Document 3Ja08YXVqr8QwODDynYB7bRY0
FILE NAME: Smoking (SMOK) DATE: 1951 Mar
DOC#: SMOK020
DOCUMENT DESCRIPTION: Journal Article - Cancer of the Lung in Relation to Tobacco
BRITISH JOURNAL OF CANCER
VOL. V
MARCH, 1951
NO. 1
CANCER OF THE LUNG IN RELATION TO TOBACCO M. E. DAFF, R. DOLL and E. L. KENNAWAY.
Frotmh,e tSh,teaPtisattihcoalloRgiecsaelaDrcehpaUrntmiteonft,thSet.MBeadritchaollo'mReeswea'srcHhoCspoiutanlc,ila, nd London School of Hygiene and Tropical Medicine.
Received for publication February 20, 1951
Further Data on the Arsenic Content of Cigarettes. conItennatnoefa5rliberrapnadpseorf(DciagfafraenttdesKoefnBnarwitiasyh, a1n9d50A) dmaetraicwaenretygpievse,nofofr8thberaanrdsesnoicf Tofurakrsisehnictypveo,laatinlidzeodf itnwosmootkhienrgs. (FArenfcuhr,thRerhosdeeriseisano)f, easntdimaaltsioonfsorotfhaersaemniocunint Ictiaglayr,etBteuslgfarroiam, P8olacnodu)ntirsiersep(oUrt.eSd.Ai.,n CTaanbaledaI,. NoInrwaalyl,, 2S7wibtrzaenrldasndh, avAeusbteriean, examAlilneqdu.antities of arsenic given in this paper are stated as As20 3 gg/g., which is nTuhmeerriecsaulllyts tghievesnamine tahsispaarntds tpheer emairllliieorn.paper show-- Eng(l1a)nAd, hUig.Sh.Aa.r,seCnaincadcoanatnedntN(o2r4wtaoy.106) in 10 non-Turkish brands smoked in in a(2R)hAodleoswiaanrsbernaincd,coinntaenptop(0u-l0artoA4u-s8t)riiann 8brTaunrdk,isahndbirnancdigsaarsetsteosldfrionmEFngralanncde,, Pola(3n)dInantedrmBeudlgiaatreia.amounts (3-1 to 12-0) in a less popular Austrian brand, and ionf c8-ig6atroet1te8s-7f.rom Switzerland and Italv. One Canadian brand showed a range havOe fhacpoupresneednotocloaibmtaiins tmhraoduegthhathtethkeinadnnaelsysseosf ovfartihoeussefrciiegnadres,ttecsa,nwghivicehawnye cBoumt pmleotestpoicfttuhree borfatnhdescaorme ppaorpautilvaer hoanbesitsanodf stmheokreerssulitns tshheowdi,ffoenretnhtecowuhnotlrei,esa. gporaodraTtiuornkifsrhomtytphee ianrstehneicE-raicsht, AwmitehriacnanintytepremiendiWateesmteridn-EEuurrooppeeatno zthoneea,rwsehniiccha(Pc-co3)r.ds with Hutson's (1937) account of tobacco culture in Europe quoted below Cancer of the Lung in Relation to the Types of Tobacco Smoked in Various Countries. andSoofmDeorlelcaenndt iBnrvaedsftoigrdatiHonilsl,(a1n9d50e)s,psehcoiawllyanthaossseocoifaWtioynnbdeetrwaenednGthraehsammok(1in95g0o),f tobacco, and especially of cigarettes, and cancer of the lung. Since arsenic is under
i - id
2
M. E. DAFF, R. DOLL AND E. L. KENNAWAY
T a ble I.--Arsenic Content of Cigarettes. Brands other than English.
Brand.
Nciugmarbeettreso.f
As2Os ,ig. per g.
U.8.A.
Bra,,nd PC.M. 21 4561--04. ; 46-7.
Canada. Bra,,nd oK ,,,, BW.C.
45 836-7-8: ;1588-4-2; ;84-76-;1 1;85-57-;1.9-1. 36 4413--15;; 4567--56;; 5472--95.; 79-5 ; 7-5 ; 41-7.
Norway Bra,,nd BT
43 5741--47 ;; 5625--48 ;; 5754-'66.; 49-7.
Switzerland. Brand P
4 6-4; 3-1 ; 3'9; 3-4.
Italy. Brand N
6 10-5; 9-8; 10-2; 13-7 ; 9-1 ; 8-3.
Austria. Bra,,nd MD
31 T12ra-0c.e ; 2-1 ; 0-9.
Poland. Brand Z
5 2-5; 2-1; 1-2; 2-7; 1-5.
Bulgaria. Bra,,nd RA
44 00--67;; 01--62;; nniill;; 00--23..
sfoormdeHciilrlcuamndstaFnacneisngc,ar1c9in48o)g,etnhice iqnuemstaionn. (Nareisuebsa,uwerh, e1th94e7r ;thCe uarrrsiee,ni1c94in7 ;to]l itso caornsceenrinceadreingtihviesnpbroycethsse. CIhniesftaInncsepsecotfocraonfceFraoctfotrhieeslu(n1g93i9n).worIkneras ecxajl amrsoernteicmalepxoaimsoinniantgio"n re.vea. led. thdaute itno asdoddiiutimonatrosepniigtem, wenhtiacthiownaosfftahtael,trtuhnek lwimasbsa, pwraimrtyarygrocawntchesraollf othveerritghhetbloudnyg awnidthpemrfeotarasttiaotincogfrtohwetnhassainl sneepitguhmbo, i ganlaontdhserancadseinisthreecloivrdeer.d" "In a later Rinepaortfil(lCinhgiefmIancshpinecetoorpeorfatFoarc, taogrieeds,5',i 4ca3uyseeaorfs dienatah fbaecitnogrydumeatnoucfaacrctuinrionmgasohfeetphedriipghctolnutnaign.ingThsoredeiusmimairlsaernciates
CANCER OF THE LUNG IN RELATION TO TOBACCO
3
psiunlcmeo1n9a3r9y."carHciennormya(1o9c5c0u)rrdinegscirnibaersseancicaasel sohfeecpu-tdainpewouosrkcearsnchearve be.en. n.otifieidn a. fu. rn.a"cemTawnomnaokni-ningdsuosdtriuiaml caarsseesniotef bwrhooncehvieanl tucaanllcyerdiaerdeorfeccaonrdceedr oifnthpeersluonngs Staekminogn,a1rs9e4n5i)c. mTehdiisciqnuaellsytioonvemr ilgohntg bpeerdioecdisde(dMiofnotngeomcoeuryldahnadveWeaqiusmallayn,re1li9a4b1le; sdtoamtisitniacnst ftoorbatchceoinsmciodkenedceisooffctahnecearrsoefnitch-ericlhu,ngorinofcotuhnetriaerssewnihce-preootrh,etyppree. sWloewhaanvdedbifefeicnulctopllreoccteinssg. daIntavoienwtohifsthqeugersetiaotnprbaycticcoarlreimsppoonrdtaennccee,obfutthethmisatitsear ihtasnedeminsqbueitrtyerintoappupbrolipsrhiattheecaovuaniltaribelse. data now in the hope of promoting first to cSiogafarertates wsme okknionwg, wthheicohnlyhasvteaticsotimcael fsrtoumdiesanoyf ccaonucnetrrioefsthoethluerngthinanrelGatrieoant DBruintagianl, (t1h9e50U).Sfr.oAm. aIncedlaGnedr.many are those of Saglam (1944) from Turkey and of
