Tobacco and Public Health - TCSC Indonesia

488
SMOKING AND LUNG CANCER
smoking patterns, since there is an interval of several decades between the change in
smoking habits in a population and its consequences on lung cancer rates. Over 90 per
cent of lung cancer may be avoidable simply through avoidance of cigarette smoking.
Rates of lung cancer in central and eastern Europe at the present time are higher than
those ever before recorded elsewhere; lung cancer has increased 10-fold in men and
8-fold in women in Japan since 1950; there is a worldwide epidemic of smoking among
young women (Chollat-Traquet 1992) which will be translated in increasing rates of
tobacco-related disease, including cancer, in the coming decades; there is another epidemic
of lung cancer and tobacco-related deaths building up in China as the cohorts of
men in whom tobacco smoking became popular reach ages where cancer is an important
hazard (Boyle 1993) . Many solutions have been attempted to reduce cigarette
smoking and increasingly many countries are enacting legislation to curb this habit
(Roemer 1993).
The epidemiology of smoking and lung cancer
From the perspective of the early twenty-first century, a causal relationship between
smoking and lung cancer is taken as self evident, but this was not always the case.
An early observer of the then rare respiratory cancer (Rottman 1898) considered
it an occupational hazard, possibly from exposure to tobacco dust. The association
between tobacco smoking and the development of lung cancer appears to have been
suggested in the United Kingdom in 1927 (Tylecote 1927). The first interview study
on tobacco smoking and lung cancer seems to have been reported from Vienna
(Fleckseder 1936) where lung cancer rates had risen dramatically. Fleckseder (1936)
found 51 smokers among 54 patients he found with lung cancer. Thirty seven of these
smoked between 20 and 90 cigarettes daily while excessive smoking of pipes, cigars, or
both was rarer.
The same association was alluded to in a report from the United States (Ochsner
and Debakey 1939) in a study primarily of a series of 79 patients treated by total
pneumonectomy. A report from Cologne followed one year later (Muller 1940) based
on the post-mortem records of 96 patients. The patient, or more usually the relatives of
fatal cases, was interviewed as to their occupation, tobacco consumption, and
exposure to specific ‘inhalants’. Re-analysis of Muller’s data provides relative risk of
3.1 among moderate smokers, 2.7 among heavy smokers, 16.8 among very heavy smokers
and 29.2 among excessive smokers. Within the limitations of the study (e.g. small
numbers, especially among non-smoking cases, possible inaccuracies in elucidation of
precise smoking histories) these results were noticeably similar to results obtained
from later case–control studies in the United States and, apart from a lack of increase
among heavy smokers, there is the possible appearance of a dose–response relationship.
A study of smoking habits and occupation based on 195 post-mortem records of
cases of lung cancer at the Pathology Institute at Jena for the years 1930–1941 was