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Comparing 649 men with lung cancer to matched hospital controls in London, Doll and Hill found that almost none of the cancer patients were non-smokers and that risk rose steeply with the amount smoked.
Richard Doll and Austin Bradford Hill interviewed patients with lung cancer and matched controls with other diseases in 20 London hospitals between 1948 and 1949. The preliminary report analysed 649 men and 60 women with lung cancer.
Only 0.3% of male lung cancer patients were non-smokers, compared with 4.2% of controls, and heavy smokers (25 or more cigarettes a day) were far over-represented among cases. The authors concluded that smoking was a factor, and an important factor, in the production of carcinoma of the lung, and set out the case for a prospective study, which became the British Doctors Study in 1951.
Along with Wynder and Graham's US study the same year, it launched the modern epidemiology of tobacco and eventually the tobacco control policies that have prevented more cancer deaths than any treatment.
Doll and Hill's 1950 study is where the evidence that smoking causes cancer begins. Everything from cigarette warnings and tax to smoke-free laws and lung screening eligibility descends from this study and the cohort that followed it.
Smoking is the single largest preventable cause of cancer death, and quitting at any age helps, with the greatest gain from quitting young. Cessation support belongs in every cancer service, including lung screening programmes.
The methodological ancestor of modern cancer epidemiology. Cohort design, exposure recorded before outcome, and a dose-response relationship measured rather than asserted: this is the template every later study of a cancer risk factor follows.
Half of the evidence base on which every tobacco control policy in the world rests. Lung cancer was a rare disease at the start of the twentieth century and the commonest cause of cancer death by its end; this paper and Doll and Hill's are where the cause was named.
Shares Sir Richard Peto, Fifty years of the British Doctors Study: smokers lose ten years of life, quitting gives most of it back, BMJ, Prevention we already have is not deployed.
Shares Evaluate clean-air policies using lung cancer in never-smokers, Lung cancer roadmap: from Doll and Hill and the naming of tobacco, through the cytotoxic plateau, computed tomography screening, EGFR and ALK, immunotherapy by PD-L1, the perioperative trials and PACIFIC, to DLL3 in small-cell disease and a 2032 registry watch, Prevention we already have is not deployed, Lung cancer (all types).
Shares Evaluate clean-air policies using lung cancer in never-smokers, Lung cancer roadmap: from Doll and Hill and the naming of tobacco, through the cytotoxic plateau, computed tomography screening, EGFR and ALK, immunotherapy by PD-L1, the perioperative trials and PACIFIC, to DLL3 in small-cell disease and a 2032 registry watch, Prevention we already have is not deployed, Lung cancer (all types).
Shares Misinformation and unproven therapies, Prevention we already have is not deployed, Lung cancer (all types), Non-small-cell lung cancer.
Shares Fifty years of the British Doctors Study: smokers lose ten years of life, quitting gives most of it back, Prevention we already have is not deployed, Non-small-cell lung cancer.
Shares BMJ, Lung cancer roadmap: from Doll and Hill and the naming of tobacco, through the cytotoxic plateau, computed tomography screening, EGFR and ALK, immunotherapy by PD-L1, the perioperative trials and PACIFIC, to DLL3 in small-cell disease and a 2032 registry watch, Lung cancer (all types), Non-small-cell lung cancer.
Shares Misinformation and unproven therapies, Incentives reward me-too drugs and marginal gains, Prevention we already have is not deployed.
Shares Smoke-free generation laws with a built-in evaluation across countries, Prevention we already have is not deployed.