Document 8RvkrpXzgGLn8NGgDVQNO1oDk
FILE NAME Kent KNT
DATE 1943 Aug 27
DOC KNT109
DOCUMENT DESCRIPTION Article from Institute of Pathology - Lung Cancer and Tobacco Consumption
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Ser tenn
1 From the Institute Vice Chairman Prof.
of E.
PSacthhaoilroegr y
and the Scientific Institute for Research on the Dangers
of Tobacco chairman Staatstrat Prof. Dr. Pistel
from the Friedrich University in Jena
Dangers
.oee
2 LUNG CANCER AND TOBACCO CONSUMPTION
by
3) Schoeniger E. Schairer and E. 4) Received on August 27 1943
5 The significant increase of lung cancer has been an observed
fact again and again since 1920. 6
The course of the increase is
suspected in numerous circumstances by various authors suspected it mainly in certain kinds of air pollutions
7 One
8 We have
to mention here that lung carcinoma caused by industrial damage
which like the Schneeberg lung carcinoma the chromate cancer and
asbestos cancer is acknowledged as an occupational disease 9
Furthermore one has especially been considering the damages caused
by angine exhaust fumes which are inhaled especially in some
10 occupations
routes
but also generally in our big cities and main traffic Until now though it has not proven likely that
increased inhalation of such gases would lead to an increase of lung
cancer 11 Opposetdo this are the experiments done by
Schmidtmann opposed also is the fact that country and city
pollution take part in the increase of lung cancer equally and the
people working in occupations with combustion engines do not get
exceptionally sick
affected
females exceptionaly often 12 Likewise
by lung cancer more often than
the fact that males are does not support the
idea that this cancer is normally caused by exhaust fumes since
both sexes are exposed to them to almost the same extent 13 The
marked predominance of males with lung cancer in our material 6
times more men than women rather suggests internal influences over
the development however there is another external influence which
man is much more subject to than women smoking 14 It has been
mentioned occasionally that there is a strong interrelation between
the increase of the tobacco consumption and the increase of lung
cancer 15 Above all this assumption is supported by the results
of experimental cancer research
16 Roffo amongst others succeedeidn producing cancer by
applying tar obtained from tobacco 17 Roffo also was able to .
identify
carcinogenic from cigarette 4 kg of
the tar
heavily
benzopyrene in tar 18 Since
tobacco which a heavy smoker consumes in ten years
can be extracted it is understandable that by this
considerable damages of the epithelia of the airways may occur
especially if the smoke is inhaled
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19 But also on the clinical side the attempt was made to
prove the connections between tobacco consumption and lung cancer
20 Muller registered the tobacco consumption in 86 male lung
cancer patients during a certain period of time in comparison to 86
healthy men of the same age 21 The figures reveal that a much
of larger portion the lung cancer patients were heavier smokers than
one
whereas on the contrary the smokers or
might expect in moderate smokers were more highly represented the comparative lot
than amongst the lung cancer patients 22 Muller concludes from
that that the increase of
cancer is at least to a considerable
lung extent caused by an increase of tobacco consumption
23 These data by Muller seem very significant to us concerning
the problem of lung carcinoma 24 But we regarded further
investigation as
to prove their general validity 25
necessary From the material of the Institute of Pathology
Jena as well we
Pathology absolute found as Barblinger earlier a considerable absolute and relative
increase of lung cancer whereas for instance stomach cancer did not show a relative increase 26 We derived Table 1 from a thesis by
Wustner from this follows the increase of lung cancer during the
years 1910-1939 which also stayed the same in the war years 1941
27 The ratio of the number of broncial carcinoma compared to the reduced number of dissections was in 1949 3.61 in 1941 2.95
Table 1. Increase of Lung Cancer in the Dissected Material from the
Institute of Pathology in Jena 1910-1939 according to Wustner
Years
No. of Reduced Cancer Lung Dissec of Cases canc
Proportion in % Total # Lung can compared compared
red dis red
lung can compared
dis
363flflflfl8
1910 2347- 171 25914363flflflfl8
1915-1919 3280 2400
337 10
1920-1924 2430 1629
341 24
1925-1929 3358 2368
443 31
1930-1934 3220 2462
43946 43946
1935-1939 4714 3462
