Document 3djz8mYzbqZkpp0mEy9k0O2O
FILE NAME: Smoking (SMOK) DATE: 1956 Nov
DOC#: SMOKOll
DOCUMENT DESCRIPTION: Journal Article - Environmental Causes of Cancer of the Lung Other Than Tobacco Smoke
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interim Session -- Seattle, W ashington N ovem ber 25-26, 1956
VOLUME XXX
NUMBER 2
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OFFICIAL PUBLICATION
AUGUST
1.358 : A
PUBLICATION OFFICE, CHICAGO, ILLINOIS EXECUTIVE OFFICE, 112 EAST CHESTNUT SliUET, CHICAGO ij, ILLINOIS
E ntered oz Second C lass Ido d o r a t th e Postciiice a t C hicago, Illinois C op y rig h t, li)56, by Id ...merican College of C hest P hysicians
Environmental Causes of Cancer of the Lung Other Than Tobacco Smoke
W. C. H U E P E R , M.D.
Bethesda, Maryland
The recognized or strongly suspected environmental causes of cancer of the respiratory system form an important segment of the environmental carcinogenic spectrum.
1. With one exception all so far known exogenous respiratory carcinogens wore discovered during the last 25 years (Table I), that is, during the period in which a remarkable and progressive rise in the number and frequency of cancers of the lung was observed in most industrialized countries (Fig. 1).
2. The various respiratory carcinogens are more or less well defined chemical or physical agents and/or are associated with distinct occupa tional activities engaged in by circumscribed workers groups (Table If).
3. The clinical, epidemiologic, pathologic and experimental observations related to these agents all of which act through the respiratory route
TABLE I
OCCUPATIONAL RESPIRATORY CARCINOGENS AND CANCERS RECORDED DURING PAST 75 Y E A R S; THEIR CAUSES, S IT E S AND NUM BERS
Agent Arsenic Asbestos Chromates Nickel
Coal Tar Petroleum
Oils Isopropyl Oil
Radioactive Chemicals
oke of Cancer
bung
Lung
Lung'
Lung Notes and
Nasal Sinus
Lung
Lung and Larynx
Lung Larynx Nasal Sinus
Lung
Nasal Sinus
TOTAL
Discovered 1930 193d 1932 1932
1936 1936
1946
1879 1931
krumkor of 'i'cv-orded Cases (Hhor
U.K.A. Comatries Total
7
:l 6
23
20
92
112
75
65
140
0
84
84
0
51
51
0
53
53
7
33
40
1
0
4
0
6
0
0
625
3
0
123 1,019
1 4 6
625
3
1,142
National Cancer Institute; National Institutes of Health; Public Health Service; IT. S. D epartm ent of Health, Education and Welfare.
Presented at a Symposium, 21st Annual Meeting, American College of Chest Phy sicians, Atlantic City, New .Jersey, June 2, 1955.
;
142
W. C. H U E P E E
August, 19HfI i
rroresen o r cancel S.r-'Tie occ
ptumena
crrcinon
endotren Despi
on recoi observe' evidvriC'
. iC TiVde
I' x mrs
TABLE II--SPECIFIC
A r m t.
ix x ix
C hromrum
Nickel _ Iron Radioactive
Substances Isopropyl Oil Coal T ar Fumes P en oba m
Oil .s
WORKER GROUPS WITH SPECIFIC RESPIRATORY CANCER HAZARDS
______________ W o r k e r G r o u p s
Manufacturers, handlers, and users of arsenical insecticides; arsenic smelter workers; taxidermists; sheep dip w o rk e r- ; copper smelter workers
Chromate m a nufa cture rs including p la: maintenance workers; chrome pigment handlers
Nfckei-coppor matte refinery workers
Iron ore (hematite) miners ?
Radioactive ore (pitehLiende) miners; miners of nonradioactive ores working in radioactive mines
Isopropyl alcohol manufacturers
Coke oven operators; pas house retort workers
Parallel pressors; mule WO; :.ars and drill.'
: m ; metal lathe
Arsenic Asbrstc Peryili
Nickel
.XT!i
Radio; Pub
Isoprt oil
Polvc Hydr
SOO Petrc Deri-
oil (la so Dies, Exh; C asc lino
voi. x x x
ENVIRONMENTAL CAUSES OF CANCER
143
represent the only reliable factual evidence available on the causation of cancers in different parts of flu respiratory tract (Table III). Although some occupational, medicinal and experimental observations suggest that pinmonary carcinogenesis may ensue after a non-respiratory contact with carcinogens, there exists no valid evidence incriminating hereditary or endogenous factors as primary causal agents of hr,man lung1cancer.
Despite the fact that the total number of occupational pulmonary cancers on record is relatively small, the comparatively high cancer attack rates observed among the different worker groups studied provide weighty evidence in favor of actual causal associations between an exposure to the specific agents and the subsequent development of respiratory cancers (Table IV). The reported number oil cases of occupational respiratory cancers doubtlessly represent only a fraction of the total number which
TABLE III ENVIRONMENTAL LUNG CANCER SCORE BOARD
Arsenic Asbestos Beryllium Chromiu m
S ite of C ancer
2 c
* V i?
tv
C
1 !l
a
x
X
b e .s 'H. Is
pZ o
Skin
X
X
P opulation A ffected
T ype of E vidence
B k
! _i 5
a 3
1 i
^ O
l
a S5 1
o
o o
o
X
?
