Friday, July 23, 2010

Anti-smoker funding, yes; lung cancer research, no

According to an article in the Hamilton Spectator, the stigma attached to lung cancer patients could “seriously impede attention and research funding on the disease”. Dr. James Gowing, a doctor and co-chair of the Cancer Advocacy Coalition of Canada (CACC), noted in the article that: "It [lung cancer] gets 3 per cent of the total research funding for all cancers, and yet it is the No. 1 killer."

The funding disparity can be attributed to a tendency to blame the victims for their disease. Anti-smokers claim that smoking causes 85 percent of lung cancer deaths, so lung cancer generates little public sympathy.

The Lung Cancer Alliance echos the concerns of Dr. Gowing, noting: “Lung cancer kills more women than any other cancer - nearly 200 women each day. Most die within a year of diagnosis. Yet lung cancer remains the “hidden” women’s cancer - little known and rarely discussed. It is the least funded cancer in terms of research dollars per death of all the major cancers, and one of the only cancer where patients are routinely blamed as responsible for their condition.”

To put what the Lung Cancer Alliance is talking about into some context, 62.5% of lung cancers among women were attributed to smoking according to Health Canada's last report on smoking attributable mortality. And, that figure is likely a gross exaggeration. That means that at least 37.5% of lung cancer deaths among Canadian women were caused by something other than smoking. And, there's not a lot of research funding dedicated to finding out what that something might be.

The facts are that massive amounts of funding that might otherwise go into legitimate research on lung cancer is going to anti-smoker campaigns, in the belief that if people will simply stop smoking, then lung cancer can be eradicated.

But, is that a reasonable assumption? Or are anti-smoker estimates of “smoking attributable” deaths obfuscating the true extent of the disease among never smokers and masking other potential causes of lung cancer? Are anti-smoker efforts to link smoking to lung cancer (and every other disease imaginable) siphoning off funds which might be better spent on legitimate research into the other causes and possible treatments of the disease?

The public has been led to believe that smoking is “the” cause of lung cancer. That, if smokers quit, they can escape the ravages of that dread disease. But, there is evidence to suggest this may not be the case.

A Nov. 21, 2008 article in Science Daily, states: “Smoking is the biggest risk factor for developing lung cancer, even after quitting for long periods of time. "More than 50 percent of newly diagnosed lung cancer patients are former smokers," said Emily A. Vucic, a graduate student at the British Columbia Cancer Research Centre, Vancouver, B.C. "Understanding why some former smokers develop lung cancer is clearly important to the development of early detection, prevention and treatment strategies."”

The Lung Cancer Alliance estimates an even higher percentage of former smokers among new cases. A chart on their website claims 60% of new lung cancer cases are former smokers, 20.9% are current smokers and 17.9% are among those who have never smoked. The remaining 1.2% presumably represents the fraction for which smoking status was unknown.

The fact that the overwhelming majority of new cases of lung cancer are among former smokers may be an indication that smoking attributable deaths are grossly exaggerated in that segment of the population.

A former smoker is defined as someone who has smoked more than 100 cigarettes in his or her lifetime and who has not smoked within the past year. This means that old John, who smoked ten a day the summer he worked on Uncle Matt's farm 30 years ago, is considered a former smoker. And, should he contract lung cancer, he will become a smoking attributed death, despite the fact that he quit 30 years ago, after only a brief fling with the demon weed.

But, is it really reasonable to assume that, because he smoked a carton or two of Player's Filter thirty years ago, that smoking “caused” his lung cancer? Is it reasonable to assume that an individual who smoked a pack a day during his freshman year at college before quitting has the same risk of developing lung cancer (or any other cancer, for that matter) than someone who has smoked a pack a day for fifty years? For, it is those assumptions on which smoking attributable mortality statistics are based.

And, if those aren't reasonable assumptions, then shouldn't some research be dedicated to finding out the real cause of those lung cancers?

Shouldn't some research funding go to finding out what caused the 22% of lung cancer deaths in Canada which are not attributed to smoking? According to Dr. Ping Yang, M.D., Ph.D., a Mayo Clinic genetic epidemiologist, 30% to 40% of lung cancers in Asian countries are among never smokers. Something other than smoking is obviously causing those deaths. Shouldn't someone be trying to find out what?

In a study titled “Lung Cancer Incidence in Never Smokers” by Heather A. Wakelee et al, it is noted that: “Clinical observations suggest that the percentage of never smokers among lung cancer patients may be increasing; however, it is unclear whether this apparent trend represents an increase in lung cancer incidence among never smokers or the increasing prevalence of never smokers in the general population. The growing number of never smokers in the United States and other countries underscores the importance of understanding the epidemiology and biology underlying lung cancer in this population.”

