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In the United States, a comparison by the Surgeon General of two prospective surveys of a million people, one in the 1960s and one in the 1980s, found no evidence of a change in lung cancer rates in non- smokers over a 20 year period but a big decrease in the mortality from coronary heart disease.11 Likewise, in the present much smaller study there has, over the same period, been no evidence of any change in the mortality of non-smokers from lung cancer, although there has been a substantial reduction in their mortality attributed to stroke and also to heart disease (if we combine ischaemic heart disease and other cardiovascular disease, as probably needs to be done to take account of nosological changes)

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