Document eg2oVa209n6BNp1Ra3vYN6kp
FILE NAME: Kent (KNT)
DATE: 1951 Mar
DOC#: KNT124
DOCUMENT DESCRIPTION: Journal Article - Cancer of the Lung in Relation to Tobacco - British Journal of Cancer
t ~.Oi
BRITISH JOURNAL OF CANCER
VOL. V
MARCH, 1951
NO. 1
GANGER OF THE LUNG IN RELATION TO TOBACCO M. E. DAEF, R. DOLL and E. L. KENNAWAY.
FrotmhethSetaPtiasttihcoallogRiecsaelaDrcehpaUrtnmitenotf,thSet.MBeadrtihcaolloRmeeswea'srcHhoCsopuitnacl,ila, nd London School of Hygiene and Tropical Medicine.
Received for publication February 20, 1951
Further Data on the Arsenic Content of Cigarettes. [Si' conItennatnoefa5rlbierrapnadpseorf(cDigaaffraenttdesKoefnBnarwitiasyh, a1n9d50A) dmaetraicwaenretygpivees,n ofofr8thberaanrdsesnoicf
Tofuarkrsisehnictyvpoel,aatinlidzeodf itnwosmootkhienrgs. (FArenfuchrt,hRerhosdereiseisano)f, easntdimaaltsioonfosrotfhaersaemniocunint Ictigaalyr,etBteuslgafrroiam, P8olacnodu)ntirsiersep(oUrt.Sed.A.i,n CTaanbaledaI,. NoIrnwaalyl,, 2S7wibtzrearnldasndh, aAveusbtreiean, examined. is nAumll eqruicaanltliytiethseosfaamrseenaisc pgaivrtesnpienr tmhiislliopna.per are stated as As20 3 xg/g., which
T(1h)eArehsiuglhtsagrisveennicincotnhtiesnatnd(24thteoea10rl6i)erinpa1p0ernoshno-Twu--rkish brands smoked in Eng(l2a)nAd,lUow.Sa.Ars.e, nCicancaodnateanntd(0N-o0rtwoa4y-.3) in 8 Turkish brands as sold in England, iPnoalaRndhoadnedsiBanulbgraarniad., in a popular Austrian brand, and in cigarettes from France, in c(i3g)arIenttteersmfreodmiatSewaimtzoerulnatnsd(3a-n1dtIota1l2y-.0) iOnnae lCeassnapdoipaunlabrraAnudstsrhiaonwebdraandr,aanngde of 8O-6f tcoou1r8s-e7. no claim is made that the analyses of these cigarettes, which we choamveplheatepppeicnteudretoo fotbhteaicnomthproauragthivtehhe akbiintsdnoefsssmoofkvearsrioinusthferiednifdfes,recnatncgoiuvnetraiensy. Bgruatdmatioosnt forfomthethberaanrsdesniacr-ericphopAumlaerriocnaenstaynpde itnheWreesstuelrtns sEhuorwo,peontoththeewahroselen,icapacocoorrTdsurwkiitshh Htyuptesoinn'sth(1e93E7a)sta,ccwoiuthntaonf itnotbearcmcoedciautlteumreidin-EEuurrooppeeanquzoonteed, wbehliocwh Be i (P- 3). Cancer of the Lung in Relation to the Types of Tobacco Smoked in Various Countries.. . andSoofmDeorlelcaenndt BinrvaedsftoigradtiHonilsl,(a1n9d50e)s,psehcoiawllyanthaossseocoifaWtioynnbdeetrwaenednGthraehsammok(1in95g0o),f tobacco, and especially of cigarettes, and cancer of the lung. Since arsenic is under
1 - XO
2
M. E. DAFF, R. DOLL AND E. L. KENNAWAY
T able I.-- Arsenic Content of Cigarettes. Brands other than English.
Brand.
Nciugmarbeetrteos.f
As20 3 hg. per g.
U.S.A.
B
r
a
,,
n
d
PC.M.
2 1
4516--04.; 46-7.
Canada.
Brand K ,, o
.
r4>
,,,, Bw.C. 36
Norway
Brand B ,, T
43
Switzerland.
Brand P
4
83-67-
8
:
;
5818-4
2 ;
;
47-1 8-6;
1;
55-1. 8-7; 9-1.
4431-15;; 4567--65;; 5472--59.; 79-5; 7-5; 41-7.
5741--47
; ;
5625--48
; ;
5754--66.;
49-7.
6-4 ; 3-1 ; 3-9 ; 3-4.
Italy. Brand N
Austria.
B
r
a
,,
n
d
MD
Poland. Brand Z
6 10-5; 9-8; 10-2; 13-7; 9-1; 8-3. 31 T12r-a0c.e ; 2-1 ; 0-9. 5 2-5; 2-1; 1-2; 2-7; 1-5.
Bulgaria.
Bra,,nd RA
44 00--67;; 01--62;; nniill;; 00--23..
sfoormdeHciirllcuamndstFanacneisngc,ar1c9in48o)g,etnhice iqnuemstainon. (Nareiusbesa,uwerh,e1th94e7r ;thCeuarrrsiee,ni1c94in7 ;to]l tiso caornsceenrinceadreingtihveisnpbryoctehsse. CIhniesftaInncspesecotforcaonfceFraoctfotrhieeslu(n1g93i9n).worIkneras ecxaji amrosernteimcalepxoaimsoinniantgio"n re.vea. led. thdaute itno asodddiiutimonatrosepniigtem, wenhtiacthiownaosfftahtael,trtuhnek lwimasbsa, pwraimrtayrgyrcoawntchesraolfl othveerrtighhetbluodnyg awnidthpemrefotarasttaiotnicogfrtohwetnhassainl sneepitguhmbo,i: agnlaontdhserancadseinisthreecloivredre.d" "In.a l.ate.r Rinepoartfil(lCinhgiefmIancshpinecetoorpeorfatFoarc, taogreieds,5)i 4ca3uyseeaorfs dienatah fbaecitnogrydumeatnoucfaacrtcuinroinmgasohfeetphedripighctonlutnaign.ingTshordeeiusmimailrasrenciates
CANCER OE THE LUNG IN RELATION TO TOBACCO
3
psiunlcmeo1n9a3r9y."carHciennormya(1o9cc5u0r)rdinegscirnibaerssaencicaasel sohfeecpu-tdainpewouosrkcearnschearve" be.en. n.otifieidn a. fu. rn.a"cemTawnomnaokni-ningdsuosdtriuiaml caarsseesniotef wbrhooncehvieanltucaanllcyerdiaedreorfeccaonrdceerd oifnthpeerlsuonngs Staekminogn,a1r9se4n5i)c. mTehdiisciqnualelsytioonvemr ilgohntg bpeerdioecdisde(dMiofnotngeomcoeuryldahnadveWeaqiusmalalyn,re1li9a4b1le; sdtoamtisintiacnst ftoorbathcceoisnmciodkeendceisooffctahnecerarsoefnitch-ericlhu,ngorinofcotuhnetriaerssewnihce-preootrh,e typpree. sWloewhaanvdedbifefeicnulctopllreoccteinssg. daItnavoienwtohfisthqeugersetiaotnprbayctcicoarlriemsppoonrdtaennccee,obfutthethmisatitsear ihtasnedeminsqbueitrtyerintoapppurbolipsrhiattheecaovuaniltaribelse. data now in the hope of promoting first to cSiogafarerttaes wsme okknionwg, wthheicohnlhyasvteaticsotimcael fsrtoumdiesanoyf ccaonucnertroiefsthoethleurngthinanrelGartieoant Britain, the U.S.A. and Germany are those of Saglam (1944) from Turkey and of DunTghael d(1a9t5a0)wfhriocmh oInceelawnodu.ld like to obtain from any given country are : of taob. aFcrcoomwnhaictihoniasl osof uArcmees.r--ica(1n), ToortaTlucroknisshu,mtpytpioen. of(3t)obParcocpoo.rti(o2n) Porfotpoobratciocno Nsmumokbeedr aosf dceiagtahrsetatettsr,ibcuigtaedrstoancdanpceipreo-tfotbhaeccluon. g.