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MAY 27, 1950, Vol 143, No. 4 >
Other Articles | May 27, 1950

TOBACCO SMOKING AS A POSSIBLE ETIOLOGIC FACTOR IN BRONCHIOGENIC CARCINOMA:  A Study of Six Hundred and Eighty-Four Proved Cases

ERNEST L. WYNDER; EVARTS A. GRAHAM, M.D.
[+] Author Affiliations

This study has been aided by a grant from the American Cancer Society. Other phases of it will be presented in subsequent publications.


St. Louis

From the Department of Surgery, Washington University School of Medicine and Barnes Hospital.


JAMA. 1950;143(4):329-336. doi:10.1001/jama.1950.02910390001001.
Text Size: A A A
Published online
Article
References

General Increase.—  There is rather general agreement that the incidence of bronchiogenic carcinoma has greatly increased in the last half-century. Statistical studies at the Charity Hospital of New Orleans (Ochsner and DeBakey),1 the St. Louis City Hospital (Wheeler)2 and the Veterans Administration Hospital of Hines, Ill. (Avery)3 have revealed that at these hospitals cancer of the lung is now the most frequent visceral cancer in men.Autopsy statistics throughout the world show a great increase in the incidence of bronchiogenic carcinoma in relation to cancer in general. Kenneway and Kennewat,4 in a careful statistical study of death certificates in England and Wales from 1928 to 1945, have presented undoubted evidence of a great increase in deaths from cancer of the lung. In this country statistics compiled by the American Cancer Society show a similar trend during the past two decades.5

Tobacco as a Possible Cause 

REFERENCES

1 +
Ochsner, A., and DeBakey, M.:  Surgical Considerations of Primary Carcinoma of the Lung , Surgery 8:992-1023 ( (Dec.) ) 1940.
2 +
Wheeler, R.: Personal communication to the authors.
3 +
Avery, E. E.: Personnal communication to the authors.
4 +
Kenneway, N. M., and Kenneway, E. L.:  A Study of the Incidence of Cancer of the Lung and Larynx , J. Hyg. 36:236-267 ( (June) ) 1936.
Link to Article
5 +
Kenneway, E. L., and Kenneway, N. M.:  A Further Study of the Incidence of Cancer of the Lung and Larynx , Brit. J. Cancer 1:260-298 ( (Sept.) ) 1947.
Link to Article
6 +
Statistics on Cancer , New York, American Cancer Society, Statistical Research Division, 1949, p. 19.
7 +
Adler, I.: Primary Malignant Growths of the Lungs , and Bronchi, New York, Longmans, Green and Co., 1912.
8 +
Tylecote, F. E.:  Cancer of the Lung , Lancet 2:256-257 ( (July 30) ) 1927.
Link to Article
9 +
Hoffman, F. L.:  Cancer of the Lung , Am. Rev. Tuberc. 19:392-406 ( (April) ) 1929.
10 +
McNally, W. D.:  The Tar in Cigarette Smoke and Its Possible Effects , Am. J. Cancer 16:1502-1514 ( (Nov.) ) 1932.
11 +
Lickint, F.:  Der Bronchialkrebs der Raucher , München med. Wchnschr. 82:1232-1234 ( (Aug. 2) ) 1935.
12 +
Arkin, A., and Wagner, D. H.:  Primary Carcinoma of the Lung , J. A. M. A. 106:587-591 ( (Feb. 22) ) 1936.
Link to Article
13 +
Roffo, A. H.:  Der Tabak als Krebserzeugende Agens , Deutsche med. Wchnschr. 63:1267-1271 ( (Aug. 13) ) 1937.
Link to Article
14 +
Maier, H. C.: Personal communication to the authors.
15 +
Müller, F. H.:  Tabakmissbrauch und Lungencarzinom , Ztschr. f. Krebsforsch. 49:57-85, 1939.
Link to Article
16 +
Ochsner, A., and DeBakey, M.:  Carcinoma of the Lung , Arch. Surg. 42:209-258 ( (Feb.) ) 1941.
Link to Article
17 +
