Smoking Causes Cancer

https://www.allendowney.com/blog/2023/12/12/smoking-causes-cancer-2/

by alexmolas • 3 years ago

89 124 3 years ago

aldarion• 3 years ago

Didn't know that there was anyone arguing it doesn't, but... nice article.

dekhn5• 3 years ago

Fisher, one of the great statisticians, argued that insufficient evidence existed to conclude with certainty that smoking causes cancer.

https://pubmed.ncbi.nlm.nih.gov/2000852/

After that, a number of well-designed experiments on rodents demonstrated that smoking causes (strong causation) cancer (in rodents) beyond a reasonable doubt (as in, if you disagree, you'd better bring some impeccable data).

alexmolas2• 3 years ago

Is this Fisher the one that proposed the "p<0.05" rule?

hughw• 3 years ago

Judea Pearl wrote a book, Causality, introducing Bayesian networks to address the inadequacy, even refusal, of Fisher's statistics to model causes and effects. Here's a lecture he gave almost 30 years ago [1] that's entertaining and accessible. He mentions the tobacco issue and Fisher specifically.

[1] http://bayes.cs.ucla.edu/BOOK-2K/causality2-epilogue.pdf

rdedev• 3 years ago

Fisher was a smoker too right? Pretty sure his bosses played a part too

latchkey4• 3 years ago

Both my parents are lifelong smokers from their early teens and were a year or two apart in age.

My mom died of lung cancer at 54.

My dad is still going strong at 77 and smokes Camel unfiltered.

Humans are weird.

Regardless, you don't want to die from lung cancer. It is pretty horrible. Your body attacks itself, fluid collects in the lungs, it is painful, and you basically drown from within. Your only option is high doses of morphine and one day you just don't wake up. I wouldn't wish that on anyone.

hinkley• 3 years ago

People always talked about how long George Burns survived as a cigar smoker, but luck, genetics and how much you inhale all alter your risk profile. Cigar smokers tend not to inhale, but they still expose their throats and stomachs to all that smoke. Throat cancer sounds terrible.

Camel unfiltered is some sort of statistical anomaly. Hope for those genes.

latchkey4• 3 years ago

Camel unfiltered is some sort of statistical anomaly. Hope for those genes.

Never mind the addition of both of my parents alcohol abuse. My dad's mom lived to nearly 100. Lost one lung to cancer. It must be genes.

I've never smoked a day in my life (except all the 2nd hand growing up) and I'm on the generally more healthy side of life, I bet I die from some sort of cancer. ¯\_(ツ)_/¯

AceJohnny2• 3 years ago

A former colleague died of throat cancer. He was an avid tobacco chewer.

andrewinardeer2• 3 years ago

My understanding is that George Burns only brought the cigar in as a prop towards the tail end of his career.

rootusrootus• 3 years ago

Good friend of mine never smoked in his life, aside from cigars. Didn't inhale. One day he developed a cough, went to the doctor, diagnosed with throat cancer. Died about 9 months later, at 55 years old.

Some people are like George Burns. Some are definitely not.

mongol• 3 years ago

Throat cancer is no fun either. Also associated with smoking. Eventually you can't swallow and basically start starving to death.

NikolaNovak• 3 years ago

We are, sadly,practically twins in this.

My mom died from lung cancer at 50. Horrible horrible way to go. My dad is 79 and (thankfully) going reasonably well. Bit started smoking in early early teens ;-(

gerdesj2• 3 years ago

My mum never really smoked. She died from cancer (a rather cruel, ladies only one to start with. A reprieve with all clear and then it re-appeared after 18 months, and went berserk) around 30 years ago.

My dad did smoke for around 30 years but just stopped in the mid eighties. He's still with us but at one point a few years back a surgeon gave him a heart massage - as in heart in hand - and he came back. Long story!

I am 53 as of Pearl Harbour day. I smoked for around 30 years (I've double checked all these 30 year timescales). I gave up April 2018. My personal message is that the effects of smoking can be rather insidious. You don't notice the shortness of breath for years until you realise it isn't normal. You might blame it on getting older or less active or whatever but it isn't.