aT.heFrdoamtanwathiiocnhalonsoeuwrcoeus.l--d l(i1k)eTtootaolbctaoinnsufrmopmtioannyofgtiovebnacccoou. ntr(2y)aPrreo:portion osmf otokbeadccaos wchigicahretisteso,f cAigmaerrsicaannd, opripTeu-trokbisahc,cot.ype(.4) P(3o)pPurlaotpioonrtiobny oafgetos.bac(c5o) Nanudmwbeormoefndseeaptahrsataetltyr.ibuted to cancer of the lung. The two last items for men agesb)..--Fr(1o)mNuunmivbeerrsiotyf acultionipcssies(f.or (m2)eNnuamnbderwoofmaeuntopsespieasrastheolyw--inpgrecafenrcaebrl.y (b3y) NumInbethr eofcaouutnotpriseiseswshheorweinag(5)cainscenrotofalvuanilga.ble one must rely on b. The ratio pouf rbp(o3s)et(oHbea(1d)y haansd bKeeennnsauwgagye,ste1d949a)s. thFeigmuroesst froerliaabnleuminbdeerxoffosreptahreatepryeeseanrst sahreo,wofccoonusrisdee,ravbelrey ddeisstiurarbblaen,cbeust t(hFoigs.e f2o,r t5h)eawnadr pmeruiostd b19e40avtooid19e4d5. gWeneeraalrley ainnddeb(t4e)d, itno athdedistitoafnfstoofwvahraitoucsanEmbebafsosuiensdininLsouncdhonwoforkr sdaotfareofneraen(1c)e, (a2s), t(h3e) CStoantessummapnt'isonYaeanrd BPorookd.uctAiognroeaftTdoebaalccoof iinnfoErumroatpieo,n" ibsygiJv.eBn.inHuatsreopnor(1t,93"7T).he geniIcnfsaucctohrscommupsatribseoncsonbseitdwereeedn, dniaffmereelnyt:c(olu) nStrmieoskiantgleoafsttofboaucrcop.ossi(b2)leScmarockiinnog-' osmf otokbea.cco(4)cIonnhtaailnaitniognaorsfepnriocd. uc(t3s)oIfnthhaelaintitoenrnoafl tchoemdbuussttioonf etonwginnse.and of coa_l_ factTorhsu,sanpdopounlalytiosnlisghintlyeaifstaetrnalEl utorotphee wsehciocnhd,arweilsluabljseoctbetocothmepafirrasttivoeflythferesee fwroilml bethme othstiredxpaonsdedfotuortthh,ewsehciolendth, ethiinrdduasntrdiaflopuertohplteosgeotfhBerr,itaanind tahnedinthheabUi.tSan.Ats. ofIceland will be subject to the second only.
Hutson (1937) classifiesTtohbeactycopeCsuolftutroebaicncoEugrroopwen. in Europe thus : ((12)) SOermiein-tOalr:ienTtualr:keyS,.EG. reIetcaely, ,BuSl.gWar.ia,YSu.goYsluagvoias,lavRiau,mUa.nSi.aS,.B>H.ungary, S. Czechoslovakia, S. Poland.
4
M. E. DAFE, R. DOLL AND E. L. KENNAWAY
Fran(3c)e, SpaDina,rkBaeilrg-icuumre,dS:wHeduenng, aSryw,itRzeurmlaanndi.a, Czechoslovakia, Germany, N. Italy, H(1e) TdhivoisdeesinthwehcicohunatrpieosrtoiofnEuorfotphee ifnatcoto4rygrcoounpssu:mption is grown (Germany,
Spa(i2n), TBheolgsieumin,wPhoilcahndp,roCdzueccthioonsloisvaakpiap,roSxwimitzaeterllaynde)q.ual to consumption (Italy, Yug(o3)slTavhioas,eRwuhmicahnipar)o. duce a surplus (Greece, Turkey, Bulgaria, Hungary). abov(4e). Those in which little or no tobacco is grown, which are all those not named the Ttohbeacccoounstmrioeskeidn tthheerethiisrdatgarnoyupraatreevoefrymloasrtgeinlyteorefstth,eifarosneenicca-pnoaosrsutympee,thbautt uponpfourltautinoantealyre tnhoet caosnydeittiovnesryfofravtohuerasbtuledyin othfecman,caenrdotfhtihsesulubnjegcti,nliktheethwahtoolef fcuasnicoenr ooff pthriemliavreyr,apnrdesseenctosnpdeacryuligarrowditfhfisc.ulties on account of the danger of con TurkeyT.obacco Consumption and Cancer of the Lung in Various Countries.
(1) Data on the consumption of tobacco in Turkey are given in Table II.
T able II.--Consumption of Tobacco in Turkey.
Year.
1925
Toba(cmcoi1ll5cioo-n8n*slub.m) ption
Population.
13,023,000
Tob(albcc. op1ec-ro2nh1seuadm.)ption
11993350
2215--09**
1164,,155981,,001080
11--5550
11993472
2387--22ff
1176,,882000,,905000
21--0698
11994497
4309--77ff
2108,,980700,,070895$
21--1906
t* FFiigguurreess pfrroomvidHeudtsboynth(1e9T37u)r.kish Embassy,
j The Times, October 30, 1950.
toba(c2c)oPriosf.coSncshuwmaerdtz,alomf otshte wUhonlilvyerisnitythoef fIosrtmanboufl,ciwgarirteetstesth;atthinat Tcuigrkaresy,
Eofutrhoepepaenoppliep,esanadndthtahte tohreireentaarlewmataenry-phipeeavayresamlmokoesrtsuanmknonogwnwoammeonn.g the bulk
in re(3la)tTiohnetoonslmyopkuinbglicaaptpioenarfsrotombeanthyaBt aolfkParnofc.oSuangtlraymu(p1o9n44c)aonfctehreoUf nthiveerlsuintyg
iomf Ipsotratnabnucel, owfhhoisgoivriegsinthalepfaoplleorw, ianngddtehteaidlsi,ffwichuilctyh oarfeacqcueosstetdoiint.full in view of the
" The clinical statistics of pulmonary carcinoma in Turkey :
Year Npuamtibenerts.of Ptuulmmoonuar.ry tRhoautesapnedr.
TThhee IInntt.. CClliinniicc ooff GGuullhhaannee ((STuelvefyikmSanagNlaumm) an) 11899293--11990286 .. 42237403 .. 27
02-146(3(0-0-)4*7)
The SSaegclta, mfo)r Int-.. Dis.eases. of G. ureb.a (T.evfik 1931-32 . 1459 . 9
7-1 (6-2)*
Haydarpaxa Numune Hast. (Tevfik Saglam) . 1936-1939 . 4230 . 24
5-6 (5-7)*
* Recalculated from the figures given by Prof. Saglam in the two adjacent columns.