X
X
? X
?
X
X
? X
(J
11
I
kTa
X X ?
Nickel
X
X
X
X
1ron
X
X
X
Radioactive
Skin
Substances X
X
Bor e
X
X
X
Hem at. tissue
Conn, tissue
Isoproi: vl oil
XXX
X
X
Poiyoyulic
Kyuroc arbons
coal tar,
,,
b i n i i , pitch
XX
Skin
X
? X
Petroleum Derivatives
oil mist
XX
Skin
X
X
Gasoline
Diesel engine
Exhaust
X
x ?
X
Gasoline Epoxides
?
?
E xp erim en tal E vidence
e
O th er organs
Bone Bone Conn, tissue Bone C o n n , tissue
Bone Conn, tissue Hemal,
tissue, etc.
Skin Conn, tissue,
etc.
Sk, n Conn, tissue
Skin
Skin
144
W. C. H U E P E R
August, 1956
TABLE IV
RESPIRATORY CANCER ATTACK RATES BY ENVIRONMENTAL CARCINOGENS
Affents
Aromatic hydrocarbons: Coal ta r fumes Petroleum oils
Carbon and silicon poly mors:
Isopropyl oil Asbestos
Metals: Arsenic Chromates Nickel
Ionizing- radiation: Radioactive area
Sites of
Cancers
Lung' Lung;
Paranasal sinuses
Larynx Lung
Incidence in
Poymiation at Risk
500:100,000 2000:100,000
10:100
............
Lung
Lung
Nun's
)
1'n r a u a s a l sinuses
Lung
yJf.
............
329:100,000 574:100,000
Lung'
...........
Attack Rates
Percent Morbidity
Mortality
of All
Rate
Rate
C a n c e r ---------------------------------------------
Deaths
P e r 100,000
45% 55%
134.5 ........ (normal
6.5) .........................
........
13.2-2091; asbestosis autopsied
(0.8-2.4%
normal)
......................... (42x
normal)
(2 Ox ........ normal)
145.7 males (10.9 normal)
140-338
....... .......
(50-80% of all deaths)
occurred. Some of the lung cancers were certainly mistaken for tubercu losis, pulmonary abscesses, silicosis, asbestosis, siderosis or other forms of chronic pulmonary disease. Another portion of these tumors was recog nized as of occupational origin but not made a matter of public record, while a third fraction developed in workers many years after they had left the hazardous occupation and when the causal relations to their previously sustained exposu.-a -! had been obscured by the passage of time (Table V. Page 156).
The almost exclusive occurrence of occupational king cancers in male
TABLE VI LATENT PERIODS OF ENVIRONMENTAL RESPIRATORY CANCERS
Agent
Asbestos Chroro sites Nickel Tar fumes Isopropyl oil Ionizing radio Ron
Average Latent Period
18
15
22
10
Lunff
....
25 - 35
Ran;>-e of Latent Period
15 - 48 ,5-47 6-30 9-23
....
7 - 50
N arcs &Nnmd Sinuses
Average Latent .Period
Kant?e of
Latent
Period
....
....
....
ii
3-26
....
10
6-16
25
19 - 32
AN' '
r'C
' Wg
,,C A (
f TM^
'*
sw __
?;-v ' *r
i i akSAx
' * '
* `~
` kid
voi. x x x
ENVIRONMENTAL CAUSES OF CANCER
145
workers is in good agreement with the fact th at males are predominantly employed in occupations having lung cancer hazards. One oi; the known exceptions in this respect are the lung cancers found in female ashes n workers. The male-female ratio of lung cancers among workers who bestosis cancer of the lung is for this reason at the low level of 2.3:1, indicating that with an. equalization of the degree of exposure there
FIGURE 2 (Reproduced by permission of the British Empire Cancer Campaign.)
I
rw g p i-T -w "
1.
W. C. H U E P E
Aujfusl, lr,i;
HISTOLOGIC TYPE
TABLE1 VII OF O CC UPATIONAL RE SP I P.A T 0 R Y CANCERS
Agent T:u' Fumes Nickel Chromium Asbestos Radioactive
Gases & Dust Nickel
Radioactive iases & Dust
Isopropyl r ! i
Organ
Lung Lung Lung1 hung
Cling* Naves and
Nasal Sinus Naves and
Nasal Sinus Naves and
Nasal Sinus
S q u a m o u s Coll
Carcinoma With or Without.
Pound
Cull or A n a p l a s t i c o r
Cat Cell P olym orphic
OorrnY.ciP.ion C a r c i n o m a C a r c i n o m a
Adeno carcinoma
o
2
4
3
2
11
3
2
6
14
!)
