Cigarettes to blame for rising cancer deaths: Effects of smoking filter through as oral surgeon condemns 'ignorance' and Liverpool acts on stake in BAT. Celia Hall reports

A CANCER epidemic is taking place in England and Wales, according to senior scientists. It is caused by smoking, particularly the strong unfiltered cigarettes earlier this century.

But if the lung cancers are discounted, there is no overall rise in incidence, except for some specific cancers, says Dr David Coggan, of the Medical Research Council's environmental epidemiology unit at Southampton University.

He says there is 'no evidence that toxic hazards such as pesticides, chemical waste and other forms of industrial pollution have had a major impact on overall rates of cancer'.

In England and Wales in 1992, a total of 145,153 people died from cancer, a rate of 281.1 per 100,000 compared with 118,953, at a rate of 241.2, in 1972.

Broken down, the rates for men were 300.6 in 1992 and 268.6 in 1972, and for women 262.5 in 1992 and 215.2 in 1972. Figures from the office of Population Censuses and Surveys show that in 1961 male deaths from lung cancer were at a rate of 86.9 per 100,000 compared with 91.2 in 1992. The rate began to decline in the late 1980s.

For women the rates for lung cancer were 13.9 in 1961 compared with 42.2 in 1992. This rate is still rising.

Dr Coggan, who has made an analysis of cancer deaths by age, says in tomorrow's British Medical Journal: 'It becomes clear that the generation of men born just after the turn of the century has experienced peak mortality from lung cancer at all ages.

'In women the pattern is similar but displaced so that the highest death rates occur among those born in the 1920s. The rise in mortality can be attributed to the uptake of smoking which reached its maximum later in women than in men.

'Once deaths from lung cancer are discounted there is no evidence that total cancer mortality is increasing at any age,' he says.

Dr Coggan and Hazel Inskip, a statistician in the unit, say that deaths from stomach cancer - which as recently as 1952 was a greater killer in England and Wales than lung cancer - have reduced by 60 per cent. Success in treating lymphoma and testicular cancer has also had an impact on deaths.

The researchers point to more fresh fruit and vegetables in the diet, and greater use of refrigeration instead of the use of salt as a preservative as two reasons for the decrease in stomach cancer.

Another has to do with the link now made between stomach cancer and the bacterium Helicobacter pylori.

'Other research has shown that infection by H pylori is most common in people brought up in overcrowded houses . . . This suggests that the decline in stomach cancer could also be a long-term consequence of improvements in housing which have led to reduced transmission of H pylori.'

Dr Coggan says an increase in cancer of the brain and nervous system cannot be easily explained. Deaths have increased in men and women, particularly in those aged 70 to 74. In this group rates have risen sixfold between 1950 and 1989.

Similar trends are seen in America, Italy, Japan, France and Germany. He says that overall exposure to radiation is 'insufficient to have had a major impact on brain cancer incidence' and doubts whether exposure to magnetic fields has been an influence.

'Very little is known about the cause of brain cancer,' Dr Coggan says.

(Photograph omitted)