COMMENTARY partment of H.E.W., U.S. Government Printing Office, Washington, D.C. 2. Todd, G. F. Statistics of Smoking in the United Kingdom. Tobacco Manufacturers Standing Committee, London, 1962. 3. Hirayama, T. Smoking in Relation to the Death Rates of 265,118 Men and Women in Japan. A Report of 5 Years Followup. Presented at the American Cancer Society's Fourteenth Science Writer's Seminar, Clearwater Beach, Florida, March 27, 1972, lSpp. 4. Cederlof, R., L. Friberg, Z. Hrubec, and U. Lorich. The Relationship of Smoking and Some Social Covariables to Mortality and Morbidity. A Ten Year Follow-Up in a Probability Sample of 55,000 Swedish Subjects Age 18 to 69. Department of Environmental Hygiene, Karolinska Institute, S-104-01. Stockholm, Sweden, 1975.
5. Haenszel, W., D. B. Loveland, and M. G. Sirken. Lung-Cancer Mortality as Related to Residence and Smoking Histories, White Males. J. Nat. Cancer Inst. 28, 947-1001, 1962. 6. Haenszel, W. and K. E. Taeuber. Lung-Cancer Mortality as Related to Residence and Smoking Histories, White Females. 7. Doll, R. Cancer Bronchique et Tabac les Bronches, 16, 3131, 1966. 8. Haenszel, W., M. B. Shimkin, H. P. Miller. Tobacco Smoking Patterns in the United States. Monograph 45, publication 463. Public Health Service, 1956. 9. Monthly Vital Statistics Report Health Interview Survey-Provisional Data From the National Center for Health Statistics. National Center for Health Statistics, 1972, vol. 21, pp 72-1132.
Communication from Bross One of the graphs shown by Sterling I (Figure 3) as "contradicting" the cigarette-cancer relationship really serves to suggest an interesting point about this relationship. What the graph shows is that in England the lung cancer mortality in the older age group (such as age 65-74) continued to rise, while the mortality in the youngest age group stayed level or even declined between 1950 and 1968. Sterling comments that "it would be unreasonable to observe a decline in lung cancer rates at a time when the consumption of cigarettes is increasing if it were true that cigarettes are a major cause of lung cancer." However, as I have previously pointed out to Sterling, there was an important change in the nature of the cigarettes themselves during the period 1950 to 1968 shown on this graph. Filter cigarettes won a large share of the market, particularly among the younger smokers. Although the total
number of cigarettes increased, the total amount of tar and nicotine actually decreased in the 1960s. This would have more impact in the younger than the older group. So what the graph really suggests is that reducing tar and nicotine levels can have some impact on population death rates. Hopefully, this may become more evident in U.S. and English death rates in the next few years. IRWIN D.J. BROSS, PHD Dr. Bross is Director of Biostatistics, Roswell Park Memorial Institute, Buffalo, NY 14263
REFERENCE 1. Sterling, T. D. A critical reassessment of the evidence bearing on smoking as the cause of lung cancer. Am. J. Public Health. 65(9): 939-953, September 1975.
Additional Comments on the Critical Assessment of the Evidence Bearing on Smoking as the Cause of Lung Cancer**
Communication from Sterling
Competition for Causes of Lung Cancer
Disagreements about scientific evidence usually are clarified by discussion. This exchange is no exception. As is common, it also may focus on heretofore neglected evidence. The points raised by Bross, Higgins, and Weiss* touch on a number of major issues in my review.
Higgins is correct. I did infer that "occupational and environmental factors are more important than smoking.**" To Higgins, the evidence from the British physicians' study, "not many of whom (he imagines) moonlight in steel, coke oven, or asbestos work, is against this." But direct com-
*See Weiss, W. Smoking and cancer: A rebuttal. Am. J. Public Health. 65:954-955, 1975.
**See Sterling, T. D. A critical reassessment of the evidence bearing on smoking as the cause of lung cancer. Am. J. Public Health. 65:939-953, 1975.
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5. Haenszel, W., D. B. Loveland, and M. G. Sirken. Lung-Cancer Mortality as Related to Residence and Smoking Histories, White Males. J. Nat. Cancer Inst. 28, 947-1001, 1962. 6. Haenszel, W. and K. E. Taeuber. Lung-Cancer Mortality as Related to Residence and Smoking Histories, White Females. 7. Doll, R. Cancer Bronchique et Tabac les Bronches, 16, 3131, 1966. 8. Haenszel, W., M. B. Shimkin, H. P. Miller. Tobacco Smoking Patterns in the United States. Monograph 45, publication 463. Public Health Service, 1956. 9. Monthly Vital Statistics Report Health Interview Survey-Provisional Data From the National Center for Health Statistics. National Center for Health Statistics, 1972, vol. 21, pp 72-1132.
Communication from Bross One of the graphs shown by Sterling I (Figure 3) as "contradicting" the cigarette-cancer relationship really serves to suggest an interesting point about this relationship. What the graph shows is that in England the lung cancer mortality in the older age group (such as age 65-74) continued to rise, while the mortality in the youngest age group stayed level or even declined between 1950 and 1968. Sterling comments that "it would be unreasonable to observe a decline in lung cancer rates at a time when the consumption of cigarettes is increasing if it were true that cigarettes are a major cause of lung cancer." However, as I have previously pointed out to Sterling, there was an important change in the nature of the cigarettes themselves during the period 1950 to 1968 shown on this graph. Filter cigarettes won a large share of the market, particularly among the younger smokers. Although the total
number of cigarettes increased, the total amount of tar and nicotine actually decreased in the 1960s. This would have more impact in the younger than the older group. So what the graph really suggests is that reducing tar and nicotine levels can have some impact on population death rates. Hopefully, this may become more evident in U.S. and English death rates in the next few years. IRWIN D.J. BROSS, PHD Dr. Bross is Director of Biostatistics, Roswell Park Memorial Institute, Buffalo, NY 14263
REFERENCE 1. Sterling, T. D. A critical reassessment of the evidence bearing on smoking as the cause of lung cancer. Am. J. Public Health. 65(9): 939-953, September 1975.
Additional Comments on the Critical Assessment of the Evidence Bearing on Smoking as the Cause of Lung Cancer**
Communication from Sterling
Competition for Causes of Lung Cancer
Disagreements about scientific evidence usually are clarified by discussion. This exchange is no exception. As is common, it also may focus on heretofore neglected evidence. The points raised by Bross, Higgins, and Weiss* touch on a number of major issues in my review.
Higgins is correct. I did infer that "occupational and environmental factors are more important than smoking.**" To Higgins, the evidence from the British physicians' study, "not many of whom (he imagines) moonlight in steel, coke oven, or asbestos work, is against this." But direct com-
*See Weiss, W. Smoking and cancer: A rebuttal. Am. J. Public Health. 65:954-955, 1975.
**See Sterling, T. D. A critical reassessment of the evidence bearing on smoking as the cause of lung cancer. Am. J. Public Health. 65:939-953, 1975.
AJPH February, 1976, Vol. 66, No. 2
161
