Authors' Affiliations: Center for Tobacco Control Research and Education, Department of Medicine, and Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, California; and Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ontario, Canada.
Cancer Epidemiol Biomarkers Prev. 2014 Jan;23(1):37-46. doi: 10.1158/1055-9965.EPI-13-1081.
Despite the Surgeon General's strong track record and the rapidly expanding body of solid scientific work demonstrating that smoking caused a wide range of diseases, the decision making process for concluding "causality" in Surgeon General reports has become increasingly cautious and defensive. Whereas, the 1964 report did not conclude that smoking caused heart disease, it recommended that "from the public health viewpoint [one should] assume that the established association has causative meaning rather than to suspend judgment until no uncertainty remains," the de facto practice has become to do just the opposite. In particular, the 2004 report reached an affirmative negative conclusion that active smoking did not cause breast cancer and the 2006 report on passive smoking only found the link "suggestive." In contrast, in 2005 the California EPA found both active and passive smoking caused breast cancer in younger women. The evidence has continued to strengthen since 2005: there are now 12 large cohort studies that consistently demonstrate a dose-response relationship with smoking before first birth and increased breast cancer risk. The Surgeon General's increasing caution is preventing young women around the world from appreciating the risks that smoking and secondhand smoke pose for developing breast cancer.
尽管美国卫生总监拥有丰富的经验和大量确凿的科学研究成果，这些成果表明吸烟会导致多种疾病，但在确定《卫生总监报告》中“因果关系”的决策过程却变得越来越谨慎和保守。然而，1964 年的报告并没有得出吸烟导致心脏病的结论，而是建议“从公共卫生的角度来看，[人们]应该假设已确立的关联具有因果意义，而不是在没有不确定性的情况下暂停判断”，但事实上的做法恰恰相反。特别是，2004 年的报告得出了一个肯定的否定结论，即主动吸烟不会导致乳腺癌，而 2006 年关于被动吸烟的报告只发现了“提示性”的联系。相比之下，2005 年加利福尼亚州环保署发现主动和被动吸烟都会导致年轻女性患乳腺癌。自 2005 年以来，证据不断增强：现在有 12 项大型队列研究一致表明，吸烟和二手烟与首次生育前的乳腺癌风险增加之间存在剂量反应关系。美国卫生总监的日益谨慎，使世界各地的年轻女性无法认识到吸烟和二手烟对患乳腺癌的风险。
