Tobacco and Public Health - TCSC Indonesia

Summary
Chapter 28
Smoking and lung cancer
Graham G. Giles and Peter Boyle
The establishment of the causal link between smoking and lung cancer was an
epidemiological triumph won against considerable resistance marshalled by the tobacco
industry. This chapter reviews how the evidence that smoking causes lung cancer was
accumulated and weighed against criteria adopted to establish the causal significance
of epidemiological associations between an exposure and disease. The history of
elucidating the association between lung cancer and smoking is now fundamental to
modern epidemiological thinking and practice but in the early to mid-twentieth century
the science of epidemiology was new and in the making, and the research on
smoking and lung cancer contributed to the development of epidemiology as a discipline
(White 1990). In addition to the evaluation of epidemiological evidence, the case
for causality was strengthened by evidence from human pathology and by evidence
from experimental studies using animal models. Much of this material has been
reviewed previously elsewhere (IARC 1986) to which the interested reader is referred
for more detail than can be given here.
Introduction
The last century has witnessed a remarkable epidemic of lung cancer. The words of
Adler (1912), today make salutatory reading. ‘Is it worthwhile to write a monograph on
the subject of primary malignant tumours of the lung? In the course of the last two
centuries an ever-increasing literature has accumulated around this subject. But this literature
is without correlation, much of it buried in dissertations and other out-of-the-way
places, and, with but a few notable exceptions, no attempt has been made to study the
subject as a whole, either the pathological or the clinical aspect having been emphasised at
the expense of the other, according to the special predilection of the author. On one point,
however, there is nearly complete consensus of opinion, and that is that primary malignant
neoplasms of the lungs are among the rarest forms of the disease. This latter opinion
of the extreme rarity of primary tumours has persisted for centuries.’
The lung is the principal body organ susceptible to tobacco carcinogenesis and, apart
from non-melanocytic skin cancer, in many populations it has been or remains the
most commonly diagnosed cancer in men and an increasingly common cancer in