Search tips
Search criteria 


Logo of brmedjLink to Publisher's site
Br Med J. 1976 December 25; 2(6051): 1525–1536.
PMCID: PMC1690096

Mortality in relation to smoking: 20 years' observations on male British doctors.


In 1951 the British Medical Association forwarded to all British doctors a questionnaire about their smoking habits, and 34440 men replied. With few exceptions, all men who replied in 1951 have been followed for 20 years. The certified causes of all 10 072 deaths and subsequent changes in smoking habits were recorded. The ratio of the death rate among cigarette smokers to that among lifelong non-smokers of comparable age was, for men under 70 years, about 2:1, while for men over 70 years it was about 1-5:1. These ratios suggest that between a half and a third of all cigarette smokers will die because of their smoking, if the excess death rates are actually caused by smoking. To investigate whether this is the case, the relation of many different causes of death to age and tobacco consumption were examined, as were the effects of giving up smoking. Smoking caused death chiefly by heart disease among middle-aged men (and, with a less extreme relative risk, among old men,) lung cancer, chronic obstructive lung disease, and various vascular diseases. The distinctive features of this study were the completeness of follow-up, the accuracy of death certification, and the fact that the study population as a whole reduced its cigarette consumption substantially during the period of observation. As a result lung cancer grew relatively less common as the study progressed, but other cancers did not, thus illustrating in an unusual way the causal nature of the association between smoking and lung cancer.

Full text

Full text is available as a scanned copy of the original print version. Get a printable copy (PDF file) of the complete article (2.8M), or click on a page image below to browse page by page. Links to PubMed are also available for Selected References.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • DOLL R, HILL AB. The mortality of doctors in relation to their smoking habits; a preliminary report. Br Med J. 1954 Jun 26;1(4877):1451–1455. [PMC free article] [PubMed]
  • Doll R, Hill AB. Mortality of British doctors in relation to smoking: observations on coronary thrombosis. Natl Cancer Inst Monogr. 1966 Jan;19:205–268. [PubMed]
  • Doll R, Pike MC. Trends in mortality among British doctors in relation to their smoking habits. J R Coll Physicians Lond. 1972 Jan;6(2):216–222. [PubMed]
  • DOLL R, HILL AB. A study of the aetiology of carcinoma of the lung. Br Med J. 1952 Dec 13;2(4797):1271–1286. [PMC free article] [PubMed]
  • HUEPER WC. Lung cancer and the tobacco smoking habit. Ind Med Surg. 1954 Jan;23(1):13–19. [PubMed]
  • Passey RD. Carcinogens in Cigarette Smoke. Br Med J. 1954 Dec 18;2(4902):c1485–1485. [PMC free article]
  • MAXWELL J. The incidence of cancer of the larynx in relation to the incidence of cancer of the bronchi. Lancet. 1955 Jan 22;268(6856):193–193. [PubMed]
  • WYNDER EL, BROSS IJ, FELDMAN RM. A study of the etiological factors in cancer of the mouth. Cancer. 1957 Nov-Dec;10(6):1300–1323. [PubMed]
  • WYNDER EL, BROSS IJ. A study of etiological factors in cancer of the esophagus. Cancer. 1961 Mar-Apr;14:389–413. [PubMed]
  • Berry G, Newhouse ML, Turok M. Combined effect of asbestos exposure and smoking on mortality from lung cancer in factory workers. Lancet. 1972 Sep 2;2(7775):476–478. [PubMed]
  • SCHWARTZ D, FLAMANT R, LELLOUCH J, DENOIX PF. Results of a French survey on the role of tobacco, particularly inhalation, in different cancer sites. J Natl Cancer Inst. 1961 May;26:1085–1108. [PubMed]
  • Nefzger MD, Quadfasel FA, Karl VC. A retrospective study of smoking in Parkinson's disease. Am J Epidemiol. 1968 Sep;88(2):149–158. [PubMed]

Articles from British Medical Journal are provided here courtesy of BMJ Publishing Group