734 88
* Dissections of 20 years and over
21.05
14.05 21.08 18.74 17.82 21.87
0.46
0.42 1.53 1.31 1.87 2.77
2.2
2.9 7.0 7.0 10.5 12.0
28 Hence we started investigations of our material of the
years 1930-1941 of lung cancer tobacco consumption comparable
concerning patients 195 cases
the
to the ones done by Muller 29 We
in sent a questionnaire to the relatives who resided mainly by Thuringen which was very similar to the one compiled Muller and
in which we inquired whether the departed was a smoker what his
daily tobacco consumption was whether he possibly reduced or
stopped especially smoking
during his illness 30 Moreover
collected information concerning his profeas ndspi osso ibn le
we
occupational occupational damages from air pollution 31 Corresponding questionnaires have been sent to the
relatives of stomach rectum prostate esophagus and lung cancer
patients who died during the same period of time 32 By that
means we wanted to obtain a very accurate comparative basis and
possibly record the influences upon other cancer types
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33 As seen in Table 2 the questionnaires have been answered in
by such a way 50-60 of the questioned that they could be only
evaluated for instance in 109 out of 195 cases of lung carcinomas
34 Besides that we sent questionnaires to 700 men in the city
Jena of age 53 and 54 in accordance with the average age of 53.9
years old from our death cases from
cancer to assess their
lung tobacco consumption before the war and during the war 35 These
questionnaires have been answered satisfactorily by only 270 men
36 The results of these inquiries are shown in Table 2. 37
In the first vertical column a separation between men and women has
been made 39 Hence one can see that in lung cancer 6 times more
given usable answers were
by men than by women corresponding to the
6 times higher morbidity rate 40 The corresponding fact applies
also to esophagus and tongue cancer whereas the ratio in stomach
and rectum cancer is 2
41 Since amongst the women there were only two moderate and
one average smoker see last column of Table 2 they have been omitted from further revision 42 In the four additional vertical
columns of Table 2 the men are arranged in order of tobacco
consumption before the onset of their illness 43 Here we used the classification by Lickint 44 According to him a moderate smoker smokes 1 cigar or up to five cigarettes an average smoker 2 cigars or up to ten cigarettes a heavy smoker 3-4 cigars or 11-20 cigarettes daily 45 A very heavy smoker smokes
more than 4 cigars or over 20 cigarettes daily
46 From Table 2 one clearly derives that amongst the lung
cancer patients the smokers rather scarcely emerge the heavy
and especially the very heavy smokers are very strongly represented on the other hand if we compare them for instance to the stomach
cancer patients and the average cases 47 The ratio in tongue and
esophagus carcinoma is similar to the one in lung cancer 48 However the figures for both cancer types are too low to be
In evaluated statistically Tabl Tabe le 3 we have combined those in
one group in which an influence of smoking was not very likely since the number of rectum and prostate cancer was also relatively low
1. Lung cancer 2. Tongue cancer 3. Esophagus cancer
4. Stomach cancer
5. Rectum cancer
6. Prostate cancer
7. Average Population
TABLE 2
* of quest
sent out
Urable
Answers
195 32 35
320 108
60 700
109 17 14
189
65 33 270
Men
93 15 10 128 40 33 27.0
Comen
+
16 2 4
61 25
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. TABLE 3. Percentage Distribution of Tobacco Consumption amongst Various Kinds of Cancer and amongst the Average Male Population
Lung cancer
Stomach cancer
Prostate cancer Total of Examined Male
Cancer Patients
Average Male Population
53-54 years old
smokers
Moderate
Average
Heavy
1.1.8 8
3.3
3.8
10.7
15.9
3.73.7
4.5 3245.4
28.4
3344.9
2073.6 1874.6
4.7
= 3.7
3845.7
2.4
24.2 36.7
36.3 21.1 26.7
In In Table 3 we have stated in percentage the number of
smokers moderate average and heavy smokers we have combined the number of heavy and very heavy smokers in Table ) in each of the three main categories of cancer lung stomach rectum and prostate cancer which we have observed to facilitate an immediate
comparison 51 The female illness cases are not counteidn this
since the women were smokers with a few exceptions 52 We
have recorded in the same way as the 4th group the entire male
cancer cases revised by us correspondingly about 2/3 of the sum
total of male cancer cases in this time span and as the 5th group
the normal comparative cases
TABLE 2
Men were ...
