Document K6ZNxRY4Yy03jb6akDwKmGVG0

# cs, / jy1 fA 'S ... D R t. (J u i v ^ ^ >1. fv'AY 10 <373 R. A. P^COt :nr IRVlC^'n. >*r^ - - A |97C - I5.R* c., Q, jci U l L received JUNO 6 1978. * N. WHeiR/ JR> A RATIONAL VIEW OF CANCER IN NEW JERSEY' by Harry 8. Oemopoulos, M.O. Associate Professor of Pathology New York University Medical Center New York, New York RECEIVED SEP 18 1978 r. N. WHEfct-tR, JR. In the in taras t of an informed approach to the problem of cancer in New Jersey this paper has been reproduced, with permission of the author, by. New Jersey State Chamber of Commerce 5 Commerce Street Newark, New Jersey 07102 Additional copies are available upon request. ucc 057550 The following document contains simplifications for ease of under standing. As In most aspects of human disease, there art exceptions, and alternate opinions. The follow ing attempts to condense the contemp orary, responsible thoughts on the different aspects of cancer. This Analysis was prepared while Dr. Demopaulos was Director of the Cancer Institute of New Jersey ucc 057551 SUMMARY A RATIONAL VIEW OF CANCER IN NEW JERSEY This summary outlines the essential points that are explained in the attached documents. X. Definitions o A major distinction is made between mortality and incidence rates. Mortality rates simply represent statistics reported from death certi ficates and provide insufficient data for any solutions; incidence rates are the numbers of new cases/year and relate to living patients. The status of New Jersey as "the number one cancer state" is based on mortality rates. o The difference between industrial and environmental cancer is' stressed. Industrial exposures in the "work place" cause a minor number of can cers, and there is an even smaller number attributable to industrial carcinogens that "have escaped into the community" (less than 0.00001* of cancer deaths). Environmental cancer refers to cancers induced by an individual's personal environment which includes cigarette smoking, excess alcohol consumption, 'ingestIqnTcijF'hl'gh~fat/low fibre'diets,^'usa: of 'nitrate/nitritecoritaining'meats', consumption oiCfoods. with'artifi-' f"elal.Jcplors, and other aspects of life-style; the occupational aspects v'of~the environment are important, but relatively less important. II. How Cancers Scart o Normal cells have repair mechanisms to undo the damage caused by chemi cal and physical agents. However, these repair systems can be over loaded. o Cancer-causing agents generally take 20-25 years to produce a cancer. The example of the Hiroshima and Nagasaki survivors is given. * This 2025 year period is known as the "lag phase" in carcinogenesis, o Many substances can act together, either in an additive way or synergistically (the sum total of the effect Is greater than just additive). III. The Causes of Human Cancers ucc 057552 o Specific cancers have been linked with definite agents, but the major lethal cancers, lung and large bowel, are linked to personal habits. Only a small percent of cancers are industry-related. o Nitrltes/nitrates and artificial colors are cancer causing chemicals (nltrltes/nitraces are converted into dangerous nicrosaalnes when preserved meats are heated), but specific human cancers have not yet been linked to these substances. o Life-styles that include obesity, and multiple pregnancies, are asso ciated with a greater risk for cancers of the breast and uterus, respectively. ......... ............. o The most dangerous.human carcinogens_are_cigarettes, alcohol, dietary fats, nitrites/nitrates, and artificial food colors. These are the most widely distributed in the communities, and are proven to be respon sible for the largest percentage of cancers, estimated as high as SO" (by Dr. Frank Rauscher, the recent Director of the National Cancer Insti tute, and Or. Theodore Cooper, the recent Assistant Secretary for Health in HEW). IV. Specific Problem in New Jersey o There is a complex array of medical, social, geological and geographic factors chat must enter into any analyses and solutions for New Jersey's cancer problems, e.g., the dense urban population in N.J., Inadequate educational and medical leadership in the past, etc. The sensitive area of "the quality of medical care in New Jersey" may explain a por tion of the high cancer mortality, races during the period covered by the mortality study. o New Jersey's unfortunate prominence as the "number one cancer state" Is based solely on mortality data from 1950-1969 and does not c nslder ehe mobility and shifts in populations from New York City and Philadel phia. These two cities, as well as other non-Industrialized urb n areas, have death races as high as those of New Jersey. The density of the urban population of New Jersey confounds any analyses of the data available. V. New Jersey Industry and Cancer