(4)ThPeoptwuloatliaosnt ibteymasgfeosr. m(e5n) andbw. oFmroemn suepnaivreartseiltyy. clinics (for men and women separately--preferably by aNguems)b.--er(1o)f Nauutmopbseiresosfhaouwtoinpgsiecsa.nce(r2)oNf luumngb.er of autopsies showing cancer. (3) of bIn(3)thteo cbo(u1n)trhiaess wbeheenresaug(5g)esistednoatsatvhaeilambloestonreelimabulestirnedleyxonforB.theThperersaetniot paruer,poofseco(uHrseea,dvyeraynddeKsireanbnlaew, abyu,t t1h9o4s9e).forFtihguerwesarfopreraiondum19b4e0r toof 1s9ep45argaeteneyreaalrlys sinhdoewbtecdontsoidtehraebsletafdfsistoufrvbaarnicoeuss E(Fmigb.as2s,ies5)inanLdondmounstforbedataavooindead(.1),W(2e), a(r3e) aSntadtes(4m),anin's aYdedairtiBonookto. wAhagtrecaatndebael foofuinndforinmastuiochn iws ogrikvsenofinreaferreepnocret,a"s Tthhee ConIsnumsupcthiocnomanpdarPisroondsucbteitowneoenf TdoifbfearcecnoticnouEnutrroiepsea,"t lbeyasJt.foBu.rHpuotsssoibnle(1c9a3r7c)in. o ogefntiocbfaaccctoorcsomntuasitnibnegcaornsseindiecr.ed,(3n)aImnehlayla:t(i1o)nSomfotkhiengdoufsttoobfactocwo.ns (a2n) dSmofokcionagl smoTkhe.us (p4o)pIunlhaatiloantisoninofeapsrtoedrnucEtsuorfoptheewinhtiecrhnaalrecosmubbjuescttiotnoetnhgeinefi.rst of thes_e_ ffraocmtortsh, eanthdirodnalyndslfioguhrtltyh,ifwahtilealtlhteo inthdeusstercioanl dp,eowpillelsaolsfoBbreitacoinmapnadratthiveeUly.Sf.rAee. owfilIlcbeleamndoswtiellxbpeosseudbjteoctthtoe stheceosnedc,onthdirodnlayn.d fourth together, and the inhabitants
Tobacco Culture in Europe. H(1u) tOsornie(n1t9a3l7:) Tcluarsksiefyie,sGthreeetcyep, eBsuolgfatoribaa,cSco. YgruogwonslianviEau, rUop.Se.Sth.Ru.s : (2) Semi-Oriental: S.E. Italy, S.W. Yugoslavia, Rumania, Hungary, S. Czechoslovakia, S. Poland.
4
M. E. DAEF, R. DOLL AND E. L. KENNAWAY
Fra(n3c)e, SpaDianr,kBaeilrg-icuumre, cSl:wHeduenng, aSrwy,itRzeurmlaanndi.a, Czechoslovakia, Germany, N. Italy, H(1)e TdhivoisdeesinthwehcicohunatrpieosrtoiofnEuorfotphee ifnatcoto4rygrcoounpssu:mption is grown (Germany,
Spain, Belgium, Poland, Czechoslovakia, Switzerland). Yug(o2s)laTvhioas,eRiunmwahniicah).production is approximately equal to consumption (Italy,
((43)) TThhoossee iwnhwichhicphrloidttuleceora nsuortpolbuascc(Goriesegcreo, wTnu,r'kwehyi,chBuarlgeaarlilat,hHosuenngaortyn)a. med aboTveh.e countries in the third group are of most interest, if one can assume that uthnefotrotbuancactoelsymtohkeedcothnedrietioisnsatfoarnythreatsetuvedryy olafrgcaenlyceorf tohfetahreselnuincg-poinortthyepew,hboulet pcaonpcuelratoiofnthaerelivneort, apsreyseetntvserpyecfualviaorurdaibffliecuinltitehseomn,aacncdoutnhtisosfutbhjeecdta,nlgikeer othfactonof fusion of primary and secondary growths.
TurkeyT.obacco Consumption and Cancer of the Lung in Various Countries. (1) Data on the consumption of tobacco in Turkey are given in Table IT.
Table II.-- Consumption of Tobacco in Turkey.
Year. Toba(cmcoillcioonnslubm.) ption Population.
Tob(albc.copecronhseuamd.)ption
1925 1930
2115--98**
1143,,509213,,000000
11-'5210
11993375
25-0* 28-2f
1166,,810508,,000108
11--5658
11994472
37-2f 40-7-f
1187,,887200,,798550
22--1069
1949
39- 7f
20,900,009j;
1-90
t* FFiigguurreess pfrroomvidHeudtsboynth(1e9T37u)r.kish Embassjn
j The Times, October 30, 1950.
toba(2c)coPriosf.coSncshuwmaerdtz,alomf otshte wUhnolilvyerisnitythoef fIosrtmanboufl,ciwgarriteetstesth;atthinat Tcuigrakresy,
oEfutrhoepepaenoppliep,esanadndthtahte tohreireentaarlewmataenry-phipeeavayresmalmokoesrtsuanmkonnogwnwoammeonn.g the bulk
in re(3la)tTiohnetoonslmy opkuinbglicaaptpioenarfsrotombeanthyaBt aolfkParnofc.oSuangtlraymu(p1o9n44c)aonfctehreoUf nthiveerlusintyg
iomf Ipsotratnabnucel,owfhhoisgoivriegsinthalepfaoplleorw, ianngddtehteaidlsi,ffwichuilcthy oarfeacqcueosstetdoiint.full in view of the
" The clinical statistics of pulmonary carcinoma in Turkey :
Year. Npuamtibenerts.of Ptuulmmoonuarr. y tRhoautesapnedr.
TThhee IInnftc.. CClliinniicc ooff GGuullhhaannee ((STuelvefyikmSanagNlaumm)an) 11899293--11990286 .. 42237403 .. 27
02--146(3(0-0-4)*7V
The SSaegctla, 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 1 Prof. Saglam in the two adjacent columns.
