Document 1QpeL9oZqvQjmbG76qExaK4mK

FILE NAME: Saranac 7th Symposium (SSY) DATE: 1952 DOC#: SSY054 DOCUMENT DESCRIPTION: Text of Presentation by Dr. Merewether </> TA2221 FROM PAGE 397. RECEIVED F.H.H&S nap- JUL ? 1 M.E.M E? DOCTOR HZ?JVS?HE Doctcr Rhoads, Ladies and Gentlemens I an greatly honored to be invited to attend th is erudite meeting which has now, by v irtu e of the diverse and inspired work of my eld frien d , the la te Doctor LeRoy Gardner, and Doctor Vorvtld, become an in terneticcal event. Hov, only a foolhardy crin in al would apeak a fte r the most stim ulating papers of th is morning, tu t I ' l l endeavor to do my b est, ana I shell not detain you long. All I have been able to do in the short time available is to bring up tc date our m ortality and pathological data on th is matter and lay then before you in the confident hope th a t i f there is an explanation of then, and there are deductions tc be drawn from them, I shall obtain then during th is conference. Frankly, I'm puz led and disturbed a t the p o ssib ility which may emerge, not only in connection with the W.l-M q u estio n of an e tio lo g ic a l re la tio n s h ip between cancer of the lung end a sb e sto s, b u t also between cancer of the lu re and other lo cal illn ess* In 19*4.6, I made a n o te of th e d e a th s from a s b e s - t o s i s , a s b e sto s is w ith tu b e rc u lo sis and e ith e r of th ese w ith a lso cancer of the lung, recorded in the u n ited King dom from 1 9 2 i to 1 9 i7 . I p la c e d a lo n g sid e them f o r com p a r i s o n , th e c o rre s p o n d in g d a ta we have from s i l i c o s i s and cancer of the lu n g . These were fa c tu a l d ata w rie r speah f o r th em selv es i n s o f a r as th e y g o , b u t I a tte m p te d to make d ed u ctio n s sin c e I f e l t the a s b e s to s is deaths were to e few f o r th e p u rp o s e . I have now b r o u g r t t r e s e f ig u r e s up *c d a te . The c o rre sp o n d in g f ig u r e s f o r s i l i c o s i s d e a t r s amount to s e v e ra l th o u sa n d s. They were, I th in k , s u f f i c i e n t l y la r g e to show t h a t th e r e i s no e t io lo g ic a l, r e l a t i o n s -- r between s ilic o s is and cancer of tre lung arc in tn is i 'n f o r t i f i e d by the d ata produced by the South A frican e x p e rts. I w ill n o t weary you, th e re fo re , w ith tne ad d itio n s in the l e s t three and a q u arte r years to our s ilic o s is fig u re s . B rie fly , th e re fo re , our la te s t fig u res are recorde. d eath s from a s b e s to s is , a s b e s to s is w itn tu b e rc u lo s is , c. e ith e r com plicated w ith cancer of the lung, w ith cancer, a r e 306. I am e x c lu d in g te n of th e s e w here th e r e i s a ls o c a n c e r o f s i t e s o th e r th a n th e lu n g s . Our n e t f i g u r e s a r e , V.1*- p e rc e n t were a s s o c ia te d w ith can cer of the lu n g . This shows an in c re a se from a 13*2 p e rc e n t d is c lo s e d by our e a r l i e r f ig u r e s . This means t h a t , as more ceaths frcro a s b e s t o s i s come to h an d , th e c u m u la tiv e p e rc e n ta g e of deaths w ith com plicating cancer of the lung is ris in g ra th e r than fallin g * Sow, where do we go to from h e re ? JLre th e s e f i g u re s s u f fic ie n t to in d ic a te a cau sal re la tic r.sr.ip between th e r e t e n t i o n o f a s b e s to s d u s t i n th e lu n g s anc. su b se q u en t can cer o f the lung? The sm all numbers c e r t a i n l y d ic ta te ca u tio n , n e v e rth e le ss, they re p re se n t the g re a t m ajority o f the deaths from a s b e s to s is which have occurred in tne U n ite d Kingdom d u rin g th e p a s t q u a r te r of a c e n tu ry . Nowadays, because of the g re a tly in creased aware ness of workers, doctors and others in the neignocrnocc of asbestos p la n ts, of the d ise a se , because of the duty of C o ro n ers to i n v e s t i g a t e w ith a u to p sy and to r e p o r t to my d e p artm e n t, deaths s u sp e c te d to be due to o cc u p atio n al d i s e a s e , w h ate v er i t may b e , t h e com pensation b e n e f i t s a c c r u in g to cases of pneum oconiosis, the system o: fa c to ry i n spection, our p erio d ical check-up of tne death c e rti:ic a * e s provided by the R e g is tr a r G eneral, and fo r