CANCER OP THE LUNG IN RELATION TO TOBACCO
o
" The anatomo-pathologic statistics :
Year. GGuullhhaannee ((DLuefytci)ke.-Rem.hard.) . . . 11899293--11990286 THhaeydAarnpaat-osma oN-puamthuonleogHicasItn. s.titut.e of.the .Uni 1936-1939
versity of Istanbul (Prof. Ph. Schwartz) . 1935-1943
Nauutmopbseireos.f Puclamnocenra.ry 580020 .. 35 635 . 14
. 5126 . 79
tRhoautesapnedr. 103-7 22 15-4
yearsTthakeiningcrtehaesecliinnicoaulrsctlaitniisctsiciss i1n2totimcoenssiadnedraaticocnoridtiinsgctloeatrhtehaant awtoitmhion-p,3a0th-4o0 logic" sWtaetihstaivces isteeisn41-11 tciamseess aosf pmuulmcho."nary carcinoma in the newly inaugurated 3. Ic" HAallsttahleiskelasritaKtilsitnicigsi sihno2w3 mthoanttihns o(aumr ocnogun2t0r8y4, pwaittiheinntst,he5-3laisnt a30thyoeuasrasn, dp)u."l monSaargylacmarcrienjeocmtsa hcaigsairnecttree-assmedokiinnga gasreaat fparcotpoorrtiinonth."e incidence of bronchial csmarocikninogmat.oba"ccSoomaendauinthhoarlisngbetlhieevesmtohkaet athnedrepuelxmisotsnarayreclaartciionnosmhiap. bAetnwimeeanl tehxaptereismpeenctisalslyeemcigtaorestutepspoprltatyhias pgoreinatt opfavritewin. itsSopmroedauuctthioonr.s arWe eofdtohenoopt inhoioldn athree ssmamoekevdieiwn. ouFrocroaunlotrnyg. timIne,spaitteleoasftthsiinsceth5e0inyceraerass,ealimn opsutlmonolnyacryigaGrea.tteins pthipisescoaruentmryoshtlays sgmonoekeodn. thTehesaammeopuancteoafstoibnacthcoosceoncosuumnteridesinwohuerrecocuignatrrsy ahnads skhgor.winn a19c4o2n.staBntutintchriesarsies,eainsdnofrtomsuf9fi,3ci7e0n,t00t0o kegxr.plianin19t2h6e hinacsrreiasseenitnop1u6l,m68o0n,0a0ry0 Ca,"But there is no exact basis for any such argument. We do not yet know what cnoonrsduomwpetioknnoowf atnhye ttoimbaec-creolaptrioodnuscoefs aannyy sguivchenefinfeccitd.ence of bronchial carcinoma, (a) (f4u)ll proWtoceoalsreoifntdheebt1e9d3toauPtorposf.ieSsaognlamca,sePsrooff. pSrcihmwaarrytztuamndouDrr.ofYtehneerlmunegn for tcoatrarlieaduotoupt saitesthaenUd naiuvteorpssitiyesofonIstcaansbesulodfucrainngcer1,93b4v-1s9e5x0e,s,anfodr (tbh)efigsuamrees fpoerritohde (TaTbole-mIIIa)k.e the material comparable with other series, we have omitted the
Table III.--Cases of CUannicveerrsoitfy thoef ILsutanngbuAlm, o1n9g35-A1u9t5o0p.sies Carried Out at the
Number of autopsies.
Period,
All cases.
All cancer.
Cancer of lung.
1935-9
.
Male. 1833
Female. 947
Total. 2780
Male. Female. Total. 217 97 314
Male. Female. Total. 33 5 38
11994405--49 .. 22568152 1734273 33393325
330529 17209 438728
4738 107 5835
W49-50 . 767 488 1255
104 53 157
31 4 35
KtwniocCweh.naansgepseirnceinntcaigdeesncoef walilllabuetospeseinesmaonrde colfeaarlllycainncTerasb.le NIXot,ewthhearte dcaastaesfoorf cthaencyeeraorf 1th94e9luanpgpeaarer
6
M. E. DAFF, R. DOLL AND E. L. KENNAWAY
dfraotma ftohre1t9o3t4alanodf phraivmearreymlouvnegdtu3mcaosuerss, a(lal cinhomnednr,omdeascinrib1e9d35a,s abneontihgenrtuinmo19u3r9s,, laongdicaallpyoalyspnoint b1e9i3n7g).caWrcienohmavae,,nhaomweelyv,erl,ymreptahiongerdanfuoluormcaasiens ademscarnib, eodnehicsatsoe each in 1936 and 1937 ; sarcoma in a man, 1941 ; cylindroma in a woman, 1942.
Bulgaria and Greece. thatHfurtosmonT(1u9r3k7e)ystaantdesHthuantgathrye,sumrapkluess purpodtuhceedbuinlkBouflgtahreiawaonrdldG'sreseucpep, lwy itohf olorcieanlltyalasciagnaruenttkenotowbnacacmo.ounItt isisgrdoifwfincuflotr tpoeresostnimalautese tahned aemscoaupnets tcaoxn.su.mTehde mofafinci'salYfiegaurreBsofookr, t1o9b3a1c)ciondciocnastuemanptiaonnnu(Haluctsoonns,um19p3t7io) nanodf faobropuotp1u-7laltbio. npe(Sr thaeteasd finiguGrereseacreeasnimd iolafr1t-o9 tlhbo. speerobhteaaindeidn fBorulTguarrkiae,yininth1e93p7er(1io-6d81lb92. 5petor h1e9a.3d0,. TaTbhlee II).We have no data on the incidence of cancer of the lung in these countries.
Yugoslavia. KosWir,eodfoLjnuobtljkannoaw, htahseparomvoiduendt uosf wtoibthacicnofocromnastuiomnedabionutYtuhgeosslmavoikai,ngbuhtabDitrs. aorfeth: e" p(ao)ptuylpateioMn.akeHdeonwijarit(ecsigtahraetttetsh)e;k(ibn)dtsypoef tHobearccecgoosvminoak(ecdigianreYttuegso);slaavnida (c) t"yTpheeVreojacroedisnmao(kpeidpeparnindcicpiaglalyrs)c."igarettes. These are of the oriental type, i..e.,. th.eyOhnalvye ian nthaetunraolrth`b-woueqstueertn'pwahritchofgYivuesgotshleavtioabtahcecroe tayrpeesMmaokkeeddonciigjaa.r"s alansdt wpiapre.theUosnelyofimtopboarctcwo afosrssonmueffDinugticshqtuoibteacicnosifgonrifcicigaanrts. ; d. ur.ing."theBwefaorresotmhee iBmuplgoartreiadn, bauntdalalfttheerseitamsoomunets Awmereerivcearny stombaalcl.co (through U.N.B.R.A.) was the Wnuemabreeraslsoof ianudtoepbsteiedstaonDdro. fKthoosisreanodn taoll Pcraosfe.sPo. fHmriablaigrnfaonrt adissteaatseemaenndt ooff Scalonvceenriao,fdtuhreinglun1g9,25byto s1e9x4,9.carTriheedseoudtataatarteheshCowlinnicianl THabolsepiItVal., Ljubljana,
Table
Period. 11992350--94 11993450--94 11994485--99
IV.'--Cases CoflinCiacancleHroospf itthael, LLujunbgljaAnmao, n1g92A5utotop19si4e9s. Carried Out at the
Number of autopsies.
All cases.
All cancer.
Male. Female. Total. Male. Female. Total.
.. 579634 575635 11515187
11772 9615 210387
.. 11006830 1085608 21193310
113229 113153 224654
.. 1982997 1578919 31561888
214416 219524 523985
See footnote to Table III.
Cancer of lung.
Male. Female. Total.
58 21 106
1181
11 1192
2189
97 2368
CANCER OP THE LUNG IN RELATION TO TOBACCO
7
Switzerland. abo(u1t) the aWmeouanrte oifntdoebbatcecdo tcoonthsuemBeduroevaeur tFheedeprearliodde1S93ta6titsotiq19u4e9,foarndintfoortmheation tDoibraeccctioo.n GTheneedraaltadeasreDsouumamneasrizfeodr ininfToarbmleatVionanadbFouigt. t1h.e sources of imported
T able V.-- Consumption and Sources of Tobacco in Switzerland. 1936 to 1949.