7
1
6
1
OJOtJ
4
VX. XXX
o: cryp
etio'ogx
Occui
like othi
The rel
;rg und
a niultic
asbestos
Piumon
with sid
'0 cancc
tional ,
ir.wuitui
s;
]
s.arre iu
have- an tew (W
'.rp-'- a s ' t
develops a tendency toward an equalization of liability to lung cancer.
w, UK
Several types of industrial lung cancers, such as those caused by radio
iT-Ociiain
|
active substances, chrome pigments, and coal ta r fumes, show a definite
S in c e lb
shift into younger age groups than those observed in cancers of the lung
bn ' sno
m n m t m o r a s t , whit* m ass, m v m m ts , 19m
( eowafo a. lew ]
Aft Adjusted fiath Sates y.-sj* 105,000, Kbit* Jfetls Pepalatic
Whiff
oo OQ o (
Ul
<[ UoJ
s il sc
FIGURE 3
Voi. XXX
ENVIRONMENTA i.. CAUSES OF CANCER
147
of cryptogenetic origin, but characteristic of cancers of occupational etiology.
Occupational respiratory cancers moreover have long latent periods iilce other cancers of known industrial or environmental origin (Table V I). The relatively massive exposure to carcinogens not infrequently prevail ing under occupational conditions may perhaps account for the fact that a multicentric genesis of several types of occupational lung cancer, i.e. a/oestosis cancer and radioactive cancer, is not infrequently observed.
Pulmonary fibrosis associated with silicosis in radioactive ore minces or mth siderosis in hematite miners seems to decrease the individual liability m cancerous developments in the lungs thus affected. While many occupa. onal lung cancers are of .squamous cell type, many others display an ir,mature cr round cell type or exhibit glandular structures. In fact, several different histologic types of cancers may occasionally occur in the same tumor mass (Table V II). Thus, no special histologic type seems to have any fixed relation to any specific causal factor. Occupational respira tory cancers critically studied exhibit a general symptomatic pattern summon to and characteristic of environmental cancers.
4. Many of the agents incriminated in occupational respiratory carcino genesis, such as arsenicals, radioactive substances, coal tar and petroleum offs, had previously been known as important causes of occupational and medicinal cancers of the skin developing usually upon cutaneous exposure. Since the mucosa of the respiratory tract may be considered as an inverted, but specialized entodermal extension of the ectodermal outer lining of the
RESPIRATORY SYSTEM CANCER DEATH RATES BY AGE AND SEX White Population,Urban States and Rural States,'United Sta te s, 1349
S ic trs with less than 4 0 % urban papulation colled rural, and states with mere then 0% urban
population called urban. Rural states: V t> \ SO, Miss., Ark, N.C.,S.G.,W.Vi!.,Ky. Urban stater*: R.l, M ass,NX, N.J.,Calif.,D.G.
SOURCE1V ital Statistics of the Um'cd States,1949;
S T A T IS T IC A L RESEARCH S Z G T m
!9 5 0 Popuiotion Censu3 of the United States
AMERICAN CANCER
9*53
FIGURE 4
148
W. C. H U E P E R
August,
TABLE VIII
THE TIME TABLE OF DISCOVERIES OF OCCUPATIONAL CANCERS
Name of Ajront
D :\tC
Discoveror
Organs yvfTootod
Nature of Exposure
Chemicals: Organic Soot
1775 Pott
Skin (Scrotum) Occupational
Coal T ar (Lignite)
1.87(j Volknuxnn
Skin
Occupational
Coal T ar (Bituminous) 1892 Dutlin
Skin
Occupational
Coal Tar (Anthracite) 1910 Zweig
Skin
Occupational
Coal Tar (Fumes)
PAG Kaushata
Lung
Occupational
Creosote Oil
1920 O'Donovan
Skin
Occupational
Anthracene Oil
1908 Olivei-
Skin.
Occupational
Paraffin Oil
Bell
Skin
(Shale Oil)
1870
Occupational
Petroleum Still Coke
1890 Derville and
Skin
G uermongrez
Occupational
Petroleum Paraffin Oil 1910 Sehaothovg
Skin
Occupational
Petrolc um im1aie: tii:g
Heller
Skin
Oil
19.30
Occupational
Shale Lubricating Oil 1910 Wiisbn
Sk'.u
Occupational
Benzol
1928 Dele re and Borgmano
Blood Form ing Tissues
Occupational
Aromatic Amines (live Intermediates)
Rehn 1895
Bladder, Ureter Kidney
Occupational
Isopropyl Oil Mustard (las Chemicals: Inorganic Arsenic
Asbestos Chromates Nickel Physical Agents: Ultraviolet Radiation Roentgen-Iiadiation
Radioactive Substances
1940 1953
Hale and ITueper
Yamada, Hirose & Miyarnishi
Nasal Sinuses, Survnx Lung
Lung
Occupational Occupational
1822 1887 19110
1935
1935
1 932
Paris Hutchinson Saupe
Lynch & Smith
Pith)
Grenfell
Skin Skin L ite g
Lung Lung
Nasal Cavity & Sinuses, Lung
Occupational Medicinal Occupational
Occupational
Occupational Occupational
1894 Unna
1902 1906 .1911
1922 1879 1923 1928
Fricben Wyes Von Jagic,
Schwartz & von Siebenrock Beck
Haerting & Hesse IVIeNeal, W ard
& Willis Loc-wy
1931 Mai- 'and
SITn
Skin Skin. .Blood Form ing
Tissues
Bone, Sung
Skin
Blood Forming; Tissues
Bone
Occupational Environmental Occupational Medicinal Occupational
Medicinal Occupational
Occupational
Occupational
Occupational
Vr>'. XXX
LI
body, .ory
c:,'Oy(
Asoly a -'on
or sin
'Clip
: wie
have
for di
a refii as we
.ons fact f iny v,
proclu
Ra
The
ating
V,:!. X X X
ENVIRONMENTAL CAUSES OF CANCER.