Schrek, R.; Baker, C. H.; Ballard, G. P., and Dolgoff, S.:  Tobacco Smoking as an Etiological Factor in Disease: I. Cancer , Cancer Research 10: 49-58 ( (Jan.) ) 1950.
18 +
Wynder, E. L., and Graham, E. A.: Tobacco and Bronchiogenic Carcinoma: Preliminary report to the National Cancer Conference, Memphis, February 1949 .
19 +
The questionnaires were sent to male and female patients with cancer of the lungs from Dr. W. L. Watson's Thoracic Surgery Service at Memorial Hospital, New York.
20 +
California: Private patients of Drs. L. Brewer, Daniels, F. Dolley, D. Dugan, H. Garland, E. Holman, J. Jones, W. Rogers, P. Samson, B. Stephens. Hospitals: Birmingham General, French, Good Samaritan, Letterman General, Los Angeles County, Southern Pacific General, Stanford, United States Marine, United States Naval, University of California, Wadsworth General. Colorado: Private patients of Drs. A. Brown, F. Condon, J. Grow, F. Harper, M. Peck. Hospitals: Colorado General, Denver General, Fitzsimmons, Fort Logan Veterans, General Rose, St. Lukes. District of Columbia: Private patients of Drs. B. Blades, E. Davis. Hospitals: Georgetown, George Washington, Walter Reed. Illinois: Hospitals: Cook County, Veterans Administration, Hines, Ill. Maryland: Hospitals: Johns Hopkins, United States Naval. Massachusetts: Private patients of Drs. D. Harken, R. Overholt. Hospitals: Boston City, Massachusetts General, New England Deaconess. Michigan: Hospitals: Dearborn Veterans. Missouri: Private patients of Drs. J. Fiance, A. Goldman, R. Smith. Hospitals: Jefferson Barracks Veterans, Jewish, St. Louis City, St. Louis County. New Jersey: Hospitals: Berthold S. Pollack, Newark City. New York: Private patients of Drs. W. Cahan, H. Maier, J. Pool, W. Watson. Hospitals: Bellevue, Veterans Administration, Brooklyn Cancer Institute, Kings County Memorial, Montefiore, New York City Cancer Institute, New York Hospital, Presbyterian, Roswell Park Memorial Institute. Ohio: Hospitals: Veterans Administration. Pennsylvania: Private patients of Dr. J. Johnson. Hospitals: Jefferson Medical College, Temple University, University of Pennsylvania. Utah: Private patients of Drs. W. Rumel, Cutler. Hospitals: Holy Cross, St. Marks, Salt Lake County General, Veterans Administration, Dr. W. H. Groves, Latter-Day Saints.
21 +
21. pital. Betty G. Proctor, A.B., and Adele B. Croninger, M.A.
22 +
City Hospital, Jewish Hospital and Veterans Administration Hos
23 +
13.6 × 2.3 = 0.312 This is the quotient which, added to the others 100. determined in the same manner, makes the data shown in figure 3.
24 +
Of the service of Dr. James B. Amberson.
25 +
Of the service of Dr. John W. Strieder.
26 +
Eight of these cases were diagnosed in Dr. Papanicolaou's laboratory on conclusive evidence of carcinoma. One sputum and one pleural fluid examination were made at the Boston City Hospital.
27 +
Includes 3 cases of Dr. C. T. Surington and 1 case of Dr. H. G. Turner.
28 +
Includes 4 cases of Dr. H. G. Turner and 3 cases of Dr. G. W. Ware.
29 +
See table 5.
30 +
It is taken for granted, of course, that by itself such parallelism would mean little since similar curves could be drawn for many other commodities.
31 +
Lindskog, G. F.:  Bronchiogenic Carcinoma , Ann. Surg. 124:667-674 ( (Oct.) ) 1946.
Link to Article
32 +
Lindskog, G. F., and Bloomer, W. D.:  Bronchiogenic Carcinoma , Cancer 1:234=237 ( (July) ) 1948.
Link to Article

