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THE importance of distinguishing between the various histological types of lung cancer has been stressed in many epidemiological studies. It has been suggested for example that cigarette smoking is associated with squamous and anaplastic rather than with glandular celled tumours. There are not, however, any statistics available on a national basis which make this distinction. Under the Registrar General's National Cancer Registration Scheme (see, for example, Stocks, 1950) information is collected concerning a proportion of all cases of malignant disease diagnosed throughout England and Wales. This proportion was believed to be about 55 per cent in 1952 (Ministry of Health, 1956). Although histological descriptions are not reported, the existence of the scheme makes it possible to identify all cases of lung cancer recorded in the participating hospitals and thus to collect details of the histology and any other factors recorded locally. The original purpose of the present study was to identify all cases of lung cancer registered in the South Western Hospital Region of England during the 12 years 1945-56 for which a histological diagnosis had been made, and to determine the proportions of the main histological types of lung cancer among various groups of the population. The South Western Region was chosen because it was believed to have had, throughout the period, a registration coverage higher than that of the whole country and because its geography made it unlikely that many patients living within its boundaries would go outside them for medical care. The accumulated records for such a region should provide a reasonably unselected series of patients in contrast to some highly selected series described in published reports. The proportion of cases histologically described was considerably lower than expected. Although 60 per cent of South Western Regional cases were reported as confirmed by pathological examination, in only 40 per cent of those records studied was there a record of microscopical diagnosis. This finding persisted throughout the 12 years of the survey and meant that the cases under review, which represented one fifth of the total lung cancer deaths in the region in 1945 had only increased to represent one-third of the deaths in 1956. The selection implied ill these proportions nullified the advantage implicit in the nearly complete overall registration. The original aim of confining the study to a single geographical region was accordingly abandoned and similar material was collected from two London teaching hospitals, St. Bartholomew's and the London Hospital.

Cancer of the Lung in South-West England and London: an Epidemiological Study of Histological Type