Document K661KKwq0YrwO6dYo3v3vdYD2
FILE NAME: Smoking (SMOK) DATE: 1955
DOC#: SMOK006
DOCUMENT DESCRIPTION: Book Excerpt - Industrial Aspects of Bronchiogenic Neoplasms
In d u s tria l A sp e c ts o f Ilronchio.uenic N e o p la sm s
hK ST K U ISUKSI.iiW . M.H.
llerkeley, California
Medical students usually leant as tin- classical example of occupational cancer that scrotal cancer occurred iintmi).' chimney sweeps`in 18th century England.1 Their attention would perhaps more readily he attracted to the story of lung cancer anumj; miners in the Srhiiecborg- and Joachimsthal mines.'1 The fact that approximately half of all deaths among miners in the latter area resulted 1'rum lung cancer establishes the occupational origin of this disease, in at least some cases. Furthermore, the striking increase in frequency of lung cancer and the millions of persons employed in the several 2Uth century occupations now suspected of having a relation ship to the disease confirm the importance of this subject today.
Lung cancer now causes more than 18,000 deaths annually in the United States.1 Even adjusting for the aging of our population, this represents a four-fold increase during the past two decades.'1 Diagnostic techniques have improved tremendously. Dut the fact that lung cancer mortality among males has been rising much more rapidly than among females in dicates that we are dealing with a real increase in the disease. Jt now accounts for more deaths than tuberculosis in many states.
llecently attention has focused oil cigarette smoking as a cause of lung cancer. Several studies1, based upon interviews with a series of lung cancer patients and a matched group of ``controls" have demonstrated a greater frequency of cigarette smoking, especially heavy cigarette smok ing, among the lung cancer jiatiepts;
As a further investigation of this question7 we obtained cigarette smok ing histories from 518 lung cancer patients and a like number of matched "controls" in 11 California hospitals. The control group consisted of pa tients admitted to the same hospitals for conditions other than cancer and other than chest disease--matched for age, sex and race with the lung cancer patients, 'fables 1 and 11 indicatc the similarity of our two groups in respect to biological characteristics. The greater frequency of cigarette smoking, especially in excessive amounts, among lung cancer patients as compared with controls is shown in Table 111.. In Table IV one may observe that several other measures of the degree of cigarette smoking--age at which began, inhaling, and smoking before breakfast--all confirm that lung cancer patients smoked cigarettes to a greater extent than did the control group. Of particular interest to physicians is that so-called "ciga rette cough" occurred among approximately two-fifth of the lung cancer patients; this usually antedated the onset of illness by many years. One
Chief, B ureau of Chronic D iseases, C a lifo rn ia S ta le D epartm ent of I'ttidir H ea lth , Berkeley, C alifornia. T his paper is based on a study supported i>v a re.-eau-h g r a n t, (CS-UU-J7) from the X alhm nl C ancer In stitu te , 1'tililic llealili Service, lb S. D e partment of H ealth, Kducation and W elfare. Presented at the Utith A nnual M eeting. A m erican College of Ch<--t P hysicians, San Kraticiseo, C alifornia, Ju n e Hi, 105-1.
121
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m
f,
N?
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I.'A
d
b ii t
A r.F.
I r a I fifti -*
JL
422
LKSTKK HKESUOW
i?:.i
hundred twcnlv of the patients staled that they had n<>ti<i a cough for I
five years nr more whereas only 3d of the control group gave a similar
history.
j
These data, consistent with the other recent well-controlled investiga
tions" of the subject, demonstrate a substantial correlation of cigarette
smoking and lung cancer. This correlation increases steadily with the
amount of cigarette smoking. Tkwih'"has most recent ly assembled the find-
ings of these several studies and. using a method developed by Cornfield.*
compared the relative prevalence of lung cancer among cigarette smokers
and non-smokers. Table Y indicates that, for men aged 50-oD years lung
cancer is four to 1] times as prevalent among smokers as among non- j
smokers, and seven to 27 times as common among heavy smokers as among
non-smokers.
