E. Cuyler Hammond

Changes in Bronchial Epithelium in Relation to Cigarette Smoking, 1955–1960 vs. 1970–1977

To test the hypothesis that the reduction in tar and nicotine content of cigarette smoke that began in the 1950s should be reflected by the histologic changes in the bronchial epithelium of cigarette smokers, 20, 424 sections taken at autopsy from the bronchial tubes of 445 men (non-lung-cancer deaths) were examined microscopically in random order. There were 211 men who died in 1955-1960, of whom 154 smoked regularly, and 234 men who died in 1970-1977, of whom 181 were regular smokers. Changes studied included basal-cell hyperplasia, loss of cilia and occurrence of cells with atypical nuclei. In both periods studied these histologic changes occurred far less frequently in nonsmokers than in cigarette smokers and increased in frequency with amount of smoking, adjusted for age. Sections with advanced histologic changes in those dying in 1955-1960 occurred in 0 per cent of nonsmokers, in 2.6 per cent of those smoking one to 19 cigarettes a day, in 13.2 per cent of those smoking 20 to 39 and in 22.5 per cent of those smoking 40+ cigarettes a day. In those who died in 1970-1977 the percentages were 0, 0.1, 0.8, and 2.2, respectively.

Latency of asbestos disease among insulation workers in the United States and Canada

Two thousand two hundred seventy‐one deaths were recorded among 17,800 asbestos insulation workers observed from January 1, 1967‐December 31, 1976. There was little increase in cancer deaths or of asbestosis in less than 15–19 years from onset of employment. In general, though, the period of clinical latency was 2–4 decades or more and there were important differences among the several asbestos‐associated diseases. Lung cancer peaked at about 30–35 years from onset and asbestosis at 40–45 years. Each tended to decline in incidence afterwards. Pleural and peritoneal mesothelioma reached their highest incidence later than lung cancer, but the incidence did not decline. In studies of effects of asbestos exposure, it appears advantageous to observe for at least 35–40 years or more from onset of exposure and to analyze the experience in duration‐from‐onset categories. If this is not possible, only the very limited early effects will be identified and the full import of the exposure may not be appreciated.

“Tar” and nicotine content of cigarette smoke in relation to death rates

Abstract Over 1,000,000 men and women who enrolled in an epidemiological study in 1959–1960 were (with few exceptions) traced for 12 years. They all answered questionnaires on cigarette smoking and various other factors at time of enrollment; and survivors answered repeat questionnaires on three later occasions. In this analysis, cigarette smokers were classified by the amount of tar and nicotine delivered by the brand they usually smoked at the start of each of two 6-year periods. Among subjects who smoked the same number of cigarettes a day, total death rates, death rates from coronary heart disease, and death rates from lung cancer were somewhat lower for those who smoked “low” tar-nicotine cigarettes than for those who smoked “high” tar-nicotine cigarettes. The death rates of subjects who smoked “low” tar-nicotine cigarettes were far higher than the death rates of subjects who never smoked regularly.

Changes in Bronchial Epithelium in Relation to Sex, Age, Residence, Smoking and Pneumonia

IN previous investigations, we found a high degree of relation between cigarette smoking and certain changes in the bronchial epithelium of men who had died of causes other than lung cancer.1 2 3 T...

Histologic changes in the larynx in relation to smoking habits.

Histologic changes in the larynx were microscopically studied in 942 men who died and came to autopsy at the Veterans Administration Hospital, East Orange, N. J., between 1964‐1967. Atypical changes in cells in the epithelium of the larynx were most often observed in the true vocal cord and, to a lesser degree, in the false vocal cord and the area of the larynx above the vocal cord. The least changes were observed in the area below the vocal cord. The histologic changes (including cells with atypical nuclei, carcinoma in situ, and early invasive carcinoma) were highly related to smoking habits. They were much higher in cigarette smokers than in men who never smoked; they increased in proportion to the number of cigarettes smoked per day before death and were seen to a greater degree in cigarette smokers than in cigar and pipe smokers. Ex‐cigarette smokers had fewer such changes than men who continued to smoke cigarettes up to the time of death. Cells with disintegrating nuclei were found mainly in ex‐cigarette smokers.