I gave up when I had obvious trouble breathing in bed after yet another chest infection. Five and a half years later I am much better off but still have snags. I will be visiting a doc soon and expecting a diagnosis of a variety of COPD. I will also be asking for a PSA test sigh. I can run up hill a way etc but I run out of puff very quickly. Even if you avoid cancer itself, the other side effects are ... insidious.

On the bright side, I'm roughly £3-4000 per year better off, have a sense of smell and taste and still going 8)

gedy• 3 years ago

Yeah my mother has been smoking since Kennedy was president, and she's still going. I do think that even without cancer or emphysema, the quality of her life is poor. My wife plays sports with ladies older than my mom and it's a bummer to see mine unable to do much.

latchkey4• 3 years ago

Agreed. While my dad is still alive, he has all the textbook ailments from being a lifelong smoker / drinker. His quality of life is shit. His legs are swollen red tree stumps, skin is splotchy and very thin/prone to bruising/bleeding, overweight, can't walk more than a few feet without getting winded, who knows what's internal, but he spent 6 months in the hospital with a mrsa infection. Brain function is also clearly diminished. I love him a lot, but there is no way that I want to end up anything like him.

Just looking at him, it was easy for me to stop drinking entirely. It is poison.

jejeyyy77• 3 years ago

the vast majority (90%) of lifelong smokers never develop lung cancer.

kbelder• 3 years ago

This is an important point, and making it doesn't mean you condone smoking.

"A study in Preventive Medicine Report looked at the risk of smokers developing lung cancer. The researchers found that the average risk for nonsmokers over the study period was 1.8% for males and 1.3% for females. The risk jumped to 14.8% for males and 11.2% for females in current smokers. However, the study did not take into account the number of cigarettes each person smoked per day."

https://www.medicalnewstoday.com/articles/smoking-lung-cance...

It's higher than 10%, but still, doesn't happen to most smokers. That's why so many of the anecdotes in this thread... person X smoked and lived to 90, person Y smoked and died at 35... don't make a strong point, other than cancer is purely a game of odds, and smoking increases risk by 5-10 times. Still, it shouldn't be surprising if somebody smokes and doesn't get lung cancer. That's the most likely outcome.

000ooo0003• 3 years ago

My old man is over 70 now, lifelong smoker. One of his first jobs in his mid-teens was breaking up asbestos lining in steel moulds/pipes, and he sometimes tells me of the slew of now-banned chemicals his old man would use around the home, e.g. IIRC, some kind of pest detterent powder he would sprinkle handfuls of in the pantry, which was some variety of DDT. It's crazy to me that he's still going; I still expect a call some day, "well, turns out it's got me".

WolfeReader2• 3 years ago

Also, alcohol causes cancer.

https://www.cancerresearchuk.org/about-cancer/causes-of-canc...

tensor• 3 years ago

Also food causes heart disease, and cancer.

WolfeReader2• 3 years ago

"Alcohol" and "smoking" are pretty specific terms, in a way that "food" is not. The first two refer to IARC Group 1 carcinogens, specifically.

monero-xmr3• 3 years ago

I agree that alcohol increases cancer but can you find any statistics of the increase of each cancer vs. non-drinkers? Like “cancer X is 1% for non-drinkers and 3% for drinkers” but I can never find this.

anothernewdude2• 3 years ago

Could you show me the cancer rates of non-eaters?

hn72774• 3 years ago

There are some pushes to label it as a carcinogen similar to tobacco

ekianjo2• 3 years ago

Yup and nobody talks about it... or not nearly enough. It kills way more than cigarettes.

michaelmrose2• 3 years ago

Stats seem to say 140K to alcohol and 480k to smoking. Keep in mind that this is with a MASSIVE push to reduce smoking if we party like its 1990 and project current deaths vs the death rate to smoking we had in 1990 we would be seeing over 800k today.

https://ourworldindata.org/grapher/death-rate-smoking?countr...

https://www.cdc.gov/tobacco/data_statistics/fact_sheets/heal...

https://www.niaaa.nih.gov/alcohols-effects-health/alcohol-to...

Scoundreller2• 3 years ago

I always found the de-alcoholization of mouth wash a bit interesting. Seemed to happen a little after big tobacco lawsuits. Almost like they know something and worry about it.