One must accept the conclusion of the New England Journal of Medi
cine10 that the evidence-for cigarette smoking as a factor in lung cancer is
"so strong as to be considered proof within the every day meaning of the
word."
TAHLE I AGE D1STR1 RUTH IN OF LUNG CANCER
PATIENTS AN il CONTROLS
CASKS
A jfr
Total U nder 40 40-40
pnrrin*ntj>
4*t
-n
ft
O llie r T.vjn-t of Ciirriiiiiiu:i
472
to
5 ft
Tntnl
SIS 25 62
50-5!)
1!)
GO-6!)
14
1!)4
2 in
154
16S
70 and over
4
46
50
!
T A l'.LE 11 S E X AND RA CE m S T R II'.UTIOX OF LUNG GANCE! ! PATIENTS AND CONTROLS
CASKS
Sox nn<f Knee Total
Atlenn* rnrritiom n
4G
l )th-r Tytic n f Carrm im ia
172
TnC.I
51S
T otal Male
- 42
W hite
41
451
4!i:>
420
461
Negro
20
20
O ther
1
Tolal l-'vmale
4
W hite
a
11
32
2!
25
15
1S
Negro
i
~ Other
n
4
t *
.7
CONTROLS T ..ln l
SIR 26 50 ; -
217
16!) 51 '
C O N T U O I.S Total
51R 407 461
20
12
25
18
4
7
*'.'i f.-T
- I
"T.^.- T ...r T .*S`' *Vt.,*j .T *; 'J. ? . -v.>V'\~/-.' ... O v--`V..'v 7 -fv; -Nv?' /..i><W**"$"-::ti* '' i
; ;.f~sF, '*
iug Jl-iw- iJi..',.l;v,m->r;/*Jrj . A.J'.-T > *? III '*"* L*r'\. --..'."".;;. .
VU. XXY1I1
BRONCHIOGENJC NEOPLASMS
T A B L E 111
A M O UN T OK C IG A R E T T E SMOKING D URING T W E N T Y V E A L S 1'LIOK TO STUDY R E P O R T E D BY LUNG C A N C E L P A T IE N T S AND CONTROLS
TASKS
ruNTuoi-s
l*arktfn of CigarviH-b Smokiti lVr Day KuiiiUt
Total
518
IVr Cent ltio
Number 518
1Vr Cent inn
None
34
7
124
24
is*
4
50
HI
71
14
105
20
1--
:it)4
...
2 or more
80
Not recorded
10
51*
11(11
::k
15
*}
4
2
18
3
T A B L E IV <
AGE OF BEG INN IN G CIG A R ETTE SMOKING,
lL
r-
SMOKING HABITS AND "C IG A RETTE COUGH"
R E P O R T E D BY LUNG C A N C E R P A T IE N T S AND CONTROLS
*
C A SK S
C O N T m il-X
C ig a r e tte S iiM ik iitu C h iir M t`W T i s l u -3
N um ber
l V r ( 'n i l H u k M u ii C ig a r e tte Sm okers
O n ly
lV r C en t H a s <i on T o ta l
N um ber
IV* T e lit o il
r ic a i.tu * Sm oker*
O n ly
1V r (V u l
on T o ta l
Total
518
100
518
100
Total cigarette smokers
484
100
03
304
100
70
Began 15 y ears of age
100
34
32
11G
20
>>
Began 15-24
28G
51)
55
243
G2
47
Began 25 years of age
32
7
G
35
0
7
"Inhale"
440
03
87
327
83
G3
"Smoke before b re a k fa st"
373
77
72
220
58
44
V
"Cigarette cough"
204
42
30
112 ' 28
>>
fi However it is not the sole cause. Some persons with lungcancer deny [; ever having smoked cigarettes. Levin11 estimates on the. basis of our data
I that 70 per cent of all lung cancer may be "attributable to smoking."
