Evarts A. Graham

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This article is part of the Tobacco portal on Sourcewatch funded from 2006 - 2009 by the American Legacy Foundation.

Dr. Evarts Ambrose Graham was the first surgeon to cure a case of human lung cancer by removing the affected lung. He worked at the Washington University School of Medicine, St. Louis, Missouri, where Ernst Wynder studied immediately after the war circa 1945-49 [1]. Graham was a former president of the American College of Surgeons (pre-1950) [2].

Graham and his student, Ernst L. Wynder, published the results of the first large-scale epidemiology study on smoking and lung-disease in the May 27th 1950 issue of the Journal of the American Medical Association (JAMA), "Tobacco Smoking as a Possible Etiologic Factor in Bronchiogenic Carcinoma." They concluded that "excessive and prolonged use of tobacco, especially cigarettes, seems to be an important factor in the induction of bronchiogenic carcinoma." [3].

Ernst L. Wynder
Dietrich K Hoffman
Evarts A Graham
American Health Foundation
Naylor Dana Institute
Environ. Health & Safety Council
AHF (Doc Index)

In late 1953, Dr. Wynder and Dr. Graham reported the results of a study in which they had painted the backs of mice with cigarette smoke condensate, or "tar." Some of the animals developed skin cancer. In February 1956, Graham reported on another study in which he had painted mice with tobacco tars. The earlier study had been criticized for using only one type of mouse. In the new study, Graham used other strains and also painted rabbits' ears with the tars. The tests successfully induced cancer.[4].

A heavy smoker, Graham died in 1957 of lung cancer. [5]

Documents & Timeline

1945-50 Immediately after the war, Ernst Wynder begins his training at the Medical School, Washington University in St. Louis. In 1950, he received both a bachelor of science and a medical degree.

1946 Wynder conducted an epidemiological study of smoking behavior among 146 lung cancer patients in New York City with funding from the American Cancer Society. Epidemiological studies at this time were fairly rare, and never well done. Wynder's material was an exception.

1947-51 Wynder began collaborating with his teacher, the famous lung surgeon, Evarts Graham in 1947. His study of the hospital patients in the files provided epidemiological proof that cigarettes caused cancer. (They jointly published a ground-breaking paper in the Journal of the American Medical Association (JAMA) in 1950 - his first year out of medical school). Wynder concluded:

"From the evidence presented .. the temptation is strong to incriminate excessive smoking, and in particular cigaret smoking, over a long period as at least one important factor in the striking increase of bronchiogenic carcinoma." [6]

Graham and Wynder collected extensive data on 604 patients with lung cancer at various US hospitals. They applied statistical methods to their data, dividing the patients into categories of "moderate" or "heavy" smokers (derived from retrospective interviews of each patient's smoking behavior). They also controlled confounding factors like, age, types of tobacco use, inhalation level (which was thought to be important at this time). They also compared their dead smokers with a control group of cancer-free individuals in hospitals.

So it is fair to say that by using relatively modern techniques, Evarts Graham and Wynder proved that cigarette smoking was a factor in lung cancer. At this time it was the name of Evarts Graham that made the medical profession take notice. The conclusion was obvious: excessive cigarette smoking carried out for a long period of time (twenty years or more) was the key factor in causing the remarkably increased frequency on bronchiogeneic carcinoma. [7]

1950 May 27 The Journal of the American Medical Association published the resulting scientific report

1950 Confirmation for the Graham-Wynder claims came in the same year, 1950. Richard Doll and Bradford Hill, a celebrated physician and statistician in the UK, published a large scale survey of 709 lung cancer patients which confirmed Wynder's conclusions about cigarettes and lung cancer. Only two nonsmokers were found, leading the investigators to conclude that...

"... smoking is a factor, and an important factor, in the production of carcinoma of the lungs. Only one lung cancer patient in 200 was a non-smoker, as compared with one in 22 among the controls." (Furthermore, the researchers found ample evidence of dose-response:)

"The risk of developing carcinoma of the lungs increases steadily as the amount smoked increases … it may be approximately 50 times as great among those who smoke 25 or more cigarettes a day as among non-smokers."



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  1. (E. Whelan 1984)
  2. (Merchants of Death, 1988)
  3. (L. White, Merchants 1988)
  4. (L. White, Merchants of Death, 1988)
  5. (E. Whelan 1984)
  6. Wynder EL, Graham EA. Tobacco smoking as a possible etiologic factor in bronchogenic carcinoma . JAMA 143 :336-338 (1950).
  7. Graham EA. Primary cancer of the lung with special consideration of its etiology. Bull NY Acad Med 1951 May
  8. Doll R, Hill AB. Smoking and cancer of the lung. Br Med J 1950;2:739-748 (1950).