149
LUNG
\B LE IX
CANCER DEATH R/3 ' PER 1,000 D EATH S OF ALL FOR SEVEN (7) INDUSTRIAL GROUPS IN OHIO, 1947 AMONG 5,-309 MALE CANCER DEATH S (MANCUSO)
CAUSES
Industry
Iron and steel Transportation Agriculture Rubber and plastics Stone, clay, glass Non-ferrous metal Mining and quarrying
TOTAL
Respiratory Cancer
2.18 2.91 0.82 2.34 0.03 3.22 1.53 1.76
body, the development of cancers from these structures following a respira tory contact with the mentioned exogenous carcinogens appears to be a phenomenon in line with previous experience (Table V III).
5. Although the existing factual data on occupational respiratory car cinogens are at present limited to relatively restricted worker groups and apply to a comparatively small number of cancers of the respiratory organs, a considerable amount of circumstantial evidence suggests that identical or similar respiratory cancer hazards may prevail for much larger worker
groups having occupational contacts with the known carcinogens. Epidemi ologic studies on lung cancer death rates made in this country and Europe rave shown the existence of marked variations in the liability to lung cancer
for different large occupational groups (Tunic I X ) . Some of them revealed
- definitely excessive frequency of pulmonary cancer (Table X, XI, and XII) as well as of cutaneous cancer. The possible significance of these observa tions in perms of occupational lung cancer hazards is evident from the fact that there are over 5,000,000 employed in American industries sustain ing various degrees of exposure to combustion, distillation and cracking products of coal, petroleum and other carbonaceous matter (soot, carbon
(Continued on, , ' .79)
TABLE X
LUNG CANCER FREQUENCY AMONG OPERATING AND NO N-O PERATiXG RAILROAD W ORKERS
Railroad
A B
Period
1940 - 1950 1939 - 1940
Total No. Lung Cancers
29
104
Lun g ' C htkumy Oporaljnp; HR
Workers
No. Per Cent
24 83
59 57
Lunc; Cancers N o n - O p e r a tin??
RR Workers
No. Per Cent
5 17
15 14
X-uofc C a n c e r s Undetermined
RR Workers No. Per Cent
30 29
There were four timer as many non-operating RR workers in one company as oper ating ones, who represented train personnel, round house and track workers.
150
W. C. H U E P E R
A ugust, J.95!>
TABLE XI OCCUPATIONAL GROUPS W I T H A N E X C E S S I V E L U N G C A N C E R INCIDENCE
Occupational Group
M( tal workers, welders, nders and polishers,
.f e makers, tool v, d die foundry 'w raie's,
i. al moulders, lathe workers, etc.
()istar runtutfacturers and tolneeonis is
Engineers, mechanics, machinists, plumbers, etc.
Painters, and decorators
Tar workers, road workers, asphalters, paviours, stokers, patent fuel workers, furnace men, foundry laborers, rollers, etc.
Potential Kespiratorv Carcinogens
Investigator
Metal dust, lubricating oil mist
Borst; Kennaway and Kennaway; Turner and Grace; Mueller; Dublin and Vane, Wynder and Graham; McLaughlin; Brealow et al.
Tobacco dust, insecticides, soot
S ey farth ; Borst; Kenna-
nay; Engor; Varaiuya, L rinkmarm
Metal dust, soot, lubricating oil
BECC* 1944 & 1952: Gillespie: Turner and Grace; Mueller; Wynder arc' Graham
Meta! pigments, coal ta r dyes, carbon black, asphalt paints, solvents, vehicles
(lacquers, rosins synthetic p lo Ges)
BECC 1944; Mueller; Dublin and Vane; Fulton; Wynder and Graham
Tar and pitch fumes and dust, soot
'
Kennaway and K ennaw ay; F u lto n ; BECC 1952 Regis-
trar-General (1938) ; McLaughlin
*Report of the British Empire Cancer Campaign,
TABLE XII
LUNG CANCER MORTALITY IN SEVERAL COUNTIES OP .MONTANA 1947-1948 (LULL AND WALLACE)
County and
Total Population
11)40
Major Industry
Deer Lodge Copper 13,627 Smelting;
Silver Bow Copper 58,207 Mining
Cascade 41,499
Copper Mining
Smelting
Gallatin 18,269
Agriculture
Number Lung Cancers
Male Female
21 0
....
....
27 2
....