other reasons, i t is lik e ly th a t very few deaths from a sb e sto s is escape notice r C *rL' W.I.W T h e r e f o re , W ith c o n f id e n c e , I th ird : we car. set th a t the fig u re s p o in t to the n e c e ssity fo r the c o lle c tio n of s im ila r data from o th er communities w ith an a sh e sto s.s h a z a rd , so t h a t by means o f s t a t i s t i c a l exam ination o f tr.e g lo b a l f i g u r e s so o b ta in e d , we can s e t t l e th e q u e s tio n o. w hether cancer of the lung is an ad d itio n al r is k of asses* tos exposures. Now, I sh o u ld m en tio n h e re t h a t th e f ig u r e s in U n ited Kingdom, th a t th e se f ig u re s in c lu d e t i l of th e n , b e c a u se th e y cone to ice, so t h a t we m ust n o t td d up ex c e ss fig u re s and - the X fig u re s and Y fig u re s and 2 fig u re s , and th a t th e y 're a l l ad d itio n al cases of a sb e sto sis, w ith carcinom a o f th e lu n g . One can add u p , of c o u rs e , d iffe re n t c o u n trie s, b u t one must be very c a re fu l adding up or d u p lic a tin g the sane cases in the sane c o u n trie s. There i s a n o th e r p o i n t t h a t was b ro u g h t u? tr.us m orning, t h a t the p o p u latio n r is k of asbestos is small r e la tiv e l y to o th e r In d u s trie s and i t f lu c tu a te s . A war b rin g s a great increase of people, because obviously, th ere i s a g r e a t demand f o r h ig h c la s s a s b e sto s in s u la tio n f o r use in war ships and e th e r types of work, and then i t crops o ff ag a in , so th a t one could never r e a lly g e t a p o p u la tio n , f o r in s ta n c e , to wnich one could r e l a t e a p a r t i c u l a r of a s b e s to s is , assuming th a t asb esto s is a fa c tc r ir. th is m atter. " - l, t C * * r' C * - v# How, a n o th e r th in g i s th e r e v e r s e w nicn I t s . r . i h a s g o t to be b ro u g h t in n in e , i n t o m ind, t h a t wnen one is c o n s id e rin g a h azard in an in d u s try and one w ants, as tne s t a t i s t i c i a n s alw ays do w an t, so m eth in g l i k e a w o rld popu la tio n before they give us anything very s a tis fa c to ry eicuo the m a tte r, th a t.y o u - you say th a t, f or a l l purposes, tne p o p u la tio n o f an in d u s try i s say two hundrec. tnc-sar.c., y v e r y r i s k may be l o s t in th e mass of th e p o p u la tio n . That occurs, fo r in sta n c e , in coal carbon tra d e , where I t r i e d a number of y e a rs ago, a r e la tiv e l y smc.ll p o r tio n o f people exposed to t a r or ta r r y v ap o rs, and t h e y 'rft- l o s t in th e w hole p o p u la tio n o f th e tr a d e , bu* when you l i m i t them to th e p e o p le who a re e x p o se - to t a r and t a r r y v a p o rs , you f i n d tn e ire is s ix tim es tne r i s k o^ c u ta n e o u s 'c a n c e r . In o th e r w o rd s, th e r i s k was l o s t in tn e o v e r a ll numbers assumed to be an r i s k . trtd e. And, i t i s so m eth in g l i k e th a n in xr.e as-cesnos 0 A l e t of people d o r.'t have nuch exposure to asbes to s a t a l l . Sow, as f a r as th e r a t e In a s b e s to s , 1 h a v e r .'t g o t in to th a t y e t, t u t fo llo w in g a re n a rk r.ade th is r.o rrir. , I w i l l tr y and do so . Then Docnor Lynch d id say , v n at is tr.e det .c e -- a s b e s to s is . i:ov, a l l th e se people have been a u te p s ie a l l o f them died p r im a r ily of a s b e s n o c is , w nenner n.iey tubercle or cancer la te r . M.E.M flow, I won't weary you w ith th e s t a t i s t i c a l ap p r o a c h e s , B esides t h a t , I 'm v e ry f r ig h te n e d of s t a t i s t i c ia n s , They're going to die i f I find an e rro r in th is , Kot q u i t e as bad as a p s y c h i a t r i s t , o f c o u r s e , I 'n ic o n ic f o r th e day when we have a s t a t i s t i c a l p s y c h i a t r i s t , w's-- j u s t a n o th e r page of t h i s , s i r , th e n w e'uu be reao y tc *nr roe o u t. Of th e 296 d e a th s we a re c o n s id e r in g , 17* occur in m ales and 126 in fem a les. Eighty-tw o or 27,7 percer.o, h a lf males and h a lf fem ales, were a sso cia ted w ith pulnona t u b e r c u l o s i s . The mean age o f d e a th was 1*6.2 y e a r s , w ith a ra n g e o f 21+ to 73 y e a rs f o r th e c a se s o f a s b e s to s i s , 3^ w ith a range of 17 to 66 y e a rs , fo r th e cases of asb esto s f o r r w ith tu b e r c u lo s is and p3*4 y e a rs v i m tr e ran g e c,, 32 to 77 f o r the c a s e s o f a s b e s t c s i s and ca n ce r c: tn e -u The mean d u r a tio n o f ex p o su re was I p . 