o New Jersey had a 17Z greater death race, for white males, and a 14Z greater death rate, for white females, compered to the rest of the country. This is the basis of New Jersey's infamy, o Other urban centers, even with light industry, share New Jersey's death races, e.g.. New York Cicy, its Northern Westchester suburb, its Eastern Nassau suburb, and San Francisco. The state of New Jersey, when com pared to other states, ranks number one. If, however, only populations are compared and state boundaries are ignored, then New Jersey's rates are equal to the rates of urban areas in other parts of the country. The'problem lies however in the fact that even the rural areas of New Jersey have "urban rates"; this Is the heart of the problem and requires further study. The answer may be as simple as the fact that many New Jersey rural dwellers, who died in 1950-1969, may have been city Inhab itants from New York and Philadelphia at some time in the past and carried their damaged cells with them when they moved, o The types of cancers that are typically "industry-related" do not account for New Jersey's excess 2,000 cancer deaths each year. All types of cancer deaths are Increased, and in some cases there is a negative correlation (benzene causes lymphomas and leukemias, and benzene is a prominent industrial pollutant - yet, the mortality races from lymphomas and leukemias are not above the national average). o Separate studies by Drs. Louria and Demopoulos have suggested that only 600 of the 14,000 deaths in New Jersey might be "industry-related". VI. The List of Carcinogens in S-3035. Section 6 o The list includes a mix of substances; some are no longer in use, some are not carcinogens, some are strong and others are weak carcino gens. Apparently, at the present time, all are being handled with ade quate precautions. o Asbestos and vinyl chloride are weak carcinogens. o Research is required to determine permissible exposure levels as ha3 been done with the most powerful carcinogenic agent, x-rays. UGC it 057553 A RATIONAL VIEW OF CANCER IN NEW JERSEY New Jersey has unfortunately achieved infamy because statistics from a National Cancer .nstitute study reveals that New Jersey had the highest mortality rate, per 100,000 general population, in America in the period 1950-1969. This r.eans one of two things: a) if you developed cancer'and lived in New Jersey at that time, you were more likely to die of it because your cancer has been detected at a more advanced stage than in other states, and/or the complicated treatment that was needed was not as available as in other parts of the country; b) the risk of developing a lethal form of cancer was greater in New Jersey than in other states. It is not possible to deter mine which of these two reasons, or what combination-is the truth because reliable incidence data does not exist throughout New Jersey. The data that is available is mortality data, which only shows how many people die each year from cancer. The mortality data, although very inadequate, has triggered massive controversies regarding: o industry-related cancer o environmental cancer o the personal environment o life-styles and cancer o inadequate health resources o toxic substances o dietary factors o banning of so-called carcinogens o politics o early detection o financial aspects of cancer o possible solutions Cancer is the most complicated disease process, compared to the other major killers such as heart disease, strokes and accidents. There are over a hundred different forms of cancer, and they start in different organs of the body, in different types of individuals, and under poorly understood circumstances. No other disease process is so intricately interwoven with the very fabric of society; as chough to emphasize their perplexing, intri cate nature, cancer cells remain very similar Co the patient's normal cells, thereby frustrating most attempts to "weed" them out. In order to put cancer into perspective, so that possible solutions can be evaluated, the major complex aspects must be understood. ucc -I 057554 1. DEFINITIONS Cancer - a malignant growth, composed of solid masses of disorganized cells that are ever-growing, and are capable of spreading to organs far from the original site, e.g., breast cancer starts as a lump, and some of its component cells will microscopically invade the blood stream which will carry them to the lungs, bones, liver, and brain. Metastasis - the term U3ed to refer to the spread of cancer cells from its site of origin, to ocher organs. Early Detection - the process of detecting the cancerous mass while it is still small and therefore less lately to have metastasized. Radical Surgery - the principal weapon in use today for treating cancer; the surgeon cuts widely around the cancerous mass hoping that none of the cancer cells