....
20 5
....
10
....
Tot.il 21 29 25
t
Total Cancer deaths 98
Per Cent Lung Cancer
Male Female 80.8 0.0
259
22.6 1.5
....
299
12.7 3.5
Annual Lung Cancer Death . Kate per 100,000 Male Female
145.7
0
* --
....
48.6
3.9
....
....
46.3 12.3
81
3.0 0.0
5.2
0
....
....
The estimated crude death r..:e for lung cancer among white males in the entire United Ctalcs in 1947 is 10.9 per 100,000 population.
The workers employed in copper ore mining' and smel-dng inhale dust and fumes of
arsenic contained in the are and released as a by- and waste-product during the smelting nrocess.
, 3,,
Vo!. XXX LUNG Ci
CAN!
Type
G"oa ..oun
Othe
Tier:
S-V. NDA (
(IMA
' dado-
**Mctr<
***Urba
**;::*Rura
voi. x x x
ENVIRONMENTAL CAUSES OF CANCER
151
TABLE x m
LUNG CANCER M O RTA LITY E N N I S IN A U ST R IA P E R 1,000 D E A T H S (J. H E E B IC H AND R. NEUBO LD )
Community
Vienna C ' s 60,000 - 1,000,000 ( m s N ,000 - 60,000 Rest of Austria
Total
.32.7 18.2 18.4 10.3
Males
59.0 31.6 32.3 17.3
Fem.v'lea 7.8 5.0 3.9 3.7
TABLE XIV
CANCER OF THE LUNG AND LARYNX, ENGLAND AND WALES 1946 - 1949 (K E N N A W A Y AND K E N N A W A Y )
u 5 j
g-2 1
fc ll
d *c- o!
T y n e of C o m m u n i t y Greater London County Borough Other Urban Districts Rural Districts
Lunf? Cancer P a t i o - N u m b e r of `P e r s o n s
Producing One Death
Male
Female
100
100
129
137
160
156
233
185;:'-
Mole
100 125 148 :i 70
rer
Persons
Death
0
Female
100
55
60
42
TABLE XV
STANDARDIZED MORTALITY RATIOS* FOR LUNG CANCER MORTALITY OF S E L E C T E D S IT E S TN U RB A N AND RURAL C O U N T IE S OF OHIO, W H IT E MALES, 25-64 YEARS
(MANCUSO, Th. F., MacF A E L A N E , E. M. AND P O R T E R F I E L D , J. D.)
Cancer Si--- cod
Years Included
Kinbl Metropolitan Seven Other C o u n tie s ** U r b a n iz e d Counties*** "Rural Counties****
Lung, 1947-1951
122.9
81.8
68.6
s
- Ratio-- Observed Deaths
------------------------- x 100
*
Expected Deaths
"" Metropolitan County: Counties with cities of 100,000 or more in 1950 (91 per cent urban).
***Urban County: Counties with cities with populations between 50,000 and 100,000 in 1950 (66.2 per cent urban).
****Rural County: Counties with communities with populations below 50,000 in 1950 (41.4 per cent u rb a n ), comprising 73 counties.
%
W. c. H U E P E R
August, I 960
LUNG
GANGER
TABLE XVI
D E A T H R A T E S I N 25 S T A T E S O F T H E IN 1940 AND 194S
CRUDE DEATH RA T E S PER 100,000
UNITED
STATES
INDUSTRIALIZED STATES
State
IMli
.1948
Connecticut
8.5
u .i
I! lino is
8.1
8.?
Marybtno
6.5
8.4
M a s s a e h n s o i ;.
10.1
10.2
Mlc :i ; o'OO
5.7
7.1
Mew Hampshire
7.4
10.1
New Jersey
9.7
9.7
New York
10.3
11.9
Ohio
6,0
7.3
Pennsylvania
6,7
8.4
Rhode Island
`i ' 8.7
7.4
STATES W I T H REGIONAL INDUS?!; tATJZATION
S i aU>
I9.U5
1948
Florida
6.8
7.4
Louisiana
6.5
8.5
Missouri
7.3
9.4
Montana
10.0
8.8
Nebraska
5.7
8.0
AGRICULTURAL S T A T E :i
State
1.9 4 0
1948
Alabama
4.0
5.1
Arkansas
3.6
5.4
New Mexico
2.6
.3.0
North Carolina
3.1
4.0
North Dakota
5.6
4.1
Oregon
4.1
4.4
South Carolina
3.6
3.7
Washington
5.1
4.2
Wyo ring
4.9
3.9
The death rates for the year 1946 were taken from "r|'he American Cancer Society. Inc., 1949, Cancer Death Ratos for oach State in the h oh.od States by Site" (3) ; those For the year 1941; wore pwOrced by the National Office of Vital Statistics.
V o'. X XX
LUNG
A!!
a ;-.
MO
Fri m;try
C
11 - - r h o . s
Atiur-ta
Xew i ^[;;4 . ..
') h
.a.ver .ban Fr
Chicane
P i t l s 'm Detroit Larynx AiU at;
irmin Den vex San E-
Chicag
'hr -or sit
vBinm<
. ; C "
WWiWiB
.T-MKbv " / 1 .A /: : .