Percentage of tobacco
Yoar
Toba(clbc.opceornhseuamdp).tion
Home-grown
Imported from Balkans. TJ.S.A. Other
1936
3'5
6
10 . 38 are4a6s.^
11994370
44--60
1122
11994435
45--99
2108
11994479
45--57
1189
11 . 42
28
* Mainly Brazil and the East Indies,
smoWkeed,hbavuet unnotidleWtaiolreldd iWnfaorrmIIatciiognaraebttoeustfothrme emd aonnnlyerainsmwahllicphrotphoerttioobnacocfothies who(l2e) (PTraobf.leHX. )v.. Meyenberg has provided a summary of the autopsies performed a20t,6th81e aPuattohposlioegsi,cathleIrnestwiteurete,35Z8u4riccahs,esduorfincgantcheer apnedrio2d7619c2a7sestoof19c4a1n.cerAomfothnge lung(3. ) ITthies,sehofiwguerveesr,anreotconmecpeasrseadrywtoithbethdoespeefnrdomentoothnehr ocsopuintatrliestsatiinstTicasblfeorIXan. easretimavaateilaobflethfeorinthceidewnhcoeleocfocuanntcreyr. ofWthee alurenginidnebStweditzteorltahned,BausrevaiutaFl esdtaetriasltidces tShteatibsrtoiqnuceh,i Banedrnleu,nfgosr, abystsaetxe,mfeonrteashcohwyienagr th19e29detaoth1s94a9ttr(iFbigu.te1d) atondcaanlscoerfoorf TdaabtaleoXn, aingecodmisptrairbisuotinown iothf tthheeraptoepsuflraotmionE.ngTlahned carnuddeWdaleeasthanrdatferos,msNhoowrwnayin, choavmembueneincatciaolnc)u.lated from population statistics provided by Stocks (personal
Norway. the(p1)roducPtiroonf.oLf teoivbaKccroey(bpeipreg,, coigfatrhseaUndnicviegrasriettyteos)f fOorsleoa,chhaysesaurp1p9li3e0dtofig1u9r4e7s for (FigM. r2., 0a.ndJafkoorbsseelne,ctoefdtyheeaNrsorinweTgaibanleEVmI)b.assy, writes that " Norway normally fimropmortthse85MpidedrleceEntasotf h(Teur rtkoibsahcctoobfarcocmo)Aamnderi6cape(rVicregnintiafrnomtobealcsceow)h, e9rep."er cTehnet immeprcoartnstialeremparraicntei.callTyoebqacucaol,toextcheeptcocnigsaurms,pitsioanl,maosstthaelloinmlypoerxtepdoratss asruechto, atnhde nowotnacsigcaigreatrteetst,eso.btaMinainnyg tpheurssonnesabrluyytwthiececahseampearnypifpoer taobgaivcceon saunmd m; haeknecethtehier
8
M. E. DAFF. K. DOLL A'ED E. L. KEInXAWAY
Fig. 1.--Cancer of lung. Deaths, 102199-3169--4199.49.ConSswuimtzpetriloanndo.f tobacco (hundred thousand pounds),
oPfifpicei-aslmfiogkuirnegs ifsormtohset ccoonmsmumonptiinonruorfapl iapreeatos.bacco and cigarettes are misleading.
T able VI.-- Consumption of Variou(s.KTreyypbeesrgo)f. Tobacco in Nonvay. 1931 to 1947
Tobac(lcbo. cpoenr shuemadp)t.ion
Percentago of tobacco in form o f: Cigars. Cigarettes. Pipe tobacco.
11993312
11--44
23
3365
6622
11993376
11--79
33
3369
6518
11994403
21--20
31
4399
4598
11994467
22--69
11
4441
5558
canc(2e)r of thPerloufn.gL, ebiyv seKxr,efyobretrhge hyaesarssup19p3li0edto f1ig9u4r8es(Ffiog.r 2t,h3e),dfeoarthdseaathttsrisbeuptae-d to
CANCER OE THE LUNG IN RELATION TO TOBACCO
rdaetaetlhy rianteusrbfraonmancadnrcuerraolfatrheeasl,unagndarfeorshtohwe npoinpuTlaabtiloenXb.y sex. The calculated " ThTehedoncattoior nwahl ofighuasrestreaaretedreathsoendaebcleyasreedliadbulerinags, haicscloarsdtinilglnteossMisr.reJqaukiorbedsento, fsitlal tiend ainn omffeidciiaclalcteerrtimfiscaates sptraetciinsgelythaes cpaoussseibolef,daenadthit i.s n. ot. pewrmhiicthtedmutostubsee general diagnoses such as " disease of the heart " or " disease of the lungs." The
160r
CancDereaoffchlsung?
m o 1932 1934 1930 19381940 1942 1944 19401948
Fig. 2.--Cancer of lung. Deaths. 19C3o0n-s1u9m47p.tion(Kroefybteorbga.)cco (hundred metric tons), Norway.
sta.tem.enTt hmeudsotcbteorinisarcecqourdiraendcetoweitxhamaninoefftihciealpnaotimenent calfatteurredeoaftcha.u"ses of death.
citie(s3)oTfwIveonrtwy-aeyigihnt bpoetrh c1e9n3t0oafntdhe19p4o6p;ultahtieonprowpeorertieosntimlivaitnegd intoulribvaeninarethaes
rceavni,ewth.ereTfohree,foblleowcoinngsidaereretdhetoeshtaimveatbeedencrcuodnestdaneat tthhrroautegshfoourtetahcehpseerxioind uurnbdaenr
and rural areas.
Norway
Death Rates of Cancer of Lung per million.
Death rates of cancer of lung per million.
Urban.
Rural.
1930-38
M2a4le. . 1Fe9male. . Pe2rs1ons. M1al4e. . Fem12ale. Per1s3ons
1939-47
63 . 42 . 52
30 . 24. . 27
10
M. 15. DAFF. R. DOLL AND E. L. KKNNAWAY
The data show th a t: ((iab)) TThhee uinrcbiadnenecxeceisssgirsesaltiegrhitnlyugrrbeaantearrfeoars.men than for women--
11993390--4378 urban,,: rural rat,,io, mmaallee 21--71::11, ;fefemmaalele, ,1-18-6: :1.1. the (cc)ouTnhteryinacnredasgerebaettewr efeonr m19e3n0 tahnadn 1f9o4r7whoams ebne.en greater in the towns than in
URurbraaln incr,,ease mmaallee,, 22--16::11;; ffeemmaallee,, 22--02 :: 11..
F ig. 3.--Cancer of lung. Deaths. Norway, 1930-1947. (Kj-eyberg.)
Sweden. ing Spnruofpfo, urtsieodnfoofr cahllewthiengtoabnadcfcoor ipnrsoudfuflcattsiocno,nmsuakmeesdup(Hauvtesroyn,la1rg9e37bu: tPdriomf.inEislhis vBeerryvefnin,eppeorswodnearl lcikoemtmheunEicnagtliiosnh.sTnuabffleanVdIIis).inhParloefd. iBnesrmveanllwqruiatenst,iti"esSnthurfof uisgha tphinecnhoesse,.i.e.Foabr ocuhtewoinnegttehaesrpeooanrefutlw, otatkyepnesfr:om(a)thTehesnsuafmf-ebotyx)peisopfustnuinff b(3et-w4 ebeing tahteouligphamndastsh,einmsainzediobfleabaonudtias chhaezwele-dnubta, cwkhwicahrdiss alynidngfoarwt tahredssaumnteilpiltacbeecaobmoeust 3 to 4 hours ; . . . (b) Chewing tobacco is to be had in the form of braids,
CANCER OE THE LUNG IN RELATION TO TOBACCO
11
Table
VTear. 11002018 11993316 11994484 1949
VII.--CoDnissutrmibputitoionn.
Cciiggaarr-sciagnad- Cigarettes.
ret0t/es. 0/
1100--18
38-33
98--35 2126-13
56-71 4247--99
4-7 46-9
oSf wDeidffeenre(nBterKviennd,speorfsoTnoablacccoommasunPiecratCioenn)t. of the Total
Tobfoarcco Tobfoarcco Snuff. Tobacco. (lb. peCrohnesaudmppetrioynear.)
smo07k/oing. chew0/o/ing. 0/o/
0/o/ Snuff. Tobacco.