have microscop'.cally metastasized; the surgeon and ocher cancer experts generally have no way of.knowing whether an individual case has already spread oierosccpically; however, the smaller the original can cer mass, the less likely it Is to have spread. Mortality Rate - the number of people dying as a result of cancer each year; it is generally given as the number of cancer deaths per 100,000 general pop ulation. In America, the average figure Is about 170/100,000. Incidence Rate - the number of new cases that are diagnosed each year, again given per 100,000; in America the average figure is about 340/100,000; about one-half of this number will eventually die of their disease, but over'a period of 2-8 years; the other half of the newly diagnosed cancer cases will live out a normal life expectancy and die of some other cause. Industry-Related Cancer - a cancer whose cause can be, at least in part, traced back to a distinct exposure to a chemical or sometimes a physical agent that was present in the "work-place"; this generally encompasses employees and, more rarely, members of their families who are exposed to the employees "contaminated" work cloches. Environmental Cancer - refers to most cancers, possibly 80Z; however, the term "environment" is all-encompassing and relates mostly to the personal environment that results from life-styles, habits, and dietary factors; occupa tional exposures, and industry-related events comprise a minor component of "environmental cancer". Carcinogen - an agent, chemical or physical, that is capable of initiating Irreparable damage to a cell, such that the cell may be untimacely trans formed Into a cancer cell. Co-Carcinogen - a chemical which by itself is incapable of causing cancer, but in combination with small doses of carcinogens (doses too small to cause cancer) will causa the development of cancers. Epidemiology - the science of studying what disease occurs in which types of people, and under what circumstances - it constitutes medical detective work. ucc 057555 II. HOW CANCERS START Cancer cells are no longer "self-controlled", the way normal cello are. Of the many trillions of ceils in our bodies, many of them divide and multiply in order to replace "worn out" cells. Most remarkable is that the normal re placements are exactly like the worn-out ones. Cancers start as a result of some cell3 losing their normal control mechanisms. This happens as a result of damaging the genetic material and the delicate membranes of a cell beyond repair. It is important to realize that from conception, i.e., when a sperm and egg cell have united to form a unique individual, that single cell and all of its subsequent dividing cells are constantly barraged by damaging agents such as viruses, chemicals, and ionizing radiation. In the overwhelming majority of damaging insults, our cells repair themselves. When repair is inadequate, we see the development of birth defects, cancer, or death. The genetic material of the nucleus, the DMA, has incredible repair machinery, and the membranes of a cell, in spite of their extraordinary delicacy and complexity, are undergoing incessant replacement, 24 hours a day, 365 days a year. In short, evolution has given us resilient cells so that our bodief can take a certain amount of damage. However, the repair systems can be overloaded and some damaging agents can specifically attack the repair systems. It is clear that there are certain tolerance limits, and If exceeded, the results may be birth defects, cancer or cell death. Most cancers are the result of a complex sequence of damaging events that have not been repaired. However, the damage need not be expressed; there is a need to have other factors.which will "bring out" the cancerous damage. In some Instances, It may take 20-25 years to "bring out" the cancerous damage. This is referred to as the "lag phase" and is best exemplified by the survivors of the atomic blasts at Hiroshima and Nagasaki. These large amounts of radia tion caused Irreparable damage to cells, but the cancerous nature of the damage was not expressed as a lump of uncontrolled cells until 20-25 years later. In these and a few other Instances, there are exposures to a single damaging agent and clear cut blame can be affixed to that agent. In the overwhelming majority of cancers, there are multiple agents which interact and cause cumulative damage. While there are many hundreds of dam aging agents, there are only a few different types of parts in a cell; hence, the same type of cell part may be damaged by several different substances. We can therefore see additive effects, and sometimes synergism, wherein the result is more than just additive. -3- ucc 057556 III. THE CAUSES OF HUMAN CANCERS The causes of many cance rs are known and are listed below. The numbers in parentheses