A"
. I
w . \xx
E N V IR O N M E N T A L CA U SES OP1 CANCER
153
TABLE NVII LUNG CANCER MORTALITY AND POPULATION
ENGLAND
DENSITY
(STOCKS)
Groups of adjacent towns with over 200,000 occupied dwelling's: London and Suburban A re a ..................................................... 156 Birmingham and Suburban A re a .......................................... 134 Manchester and Suburban A re a ............................................ 159 Liverpool and Suburban A re a ................................................. JA2 Leeds and Suburban A re a ......................................................... 132
Sheffield with 124,000 occupied dwellings............................................. ......... 135 Newcastle and Gateshead with 87,000 occupied dwellings.................. -..... 114 A ggregate of 6 towns with 50,000 to85,000 occupied dwellings............ 113 A ngi'C.^t,te of 3 towns w ith 40,000 to50,000 occupied dwelling's............ 107 A ggnw ute of 12 towns with 30,000 to40,000 occupied dwellings............ 104 Aggregate of 13 towns w ith 20,000 to30,000 occupied dwellings............ 100 Aggregate of 29 towns with less than 20,000 occupied dwellings............ 89
TABLE XVIII
IN C ID E N C E OF R E S P IR A T O R Y CANCER, 1937 AND 1947 MORBIDITY RATES FOR NINE METROPOLITAN CENTERS, BY SEX
P E R 100,000 POPULATION*
Males
.Females
Total
P rim a ry Site arid City
1937 1947
Per cent
P er cent
Per cent
I n c r e a s e uMV j F ; 7 I n c r e a s e IPMV j947 In cv onsc
Bronchus a n d bang
A Santa Orleans
J..;-.1Ii d S
Birmingham
D enver
San j
>co
' b jr _
i * mini' s 'h
Detroit
5.0 13.4
:os
1.0 5.3 400 2.3
207
:i 3.1 39.1 198 2.8 4.2
50
7.0 2 0 . 8
174
5.9 29.0 392 0.5 0.4 1180 8.1 j. '''.2 7 h n
4.5 I S . 9 320 2.1 3.9
86
3.3 11.0
;
0.1 21.9 1.41 4.2 8.1
93
U.b 1 4 . 8
j 5.6 34.3 120 3.9 8.1 1 0c :,v 29.S j- j. 2
13.3 29.3 .122 4.8 7.0 . 63 8 .8 13.0 105
9.7 26.j 169 4.9 5.5
12 7.8 15.6 114
1 2 . 6 32.0 154. 2.3 5.7 148 7.6 19.0
I 1
o!
j t-- ! j
LrV.ynx 1
.du; i
1.4 4.0
1.86 0.3 0.3
0.9
1 02
X O i ns
11.3 14.9
32
0.4 1.0
150
0. 1) i .fi
36
Dallas
3.2 5.3
66 1.5 0.4
73 2.3 2.7
17
Birmingham
1.4 4.0 186 0.0 1.3
0.7 2.6 271
Denver
2.0 4.1
105
0.0 0.0
......
0.9 2.0
122
San Francisco
4.5 8 . 8
96 0.2 0.8 300 2.4 4.6
92
Chicago
6.7 7.0
4 0.4 0.6
50 3.5 3.7
6
Pittsburgh
4.4 8.0
82 0.4 0.8 100 2.4 4.4
83
Detroit
3.5 6.4
83 0.4 0.3 -- 25 2.0 3.4
70
'"Biometries Section, National Cancer Institute.
1
v
1
' F t p * ci
w. c.. HUEPKR
August, 10"
X X A ROM.
AS)
' ooo
bbtCOS.
.'A id Cli
contact
inhnbn
as ar.se 0. Si
been fc 0 '0:n ;
sustain .srens. V
corcma tos is i elnuent special '. '.sor c
in soot
indusb e>Y r' 1)() {;
.v . , ; ,,,u
A'th
uncosi
voi. x x x
ENVIRONMENTAL CAUSES OF CANCER
155
TABLE XIX
AROMATIC HYDROCARBON ESTIMATED IN ONE-MINUTE SAMPLES OF DIESEL EXHAUST WITH VARYING LOAD AND ENGINE REVOLUTION SPEED WITH FUEL INJECTION INEFFICIENCY (P. KOTIN)
RPM Lead 1000 0
1 /X i/2 8/4 4/4 1200 0 1/4 1/2 3/4 4/4 1400 0 1/4 1/2 3/4 4/1
Q uantities Expressed in U gm ./M inute
Co n cli-ion
Compression Release
Pyrene
137
CPD. X
22
Benz pyrene
146
Compression Release
267
76
465
Compression Release
536
175
772
Compression Release
1800
640 1320
Compression Release
2500
639
876
Compression Release
208
0
9
Compression Release
257
0
47
Compression Release
448
278
437 ,
Compression Release
888
488
432
Compression Release
1912
614 1706
Compression Release
188
0
80
Compression Release
177
56
78
Compression Release
220
76 1372
Compression Release
734
837
892
Compression Release
822
346 1687
Benz- AnthFerylene anthrono .
