Document 6M10wJg8w45XZaYx6wJwRMv4

FILE NAME: Saranac 7th Symposium (SSY) DATE: 1952 DOC#: SSY017 DOCUMENT DESCRIPTION: Transcript of Presentation by Dr. Rhoades Pneumoconiosis and Pulmonary Cancer ________________9:00 A. M. - 1:00 P> M . ________________ 33k. X PNEUMOCONIOSIS AND PULMONARY CARDER Chairman: C. P. Rhoads, M. D. Philosophy of Biostatistics as Applied to Environmental Pulmonary Cancer Morton L. Levin, M. D. Discussion General Review W. C. Eueper, M. D. Discussion Asbestos Miners Paul Cartier, M. D. Dieoussion Asbestos Weavers Kenneth M. Lynch, 21. D. Discussion, lad by 33. R. A. Herewothar, M. D. BY DOCTOR V0KWA3LD: Ladies and gentl men, it's past time to begin. We*re behind schedule by twenty minutes. We hope that wo will proceed in raking up this tine during the course of the day. I will admit it*s a very tight schedule, but with the leadership of our chairman, I am sure that we will ac complish our obiactive for iodav. Before wo begin formally, there are just, again, a few announcements which I must nak * I cull your atten tion to the banquet tickets for tomorrow -md also the.. ______________________ 335. gathering at the Hotel Saranac tonight on colored photo graphy, by the Ansco Laboratories* In addition, there Is a book here which was left on the seat. It is a brown book full of notes. I should like to read the notes, because I think I might glean In there some of the weaknesses of our Symposium, but never theless, hare is the book. It has no nsme and I 'm hoping that whoever owns it might, might get it hare, so 1*11 put it right on the table* With that then, we open our today's sessions on pulmonary cancer, and pneumoconiosis, from the Inhalation of dust, and I think it follows logically, this topic fol lows logically along the same lines as we were discussing yesterday* The Chianaan for today's sessions is Doctor Rhoads, whom you know, and Doctor Rhoads is the Director of the Memorial Center for Cancer and Allied Diseases in Hew York City, and Director also of the Slosn-Ketter'ng Institute for Research Study of Cancer. With that. Doctor Rhoads* gY DOCTOR RHOADS: Doctor Vorw&ld and Guests* I appear before you in a distinctly singular position. I hava not boen identi fied with the field of pulmonary cancer, nor with exposure to dust inhalation. I am in an always very difficult and TAKER FBGM PAGE 335 / lector ?art?ld am o*stsi I app**1tofor* you In a distinctly singular position. I liaw act fceea Ifiantlfiod v&tb fiei-d of yaXsoriary es&esr, ror vith ajxseur* to cast lahalatlon. I aa in sa always vary difficult and 316* much publicized position of research director, that unhappy type of individual trying to persuade or threaten individ uals to do what he thinks they ought to do* He always find this very difficult indeed, of course, if not impossible* However, I was very happy to be able to accept Doctor Vorwalds invitation, because in our group and other groups associated with us, have coos certain aspects of work which pertain, I think, to your intoreat and to the field of pulmonary cancer# I have no comments in the field! of statistics, and so will leave that important topic to those who will present papers* I was impressed, however, with the program, to observe what seems to be a strongly inclined point of view toward the purely industrial hazard aspect of this problem and perhaps less attention givan to diagnostic, therapeutic and experimental considerations, which perhaps pl&y an in teresting role* Until we can, through your effort*-;, eliminate the cause of this veryserloua condition, we must consider what j i can be done better to handle it once it has occurred* j i "de have been interested, in our institution, in ! i .V the development; of t echniques. He permit study of tnera- j peutic problems relating to pulmonary and other environment ally indue d cancer. He are vary happy, some years ago, to; be able to ovide facilities for Doctor Willie. Smith, 222. which have permitted the development of highly precise and satisfactory techniques for carcinogenic principals# Many of us have felt that that enterprise subse quently conducted at Hew York University, in the Medical Department# hae provided important data, indeed principals which may lend themselves to study of pulmonary as well as other environmental types of cancers* I refer, of course# to the study of that form of cancer induced in experimental animals and conceivably in man, by the positive action of high temperature catalytlo agents, fuel oil# Doctor Smith and his associates were able to demonstrate the oause of these activities of these can-- pounds of this material, and of certain compounds contained therein* There are strong suggestions that no one pure compound induces the neoplastic change, but rather a combin' 1 ation of several# There was also strong evidence that tala combination of materials will induce cancer in the primate, which I regard as an important advance# If we have, then, the principal of possible k u 1" tiple origin