represent the percent of total cancer deaths caused bv that particular type of cancer. Type of Cancer o lung cancer (% of Deaths) <20%) Causes cigarette smoking* o mouth cancer (2%) cigarette smoking* plus excess alcoholism** plus inadequate mouth care o larynx cancer ("voice box") (1Z) cigarette smoking* plus excess alcoholism** o esophagus cancer ("food tube") (5Z) cigaret .e smoking* plus excess alcoholism** o colon and rectal <16*) high dietary fat plus low dietary fibre o liver cancer (ordinary type) (0.5Z) excess alcoholism** o urinary bladder cancer <5Z) unrestricted use of certain chemicals used In dye production o mesothelioma (0.001Z) unrestricted use of asbestos o hemangiosarcoma (a special type of liver cancer) (0.001%) unrestricted use of vinyl chloride From che preceding line. It is clear that we know whae causes over 50% of cancer deaths. There are several major cancer Cypes whose causes are not known and account for a total of 30Z of che deaths; these are cancers of che breast, ovaries, pancreas, and prostace. In some of these cancers, we know a spectrum of associated findings that add up co a greater risk, as in cancer of che breast, but this does not mean chat a causal factor(s) that can be con trolled has been discovered. In addition to the above known causes of cancer, the following substances have been identified as potent carcinogens Chat are consumed in significant quantities (milligrama/day) by che majority of Americans; these substances have not yet been linked as causative factors to a specific type of cancer, as in the case of cigarette smoking and lung cancer, but they are nonetheless * generally more chan one pack/day ** generally more than three ounces of distilled liquor/day, or more chan sixteen ounces of vine/day -4- ucc 057557 suspected of causing several different types of cancers. They may act as co carcinogens, or act synergistically. o nitrites/nitrates - are converted to dangerous nitrosamines when preserved neats, such as frankfurters, ham, etc., are heated o artificial food colors - some colors that are widely used in a multitude of foods and beverages are powerful carcinogens Some aspects of particular lifestyles are associated with a greater risk for developing cancer and include: o obesity o multiple pregnancies coupled with inadequate gynecologic care associated with breast, colon and rectal cancer associated with cancer of the 'uterine cervix o repetitive sun exposure causes cancer of the skin Added to all of the above are many other agents that are carcinogenic, but they are either weak, sparsely distributee, or not well delineated. This includes: o hormones used to relieve associated with cancer of symptoms of the menopause the endometrium o pharmacologic drugs used to treat high blood pressure associated with cancers of the breast and colon o high benzene levels capable of causing leukemias o varied organic com pounds in the work place thought capable of causing cancers of the skin, stomach, liver, lungs and urinary bladder The conclusion that should be reached at this point is that everyone is exposed to some combination of carcinogenic substances every day and the most significant ones are uncontrolled. Many agents are carcinogenic and there Is a desperate need to study and define which of these agents should be brought under more restrictive control. Logic would direct immediate attention, at this time, to chose carcinogens chat cause the greatest number of cancer deaths, and are also widely used. This would result In a list, in order of importance, as follows: o cigarettes o alcohol o dietary fat and fibre . o nitrites/nitrates o artificial food colors ucc 5- 057558 IV. SPECIFIC PROBLEMS IN NEW JERSEY The State of New Jersey is characterized statistically in a number of areas that have a relevance to the high cancer mortality rates, and which may also be involved in the solutions: o Most densely urbanized population o Lowest average land elevation with respect to sea-level o Highest unemployment rates o Reliance on local water sources of household consumption, in contradistinction to other states where water sources are not derived from the water table or rivers found in the concentrated urban areas. o Ranks 46th among the states in money spent for higher education per capita. o Until recent years lacked any credible medical schools ; the two existing ones are developmental and reportedly rank 85th and 87th out of the approximate 100 American Schools according to the average scores of the students on the National Medical Board Examinations. o 752 of the interns and residents in the hospitals are foreign medical school graduates; this is the highest in the country; in New York, the second highest, the figure is 502, while in Cali fornia, this number is 52; the reliance on foreigners is directly traceable to