Smoking & Cancer

"Lies, damned lies and statistics." Thus, only last week, the A.M.A.'s incoming President Elmer Hess, an Erie (Pa.) kidney and bladder specialist, had characterized much of the hard-won information on the subject of smoking and cancer. This week Dr. Hess--a smoker himself--was to hear some hard facts on the subject at A.M.A.'s convention in Atlantic City. Reason for the convention's preoccupation: lung cancer now causes around 24,000 deaths a year in the U.S., which puts it in the category of epidemic diseases.

The American Cancer Society's Statistician Edward Cuyler Hammond rose at the gavel to explain what kinds of smokers get the most cases of lung cancer, and to discuss whether it does any good to quit. He and Assistant Daniel Horn drew from impressive data: the smoking and life histories of 188,078 men interviewed in 1952, and watched ever since. By the end of last October, 8,105 had died--285 from apparent lung cancer.

Victims & Packs. The crude figures were striking enough: in 32 months, lung cancer had killed only 33 per 100,000 of the observed nonsmokers, but 246 regular cigarette smokers--more than seven times as many. Cigar smokers had about the same rate as nonsmokers; pipe smokers had double the rate. But when Dr. (of Science) Hammond pinpointed his attention on the 168 cases in which typical carcinoma of the lung had been most clearly proved, he found the disparities even more striking. In this category, there were only two deaths among men who had never smoked--a 32-month rate of 4.9 per 100,000. Among regular cigarette smokers, with 152 deaths, the rate was 145--or 29 times as great. Finally, Dr. Hammond broke it down according to how much the cancer victims had smoked:

P: Among those using less than a pack a day, 128 deaths per 100,000.

P: One to two packs: 227 per 100,000.

P:More than two packs: a rate of 460--or 90 times higher than the nonsmokers.

Dr. Hammond had good news for onetime regular smokers who quit: 20 deaths gave a rate of 102 per 100,000. Yet among those who had never smoked, the rate was less than 5 per 100,000.

Town & Country. Doctors who doubt or deny a cause-and-effect relation between cigarette smoking and lung cancer have always seized on the fact that death rates from this disease are higher in the cities than down on the farm. Therefore, they argue, the cause must be smog or exhaust fumes, or simply the sinful exhalations of mass man. They may be half right, but no more, according to Dr. Hammond's figures: the smaller a man's home town, the less likely he is to smoke cigarettes heavily. This accounts for part of the urban-rural difference.

Lung & Larynx. Another widely used argument has been that smoking could hardly cause cancer of the inner lung without causing many cancers of the more exposed larynx. Yet the death rate from larynx cancer has not gone up in step with that from lung cancer. This question was tackled by Epidemiologist Ernest L. Wynder, of Manhattan's Sloan Kettering Institute for Cancer Research, who created a stir 17 months ago when he produced cancers consistently on the backs of mice by using tobacco tar. Said Researcher Wynder: larynx cancer has become commoner, but it has not become a commoner cause of death. Reason: earlier detection and therefore more effective surgery, possible with easy-to-get-at larynx cancers but not with those deep in the lung.

Cigarettes & Liquor. Wynder and colleagues studied 209 U.S. victims of larynx cancer, 132 of lung cancer (for comparison), and 209 victims of other diseases, including some forms of cancer, of the same ages and backgrounds as the larynx-cancer cases. Their key findings:

P:Heavy smoking alone, or in combination with heavy drinking, greatly increases the likelihood of cancer of the larynx.

P: The likelihood goes up with the amount smoked: if a light smoker (up to 15 cigarettes daily) has X chance of larynx cancer, a 16-to-34 man has almost double that chance and an over-35-a-day smoker nearly four times that chance. Noninhaling cigar and pipe smokers run about the same risk as 16-to-34 cigarette men (higher, relatively, than their risk of lung cancer).

P: Larynx cancer is ten times commoner among men than women in the U.S.

P: A smoker who drinks more than six ounces of hard liquor daily is seven times as likely to get larynx cancer as a teetotaler who smokes the same amount. Below six ounces, the liquor does not seem to affect the cancer risk. Liquor does not influence the development of lung cancer.

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