Document 937MQOeOZKyn0RdqgjXBgeYBR

FILE NAME Industrial Hygiene Foundation IHF DATE 1957 DOC IHF039 DOCUMENT DESCRIPTION Memo - Proposed Epidemiological Study of Lung Cancer in Asbestos Workers for the Quebec Asbestos Mining Association with Cover Letters NANTS PHILALA PHILALA LANTA LANTA KA 4 ASTEN Mfg PHILADELPHIA 29 PA April 26 1957 Asten *, . TRADE MARK Dryer Felt Dr. Daniel C. Braun Medical Director Industrial Hygiene Foundation of America Mellon Institute 4400 Fifth Avenue Pittsburgh 13 Pennsylvania Inc. Dear Dr. Braun The Air Hygiene Committee of the Asbestos Textile Institute has had two memorandums from your institute under study for about a year now At the last meeting of the Air Hygiene Committee in Philadelphia on March 7th it was the opinion of the Committee that both of these memorandums were to be dropped at this time The first was a memorandum regarding the Environmental Dust Survey for the Asbestos Textile Institute This memorandum was forwarded from your office on February 29 1956. The second memorandum was entitled Epidemiological Study of Lung Cancer in Asbestos Workers Both of these proposals were rejected at this time for various reasons and therefore the writer as Chairman of the Committee was instructed to inform you of the decision of the Committee on these two memorandums If at a later date it is the Committee's desire to reopen either of these memorandums you will be so informed Very truly yours DRH fk -- -- ---- D. -- -- ---- Chairman Air Hygiene Committee Asbestos Textile Institute RRR Oee e YR wee oe CS enn eyEe oe a +O Wh ray August 23 1957 . Mr. Hugh M. Jackson Manager Industrial Health Program Corporation Manville 22 East 40th Street New York 16 New York . Dear Hugh } tember Thank you meeting of the letter for your of ATI a f August 19 regarding the Sep - . As a matter offact having completed theliterature search it is apparent to us that the possibility of an association between lung cancer and asbestosis is much more likely to exist in asbestos factories than in mining operations For example of 99 cases which had been re- ported up to 1955 at least 80 appear to have occurredin asbestos workers other than miners A number were women and the occupations given lagger were weaver bagger spinner etc. carder mattress maker pipe coverer . type mention exposure of the .., Two specific articles which . and the job that by Doll and that by isselbacher Seventeen ' cases studied by Gloyne and 31 reported by Merewether as well as three | mentioned by Harrison and one each by Carston and Owen occurred in England If my information is correct there is no mining of asbestos in England and these must all have been workers in contile 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 Isselbacher's cases involved a contractor's asbestos and helper engaged in cutting and sawing mill board sorter in an asbestos oo, ~ me Mr. Hugh M. Jackson . -2- August 23 1957 The QAMA study is in the final stages which are of course the slowest All of the statistical analysis has been completed and the report is 99 written What remains is mainly minor revisions typing .. the manuscript and proofing It should go to the print shop by the end of this month supplies meeting the I hope this you with what you need for If there is anything further please let me know and I will try to get it to you in time Sincerely yours DCB Enclosure Daniel C. Braun M.D. Medical Director References | 1. Doll .: Mortality from Lung Cancer in Asbestos Workers Brit J. Indust Med 12 81-86 1955 2 Isselbacher K. .; Klaus .; and Hardy H. .: Asbestosis and Med Bronchogenic Carcinoma Am J. 1953 ; 15 721-732 November 3. Doll .: Bronchial Carcinoma Incidence and Aetiology Milroy J. 1953 Lectures abridged Brit M. 585-590 Sept. 12 1953 2 521-527 Sept. 5 _ se INDUSTRIAL HYGIENE FOUNDATION OF AMERICA INC MELLON Institute 4400 FIFTH AVENUE PittsburgH 13. PA Memorandum on March 16 1956 PROPOSED EPIDEMIOLOGICAL STUDY OF LUNG CANCER IN ASBESTOS WORKERS for the QUEBEC ASBESTOS MINING ASSOCIATION . INTRODUCTION Reports of the occurrence of cancer of the lung in patients with | asbestosis have been accumulating since about 1935 Lynch and Smith | Angrist Desmoules et al Cartier Gloyne Merewether Kennaway and Kennaway Doll and others According to Hueper such cases now total about a hundred Many of the above authors refer to asbestosis cancer of the lung and claim to show a definite relationship between the two conditions Up to the present time all attempts at