1 Application of the same method of estimation to other data gives a range
\ of 56 to 92 per cent "attributable to smoking."
In the present and justified concern about cigarette smoking as a cause
of lung cancer too little note has been taken of evidence that several occu
pations may likewise be involved in the etiology of the disease. Unlike
the infectious diseases where specific micro-organisms have been identified
as the cause, sine <jua non, cancer appears to result from a variety of
exogenous agents. The classical studies of the Schneeberg and Joaehimsthal miners do not
stand alone. Machle and Gregorious1- found that those employed in cer-
b
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TA,?'w*--"<{ii,i*tv, i<.-.iv^,ym"*11.^Xr. tv, ni" A
rmpm
i\ v. / "'t
i'
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. li. i
*-
Vr .-ii
i i iI
;k i i
ii?
i
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,1
t \ F- {
424
LKSTKK BKKSLOW
()ft.vr. 1 t
lrr *.
tain chromate ore operations in the United Stales experienced a ]G tinvj
greater mortality for lung cancer Ilian (lift the general population of t'j
same age-sex distribution. Kennaway and K ennaw ay'' using death n j '
tificate data for England and Wales noted that metal grinders, worke;
exposed to road dust, coal gas and tar, asbestos -workers, cabinet make:
and painters were reported as occupations more frequently among hn
cancel* paljents than would be expected from the general mortality <
... ........
'
:
\\\
TABLE V
; |l
E S T IM A T E D P R E V A L E N C E K A T E S ' O F LUNG C A N C E R PEP. loo.oud MALI: ' OK SELEC TED ACES AND VARIOUS C IG A R ETTE SMOKING H ISTO RIES. -
M 'M U F .H
KSTIMATKD I'lSKVM.KNCK KATKS. QUANTITY
i ' tIF.I.ATIVV : ;
SMOKK1) DAILY-
PHKVALKM , ! ;
titine (*crr
rttnlrul
All
qu-.i
Nnt` H iavy Mii;
P a tie n ts aged 50 to 50 years
Doll and HillIV yiulerand Graham*
270
275
0-1
42
7
in
h
25X
210
117
47
4
27
n;
Sadowsky, Gilliam; ^nd Cornfield7
ioa
20X
87
44
12
i
4
Breslow, Hoaglin,
Rasm ussen, and Abrams* 2 1 "
2 in
102
40
0
17
7
Roswell Park Memorial Institute
17::
057
Ml
1 <)*f
35
!
I
P a tie n ts aged 00 and 00 years
t
Doll and H ill'
107
1
1"7
o::
tt
AVynder and G raham
1X7
i f.o
Dis
70
5
20
ir
Sadowsky. Gilliam, anil Cornfield'
t;
71
44
71
5
t
4
. Breslow. Hoaglin.
i
Rasmussen, and Abrams Iox
10!)
4.".::
78
17
25
5
Roswell P ark Memorial Institute
107
075
470
280
50
!l
ci
'1
E stim ated aecording to Ihe method of Cornfield.*
j
'All d a ta ap p e arin g in this tattle, except for Roswell P a rk M em orial In stitu te figures
a rc taken from the paper hv P.reslow et nl.r
!
(Juantity smoked daily, except fo r (lie present stu d y , is all fo rm s of sm oking ex
pressed as cig arettes with pipes and cig ars converted to th e ir equivalents in ciga
rettes as follows:
!
Doll and Hill-- 1 ounce tobacco j cigarettes a day.
!
AVyndcr and G raham -- 1 cig ar ^ 5 c ig a re tte s; 1 pipeful -- 2 '.. cig arettes.
Sadow sky. Gilliam, and Cornfield-- 1 cig ar = 10 c ig a re tte s; 1 ounce pipe tnbaccf -- 20 cigarettes.