4-4
hi
37--69
7636--69 3236-41 22--2038
01-17
1135-'05 11--28 5529--58 4407--25 11 --5735 11--24
2136--37 00--64 4313-31 5668--79 11--0165 21-17
15-6 0-4 32-4 67-6 1 -02 2 1
fwrohmichwishitchhenthleyyinbgitaet 1thteo s2amcme.plaTcehiassptiheceesinsucffh.e"weUdntofoartuhnalaft-efilrymnocofnigsuisrteesnfcoer, the incidence of cancer of the lung are available. Iceland. " ThSemcookninsugmhpabtiiotns ionfItoceblaacncdo,apreardtiicscuulassrleydibnythDeufnograml o(1f9c5i0g)a,raecttceosr,dhinags ctoerwtahinolmy Dbeuenngaml'sucfhiguleresss fionr Iccieglaarnedttethcaonnsiunmmptoiosnt EaunrdopfeoarnthceouinntcriideesncaendofAlumnegriccaa.r" cinoma are summarized in Table IX. Britain. lungDiantaBrwitiathinrheagvaerdbteoentopbraecsceontecdonpsruemvipotuioslny a(nKdenthnaewinacyidaenndceKeonfncaawncaeyr, o1f94t7he; Fhoigs.pi4t,al5s).havNeebweednatcaololencttehde(TauatbolepsVyIIinI)c.idence of cancer of the lung in British
Table VIII.*--Cases of CaBnrcietrishof HthoesLpiutanlgs,Am19o2n5g-4A8u. topsies Performed at Three
Number of autopsies.
Hospital.
Period.
All cases.
All cancers. Cancer of the lung.
Glasgow. Western 1925-9
M. F. Total. 1154
M. F. Total. ' m . F. Total. 133 83 216 . 22 12 34
Infirmary (Cappell) 11993350--94
11329154 115930 12842 321345 .. 3316 57 4336
11994450--84
11237234 212800 113234 335034 .. 4513 1196 5772
St. Mary's, London 11994370--84 827 481 1360887 114003 7678 211771 .. 3310 59 3450
(Newcomb)
11993450--94 746 442 1188 171 112 283 . 36 9 45
11994475--88 367813 422289 m60i0 18339 4970 212390 .. 423i 68 4299
St.LBonadrtohnolomew's, 11993305--49 . 1908576 555288 11561154 210926 12915 330113 .. 3577 1103 4770
(Cunningham)
11994405--48 544 217 761 111 60 171 . 43 io 53
1947-8 301 125 426
60 27 87 . 25 4 29
* See also Table IX.
12
M. E. DAEF, E. DOLL AND E. L. KENNAWAY
loooor-
F ig. 4.-- Cancer of luntgh.ouDsaenadthpso, uEnndgs)l,anUdniatendd KWinagledso.m,C1o9n2s4u-m19p4ti9o.n of tobacco (hundred F ig. 5.--Consumption of tobacco (lb. per head). United Kingdom, Switzerland and Norway.
------ ------- USnwiittezderKlainndg.dom. X----- x -------X Norway.
CANCER OS' THE LUNG IN RELATION TO TOBACCO
13
Incidence of Lung Cancer. Comparison of the data from various countries. YugIonslTavaibal,eSIwXitzheorlsapnidtalanddatIaceflraonmd, fairvee psroeusrecnetsedintoBgertihtaeirn. anTdhefrcoamsesToufrlkuenyg, coafnmcearliagrneanshtogwronwatshspefrocuenndtagaet sauoftotphseyn;umsebxeers oafreausthoopwsiness,eapnadraoteflythewhneunmebveerr othfetodbaatcacoarearaevianilcalbuldee.d. For comparison, estimations of the annual consumption
The data show that-: third(1,) aArehnigohw'pfrooupnodrtitoonshoofwauctoanpcseiersoofnthceasleusngofincaBncreitri,shbehtwosepeintalas f;ift2h0aynedaras ago(t2h)eTfhigeuerexpwearsiebnectewceoennc1e0rnainngd m15apleesr icnenIts.tanbul in recent years is not unlike the (B3)riTtihseh eexxppeerriieennccee. in Slovenia is cojnparable with British experience in the first(4q)uTahretelro-owfetshtirseccoerndteudryf.igures are found in Iceland. lunv(eov)er, inSdwicisastefiaguhriegshaerreinccoimdepnacraeb(lTeawbliethXS)loavnednetooonems.uchSwsiigsnsifniactainocnealshsotautlidstics, notTbaeblaettXachsheodwt'os tohneechroudspeitdaelastehrireast.es from cancer of the lung in England and eWstailmesa.teSswoitfztehrelanandnaunadl rNatoerswoafycfoonrsusmelepctitoedn oyfeatorsbabcectow. een 1931 and 1947, and -Mr.[OAlacfoJmapkaorbissoenn hofasthkeinadglye-dsuisptprilbieudtiofinguirnesthfoertNhroerewacyoubnytriseesxeiss fgoivre1n93b0elaonwd. S1w94i6tz;ertlhaendfiwguerreessfuoprptlhieedlabtyterthyeeaBruarereausuFmemdearrailzedde iSnttahtiesttiaqbulee,. BeTrhnee.data for
Population.
Per cent of all ages.
Males.
All
EWnaglleasn, d19a4n7d. No19rw46a."y, Swi1tz9e5r0l.and, 48*4 49-3 48-3
20- 7-4
8-6
7-4
30-
4500--
77-'81
5-3
7-9 6-6 5-0
77--12
5* 3
60-
4-0
3'3
3-7
70-
2-6
2-7
2-4
Females.
AH
WEnaglelasn, d19a4n7d. N1o9rw46a.y, Swi1tz9e5r0l.and,
51-6
50'7
51-7
2030-
7-5 7-9
81--39
7-5 7-3
40-
7-5
7-0
7-7
50-
6'3
5-4
6-2
60-
5-0
3-9
4-5
70-
3-8
3-5
3-4
of tMhealpesopoufltahteioinmipnorEtanngtlaangde-ganrodupW5a0letso (699-3m) athkeanupina Nraotrhwearylar(8g-e3r),pewrhceilnetathgee paoccsiotuionnt foofr tShwe idtzieffrelarenndceiss ininttheremdeedaitaht-era(t9e-s0,)a;ndthjeussetifsymtahlel udsifefeorfenccreusdecadnenatoht rates.]
T able IX.-- CancerCoofuLnturniegs aasndPeinr cDeinftfeorefnAtlPl eAruiotodsp,siCesomapnadreodfwAiltlh CTaonbcaecrcoDCiaognnsousmedptiaotnA. utopsy in Different
Locality.
Period.
Cancer of the lung as per cent o f:
All autopsies.
All cancer autopsies.
tobaccoAcnonnusaulmption
9^
Bri1t6aiBnr.itish hospitals*
1894-1918
Male. Female. 0P-9er6s-o1n-s1.6 . Male. Female. Persons.
(lb. per head). 1900-02, 1-9 (cgts. 0-6)
(Passey and Holmes) 11992149^--11992238
21-1613
11990161--0183,, 22-10 (( 00--7) 9)
Leed(sBGonesneerr)al Infirmary* 11899331--11993372
0-821---311-38 .
4-9151--83-227
11992239--3215,, 32--39 (( 21--48)) 1934-36, 3-6 ( 2-7)
W estGerlansgInofwirm(Caarpyp, ell)
11992350--2394 1935-39
323-091
2106--52 164--15 1155--73 18-9 5-6 13-7
1936-37, 3-9 (cgts. 2-9) tel
DAPS', R. DOLL AND E. L. KENNAWAY
St. Mary's, London
11994405--4484 1930-34
3-6 1 0 245---744
2242--18 1124--93 2108--84 21 -4 6-1 16-1
1946-47, 5-0 ( ,, 4-3)
(Newcomb)
11993450--3494
4-8 2-0 3-8
21-1 8-0 18-9
S t.LBoanrdtohno lo m e w 's,
11993405--3448 1935-39
56--42 21--39 44--34 3-7 1 -9 3-1
2279--75 138--79 223i--43 19-3 8-2 15-0
(Cunningham) Turkey.
