The U.S. Surgeon General's report on smoking and health

Historical milestone — this page describes an event dated 1964. It is not current breaking news.

How the committee was assembled

The evidence had been building for thirty years. Through the 1930s, 1940s and 1950s, epidemiologists used large surveys to link rising lung cancer deaths to smoking. Pathologists confirmed it in tissue. The National Library of Medicine's account is blunt about what those studies showed. Smoking, not air pollution, asbestos or radioactive material, was the chief cause of the century's rise in lung cancer.

In 1957 Surgeon General Leroy Burney had already declared a causal relationship the official position of the US Public Health Service. It did not move the country.

What moved it was a report nobody could accuse of bias. In June 1961 the American Cancer Society, the American Heart Association, the National Tuberculosis Association and the American Public Health Association wrote to President Kennedy asking for a national commission. On 7 June 1962, Surgeon General Luther Terry announced one.

The design of that committee was the clever part. Terry took nominations from the four health groups. He also took them from the FDA, the Federal Trade Commission, the American Medical Association, and the Tobacco Institute, the industry's own lobby. Ten members were chosen across medicine, surgery, pharmacology and statistics. Anyone who had taken a public stand on tobacco was ruled out.

They met at the National Library of Medicine in Bethesda from November 1962 to January 1964. With over 150 consultants, they read more than 7,000 scientific articles.

What it said

Terry released Smoking and Health: Report of the Advisory Committee to the Surgeon General on Saturday 11 January 1964. He picked a Saturday to limit the hit to the stock market and to reach the Sunday papers.

The findings were specific. The report held cigarette smoking responsible for a 70% rise in the death rate of smokers over non-smokers. It put the lung cancer risk of average smokers at nine to ten times that of non-smokers. For heavy smokers it was at least twenty times. Risk rose with the years smoked and fell after stopping.

It named smoking as the most important cause of chronic bronchitis. It pointed to links with emphysema and heart disease. It noted that smoking in pregnancy lowered average birth weight.

On one point it flinched. The committee wrote that the tobacco habit was habituation rather than addiction. The addictive properties of nicotine were not yet established. That call took decades to correct.

Terry recalled later that the report "hit the country like a bombshell."

What the evidence says now

NCI's current position is far broader than lung cancer. Smoking causes cancer of the lung, esophagus, larynx, mouth, throat, kidney, bladder, liver, pancreas, stomach, cervix, colon and rectum. It also causes acute myeloid leukemia.

Tobacco smoke contains more than 7,000 chemicals, of which at least 250 are known to be harmful, including hydrogen cyanide, carbon monoxide and ammonia.

Cigarette smoking and exposure to tobacco smoke cause about 480,000 early deaths a year in the United States. About 36% of those are from cancer. About 39% are from heart disease and stroke, and 24% from lung disease. Death rates among smokers are roughly three times those of people who never smoked.

What stopping is worth

NCI puts numbers on this too, drawn from the US National Health Interview Survey. People who quit between ages 25 and 34 live about 10 years longer than those who keep smoking. Quitting between 35 and 44 gains about 9 years. Between 45 and 54, about 6 years. Between 55 and 64, about 4 years.

People who quit at 45 to 54 cut their chance of early death by about two-thirds. One study followed people aged 70 and over. Even smokers who stopped in their sixties had a lower risk of death than those who kept going. Our guide to quitting smoking covers the methods with evidence behind them.

Lung cancer today

SEER publishes the American Cancer Society's projection of 229,410 new US lung and bronchus cancer diagnoses and 124,990 deaths in 2026. SEER's own five-year relative survival across all stages, for 2016 to 2022, is 29.5%.

By stage, in that same span, it is 65.5% for localized disease, 38.2% for regional disease and 10.5% for distant disease. Only 24% of cases are found while still localized; 51% are already distant. These are group figures over past years and describe no individual. Our page on lung cancer covers types and treatment.

When to get checked

Screening with low-dose CT is offered to a defined high-risk group. Symptoms are separate, and worth an appointment when they persist:

• A cough lasting more than three weeks, or a change in a long-standing cough
• Coughing up blood, even once
• Breathlessness that is new or getting worse
• Chest or shoulder pain that does not settle
• Repeated chest infections
• Unexplained weight loss, hoarseness, or persistent fatigue

Our guide to lung cancer screening sets out who qualifies for a scan.

What this does not mean

• The 1964 report described risks in the smokers of that era, with the cigarettes of that era.
• The committee's judgment that nicotine was habituation rather than addiction was wrong, and it was later reversed by the Surgeon General's office.
• A twenty-fold relative risk is not a twenty-in-twenty chance. Most heavy smokers do not develop lung cancer, and some non-smokers do.
• The gains from quitting are averages. They do not predict any one person's outcome. They are not a reason to put off stopping at any age.
• Smoking causes far more than lung cancer. Judging tobacco risk by lung cancer alone understates it substantially.

Sources

• NLM Profiles in Science, The 1964 Report on Smoking and Health — https://profiles.nlm.nih.gov/spotlight/nn/feature/smoking
• GovInfo, Anniversary of the Surgeon General's First Report on Smoking and Health — https://www.govinfo.gov/features/anniversary-report-smoking-health
• NCI, Harms of Cigarette Smoking and Health Benefits of Quitting — https://www.cancer.gov/about-cancer/causes-prevention/risk/tobacco/cessation-fact-sheet
• SEER Cancer Stat Facts, Lung and Bronchus Cancer — https://seer.cancer.gov/statfacts/html/lungb.html

How this article was prepared

An AI-assisted editorial system helped prepare this page. No named medical reviewer has reviewed it unless one is listed.

The National Cancer Information Foundation publishes Cancer Explained. This page is for learning. It is not medical advice and does not suggest a test or treatment.

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