or whole carcinogenesis, that provides at least leads for further laves tigation* e have also been h&ppy to have with ua Doctor 1-WXttt'**?' who ca-se subsequent to his ( smjor observations with Doctor ,,ines in St* bonis* I a ? strong defender of Doc -r Winter, whom I regard as an ensr-j gatic and reliable worker. I am auara that his statistic* ! -131. has - have been brought Into question, but his tables, his data, with those of others, would seem to many of us to provide adequate evidence to suspect the Inhalation of tobacco smoke from cigarettes as a participating etiologloa]. factor in pulmonary neoplastic disease* Doctor Winter has never, a far as I know, claimed that this was the only faotor, but only that it is an important one which Justify* further study. We have been fortunate to have certain ob servations which we think may give techniques suggesting the possibility of further study, both of etiologic, of a prophyllaefcic and a therapeutic nature* Kay I have the first slide, pleaaet I am going to show Just a few slides which indicate certain areas of study, and of thought which may amplify the topics of today1 discussion* I presums that you have all seen the article of Siofct*s which appeared in the sursaier issue of the Brays Journal of Cancer* If you have not, for your intorost, I threw it before you, because it doo._ amplify those studies of the individuals who have concerned with smoking as ] etiologic and pulmonary cnncer&tien* j This is the chart of the London areas and suggest aj j very strongly a concentration of pulmonary cancers in those i areas heavily contaminated with, industrial smoko and a tread toward the areas to which the preva "ing wind blows* This . nay, in the opinion of Stotts, whica seems to be well 319* established by the evidence, provide an additional factor to the one referred to by those concerned with cigarette smoking* And I would like to emphasise again the possibil ity of multiple factors in the etiology of pulmonary neo plastic change* Doctor Winter has allowed me, since he is in Europe* to present one example of cancer in the experiment al animal, induced with the production of the burning of cigarettes under cireumstances which are considered to b related or reasonably close to those which obtain in man* J True cancer now has been induced by these pellets and it ia hoped that It will enable us to go forward to a more xaot knowlodgeof the physical circumstances involved in smoking, to be developed, and more adequate evidence concerning the nature of the active principal and the mode of its produc tion and the mode of preventing the lesions thereby esuaed, , can be had, but this ia a true cancer in the experimental animal, caused by cigarette smoked tsr* How, we have an important area in the early diag nosis, and I hope that those concerned with public health measures. Doctor Levin and otht. ", will rofor to the ques tion of hew wall we can pick up treatable d:lc m s e by mass survey* In our own experience of about one hundred rifty ; to two hundred patients a year, with pulmonary patients, we f.*d that the pick-up h a t come? .o us from that survey is comparatively limited, but there ia a very active pick-up i from armed ssrvioa examinations and from e seminations in th$ dootors* offices or the hospital* This suggests soma practices in bringing before the practitioner, the Importance of considering neoplastic change as etlologle, as possibly suspicious of any pulmon ary lesion, and I do hope we will learn more of early diag nosis by moans of mass survey techniques* Uext slide. Of course, in cur particular intar es t, we are deeply concerned with getting a symptomatic dl3s.se in a stags where i t 's still treatable and we*re very happy to be able to report that steadily the incidence of operable disease increases, in part because of the greater conpetense of the surgeon and to aone extent perhaps, b e cause of the early rendition because of adequate diagnostic sj^aauros, and these ere very tap or*tent factors from the j standpoint of the life of the effected individual* i * I go, we are now working on some thirty percent of the pationts who present pulmonary loaiorr. * Now, very happily, we have bsen ablo to define - to dsviBe and apply a more radical technique of surgical retrieval* For many years, it was regarded as impossible to attack the lesion* Involvsd, and, or course, it is their invoiveiwm-t whies renders the pure rate so low in pulmonary cancer* Daszda, Hand, buteon and associates, have devised a procedure now in general use, which includes in the red line, accessible mediastinal nodes and some fifty patients have bean sub jected to this radical disection, applying tha principal, the same principal of bi--section which has been so success ful in X-ray surgical patients in cancer* And, we are able to report at this time, seme suggestion of to what extent this may bo an advance. I t `s not a very emphatic suggestion, and we have no idea what will be the factor at