the absence of a large enough pool of graduating medical students who have a desire to undertake or continue their training in New Jersey hospitals. The intermingling of medical, social, geographic, and geological factors listed above, provide clues for analyzing New Jersey's complex cancer problems, and the thought that is required for the solutions. There Is no simple approach. and to highlight this, a critical examination of the New Jersey cancer data is in order. The National Cancer Institute, under a program directed by Dr. Fraumeni, conducted a nationwide county-by-county study of cancer death rates per 100,000 general population. This was done by transcribing what was written on the death certificates. The medical records of the patients were not examined. The death races from 1950-1969 were catalogued from death certificates, and were classified by anatomic site, and sex. Hence, the number of deaths from cancer of the mouth, or of the stomach, in males or females, in Atlantic County, or Essex County, and other such numbers became available. These num bers are interesting, and, in general, there is no county in New Jersey that could be considered "safe" according to these data. The 1950-1969 mortality study was not designed by Dr. Fraumeni to provide information for definitive solutions. To employ this type of data for direct ing conclusive solutions is a frank misuse. The study was conducted to pro vide an overview of the scope of the cancer problem in the nation and nothing more. The reasons that the Fraumeni data of 1950-1969 cannot be used to dir ect any solutions stem from the lack of medical records data such as: o Size of cancer and extent of disease when the patient was first admitted and diagnosed in the hospital. These two ucc 057559 factors, size and extent of disease at time of diagnosis, are the principal determinants of the patient's prognosis as to life or death; if the cancer is large, chances are very high that the cancer cells have already metastasized, o No treatment data is available to judge adequacy of therapy, and of long term, dedicated follow-up. o No patient histories with respect to dangerous habits, nature of the diet, previous places of residence, occupation, income and educational level. If the Fraumeni data were to be used for a direct attack on the cancer problem, without any further extensive studies, several false leads would be pursued based simply on mobility and shifting of the population, espec ial'/ in the years from 1950-1969. Miami, Florida has cancer death rates equal to those of New Jersey. With a moment's careful thought, the reason becomes obvious - many Miami residents are retired Northeastemer3 who have come from crjwded urban settings. It is critical to remember that a 20-25 year lag period is required to develop a cancer from the numerous environmental exposures (in cluding cigarettes and alcohol). Further examination of the N.C.I. mortality studies reveals the following death races of ocher urbanized areas and their suburbs. o New York City o Westchester County (a Northern suburb of New York City) ... o Nassau County (an Eastern suburb of New York City) o Philadelphia o Chicago o Sc. Louis City, Missouri o San Francisco 215/100,000 200/100,000 212/100,000 221/100,000 206/100,000 220/100,000 206/100,000 Since New Jersey received former dwellers of New York City and Philadelphia during the post-war years of suburban expansion, circumstances in these two cities may ultimately be responsible. Westchester and Nassau Counties may be high in mortality rates for the same reason that New Jersey is, i.e., the city dwellers led life-styles chat predisposed to cancer and when the population shift out of the cities occurred, these individuals carried their irreparably damaged DNA and altered cell parts with them. If many of these individuals were in the lag phase (20-25 years), this could explain, at least in part, the findings. This is a similar explanation for the high rates In Miami, Florida. There are many other confounding factors that preclude conclusions, and these are as follows: o While the population was shifting into the suburbs. Including into New Jersey, industry also continued to grow in the state, o In the 1930's-1940's (the period of time when people were being exposed in order to develop their cancers and live 20-25 years later in 1950-1969), industry and government were largely ignorant of chemical carcinogens, hence fewer safeguards may have been used in this period. ucc -7- 057560 V. NEW JERSEY INDUSTRY ANO CANCER The county-by-councy death statistics of 1950-1969 are divided by anatomic site and by sex. The overall death rates for white males was the highest in the country, but this was not the case for females or non-whites. This can lead to a great deal of speculation, but the data is insufficient