Document 3eBwJXq155LdL43MR4JgGeZ36

Occupations and Cigarette Smoking as Factors in Lung Cancer LESTER BRESLOW, M.D., F.A.P.H.A., LeMAR HOAGLIN, GLADYS RASMUSSEN, and HERBERT K. ABRAMS, M.D., F.A.P.H.A. studies have implicated cigarette smok This jour-year study offers addi tional evidence lending to connect heavy cigarette smoking with can cer. In addition, it lists several occupations that seem to have some etiological relationship to the dis ease. They need further study, as it is suggested. ing 2 5 and certain occupations 0 -- es pecially those involving exposure to radioactive7 and chromate ores8 and asbestos9--in the causation of lung cancer. However, the number of per sons known to have such occupational exposures in the United States is rela tively small. f. The sharp increase in lung cancer mortality constitutes one of the most spectacular disease phenomena of the past two decades. In the United States the age-adjusted mortality rate for lung cancer climbed from 2.7 per 100,000 population in 1930 to 11.0 in 1948, a The present investigation was under taken four years ago: (1) to determine whether any additional occupations might be involved in lung cancer and thus deserve intensive investigation, and (2) to obtain data on the role of tobacco usage in lung cancer. more than fourfold increase. In at least one state, California, pulmonary cancer Methodological Considerations now accounts for more deaths than does pulmonary tuberculosis, and among males aged 45-64 it causes 4 per cent of all deaths. Attempts to explain this rising mor tality as spurious, e.g., as due to im proved diagnosis of the disease, do not stand up. The lung cancer death rate-- which unfortunately is still our best Definitive study of whether an occu pation or cigarette smoking is a causa tive factor in lung cancer requires that the incidence rate for the exposed group be determined. This rate is then com pared with that of a control population, the most acceptable control being all the rest of the population from which the approximation of incidence rate -- has increased two and a half times more rapidly among men than among women. One can hardly presume that physicians have applied diagnostic improvements so much more completely to men than to women. Likewise, the increasing pro portion of lung cancer found as a cause of death among autopsies supports the conclusion that we are dealing with a real increase in Lhe disease.1 Environmental changes appear to offer the best explanation for the phenomenon. Previously published Dr. Breslow is chief, Bureau of Chronic Diseases, California State Department of Pub lic Health, Berkeley, Calif.; and Mr. Hoaglin and Mrs. Rasmussen are also associated with this department. Dr. Abrams, who was formerly chief, Bureau of Adult Health, California Slate Department of Public Health, is now medical director, Health and Welfare Fund, Chicago Office, Theater and Amusement Building Janitors' Union, Local 25, Chicago, 111. This paper is based on a study supported by a research giant (CS 9047) from the Na tional Cancer Institute, PHS, and was pre sented before the Industrial Hygiene Section of the American Public Health Association at the Eighty-first Annual Meeting in New York, N. Y., November 10, 1953. 171