22
0
42
43
124
223
610
472
1265
469
79
4.3
10
24
171
197
930
320
976
944
0
20 "
0
16
368
69
1071
577
944
656
o ;acks, t a r f umes and dust, pitch and asphalt dust and funios, lubricating
and
ng oil mists and fogs, engine exhausts) ; over 2,000,000 with
comnci id metal fumes, vapors ancl dusts; and many thousands of others
bunding for occupational reasons other occupational carcinogens, such
as si'scnicaiS; asbestos and radioact ive materials.
I. Since some of the recorcvi.x'd occupational respiratory agents have
a ssl found among the local a acl 'or general air pollutants particularly of
a;- an and industrialized areas, people living and working in such regions
ain beyond any doubt an attenuated form of exposure to ibese careino-
g ; While inhalation contact with chromium compounds (chromite ore,
chinmates, chrome pigments), beryllium compounds, arsenicais and asbes-
to- is usually of local character and depends upon the release of specific
effluents by certain industrial plants or the use of certain chemicals for
special purposes (pesticides, antirusting agents), respiratory exposure to
other carcinogens air pollutants, such as polycyclic hydrocarbons contained
in soot, exhaust fumes of gasoline and diesel engines and fumes from
industrial furnaces, oxidized unsaturated aliphatic hydOcarbons from
evaporated or non-combusted gasoline acted upon by atmospheric oxidants,
and radioactive matter, is of more or less generalized nature.
Although the atmospheric concentrations of carcinogens encountered
under these conditions are considerably below those prevailing with occu-
6
W. C. HIJ'EPER
August, 195B
ENVIRONMENTAL CANCER OF LUNG IN FORMER CHROM ATE WORKERS
W .. XXX
AR0MA1 GA SOL
TRENDS IN SELECTED ENVIRONMENTAL FACTORS
United States, 1900-1953 (1924-1926=100)
F IG U R E 5A
p ation a] cal dish
genicali
In f;i
of limy densely Some, y populat mere b(
A si: rates of Aus'
F iy . 2,
States the siz therefc factors except: of air envi.ro rates, urbanthe im
dustrj!
duetio
1. 1 dofne
produ
of cer
O C
Vo;, x x x
ENVIRONMENTAL CAUSES OF CANCER
157
TABLE XX
AROMATIC HYDROCARBONS ESTIMATED IN ONE-MINUTE SAMPLES OF GASOLINE EXHAUST WITH VARYING ENGINE REVOLUTION SPEEDS (P. KOTIN)
TIPM 500 1000 1500 1000 2500 8000 1500
Quantities lpNT>rc: sod in Ugm. at 0 Lead
Pyrene
CPU. X
Benzpyrene Benzperlone Anthanthrenc
225
289
120
235
J :Y
439
325
61
177
102
507
266
33
60
36
oV4
142
40
73
27
346
127
25
70
121
25
13
85
J. 4
48
5
10
39
15
Rational exposures, numerous epidemiologic observations on the geographi cal distribution of lung cancer suggest that they are nevertheless carcinogenically effective.
In fact, the first observations on an appreciable rise in the frequency of lung cancer were reported from the highly industrialized cities of densely populated Saxony during the first two decades of this century, borne years later it was found that high lung cancer rates existed for the population of the industrialized territory of the Ruhr valley, while they were below average for the agricultural region of the Main valley.
A similarly irregular distribution pattern of lung cancer frequency rates was recently established for urban-industrialized and rural regions o' Austria, England and the United States (Table XIII, XIV, XV, XVI; big. 2, Fig. 3). There is moreover evidence from England and the United States showing that in general the lung cancer death rates incren.- c with the size of the community and the population density (YUnc X V I I ) and therefore display a certain amount of parallelism between these two factors and the presumptive degree of air pollution. However, definite exceptions to this rule have also been noted indicating that the quality of air pollutants may play a role and/or that additional, still unknown environmental factors may he active in controlling lung cancer attack rates, on a local level (Table X V III). It is finally noteworthy that this urban-rural distribution pattern of lung cancer death rates conforms with the increased exposure of urban populations to known environmental inriustry-reloi rd carcinogens and their progressively increased use and pro duction particularly in urban areas (Tables XIX, XX; Figs. 4, 5, 5A).
CONCLUSIONS
1. The evidence presented definitely establishes the fact that some well defined exogenous physical and chemical agents are causally involved in the production of occupational cancers of the respiratory system of members of certain restricted worker groups.
2. Since epidemiologic studies of various large worker groups and of the
158
W. C. H U E P E R
A ugust, 1956
membership of special occupations have shown marked differences in their Jung cancer death rates and in view of the fact that excessive lung cancer death rates h a v e been found in occu patio nal g r o u p s w i t h occupational exposure to known industrial respiratory carcinogens, it is likely that in dustry-related factors account for a much larger number of lung cancers than that on record.
