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The Epidemiologic Necropsy

Paul Fischer, MD; John W. Richards, MD; Alan Blum, MD
JAMA. 1987;258(22):3255. doi:10.1001/jama.1987.03400220053023.
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To the Editor.—  McFarlane and colleagues1 have recently published an article based on 159 necropsy-proved cases of lung cancer during a 12-year period at one medical center. They suggest that there may be a large and undiagnosed reservoir of lung cancer cases in the population, that the relationship between smoking and lung cancer is overstated, and that the observed increase in the rate of lung cancer in women is due to occupational carcinogen exposure.It is hardly surprising that patients pass through a stage during which their lung cancer is either asymptomatic or symptomatic but unsuspected by their physician. Nor is it surprising that some patients with lung cancer will die of other diseases. As indicated in the article, most of these deaths are due to diseases that are related to tobacco smoking (ie, myocardial infarction, pneumonia, and stroke). Of the 2996 necropsies performed, lung cancer was found as


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