Document DpKKVbnJrNV4B4L4Qx4jG2J5

FILE NAME: New York State & NY Times (NY) DATE: 1950 DOC#: NY007 DOCUMENT DESCRIPTION: Journal Article - NY Occupational Cancer Committee Presents a Program on Occupational Cancer divisionindustrialm m DEPT OF LABOR 80 CENTRE STREET, NEW YORK OFFICIAL PUBLICATION of the AMERICAN ACADEMY of COMPENSATION MEDICINE ORIGINAL ARTICLES The Rehabilitation of Injured Workmen in Puerto Rico 5 GUILLERMO ATILES MOREU H ER M A N J. FLAX, M.D. * * EUGENE J. TAYLOR Fr * Occupationol Ca'ncer . * ~ ^ 9 . -- '"N EW -YORK STATE O CCU PATIO N AL CA N CER COMMITTEE Gastroenterology and Industry 17 Z. T. BERCOY1TZ, M.D. Excision of the Femoral Head ...... ................ ........................... 21 O. C. HUDSON, M.D. .. _ A. J. P R ISC O . M.D. Atomic Data . .. ........................................................... 25 President's Page .......................................................... 31 Editor's Page 32 VOLUME 3 S E P T E M B E R - N O V E M B E R , 1950 NUMBER 3 O f V O T E D t o t h e C A R E of t h e I LL a n d I N J U R E D in IN DU ST TEE NEW YORK STATE OCCUPATIONAL CANCER COMMITTEE PRESENTS A PROGRAM ON We are indebted to the \ r Y o r k State Occupational Cmrnrcr Com m ittee and Us sponsors for making this in formation orailable. IICCUPATIOML a challenge to the physician . . . Sponsored by: Medical Society of the State of New York New York Slate Department of Health New York State Department of Labor HtnaetucttM t ix t h e prevention of occupational diseases we have a ent information. A copy of the form used by physicians fertile field to which the practicing physician can make in New York State, exclusive of New York City, for re a vital contribution in the course of his regular work. porting cancer cases is also included. It is unique in that the data required cannot be developed If called upon by any physician interested in cooperat in a research laboratory or in a university. It must come ing in this program, the New York State Occupational from the phvsicians who actually see cancer cases or Cancer Committee is prepared to follow any suspected cases of suspected cancer, either in their own private case of occupational cancer in New York State into the oihees. in cancer-screening clinics, or in the hospital. workroom where it is believed that it had originated, and Ii Ls thus a research problem of extraordinary importance to make all necessary technical investigations of the envi practicallv made to order for the busy practitioner who ronmental factors which might have been responsible. is willing to devote the few extra minutes necessary to Such investigations will include chemical analysis of mate lake a careful occupational history on his cancer patients: rials. radiation measurements, chemical analysis of air and report for further investigation, cases suspected of contaminants in the form of dusts, gases, fumes, dust having been exposed to carcinogenic agents in industry . counts, or any other techniques as indicated. In thus trac To assist the practicing physician in this matter, the ing back the occupational exposures of cancer patients, New York State Occupational Cancer Committee has it is hoped that occupational factors not now suspected prepared this information. The table provides a few useful of causing cancer will thereby be. brought to light. clues, includin' a list of the chemical substances and In New York State, the professional staff of the Divi pkvsicai agents found ir. industry, which are. at the sion of Industrial Hygiene and Safety Standards may be present time, suspected of called upon at all times for having carcinogenic proper- consultation and study of tats, and the tvpes of cancer believed to be caused bv ir.-rr,. t 'j n h e r >: u d v w ill no E d r i': recocniliur. o; the possible occupa lierai (tiolos'i oi cancer will: these problems in particular plants: the scientific evalu ation of any health hazards g ht . jfCC <-*iher - i o t h i s : -t: I'ltorinciioii a 1 I: il: he which may be present, and r. : y, or. t h e ii: m a v ve re pc: lust a: old in th uturi practical assistance with con be cropped a* neu data "rr.T - v a i l a : ' . - r. T h e :a U c : --r - ' *` -r >. : h - > GP.it " V. :. . -x- i.