11994405--4448
7-9 4-6 7-0
38-7 16-7 31-0
IstanSbcuhlw(aSratgz)lam, .
11993450--3494
11--98 00-9o 11--74
1155--29 150--20 1124-81
11993472,, 21--17
Yugoslavia.
1945-49
2-8 0-8 2-1
20-3 7-8 17-0
1947, 2-2
Ljubljana (Hribar, Kosir) 11992350--2394
01--64 00--14 00--94
141--13 31-11 72--39
11993450--3494 1945-49
11-07 00 11 00--69 1-5 0-6 1-1
184--30 00--79 47--28 11-8 3-1 7-1
SwZituzerirclahn(dM. eyenburg) . 1927-41
1 -33
7-7
1936, 3-5
IceRlaenydk.javik (Dungal).
1932-48 *
0-6
2-9 f 11991332 ((cg,,ts.)) 00-0-33
BrWitaeisnt.ern Infirmary
1947-48
Most rece5n-8t period. 30-1 13 2 23-5 L1947 ( ,, ) 1-4
SStt.. MBaarrtyh'oslHomosepwit'sal .
11994477--4488
68--32 32--26 46--88
4217--77 1142--88 3223-33
1947-48, 4-4 (cgts. 3-7)
TuIrskteayn.bul .
1949-50 4 1 0-8 2-8
29.8 7-5 22-3
1949, 1-9
YuLgjousblalvjaian.a
1948-49 2 1 0-9 1 -5
13-5 4 5 8 -8
* .Figures refer to mix'athMmoiu oizncojr.
CANCER OE THE LUNG IN RELATION TO TOBACCO
T a ble X.--Death Rates from Gamer of the Lung in England and WalesaSwitzerland and Norway,
N N
Compared with Tobacco Consumption.
England and Wales.*
Switzerland.
Norway.
Year. DeCatahncrearteosf ptheer mluinllgi.on. tAobnancucaol DeCaatnhcerartoesf tpheer lmunilgl.ion. Atonbnacucaol DeaCtahnrcaetreosfptehremluilnligo.n. tAobnancucaol
M. F. X61'SUUS. (lb./head). M. F. Persons. <.*o(rlbis.u/hmeapdti)o.n M. F. Persons. (lb,/head).
11993312 9835 3312 1936 . 142 43
5671 .. 33--32 ((cg,,ts. 22--34)) .. 6662 1179 4410 91 . 3-8 ( ,, 2-8) . 86 21 52
tt
.. 1124 109 1112 11--44 ((cg,,ts. 00--55))
3-5 . 18 20 19 1-7 ( ,, 0-6)
1937 . 1C1 43 100 . 4-0 ( ,, 3-0) . 94 19 55 (cgts. 419039 1-4) . 28 20 24 1-9 ( ,, 0-7)
11994403 .. 232212 5650 1946 . 366 71
113713 .. tt
111652 3313
206 . 5-4 (cgts. 4-6) . 177 36
7915 104 .
44--69 5-9
.. 3319 2184 . 43 36
2314 2l--20t(( ,,,, 00--95)) 39 . 2-6 ( ,, 1-lj
1947 . 398 78 228 . 4-5 ( ,, 3-8) . 183 34 106 . (cgts. 51-9749 2-3) 56 40 48 2-9 ( ,, 1-3)
the *smTohkeinfgiguhraebsitasvianilaSbcloetlfaonrdtoabnadccNoorretfheerrntoIrtheleanUdniatreednKoitnvgedroymd,ifafnedretnhtofsreomforthcoasneceinr oEfntghleanludnagntdo WEnaglelsa,nwd haincdh cWoanlteasi.n 8I7f
per fceDnitsotufrtbheedpboypuwlaatri.on, this difference is of no importance. EstimatedMpido-pyuelaart,io1n94i7n thousands,
j Not available.
(AnnualNAob. s8tr5ac(1t9o4f8S).t)atistics,
EScnogtllaanndd an.d W.ales . . Northern Ireland
4351,,,013355900''} Great Britain, 48,189.
United Kingdom
49,539
16
M. E. DAFF, ft. DOLL AND E. L. KF/NNAWAY
The data show th a t: all t(h1r)eTehceoaupnptraieres.nt incidence of cancer of the lung is increasing in both sexes in sam(e2)inTthheertahtreeeofcionucnrteraiesse ;ininthtehe10fivyeeayresar1s913963-71-t2oto1914963-76-7haist wbaesenmmoruechrapthide in Norway than in England and Wales, and was slowest in Switzerland.
Death Rate from, Cancer of the Lung.
1936-7 as percentage of 1931-2.
England and Wales.
Switzerland.
Norway.
M. F. Persons.
M. F. Persons.
M. F. Persons.
11993361--72
117000 113070 116020
114010 111010 113020
117070 211010 118070
1946--7 as percentage of 1936-7.
11993466--77
215002 110703 212070
210000 110705 119060
211050 119000 210020
and(3W) aTlhese arantde ionf iSnwcrietzaesrelahnads. been greater for males than for females in England rate(4w) aTsheapipnrcoidxeimncaeteislycothmepsaarmateivealsyiltohwadinbNeeonrwianyE. ngInlan1d94a7ntdheWcarluedseadnedatihn Switzerland 16 years previously.
Populationfro(bmotchansecxereso)fptrhoedulucningg. one death
NSworiwtzaeyrland . England and Wales
8319,3310.0 . 2109,4870.0 2147,,640000 .. 49,,440000
denc(6e) iTnhwe odmifefnereisncseimisilaerssiennNtiaolrlwy aay dainffderSenwcietzeorflainncdidaenndceabinoumt etwn.iceTahsegirnecait in ETnhgelainncdidaenndceWoaflceasn(cTearbolfetXhe).lung is much more nearly equal in the two sexes in Norwa}^ than it is in the other countries which have been studied.
ENnogrwlaanyd and.Wal.es . . . Switzerland . . . .
iDneawthomraetne farosmpcearcnecnetraogfethoefluthnge
death rate71in%men (1947).
.
1290%%
indiTchateesraatioreslaotfivcealnycelorwofintchiedelnucneg iinn wwoommeennitnoTtourtakleyauatnodpsYieusgionslwavoima e(nTaablsleo IX).
CANCER OF THE LUNG IN RELATION TO TOBACCO
17
The relation between increases in the consumption of tobacco, and in cancer of the lung. abseOnncee sohfoaunldypneercheaspssarryefecronangeacinti,otnhobuegtwhetehnertewmo aqyubaentnitoiensewedhitcohdaoresov, atroyitnhge ivnertyhesismamilaer wtoatyha; ttshhuoswwnibreylecsasnlciecrenocfetsheinlutnhgis(cKoeunnntarwy ahyavaendmKueltnipnlaiwedaya,t 1a94ra7)t.e NorIwnaTy,abalneds XSwI iatznedrlXanIdI dcuorminpgartihsorenes pareerioadttse,m1p9t3e1d-2o,f1d9a3t6a-7froamndth1i9s46c-o7u.ntry,
T ablaendXDI.e--athCoRmapteari(Psoenrsobnestw)efreonmToCbaanccceor CofonthseumLputniogn,atCDigifafreertetent CPoenrisoudms.ption
Country.
conTsoubmacpctoion coCnsiugmarpetttieon frDoematchanracteer
(lb. per head). (lb. per head). of the lung.
England and Wales 1946-7 as pe1rc2e8ntage of 1936-174. 5
227
NSworiwtzaeyrland
115553
117805*
210926
England and Wales . 1936-7. as pe1rc2e0ntage of 1931-122.3
162
Norway
129
130
187
* 1949 as percentage of 1939.
