Smoking and Carcinoma of the Lung: Preliminary Report
period journal · 1950
LINK
SUMMARY
Doll and Bradford Hill's 1950 case-control study compared 649 lung-cancer patients with 649 matched non-cancer controls drawn from 20 London hospitals between 1948 and 1950, and reported a strong dose-response association between cigarette smoking and lung-cancer incidence. The paper is the founding modern epidemiological demonstration of a causal disease-environmental association in a major non-infectious disease, and (together with Wynder and Graham's 1950 JAMA paper) the methodological prototype for all subsequent observational-epidemiology investigations of chronic disease. Bradford Hill went on to formalize the criteria for causal inference from observational data in his 1965 Royal Society of Medicine address. Wootton (2006, ch. 13 'At Last, Good Medicine') treats this paper as the inflection point at which modern statistical epidemiology becomes operationally available to medicine; until 1950 the discipline lacked any standard procedure for distinguishing causal claims from artefacts of selection.
NOTES
Richard Doll (1912 to 2005) and Austin Bradford Hill (1897 to 1991) collaborated at the Medical Research Council’s Statistical Research Unit at the London School of Hygiene and Tropical Medicine. The 1950 BMJ paper was followed by their 1954 prospective study of British doctors (BMJ 1954;1:1451 to 1455), which confirmed the case-control findings with substantially stronger evidentiary weight and is the more frequently cited of the two papers. The 1950 paper is the appropriate source for the founding methodological event; the 1954 paper is the appropriate source for the confirmed result. The British Medical Journal has open-access archives back to 1840 and the 1950 paper is available without subscription at the listed URL.