Report from the Surgeon General

By Anastasia Toufexis

'The chief preventable cause of death "

Since 1964, the Surgeon General's report on the nation's health has dramatically changed the public attitude toward smoking. As a result of its insistent proddings and calls for "remedial action," smoking ads have been banned from television and radio, and the warning on packs of cigarettes has escalated from a modest "may be hazardous to your health" in 1970, to the current "Warning: The Surgeon General Has Determined That Cigarette Smoking Is Dangerous to Your Health." That notice may become even blunter. Last week's report from Surgeon General C. Everett Koop was the most serious indictment of smoking yet made. The conclusion: "Cigarette smoking is clearly identified as the chief preventable cause of death in our society and the most important public health issue of our time."

According to the report, men who smoke are twice as likely as nonsmokers to die of cancer. The risk faced by female smokers is 30% greater than nonsmokers and still rising. An estimated 430,000 people will die of cancer in the U.S. this year, and the report charges smoking will lead to 129,000 of those deaths. Tobacco, Koop said at a press conference, "is responsible for some 340,000 deaths in this country annually," not only from cancer but from heart trouble, chronic lung and respiratory diseases, and other ailments. Previous reports have blamed smoking by pregnant women for miscarriages, premature births and birth defects. Discussing the effects of smoking, Koop said: "This can only presage human tragedy in the years ahead and enormous economic loss to our country." He noted that smoking exacts a financial toll: more than $13 billion a year spent on smoking-related health care and at least another $25 billion in lost production and wages.

This year's report, like its 14 predecessors, is essentially a review of existing data. But it is the first to focus exclusively on the relationship of smoking to cancer. The 1964 report concluded that cigarette smoking was the primary cause of lung cancer in men and probably in women. Today smoking is considered a major cause not only of lung cancer but of cancer of the larynx, oral cavity and esophagus, and a contributing factor in the development of malignancy in the bladder, pancreas and kidney. The report also notes an association between smoking and cancer of the stomach. There may also be a tie to cancer of the cervix.

The number of deaths due to lung cancer is steadily increasing. In 1950 the disease claimed 18,313 lives. This year it is expected to kill 111,000. "It is estimated that 85% of lung cancer mortality could have been avoided if individuals never took up smoking," the report says. "An epidemic among men has existed for many years; now it is being repeated among women," Koop adds. Reason: lung cancer may take decades to develop, and women began taking up smoking in large numbers only after World War II. Lung cancer, in fact, is likely soon to replace breast cancer as the leading cause of cancer death among women. "If it were not for lung-cancer deaths," says Koop, "the overall cancer mortality would have fallen, reflecting improved diagnosis, treatment and survival times" for other forms of the disease.

Unlike cancer of the prostate and breast malignancies, lung cancer, which accounts for a fourth of all cancer deaths, often fails to respond to treatment. According to the report, only 10% of its victims survive five years after diagnosis. The report cautions against the use of pipes, cigars, snuff and chewing tobacco, and warns of dangers to nonsmokers exposed to cigarette smoke. "Side- stream" smoke emitted into the air from a smoldering cigarette sometimes includes carcinogens in higher concentrations than those inhaled directly by a smoker. The Surgeon General cites two studies that showed increased risk of lung cancer in nonsmoking women who are married to smokers. Such findings are considered preliminary but, the report notes, "the evidence does raise concern about a possible serious public health problem." Says Dr.

Edward N. Brandt Jr., Assistant Secretary for Health:

"Nonsmokers should avoid being in smoke-filled rooms." Since the 1964 report, almost 30 million people have managed to give up smoking. "Quitting 'cold turkey' appears to be a more effective strategy than cut ting down without trying to stop entirely," says the report. Surprisingly, 95% of the people who broke the smoking habit did so without the help of organized programs.

However, the report notes the use of such aids as televised smoking clinics and taped telephone messages to encourage maintained abstinence. "Brief and simple advice to quit smoking delivered by a physician" can offer substantial support. Even after a person quits, the report says, it takes up to 15 years for the ex-smoker's chances of developing cancer to drop to those of a nonsmoker. The Surgeon General's report notes that a child is about twice as likely to become a smoker if either parent is one. As to giving up cigarettes, a college degree helps.

Smokers who have gone to college are almost twice as likely to break the habit eventually as noncollege smokers. Smoking among men reached a high in 1955 when almost 53% of American men smoked. For women, the peak year was 1966, when 33% were cigarette users. Today 37% of men and 29% of women use tobacco regularly. Teenagers, particularly girls, were of special concern in the 1970s when they began to take up smoking in record numbers, but the young appear to be cutting down a bit now. In another study published last week (see following story) researchers at the University of Michigan announced that only 20% of high school seniors smoked daily in 1981, down from 29% in 1977. Boys seem to be quitting slightly faster than girls, according to the American Cancer Society. Still, 53 million Americans 17 years old and older smoke. In 1980 they spent $19.2 billion and consumed 630 billion cigarettes.

Predictably, the industry-funded Tobacco Institute contested the report.

Says Horace Kornegay, institute chairman: "While many people believe a causal link between smoking and cancer is a given, scientific research has not been able to establish that link, nor has it been able to determine how normal cells become cancerous." Antismoking groups hailed the study but protest that the Reagan Administration has been inconsistent on the issue. They note that the budget and staff of the Government's Office on Smoking and Health have been drastically cut, and complain that a TV campaign featuring Brooke Shields and aimed at discouraging teen-agers from smoking was scrapped, supposedly because of industry pressure. The American Lung Association later picked up the campaign. The Civil Aeronautics Board has eased the regulation requiring airlines to provide no-smoking sections and is considering dropping the rule altogether. The Government has so far failed to take a position on bills pending in Congress that would require more explicit warning labels on cigarette packages. Among the proposed candidates: "Warning: Cigarette smoking is the number one cause of emphysema and lung cancer"; "Warning: Cigarette smoking is a major cause of heart disease"; "Warning: Cigarette smoking by pregnant women may result in birth defects or spontaneous abortion." Says John Banzhaf, executive director of Action on Smoking and Health, a consumer group: "So far, the Surgeon General's report is the only positive thing this Administration has done on the smoking and health issue."

Koop, who was a prominent Philadelphia pediatric surgeon before he became Surgeon General last year, says that the Reagan Administration backs the report and is committed to alert people to the hazards of smoking. In that effort he is counting mostly on the public's common sense. Says he: "If I were a smoker of a pipe, cigar or cigarette and were reasonably intelligent and had read this report, I would long since have quit." Indeed, Koop once did smoke a pipe, but, setting a good example, he gave it up ten years ago. --ByAnastasia Toufexis. Reported by Jeanne Saddler/Washington and Nancy Pierce Williamson/New York

With reporting by Jeanne Saddler, Nancy Pierce Williamson

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