CANCER OP THE LUNG IN RELATION TO TOBACCO
" The anatomo-pathologic statistics :
Year. GGuullhhaannee ((DLueyftcik) e-.Rein.hard.) . . . 11899293--11990286 THhaeydAanraptaosma oN-upmatuhonleogHicasItn. s.titut.e of. the .Uni 1936-1939
versity of Istanbul (Prof. Ph. Schwartz) . 1935-1943
Nauumtobpesrieos.f Puclamnocenra.ry 580020 .. 35 635 . 14
. 5126 . 79
tRhoautesapnedr. 103-7 22 15-4
year"sTthakeiningcrtheaesecliinnicoaulrsctlaitniisctsiciss i1n2totimcoenssiadnedraaticocnoridt iinsgctloeatrhtehaant awtoitmhion-p,3a0th-4o0 logic" sWtaetihstaivces isteeisn 41-11 tciamseess aosf pmuulmcho."nary carcinoma in the newly inaugurated 3. Ic" HAallsttahleikselasrtiaKtilsitnicigsisihno2w3 mthoanttihns o(aumr ocnougn2t0r8y4, pwaitthieinntst,he5-3laisnt a30thyoeuasrasn, dp)u."l monSaargylacmarcrienjoemctsa hciagsarinecttree-assmedokiinnga garseaat fparcotpororitnionth."e incidence of bronchial csmarockininomg at.oba"ccSoomaendauinthhoarlisngbetlhieevesmtohkaet athnedrepuelxmisotnsaray rcealartciionnosmhiap. bAetnwimeeanl tehxaptereismpeencitaslslyeemcigtaorestutpespoprltatyhias gproeinatt opfavrtiewin. itsSopmroedauuctthioonr.s arWe eofdtohenoopt inhoioldn tahree ssmamoekevdieiwn. ouFrocroaunlotrnyg. timIne,spaitteleoasftthsiinscteh5e0inyceraerass,ealimn opsutlmonolnyacriygaCrae.tteins tphipisescoaurentmryoshtlays sgmonoekeodn. thTehesaammeopuancteoafstoibnacthcoosceoncosuumnterdiesinwohuerrecocuignatrrsy ahnads skhgor.winn a19c4o2n.staBnut tintchriesarsies,eainsdnofrtomsuf9fi,c3i7e0n,t00t0o kegxrp. lianin19t2h6ehinacsrreiasseenitnop1u6l,m68o0n,0a0ry0 Ca." conBsuumt pthtieorne oisf naonyextoabctacbcaosipsrfoodruacneys asuncyhgaivregnuminecnidt.encWe eofdbornonotchyieatl kcanrocwinwomhaat, nor(d4o) we kWnoewarteheintdimebet-erdelattoioPnrsoof.f aSnayglasumc,hPerffoefc.t.Schwartz and Dr. Yenermen for c(ua)rrfiuedll opurtotaotctohlse Uofntivheers1i9ty3 oafuItsotpasniebsulodnucrainsges1o9f34p-r1i9m5a0r,yantudm(bo)ufriguorfetshfeorluthneg t(oTtaabl lea-uItIoI)p.sies and autopsies on cases of cancer, bv sexes, for the same period
To make the material comparable with other series, we have omitted the
Table III.--Cases of CUannicveerrsoitfy tohef 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 17290 438728
4783 107 8535
1949-50 . 7GT 488 1255
104 55 157
31 4 35
showCnhaansgepserinceinntcaigdeesncoef walilllabuetospeseinesmaonrde colfeaarlllycainncTerasb.le NIXot,ewthhearte dcaatsaesfoorf cthanecyereaorf 1th94e9luanpgpeaarre
twice.
6
M. E. DAFF, R. DOLL AND E. L. KENNAWAY
dfraotma ftohre1t9o3t4alanodf phraivmearreymluovnegdtu3mcaosuerss, a(all cinhomnednr,omdeascirnib1e9d35a,s abneontihgnertuinmo19u3r9s,, laongdicaallpyoalyspnoint b1e9i3n7g).caWrcienohmavae, ,nhaomweelyv,erl,ymreptahiongerdanfuoulormcaasiens ademscarnib, eodnehicsatsoe each in 1936 and 1937 ; sarcoma in a man, 1941 ; cylindroma in a woman, 1942.
Bulgaria and Greece. thatHfurtosmon T(1u9r3k7e)ystaantdesHthuantgathrye,sumrapkluess purpodtuhceedbuinlkBouflgtahreiawaonrdldG'srseuecpep, lwy itohf loorciaenlltyalasciagnaruenttkenotowbnacacmo.ounItt isisgrdoifwfincuflotr tpoeressotnimalautese tahned aemscoaupnets tcaoxn.su. mTehde mofafinci'salYfiegaurreBsofookr, t1o9b3a1c)ciondcoicnastuemapntiaonnnu(Haluctsoonns,um19p3t7i)onanodf faobropuotp1u-7laltbio. npe(rSthaetaesd finiguGrreeseacreeasnimd iolafr1t-o9 tlhb.ospeerobhteaaidneidn fBorulTguarrikae,yininth19e3p7er(1io-6d8 1l9b2.5petro h1e9a3d0,. TaTbhlee II).We have no data on the incidence of cancer of the lung in these countries. Yugoslavia. KosWir,eodfoLjnuobtljkannoaw, htahseparomvoiduendt uosf wtoibthacicnofocromnastuimonedabionutYtuhgeosslmavoikai,ngbuhtabDitrs. aorfeth: e" p(ao)ptuylpateioMn.akeHdoenwijrait(ecsigtahraetttetsh)e;k(ibn)dtsypoef tHoberaccecgoovsminoak(ecdigianreYttuegso);slaavnida (c) t"yTpheeVreojacroedisnmao(kpeidpeparnindcicpiaglalrys)c."igarettes. These are of the oriental type, i..e.,. th.eyOhnalvye ian nthaetunraolrt`hb-woueqstueertn' pwahritchofgYivuesgotshlaevtioabtahcecroe tayrpeesMmaokkeeddonciigjaa.r"s laansdt wpiapret.heUosnelyofimtopboarctcwo afosrsosnmueffDinugticshqtuoibteacincosigfonrifcicigaanrts. ; d. ur.ing."theBwefaorrseotmhee iBmuplgoarrteiadn, bauntdalalftthereseitamsoomunets Awmereerivcearny stmobaallc.co (through U.N.R.R.A.) was the Wnuemabreeraslsoof ainudtoebptseiedstaonDdro. fKthosoisreanodn taoll Pcraosfe.sPo. fHmriablaigrnafonrt adissteaatseemaenndt ooff Scalonvceenriao,fdtuhreinglun1g9,25btyo s1e9x4, 9.carTrihedeseoudtataatarteheshCowlinnicianl THabolsepiItVal., Ljubljana,
Table
Period. 11992350--94 11993450--94 11994485--99
IV.'--Cases CoflinCiacnalceHroosfpitthael, LLujunbgljaAnmao, n1g92A5 utoto1p9si4e9s. Carried Out at the
Number of autopsies.
All cases.
All cancer.
Cancer of lung.
Male. Female. Total. .. 576943 575635 11515187 .. 11006830 1085680 21193310 .. 1899279 1578919 31561888
Male. Female. Total. 11772 9615 210387 112392 113153 226454 214416 219524 523985
Male. Female. Total.
58 21 106
1181
11 1192
2189
97 3286
See footnote to Table III.
CANCER OE THE LUNG IN RELATION TO TOBACCO
7
Switzerland. abo(u1t) the aWmeouanrte oifntdoebbatcecdo tcoontshuemBeduroevaeur tFhedprearliodde1S93ta6titsotiq19u4e9,foarndintfoortmheation tDoibraeccctioo.n GThnedraaltadeasreDsouumamneasrizfeodr ininfToarbmleatVionanadbFouigt. t1h.e sources of imported
T able V.-- Consumption and Sources of Tobacco in Switzerland. 1936 to 1949.