As with coca-cola decreasing bottle sizes (before that was the cool thing to do). We went from 591mL to 500mL. And new smaller cans in addition to the 355mL cans (222mL). Huge promotions on Coke Zero. Decreased the sugar content in the regular product. https://www.cbc.ca/news/health/why-coke-is-lowering-its-suga...

pelagicAustral2• 3 years ago

I quit for the longest of time...(started at 16), all of the sudden I found myself in Colombia, and all the restrictions I've gotten used to (no smoking in public places, etc) where non-existent. Further more, the packing of the cigarettes was still all branded, almost no warnings, and all kinds of 'clicky' flavored types. Don't want a whole pack? no problem, we got you! Buy singles on every corner...

Needless to say I started smoking again... I then quit again for a few years... went to northern Africa, and guess what? People literally smoking at the airport, £1 packs of camel, etc...

I haven't had one in a bit now... People think the restrictions don't work, but they absolutely do.

hankchinaski• 3 years ago

I stopped smoking when I moved to the uk. A pack of 20 is 4 times as much as it is back in Spain or Italy. That alone made the trick

pelagicAustral2• 3 years ago

Absolutely, and I love it. No branded packs, no flavored cigarettes, no menthol, huge horrendous depictions of what you're exposing yourself to, £12 a pack, cannot smoke near public buildings, cannot smoke in public places, etc... This is beautiful. I will never stop saying, please, tax me on this crap, tax me more.

jkubicek• 3 years ago

People think the restrictions don't work, but they absolutely do

It's wild to me that people make assertions like this. We can (and should) argue about the effectiveness of smoking restrictions on decreasing cancer and heart disease, but to make the argument that they have no effect is just silliness.

You hear the same arguments from the right whenever gun control, environmental protections or really any sort of government regulation comes up, and from the left (though to a much lesser degree) on the topic of tax rates. We should all be able to agree that any sort of regulation will have a marginal effect, and be able to have a discussion about the level of that effect.

objektif5• 3 years ago

How about legalizing drugs? Somehow people believe that it is going to magically work.

Freedom2• 3 years ago

I was always under the impression from people here on HN that regulation stifles the free market, one of the pillars of the US. This in turn negatively affects innovation, impacting jobs and sectors across the country.

Is this no longer the case?

ohthatsnotright• 3 years ago

Counter-dote: I started smoking when deployed. It took me a few years to quit and that was a smoking -> chew -> patch/gum -> nothing.

No restrictions on sale other than 18+ (I was 24 when I started), and inside public places were only restricted a few years after I came back so I smoked a fair bit in local bars.

Smoking and similar habits are such a wild spectrum you can't prescribe any one thing and restrictions might help some who are prone but aren't really a cure.

thefz• 3 years ago

Now that we are no longer used to smell the smoke, even getting close to someone smoking a cigarette makes me nauseous. Does not work with rolling tobacco, though.

ternus• 3 years ago

Tangential, but if you haven't had your house tested for radon, I strongly recommend it. Radon is a radioactive decay product of uranium in rock and soil, naturally accumulates in houses, and is the second leading cause of lung cancer in the US after smoking.

I got a RadonEye meter to check the levels in my old place. It was around 4 pCi/l, which is apparently equivalent to smoking a pack a day in terms of relative cancer risk. After adding some ventilation, it dropped to lower than 1. Great.

The next place I moved into had a radon level of 14+ (!!) pCi/l. I couldn't believe the meter reading, so double-checked with another meter, which produced the same result. Got a radon mitigation system installed.

Seriously, check it out, especially if your place sits below grade or you live in a risk area. It could save your life.

000ooo0003• 3 years ago

Thank you for posting this. Had never heard of such things.

zdragnar2• 3 years ago

This and the sibling comment boggle my mind. Around here, it seems like requesting a radon test is standard when looking at buying a house. Installing radon mitigation is likewise relatively straight forward.

Are basements less common out there? Maybe it's just because we tend to have basements that are made into livable space, where the risk of exposure is higher.

ct0• 3 years ago

Its extremely common, and usually part of the inspection when buying and selling a home.

colordrops2• 3 years ago

Identical situation. In the hills of LA, bought a house, tested at 14+. Down below 2 most of the time after mitigation. Found out the hills of LA are one of the radon hotspots in California. I talked to many real estate agents, contractors, and neighbors and no one is aware of it, no one took me seriously, and generally no one wants to hear about it.

evanreichard• 3 years ago

Definitely recommend. We were at around 14 (pCi/l) as well. Peaks up to 20. Got an active mitigation system installed last year for around $1k. Hasn’t exceeded 2 since.

