City. They concluded that cancer of the lung is a rare disease among men who have never smoked; that lung cancer is an important cause of death among men smoking two or more packs a day; that the death rate from lung cancer increases with the amount of cigarettes smoked, and that evidence indicates that riving up cigarette smoking reduces the risk of lunr cancPr.

The report also linked cigarette smoking to cardio-vascular diseases. Also in 1956, the American Cancer Society, the American Heart Association, the National Cancer Institute and the National Heart Institute ~oined in establishing a Study Group on Smoking and Health, consisting of seven scientists. They were charged with reviewing all of the evidence so far developed on the problem of smoking and health. After months of study, they reported in March 1957: "The sum total of scientific evidence establishes beyond reasonable doubtthat cigarette smoking is a causative factor in the rapidly increasing incidence of human epidermoid carcinoma of the lung and that smoking of tobacco, particularly in the form of cigarettes, is an important health hazard. The implications of this.statement are clear in terms of the need for thorough con- sideration of appropriate control measures ry the official and voluntary agencies concerned with the health of the people." This Study Group report was widely publicized by press, radio and television. The scientists making the report were: Dr. Richard J. Bing, Washington University Medical School, St. Louis, Mo.; Dr. Rolla E. Dyer, Emory University Medical School, Atlanta, Ga.; Dr. Abraham M. Lilienfeld, Roswell Park Memorial Institute, Buffalo, N. Y.; Dr. Norton Nelson, Postgraduate Medical School, New York University, New York City; Dr. Michael B. Shimkin, National Cancer Institute, Bethesda, Md.; Dr. David v ~ M. Spain, Peth-E1 Hospital, Erooklyn, N. Y.; and Dr. Frank M. ~ 1 Strong, University of ':Jisconsin, Madison, Wisc. Dr. Dean F. ,~,