Percentage of tobacco
Year. Toba(lcbc.opceornhsueamdp).tion Home-grown.
Imported from
Balkans. U.S.A. a0rtehase.i
11993376
43--05
126 .........1..0..................3..8........ 46
11994430
44--96
1182 .............................................................................
11994475
55--79
2109 .............................................................................
1949
4'5
18
11 . 42 28
* Mainly Brazil and the East Indies.
smoWkeed,hbauvet unnotidleWtaoilreldd iWnfaorrmIIactiiognaraebttoeustfotrhme emdaonnnleyrainsmwahllicphrotphoerttioobnaoccfothies who(l2e) (PTraobf.leHX. )v.. Meyenberg has provided a summary of the autopsies performed a20t,6th81e Pauattohposlioegsi,cathl eIrnestwiteurete,35Z84riccahs,esduorfincagntchere apnedrio2d7619c2a7sestoof19c4a1n.cerAomf othnge lung(.3) ITthies,sehofiwguerveesr,anreotconmecpeasrsaedrywtiothbethdoespeefnrdomentotohnerhocsopuintatrlisetsatinistTicasblfeorIXan. easrteimavaatielaobflethfoerinthceidwenhcoeleofcocuanntcreyr. of Wthee alurneginidnebStweidtzteorltahned,BausrevaiutaFl sdtatriasltidcse tShteatbisrtoiqnuche,i Banedrnleu,nfgosr, abystsaetxe,mfeonrteashchowyienagr t1h9e29detaoth1s94a9ttr(Fibigu.te1d) taondcaanlscoerfoorf dTaatbaleoXn, aingecodmisptrairbisuotniown itohf tthheerpatoepsuflraotmionE.ngTlahned carnuddeWdaeleasthanrdaftreos,msNhoowrwnaiyn, hcoamvembueneincatciaolnc)u.lated from population statistics provided by Stocks (personal Norway. the (p1)roducPtiroonf.ofLteoibvaKccroey(bpiepreg,, coigfatrhseanUdnicviegrasriettyteos)f fOorsleoa, chhaysesaurp1p9l3ie0dtofig1u9r4e7s for (FigM. r2., Oa.ndJafkoorbsseelne,ctoefdtyheeaNrsorinweTgaiabnleEVmI)b.assy, writes that " Norway normally imports 85 per cent of her tobacco from America (Virginian tobacco), 9 per cent fimropmortthsearMeipddralectEicaasllty (eTquuraklistho ttohbeaccocno)suamnpdti6onp,erasctehnet ofrnolmy eexlpseowrthseraer.e"toTthhee mnoetrcaasnctiilgearmeattreisn.e. MTaonbyacpceor,soenxscebputycitghaersc,hiesaaplemr opsitpealtloibmapcocorteadndasmsaukceh,thaenidr own cigarettes, obtaining thus nearly twice as many for a given sum ; hence the
8
M. E. RAPE. R. DOLL AXI) E. L. KEaLYAWAV
F ig . 1.--Cancer of lung. Deaths, 192199-3169-4199.49.ConSswuimtzpetriloann,do.f tobacco (hundred thousand pounds),
Pofifpicei-aslmfoigkuirnegs ifsormtohset ccoonmsmumonptiinonruorfapl iapreeatos.bacco and cigarettes are misleading.
Table VI.--Consumption of Variou[sKTreyypbeesrgo)f. Tobacco in Norway. 1931 to 1947
Year.
Tobac(lcbo. pcoernshuemadp)t.ion
Percentage of tobacco in. form of : Cigars. Cigarettes. Pipe tobacco.
11993312
11--44
23
3365
6622
11993376
11--79
33
3396
5618
11994430
21--20
31
4399
5489
11994476
22--69
11
4414
5585
canc(2e)r of thPerloufn. gL, ebiyv seKxr,efyobretrhge hyaesarssu1p9p3l0iedto f1ig9u4r8es(Ffiogr. 2t,h3e),dfeoartdhesatahtstrsibepuate-d to
CANCER OE THE LUNG IN RELATION TO TOBACCO
9
rately in urban and rural areas, and for the population by sex. The calculated deaTthheranteastifornoaml cfiagnucreers oafrteherelausnognaabrelyshreolwianblien aTsa,baleccXor.ding to Mr. Jakobsen, f"illThine adnocotoffricwiadliocehratisfitcraetaetesdtattihneg dtehceeacsaeudseduorfindgeahtihs la.st .illn.esswi'hsicrheqmuiuresdt btoe sgteanteerda]indiamgendoisceasl stuecrhmassa"s dpirseecaisseeloyf athsephoessairbtle", oarn"d diitseisasneootf ptheremluitntegds."to Tuhsee
160
Deaths
Cancer of Iung?
120
80
rm
40 J
yb
Tobacco
1930i 19I32i 19I34i 19I30i19138i19140i 19142 19+119!40i19I48
Fig. 2.--Cancer of lung. Deaths. 19C3o0n-s1u9m+7p.tion(Kroefybteorbga.)cco (hundred metric tons), Norway.
sta.tem. enTthmeudsotcbtoerinisarcecqorudiraendcetoweitxhamaninoefftihciealpnaotmienentcalaftteurredeoaftcha.u"ses of death.
citie(s3)of NoTrwweanytyin-eibgohtthp1er930cenant dof19t4h6e ;pothpeulpartioopnorwtieorne leivstinimgaitnedurtboanlivaereians the
rceavni,ewth.ereTfohree,foblleowcoinnsgidaerreetdhetoeshtaimveatbeedencrcuodnestadneattthhrroautegshfoourtetahcehpseerxioidn uurnbdaenr
and rural areas.
Norway
Death Bates of Cancer of Lung per million.
Death rates of cancer of lung per million.
11993390--4378
Urban.
M2a4le. Fem19ale. . Per2s1ons. 63 42 52-
Rural.
M1a4le. Fem12ale. Per1s3ons 30 24. . 27
JO
M. E. DAFF, R. DOLL AND E. L. KE'NNAWAY
The data show th at: ( ) The incidence is greater in urban areas. ( ) The urban excess is slightly greater for men than for women--
11993390--4378 urban,,: rural ra,t,io, mmaallee 21--17::11,; fefmemaalel,e,1-18-6: :1.1. the (cc)ouTnhteryinacnredasgerebaettewrefeonr m19e3n0 tahnadn1f9o4r7whoams ebne.en greater in the towns than in
URurbraaln incr,,ease mmaallee,, 22--61::11;; ffeemmaallee,, 22--02 :: 11..
iii
Fig. 3.--Cancer of lung. Deaths. Norway, 1930-1947. (Kveyberg.)
