Objective: The California tobacco control program enacted in 1988 has been associated with declines in smoking and heart disease mortality. Since smoking also causes lung cancer, we investigated whether the program was associated with a decline in lung and other cancer incidence. Methods: Age-adjusted incidence rates of lung and bladder cancer (which are caused by smoking) and prostate and brain cancer (which are not) in the San Francisco-Oakland (SFO) Surveillance Epidemiology End Results (SEER) registry and other eight SEER registries from 1975 to 1999 were fitted in multiple regression analyses accounting for the time lag between program implementation and its effects on cancer incidence. Cigarette consumption over time was also analyzed and related to lung cancer incidence. Results: With a one year lag, the incidence of lung cancer in SFO, relative to eight other SEER registries, fell significantly below that predicted from the pre-1990 rates, by -0.981 (cases/100,000/year)/year (p=0.001). With a three year lag, the incidence of bladder cancer fell by -0.234 (cases/100,000/year)/year (p = 0.066). No association of the program was observed on prostate or brain cancers in SFO. During the first decade, the Program was associated with about a 6% reduction in lung cancer incidence; state-wide that corresponds to about 11,000 cases avoided. Conclusion: A comprehensive tobacco control program is associated with a lower incidence of lung cancer.

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Mutations in the p53 tumour suppressor gene lead to uncontrolled cell division and are found in over 50% of all human tumours, including 60% of lung cancers. Research published in 1996 by Denissenko and colleagues demonstrated patterned in-vitro mutagenic effects on p53 of benzo[a]pyrene, a carcinogen present in tobacco smoke. We investigated the tobacco industry's response to p53 research linking smoking to cancer. We searched online tobacco document archives, including the Legacy Tobacco Documents Library and Tobacco Documents Online, and archives maintained by tobacco companies such as Philip Morris and R J Reynolds. Documents were also obtained from the British American Tobacco Company depository in Guildford, UK. Informal correspondence was carried out with scientists, lawyers, and tobacco control experts in the USA and Europe. We found that executives and scientists at the highest levels of the tobacco industry anticipated and carefully monitored p53 research. The tobacco industry's own scientists conducted research which appeared to cast doubt on the link between smoking and p53 mutations. Researchers and a journal editor with tobacco industry ties participated in the publication of this research in a peer-reviewed journal without clear disclosure of their tobacco industry links. Tobacco industry responses to research linking smoking to carcinogenic p53 mutations mirror prior industry efforts to challenge the science linking smoking and lung cancer. The extent of tobacco industry involvement in p53 research and the potential conflict of interest discussed here demonstrate the need for consistent standards for the disclosure and evaluation of such potential conflicts in biomedical research.

OBJECTIVE: To evaluate the processes and outcomes of tobacco litigation in Argentina and to analyse the strategies of the tobacco industry to oppose litigation using tobacco industry documents. METHODS: A systematic search of tobacco industry documents on the internet dating from 1978 to 2002. Law library searches using Argentinean official and unofficial reports systems were combined with computerised online searches. RESULTS: There have been at least 15 failed litigation cases in Argentina and the tobacco industry presented a concerted defence in every claim regardless of cost. We categorised 11 cases as product liability and nicotine addiction, two as health care reimbursement, and two as criminal law and secondhand smoke. Industry strategies included hiring legal consultants from prestigious international and Argentinean law firms and developing litigation prevention programmes. Industry monitored legal academic meetings, controlled the development of new product liability legislation, obtained favourable opinions from experts, and closely observed the development of litigation in Argentina. CONCLUSION: The strategies used by the industry have been successful in preventing recovery for tobacco injuries through litigation. Argentinean health advocates and lawyers need to be aware of the roles and strategies of the tobacco industry in order to develop effective litigation in Argentina.