Women have smoked
smokers Moder Aver Heavy Very heavy smokers
ne
3
11
19
29
2
0
4
6
3
0:
2
3
1
4
20
55
26
14
13
3
14
6
8
8
43
8
7
69
6
43
98
57
69
25
%
me
0
0
2
Moderate
1
Average
--
on "
of 53 From Table 3 one can learn that the distribution cases
of the respective cancer types rather varies amongst the various groups of smokers 54 In lung cancer we find the fewest number of smokers and the most heavy smokers instomach cancer to the
contrary we find the most smokers and moderate smokers and the
fewest heavy smokers 55 The percentage in the group of prostate cancer are almost in between both as well as -- as anticipated -- the percentage for all types of cancer combined
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56 Hence the figures for the
population are found in
average between those of stomach cancer and those of prostate
cancer 57 Thus one gets the impression that lung cancer is much
more predominant in heavy smokers and extremely rare in smokers
than prostate cancer 58 In reverse the heavy smokers
seem to be relatively scarce in stomach cancer patients also in
to comparison to prostate cancer or in comparison the average
population 59 The differences between lung cancer on one hand
stomach cancer and the average population on the other as far as
the
of smokers and heavy smokers are concerned are
groups likely statistically 6161 Muller as mentioned above in his material from Cologne
comes to the conclusion that heavy smokers get sick from lung cancer more often than smokers or moderate smokers 62 A comparison of our results presents difficulties at first since Muller had
to established another classification of smokers 63 His heavy
extreme smokers correspond
to our heavy and very heavy
roughly smokers his moderate smokers correspond to our moderate and
average smokers 64 In Table 4 we made a comparison on this
basis in which the percentage was given 65 One seas that the
figures from Cologne and Jena essentially match 66 Indeed the
heavy smokers are more frequent amongst the average population of
Cologne than that of Jena but also corresponding to
cancer
lung patients 67 In the research material by Muller the differences
between the average population and lung cancer patients are for the
group of heavy smokers and smokers statistically proven
Table 4 Comparison of Tobacco Consumption of Material from Cologne
and Jena in percentage
Lung cancer
Col. Jana
Average cases Col. Jena
Muller Reavy smokers heavy
according to
to extreme
Moderate & Average smokers
moderate according to Muller
smokers
65.12
31.19 3.49
52
.
45 3
36.04 26.7
47.68 16.28
57.4 15.9
68 Peculiar is the high
Cologne comparative material
of smokers is
number of 15-16 smokers from the as well as the one from Jana 69 The
for instance indicated as being much
percentage 70 lover 5-10 by Lickint
One could imagine that the age
groups in question possibly do not smoke as much as the
younger people 71 But one must suspect that some of the
people
declared questioned about their tobacco consumption have not declared it .