7 y e a rs v i a range of one to f o r ty - e ig h t f o r deaths from a s b e s to s is , Some took, a E e ll of a lo n g tim e tc d ie -- 1 1 .1 w ith a r a : o f 133 - no, I p u t th e wrong one, I 'm s o r r y , 1 1 .1 y e a rs , a range o f 33 y ears w ith a s b e s to s is v i t a tu o e rc u lo s is an 19 y e a rs w ith a ra n g e o f 2 to i+9, 2 to 1+2 y e a rs fo r asbe to sis w ith cancer of the lung. The mean d u r a tio n of l i f e betw een c e s s a tio n of ex p o su re and d e a th was 6 .5 y e a rs v i t n a range of 1 tc p2 f o r a s b e s t o s i s , 1+17 y e a r s - t h a t sh o u ld be 1+.7 y e a rs w it u > M..W . c r ( 3 e o f 1 to 21 f o r a s b e s to s is w ith t u b e r c u l o s i s , sno . . , e a - s w ith a r u g . of 1 to 2b f o r e s b e s t o s i s o i oei>cer of the rung* # you see the ranges are very wide isd eed , which i s o f some i n t e r e s t . They sey w ith t u b e r c l e , you con g e t t u b e r c l e any t i n e . I t can cone on th e n a t any t i n e end h i l l th e n a t any t i n e . Sow, t h e r e a r e i n d i c a t i o n s , from our ^ d ata, th a t our preventive reg u la tio n s which cane into f u ll o p eratio n s in 1932, twenty years ago, are having an e ffe c t and t h i s nay be th e e x p l a n a t io n o f why the in c id e n c e of com plicating cancer of the lung appears t . be . ls_ng. " Today, we do n o t e n c o u n te r c a se s of extreme m ass ive f i b r o s i s and gross b r o n c h ie c ta s is and ever, a sa-coma -nutmeg- liv er w ith death, and com plicated w ith tubercu lcsi o r c a n ce r o f the lu n g a t an e a - l y age, v i t h i r . f iv e to sever years from the commencement of e x p o s u re . Those esses ccr.' seem to o c c u r. The d u r a t i o n o f ex p o su re w hich r e s u l t s in ^ death from e sb e sto sis i s lengthened, the age of death is i creasin g and the degree of f ib r o s is found a t autopsy is less. This means th a t eases o f a s b e s to s is a-e ilm .te d to th e cancer o cc u rrin g age p e r io d , and i f - and 1 ay i f - th ere is e re la tio n s h ip between esb eeto cis and cancer of , ^ s-urxrise f r o n the &s-es the lung and i f i r r . t a t . c n , l a -- f ib e r is a cc-carclncger. w ith a long exposure period, the .r* ' l-o RECEIVED F.H.H!|S.a. -W TW tttfcfcSS*- M.E.M ve vould expect an in creased incidence of cancer of the l u n g ov er t h a t found i n the g e n e r a l p o p u l a t i o n to become afterwards# Regarding these cancer cases, the near age of d e a t h , I s a i d was y ears, so I put th is in for - sin ce I fo u n d I ' d be k i c k e d o f f i f I d l c n ' t . How, the o c c u p a t i o n s in v o lv e d are somewhat i n t e r e s t i n g . They're always d i f f e r e n t , as you know, bec ause sometimes two o c c u p a ti o n s c a m e o o u t i n t h e same room w i t h d i f f e r e n t d u s t ex p o s u re s or w i t h o th e r d i f f e r e n t f a c t o r s , b u t i t i s a . l i t t l e i n t e r e s t i n g to see th a t the majority of these fo rty -e ig h t cases, th a t the more dusty the p ro c e s s, of course, i t ' s n e s t f a l l a c i o u s , b u t s t i l l we w atch w i t h c a r e , f o r i n s t a n c e , weaving. Weav i n g i s n o t o r i o u s l y d u s t y , one case t h e r e w i t h te n c* t n e s e c a n c e r l u n g c a s e s , one case a l s o a s s o c i a t e d wizn t a r o on g and s p i n n i n g t h a t the man had done, andone case n i x i n g arc so rtin g , d isin te g ra tin g and mixing, e ith e r - w ell, eig h t oipe and b o ile r coverers, including mixing; seven, ana m a t t r e s s making, s i x and a l l t h e r e s t a r e be_ov t h a t , er.o a l l those are dusty jobs# V eil, what then is the etio lo g ic al facto r, if any h e re ? And, Id be most g r a t e f u l f o r your views. I know t h a t p h y s i c a l i r r i t a t i o n as a d i r e c t c a rc in o g e n ic ag e n t has been r a th e r debunked by the cancer experts, but I remember t h a t some r e c e n t work by a U n ite d S t a t e s e x p e r t .