FORCES - SMOKING DOES NOT CAUSE MULTIPLE MYELOMA

When the Mills study of multiple myeloma among Seventh-Day Adventists claimed in 1990 that smokers had over three times the risk of non-smokers, the national media eagerly trumpeted it as yet another new danger of smoking. This was despite the fact that previous studies actually found a slightly reduced overall risk among smokers, and that Mills' 21 cases represented not even 3% of the multiple myeloma cases studied to that date. It's a classic "little tiny study with a great big headline."

Just as important is the basic epidemiological principle that cases and controls should be as ALIKE as possible except in the condition or protocol being studies. Seventh-Day Adventists are not representative of the general population. Their drinking, smoking, dietary and exercise habits are well outside the parameters of the population at large. In effect, using them as a "control group" is not only scientifically unsound; it borders on the absurd..

What is more, even Mills et al. later admitted that "recent evidence from this study has indicated the presence of substantial 'healthy volunteer effect' during the first few years of follow-up, suggesting that it may be inappropriate to compare participants in a study such as this with the general population."

Judging by its discrepant finding, which doesn't even agree in direction with others, it probably has a "healthy volunteer effect" operating internally as well, involving the from-birth Adventists more than the converts from whom most of the smokers and ex-smokers were drawn.

Most importantly, this Adventist study has been the basis of major anti-smoking propaganda, namely the Repace and Lowrey claim of 5,000 deaths (Environ Int 1985;11:3-22). But the antismoker and the mainstream media have never retracted their false claim.

* Mills PK et al. History of cigarette smoking and risk of leukaemia and myeloma: Results from the Adventist Health Survey. JNCI 1990;82:1832-1836. 21 cases <5 cigs per day 3.58 (0.95-13.50); 5-14 2.26 (0.47-10.80); 15+ 3.63 (1.17-11.25).

* Linet MS et al. Is cigarette smoking a risk factor for non-Hodgkin's lymphoma or multiple myeloma? Results from the Lutheran Brotherhood Cohort Study. Leuk Res. 1992 Jun-Jul; 16(6-7): 621-624. 21 Cases. Ever 1.3 (0.4-3.9), no dose-response.

* Hammond EC, Horn D. Smoking and deaths rates - Report on forty-four months of follow-up of 187,783 men. II. Death rates by cause. JAMA 1958 Mar. 15;166(11):1294-1308. 28 cases. Regular smokers 0.66.

Gallagher RP et al. Allergies and agricultural exposure as risks factors for multiple myeloma. Br. J Cancer 1983;48:853-857. 84 cases, 0.48 not significant.

Williams RR, Horm JW. Association of cancer sites with tobacco and alcohol consumption and socioeconomic status of patients: Interview from the Third National Cancer Survey. JNCI 1977 Mar; 58(3):525-547. 40 male cases, by amount smoked: 0.97, 0.37, 1.0; 46 females, 1.25, 2.26, 0.65.

Linet MS et al. A case-control study of multiple myeloma in whites: Chronic antigenic stimulation, occupation, and drug use. Cancer Res. 1987;47:2978-2981. 100 cases, male & female. "No increased risk was found for cigarette smoking," no detail.

Flodin U et al. Multiple myeloma and engine exhausts, fresh wood, and creosote: A case-referent study. Am J Ind Med 1978;12:519-529. 131 cases, male & female. Current smokers 0.78 (0.4-=1.3).

Brown LM et al. Smoking and risk of non-Hodgkin's lymphoma and multiple myeloma. Cancer Causes Control 1992;3:49-55. 173 cases. Any tobacco 1.0 (0.7-1.6); cigarettes only 1.3 (0.8-2.0).

* Boffeta LM et al. A case-control study of multiple-myeloma nested in the American Cancer Society prospective study. Int J Cancer 1989;43:554-559. (CPS-II) 282. Ever 0.9 (0.6-1.3) Mantel-Haenszel; 0.9 (0.6-1.4) logistic regression.

* Heineman EF et al. A prospective study of tobacco use and multiple myeloma: evidence against an association. Cancer Causes Control 1992;3(1):31-36. Cases = 582 male veterans. Current 0.9 (0.8-1.2). No dose-response.

Herrinton LJ et al. (comment) Smoking and multiple myeloma. Cancer Causes Control 1992 Jul; 3 (4):391-392. 689 cases. Current 0.8 (0.7-1.1) all respondents; 0.7 (0.5-0.9) self-respondents.

Brownson RC Cigarette smoking and risk of myeloma (letter re Mills). JNCI 1991;83:1036-1037. 824 cases. Ever 1.03 (0.85-1.25) no dose-resp.: <20 1.07 (0.73-1.58), 20+ 1.03 (0.77-1.37).

* = prospective study.

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Courtesy of Carol Thompson 08/23/93
Smokers' Rights Action Group
P.O. Box 259575
Madison, WI 53725-9575
Phone: 608-249-4568