Smoking Does Not
Cause Lung Cancer
(According to WHO/CDC Data)*
By: James P. Siepmann, MD
Yes, it is true, smoking does not cause lung cancer. It is only one of many risk
factors for lung cancer. I initially was going to write an article on how the professional
literature and publications misuse the language by saying "smoking causes lung
cancer"1,2, but the more that I looked into how biased the literature,
professional organizations, and the media are, I modified this article to one on trying to
put the relationship between smoking and cancer into perspective. (No, I did not get paid
off by the tobacco companies, or anything else like that.)
When the tobacco executives testified to Congress that they did not believe that
smoking caused cancer, their answers were probably truthful and I agree with that
statement. Now, if they were asked if smoking increases the risk of getting lung cancer,
then their answer based upon current evidence should have be "yes." But even so,
the risk of a smoker getting lung cancer is much less than anyone would suspect.
Based upon what the media and anti-tobacco organizations say, one would think that if you
smoke, you get lung cancer (a 100% correlation) or at least expect a 50+%
occurrence before someone uses the word "cause."
Would you believe that the real number is < 10% (see Appendix A)? Yes, a US white male (USWM)
cigarette smoker has an 8% lifetime chance of dying from lung cancer but the USWM
nonsmoker also has a 1% chance of dying from lung cancer (see Appendix A). In fact,
the data used is biased in the way that it was collected and the actual risk for a smoker is
probably less. I personally would not smoke cigarettes and take that risk, nor
recommend cigarette smoking to others, but the numbers were less than I had been led to
believe. I only did the data on white males because they account for the largest
number of lung cancers in the US, but a similar analysis can be done for other groups
using the CDC data.
You don't see this type of information being reported, and we hear things like,
"if you smoke you will die", but when we actually look at the data, lung
cancer accounts for only 2% of the annual deaths worldwide and only 3% in the US.**
When we look at the data over a longer period, such as 50 years as we did here,
the lifetime relative risk is only 8 (see Appendix A). That means that even using
the biased data that is out there, a USWM smoker has only an 8x more risk of dying from
lung cancer than a nonsmoker. It surprised me too because I had always heard numbers
like 20-40 times more risk. Statistics that are understandable and make
sense to the general public, what a concept!
The process of developing cancer is complex and multifactorial. It involves
genetics, the immune system, cellular irritation, DNA alteration, dose and duration of
exposure, and much more. Some of the known risk factors include genetics4,5,6,
asbestos exposure7, sex8, HIV status9, vitamin deficiency10,
diet11,12,13, pollution14 , shipbuilding15 and even
just plain old being lazy.16 When some of these factors are combined they can
have a synergistic effect17, but none of these risk factors are directly and
independently responsible for "causing" lung cancer!
Look in any dictionary and you will find something like, "anything
producing an effect or result."18 At what level of occurrence would you
feel comfortable saying that X "causes" Y? For myself and most scientists, we
would require Y to occur at least 50% of the time. Yet the media would have you believe
that X causes Y when it actually occurs less than 10% of the time.
As ludicrous as that is, the medical and lay press is littered with such pabulum and
gobbledygook. Even as web literate physician, it took me over 50 hours of internet time to
find enough raw data to write this article. I went through thousands of abstracts
and numerous articles, only to find two articles that even questioned the degree of
correlation between smoking and lung cancer (British lung cancer rates do not correlating
to smoking rates)19,20 and another two articles which questioned the link
between second hand smoke (passive smoking) and lung cancer.21,22 Everywhere I
looked, the information was hidden in terms like "odds ratio," "relative
risk," or "annualized mortality rate." Most doctors probably could
not accurately define and interpret them all these terms accurately, let
alone someone outside the medical
profession. The public relies on the media to interpret this morass of data, but instead
they are given politically correct and biased views.
If they would say that smoking increases the incidence of lung cancer or that smoking
is a risk factor in the development of lung cancer, then I would agree. The purpose of
this article is to emphasize the need to use language appropriately in
both the medical and
scientific literature (the media, as a whole, may be a lost cause).
Everything in life has risk; just going to work each day has risk. Are we supposed to
live our lives in bed, hiding under the blanket in case a tornado should come into our
bedroom? We in science, have a duty to give the public accurate information and then let
them decide for themselves what risk is appropriate. To do otherwise is
a subtle imposition of our biases on the populace.
We must embrace Theoretics as a discipline that strives to bring objectivity and logic
back into science. Every article/study has some bias in it, the goal is to minimize such
biases and present the facts in a comprehensible and logical manner. Unfortunately, most
scientists have never taken a course in logic, and I'm sure that English class was not
their favorite. Theoretics is a field of science which focuses on the use of logic and
appropriate language in order to develop and communicate scientifically credible theories and ideas which
will then have experimental implications. As someone whom I respect says, "Words mean
things." Let us use language and logic appropriately in our research and
way that we communicate information.
