Passive smoking and lung cancer.

One or two of you may have missed the headline news about passive smoking:

The article describes a large prospective study that "confirmed a strong association between cigarette smoking and lung cancer but found no link between the disease and secondhand smoke." The study tracked more than 76,000 women, 901 of whom eventually developed lung cancer. Although "the incidence of lung cancer was 13 times higher in current smokers and four times higher in former smokers than in never-smokers," says the JNCI article, there was no statistically significant association between reported exposure to secondhand smoke and subsequent development of lung cancer. 

In some ways the findings aren't a big surprise, the link between passive smoking and lung cancer has always been more emotional than scientific. However, the obsession with this single risk factor has meant that lung cancer receives the smallest amount of research spending of any major cancer - just five per cent of total research spending into the 20% plus of cancer deaths that are from lung cancer. The research bodies have chosen instead to direct resources into campaigns for smoking bans, advertising bans, higher duty and now plain packaging.

The problem isn't that people want to reduce deaths that result from smoking but that they do so knowing that what they say is inaccurate, even incorrect:

...the U.S. Centers for Disease Control and Prevention will tell you that "secondhand smoke causes an estimated 3,400 lung cancer deaths among U.S. nonsmokers each year," scientists have long understood that the actual number might be closer to zero.

All those smoking bans - whether you agree with them or not - were introduced on the basis of, at best poorly understood epidemiology and probably with the absolute knowledge that the claims for passive smoking and lung cancer simply weren't true.

It was always about denormalising smoking:

"The strongest reason to avoid passive cigarette smoke is to change societal behavior: to not live in a society where smoking is a norm."

Of course they didn't give that as the reason when they kicked you out from the bar and onto the pavement, did they!

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A surprising comment about lung cancer...

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From a doctor too:

Nearly 80% of people diagnosed with lung cancer now, in 2012, are non-smokers. All of the anti-smoking campaigns imaginable are not going to make a difference for this 80%.

Maybe a few numbers will make it even clearer. In 2008, the last year from which we have numbers available, there were 158,592 deaths from lung cancer in the United States, including 70,051 deaths in women. (Note that in the same year, there were 40,589 breast cancer deaths in women.) Using the 80% statistic, 126,874 of these deaths could not have been prevented by anti-smoking campaigns.

Perhaps we need to start looking at how we diagnose earlier and treat better rather than incanting the magic words "stop smoking, stop smoking"?

Update: It isn't. of course, quite that simple - here's a little challenge to the good doctor's argument (lifted from the comments below)
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So why is there less research into lung cancer compared to other cancers?

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Here are the statistics from the USA - which is the biggest spender on basic cancer research:

A

Which of course begs the question as to why this is happening:

The stigma of smoking is largely to blame. Anti-tobacco campaigns have, in a way, done their job too well, leading many to see lung cancer as self-inflicted. That stigma keeps some families and patients from speaking out, while corporate donors stay away from the disease, and some scientists and policymakers question whether scarce research dollars should be devoted to a smokers’ illness.

And, of course, the cancer research bodies wouldn't dare take money from the tobacco industry which might actually be interested in funding research into lung cancer! And the situation is the same in the UK:

In 2010 lung cancer attracted 5.5% of funding spent on research into specific types of cancer (£11.8m / £213m), an increase from 3.9% (£6.1m / £158m) in 2006.

Lung cancers are responsible for over 20% of cancer deaths yet research into the disease has lagged behind research into other cancers and especially breast cancer and leukaemia. We can also note that spending on pancreatic, bowel and stomach cancers also lags behind.

The reason for this relative underspend on lung cancer is that the "researchers" strategy has but one club - stop people smoking. Which is a bit tough on the 10-20% of lung cancer patients whose cancer isn't caused by smoking! And - more importantly - for the past ten years the 'stop people smoking' strategy has ceased to work quite as effectively (if at all):

Since 2000 overall adult smoking rates had been declining by around 0.4% per annum.2 Between 2007 and 2009, overall smoking prevalence among adults in Great Britain remained the same at 21%, dropping to 20% in 2010 (21% of men and 20% of women).

It seems to me that - notwithstanding our opinion of smoking - the purpose of public health would be better served focusing on harm reduction, early diagnosis and better treatment than on what seems a pretty futile process of "denormalisation".

But I guess no-one's listening. They prefer just to ban stuff.

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Respect...

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This anonymous comment from my post about the fleece closing closing left me (almost) at a lost for words:

Sorry to hear about the Fleece. Just about to spend a few days in Cullingworth too! As someone who was diagnosed with incurable lung cancer 10 months ago and a life-long non-smoker, aged 46, I am less sympathetic to smokers as nine out of 10 people with lung cancer are or have been smokers. However, smoking is all about personal choice and people should be able to do what they like in their own personal space. A room set aside for smokers in a pub is certainly preferable to allowing people to smoke in a pub garden, where the smoke always seems to waft my way.

Respect...

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