Sweden. ing Spnruofpfo, rutsieodnfoorf cahllewthiengtoabnadcfcoor ipnrsoudfuflcattsiocno,nmsuakmeesdup(Hauvtesroyn,la1rg93e7bu: tPdriomf.inEislhis vBeerryvefnin,eppeorwsodnearl lcikoemtmhuenEicnagtliiosnh. sTnuabffleanVdIIis).inhParloefd. iBnesrmveanllwqruiatenst,iti"esSnthurffouisgha tphinecnhoesse,.i.e.Foarbocuhtewoninegttehaesrpeooanrefutlw, otatkyepnesfr:om(a)thTehesnsuafmf-ebotyx)peisopfustnuinff b(3et-w4 ebeing tahteouligphamndastsh,einmsainzediobfleabaonudtisa chhaezwele-dnubta, cwkhwiachrdiss alynidngfoarwt tahrdessaumnteilpiltacbeecaobmoeust 3 to 4 hours ; . . . (b) Chewing tobacco is to be had in the form of braids,
CANCER OP THE LUNG IN RELATION TO TOBACCO
11
'Fa b l e Year. 11992018 11993316 11994484 1949
V I I .--CoDnissutrmibputitoionn.
Ceiiggaarr-sciagnad- Cigarettes.
rettes.
0/
0/
1100--18
38--33
98--35 2126--13
56-17 4247--99
4-7 46-9
oSf wDeidffeenre(nBteKrviennd,speorfsoTnoablacccoommasunPiecratGioenn)t. of the Total
Tobfoarcco Tobfoarcco Snuff. Tobacco. (lb. peCrohnesaudmppetrioynear.)
smoking. chewing.
0/o/
0/o/
0/o/
0/o/ Snuff. Tobacco.
4-4
hi
37--69
7636--69 2336-41 22--2038
01-17
1153-05 11--8 5529--58 4407--25 11 -5753 11-24
2136--73 00--64 4313-31 5686-'79 11-1056 211-7
15'6 0-4 32-4 67-6 1 -02 2-1
wfrhomichwishitchhenthleyyinbgitaet 1thteo s2amcme.plaTcehiassptiheceesinsucffh.e"weUdntfooratuhanlaf-tfeilrymnocofnigsuisrteesnfcoer, the incidence of cancer of the lung are available. Iceland. " ThSemcookninsugmhpabtiiotns ionf Itoceblaacncdo,apreardtiisccuulassrelyd ibnythDeufnograml (o1f9c5i0g)a,raecttceosr,dhinags ctoerwtahinomly Dbeuenngaml',uscfhigulersess fionr Iccieglaarnedttethcaonnsiunmmptoiosnt EaunrdopfeoarnthceouinntcriideesncaendofAlumnegriccaa.r" cinoma are summarized in Table IX. Britain. lungDiantaBrwitiathinrheagavredbteoentopbraecsecnotecdonpsruemvipotuioslny a(nKdentnhaewinacyidaenndceKeonfncaawncaeyr, o.1f94th7e; Phoigs.pi4t,al5s).havNeebweednatcaolloencttehde(TauatbolepsVyIIinI)c.idence of cancer of the lung in British
Table VIII.*--Cases of CaBnrcietrishof HthoesLpiutanljs,A1m9o2n5j-4A8u. topsies Performed at Three
Number of autopsies.
Hospital.
Period.
All cases.
All cancers. Cancer of the lung.
M. F. Total. M. F. Total. M. F. Total.
GlIansfgiormw.aryW(Cesatpeprenll) . 11993205--49
11125144 .. 115333 8823 221365 .. 3212 152 3364
11994350--94
11237953 .. 118900 112244 331044 .. 3416 167 4537
11994475--88
1638274 .. 120230 16383 137513 .. 5313 199 4702
St.(NMeawrcyo'sm, bL)ondon . 11993350--94 872476 444812 11138088 . 117410 11772 221873 .. 3306 59 3455
11994405--48 683 428 l i i i . 139 90 229 . 4 8 49
St, Bartholomew's, . 11994370--48 . 1037516 525289 1660104 . 20863 4957 310310 .. 2573 136 2790
L(Counndnoningham)
11993450--94 987 528 1515 . 192 121 313 . 37 10 47
11994475--88 534014 211273 746216 . I6l0l 6270 17817 . 4235 104 5239
* See also Table IX.
12
M. E. DAFF, R. 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 OE THE LUNG IN RELATION TO TOBACCO
13
Incidence of Lung Cancer. Comparison of the data from various countries. YugIonslTavaibal,eSIwXitzherolsapnidtalanddatIaceflraonmd, fairvee psroeusrecnetsedintoBgertihtaeirn. aTndhefrcoamsesToufrlkuenyg, ocafnmcearliagrnea-nsht ogwronwatshspefrocuenndtaagtesaouftotphseyn;umsebxeers oafreausthoopwsiness,eapnadraoteflythewhneunmevbeerr tohfetodbaatcacaorearaevianilcalubdlee.d. For comparison, estimations of the annual consumption
The data show th at: thir(d1,) aArehnigohwpfrooupnodrttioonshoofwa"uctaonpcseiersoofnthceasleusngofincaBncreirti,shbehtwosepeintaals f;ift2h0 aynedaras ago(t2h)eTfhigeuerxepwerarsiebnectewceoennc1er0nainngd m15apleesr icnenIts.tanbul in recent years is not unlike the (B3)riTtihshe eexxppeerriieennccee. in Slovenia is comparable with British experience in the first(4q)uTahrteelrowofetsht irseccoerndtuedryf.igures are found in Iceland. how(e5v)eSrw, iinssdifcigautereas ahrigehceorminpcairdaebnlecew(iTthabSlleovXe)neanodnetso.o mSwucishssnigantiiofincaalnscteastihsotiuclsd, notTbaebalettXachshedowtso tohneechrousdpeitdaelastehrireas.tes from cancer of the lung in England and eWstaimlesa,teSswoitfzethrleanadnnaunadl rNatoerswoafycfoonrsusmelepcttieodn oyefatorsbabcectow. een 1931 and 1947, and Mr.[OAlacfomJapkaorbissoenn ohfasthkeinadgley-dsuisptrpilbieudtiofinguirnesthfoertNhroerewacoyubnytriseesxeiss fgoirve1n93b0elaonwd. S1w94i6tz;ertlhanedfigwuerreessfuoprptlhieedlabtyterthyeeaBruraeraeusuFmdmarrailzedde iSntathtiesttiaqbulee,. BeTrhnee.data for
Population.
Per cent of ail ages.
k 2A0l-l
4300--
M i
3060-
p 70-
EWnaglleasn, d19a4n7d.
478--44 77--18 54--30 2-6
Males. No1r9w46a.y,
498--63 67--09 53--03 2-7
Swit1z9e5r0l.and,
487--43 77--12 53*-73 2-4
Females.
WEnaglelasn, d19a4n7d. N1o9r4w6a.y, Swit1z9e5r0la. nd.
.All 51-6 50-7 51-7
20- 7-5 8-3 7-5
30- 7-9 7-9 7-3
4500--
7-5 6-3
7-0 5-4
76--72
60- 5-0 3-9 4-5
70- 3-8 3-5 3-4
fy
of
tMhealpeso
of
pu
ltahtei oinmpi norEtanngtlaangde-garnodupW5a0letso
(699-3m) athkeanupina
Nraotrhwearylar(8g-e3r),pewrhcielnetathgee
y pacocsoituionnt foorf tShweitdzieffrelarenndceiss ininttheremdeedaitaht-era(t9e-s0,)a;ndthjeussetifsymtahlel udsifefeorfenccreusdecadnenatoht
rates.]
T able IX.-- CancerCoofubnutrniegs aasndPeinr cDeinffteorefnAt lPl eAruiotdosp,siCeosmapnadreodfwAilthl CTaonbcaecrcoDCiaognnsousmedptiaotnA. utopsy in Different
Locality.