correlation appear to have been limited to lung cancer with asbestosis although a connection between cancer and mare exposure to asbestos has been inferred Pub- lished reports together with the occurrence of some fifteen cases in the towns of Thetford Mines and Asbestos led the industry to consult the Industrial Hygiene Foundation regarding the possibility of a study having a = t JETRIAL HYGIENE HYGIENE HYGIENE FOUNDATION OF AMERICA INC my - Memorandum the G.A.M. A. | ~ 4 2 as its objective to prove or disprove if possible 1. Whether there is a relationship between asbestosis and lung cancer and 2. Whether a relationship exists between exposure to asbestos and lung cancer It is believed that persons having any considerable exposure to asbestos should be included in any study because eventually clairns of lung cancer in this group will undoubtedly be made SOURCES OF INFORMATION During the week of February 20 1956 a preliminary survey of potential sources of information was made with the help of Dr. Kenneth W. Smith Medical Director of Manville Corporation Dr. Paul Cartier Director of the Thetford Industrial Clinic and Mr. Ivan Sabourin General Counsel for the Quebec Asbestos Mining Association Conferences with representatives of the Health Departmenotf the city of Montreal the Deputy Minister of Health for the Province of Quebec representatives of the Canadian Cancer Society leading clinicians in the field and many others indicated that considerable data relating to the general population of the Province can be obtained for purposes of comparison with the population group under study Morbidity data although limited is potentially available from such sources as the hospitals in Montreal and Quebec city and some of the 13 cancer detection centers in the Province Mortality figures also subject to certain limitations are available through the Ministry of Health's Vital Statistics Department headed by Dr. Paul Parrot 2 STRIAL HYGIENE FOUNDATION OF AMERICA INC Memorandum for the M. . . 3 Simultaneously the various categories of information relating to the asbestos workers were explored with Dr. Cartier at Thetford Mines and Dr. Granger at Asbestos From these conferences it was apparent that extensive and detailed information is obtainable with respect to this group . \ \ 1. Medical data including serial ray examinations of the | chest extend over a period of about 20 years 2. In Asbestos it will be possible to obtain through insurance company records information on the diagnoses and causes of death among the insured workers 3. Hospitals in Sherbrook and Arthabaska serve most of the people in Asbestos and records in these institutions should be obtainable 4. Finally autopsy findings exist on most of the cases of lung * cancer from the Thetford Mines ) area PROPOSAL Obviously several possibilities exist for a comparative statistical study between the asbestos workers and either the general population of the Province of Quebec or segments of that population having similar cultural and ethnic characteristica Careful consideration of the sources DUSTRIAL HYGIENE FOUNDATION OF AMERICA INC y Pod ^' Yo Memorandum the Q.A.M. ; oe 2 - . 4 and kind of available information and of its probable reliability in con- sultation with biostatisticians has led to the conclusion that a study of this problem is feasible and should resuit in statistically valid deductions The details of procedure Including the decision as to which data should should be utilized and in which order the available information be studied must await more detailed investigation However it would appear from a review of copious notes assembled at the time of the preliminary survey that a reasonable starting point would be an industry study selecting industry years a group which entered the asbestos from 10 to 20 ago Such a cohort of workers could then be followed according to their subse- quant exposure to asbestos as well as to the subsequent development of asbestosis cohort The precise incidence of lung cancer in the would be determined by detailed study of the experience of these various groups as reflected in insurance company records and careful analysis of the medical and ray examinations This method would approximate as nearly as possible the controlled conditions of an actual experiment and information derived therefrom should be of prime importance The next logical procedure would be a comparison of the experi determined ence among asbestos workers as by the previous