F or the Breslow et al. study quantity smoked daily includes only cig arette smoking
'Relative prevalence are the following ratios; heavy rate am ong heavy smokers, rate am ong non-sm okers; all q u an tities =: ra le am ong sm o k e rs /ra te am ong non smokers.
`H eavy sm oking is defined as the following n um ber of c ig a re tte s or equivalents ol c ig arettes p er d ay ; Doll and Hill, ho or m ore; M 'ynder an d G raham , 05 or more Sadow sky, G illiam , ami Cornfield. -II or m ore; Breslow et al., -10 or m o re; presen study; 20 or more.
S ource: Ix'vin. M. L. Etiology i,f Lung C ancer; P resen t S ta tu s . New York S tate .1 Med., 54:G, p. 770, M ar. 15, 1051.
-.t " : . - . >~-
7Z
: 1 A
r--1' * - '-v n, **: ;A: ..avV,*-
v a x x v iii
RKONOHlnOENJC NEOPLASMS
425
pcrience. Information obbiincd by interview with hospitalized patients in St. Louis ami elsewhere in the United States, studied by Wynder and Graham." disclosed that painters and " hot metal workers" stood out as excessive among I n n c a n c e r patients as compared witli a control group. Mortality experience among industrial policy holders in the Metropolitan Life Insurance ('ompiiny indicated.'"according to 'Lew,'7' several occupa tions with a higher than average rale from cancer of the lung; Table VI
T A ltl.i: VI
" MORTALITY E X l'F.Rl KNCK AM ONt; W H IT E MALE WALK- E A R N E R S
l.N'SUREH C N IiE R IN D U S T R IA L P O L IC IE S ] \ T H E M E T R O PO L IT A N L IF E
INSURANCE COMPANY 1
; OCCUPATIONS WITH PROBABLY
HKHIER-THAN-AVERAOE DEATH RA TES FROM CANCER OF T H E LU ND S'"
Ocru|i<Hi>iiul tirnut*
Death* Kroin AH
Delete Kmtu All Knm* f l*an'*T
Numlecr
From
*f l.uiuic
lVfft,ntai'i` lU'lattVf ( Death'* From All Faust'*
IVr*`Hlat!f liflalivc lo
Front AIJ Kurin.* of Fam*T
All W age E arn ers
il2,m ti
Rlaeksmitlis
51W
. Brick and Stone Masons''
722
Cooks-- Hotel
and Restaurant
315
Coppersmiths, Tinsmiths,
Etc.*-- Nut Roofer-
-1112
Engravers (Metal)
and l'liotocngravci s
til
Laundry W orkers (Except Laborers)
Mail C arriers
212
.Miners ( U nderground, excluding Coal Miners) 222
Painters and VarnishersHuuse, Shop, etc.
2,821
Plasterers
P.KI
Plumbers, Steam litters, and (L>slillcrs'
1,178
Hoofers ami S laters-
225
Slaughter and Packing-
House Operatives
27U
Street Cleaners
Tannery Operatives
227
Tailors and Other Clothing Workers
1,5(0
Traveling Salesman
374
Welders*
21 r
13,858
1,082
1.5
75 I
11
2.2
324
38
2.5
48
8
2.3
(11
t!
2.2
15
5
0.0
27
5
2.3
41
7
2.1)
30
0
2.7
"(ill
G2
2.2
31
5
2.G
15(1
211
2.5
;;i
5
* >
41
7
2.5
(14
!J
2.7
33
5
2.2
228
37
2.4
4(1
10
2.7
24
*4
3.2
12.1 14.7 14.5
1G.7
14.8
33.3
18.5 17.1
30.0
1G.U 10.1
18.0 10.1
17.1 14.1 15.2
10.2 21.7 2H.2
Mil these occupations the m o rta lity from all form s of cancer was som ew hat h ig h er than average as follows: HricU anil Slone Masons, 1 5 3 'I of av erag e; Cooks-- Hotel' and R e sta u ra n t, l l ! 1'! o f a v e ra g e ; C o|i|iersm itlis, Tinsm iths, etc.-- .Not Roofers, 12371 of av e rag e; l'lum liers, Steam F ilte rs, and (bis F itte rs, 110VL of a v e ra g e ; Roofers and S laters, 11275 of a v e ra g e ; W elders, 120'. 1 of average.
