Us Surgeon General's Report, 1964
Shortly after release of the RCP report, the US Surgeon General set up the Surgeon General's Advisory Committee on Smoking and Health to produce a similar report on the effects of smoking. The tobacco industry was allowed to veto any proposed member of the advisory committee that it deemed was not impartial on the issue of smoking and health. The committee therefore consisted entirely of scientists who had not yet publicly expressed any opinion about the health effects of smoking and who were willing to look impartially at the evidence. After working for fourteen months, the advisory committee released its report in 1964.
The major conclusions of the 1964 Surgeon General's report, Smoking and Health (4), were these:
The Effects of Smoking: Principal Findings
Cigarette smoking is associated with a 70 percent increase in the age-specific death rates of males. The total number of excess deaths causally related to cigarette smoking in the U.S. population cannot be accurately estimated. In view of the continuing and mounting evidence from many sources, it is the judgment of the Committee that cigarette smoking contributes substantially to mortality from certain specific diseases and to the overall death rate.
Cigarette smoking is causally related to lung cancer in men; the magnitude of the effect of cigarette smoking far outweighs all other factors. The data for women, though less extensive, point in the same direction.
The risk of developing lung cancer increases with duration of smoking and the number of cigarettes smoked per day, and is diminished by discontinuing smoking. In comparison with non-smokers, average male smokers of cigarettes have approximately a 9- to 10-fold risk of developing lung cancer and heavy smokers at least a 20-fold risk.
The risk of developing cancer of the lung for the combined group of pipe smokers, cigar smokers, and pipe and cigar smokers is greater than for non-smokers, but much less than for cigarette smokers.
Cigarette smoking is much more important than occupational exposures in the causation of lung cancer in the general population.
Chronic Bronchitis and Emphysema
Cigarette smoking is the most important of the causes of chronic bronchitis in the United States, and increases the risk of dying from chronic bronchitis and emphysema. A relationship exists between cigarette smoking and emphysema but it has not been established that the relationship is causal.
Studies demonstrate that fatalities from this illness are infrequent among non-smokers.
For the bulk of the population of the United States, the relative importance of cigarette smoking as a cause of chronic broncho-pulmonary disease is much greater than atmospheric pollution or occupational exposures.
It is established that male cigarette smokers have a higher death rate from coronary artery disease than non-smoking males. Although the causative role of cigarette smoking in deaths from coronary disease is not proven, the Committee considers it more prudent from the public health viewpoint to assume that the established association has causative meaning than to suspend judgment until no uncertainty remains.
Although a causal relationship has not been established, higher mortality of cigarette smokers is associated with many other cardiovascular diseases, including miscellaneous circulatory diseases, other heart diseases, hypertensive heart disease, and general arteriosclerosis.
Other Cancer Sites
Pipe smoking appears to be causally related to lip cancer. Cigarette smoking is a significant factor in the causation of cancer of the larynx. The evidence supports the belief that an association exists between tobacco use and cancer of the esophagus, and between cigarette smoking and cancer of the urinary bladder in men, but the data are not adequate to decide whether these relationships are causal.
Data on an association between smoking and cancer of the stomach are contradictory and incomplete. (4, pp. 31–32)
After discussing the role of nicotine in tobacco use and recognizing that tobacco use is "reinforced and perpetuated by the pharmacological actions of nicotine" (p. 32), the committee offered the following summary conclusion:
On the basis of prolonged study and evaluation of many lines of converging evidence, the Committee makes the following judgment:
Cigaretter smoking is a health hazard of sufficient importance in the United States to warrant appropriate remedial action [emphasis in original]. (4, p. 33)