Period.
Cancer of the lung as per cent of :
All autopsies.
AH cancer autopsies.
tobaccoAcnonnusaulmption,
if*
Bri1t6aiBnr. itish hospitals*
1894-1918
Male. Female. 0P-9e6rs-o1ns1.6
Male. Female. Persons.
(lb. per head). 1900-02, 1-9 (cgts. 0-6)
(Passey and Holmes) 11991294--11992238
12 -6131
11990161--0183,, 22-10 (( ,,,, 00--79))
Leed(sBGonesneerr)al Infirmary* 11899313--11993327
0-821-311-38
4-9151--83-227
11992293--3215,, 32--39 (( ,,,, 21--48)) 1934^36, 3-6 ( ,, 2`7)
WestGerlnasgInofwirm(Caarpyp, ell)
11992350--2394 1935-39
23--90 3 1
2106--52 164*-15 1155--73 18-9 5-6 13-7
1936-37, 3-9 (cgts. 2-9)
fel
DAEF, R. DOLL AND E. L. KENNAWAY
St. Mary's, London
11994450--4484 1930-34
45 --44 3-6 1 -0 2-7
2224--18 1124--93 1280--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
St.LBoanrdtohnolomew's,
11994350---3448 1935-39
56--42 21--39 44--34 3-7 1-9 3-1
2279--75 183--97 223-43 19-3 8-2 15-0
(Cunningham) Turkey.
11994405--4448
7-9 4-6 7-0
38-7 16-7 310
IstanSbcuhlw(aSratgzl)am, .
11993450--3494 1945-49
11--89 00--59 11--47 2-8 0-8 2-1
1155--92 150--20 1142-18 20-3 7-8 17-0
11993472,, 21--17 1947, 2-2
YuLgjousblaljvaian.a (Hribar, Kosir) 11992350--2394
01--64 00-14 00--49
141--31 31-11 27--93
11993450--3494 1945-49
11--07 00--11 00--69 1-5 0-6 1-1
184--30 00--97 47--82 11 -8 3 1 7-1
SwZitzerirclahn(dM. eyenburg) .
1927-41
I -33
7-7
1936, 3-5
IceRlaenydk.javik (Dungal).
1932-48
0-6
2-9 if 11991332 ((cg,,ts.)) 00-0-33
Britain,
Most recent period.
(.1947 ( ,, ) 1-4
WSte. sMteranr.y'IsnHfiromspairtyal . St. Bartholomew's
.. 11994477--4488 . 1947-48
6-2 2-6 54--S8 8-3 3-2 6-8
3207-71 1132--28 2232--53 41-7 14-8 33-3
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
YuLgjousblaljvaian.a
. 1948-49 2 1 0-9 1 5
13-5 4-5 8-8
* i?igures refer t o izitra.thoro.ciG cancer
CANCER OP THE LUNG IN RELATION TO TOBACCO
Table X .--Death Rates from Cancer of the Lung in England and Wales#Switzerland and Norway,
/
Compared with Tobacco Consumption.
England and Wales.*
Switzerland.
Norway.
Year. DeCatahncrearteosf pthere mluinllgio. n. tAonbnauccaol consumption
DeCaatnhcerratoefs tp-h-e-e-r-l-mu--n-i-lg-l-i.o^n.
tAonbnauccaol consumption
DeaC--tahnrcearteosf-p-te-h-r-e-m-l-u-i-lnl-igo,n.
tAonbnacucaol consumption
M. F. Persons. (lb./head). M. F. Persons. (lb./head). 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
3-5
1124 109 1112 18 20 19
11--44 (icgts. 00--55))
1*7 ( 0-6)
1937 . 161 43 100 . 4-0 ( ,, 3-0) . 94 19 55 (cgts. 419039 1-4) 28 20 24 1- 09-7()
11994403 .. 232212 5650 113713 .. tt
111652 3313 7915
44--69
3319 2184 2314
2-
1-
0020--t9(() 5)
11994476 .. 336968 7718 222086 .. 54-*54 ((cg,,ts. 43*-86)) .. 117873 3364 110046
55--79
4536 4306 4389
22--9 ( 116--3() 1)
(cgts. 1949 2-3)
the *smTohkeinfigguhraebsitasvainilaSbcloetlfaonrdtoabnadccNoorrethfeerrntoIrtheleanUdniatreednKoitnvgedroymd,ifafnerdetnhtofsreomforthcoasneceinr oEfntghleanludnagntdo WEnaglelas,n-dwhaincdh cWonalteasi.n 8I7f
perfceDnitstoufrtbheedpboypuwlaarti.on, this difference is of no importance, EstimatedMpido-pyuealart,io1n94i7n thousands,
j Not available.
(AnnualNAob. s8tr5ac(1t9o4f8S).t)atistics,
EScnogtllaanndd an.d W.ales . . Northern Ireland
4351,,,013535090} Great Britain, 48,189.
United Kingdom
49,539
Ox
11
16
M. E. DAFF, R. DOLL AND E. L. KENNAWAY
The data show th at:
all t(h1)reTehceoaupnptrairees.nt incidence of cancer of the lung is increasing in both sexes in
sam(e2)inTthhee
rtahtreeeo
fcoinucnrteraieses
;ininthteh
e10fivyeeayresar1s9
3 1
6 9
-7 31
to -2
to1
946-7 1936
-7haist
wbaesenmmoruechrapthide
in Norway than in England and Wales, and was slowest in Switzerland.
Death Bate from Cancer of the Lung.
1936-7 as percentage of 1931-2.
England and Wales.
Switzerland.
Norway.
11993361--72
M. F. Persons. 117000 113070 116020
M. F. Persons. 114010 111010 113020
M. F. Persons. 117070 211010 118070
1946-7 as percentage of 1936-7.
11993466--77
215002 110703 212070 .. 210000 117050 119060
211050 119000 210020
and(3W) aTlhese arantde ionf Sinwcirtezaesrelahnads. been greater for males than for females in England rate(4w) aTsheapinpcriodxeinmcaeteislycothmepsaarmateivaelsyitlohwadinbNeoenrwianyE. ngInlan1d94a7ntdheWcarluedseadnedatihn Switzerland 16 years previously.
SNworitwzearyland . England and Wales
Populationfro(bmotchansecexreso)fptrhoedluucning.g one death
1931.
1947.
a1
83,300
20,800
24,400
9.400
17,500
4.400
denc(5e) in woTmheendiisffseirmenilcaer iisneNssoernwtiaayllyanad dSiwffietrzeenrclaenodf ainndcidaebnocuet itnwimceena.s gTrheaetinci in ETnhgelainncdidaenndceWoaflceasn(cTerabolfetXhe).lung is much more nearly equal in the two sexes in Norway than it is in the other countries which have been studied.
ENnogrwlaanyd and Wales Switzerland .
iDneawthomraetne farosmpcearncecnertaogfethoeflutnhge death rate in men (1947).
2701%% 19%
indiTcahteesraatiorselaotfivcealnycelorwofintchiedelnucneg iinn wwoommeenn intoTtuotrakleyauatnodpsYieusgionslwavoima e(nTaablsloe IX).