In all three countries the increase in canc\er of the lung was greater than the i1n9c3r6ea-7seanind t1o9b4a6c-c7o. cTohnesuimncprteioasne binetwcoenensum19p3ti1o-n2 oafndcig1ar9e3t6te-7s, waansdmboertewleiekne tghaep ibnectrweaeseen itnhelufniggurceasncinerEonvgelranthdealnadteWr paleersio. d, but there was a considerable
TablaendXDIeIa.--thCRoamtepa(Priesrosnonbse)tfwreoemn CToabnaccecroofCtohnesLuumnpgtioinn,ECngiglaarnedtteanCdonWsaulmesptaionnd
Norway, and in England and Wales and Switzerland.
Period.
conTsoubmacpctioon coCnsiguamreptttieon frDoematcharnacteer
(lb. per head). (lb. per head). of the lung.
1946-7
England
and
W ale1s 8a0s
percentage
of Norway.
350
499
11993316--27
213920
447406
454134
1946-7 1936-7
England
and
Wales
a0s 8p5ercentage
of
Switzerland.
162
205
104
(1296469)
179
(1939)
alsoThveerdyifmferuecnhcegirneadteeratthh arantetshebedtwifefeernenEcengilnantdobaancdcoWcaolenssuamndptiNoonr;wiaty wwaass,
2
18
M. E. DAITS', R. DOLL AND E. L. KENNAWAY
hlaonwdetvoebra,crceoascoonnasbulmy pcltoiosentwoatshme duicfhfetrheencseaminecaigsainreEttnegcloannsduamnpdtiWona.lesI,nbuStwditezaetrh rwaittehs twheerdeifofenrleyncheaslfinasdehaigthh.ratDesifbfeertetnecretshainn cdiogadrieffteterenccoenssuinmtpottiaolntoabgaacincoacgorene sinumthpetifoonr.m oTfhcisigiasrbeettceasuisne SawmiutzcehrlsamndaltlheranprionpoErntigolnanodf.the tobacco is consumed betwCeleeanrltyhenoamexoaucntt porfotpoobratcioconaslmityokheads abnedenthfeoupnredvainlenthcee odfatcaanscoerfaorfatvhaeillaubnlge iinncrdeiaffseeremnotrecoruanptirdileys tahnadn adtoedsiftfheereunstepoefritoodbsa.ccoC;anscuecrhoaf cthhaenlguenign aepffpeecatrms atyo wochceunr tahte apocpeurtlaaitnionlevoeflaicnotuhnetrdyocsoangseumofeas mdrourge.tobAacccoom, opnliecadtoinesg nfoact tkonroiws thhoawt umsuecohfotofbthaicscoisbdyuethtoostehewihnoitsimatoiokne oalfrneeawdys.mokers and how much to the increased
DISCUSSION.
of m(1a)liTgnhaenhtigdihseparsoepionrtmioanleosfincaInsctaenr bouflthsueffliucnegs tfoousnhdowamthoantgthauetaorpsseineiscocnonctaesnest ocifattoiobnacbceotwheaesnncoitgaprreotvteidesmd oakniyngsiamnpdlethainsdfoerxmcluosfivceanecxeprl.anaIttioins poefrthhaepsastsooo sinofoonrmtoatisoany atbhoaut tatrhseenimc inisimquumiteefufneoctbijveectdioonseabolef ainnytocbaarcccino,ogfeonr iwnemhaanv,e nnoor aboAuts tyheet pwoesshibalveesauumtompastyiofnigoufreesffoencltyoffrodmiffearesnintgclaercciennotgreenisn. Turkey, and of acoreurvseermy odreesdiraatbalef.romThtheisfiagnudresotfhroemr s,oaursciensg,leinhGorsepeictaelainndYBuuglgoaslraiav,iafosruigngsteasntcaen, iWnceidheanvceenooffciagnucreesr foofrtthheeliunncgidceonmcepoafracbalnecetor othfethBerliutinsgh ufipgounretsheofw3h0oyleeaprospaugloa. toifohnomofe-agnryowEnatsotbaEcucroopaereanliacboluenttoryt.he Terhreoro, ftfhicaiatlafipgourrteisonfomr atyheesccaopnesurmecpotrido.n or w(2h)etWheer dthoenportacktnicoewowf shmetohkeirngtorbeancdceorssmthoekereistpseirlaftcooryntatriancstsmomoree csaursccienpotgibenle, Itof tahgeencatsrcfirnoomgeenxitserinnatlh(ee.tgo.btahcecobsemnzopkyer,eanned oisf icnopala-rstmicouklea)teofroirnmte,rwnael,fascoiulritcaetse. nitasspalenfeilttreart.ionThtoe theveidbernocnechaivbayilainbhlealaattiotnhethmrooumghenttheismaoguatihn,stthtuhseedvairdeicntgctahre ocibnvoigoeunsicciamrcpinoortgaenncse, oafrstoenbiacccaonsdmboekne,zpbyerceanues,e iwt hteicnhdsotnoe emxcilguhdte ethxepetcwtotomobset pwriedseentht.at Bonuet mthuestracnognesidoefrcohtehmericpaol ssstirbuilcittuierse. of known carcinogens is now so of t(h3i)sAclolntnheectoioldnerwditahtasmabookuint gca;ncoenreomf tuhset lruencognmsiduesrt btheereinvvieewrseed rienlatthioenlsihgihpt awsistohrtsmunelnitghotf (oSctcoucpkas,tio1n9s4,7)naamndelyth, eagvreicruyltluorwe, incociadl-emncineinugp,oannad rmatuhlee-rspciunrnioinugs c(KanennontawsmayokaenddurKinegnnoanwea-tyh,ird19o4f7)t.heTdhaey,coaanld-mtihneermwuhleo-spwionrnkesr, baenlodwt-hgorsoeunidn man(4y)oTthheerinoccicduepnacteioonfs,cacnacnenrootfstmheokleunwghiinleSawt iwtzoerrkla.nd, and in Istanbul, where comparatively little coal-smoke would be expected, is against the importance of
CANCER OF THE LUNG IN RELATION TO TOBACCO
19
o1f94t7h)isanfadctionr,Nbourwt aiyn (tsheies acboouvnet)ryth(eStmocokrst,ali1t9y36is; hKigehnenrawinaytowannds tKhaennnianwtahye, fcaocutonrtrsy, .namInelya,ll(as)uscmh ockoinmgpharaibsoitns,s (bo)nfeacmiliutisets cfoornsdiidaegrnoastislaeansdt trthearetme epnots,saibnlde i(nc)teartnmaloscpohmebriucstpioonlluetniogninew. ith products of the combustion of coal tar, or of the in re(5la)tTiohnetiondciacnactieornotfhthate cliugnagrertatiessesartehemoqrueesatciotinv,ewthhaenthceirgtahrsisadnidffepriepnecteoibsadccuoe c(aa)ntnootthaenmsweethrotdhiosfqcuoemstbiounstiaotnp, roerse(6n)t,tobsuotmiteipsreosppeerctiyalolyf cimigparoertttaenttoibnacccoou.ntOrinees Nwhoerwreaysmoonkeeorsbtbauinystihnethcihseawpaeyr npeipaerlytotbwacicceoatsommaankyectihgeairretotewsnfocrigaargeitvteesn. suImn P(Jiapkeotbosbeanc,cpoesrsmoonkael dcoinmpmiupneisc;at(i2o)n)p.ipeOtnoebamccuostsmcoonkseiddeirnthcrigeearpetotsessib;il(i3ti)esci:ga(1r) ette (t6o)baTchceo dsmatoakegdiviennciagnadretdteissc. ussed above from this country, Norway and tSowbaitczceor,laanndd snhaotwiontahlaitncthideenscteudoyf coafnctehre orfetlhaetiolunnsgo, fhansatsicoanraclelycobnesguumnp. tion of
SUMMARY.