`Lew, E. A., Use of Life In su ran ce Com pany lleeurds, for Cancer Studies. A rch, of lnd. Ilyg. and Occup. Med., 5:PJ'J-2U3, J la r., l `J52.
'v ".*V*' -v/-W~ *' <
r*?V't %' '
4-ji;
LKSTKIt IIKESLUW
;i **>
IWt
TA III.E VII
C A S E S A N I fONTIIOLS EMPLOYED F O Ii AT LEAST -- 15-YEA IIS -I N S E L E C T E D O C C U PA TIO N C 110 U I'S ` --
Orrun^iM.n
J Weldors and sheet nielal workers lining welilinjr 2 Steamfiltcrs, Imilerninkers, asbestos workers 3 Electric bridge crane operators--metal industry
P K K S O N S KMri.OVF. H IN
O C CU PA T IO N AT I.HAST . S VKAUS
-- I Cw^ (*>ntr**k
tt; 14
2
t i,
1 10
i f
1 5
4 Occupations in the extraction of lead, zinc, anil copper ore
!
i :
5 M arine engineers, firemen, oilers and wipers
12
r.
6 Construction and m aintenance painters 7 Cooks, commercial (excluding cannery cooks)
22
12
35
21
Occupation groups based on regrouping according to common occupational exposures a fte r detiiled examination of records.
shows these occupations. Hueperln mentions several exposures suspected
of being involved in lung cancer.
!
Interviews with lung cancer patients and a control series in our study7
included life-long occupational histories taken by persons skilled in occupa
tional analysis. Information about every occupation in which the person
had engaged was so detailed that the session often lasted two hours or
more. It covered an exact description of the work, the industry, the dura
tion of employment, known exposures to toxic materials, and other factors.
Interviewer bias as to the occupational data can be practically ruled out ; .
inasmuch as both lung cancer patients and the controls mentioned hundreds j
J of occupations, none of which was suspected by the interviewers.
` j
Although the information included type of industry and exposure to
known toxic agents, efforts to analyze these were not productive. There- ;
fore major emphasis in the analysis went to occupation itself, coded ac- :
cording to the United Slates Dictionary of Occupational Titles (Second
Edition) Washington. 1). U. S. Employment Service. 1040. This lists j :
"G7 categories.
! |
Table VII presents a list of apparently significant occupations based `
upon our study. This tabulation was developed by first observing the rela
tive frequency of occupations in which individuals of the case and control
series had spent at least five years. This gave leads for further study.
Thereafter, since the code used was not designed to reflect common occu
pational exposures, analysis was carried to the examination of records of
individual cases and controls. Regrouping of occupations based upon
common exposures resulted in Table VII. It. appears th at exposure to 1
metallic particles or fumes, asbestos, paint and other materials appear '
to play some role. Similarity of this list to other studies, particularly that
of Lew'*1 is immediately apparent.
h
Comparability of the findings in four studies is shown in Table VIII.
These separate investigations, extending over a 20-vear period and two : -
t.
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ix *V>;<\u\.vC"3*3; *-it * He.'.
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H K O N rilitlG K N ir NEOPLASMS
J27
countries, utiii/.ed general niurtality statistics, lift* insurance statistics and
interviews with hospitalized patients. The fact that such varied data,
analyzed in different ways, consistently identify certain occupations attests
their probable significance in the development of Iuiik cancer. Uesides the
occupations listed repeatedly in Table V III--painting, welding and other
metal work, steam fitting,and. other-asbestos-work--:idditibiuiI"Tvp<\s of
"work are mentioned l'ragiently in the findings of studies of occupational
aspects of lung cancer. These include furnace men, engineers, workers
exposed to petroleum and petroleum combustion, carpenters, cabinet
makers and wood workers generally.