phase and among the general population of the Province of Quebec or a suitable s^,g- ment thereof Our preliminary observations would strongly indicate that would this phase would also be both feasible and meaningful It involve de talled study of morbidity data at hospitals in Megantiancd Richmond counties Doe Perron mere, Sap ne eS aren Naber ae SEE Lomnpme yereTrnre ge mmmmme ee STRIAL STRIAL HYGIENE FOUNDATION OF AMERICA INC . Y Memorandum the M. 5 va ao in Arthabaska county and in Montreal and Quebec city It would also re- quire careful investigation of the mortality rates developed in the office of Dr. Parrot Extensive individual checking of hospital records and death certificates and thorough follow of individual cases would be necessary The third and ultimate phase of the study would be a comparison of data relating to morbidity and mortality as developed in the first two stages for the asbestos workers and the general population of Quebec with similar statistics for the Dominion of Canada and for ths United States It is not anticipated that the statistics for Canada and the United States would be developed during the study since they are available through the public health services of both countries The most recent published fig- ures would be used and if necessary could be supplemented by figures | in possession of the respective national cancer societies The cost of the proposed study will be 20,000 20,000 U. S. currency including all travel expenses and the cost of preparing and printing the report eee oe August 26 1955 Mr. Hugh M. Jackson Manager Industrial Health Program Manville Corporation 22 East 40th Street New York 16 New York Dear Hugh The enclosed letter to explanatory We did not feel that we could reply in correspondence to Mr. Kane and there- fore invited him to the Institute for a conference We notified him of the fact that much information is available on the safe handling and use of practically all insulating materials and we supplied him with sufficient data to allay his fears Some time in the future I would like to discuss this mat- ter with you Sincerely yours Managing Director CRWidh Enclosure . W. Letter August 13 1955 from Mr. John W. Kane Corresponding Secretary International Association of Heat and Frost Insulators and Asbestos Workers - DH INTERNATIONAL ASSOCIATION OF HEAT AND FROST INSULATORS AND ASBESTOS WORKERS _ Affiliated with the American Federation of Labor and Building and Construction Trades Department Writer's address 36 Perry Lane Local Union No. 2 City Pittsburgh 29 Pa Dear Sir August 13 1955 | I have and always will continue to have the greatest respect for the Mellon Institute and the really great people who staff her And so is with little wonder that I urgently appeal to you people for possible help in the light of the many many advancements made by the Institute in the examination of air pollution that Sir is our problem seven of the last nine of the members of our Union the Asbestos Workers pipe covers have died of lung disorders It is believed by many of us to be an occupational disease although am familiar with the fact that asbestosis is the number 2 occupational disease I do not believe we are Hindered to any great extent as we are not subjected to breathing in great amounts of it in confined areas But I as all others also be- lieve that our new hazards are found in our comparatively newer materials all of these are fiberous they are fiberglas foamglas and other glass type insulations mineral wool the loose type wool which Has the addition of formaldehyde to it When working with these materials in confined areas it'so it'so pollutes the air that it seems to remain suspended in the air and visibility is not great where it is used extensively One of the results of this action is that it slows the men down as though they Mellon Insti- were not receiving enough oxygen These materials are also irritating to the skin of some and itchy to all Although I know the tute is not a social organization I was in deep hope that you may give us some information and practices that we may adopt for instance our men do not wear respirators in the application of these materials They claim they slow them down and provide improper breathing We would appreciaatney information you could give us on these materials and what dangers they could create We are interested both in a measure of prevention if any and control of the air pollution which if ever gauged for density would most certainly