Document 0axER2VJXVpB1amxG0kMBN7x

AS A (* < >. -y /' ' 5.. rU\INlllT^V< * EXHIBJf 7 I X/+/=% August 23, 1957 Mr, Hugh M. Jackson, Manager industrial Health Program Johns-Manville Corporation 22 .East 4 0th Street New York 16, New York Dear Hugh: Thank you for your letter of August 19 regarding tho Sep-* Umber meeting of the ATI, As a matter of fact, having completed tho literature search, it Is apparent to ua that iha possibility of an association between lung cancor and aabeatosia is much more likely to exist in asbestos factories than in mining operations. Tor example, of 99 cases which had been re ported up to 1955, at least SO appear to have occurred in asbestos workers other than miners, A number were women, and the occupations givon - were: weaver, carder, mattress maker, logger, bagger, pipe coverer, spinner, etc. \ ,u Two specific articles which mention tho type of exposure and the Job Is that by Doll (l) and that by Issalbachsr,at,al.(2). Seventeen cases studied by Oloyno and 31 reported by Mar&wether, as well as three mentioned by Harrison and one each by Cureton and Owen occurred in Lngland. If my information U correct, there is no mining of asbestos in England, and these must all have been workers in textile or similar jobs. In this country, the ten cases reported were apparently all in textile workers. The first case, reported in 1935 by Lynch and Smith was a weaver in an asbestos factory for 21 years. Isselbachor*s cases involved a contractor's helper engaged in cutting and sawing asbestos board and sorter in an asbestos mill. Mr, Hugh M. Jackson 2. August 23, 1957 The QAMA study is in the final stages which are, of course, ths slowest* All of the statistical analysis has been completed, and the report is 99 7* written. What remains is mainly minor revision*, typing the manuscript and proofing. U should go to the print shop by the end of this month. I hope this supplies you with what you need for the meeting. If there is anything further, please let me.know and I will try to get it to you in time. Sincerely yours, DCE:la Enclosure Daniel C. Braun, M,D. Medical Director References i, Doll, R,i Mortality from Lung Cancer in Asbostoe Workers. Brit. J. Indust. Med. 12, 51-36, 1955, 2, laaalbachor, K. J.; Klaus, li.; And Hardy, H, L.i Afibostosia and Bronchogenic Carcinoma, Am, J, Mad. 15, 721-752, Novcmbc 1953. 3, Doll, R.: Bronchial Carcinoma: Incidence and Aetiology {Mllroy Lectures, abridged) Bjlt. M. J,, 2,, 521-527, Sept. 5, 1953; 583-590, Sept. 12, 1953. l- \ i i i )\ t. 5 'rvit r* i< )l I NS - M A W I U.I-: ( :< Jlv'l't )IVA*n()N r i rv vn i..\m iiiiininn mki'J'T xj-;\% w>I(K s ' December 30, 193*7 "r. Ivan Saoourin St. Johns Quebec ; 1-ear Ivan: Re: I.H.F. Survey < Hugh Jackson arid I have reviewed the' condensation of the surrey which yo,, sent us. We nave noted deletion of all references to the association of asoestosis and lung cancer in this condensation* While we believe that this in formation is of great scientific value, we car. understand the desire of the Q.A.K.A. to emphasize the exposure of the asbestos miner and not the cases of Asbestosis. We also are in agreement with the deletion of the reference to sacking and lung cancer. It must be recognized, however, that*this report will be subjected to criticism when publisnea because all other authors today correlate lung cancer a.-ic cases of asbestosis. If we are to restrict this condensation to asbestos miners, greateremphasis should be placed on the choice of words used in defin ing th conort.-. The fact that all members of tne cohort had 5 or more years of exposure to asoestos should be reiterated* following are comments on certain paragraphs of the condensation. iVpg 9 \ We believe the first sentence in paragraph 2 should read "Perhaps no one nac written so extensively Page ih- In the-third sentence of paragraph 2 the definition of cohort should be expanded to emphasise, tnat nen-expesed personnel were not included in the sample. In.s mignt oe done by auding a sentence similar to the following: "office and otr.er non-exposed personnel, regardless of length of employment were not included in tne cohort". Page Id To further emphasize the exposure aspect of the miners tne second sentence of paragraph 2 might read, "All workers with more tnan 5 years* of ex posure were placed in one of three categories". It mient be advisable to add another sentence at the end of tnis para graph, "Ah previously noted workers with no exposure were not inciuaeri in tho data". , 'fir. Ivan Sabourin - 2- December 30, 135? Page 23 In the fourth sentence reference is mace to ''the 952 level of signifi cance". This phrase was. explained clearly and thoroughly on Pages 23 to 25 in the soction on Statistical Methods of the original survey. Decause this vnoie section was deleted in the condensation we feel it mignt be advisable to explain by foot note the meaning of "the 95 level of significance1'. Wo feel that the fifth sentence Right be made stronger by the following change. "However, having found just 12 cases, we arc not above this level, and therefore the hypothesis that asbestos miners do not have a higher mortality from lung cancer than does the general population cannot be rejected". Page hi The' table in the center of the page shows a rate of 271 in the US - 5^ age group. In the original survey this rate was 27. Pace 13 In "the last sentence of tne first paragraph we would like to suggest the substitution of the word "undertaken" for the word "commissioned". in the second sentence of paragraph 3 ve would like to suggest tnat the elements of tne cohort definition be repeated* "A cohort was defined as a group of asbestos miners having at least 5 years of exposure in the indatry and who were in the industry during 1950. Only those workers who met these criteria were in cluded in the study". Page 1? In the last sentence of paragraph 1 we would like to suggest the dele tion of the phrase "vnich have been explained in some detail" since such explanation was deleted in the condensation. This publication should form the ba3iu for future' surveys and reports* jr. braun shoulo be asked to establish the framework of reporting for Doctors Grainger and Cartier so that each year the status of every member of the original cohort could be reported to the Industrial Hygiene Foundation and the continuing study be analyzed by their experts. Vie cannot emphasize this point too strongly because novnere-in. the-literature today is there reported a study which is so valuable and which approximates this magnitude. We agjree. with Doctors Cartier and Sraun tnat a certain number of workers probably have^some asbestotic fibrosis which cannot bo diagnosed by x-ray.. Un fortunately, we cannot take lung biopsies on all workers and we have no other means of making a diagnosis before there axe x-ray changes. Therefore the annual study of all exposed astestes workers becomes increasingly important. We feci that Dr, braun and :iis staff are for this very valuable contribution to our medical efforts will be rewarded in the near future by the recognized journal. to be congratulated heartily knowledge. We trust that their publication of this work in a Sincerely, Kenneth W. Smith, M.D. Medical Director