2014 Surgeon General Report on Smoking Links Tobacco Use to Colon Cancer

12/09/2014

In 1964 Dr. Irving Selikoff published Asbestos Exposure and Neoplasia in the Journal of the American Medical Association. In addition to his findings related to lung malignancies, he wrote the following:

Gastrointestinal Cancer. – Rather to our surprise, the death rate from cancer of the stomach and the death rate from cancer of the colon and rectum were higher among the asbestos workers than would be expected from the rates reported for the US white male population, calculated in the same way as for lung cancer. Twelve deaths from gastric cancer occurred among the asbestos workers, as compared with only 4.3 expected. Seventeen deaths from cancer of the colon and rectum occurred among the asbestos workers, as compared with 5.2 expected.

Gastrointestinal Carcinoma. – Isolated instances of gastrointestinal carcinoma in the presence of asbestosis have been known, but there have been no data to indicate that these were more than coincidental findings. Among the asbestos workers studied here, cancer of the stomach, colon and rectum was three times as frequent as expected. These data suggest that there may perhaps be an etiological relationship between industrial asbestos exposure and carcinoma of the gastrointestinal tract.

In the 50 years since Dr. Selikoff’s paper, the causal relationship between asbestos exposure and colon and other GI cancers has been debated. Some have found an increased risk (ex. Evidence for Excess Colorectal Cancer Incidence Among Asbestos-Exposed Men in the Beta-Carotene and Retinol Efficacy Trial, Aliyu, O, et al, Am J Epidemiol 162 (9): 868-878(1 Nov 2005)) while others have found that the weight of evidence is inconclusive (ex.Asbestos and Colon Cancer: A Weight-of-the-Evidence Review, Gamble, J, Environ Health Perspect 102:1038-1050 (1994)). The National Institutes of Health formed a committee in the early 2000s to review existing evidence and determine the extent of toxicologic support for the development of cancers at selected sites (pharyngeal, laryngeal, esophageal, stomach, colorectal) after asbestos exposure. The committee did not find evidence sufficient to infer a causal relationship between asbestos exposure and colorectal cancer but instead found the evidence to be only suggestive of a relationship (see, Asbestos: Selected Cancers, Institute of Medicine (US), Committee on Asbestos: Selected Health Effects, National Academies Press (2006)). Ultimately, in the 50 years since Dr. Selikoff’s work, medical science has gotten no further than Dr. Selikoff did.

2014 was also the 50th anniversary of another important study: The Surgeon General’s Report on Smoking. On January 11, 1964, Smoking and Health: Report of the Advisory Committee to the Surgeon General of the United States was published. While the report was not the first detailing the health hazards associated with smoking, it was the first such statement by an official of the US government. The findings of the study are now common knowledge: smoking tobacco products causes lung cancer, heart disease, emphysema, and chronic bronchitis.

Unlike the still unsettled question of whether asbestos exposure causes colorectal cancers, the Surgeon General’s report provides some clarity.

The current edition of the Surgeon General’s Report on Smoking, released in January of this year, is significant because more entries are added to the list of diseases caused by smoking. The list now includes Type 2 diabetes, rheumatoid arthritis, macular degeneration, liver cancer and birth defects such as cleft palate and cleft lip. Even more significant for the defense of asbestos cases, an additional cancer was added to the list: colorectal cancer. Dr. Thomas Frieden, director of the Centers for Disease Control and Prevention said that 50 years after the initial Surgeon General’s Report “we’re still finding out new ways that tobacco maims and kills people. Tobacco is even worse than we knew it was.”

For those in asbestos practice, the Surgeon General’s Report made clear that colon and GI cancer cases should be handled as aggressively by defense counsel as smoking lung cancer cases are handled. A detailed smoking history must be obtained from a plaintiff claiming that his or her colon cancer was caused by asbestos exposure because cigarette smoking is now a known cause of that disease. The same cannot be said for asbestos exposure…


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