-m. id, a bd'i ior f,n>sosi>. . undtr Sla!> Con: /a il La: a a l a a . a i a n r , io Ih, fai- ih. .ve/ da:,i ,v ta cc idi nr>. trol measures. All such re quests should be addressed to Dr. Leonard Greenburg. Di rector, Division of Industri.i; lltgicnc and Safety Stand ards. New York State Depart . : 0 Ir . ' v e .a icona oca ment of L a b o r, b Gentle . ' . r. street. Nett Yolk 1i. N. Y. 3 " " v E=R-NOVEm BER. 1950 HE medical profession is well aware of the extent to which lack of knowledge of the basic causes of cancer is responsible for the un satisfactory state of our prophylactic and thera peutic approach to this problem. We do know that a causal relationship has been definitely es tablished between cancer and exposure to certain chemical and physical agents in industry. Thus, exposure of the skin to certain types of oil, tar or pitch are known to cause skin cancer. On the other hand, epitheliomata of the bladder are de finitely known to result from exposure to certain of the intermediates in the manufacture of ani line dyes, such as beta naphthylamine. This small group of cancer cases for which an occupational etiology has been established thus offers a rather unique point of departure for the further study of this baffling disease. Too little attention has, however, been paid to these occu pational cancers; too little is known of the envi ronmental factors responsible for their produc tion. An appreciable number of such cases have, nc doubt, gone unrecognized as to occupational etiology. This is true not only of occupational cancer, out of mans other occupational diseases as well, it i> a common fallacy to believe that occupational diseases bas e certain clinical earmark which im mediately suggest an occupational etiology, or c'e-- ^ specific occupational exposure; or that me-, present medical syndromes so distinctive as : clear!} differentiate them from non-occupa- al cisease-. This mas occur, but it is relatively "are. \\ hetr.er one is dealing with cancer or with tner systemic diseases, such as hepatitis, nephrosis aplastic anemia, resulting from exposure to toxic ~ -- mbustrv. a clinical diseases entities, thev ace m. specific clues as to euologv. In manv - i upationa! etiology is unsuspected. In oraer acquire new data as to the environ- ~.t: ta. :ac: r---suspt' ted as well as unsuspected - : a ar- responsible for cancer case, it is ne- ` w- p ti'iS rs what the patient's oceu- c\p sure wa-: what chemical substances ' ::t ont.ii: with: what other environ- .... u c o me-ent in the workroom. Since cancer will usually develop only after a great many years of exposure, and even many years after exposure to an occupational carcinogen had ceased, the occupational history of the patient must be carefully studied all the way back to hh first job. This is difficult. But it will be rewarding. At any rate, it is the only way to get the necessary data. Frequently, however, the patient will not know or remember the precise chemical sub stances, for example, with which he worked. Or he may forget to mention the only exposure which happens to be significant in his case. The names and addresses of the plants where the patient had worked are more readily obtained. This informa tion alone can be a useful guide for a technical investigation of the patient's occupational expo sure over the years. ' The importance of the occupational history form thus cannot be overemphasized, since a complete occupational history' is indispensable to developing any useful data with reference to occu pational cancer. History taking, whether it is the clinical history or an occupational history, is very time-consuming. The occupational history, how ever, is less familiar to the medical practitioner and so it always seems to present the greater hurdle. For that reason, the suggested Occupa tional History Form has been made as simple as possible. Xo matter how carefully and intelligently the case has been worked up, or how accurate the diagnosis, the possibility of an occupational eti ology must not be overlooked. Recognition of an occupational etiology, where it exists, will provide invaluable information as to the type of work the patient must avoid m