3. The demonstration of recognized environmental respiratory carcino gens in the atmosphere especially of urban areas and of consistently and markedly higher lung cancer death rates for urban populations over rural populations strongly suggests that industry-related air pollutants may play a causal role in the causation of lung cancer and its recent consider able increase in frequency in practically all industrialized countries.
4. While occupational and indu-nry-related carcinogenic air pollutants seem to play an important role ir. the causation of lung cancer and its recent increase in frequency, it is obvious that 1'ey are not the only factors responsible for pulmonary carcinogenesis.
5. Research on the etiology of lung cancer therefore should be conducted on a broad basis, including not only inhalants but also agents entering the body through noil-respiratory routes.
EE SEPi Eft
1. La evident !:'; quo se presenta definidamente asienta el hecho de que algunos agonies exogenos, fisicos y quimicos determinados, influyen causalmente en la produccion cle canceres ocupaeionaffs del aparato respiratorio en ciertos grupos limitados de trabajadores.
2. Puerto que los estudios epidemiologicos de varios grandes grupos de trabaj adores han mostrado notables diferencias en la frecuencia de las muertes por cancer del pulmon, en vista de que se han encontrado excesivas proporciones de muertes por cancer del pulmon en grupos de trabajadores que debido a sus ocupaciones sufren exposicion a substancias careinogenicas respiratorias industriales, es posible que los factores en relacion con !a imiustria tengan mucho mayor numero de canceres en su haber de lo q u o se concede.
3. La demostracion de la existencia de carcinogenos respiratorios en la atmosfera especialmente de areas urbanas con mucho mayor proporcion de muertes por cancer que en las areas rurales, fuertemente sugiere que hay polueion de aire por las industrias que pue de desempehar un panel causal en el cancer del pulmon y su aumento reciente en praticamente todos los paisos industrializados.
4. Si bien los agentes carcinogenicos que polueionan el aire en los ambientes industriales profesionales parecen desempenar un papel importante en la genesis del cancer y en su reciente aumento de frecuencia, es obvio que no son los responsabies iinicos de la carcinogenesis pulmonar.
5. La investigation sobre la etiologia del cancer del pulmon por tanto debe condueirse sobre una base araplia que inciuya no solo los agentes inhalados sino tambien a.quellos que ingresan en el organ ismo por otras vias ademas de las respiratorias.
Vo!. x>
1.
F rag; Krafi Respi
grup]
2. Beru: Diffe enkrc keits: vufiie
mum
Fakt.
Si 'it!
emsop soldi
W erl
gegeim Z
uvsiic kreb; alien . 4. Luff Zusb nahn stum
5.
HUf '
einsc ancle
Y,,l. X X X
ENVIRONMENTAL CAUSES OF CANCER
159
SCH LU SSF OLGEIiU NGEN
1. Die vorgebrachten Belege stellen abschiiessend die Tatsache ausser Frage, class einige klar abgegrenzte exogene physikalische und cbemische Krafte urslichlich beteiligt sincl bei e'er Entstehung des Berufskrebses des Respirationstraktes von Angehorigen bestimrnter beschrankter Berufsgruppen.
2. Xaehdem epidexniologische Untersuchungen von verschiedengrossen berufsgruppen und von Angehorigen spezieller Berufe ausgesprochene Differenzen ergeben haben hinsichtlich ihrer SterblichkeitszifYer an Lung enkrebs, and im Hinblick auf die Tatsache, dass ubermassige Sterolichkeitsziffern an Lungenkrebs bei Berufsgruppen gefunden wurden mit beruflicber Exposition auf bekannte industrieiie carcinogene Stofi'e der Atmungsorgane, ist es wahrscheinlich, dass auf die Industrie zu beziehende Faktoren fiir eine vie! grossere Zahl von Lungenkrebsen verantwortlich sind als die uberliefert ist.
b. Der Naehweis von anerkannten, durch die Umgebung bcciingten car cinogen'-] Stofxen des Bespirationstraktes in tier Atmosphare besonders in stadtischen Bereichen und von gleichmassig und ausgesprochen hoheren gterblichkeitsziffern an Lungenkrebs untcr der stadtischen Bevolkerung gegeniiber der landlichen Bevolkerung legt die Vermutung nahe, dass die im Zusammenhang mit der Industrie stehenden Luftverunrcinigungen eine ursachiicne Roiie spielen konnten fiir das Zustandekommen des Lungenkrebses und seine kiirzliche betrachtliche Haufigkeitszunahme in praktisch alien industrialisierten Landern.
4. Wahrend berufsbedingte und auf die Industrie beziigiiche carcinogene Luftverunreinigungen eine becleutende Roiie ,z.u spielen scheinen fiir das Zustandekommen des Lungenkrebses und seine jiingste Hiiufigkeitszur ns lime, liegt es auf der Hand, dass dies nichl. die einzigen, fiir das ZuRandekommen von LungenkrcV verantwortiichen Faktoren rind.
5. Forschungen liber die Act iologie des Lungenkrebses miissen daher auf breiter Basis ausgcfuhrt warden und nieht irur inhalierbare Stoffe einschliessen, sondern aueh solche Bestandieile, die in den Kbrner auf anderem Wege als liber die Atmung eindringen.