* * * * *
Yes, smoking is bad for you, but so is fast-food hamburgers, driving, and
so on. We must weigh the risk and benefits of the behavior both as a society and as an
individual based on unbiased information. Be warned though, that a society
that attempts to remove all risk terminates individual liberty and
will ultimately perish. Let us be logical in our endeavors and true in our pursuit of
knowledge. Instead of fearful waiting for lung cancer to get me (because the media and
much of the medical literature has falsely told me that smoking causes lung cancer), I can enjoy my
occasional cigar even more now...now that I know the whole story.
* * * * *
The Untold Facts of Smoking (Yes, there is bias in science)
"I feel like the Fox Network" (a bastion of truth
in a sea of liberalism)
- USWM smokers have a lifetime relative risk of dying from lung cancer of only 8 (not the
20 or more that is based on an annual death rate and therefore virtually useless).
- No study has ever shown that casual cigar smoker (<5 cigars/wk, not inhaled) has an
increased incidence of lung cancer.
- Lung cancer is not in even in the top 5 causes of death, it is only #9.**
- All cancers combined account for only 13% of all annual deaths and lung cancer only
- Occasional cigarette use (<1 pk/wk) has never been shown to be a risk factor in lung
- Certain types of pollution are more dangerous than second hand smoke.3
- Second hand smoke has never been shown to be a causative factor in lung cancer.
- A WHO study did not show that passive (second hand) smoke statistically increased the
risk of getting lung cancer.
- No study has shown that second hand smoke exposure during childhood increases their risk
of getting lung cancer.
- In one study they couldn't even cause lung cancer in mice after exposing them to
cigarette smoke for a long time.23
- If everyone in the world stopped smoking 50 years ago, the premature death rate would
still be well over 80% of what it is today.1 (But I thought that smoking was
the major cause of preventable death...hmmm.)
*This article was revised after errors in the
data and calculations were noticed by Charles Rotter, Curtis Cameron and Jesse
V. Silverman. This is the corrected version. A special thanks to both.
**WHO data of member countries
Keywords: lung cancer, mortality, tobacco, smoking, Theoretics,
language, WHO, cigarette, cigar, logic.
(I back up my statements with facts,
will those who respond do the same?)
- Pisani P, Parkin DM, Bray F, Ferlay J, Estimates of the worldwide mortality from 25
cancers in 1990, Int J Cancer 1999 Sep 24;83(1):18-29; "Tobacco smoking
and chewing are almost certainly the major preventable causes of cancer
- American Thoracic Society, Cigarette smoking and health.. , Am J Respir Crit
Care Med; 153(2):861-5 1996; "Cigarette smoking remains the primary cause
of preventable death and morbidity in the United States."
- Nordlund LA, Trends in smoking habits and lung cancer in Sweden, Eur J Cancer Prev
1998 Apr;7(2):109-16; "Tobacco smoking is the most important cause
of lung cancer and accounts for about 80-90% of all cases of lung cancer among men and
about 50-80% among women."
- JAMA 1997;278:1505-1508; "The chief cause of death included lung
cancer, esophageal cancer and liver cancer. The death rate was higher for those who
started smoking before age 25. If current smoking patterns persist, tobacco will
eventually cause more than two million deaths each year in China."
- JAMA 1997;278:1500-1504; "We have demonstrated that smoking is a major cause
of death in China...."
- Hecht SS firstname.lastname@example.org, Tobacco
smoke carcinogens and lung cancer, J Natl Cancer Inst 1999 Jul
21;91(14):1194-210; "The complexity of tobacco smoke leads to some confusion about
the mechanisms by which it causes lung cancer."
- Sarna L, Prevention: Tobacco control and cancer nursing, Cancer Nurs
1999 Feb;22(1):21-8; "In the next century, tobacco will become the number-one cause
of preventable death throughout the world, resulting in half a billion deaths."
- Liu BQ, Peto R, Chen ZM, Boreham J, Wu YP, Li JY, Campbell TC, Chen JS, Emerging
tobacco hazards in China: 1. Retrospective proportional mortality study of one million
deaths, BMJ 1998 Nov 21;317(7170):1411-22; "If current smoking uptake rates
persist in China (where about two thirds of men but few women become smokers) tobacco will
kill about 100 million...."
- Nordlund LA Trends in smoking habits and lung cancer in Sweden. Eur J Cancer Prev
1998 Apr;7(2):109-16; "Tobacco smoking is the most important cause of
lung cancer and accounts for about 80-90% of all cases of lung cancer among men and about
50-80% among women."
- Skurnik Y, Shoenfeld Y Health effects of cigarette smoking, Clin Dermatol 1998
Sep-Oct;16(5):545-56 "Cigarette smoking, the chief preventable cause of illness and
death in the industrialized nations."
