Cigarette Century

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World War I began to fix the cigarette habit on people, and physicians first noticed the consequence of this habit in the 1930s.

Four years later the modern era in lung cancer treatment began. Early in 1933 James Lee Gilmore, a forty-nine-year-old Pittsburgh obstetrician suffering from a persistent cough and fever, consulted a physician friend who arranged for a chest X ray. It showed a small, rounded density in the left upper lobe. Dr. Gilmore went to Dr. Evarts A. Graham, a pioneer in chest surgery at the Barnes Hospital in St. Louis. There a biopsy showed the density to be a squamous-cell carcinoma, a type of tumor now known to be almost invariably the result of long-time cigarette smoking. Dr. Graham advised Dr. Gilmore to have it surgically removed, believing he could take out the upper lobe of the lung and save the rest. During the operation, however, Dr. Graham discovered that to get out the tumor he would have to remove the entire lung. No patient had ever survived that operation, but Graham felt he must proceed. As it turned out, Gilmore tolerated the operation well. At the time perhaps a half-dozen patients in the world had survived lobectomy for lung cancer. But now surgery for the disease became much more widely accepted.

The surgeon and his patient remained close friends. Dr. Gilmore eventually returned to Pittsburgh and resumed his practice for another quarter-century before he retired. Dr. Graham always regarded this operation as his greatest achievement, and lung cancer remained his leading interest. In 1950 Graham and a medical student named Ernst Wynder published a landmark study of the disease in the Journal of the American Medical Association . They found that practically all the victims had been long-time heavy cigarette smokers. An association between lung cancer and smoking had already been suggested by a number of other researchers, and a 1932 paper in the American Journal of Cancer had accurately blamed the tars in cigarettes for the formation of cancer. But this was the first major study to make the connection. In 1953 it was followed by the Sloan-Kettering Report, in which researchers at the Memorial Sloan-Kettering Cancer Center, in New York City, announced that they had produced skin cancers in mice by painting the tars from tobacco smoke on their backs.

During the 1950s the sponsors of “The Camel News Caravan” required John Cameron Swayze to hold a burning cigarette whenever on camera.

Graham himself had been a cigarette smoker for more than twenty years, but he quit after his 1950 study and devoted himself after retirement in 1951 to research on the mechanisms of cancer production by tobacco tars. The remainder of the story is one of sad irony. In 1957 he was found to have lung cancer himself, of an especially malignant type called small-cell carcinoma. Graham died that same year; his patient Dr. Gilmore survived him by more than half a decade.

Long before the dangers of smoking became evident, cigarette companies were implying that it was actually beneficial. In 1927 the American Tobacco Company launched an advertising campaign claiming that “11,105 physicians” endorsed Lucky Strikes as “less irritating to sensitive or tender throats than any other cigarettes.” Physicians’ groups responded angrily, but they were more offended by the commercialization of professional opinion than by the specific claims involved.

In 1946 the R. J. Reynolds Tobacco Company launched its campaign featuring the “T-Zone Test” (“Taste and Throat”) with a claim that “more doctors smoke Camels than any other cigarette!” Of course, many more doctors did smoke then than now, and Camels were extremely popular. In 1949 Camel advertised its “30-day Test”with a group photograph of “noted throat specialists” who had found “not one case of throat irritation due to smoking Camels!” By the early 1950s, however, as medical studies began demonstrating close links between cigarette smoking and ill health, the manufacturers stopped claiming that smoking was healthful and began instead to insist that no connection with disease had been proved.

In the meantime, cases of—and deaths from—lung cancer among American men had begun a dizzying climb. In 1930 the death rate from lung cancer among men was less than 5 per 100,000 population per year. By 1950 it had quintupled to more than 20; today it is above 70. The numbers of new cases and of deaths have never been very far apart; even today not quite 10 percent of all lung-cancer patients can be cured. In 1989 there were an estimated 155,000 new cases of lung cancer in the United States and 142,000 deaths from the disease, making it far and away the leading cause of cancer deaths in our society, and cigarette smoking is responsible for an estimated 85 percent of the cases. The death rate still continues to rise, but there are definite signs that among men its rate of increase is diminishing, as more men give up smoking.

The rise of lung cancer among women lagged behind that among men by about thirty years. Heavy smoking remained relatively unacceptable socially for women until around World War II. Today women’s lung-cancer death rates are skyrocketing the way men’s did twenty or thirty years ago. A number of studies indicate that it may be harder for women to quit than for men, and it has been predicted that by the year 2000 more women than men will be dying of lung cancer.