for reach ing a solution. The Fraumeni numbers indicate that the national average deach rate from cancer was 174/100,000 (for white males), while in New Jersey, it was 205/100,000, a 17X Increase. In females, the national average was 130 and, in New Jersey, 148/100,000 about a 14Z increase. These are the increases that have precipi tated the curreat controversy. The increases are significant and were consis tent through the 19 years (1950-1969) of the study. More detailed numbers are presented in appendix A. Adding to this data are the estimates of the American Cancer Society, regarding N jw Jersey incidences and .mortalities. These are given in appendix B. The conclusions pertaining to New Jersey are as follows: 1. General Findings on New Jersey: Proportionally, New Jersey's figure on cancer mortality is greater than that of any other state in America. Nearly all of New Jersey falls into the highest decile in the U.S. (top 10Z) for white males and for white females (Appendix A). 2. Cancer categories In which the mortality, proportional to population. Is hlghar in New Jersey than in any other state: o Rectal cancer (males and females combined) The ratting of New Jersey as having the worst concentration of mortality from rectal cancer is based largely on the extremely high death rates among both men and women in northern New Jersey, the Trenton-Princeton area Included. This would not be classified as an industry-related cancer by cancer specialists. o Bladder cancer (males only - women not significantly different from the rest of the United States) A proportion of these are industryrelated. o Cancer of the ovary - The mortality figures among the women of New Jersey's northwest corner -- Sussex and Warren Councies -- ranks with the worst in the country. Mortality figures are nearly as high among women in Bergen, Morris,.and Passaic Councies. This causes Che mortality figures for women In northern New Jersey in this cancer classification to be worse chan for any other single concentrated area In the nation. This would not be classified as an industryrelated cancer. 3. Cancer categories In which the mortality races for the state of New Jersey rank approximately with Che worst statewide records in the nation: o Cancer of the large intestine (males and females combined) New Jersey ranks with Rhode Island as the worst in the nation. This is not regarded as industry-related. ucc 057561 -8- o Cancer of the Trachea, Bronchus, and Lung - Mortality figures among New Jersey males rank as the highest in the U.S,, along with the mortality among males in Louisiana and Florida- A small proportion of these are industry-related, o 3reast Cancer among females - The record in this category is worst in New York, with New Jersey, Rhode Island and Massachusetts just behind. This is not classified as industry-related. 4. Cancer categories in which mortality for portions of New Jersey ranks with the worst areas in the nation. o Cancer of the Esophagus (males only) - Northern New Jersey, Connecti cut, New York City, Long Island, and the Greater Philadelphia Area of Pennsylvania, combined, comprise the worst single area in the U.S. for mortality figures in this category. The rate for females in northern New Jersey i3 above the national average. This is generallycaused by a combination of cigarette smoking and excessive alcoholism. In addition, women w*th rare benign esophageal problems are predis posed to cancer of this organ. It Is not generally regarded as being indus cry-related. o Cancer of the Larynx (males only) - The highest concentrations of mortality from this type of cancer are in northern New Jersey, New York City, Long Island, the Greater Philadelphia Area and the Pittsburgh area. A small proportion of these are industry-related, but generally are caused by a combination of cigarette smoking and excessive alcoholism. If an attempt is made to correlate the types of cancers that are known to be "industry-related" (I.e., industrial substances contribute together with ocher factors to the development of cancer), with the types of cancers occur ring in New Jersey, it would be expected that most of the excess cancer deaths in New Jersey would fall into the "industry-related" tyres - this is not the case. There are about 14,000 deaths each year in New Jersey, and about 26,000 new cases each year (from appendix B, estimates for 1974). If New Jersey had average U.S. rates, these numbers would be 12,000 and 22,000, respectively. The excess 2,000 deaths each year and the excess 4,000 new cases each year should fall into the classical "industry-related" categories which Include a small portion of cancers of the: o Urinary bladder o Respiratory system o Liver o Skin o Lymph organs and bone marrow (lymphomas and leukemias) Instead, the "excess" 2,000 deaths are spread across all