Multiple primary bronchial carcinomas

From 50 to 208 sections of the tracheobronchial tree of each of 255 patients who died of bronchial carcinoma were microscopically examined. Lesions histologically classified as primary invasive carcinoma (other than the main tumor mass) were found in 77 sections; lesions similar but of somewhat less certain character were found in 26 sections. Such lesions were found in 37 of the 255 subjects (22 subjects had just one; 15 had two or more). The locations of the lesions were studied in relation to the location of the main tumor mass. Using strict criteria, we concluded that at least nine (3.5%) of the patients had multiple primary bronchial carcinomas (two or more including the original tumor). Using less strict criteria (i.e., the inclusion of cases where varying degrees of uncertainty existed) the number might be as high as 37 (14.5%).

General Air Pollution and Cancer in the United States

Abstract General air pollution may be defined as a body of contaminated air extending over a population area of appreciable size (a town, city, etc.). It excludes occupational, personal, or neighborhood pollution exposure to dusts or fumes. In the American Cancer Societys study of a half million men, subjects who had lived in the same neighborhood for at least 10 years were classified into various categories by place of residence, and whether or not they were occupationally exposed to dusts, fumes, or vapors. Lung cancer rates were computed standardized by age and smoking habits. Men who said they were occupationally exposed had mortality rates of lung cancer 14% greater than the nonexposed. Among those not exposed, there were little or no differences in mortality ratios by urban-rural place of residence, in Los Angeles and nearby counties; by whether they lived in cities with high, medium, or low levels of total suspended particulate matter or benzene-soluble organic matter. We conclude the general air pollution at present has very little effect, if any, on the lung cancer death rate.

Longevity of parents and grandparents in relation to coronary heart disease and associated variables.

This paper is based upon an analysis of data from a prospective epidemiological study in which a large number of men and women were traced for six years after they answered a detailed questionnaire. The subjects were divided into seven groups according to the longevity of their parents and grandparents. Death rates from coronary heart disease, hypertensive heart disease, and stroke were found to be considerably higher among subjects with short-lived parents than among subjects with long-lived parents. This was found to be the case for coronary heart disease among men without a history of high blood pressure or diabetes, who were not seriously overweight, who took some exersise, and who never smoked cigarettes regularly.

INCIDENCE OF CUTANEOUS CANCER IN MINNESOTA.

In a survey conducted in Minnesota, a special effort was made to record cases of cutaneous cancer encountered in 1963 by dermatologists, radiotherapists, and pathologists. The latter group probably includes almost all of the patients treated by surgeons in hospitals and the great majority of those treated by surgeons in their offices. In an earlier sample study, we found this to be true of general practitioners. A total of 2,358 Minnesotans was identified as having cutaneous cancer, presenting first during 1963. This exceeded the most plausible estimates based on previously available data. The annual incidence rates recorded were 71.5 per 100,000 men and 47.2 per 100,000 women. These rates place cutaneous cancer clearly in front among types of cancer in Minnesota, although it is a northern state whose population has relatively low actinic exposure.

Inhalation in Relation to Type and Amount of Smoking

Abstract A survey conducted by mail was made to obtain information on inhalation in relation to type and amount of smoking. The proportion of men who said that they inhaled: (1) increased with amount of smoking and decreased with age, (2) was very much higher for cigarette smokers than for cigar and pipe smokers, and (3) was much higher for men who smoked only cigarettes than for men who smoked both cigarettes and cigars. The proportion of men who said that they inhale differed very little between those smoking filter tip cigarettes and those smoking non-filter tip cigarettes. A test was made to determine whether the wording of the letter of transmittal enclosed with the questionnaires, the organization from which the questionnaires were sent, the presence or absence of a postage stamp on the envelope enclosed for reply, or the failure of some men to reply had an influence on the findings. It appeared that these factors made very little difference in the percentage distribution of responses to questions o...