Beruflich Dokumente
Kultur Dokumente
WILLIAni
L. WATSON,
M.D.,
AND
ALEXANDER
J. CONTE,
M.D.
cancer is real and, in relation to this, it is significant that in the year 1948 at Memorial
Hospital2O there were twice as many admissions
for lung cancer as for stomach cancer.
Evidence to show the carcinogenic potentialities of tar and arsenic in tobacco has been
accumulating rapidly.?*12,16.17 A recent survey
of the content of arsenic of various tobaccos
smoked in North America and Europe3
showed that no direct correlation existed between the amounts of arsenic and lung cancer.
Although American cigarettes were found to
have a much higher arsenic content than Turkish cigarettes, an autopsy series in Istanbul,
where Turkish tobacco is smoked almost exclusively, showed an equally high incidence of
cancer of the lung. Approximately 15 mg. of
arsenic has been found in a pound of tobacco
and the amount of tar taken into the lungs
during a long period of heavy cigarette smoking is amazing, being estimated at about 0.8
quarts per year.'*, 21
Many clinical reports on the relation of
tobacco smoking and lung cancer2. lo, 11, 23. 24
have pointed out that it is rare to find cancer of
the lung in a man who has not been a heavy
smoker for many years. Dungal in Iceland, in
1945, reported the consumption of tobacco to
be at the same level per capita of population as
the consumption was in England in 1920, and
an autopsy series revealed that cancer of the
lung was infrequent at that time in Iceland.
In America, Wynder and Graham22 found a
very small percentage of nonsmokers in a large
group of male patients with cancer of the lung.
There were ten times as many nonsmokers in
a control hospital group. A lag period of one to
two decades was occasionally noted, and 98.7
per cent of the patients with this disease had
smoked more than twenty years. Graham feels
that squamous carcinoma of the bronchus differs greatly from adenocarcinoma of the lung
and that only the increase in epidermoid carcinoma is directly related to the use of tobacco.
In England, in a recent report of 100 cases
of cancer of the lung,13 it was found that one
From the Thoracic Service, Memorial Center for
third of the patients had smoked more than
Cancer and Allied Diseases, New York, New York.
Supported in part by a grant from the American twenty cigarettes daily, while one fifth of the
Cancer Society, Inc., and in part by the Donner controls had smoked such amounts. No statisThoracic Fund.
tical difference was Lound in the exposure to
Received for publication. 0ctol)er 10, 1953.
24 5
246
CANCER
March 1954
to the present writing we can say with conviction that no one knows for certain of any one
specific cause of this disease. If we assume,
however, a number of additive factors working together over a period of years as leading
to neoplastic growth in the lungs, then certainly the evidence to be presented supports
the theory that chronic, heavy tobacco smoking
is one of the responsible factors in a high
percentage of all cases.
TABLE1
COMPARISON OF CONTROL GROUP WITH
CANCER-OF-LUNG GROUP
Cancer of lung
Pt.
Male
Female
No.
Control
265
36
TOTAL301
,
59.1
55.8
No.
287
181
54.2
51.6
58.6
468
52.9
VOl. 7
.....
.............
...............
.............
.....
..............
-
Pulm. adenomatosis..
1
Metast. tumor, primary
unknown.
I
Pleurisy..
2
Atelectasis..
2
Chronic lung disease.
1
Mesothelioma.. .......... 1
Hamartoma
1
Boeck's sarcoid.. ......... 4
.............
.......
Hiatus hernia
Rhabdomyosarcoma
-1
TOTAL..
............... 57
Breast
Ca. of breast.. ......... 33
Genifal Tracf
Ovarian ca.. ........... 1
Ca. of cervix..
3
Ca. of uterus..
2
Achlasii
.........
.........TOTAL
................. 6
Genitourinary Tract
Ca. of testis.. ............ 2
Ca. of bladder.. .......... 1
Ca. of kidney ............. 4
-
Abscess. .........
1
Congenital short..
2
Diverticulum.. ... ...... 12
TOTAL..
Myocardial disease..
Undiagnosed.
N o disease found.
TOTAL.ALLCASES
.............. ,142
TOTAL..
Gastrointestinal Tract
EBophagus
...............
16
...... 53
............
Ldomyoma. ........... 1
Stricture. ........ ...... 2
cp..
......
......
...............
...... 4771
.............
.........62
......468
TABLE
3
METHODS OF DIAGNOSIS USED
Method
Male
Female
SV *
P and SV
Pt
37
4
12
20
71
157
-
265
36
SMOKING
AND LUNG
CANCER
No. 2
Watson 6. Conte
247
TABLE
5
MALE PATIENTS WITH
CANCER OF T H E LUNG
Amt. of smoking
Minimal
Moderate
Heavy
TOTAL
Total
Inhalers Noninhalers av. %
6
13
18
1
50
172
223
37
3
24
73
% smokers
Lung
cancer
% nonsmokers
Lung
Control cancer
Control
~~
Present series
Watson
Doll and Hill
98.11
95
99
90.3
89
95
1.89
5
0.5
9.7
11
4.5
Nationality
. . . . . . . .
U. S. A.
Italian
Russian
Austrian
Polish
German
Hungarian
Scotch
Greek
Czechoslovakian
Irish
Nationality
NO.
'ii7'
35
29
16
15
9
7
4
4
'
. . .
English
'
Swedish
Spanish
Turkish
Puerto Rican
French
Danish
Venezuelan
Dutch
Finnish
West Indian
Nb.
3
.Z
2
2
2
2
1
1
1
1
1
248
CANCER
Mnrch 1954
Vol. 'I
TABLE7
COMPARISON OF SMOKING HABITS OF CONTROL A N D CANCER-OF-THE-LUNG MALE
PATIENTS
Nonsmokers
Smokers
8
1
33
59
8
71
72
31
40
21
. . . . . . . . . . . . . . . . . . . . . .
Nationalitv
. . . . . . . . .
Inhalers
58
42
21
15
U. S. A.
Italian
Austrian
Russian
Puerto Rican
NO.
Nationality
. . . . . . . . . .
15
4
6
4
2
N;).
. . .
Irish
Romanian
Hungarian
Polish
Czechoslovakian
1
I
1
I
1
No. 2
SMOKING
A N D LUNG
CANCER*
Watson Q Cotite
249
TABLE10
COMPARISON OF SMOKING HABITS OF CONTROL AND CANCER-OF-THE-LUNG
FEMALE PATIENTS
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6. DUNCAL,
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