I
CANCER OE THE LUNO IN RELATION TO TOBACCO
17
The relation between increases in the consumption of tobacco, and in cancer of the lung. abseOnncee sohfouanldypneercheaspssarryefecronangeacinti,otnhobuegtwhetehnertewmo aqyuhaentnitoiensewedhitcohdaoresov,atroytinhge ivnertyhesismaimlaer wtoatyha;ttshhuoswwn,ibreylecsasnlciecrenocfetsheinlutnhgis(Kcoeunnntarwy ahyavaendmKueltnipnlaiwedaya,t 1a94r7a)t.e NorIwnaTy,abalneds XSwIitaznedrlaXnIdI dcuorminpgartihsornees pareerioadttse,m1p9t3e1d-2o,f1d9a3t6a-7fraomndth1i9s46c-o7u.ntry,
TablaendXDIe.--athCoRmaptear(iPsoenrsobnetsw) efernomToCbaanccceor CofonthseumLputniogn,atCDigifafreertetent CPoenrisoudms.ption
Country.
ESwngitlzaenrdlanadnd Wales Norway
conTsoubmacpctoion conCsiugmarpetttioen
(lb. per head). (lb. per head).
1946-7 as percentage of 1936-7.
115258
117405*
153
185
frDoematchanraceter of the lung.
212976 202
1936-7 as percentage of 1931-2.
NEonrgwlaanyd and Wales .. .. 112290
113203
118672
* 1949 as percentage of 1939.
\
incrIenasaellitnhrteoebacocucontrcioesnstuhme pinticorneasbeetinweceannce1r93o1f-t2heanludng1w93a6s-7g,reaantedr tbheatnwetehne t1h9e36in-7craenasde 1in94l6u-n7g. caTnhceerinocvreerasteheinlactoenrspuemripotdio, nbuotf tchigeraerewttaess wa acsonmsiodreeralbiklee gap between the figures in England and Wales.
TablaendXDIeIa.--thCRoamtepa(Priesorsnonbse)tfwreoemn CToabnaccecroofCtohnesLuumnpgtioinn,ECngiglaarnedtteanCdonWsaulmesptainond
Norway, and in England and Wales and Switzerland.
Period.
conTsoubmapcctioon coCnsiguamreptttieon frDoematchanraceter
(lb. per head). (lb. per head). of the lung.
England and Wales as percentage of Norway.
1946-7
180
350
499
1936-7
190
446
444
1931-2
232
470
513
1946-7 1936-7
England and Wales as percentage of Switzerland.
085
162
205
104
(1949) 266
179
(1939)
alsoThveerdyifmferuecnhcegrineadteeratthharnatetshebedtwiffeeernenEcengilnantdobaancdcoWcaolnessuamndptiNonor;wiaty wwaass, 2
18
M. E. DAFF, R. DOLL AND E. L. KENNAWAY
hlaonwdetvoebra, crceoascoonnasbulmy pcltoiosentwoatshme udicfhfetrheencseaminecaigsainreEttnegcloannsduamnpdtiWona.lesI,nbuStwditezaetrh rwaittehs twheerdeifofenrleynhceaslfinasdehaigthh.ratDesiffbeertetnercetshainn cdiogadriefftetreenccoenssuinmtpottiaolntoabgaacincoacgorene isnumthpetifoonr.m oTfhcisigiasrbeettceasuisne SawmituzcehrlasmndaltlheranprionpEorntgiolannodf. the tobacco is consumed betwCeleeanrltyhenoamexoaucntt porfotpoobratcicoonaslmityokheads abnedenthfeoupnrdevianlenthcee odfatcaanscoerfaorfatvhaeillaubnlge Iinncrdeiaffseeremnotrecoruanptirdileys tahnadn adtoedsiftfheereunstepoefritoodbsa.ccoC;anscuecrhoaf cthhaenlguenign aepffpeecatrms atyo wochceunr tahte apocpeurtlaaitnionlevoeflaicnouthnetrdyocsoangseuomfeas mdrourge.tobAacccoom, opnliecadtoinesg nfaocttkonroiws thhoawt umsuecohfotofbthaicscois bdyuethtoostehwe hinoitsimatoiokne oalfrneeawdys.mokers and how much to the increased
DISCUSSION.
of m(1a)liTgnhaenhtigdhiseparsoepionrtmioanleosfincaInsctearnbouf lthsueffluicnegs tfoousnhodwa'mthoantgthauetaorpsseineiscocnonctaesnest ocifattioobnacbceotwheaesnncoitgaprreotvteidesmd oakniyngsiamnpdlethainsdfoerxmcluosfivceanecxepl'l.anaIttioins poefrthhaepsastsooo sinofoonrmtoatisoany atbhoaut tatrhseenimcinisimquumiteeuffneoctbijveectdioonseabolef ainnytocbaarcccino,ogfeonr iwne mhaanv,e nnoor aboAuts tyheet pwoesshibalveesauumtompastyiofniguorfeesffoenctlyoffrodmiffearesnintgclaercceinnotrgeenisn. Turkey, and of acoreurvseermy odreesdiraatbalef.romThtheisfigaunrdesotfhreormsoaurscinesg,leinhGosrpeeitcaelainndYBuuglgoaslraiav,iafosruigngsetasnt caen, Winceidheanvceenoof fciagnucreesr foofrtthheeliunncgidceonmcepoarfacbalnecetor othfethBerliutinsgh ufipgounretshoefw3h0oyleeaprospauglao. toifonhomofe-agnryowEnatsotbaEcucroopaeraenliacboluenttoryt.he Terhreoro, ftfhicaiatlafipgourrteisonfomr atyheesccaopnesurmecpotrido.n or w(h2)etWheer dthoenportacktnicoewowf hsmetohkeirngtorbeancdceorssmthoekereistpseirlaftcoornytatrinasctsmomoree csaursccienpotgibenle, tIof tahgeencatsrcfirnoomgeenxitserinnatlh(ee.tgo.btahcecobsemnzopkyer,eanned oisf icnoapla-rsmticouklea)teorfoirnmte,rwnael,fascoiulirtcaetse. intasspalenfeilttreart.ionTthoe tehveidbernocnechaivbayilainbhlealaattiotnhethmrooumghenttheismaoguatihn,stthtuhseedvairdeicntgctahre ocibnvoigoeunsicciamrcpionrotgaenncse, oafrtsoenbiacccaonsdmobkene,zpbyerceanues,e iwthteicnhdsotnoe emxcilguhdte ethxpeetcwtotmo obset pwriedseentht.at Bonuet mthuestracnognesidoefrcohtehmericpaol ssstirbuilcittuierse. of known carcinogens is now so of t(h3i)sAclolntnheectoilodnerwditahtasmabookuint gca;ncoenreomf tuhset lruencognmsiduesrt btheereinvvieewrseed rienlatthioenlsighhipt awsistohrtsmunenlitghotf (oSctcoucpkas,tio1n9s4,7)naamndelyth, eagvreicruyltluorwe, incociadl-emncineinugp,oannad rmatuhleer-spciunrnioinugs c(KanennontawsmayokaenddurKinegnnoanwe-atyh,ird19o47f)t.heTdhaey,coaanld-mtihneermwuhleo-spwinornkesr, baenlodwt-hgoroseunidn man(4y) oTthheerinoccicduepnacteioonfsc, acnacnenrootfstmheokluenwghiinleSawt 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,Nboruwt aiyn (tsheies acboouvnet)ryth(eStmocokrst,al1it9y36is; hKigehnenraiwnatyowannds tKhaennnianwtahye, fcaocutnortrsy, .namInelya,ll(as)uscmh ockoinmgpharaibsiotns,s (bo)nfeacmiliutisets cfoornsdidiaegrnoastislaeansdt trthearetme epnots,saibnlde i(nc)teartnmaloscpohmebriucstpioonlluetniogninew. ith products of the combustion of coal tar, or of the in re(5la) tTiohnetiondciacnacteiornotfhtahte cliugnagrertateissesartehemqorueesatciotinv,ewthhaetnhceirgtahrsisadnidffepriepnecteoibsadcucoe c(aa)ntnootthaenmsweethrotdhiosfqcuoemstbiounstiaotnp, roerse(bn)tt,obusotmiteipsreosppeerctiyalolyf cimigaproertttaenttoibnacccoou.ntOrinees Nwhorerweaysmoonkeerosbtbauinystihnethchiseawpaeyr npeipaerlytotbwaiccceo atsommaankyectihgeairretotwesnfocrigaargeitvteesn. suImn P(Jiapkeotbosbeanc,cpoersmsoonkael dcoinmmp iupneisc;at(i2o)np).ipeOtnoebamccuostsmcoonkseidderinthcrigeaerpetotsessib;il(i3ti)escig: a(1r) ette (t6o)baTchceo dsmatoakegdiviennciagnadretdteissc. ussed above from this country, Norway and Stowbiatczceorl,aannddsnhaotwiontahlaitncthideenscteudoyf coafnctehre orfetlhaetiolunnsgo, fhansatsicoanraclelcyobnesguumnp. tion of
SUMMARY.