Thus, several types of employment may constitute etiologie factors in
lung cancer. The most clear-cut evidence pertains to the Schneeberg and
Joachimsthal mines and to chromate ore operations in the United States:
in fact, one can hardly doubt the causative role of work exposure in these
groups. Other studies, including our own, strongly implicate the occu
pations shown in Table V III: painting, welding and other work involving
hot metals, commercial cooking, metal mining, steam fitting and other
asbestos work.
<
We are now engaged in another type of investigation designed to con
firm or refute the hypothesis that these latter occupations carry an exces
sive risk for lung cancer. This involves obtaining information about em
ployment from persons engaged in suspect occupations. It will include
cigarette smoking history as well as details about type of work and dura
tion of employment in it. Such information is being assembled for approxi
mately 10,000 pci-sons in the age range d5-64, now employed in each of
the suspect occupations listed in Table VII. During the next few years we
will observe the mortality experience of these groups through checking
TABLE VIII
C O R R E S P O N D E N C E OK FOU R S T U D IE S IM PL IC A T IN G S E L E C T E D O C t'll!1A TK IN S IN LUNG CA N CER
Kcitmi ini y 1' \Yijmi* '(>ohttm*'
Li
Hrrsltiu', t t ttY
Painters
Metal grinders
Pa inters
Welders, foundry and .steel-mill win kers ami oth er " hot m etal" w orkers
Painters ami varnishers-- house, shop, etc.
Welders, copper smiths, tin smiths, etc. blacksm iths
t Cooks--hotel and restaurant
- Construction and maintenance painters
Welders and shectlm-tal Workers doing welding. Electric bridge cranemivralors, metal industry
Cooks, commercial (excluding cannery cooks)
Miners (under ground, excluding coal-m iners)
Occupations in the extraction of lead, zinc ami copper ore
Asbestos workers
Plumbers, steamfitters and gasfitters
S tcam littci s, boilermakers, as bestos workers
-w
i
./: ...
; '"
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LESTER JiUKSLOW
o r t.^ r . uns
with the vital statistics imlex of the California State Department of Public
!
Health. Thus, the actual lung cancer mortality rates will be determined
for persons in occupations identified by previous studies as possibly having
etiologic significance. Comparison of the rates with that of the general
population of the state (corrected Tor_age-se.\distribution) will"indicate
---- the degree of excessive risk, if any. in the occupational groups. If their
1
lung cancer mortality rate substantially exceeds the rate for the general
j
population, one may conclude that some occupational exposure is involved.
j
Thereafter it will be necessary to determine the precise environmental
|
agent and undertake preventive measures.
As occupations are identified as causative factors in lung cancer we will
be in a better position to establish control of this disease not only by
prevention, but also by intensive case-finding efforts in high risk groups.
SUMMARY
Lung cancer has increased strikingly in recent years: it now causes more than 18.000 deaths annually in the United States. Although much evidence incriminates cigarette smoking as a major factor in the disease, it is not the sole cause. Previous studies are cited to indicate the role played by occupational exposure.
Interviews with 518 lung cancer patients in ('alifornia hospitals, and a like number of non-cancer "control" patients, confirmed the greater frequency of cigarette smoking among lung earner patients. The inter views also covered life-long occupational history. Analysis of this data disclosed that the following occupational groups appeared with substan tially greater frequency among the lung cancer ease histories, as com pared with the controls: welding and sheet metal workers doing weld(ing; electric bridge crane operators, metal industry: construction and maintenance painters; commercial cooks: occupations in the extraction of lead, zinc and copper ore: steamfitlevs. boilermakers, asbestos workers; marine engineers; firemen, oilers and wipers. The correspondence of this list of occupations with those arising from other studies of occupational factors in lung cancer is demonstrated.