The anti-smoker brigade is waging a moral crusade against smokers. Any public health benefits which may accrue from their denormalization campaign is purely coincidental. They want the public to believe they've already found both the cause and the cure of lung cancer. Any evidence to the contrary is unwelcome news.

But, consider the facts. After four decades of anti-smoker activism, the number of lung cancer deaths in Canada continues to climb. Maybe it's time that someone with the expertise took a more critical look at those smoking attributable death statistics and what they may be hiding.

I'll continue this ramble in my next post. Hopefully, I'll be able to access a computer somewhere on Canada's east coast where I plan to spend the next few weeks.


Anonymous said...

Very interesting post.
Some speculative thoughts on the smoking lung cancer correlation:

'The mortality of Doctors in Relation to their Smoking Habits'
Doll and Hill BMJ June 26 1954
Table I shows that 87.3% of male doctors were smokers in 1951

Mortality in relation to smoking: 22 years' observations
on female British doctors - Doll, Gray, Hafner and Peto
BMJ 5th April 1980
Table II shows that 50% of female doctors were smokers in 1951.

So if the doctors were typical of the overall population then 69% of the population smoked in 1951.

The median age of death from lung cancer in Britain is 73 years (ONS 2005). So typically they would have been around 19 years old in 1951. This implies that 69% of the population in 2005 would be either current or former smokers. And just 31% never smokers. In reality many who were never smokers in 1951 would have taken up smoking at some point in their lives and so the real figure in probably much lower than 31%.
Of course correlation does not imply causation anyway but if you were to suppose no correlation either then you would expect at least 69% of lung cancer deaths among smokers/ex-smokers and less than 31% among never smokers.

Given the caveats above it is remarkable how close this is to the figures from USA you posted above. Raising the question: Is there really even evidence (anymore) of a strong correlation between smoking and lung cancer? (N.B. I think there used to be but it seems to have weakened over time)


TheBigYin said...

Great post and great blog JR. This site has been blogrolled,if it's ok with you that is.

This particular blog item is a must read.

Mr A said...

One thing I don't get about these figures is that they simply don't add up. We have ASH and their ilk claiming you're nine times more likely to get lung cancer if you smoke. But looking at these figures, don't they just prove that you are actually only three times more likely? (I.e. 20% smoke, 60% get lung cancer, therefore three times more likely. And that is using their own undoubtedly distorted figures where I'm sure every single smoker who gets lung cancer has smoking marked down as its undeniable cause despite the fact that their own distorted figures show that 40% of lung cancers occur in non-smokers.

Then, there are the CRUK figures which say that 25% of overall cancer deaths are caused by smoking.... in a population where 25% smoke. Or put another way 75% of cancers aren't caused by smoking when 75% of the population don't smoke. Doesn't that just show no difference in risk?

Then there are the high (and rising) life expectancies in countries where lots of people smoke (Japan, France, Germany), places with longer life expectancies than countries with far lower smoking rates (like us).

And there are the rising levels of childhood asthma etc occurring at the same time as reducing levels of smoking and a vast reduction in exposure to smoke due to the Ban.

None of this adds up. Most people know the passive-smoking thing is a lie, but I am increasingly starting to think that the dangers of active smoking are, if not a lie, then grossly, grossly exaggerated.

Mr A said...

Sorry, meant 75% of cancer deaths are caused by not smoking.

I missed that table. Given the confusion about how they define "former smokers" why don't we just ignore them for the moment and look at those we are sure about. Around 20% are smokers and 17% are non-smokers. Not much difference, eh? Is that even significantly different? In addition, again they are saying 20% of new cancers are in smokers.... when smokers are 20% of the population. Doesn't that seem odd i.e smoking has no effect on the cancer rates?

Anonymous said...

Some interesting maps of the US

timbone said...

There was a charity in Liverpool called the Lung Cancer Foundation who boasted that they were the only cancer charity specifically researching Lung Cancer.

When Roy Castle got lung cancer he spent his remaining time campaigning for this charity, who, upon his death, became the Roy Castle Foundation.

All the money raised by Roy Castle went into lung cancer research NO NO NO a BIG NO!!! All the money raised by Roy Castle went into a campaign against passive smoking, including awards for hotels and B&B who went 'smokefree' and a campaign to make Liverpool smokefree.

Ana said...

" Maybe it's time that someone with the expertise took a more critical look..."
They take the critical look aiming profit by selling drugs.
It is amazing how easy people are indoctrinated and believe in statistics they have no idea if it is for real.
"Passive smoker" was a very catchy phrase to make people fear and stigmatize those who smoke.
Thank you for the post.

Anonymous said...

From the statistics given, there are really percentage of people continue to smoke inspite of the danger of smoking. But, there are still a lot of charities out there that help many lung cancer patient. One of these is encouraging you to donate car to help them.