Unforeseen benefit of no longer having to run my dehumidifier this summer. So it’ll end up paying for itself in electricity cost after maybe a decade hah.

ryandvm• 3 years ago

Do you guys live in abandoned missile silos?!

robwwilliams2• 3 years ago

If you think that’s the stupidest thing you’ve ever heard, you can take it up with Sir Ronald Fisher, who actually made this argument with apparent sincerity in a 1957 letter to the British Medical Journal. I mention this in case you didn’t already know what an ass he was.

Not only did Fisher state this, and not only was he an ass, but it is almost embarrassing —it turns out he was partly right. You can read all about it in Pearl’s gem The Book of Why.

In essence Fisher argued that there could be a confound between the neurochemical and behavioral propensity to smoke, and the risk of developing lung cancer.

And strange as it seems to me, the DNA variant in CHRNA5 that is most highly associated with higher risk of nicotine addiction also modulates (independently) lung cancer risk. His principle was kinda-sorta defensible for an avid smoker.

Mendelian randomization of people by their CHRNA5 gene status can indeed demonstrate that Fisher was wrong. The majority causal risk is in fact smoking.

npunt• 3 years ago

Interesting! Within almost every truth there lurks a valid but ultimately very minor counter-point.

Sorta a tangent here, but it's annoying that this is the very thing that causes people biased to not believe to latch onto as evidence they're right. Once introduced, further reasoning or curiosity about the subject tends to stop before weighing matters of degree, which leads to missing the big picture.

To generalize a lot, this is kinda where we are in the current meta of truth fracturing. Our biases drive us to discover nuances we grasp onto to avoid believing what we don't want to.

gweinberg• 3 years ago

The idea that there's some confounding factor isn't in itself implausible, but a factor of 16 increase in risk is huge. Of course, to really be sure you should also look at how lung cancer risk and smoking correlates between countries, and within a country over time. And you can segment the population by sex and ethnicity. Oh and also look for a dose-dependent effect, very important. Heavier smokers should be at a higher risk.

Of course, the link between cancer is smoking is even stronger if some of the "non-smokers" were exposed to an increased level of cigarette smoke.

robwwilliams2• 3 years ago

With Mendelian randomization a genotype can be used as an instrumental variable if it is causally linked to the trait (usually as part of a genome-wide “association” study)—lung cancer in this case. this can provide reasonable assurance of causality. See Book of Why.

neonate• 3 years ago

https://web.archive.org/web/20231212174055/https://www.allen...

andrewinardeer2• 3 years ago

I think the question of our time is does vaping cause cancer?

Zaskoda2• 3 years ago

We'll find out.

bottled_poe• 3 years ago

I’d put my money on yes, but at a far lower risk than smoking.

Zaskoda2• 3 years ago

I think it has to be said, correlation is not causation. While I believe that in this case it's almost certainly true, it's still not scientific to claim that it is indeed true until you can prove causation.

When you do the math, it turns out that 100% of people who confuse correlation with causation end up dead. Dangerous stuff.

YokoZar3• 3 years ago

The author addresses both of the possible reasons that correlation and causation could be unlinked here (reverse causality and common cause). Did you have a comment about them?

_cs2017_2• 3 years ago

The author is a PhD in CS from Berkeley and teaches data science at a (decent I think?) college. And yet, he writes completely incorrect statements about statistics. Why?

"(1) that the supposed effect is really the cause, or in this case that incipient cancer, or a pre-cancerous condition with chronic inflammation, is a factor in inducing the smoking of cigarettes, or (2) that cigarette smoking and lung cancer, though not mutually causative, are both influenced by a common cause, in this case the individual genotype."
If you think that’s the stupidest thing you’ve ever heard, you can take it up with Sir Ronald Fisher, who actually made this argument with apparent sincerity in a 1957 letter to the British Medical Journal. I mention this in case you didn’t already know what an ass he was.

Of course, it's very possible that there's a common cause. For example, people who are very depressed may choose to smoke, and depression may also cause cancer. I'm not saying it does, I'm just saying it's clearly a possibility that needs experiments to disprove.

The author's claim is so wrong, and yet he seems to genuinely believe it.

