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Cigarette Smoking, Pulmonary Metastases, and Breast Carcinoma : Coincidence or Causality?

Glen A. Lillington, MD; David P. L. Sachs, MD
Author and Funding Information

Affiliations: Palo Alto, CA 
 ,  Dr. Lillington is Clinical Professor of Medicine, and Dr. Sachs is Clinical Associate Professor of Medicine, Stanford University Medical Center.

Correspondence to: Glen A. Lillington, MD, 1020 Siskiyou Dr, Menlo Park, CA 94025-7014; glenlill@ad.com



Chest. 2001;119(6):1627-1628. doi:10.1378/chest.119.6.1627
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The demonstration of statistical associations between states or events naturally suggests that the congruity may be more than coincidental. Possibilities include that the two (or more) states have an underlying common cause, or that one event or state is affecting or causing the other. Nonskeptical acceptance of the latter post hoc, ergo propter hoc theorem may result in erroneous conclusions.

A notable example occurred early in the last century with the statistical demonstration that individuals who contracted tuberculosis appeared to have a lower subsequent incidence of bronchogenic carcinoma. A well-known statistician of that era suggested that the tuberculous infection somehow conferred some protection from neoplastic change. An equally logical explanation, which initially eluded the thinkers of that era, was that the tuberculous disease, for which there was little effective therapy, carried with it a high mortality that prevented many younger consumptives from reaching the age levels in which pulmonary neoplasms have a significant incidence.

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