Golden anniversary: data on 50 years of smoking in British docs

[Guest guest]

Golden anniversary: data on 50 years of smoking in British docs

Rheumawire

Jun 23, 2004 Nainggolan

London, UK - A British study on smoking and mortality in male

doctors has yielded new information, 50 years after it began. The latest

results appear online June 22, 2004 in BMJ [1], along with the

preliminary findings from the study, which were first published in the

journal in 1954 [2].

Lead author on both the first paper and the new one, 91-year-old

Sir Doll (Clinical Trial Service Unit, Oxford University, UK),

spoke at a press conference in London yesterday, accompanied by fellow

author Sir Peto (Oxford University), who has worked on the study

for the past 30 years.

In an editorial accompanying publication of the 2 papers [3],

epidemiologist Dr Meir Stampfer (Harvard School of Public Health,

Boston, MA), says: The 2 Sir s have been world leaders in the

study of the health effects of smoking, and this latest contribution

represents a stunning achievement. "

The British doctors' studyas it became knownhas followed almost 35

000 male doctors born until 1930, who were monitored and periodically

asked about their smoking habits. The last questionnaire was completed

in 2001; 5900 of the original population were still alive but only 134

of them were still smoking. " A lot were killed by the habit, but a lot

gave up, " Doll commented. He himself smoked until the age of 37.

Doll's 1954 publication was seminalit was one of the first

scientific papers proving a link between lung cancer and cigarette

smoking. However, it was many years before the knowledge filtered down

to the public at large, Doll revealed yesterday. " It was not uncommon

during the early 1970s and beforehand, for me to be interviewed by a

television presenter who was smoking while discussing my findings. It

took the media 20 years to catch up. "

Smoking totally erases the medical progress of the past 50 years

The study was originally supposed to last for only 5 years, " but

then we kept finding other diseases that smoking caused, " Doll said,

" and after 40 years there were 24 diseases clearly caused by smoking. "

Peto explained that these doctors " were the first subjects

followed who smoked seriously from youth. We've got the lifelong story

now and this hasn't been available before. "

" What's happened is extraordinary, " Peto said. " Basically, during

these 50 years, medical progress has been astonishing. The chance that

someone would make it from age 70 to age 90 was only 12% in the 1950s

but this had reached 33% by the 1990s. " But " the effects of smoking

totally nullify medical progress, " he explained. Only 7% of those who

smoke will reach their 90s compared with the 33% who don't.

The 50-year results show that smokers die, on average, 10 years

before nonsmokers and that at least half of all persistent smokers from

youth will be killed by their habit, and a quarter of these will die in

middle age (35-69). " What people are losing [by smoking] is 10 years of

good-quality life, " Peto noted.

In addition, a unique group of men born around 1920 faced even

worse oddssmoking killed two thirds of these people who continued to use

tobacco. They were conscripted into the army in 1939 and given low-cost

cigarettes, which established an early addiction with an intense

exposure to tobacco. In the editorial, Stampfer says this has worrying

implications for the future. " These data are all the more ominous

because the typical age at smoking initiation has continued to decrease

. . the most common age at initiation is now the early teen years. "

But the other clear message from the study is that it is never to

late to quit, Peto said. " A lot of the people in this study stopped

because they read the BMJ and said, 'Bloody hell, this doesn't just kill

patients, it kills doctors too.' "

The 50-year findings show that stopping smoking at age 30 avoids

almost all of the excess mortality risk associated with tobacco use.

However, this should not be used to send the message that it's okay to

start smoking as long as smokers give it up at a relatively young age,

Peto said, simply because the habit is so addictive and it's much easier

to begin than to stop.

But " those aged 40 who think it's not worth stopping are wrong, "

he noted, adding that those who give up at this age will gain an extra 9

years life. Equally, those stopping at age 50 and 60 will gain 6 and 3

years respectively, he added.

Peto also stressed that although this study was carried out in

mensimply because most doctors in the UK were male 50 years agothe

results are equally applicable to women. " If women smoke like men, they

die like men, " he observed.

And while the UK leads the world in smoking-cessation rates, this

does not mean the country can afford to be complacent, Peto said. " We

still run at 1 million deaths due to smoking per decade here, and we are

only 1% of the world's population. "

Worldwide, there will soon be 6 million deaths per year due to

tobacco use, Peto stressed, putting smoking on a parallel with the

HIV/AIDS epidemic. Hence, there is an incredible amount of work to be

done on smoking cessation internationally, with one of the problems

being that in many countries, " doctors smoke almost as much as their

patients, " he concluded.

Sources

Doll R, Peto R, Boreham J, et al. Mortality in

relation to smoking: 50 years' observations on male British doctors BMJ

:DOI:10.1136bmj.38142.554479.AE Available at: http://www.bmj.com

Doll R and Bradford Hill A The mortality of

doctors in relation to their smoking habits. A preliminary report. BMJ

2004; 328:1529-1533

Stampfer M. New insights from the British

doctors study. Risks for persistent smoking are substantially larger

than previously suspected. BMJ 2004; 328:1507.

I'll tell you where to go!

Mayo Clinic in Rochester

http://www.mayoclinic.org/rochester

s Hopkins Medicine

http://www.hopkinsmedicine.org