YokoZar3• 3 years ago

Wouldn't we need, like, evidence or something to believe that possibility?

We have mountains of direct evidence with underlining theory for the straightforward explanation. Sometimes we need to believe that evidence.

_cs2017_2• 3 years ago

No, you don't need evidence to prove that this is a possibility. You only need evidence to claim that this is impossible.

jll29• 3 years ago

It also seems unprofessional to call Sir Fisher an "ass", which is called an ad-hominem attack (attack on the person is obviously not a valid logical argument), and one of a dead person at that.

Fact is: Fisher made fundamental contributions and the poster himself uses these on a daily basis: "Student" [Gossett]'s t-distribution, Fisher's linear discriminant, a precursor of linear discriminant analysis, ANOVA, Fisher information, Fisher's scoring, Minimum Fisher information, the F-distribution, Fisher–Tippett–Gnedenko theorem, the Fisher-Yates shuffle algorithm, the von Mises–Fisher distribution, inverse probability, Fisher's permutation test Fisher's inequality, sufficiency of a statistic, and more. His contribution to biology are even more impactful.

It also happens that Fisher was a proponent of the "Frequentist" interpretation of probabilities, whereas the poster belongs to the recently more popular "Bayesian" camp of ideology (yes, ideology, if you think statistics as a part of mathematics is free from that, welcome to real life!).

He further held strong views about races, perhaps because he was a professor of eugenics (which we today know as incorrect unscientific nonsense, but obviously that was not the state at the time), and there is am ongoing controversy regarding whether he was a racist or not. What I read about him suggests to me I may not have liked him, but to just stamp him as "ass" wihtout elaborating is too cheap for a statistcs professional in my view. But then this is a personal blog, where the poster can write whatever he wants under US law.

spurgu• 3 years ago

eugenics (which we today know as incorrect unscientific nonsense

How is it nonsense? I am not that knowledgeable on the topic but to me the biggest issue (outside of moral ones) is the decrease in genetic diversity. Is there anything else in particular you have "scientific" qualms with?

So to me it's not "nonsense" but rather "problematic, and moreso the further you take it".

seccess• 3 years ago

"Finally, looking at that figure you might wonder why the relative risk of smoking has increased so much. Based on my first pass through the literature, it seems like no one knows. There are at least three possibilities:

- Over this period, cigarettes have been reformulated in ways that might make them more dangerous.

- As the prevalence of smoking has decreased, it’s possible that the number of casual smokers has decreased more quickly, leaving a higher percentage of heavy smokers.

- Or maybe the denominator of the ratio — the risk for non-smokers — has decreased."

My first thought was "second hand smoke". My logic is, when smoking was more normalized, non-smokers were exposed to some of the same risk as smokers due to smoking indoors, etc, resulting in higher rates of lung cancer among non-smokers.

crdrost• 3 years ago

Slight change to the description:

"Sometimes interpreting data is easy. For example, one of the reasons we know that smoking causes lung cancer is that when only -6dB of the population smoked, +6dB of people with lung cancer were smokers. If you are a doctor who treats patients with lung cancer, it does not take long to notice numbers like that."

What was the change? +12dB or 10^1.2, which is 16x.

This ties into the odds form of Bayes' theorem given in the post; this representation of probability is

    dB(p) = 10*log10(p/(1-p))
    p(dB) = 10^(dB/10) / (1 + 10^(dB/10))

so roughly 0dB = 50%, 5dB = 75%, 10dB = 90%, 20dB = 99%, 30dB = 99.9%...

bentt• 3 years ago

"...the pre-cancerous condition with chronic inflammation, is a factor in inducing the smoking of cigarettes,"

The author mocks this possibility, but the causes of chronic inflammation are not entirely understood, and it is linked with depression, cancer, obesity, stress, and a lot of other human conditions. We can't rule out that a stressed out person might want to smoke, be more likely to get addicted, and also have chronic inflammation which opens the door to the development of uncontrolled malignancies.

Still, don't smoke.

yread• 3 years ago

Note that vaping also causes DNA damage and cancer (and addiction).

https://www.pnas.org/doi/10.1073/pnas.1718185115

Smoking actually kills more people by causing heart disease than by causing cancer. But the risk isn't that much increased.

Smoking Causes Cancer

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