Smoking & Health

After a massive study of 188,000 American men observed for almost four years, two American Cancer Society researchers last week reported their final figures on the connection between smoking habits and premature death--especially from cancer and heart disease. With a total of 11,870 deaths among the men (ages 50 to 70 when the study began in 1952), Drs. E. Cuyler Hammond and Daniel Horn were able to go far beyond the findings they had earlier reported (TIME, July 5, 1954 et seq.). From a mountain of crosschecked statistics submitted to the A.M.A. last week, they concluded: 1) all smoking shortens life; 2) cigarette smoking is by far the worst offender, and the risk goes up with the amount smoked.

Especially startling was the finding that, although the increased death rate from lung cancer was the most dramatic (TIME, March 7, 1949 et seq.), smoking may cause a far greater loss of life by speeding up the process of heart disease--where a relatively modest increase in the mortality rate means many more deaths because the disease is so much commoner.

Death rates from all causes combined are 68% higher for cigarette smokers than for nonsmokers. The rates rise with the number of cigarettes smoked daily, the A.C.S. statisticians reported. As compared with the rates for those who have never smoked, they are:

P:Up 34% for those smoking less than half a pack a day.

P:Up 70% on half a pack to a pack a day.

P: Up 96% on one to two packs.

P: Up 123% on two packs or more.

For those who smoke only cigars the rate goes up 22%, and for pipe smokers only 12%. Mixed smokers, e.g., pipe and cigarettes, have intermediate rates.

The researchers' findings on the association between cigarette smoking and various causes of death:

Lung Cancer. "A spectacular relationship." Among 32,392 men who had never smoked, only four died of microscopically proved cancer originating in the lung, but among 108,000 cigarette smokers there were 265 similarly proved cases (of 397 reported). Even men who smoked less than half a pack a day ran a risk of lung cancer 15 times as great as that of nonsmokers; between one and two packs 43 times as great; on two packs or more 64 times as great.

Other Cancers. For the first time Drs. Hammond and Horn found a significant tie between cigarette smoking and cancer in other sites: the pancreas, where the death rate goes up 50%; the kidneys, up 58%; the stomach, up 61%; the prostate, UP 75%; the bladder, up 117%; liver and gall bladder, up 352%. Cancer at some such sites might have been caused either by direct action of substances in cigarette tar, or by spread from an undetected tumor in the lung. No relationship was found between smoking and leukemia, or cancer of the brain, colon or rectum.

Other Lung Diseases. Smokers' death rate was almost twice as high as that of nonsmokers; almost four times as high for deaths from pneumonia and influenza.

Peptic Ulcers. Smokers' death rate was 116% higher for duodenal ulcers. When they got to the comparison for stomach-ulcer deaths, Hammond and Horn's graph bar ran off the chart; there was not a single such death among the nonsmokers, but there were 46 among cigarette smokers (five among other smokers).

Cirrhosis of the Liver. Smokers' rate 93% higher.

Heart & Artery Disease. Deaths attributed to disease of the coronary arteries went up step-fashion according to the amount smoked: less than half a pack a day, up 29%; half a pack to a pack, up 89%; one to two packs, up 115%; two packs or more, up 141%. (Pipe smokers' rates were up only 3%; cigar smokers' rates up 28%.) Cigarette smokers' death rate from strokes was 30% higher than among nonsmokers; from general arteriosclerosis, 46% higher.

Accidents & Suicide. Smokers' death rate lower than nonsmokers' by 6%--which, Researchers Hammond and Horn say, is too small to be significant.

If cigarette smokers had died at the same rate as nonsmokers, the researchers would have expected 4,651 deaths among the men studied; actually, they recorded 7,316. Of the 2,665 "excess deaths," no fewer than 1,338 (52%) were attributed to coronary artery disease, 1,670 (64%) to all diseases of the heart and arteries combined. This compared with 360 deaths caused by lung cancer and 359 by all other cancers.

Quit Smoking? Even after a man has been a heavy cigarette smoker for many years, he can still reduce his risk of premature death by kicking the habit, declared Hammond and Horn. After a man had been off the weed for a year or more, his prospects improved; among men who had quit light smoking (less than a pack a day) ten or more years previously, the death rate from most causes was scarcely greater than among lifetime nonsmokers; ten years after heavier smoking, it was 50% greater--and markedly higher from lung cancer.

City v. Country. Cigarette smoking increases with a movement from rural areas to bigger towns and large cities; so does the incidence of lung cancer. When Hammond and Horn adjusted their figures to allow for the smoking difference (50% of rural men smoke cigarettes, 62 1/2% of big-city men), they found that the lung-cancer death rate was still one-third higher in the cities. This might be a reflection of better diagnosis in major medical centers, or a result of big-city air pollution.

Researchers Hammond and Horn are not physicians, but practitioners of biometrics--the study of disease by analyzing the medical who, what, when and how-many of people in health and illness. Baltimore-born Hammond, 45, has an Sc.D. in biology; Horn, 41, native of Rochester, N.Y., has a Ph.D. in psychology. Both were heavy cigarette smokers when their first findings came in four years ago; now they smoke pipes.

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