Eng(l1a)nEd,stNimorawtiaoyn,sPorafnacer,seSnwicitzienrlacnigda,rIettatelys, fAroumstritah,ePoUlannitdedandStBatuelsg,arCiaanshadoaw, aonrstehneicw-phooolreTautrrkainshsittiyopnefirnomthethEeaasrtse;ntihc-erliachtteArmise,roicfacnoutyrspee, sinmothkeedWinesWt, etostethrne cou(n2t)riIens aYlsuog. oslavia, Turkey, Greece and Bulgaria, the tobacco consumed is alm(o3s)tTwhheohlliyghhoinmceid-gernocweno,f ocafnTcuerrkoisfhthteypluen, ganadt aiunttohpesyfoirnmonoef cceignatrreet(tIesst.anbul), ianrsaencoicucnotnrytewntheorfetoTbuarckcioshhatsobnaoctcporiosvsidmeodkaendyaslmimopslteeaxncdluesixvcelluys,ivsheoewxps ltahnaattitohne ooff tthheeluanssgocaipaptieoanrsbteotwbeeemnuccihgalersesttferesqmuoeknitnagt aancdentthries inforYmugoofslcaavniace(rL. jubClajanncear) vthearyn daetsiIrsatbalneb. ul. More information from these and other Balkan countries is U.S(.4A).,Naonrdwa9y piemrpcoerntts farbomoutth8e5Bpaelrkacnenctouonftrthiees. tobTahcecoincciodnesnucme eodf cfraonmcerthoef t1h:e0-l7u)n;g iutpisongrtehaetertwino usrebxaens tihs annoitnvreurryalddifisfetrriecntts,(adnedatthhirsadtei,ffemreanlecetois fgermeaatleer, ignremateenr tinhamneinntwhaonmeinn.woTmheen,inacnrdeagsreeiantemr oinrttahleitytoiwnntshethlaanstin20thyeeacrosuhnatrsyb. een the (t5o)tIanl toSbwaecdceon,prsnoduuffctms ackonessuumpead mthuacnhislarregceorrfdreadctiinonot(hoenre-ctohuirndtriines.1949) of (a) d(6e)aAthscoamttrpiabruistoend tiso mcaandceeroof fththeedlautnaga, vaanidlab(6l)eifnorthtehecoinnscuremapsetsiosninocfeto1b9a3c1cion, ipnerEhnegaladnhdaasnbdeeWn afolers,thNeorlawsat y10anydearSswritaztehrelarnhdi.gheTrhien cSownistuzemrplatniodnthofantoibnacthcoe UconuintetrdieKs,inwghdiolemth, eancdruidneNdoearwtharyahteassabtetehne abbeoguintnoinnge-ahnadlfetnhdatoifnthtehepeortihoedrwtewroe
20
M. E. DAFF, B. DOLL ARD E. L. KENNAWAY
r(Nouogrhwlayyi)n. thCeigparroetptoertcioonnsuofm1p0tio(Ennwglaasnd'apapnrdoxWimalaetse)lytoin5 t(hSewitpzreorplaonrdti)o,nanodf 24 t(hEengrlealnatdivaenddeWatahlers)atteos.2 (STwhietzienrclarneads)eanind 1th(eNonruwmabye)ranodf wdeaastmhsorheaisn abceceonrdabwoiutht tahnedsacimgaer(etwtteosfohlda)sinbeaellnthlersese. couTnhteridesif,fberuetntchees inincrtehaeseinincicdoennscuemopfticoanncoefrtoobfacthcoe lcuonngsuamreedth;ertehfeoyreaqreuimteordeiffleikreen(tthinouegxhtesnttillfrdoimffetrheonstefrionmth) ethqouseanintittyheofqtuoabnatcictoy osufmcipgtaiornettoefstocboancscuomaendd. thTehenasttiuondayl ionfcitdheencreeloafticoanncbeertwofeethnetlhuengnahtaisonsacal rccoenly begun. of IWsteanwbiuslh, taondthaPnrkof.PrHofr.ibSaarg,laDmireacntdorProoff. tPh.e ScIhnwstaitrutzt,e ofofthePaUthnoivloegriscitayl gAennaetroomsiyty, ainndallDowr.inAg. uKs otsoiru, seofthethire veCrlyinivcaalluaHbolespriteaclo,rdLs.jubWljaenaar, e fionrdetbhteeidr tPoroPf.roHf.. LRe.ivSKchrienyzb, eorfg,thoef OKsalno,toMnrs.piOtalal,f ZJakriocbhs,ePnr, ooff. tHh.e vN.oMrweeygeinabnurEgm, boaf stshye, PPoapthoovl,ogoifcathl eInBsutiltguatreia, nZLreigcaht,ioMnr, .PSr.ofT. .ElHisisBimer,voenf ,thoef STtuocrkkihsohlmE,mPbraosf.syH, .MEr.. RBearwnlei,nasonnd, thoef DthireecUtinoniveGrsnityralodf eAs lDboerutaan, esth, eBeBrnuer,efaour tFhedirkrainl ddneessStiantsisutpiqpulye, Dinrg. uGs. wJ.ithCusntantiinsgtihcaaml ,anPdroof.thDer. Fm.atCeraipapl.ed,InPrtohf.isAc.ouBnrtardyfowrde hHailvle, Ptorotfh. aWnk. WNeawllceorm.abn,d DMri.ssC.MCa.rySpAictkerin, ,Dfro.rPheerlpcyinStvoacrkios,usMwr.aHys.. L.WHeenwdisehrstoon,exMprr.esRs.oEur. ggernateirtouudse gtroanthtse. British Empire Cancer Campaign and the Anna Fuller Fund for
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