the end of the five-year period, but we are satisfied, as testified by the slide, that once the j disease had gene beyond the nodes directly contiguous to pulmonary tissue, it is hardly worthwhile to carry out elaborate bisections# On the other hand, we are satisfied that there is good reason, at least, at present, to attempt to remove directly contiguous involved nodes, because we do have these four individuals who, o vwiao, would have bssn fa talities, who may wall have bean benefit tod by this rather j radical operative process* next slide, please# have been very smeh con cerned and my associate. Sector Southern, In the whole <inos-| tion of potential homotherapy of pulmonary caaear, As j Toi'tor Mergus remarked to me, it 3.2 cuivonticnal to say . it is c ;c<ar and nothing to be done* Of course, it is L-mo, it- 1. not treatable. tha patiant will not bs cured, ?.* i j________ '________________________________3k2*___ i i| - vhen a man comes to you desperate with dyspnea, deeply il!! |! cyanotic, because of superior mediastinal pressure frost j his lung cancer, he is gratified and thankful if you can provide him even a few months or weeks of relief* This can be done in many instances today, with those convention- || al therapeutical - hemotherapeutical agents of the tri- |j millimeter service, which you are all familiar with* and I simply throw on these slides to indicate the evidence that there is a transient therapeutic result to be obtained and this should not be sneered at* ~>s In one sense, it indicates that with careful care, we can achieve better th apeutic results, and secondly, | the possibility of re laving a desperate situation for aeekii or months, should be considered* j We have all bean seeking methods by which we coulc. extend the efficiency of hemo ther&peu tic attack* This has | Involved sons procedure which would allow raproducabla ox** | perinents on husan pulracrary esnear* In our laboratory, !j j; Sector Tool an has been successful in drawing epidermoid jj cancer of isaa of a v&rie tj and t -pa, la tbs axperimeatal j: technique, and applying this ten. -.mlque employing essentially i | successful hemo therapeutic nvthoris* j i This (slide) is a lew pewor of a bronchogenic | o i from aa r-amoved in t' opsr&i lag room* This (slide) j is a high power - Ihii thinking of no professional diagnosis. 3klM tnd hare, after two week* of experimental animal, low power, and the next slide, the same preparation high power, two weeks in the animal* This can be done quite regularly and lends itself candidly to various faetors and techniques* Sow, this is an example of how epidermoid cancer* this is not a lung - in the experimental animal, cancer planted in the radiograph, can be destroyed completely either b y homotharapeutic or viral means* This is a des troyed implant of human epidermoid cancer* Similarly, we are making groat efforts to grow pulmonary ar .1 ot.er forms of epidermoid disease in tissue culture* It can be done not as well as we would like end this is an example* This if. epidermoid disease* bat not pulmonary, growing in tissue culture at the and of a tan-day period* And this (elide) is - this i3 the treated culture* j J tk: first, fcha one before 11:a control, infoctod with a vir| [ us suitably adapted to the destruction of certain forms of ! human cancer under artificial conditions, and you will oh- | I serve that the cancer ceils have bean destroyod leaving the; normal cells* This can not be done in ovary f o r m of human : cancer, but It can be done with a good ar.ay and we hope | that tkey Will come to light through the development of > these techniques, with better diagnostic, better thsra; eutis Mu methods and then we will wait for you gentlemen to glre us prevention of the disease entirely* Mow, the first paper is Doctor LeTin's* You're *11 familiar with his great contribution to this field* and I personally have waited with great interest, his analysis of the data which bear on the environmental pulmonary csneer* Doctor Levin* BY DOCTOR LBVXHt j Thank you, Doctor Rhoads* Ladies and gentlemen, I am supposed to talk to you on the philosophy of the bio- atatisties of environmental pulsaonary cancer, and I have never been sure, up until this jsoment, whether I was sup posed to concentrate on philosophy or bios Statistics or environmental pulmonary cancer* I shall probably try to do all three, and succeed in neither of them or not one. I certainly would like very much to second the remarks of Doctor Rhoads as made and porh&ps I can do so &nd make some cosasients on some of the tnings he las said, J by telling you what my own point of view is in this ratter* It is primarily that of an epidemiologist which la the field in which I received most of nj medical train ing. An epidemiologist, as you probably know, is not a statistician necessarily, although ho has to know something j about statistics and use them *ad know when he is in ; trouble, some - so ha can go to s.-vseone who is a ~ t -Us tician.