Eng(l1a)nEd,stNimorawtiaoyn,sForafncaers,eSnwicitzinerlacnigda,rIettatelys, fAroumstritah,ePoUlannitdedandStBatuelsg,arCiaanshadoaw, aornsethneicw-phooolreTautrrkainshsittiyopnefirnomthethEe aasrste;ntihce-rilcahtteArmise,roicfacnoutyrspee, sinmothkeedWinesWt, etostethrne cou(n2t)riIens aYlsuog. oslavia, Turkey, G,reece and Bulgaria, the tobacco consumed is alm(o3s)tTwhheohlliyghhoinmceid-genrocwe no,focafnTcuerrkoisfhthteypluen,ganatdaiuntothpesyfoirnmonoef cceignatrreet(teIsst.anbul), ianrsaenciocucnotrnytewntheorfetoTbuarckcioshhatsobnaoctcporoisvisdmeodkaendyaslmimopslteeaxncdluseixvcelluys,ivsehoewxspltahnaattitohne ooff tthheeluanssgocaipaptieoanrsbteotwbeeemnuccihgalersesttferesqmuoeknitnagt aancdenthtries infoYrmugoofslcaavniace(rL. jubClajanncae)r vthearyn daetsiIrsatbalneb.ul. More information from these and other Balkan countries is U.S(.4A).,Naonrwd a9y piemrpcoerntst farboomutth8e5Bpaelrkacnenctouonftrtihees. tobTahcecoincciodnesnucme eodf cfraonmcerthoef t1h:e0-lu7n);g iutpiosngrtehaetetrwino usrebxaens tihsannoitnvreurryalddifisfetrriecntts,(adnedatthhirsatdei,ffemreanlecetois fgermeaatleer, ignremateenr tihnamneinn twhaonmeinn.woTmheen,inacnredagsereiantemr ionrttahleitytoiwnntshethlaanstin20thyeeacrosuhnatrsyb. een the (t5o)taInl toSbwaecdceon,prsonduuffctms ackoenssuumpead mthuacnhislarregceorrfdreadctiinonot(hoenrec-tohuirndtriiens.1949) of () d(6e)aAthscoamttrpiabruistoend tiso mcaandceerofofththeedlautnaga,vaanidlab(bl)eifnorthtehecoinncsruemaspetsiosninocfeto1b9a3c1coin, ipnerEhnegaldanhdasanbdeeWn afloers,thNeolrawsaty10anydeaSrswriatztehrelarnhdi.gh.e.Trhien cSownistuzmerplatinodnthofantoibnacthcoe UconuintetrdieKs,inwghdiolemth, eancdruidneNdeoarwtharyatheassabtetehne abbeoguintnoinnge-ahnadlfetnhdatoifnthtehepeortihoedrwtweroe
20
M. E. DAST, R. DOLL AND E. L. KENNAWAY
r(oNuogrhwlayy)in. thCeigparroetptoertcioonnsoufm1p0tio(Ennwglaasnd'apapnrdoxWimalaetse)lytoin5 t(hSewiptzreorplaonrtdi)o,nanodf 24 t(hEengrelalantdivaenddeWatahlersa)tteos.2 (STwhietzienrclarenads)eanind t1h(eNonruwmabye)ranodf wdeaastmhsorheaisn abceceonrdabwoiutht tahnedsacmigear(etwtteosfohlda)sinbeaellnthleresse. coTunhteriedsif,fberuetntchees iinncrtehaeseinincicdoennscuemopfticoanncoefrtoobfacthcoe lcuonngsuamreedth;ertehfeoyreaqreuimteodreiffliekreen(tthinouegxhtesntitllfrdoimffetrheonstefrionmth) ethqouseanintittyheofqtuoabnatcictyo osufmcpigtiaorenttoefstocboancscuomaendd. thTehenastitoundayl ionfcitdheencreeloaftiocanncbeertwofeethnetlhuengnahtaisonsaclarccoelny begun. of IWsteanwbiuslh, taondthaPnrkof.PrHofr.ibSaarg, laDmireacntdorProoff. tPh.e SIcnhswtaitrutzt,e ofofthePaUthnoilvoegriscitayl Agennaetroomsiyty, ainndallDowr.inAg. uKs otosiru, seofthethire veCrlyinivcaalluaHbolesprietaclo,rdLs.jubWljaenaar,e fionrdetbhteeidr tPoroPf.roHf.. LRe.ivSKchrienyzb, eorfg,thoef OKsalno,toMnsr.piOtalla,f ZJaukriocbhs,ePn,rooff. tHhe. vN.oMrweeygeinabnuErgm, boafstshye, PPoatphoovl,ogoifcathl eInBsutiltguatrei,anZLureigchat,ioMn,r.PSro. fT. .ElHisisBime,rvoenf,thoef STtoucrkkihsohlmE,mPbraosfs.yH, .MEr.. BRearwnlei,nsaonnd,thoef DthireecUtionnivGeresniteyralodfeAs Dlboeurtaan,esth, eBeBrnuer,efaour tFheedirekrainl ddneessStiantissutpiqpuley, Dinrg. uGs. wJ.ithCusntantiinsgtihcaaml ,anPdroof.thDer. Fm.atCeraipapl.ed,InPrtohfi.sAc.ouBnrtardyfowrde hHaivlle, Ptorotfh. aWnk. WNeawllceorm.anb,d DMri.ssC.MCa.rySpAictkerin, ,Dfro.rPheerlcpyinStvoacrkios,usMwr.ayHs.. L.WHeewndisehrstoon,exMprr.esRs.oEu.r ggeranteirtouudse gtoranthtse. British Empire Cancer Campaign and the Anna Fuller Fund for
REFERENCES.
BChriaedf fInosrpde-cHtoilrlo,fAF.,acatnodrieFsaannidngW, oEr.kLsh.--op(s1.--948(1)9B39ri)t.AJn.ni.nRdeupst.., pM.e2d2.., 5,L2o.ndon (H.M.
CurrieS,tAat.ioNn.e--ry(1O94ff7i)ceB).r--it.(1m9e4d3.) BIbuidll.,, 4p,. 44052..
DD
a o
f l
f l
, ,
MR..,
E.,
an
danBdr
aKdefnonradw-Haiyl,lE, A. L.--.--(1(915905)0)BBrirt.it.mJed. .CJa.n,ciei,r,743,9
173.
DHueangdayl, ,JN. A.--.,(a1n95d0)KLeannncaetw, aii,y2, 4E5.. L.--(1949) Brit. J. Cancer, 3, 311.
HHuentsroyn,,SJ..AB.--.--(1(1995307))AUnn.S.. RDoeyp.t,CoofllA. Sgurircg..TEencghlnaincadl, B7,u4ll2e5ti.n No. 587.
MK eonnnt
away,
gomer
yE,.HL.,.,
and and
WK
ennaw aisman
a, My,.--N.(1M9.4--1)(1J9.4I7n)veBsrti.t.DJe.rmC.a,n4c,er3,651,.
260.
SNabgulbaamu,eTr.,--0(.1--94(41)94B7u)llB.rFita.cJ..MCeadn.ceIsrt,a1n,b1u9l.2. Yil : 7, Sayi: 2, Imumi No. 28, Nisan-
SbmonH, Haz.iCra.--n, (11994445,)pP.r3o7c9. 3R.oy. Soc. Med., 38, Section of Dermatology, 128.
StocksM, Ped.--ica(l19a3n6d) APnonp.ulRaetipo.nBrSiut.bjEemct,sp. NCoa.nc1e.r CRaemgpio.,na1l3,a2n3d9.--Lo(c1a9l47D)if`fSertuendcieess oinn
WyndeCra,nEce.rLD.,eaanthdRGartaesh.a'm,LEo.ndAo.n--((H19.M50.)SJt.atAiomn.eerr.ymOefdf.icAe)s.s., 143, 329.