the future; it will provide a basis for prognosis; and it will make possible assis tance to the patient and his family under the Compensation Laws of the State in which he lives, providing them with much-needed financial as sistance during a period of disability. Recognition of the occupational etiology of cancer cases, where it exists, will provide statistical data as to incidence, distribution, causative agent', etc .. now prac tic alls non-existent. Y e n few people COMPENSATION MEDICINE realize how little reliable information there is, at the present time, as to the incidence of any of the o:upa:ional diseases. Occupational cancers, as a rule, result from Drc-longed exposure to physical or chemical car cinogenic agents in the working environment. Such exposures mav be continuous or intermittent over a period of many years. There may be a long Latent period before the first evidences of cancer begin to manifest themselves. During all or part of this period, there may be no contact whatever with the carcinogenic agent originally responsible for the cancer. In the case of radium, for example, this latent period may be as long as 20-30 years. Individual susceptibility probably plays an im portant role here as in all other diseases, occupa tional or non-occupational. No doubt, when more is known about the many metabolic and bio chemical factors involved in cancer formation generally, it will be found that some of these same factors are operative in cases of occupational cancer. It is a matter of great practical importance, for the present purpose, that the industrial en vironment is essentially a man-made artificial one Decuiiarlv susceptible of scientific measurement arm medical evaluation from the standpoint of hazards to health--including the production of occupational cancer as well as other occupational diseases. Of equal importance is the fact that ibcse environmental factors in industrv responsible for injury to health, once recognized, can be successfullv controlled. Fortunately, the techniques for the control of the industrial enviroment and the prevention of occupational diseases are highly developed at the present time. As a guide to the physician who, for purposes of pretention, is interested in investigating the role of occupation in cancerous or pre-cancerous lesions presented by his patients, Tables I and II are appended: also a selected bibliography of liter ature having a direct bearing on these problems. Table I presents a description of selected lesions which have been found, as a result of experience, to be associated with agents in the occupational environment which are known to be carcinogenic. Table II lists, alphabetically, for reference pur poses, some of the more common substances or conditions in the occupational environment which are recognized as being cancer-producing or sus pect. With each such agent the organ or system usuallv involved, is presented together with a clas sification in the right-hand columns, indicating whether the etiological relationship is doubtful (Class D ) or established (Class E ). The New York State Occupational Cancer Committee would greatly appreciate the coopera tion of practicing physicians in reporting any information they develop as to the possible rela tion of occupation to the pathological lesions, malignant or benign, which they find in their patients. r i - 1- R. Mi-.trs. M.D.. N fw York Stav D-partrr.-r.t oi Labor. V .-_d I M D . U.S ?_.b:i' H M D . s'.:-ar.-Kf.i- rir.r s-rvicr . Nrv. York rr. !>.. Y . S P - Y Y H-a:::: . M D.. M..:. : Cr.--::.mW As sociat io n i:, \[ D . Ver/: D'-partnc-nt of : P . N Y rk ;n rr,t of ( . id ! .ufficiai acenev :,-Hh the Arthu:: E. Hoa a, M.D.. Mirrili!- r. Aiuerican Petrol -un: In Lcrov S H o '.Or . M.D.. I unior t llinir Association oi ih< Sta of N e w Yorri W. C. Harper. M.D.. U .S. Pubb e- Hiahh Srrvicr Louis ( K: p M.D.. Ko-v." ll P; irk \ f -mona : I n.stitu Burirlo. X. V \ Antho rv J , La I./.:. M l ) . . Wee Ye.r!; l ` n i \ 1! s;t\ . Crii uatt Medi, .! : Si hoe'!. New t en i C:itx Morte r. I. 1 ell.. M Hr; lit!, New Voi k St.it.- D.-pa rt i:H-m fj.-ui i: r I . Iti. 'r. M n . Medie ., ; Sen it'I\ tit ittr Sl.t ir o! N. rs* EER-NC VEm BE R 1950 ! I