Figures

Tables

References

1 +
Ochsner, A., and DeBakey, M.:  Surgical Considerations of Primary Carcinoma of the Lung , Surgery 8:992-1023 ( (Dec.) ) 1940.
2 +
Wheeler, R.: Personal communication to the authors.
3 +
Avery, E. E.: Personnal communication to the authors.
4 +
Kenneway, N. M., and Kenneway, E. L.:  A Study of the Incidence of Cancer of the Lung and Larynx , J. Hyg. 36:236-267 ( (June) ) 1936.
Link to Article
5 +
Kenneway, E. L., and Kenneway, N. M.:  A Further Study of the Incidence of Cancer of the Lung and Larynx , Brit. J. Cancer 1:260-298 ( (Sept.) ) 1947.
Link to Article
6 +
Statistics on Cancer , New York, American Cancer Society, Statistical Research Division, 1949, p. 19.
7 +
Adler, I.: Primary Malignant Growths of the Lungs , and Bronchi, New York, Longmans, Green and Co., 1912.
8 +
Tylecote, F. E.:  Cancer of the Lung , Lancet 2:256-257 ( (July 30) ) 1927.
Link to Article
9 +
Hoffman, F. L.:  Cancer of the Lung , Am. Rev. Tuberc. 19:392-406 ( (April) ) 1929.
10 +
McNally, W. D.:  The Tar in Cigarette Smoke and Its Possible Effects , Am. J. Cancer 16:1502-1514 ( (Nov.) ) 1932.
11 +
Lickint, F.:  Der Bronchialkrebs der Raucher , München med. Wchnschr. 82:1232-1234 ( (Aug. 2) ) 1935.
12 +
Arkin, A., and Wagner, D. H.:  Primary Carcinoma of the Lung , J. A. M. A. 106:587-591 ( (Feb. 22) ) 1936.
Link to Article
13 +
Roffo, A. H.:  Der Tabak als Krebserzeugende Agens , Deutsche med. Wchnschr. 63:1267-1271 ( (Aug. 13) ) 1937.
Link to Article
14 +
Maier, H. C.: Personal communication to the authors.
15 +
Müller, F. H.:  Tabakmissbrauch und Lungencarzinom , Ztschr. f. Krebsforsch. 49:57-85, 1939.
Link to Article
16 +
Ochsner, A., and DeBakey, M.:  Carcinoma of the Lung , Arch. Surg. 42:209-258 ( (Feb.) ) 1941.
Link to Article
17 +
Schrek, R.; Baker, C. H.; Ballard, G. P., and Dolgoff, S.:  Tobacco Smoking as an Etiological Factor in Disease: I. Cancer , Cancer Research 10: 49-58 ( (Jan.) ) 1950.
18 +
Wynder, E. L., and Graham, E. A.: Tobacco and Bronchiogenic Carcinoma: Preliminary report to the National Cancer Conference, Memphis, February 1949 .
19 +
The questionnaires were sent to male and female patients with cancer of the lungs from Dr. W. L. Watson's Thoracic Surgery Service at Memorial Hospital, New York.
20 +
California: Private patients of Drs. L. Brewer, Daniels, F. Dolley, D. Dugan, H. Garland, E. Holman, J. Jones, W. Rogers, P. Samson, B. Stephens. Hospitals: Birmingham General, French, Good Samaritan, Letterman General, Los Angeles County, Southern Pacific General, Stanford, United States Marine, United States Naval, University of California, Wadsworth General. Colorado: Private patients of Drs. A. Brown, F. Condon, J. Grow, F. Harper, M. Peck. Hospitals: Colorado General, Denver General, Fitzsimmons, Fort Logan Veterans, General Rose, St. Lukes. District of Columbia: Private patients of Drs. B. Blades, E. Davis. Hospitals: Georgetown, George Washington, Walter Reed. Illinois: Hospitals: Cook County, Veterans Administration, Hines, Ill. Maryland: Hospitals: Johns Hopkins, United States Naval. Massachusetts: Private patients of Drs. D. Harken, R. Overholt. Hospitals: Boston City, Massachusetts General, New England Deaconess. Michigan: Hospitals: Dearborn Veterans. Missouri: Private patients of Drs. J. Fiance, A. Goldman, R. Smith. Hospitals: Jefferson Barracks Veterans, Jewish, St. Louis City, St. Louis County. New Jersey: Hospitals: Berthold S. Pollack, Newark City. New York: Private patients of Drs. W. Cahan, H. Maier, J. Pool, W. Watson. Hospitals: Bellevue, Veterans Administration, Brooklyn Cancer Institute, Kings County Memorial, Montefiore, New York City Cancer Institute, New York Hospital, Presbyterian, Roswell Park Memorial Institute. Ohio: Hospitals: Veterans Administration. Pennsylvania: Private patients of Dr. J. Johnson. Hospitals: Jefferson Medical College, Temple University, University of Pennsylvania. Utah: Private patients of Drs. W. Rumel, Cutler. Hospitals: Holy Cross, St. Marks, Salt Lake County General, Veterans Administration, Dr. W. H. Groves, Latter-Day Saints.
21 +
21. pital. Betty G. Proctor, A.B., and Adele B. Croninger, M.A.
22 +
City Hospital, Jewish Hospital and Veterans Administration Hos
23 +
13.6 × 2.3 = 0.312 This is the quotient which, added to the others 100. determined in the same manner, makes the data shown in figure 3.
24 +
Of the service of Dr. James B. Amberson.
25 +
Of the service of Dr. John W. Strieder.
26 +
Eight of these cases were diagnosed in Dr. Papanicolaou's laboratory on conclusive evidence of carcinoma. One sputum and one pleural fluid examination were made at the Boston City Hospital.
27 +
Includes 3 cases of Dr. C. T. Surington and 1 case of Dr. H. G. Turner.
28 +
Includes 4 cases of Dr. H. G. Turner and 3 cases of Dr. G. W. Ware.
29 +
See table 5.
30 +
It is taken for granted, of course, that by itself such parallelism would mean little since similar curves could be drawn for many other commodities.
31 +
Lindskog, G. F.:  Bronchiogenic Carcinoma , Ann. Surg. 124:667-674 ( (Oct.) ) 1946.
Link to Article
32 +
Lindskog, G. F., and Bloomer, W. D.:  Bronchiogenic Carcinoma , Cancer 1:234=237 ( (July) ) 1948.
Link to Article
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