entirely faithfully 72 This is true for the comparative cases
thfully from Cologne
But also our comparative material shows certain
weaknesses 74 In 700 questioned people only 270 -- this is less
than half of them -- have answered satisfactorily 75 One must
suspect that in some people consideration affected by the war conditions influenced the answering of the questionnaire 76 One
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could therefore imagine that more heavy smokers than smokers resisted the answering so that a sided selection has occurred
77 Considerations of might not have made a difference in our comparative cases i.e. stomach cancer and prostate cancer 78 The investigation has been done here in exactly the same way as for lung cancer 79 A comparison of
possible the material is therefore
mentioned before we have
and admissible 80 As found differences concerning lung cancer
81 This mainly applies applies to the groups of stomach cancer 82
The ratio of distribution amongst the various groups of smokers
population almost corresponds to the average male
population 83 Heavy
smokers are even less represented in this group 84 If we may
assume that our surveys have actually represented a cross section of
our average population then we may deduce that there is no
connection between stomach cancer and smoking
85 Since we have
reason to assume that amongst our average cases too many
smokers and too few heavy smokers appear we also have to
consider that there are amongst the stomach cancer patients
exceptionally few heavy moderate smokers 86
that a part of stomach
smokers and too many smokers and
This probably can be explained by the
cancer
patients had already suffered a
fact weak
stomach for a while and therefore renounced heavy smoking
87 The differences in tobacco consumption between stomach
cancer and for instance lung cancer are certainly not explained by
the fact that during the illness the smoking was cut down more often in cases of stomach cancer than lung cancer 88 This can be
seen clearly in
how many of the
this pleasure
Table 5. 89 Herein
smokers in their last
90 One can see that
is specified in percentage of
disease renounced or cut down
this was the case in both
cancer types to exactly the same degree
Table 5 Reduction of Smoking during the Cancer Illness
During the illness smoking was
terminated in reduced in not reduced in increased in no definite information in
In lung cancer
60
20 11
S 22
In stomach cancer
56%
28 10
% %
considerable 91 The
of prostate carcinoma shows also as shown
in Table 3 considerable differences comparetdo the group of lung
cancer 92 The distribution of the various smoker groups
corresponds largely to the groups in which all the male cancer cases studied are compared 93 Any interrelation between smoking and
the development of prostate carcinoma is -- with reservation
-- not probable 94 We therefore believe that the distribution of
group smokers in this group corresponds most likely to the norm group
95 Unfortunately the number of cases is relatively small
so
that the average statistical error becomes rather high 96 The
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97 difference to lung cancer which seems considerable in itself is
therefore not valid
The difference between
hand and the group of all cancers together on the
only probable statistically in the grouopf heavy
lung cancer on one
other hand is also
smokers and
smoking
98 When we draw the conclusions from the material which is available at present including the one by Muller it is possible
probability to say that there is a high
cancer is much more frequent
due to the fact that lung in heavy smokers and much more rare in
smokers than it would be equivalent to the average expectation
99 Unfortunately it has not been possible to collect totally errorless standard material respectively to allow reliable
statistical conclusions 100 It will therefore be a further task
to follow up the correlation between smoking
and lung cancer in a
larger amount of material 101 The same is true for the totally
different conditions in stomach cancer
102 In short we now have to discuss the question of how those shifts in tobacco consumption might come about 103 In stomach
cancer one might only imagine as mentioned above that in many cases an already long existing sensitive stomach has been leading to temperance in smoking as well as to the development of stomach cancer 104 An obstructive effect of tobacco smoke upon the
development of stomach cancer is not probable
105
effect of
On the other
high tobacco
hand it is consumption
obvious
on lung
promoting toassume a
cancer 106 This is
supported by the simultaneous high increase of tobacco consumption
and lung cancer during the last decade 107 The content of tar
and carcinogenic substances in tobacco may be of major importance in
this 108 It contradicts the assumption that the increased tobacco consumption derives from the fact that the already ill smoke more to desensitize themselves as it is shown in Table 5. 109
According to this only a few smoked more whereas most patients have stopped or reduced smoking during their illness
We 110 thus have to assume that heavy smoking is a cause for
the increase of lung cancer 111 It certainly cannot be the only cause of lung cancer since some smokers are afflicted with this disease 112 We might assume after all that smoking is an
important cause that an already existing lung cancer disposition
fully might
develop 113 We here recall experiments in which mice
breeds which have a moderate inclination to develop lung cancer a
a much higher rate of lung cancer by additional application of tar
or carcinogenic substances has been produced Andervont 114
There are plenty of examples around where in a basis already
receptive to cancer cancer has been produced by additional
rabid irritants 115 Thus could for instance
produce a rapid mutation into cancer
Rous and Friedlander
papillomas which were
induced by a virus of methylcholanthrene application 116 By appropriate design of our questionnaire we have tried
to include even more external causes of lung cancer especially air
52 pollution 117 However
about this fact 118
our material does not give us disclosures
of our lung
cancer patients had a
free occupation 119 13 have been exposed to stone dust in their professions ten were exposed to metal dust 120 I refer
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