- JAMA Website: http://www.ama-assn.org/sci-pubs/sci-news/1996/snr0424.htm
[link no longer active as of 2004];
"Yet huge obstacles remain in our path, and new roadblocks are being erected
continuously," writes Ronald M. Davis, M.D., director of the Center for Health
Promotion and Disease Prevention, Henry Ford Health System, Detroit, Mich., in urging a
review of the effort against "the most important preventable cause
of death in our society."
- JAMA Website: http://www.ama-assn.org/sci-pubs/sci-news/1997/snr1203.htm#joc6d99
[link no longer active as of 2004];
"According to the authors, tobacco use has been cited as the chief avoidable cause
of death in the U.S., responsible for more than 420,000 deaths annually ...."
- JAMA Website: http://jama.ama-assn.org/issues/v281n2/ffull/jwm80010-2.html
[link no longer active as of 2004];
"The researchers reported that deaths caused by tobacco...."
3. The World Health Report 1999, chapter 5 and Statistical Annex
and CDC data (http://www.cdc.gov/scientific.htm).
4.Mutat Res 1998 Feb 26;398(1-2):43-54 Association of the NAT1*10 genotype
with increased chromosome aberrations and higher lung cancer risk in cigarette smokers.
Abdel-Rahman SZ, El-Zein RA, Z
5. Schwartz AG, Rothrock M, Yang P, Swanson GM, "Increased cancer risk among
relatives of nonsmoking lung cancer cases," Genet Epidemiol 1999;17(1):1-15
6. Amos CI, Xu W, Spitz MR, Is there a genetic basis for lung cancer susceptibility?,
Recent Results Cancer Res 1999;151:3-12
7. Silica, asbestos, man-made mineral fibers, and cancer. Author Steenland K;
Stayner L Cancer Causes Control, 8(3):491-503 1997 May
8. Lam S, leRiche JC, Zheng Y, Coldman A, MacAulay C, Hawk E, Kelloff G,
Gazdar AF, Sex-related differences in bronchial epithelial changes associated with tobacco
smoking, J Natl Cancer Inst 1999 Apr 21;91(8):691-6
9. Ignacio I. Wistuba, MD, Comparison of Molecular Changes in Lung Cancers in
HIV-Positive and HIV-Indeterminate Subjects, JAMAVol. 279, pp. 1554-1559, May 20, 1998
10. Kumagai Y, Pi JB, Lee S, Sun GF, Yamanushi T, Sagai M, Shimojo N, Serum antioxidant
vitamins and risk of lung and stomach cancers in Shenyang, Cancer Lett 1998 Jul
11. Nyberg F, et al., Dietary factors and risk of lung
cancer in never-smokers, Int J Cancer 1998 Nov 9;78(4):430-6
12. Sinha R, Kulldorff M, Curtin J, Brown CC, Alavanja MC, Swanson CA, "Fried,
well-done red meat and risk of lung cancer in women." Cancer Causes Control
13. Young KJ, Lee PN, Statistics and Computing Ltd, Surrey, UK. Intervention studies
on cancer, Eur J Cancer Prev 1999 Apr;8(2):91-103
14. Long-term inhalable particles and other air pollutants related to mortality in
Am J Respir Crit Care Med. 1999 Feb;159(2):373-82.
15. Blot WJ, Fraumeni JF, Lung Cancer Mortality in the US: Shipyard
Correlations Source, Ann N Y Acad Sci; 330:313-315 1979 UI: 80659437
16. Lee IM, Sesso HD, Paffenbarger RS Jr, Physical activity and risk of lung cancer.
Int J Epidemiol 1999 Aug;28(4):620-5
17. Kamp DW, Greenberger MJ, Sbalchierro JS, Preusen SE, Weitzman SA,
Cigarette smoke augments asbestos-induced alveolar epithelial cell injury: role of
free radicals, Free Radic Biol Med 1998 Oct;25(6):728-39
18. The Complete Reference Collection, 1996-9, Compton's.
19. Lee PN, Forey BA, Trends in cigarette consumption cannot fully explain
trends in British lung cancer rates, J Epidemiol Community Health; 52(2):82-92 1998
20. Pandey M, Mathew A, Nair MK, Global perspective of tobacco habits and lung
cancer: a lesson for third world countries. Eur J Cancer Prev 1999
21. Jahn O, [Passive smoking, a risk factor for lung carcinoma?], Wien Klin
Wochenschr; 108(18):570-3 1996
22. Nilsson R, Environmental tobacco smoke and lung cancer: a reappraisal,
Ecotoxicol Environ Saf; 34(1):2-17 1996
23. Finch GL, Nikula KJ, Belinsky SA, Barr EB, Stoner GD, Lechner JF,
Failure of cigarette smoke to induce or promote lung cancer in the A/J mouse, Cancer
Lett; 99(2):161-7 1996
US white male data3
For those of you who actually read the whole article...
As long as I'm being controversial by presenting both sides of the story, do I
dare tell you that a woman is three times more likely to die from an abortion than from
delivering a baby (WHO data).
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