journal of men's health
Volume 5, Issue 2 , Pages 116-117, June 2008

Hypothesis: The lung cancer epidemic of American men was shaped by World War I

6 Bayberry Circle, Farmington, CT 06032, USA

Article Outline

 

This issue of the Journal of Men's Health explores the impact of the workplace on men's health. A workplace experience that is unique in scope and nature occurs when an entire generation is drafted into military service in times of war. The survivors carry with them serious physical, mental, and behavioral consequences, among them, at least in Western societies, a new or deepened tobacco and alcohol habit [1]. The lung cancer epidemic of American men, emerging in the 1940s, may have had its roots in World War I.

When the United States declared war on Germany in April 1917, the U.S. army numbered 210,000 men. Conscription was reintroduced (it had ended with the Civil War), eventually affecting all men aged 18–45 years. This brought the strength of the army to more than 3.5 million over the next two years [2]. Almost 1,250,000 of them participated in the final offensive in France [3]. By the end of the war, the American forces had suffered 48,900 battle deaths, 57,000 disease-related deaths and 230,000 wounded [4].

Cigarette consumption in the U.S. rose rapidly during the war years (as it did again during World War II). The years 1916, 1917, and 1918 showed an annual average increase of 36.7%, compared to 10.9% during the 3 years before and 8.7% during the 3 years thereafter [5]. The American Red Cross and other humanitarian agencies supplied cigarettes to the troops at home and abroad. The Red Cross operated 551 service stations in France and 700 canteens in the U.S., with the canteens distributing 70,500,000 cigarettes between July 1917 and February 1919 [6]. Cigarette smoking was becoming fixed among American men [7]. Over the next decade, consumption increased from 44.6 billion cigarettes in 1920 to 119.3 billion in 1930 [5].

Male deaths from cancer of the lung and bronchus rose markedly during the 1940s, to exceed other cancer deaths in the early 1950s. The epidemic peaked around 1990 and has continued to decline steadily since. (Lung cancer deaths of American women began to rise during the 1960s, a pattern suggestive of a World War II origin [8]). Efforts to establish a chronology of exposure based on mortality trends are hampered by changes in the types of cigarettes. Taking these changes into account, a comparison of the amount of cigarette tobacco (instead of cigarette counts) consumed nationally with lung cancer mortality changes suggested a latency of 35 years between exposure and death [9]. Furthermore, there are no national mortality data prior to 1933 when only selected states were included in death registration. However, mortality rates observed by the Metropolitan Life Insurance Company, based on millions of policy holders, show very low death rates due to cancer of the lung and pleura during the first two decades of the century. Rates began to rise slowly during the early 1930s [10].

Longer survival due to improving treatment (surgery, radiation, chemotherapy) rendered mortality trends even more problematic as a proxy measure of lung cancer incidence. National incidence data do not go back beyond 1975, a period needed to assess a temporal connection to World War I. Fortunately, the cancer registry of the U.S. State of Connecticut, the oldest in the country, has monitored state-wide cancer diagnoses since 1935. Age-adjusted 5-year incidence rates for cancer of the trachea, bronchus and lung among men show the most rapid increase, by 59.4%, in 1945–49, with a rate of 22.0 per 100,000 up from 13.8 per 100,000 in 1940–44 [11]. This parallels the rise in cigarette consumption about 25 years earlier during and after World War I. An identical pattern emerged among Connecticut women 25 years after World War II, which had seen millions of women enter the industrial workplace and, thereby, a culture of smoking.

A more detailed analysis of age-specific incidence rates should help clarify to what extent the two World Wars gave rise to the lung cancer epidemics of American men and women.

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References 

  1. Foege WH. Arms and public health: a global perspective. p. 3–11 in Levy BS & Sidel VW (editors) War and Public Health. New York: Oxford University Press, 1997.
  2. MacDonald CB. World War I: The first three years. p. 358–80 in American military history. Washington, DC: Center of Military History, United States Army; 1989. Available at: http://www.history.army.mil/books/amh/AMH-17.htm.
  3. MacDonald CB. World War I: The U.S. Army Overseas. p. 381–404 in American military history. Washington, DC: Center of Military History, United States Army; 1989. Available at: http://www.history.army.mil/books/amh/AMH-18.htm.
  4. Ayers LP. Chapter IX: Health and casualties. in The war with Germany. A statistical summary. Washington, DC: Government Printing Office, 1919, Available at: http://net.lib.byu.edu/estu/wwi/memoir/docs/statistics/stats8on.htm#9.
  5. Centers for Disease Control and Prevention. Smoking and tobacco use. Consumption data. Atlanta, GA: CDC. Available at: http://www.cdc.gov/tobacco/Data_statistics/tables/economics/consump1.htm.
  6. American Red Cross. The work of the American Red Cross during the war. Washington, DC: American Red Cross;1919. Available at: http://www.vlib.us/medical/Arc/ARCintro.htm.
  7. Addison TE. A chronology of tobacco in the civilized world. San Francisco Medicine 1998. Available at: http://www.mindfully.org/Industry/Tobacco-ChronologyJul98.htm.
  8. American Cancer Society. Cancer facts & figures 2007. Atlanta: American Cancer Society, 2007. Available at: http://www.cancer.org/downloads/STT/CAFF2007PWSecured.pdf.
  9. Walker WJ, Brin BN. U. S. lung cancer mortality and declining cigarette tobacco consumption. J Clin Epidemiol. 1988;41:179–185
  10. Dublin LI, Lotka AJ. Twenty-five years of health progress. New York: Metropolitan Health Insurance Company; 1937;p. 560
  11. National Cancer Institute. Forty-five years of cancer incidence in Connecticut:1935–79. National Cancer Institute Monograph no. 70. Bethesda, MD: National Cancer Institute; 1986. p. 304.

PII: S1875-6867(08)00053-5

doi:10.1016/j.jomh.2008.03.001

journal of men's health
Volume 5, Issue 2 , Pages 116-117, June 2008

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