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July 20, 1994

Decreased Cardiovascular Disease and Increasing Cancer-Reply

JAMA. 1994;272(3):199-200. doi:10.1001/jama.1994.03520030039015

In Reply.  —Efforts to find simple explanations for complex patterns are commendable. Dr Lemon carries Ockam's razor to an untenable extreme, however, when asserting that increased cancer risks are caused entirely by active and passive smoking. Like all disease, cancer has multiple causes. Only crude analyses that classified cancer sites, not individual cases, as related or unrelated to smoking were possible. In addition to lung and oral cancers, Lemon and others suggested that the smoking-related category should include pancreas, kidney, blasder, and colon. The Table indicates that even after reclassifying cancer sites, men born from 1948 to 1957 had three to four times the risk of developing cancers unrelated to smoking, and women had a 30% to 40% greater risk than their grandparents had at the same ages. The cancer sites in this new nonsmoking category exhibiting increased risks are brain, breast, lymphoma, melanoma, and prostate.Lemon speculates that all