be declared contaminated am sure . that you as thoughtful human beings will help us make a deep cut in the preventable cases by giving the proper knowledge and safety factors we may practice Sincerely 0 s John W. Kane 21 Corresponding Secretary St eee aE ae Se a tee a. aca Ss ae F 1. F F te L a a J. Aba September 23 1948 Mr. J.P. Woodard Director of Personnel Policies Manville Corporation 22 East 40th St. New York 16 N.Y. Dear Mr. Woodard We have made a copy of the French article Asbestosis and Pulmonary Tuberculosis as it appears in the British Journal of Industrial Medicine for April 1948. You will note that this is an abstract of the Franch article but is longer than the abstract which we published in the Industrial Hygiene Digest We have been unable to locate the full name and addreus of the French publication It is simply identified an Sem Hop Paris I suggest that you can probably sacure this article through G.K. Stechert & Co. 31 E. 10th St. New York W.Y. Another source for foreign publications is the H.W. Wilson Co. 950 University Ave. New York N.I. Finally in case you wish to write to the British Journal of Industrial Medicine their address is British Medical Assoc Tavistock Square W.C. 1 London England Very truly yours John F. McMahon Managing Director u! wa fo Te Qe ee ne me nn e ht re vs isto 5. tanta ) Some Remarks on Asbestosis ( Quelques considerations sur l'amiantose Rousseau L. 1947 Sem Hop Paris 23 1811 Experimental Asbestosis Pathognomonic Value of the Asbestos Body Amiantose experimentale Valeur pathognomonique du Corpe d'Amiante | . Giroux M. 1947 Sem Hop Paris 23 1814 Asbestosis and Pulmonary Tuberculosis 1818 Amiantose at tuberculose pulmonaire) Asbestosis and Cancer of the Lung Amiantose et cancers Desmoules R. Rousseau L. Giroux M. and Birois A. Paris 23 1820 pulmonaires) 1947 Sem Hop These four papers come from Quebec Canada where several workers in the asbestos mines have been studied The Quebec school disagrees with the statements _ of Gardner that pneumoconiosis due to asbestosis is not an important factor in the production and progress of pulmonary tuberculosis and that the presence of asbestos bodies in the sputum has no value in the diagnosis of asbestosis Rousseau gives brief descriptions of four patients some of whom are also reported in the following papers One had worked in the asbestos industry for 18 years and experienced res- piratory symptoms only during the last three He complained of cough and an asthma- like dyspnea Asbestos bodies were found in his sputum but no tubercle bacilli Radiography is said to have shown a ground appearance in his lungs unfortunately the illustration is too poor to demonstrate this This is the only case seen at this hospital in which it has been possible to make a diagnosis of asbestosis during life Another patient who had been exposed to hsbestos dust for 25 years and who died from acme unrelated cause showed no clinical or radiological signs of any abnormality in his lungs during life Giroux exposed guinea rabbits and a dog to crude asbestos dust in a chamber daily for several months The rabbits killed after periods of from three to 12-1 months had no asbestosis and no asbestos bodies The dog showed no lesions after 10 months exposure only the guinea showed lesions in the lungs and asbestos bodies In these animals he traces the stages of formation of asbestos bodies fibres reaching the alveoli are rapidly covered by phagocytic cell^,j / et / wt movement of the the haemoglobin already enclose fibres results in microscopic bleeding from damaged ; alveolar walls from the liberated red cells is taken up by the phagocytes which the asbestos fibres Subcutaneous or intratesticular injections injections into guinea of granulomatous of suspensions lesions but no of asbestos in olive oil resulted in asbestos bodies When however the the production suspension vas injected into an area into which 1 ml of blood had been injected immediately considers presence month before asbestos bodies were found after a He that the | of asbestos bodies in sputum has significance pince it implies tissue damage in | the lungs Desmoules Giroux and Richard report a patient aged 44 years in whose family there was no history of tuberculosis He had worked as a bagger of asbestos for 20 years after 10 years he began to experience dyspnea on effort accompanied by cough and expectoration He became more severely ill some nine months before his death which was due to tuberculosis and asbestosis