Further work is underway to confirm or refute tin- hypothesis that these occupations carry an excessive risk for lung cancer.
jiEstr.M i:x
El cancer del pulmon ha aiimentailo notablemente c los a nos reeientes: ahora causa m as do 18.000 defuneiones al aim on los E slados Vnidos.
Aunque oxislon evidcncias do qne el fumar cigarrillos tienc gran responsabilidnd en la enfermedad, no es la (mica causa.
Existen trabajos anteriorcs quo sc citan indieaudo el pa pel que dcsempenn la exposieion orupacinnal.
Las ontrevistas llcvadas a calm eon 51S enfernms de cancer del pulmon cn los hospitalos do ('alifornia y con un mimero igual de enfermos de "control'' no cancerosos, eonfirniu la gran froeuoncia del cancer entre los
p s p g g s g g ' V* t.
V"L XXVIII
JHtO.NfllimiilNIC NEOPLASM S
-12'J
fumadorcs de citfarrillos. Las ciilrevistas incluyeron tambien las historias ocupacionalcs de tuda la vida. El analisis do oslos dalus descuhrio quo lus siguienles grupos de ociipaciones mostraron dentodo substantial mayor frecitencin entre las historias de cancer del ptilmon on comparacion con los controles: trabajadores on soldadura y enlamina deatcero, operadoresde yruas electricas mi los ptienles, iiulustria dc metales, pintores de construccioncs y dc nuuilenimiento, cocincrns comcrdalcs, trabajados cn la extraction de plmno, zinc y cobrc dc los mincralcs, trabajadores ini maquinas dc vajior, constructores dc calderas, trabajadores ,de asbestos, maquinistas marinos, bomberos, enjfrasadores y limpiadorcs. La correspondencia tic csta lista dc ocupacioncs con las qtte resultan de otros estudius dc facturos de ocupacibu se denutestra. Esta en preparation mas investiracidn para conlirmar o rclutar la Jiipotcsis de cjue cslas octipaciones tieiien consist) un rie.<Ko mayor conrcspcclo al cancer.
RESUME
La.frequence du canter pulmtmairc s'est accrue de faqon frappante ces derniercs annees. 11 cause maintenant plus de 18.000 deces jiar an aux Etats-Unis. Ilien que, de toute evidence, on puisse incriniiner la fumee ties cigarettes comme facteur principal de cette atTection, ce n'est pas la la cause unique. L'auteur cite les etudes anterieures qui out montre le role jotie par certains risques professionnels.
L'interrojratoirc tit: 518 ntalades des hbpitaux de Californie, atteints de cancer pulmonairc, et il'un nombre semblable tie ntalades temoins non cancereiix. conlirme la plus grande frequence des funteurs chez les pre miers. L'interrotfatoire ]>orta aussi sur les antecedents professionnels de toute leur existence. L'analvse de ces donnees a demontre que comparativement au jfroupe temuin, les professions suivantes figurent avec une fre quence. notablement plus grande dans les cas de cancers: soudeurs et ouvriers lantinetirs travaillant dans la soudure, conducteurs de jjrue, ouvriers de I'industiie nietaHurj'iquc, peintres cn bailments, cuisiniers, travaillcurs s'uccupant de 1'extraction du plantb ou du zinc, on des minerals cuivreux. cli.audronniers, contlucteurs de machines a vapeur, ouvriers exposes a y'amiante, ntecaniciens tie la marine, pompiers, graisseurs ct nettoyeurs. Cette lisle de professions est en accord avec cellos tpii out ete etablies au emirs d'alitres etudes ties i'acleurs professionnels dans la frequence du cancer.
Des travaux ullerieurs sold en coin's pour confirmer on iniirnter i'h.vpothe.se selon laquelle ces professions comporlent nil risque de cancer extremenient important.
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