The authors argue that the asbestosis preceded and paved the way for the tuberculosis but admit that they have no proof of this The association of tuberculosis and asbestosis is generally admitted in Britain but is doubtful in the United States _ Desmoules Rousseau Giroux and Birois record brief details of two patients who had asbestosis and cancer of the lung The claim that carcinoma of the lung with asbestosis has been recorded before in only one case cannot be allowed For will there be general agreement with the statement that silicosis is admitted to play an important part in the pathogenesis of pulmonary carcinoma carcinoma ) --~ Taken directly from British Industrial Medicine Vol p 100 April 1948 Journal of 5 No. 2 Y x . MANVILLE CORPORATION TWENTY EAST FORTIETH FORTIETH STREET , Ps NEW YORK 1G N.Y. EXECUTIVE Offices December 30 1957 Mr. Ivan Sabourin St. Johns Dear Ivan a oo Re ' I.H.F. Survey Hugh Jackson and I have reviewed the you sent us We have noted deletion of condensation of the survey which asbestosis and lung cancer in all references to the association of this condensation While we believe that formation is of great scientific Q.A.M.A. to value we can understand the this in- emphasize the desire of the asbestosis We also exposure of the asbestos miner and not the are in agreement with the deletion of the cases of reference to It must be criticism when recognized however that this report will be published because all other authors subjected to and cases of asbestosis If we are to today correlate lung cancer miners greater emphasis should be restrict this condensation to asbestos ing the conort The fact that placed on the choice of words used in defin- exposure to asbestos should be ralelitmeermabteerds of the cohort had 5 or more years of : We believe the first sentence in one has written so extensively - ~ . _, paragraph 2 should read Perhaps no Page 14 In the third sentence of expanded to emphasize that paragraph 2 the definition of cohort should be This might be done exposed personnel by adding a were not included in the sample other exposed sentence similar to the following Office in the cohort personnel regardless of length of employment were not inaclnudded Page 18 . To further emphasize the sentence of exposure aspect of paragraph 2 might read All workers with posure were placed in one of three categories the miners the second more than 5 years of ex- a Mr. Mr. Ivan Sabourin 2 w December 30 1957 Page 23 is In the fourth sentence cance This phrase was reference made to the 95 level of signifi- section on Statistical explained Methods clearly and thoroughly on Pages 23 to 25 in the of the original survey Because this whole wnoatse dtehle eted in the condensatiowne feel it might be advisable to section meaning of the 95 level of significance explaibny foot- a So oe We feel that the fifth change However having found sentence just 12 might be made stronger by the following therefore the hypothesis that asbestos cases we are not above this level and lung cancer than does the general populamitnieornscadnonontotbehave a higher mortality from rejected Bg Page 41 The table in the center of the age group In the original survey this page rate shows a rate of 271 in the 45 - 54 was 27 Page 48 In the last sentence of the first substitution of the word undertaken for thpeawroargdrapchomwmeiwsosuilodnleidke to suggest the in the industry during 1950. cluded in the study Only those workers who met these criteria were in- Page | 49 a In the last sentence of suggest tion of the phrase which have paragraph 1 we would like to the dele- was deleted in the been explained in some detail since such condensation explanation cohort could be reported to the Industrial study be analyzed by their experts We Hygiene Foundation and the continuing because nowhere in the literature cannot emphasize this point too strongly valuable and which approximates thitsodmayaginsittuhdeere reported a study which is so We agree with Doctors Cartier and probably have some asbestotic Braun that a certain number of workers fortunately we cannot fibrosis which cannot be diagnosed by take lung biopsies on all workers and ray Un- means of making a diagnosis before there we have no other study of all exposed asbestos are ray changes Therefore the annual workers becomes increasingly important We feel that Dr. Braun and publication heartily contribution congratulated . We trust that their of this work in a Kenneth W. Smith M.D. Medical Director