of the anatomic sites in the N.C.I. mortality study (lip, salivary glands, nasopharynx, mouth, esophagus, stomach, large intestine, rectum, liver, pancreas, upper and lower respiratory tracts, breast, uterine cervix, body of uterus, ovaries, prostate, testis, kidneys, urinary bladder, skin, eye, brain, endocrines, bones, and connective tissues). Further, there are some negative correlations, e.g. benzene is reportedly an industrial pollutant In New Jersey and supposedly is -9- ucc 057562 Che highest; in Che nation, yet the cancer chat should be caused by benzene, such as lymphomas and leukemias, occur at the lower national races. o Lymphomas N.J. (White males) U.S. (White males) o Leukemias N.J. (White males) U.S. (White males) 4.93 4.89 8.74 3.31 Analyses performed by Dr. Donald Louria, Chairman of the Department of Preventive Medicine and Community Health, New ."ersey Medical School, Newark, and presented under the title of "Cancer in New Jersey: An Overview" at the "Seminar for Physicians: Cancer Risk Identification within New Jersey, and Methods of Cancer Control", May 12, 1976, in Cherry Hill, found chat only 600 of the 14,000 cancer deaths in New Jersey might by industry-related. A different analytic study conducted by Dr. Harr* B. Demopoulos, former Director of the Cancer Institute of New Jersey, also revealed the same types of numbers, i.e., no more than 600 of the 14,000 cancer deaths could be industry-related, among the deaths reported in 1950-1969; this report was given by Dr. Demopoulos to the "Skevin Coaaaitttee" in testimony on November 5, 1976. These two independent analyses therefore indicate that 4.3Z of the total cancer deaths in New Jersey could be "industry-related". These percentages are important and yet it Is essential to realize that these analyses are based on insufficient data and represent the highest passible number of "industryrelated" exposures. This does not mean that industrial pollutants were solely responsible. If an analysis is attempted of how many cancer deaths were caused solely by industrial pollutants, the data Is found to be totally inadequate and very soft estimates yield fractions of 1Z. While the cited studies and analyses refer to past events, there is meager data since 1969. The American Cancer Society estimates do not provide sufficient information to answer the obvious question - are cancer mortality rates and inci dences in New Jersey the same, better, or worse than for the period 1950-1969? Current, but inadequate, "samples" from hospitals that have excellent Tumor Registries indicate that their cancer case workload has Increased by 50Z in the past 5 years, and that the average age of the cancer patient is younger by 5-6 years. This type of data is fragmentary and may reflect changes in referral patterns to some hospitals, or it may indicate a worsening of the New Jersey cancer problems. ' Clear cut answers require far more data. -10- ucc 057563 VI. THE LIST OF CARCINOGENESIS IN SILL NO. S-3035. SECTION 6 The Use includes a mix of substances o Some are no longer in use, e.g., 4 Aminodiphenyl o Some are not carcinogenic, e.g., alpha naphthylamine - its carcinogenicity was proven to be due to contamination of alpha naphthylamine o Some are very potent carcinogens, e.g., benzidine o Some are rather weak carcinogens, e.g., asbestos and vinyl chloride o All are currently handled with precautions that lea* to low expo sures of workers such that cancers will not develop. Asbestos and vinyl chloride are termed weak carcinogens on the basis of careful analyses of the cancers that they cause. Excessive co'.ceras over asbestos as a carcinogen has been prompted by cases such as that of a 14 year old boy who developed mesothelioma; he apparently was exposed to this when he was helping his father to smooth down the joints of the newly replaced plaster board walls in their home. Asbestos was in the joint material, not in the plaster board. There was no ocher known asbestos exposure, and the father did not other wise work with it. Cases such as this are exceedingly rare and form an inade quate data base. Mesothelioma does occur in nature, without asbestos exposure, and it cannot be ascertained whether this 14 year old boy would have been a "Natural" victim, or whether the asbestos was indeed causal. Far more numbers are needed for statistically valid studies in such unusual cases. The relative weaknesses of asbestos and vinyl chloride are borne out by the fact chat workers who were exposed eo very large, uncontrolled levels devel oped relatively few cancers as a result* This Is in contrast to a powerful car cinogen such as 3,4-dimechyl 4-aminodiphenyl, wherein 15-20% of exposed workers developed urinary bladder cancer in a short lag phase (7-8 years). When the amounts of asbestos, vinyl chloride, and 4-aminodiphenyl are compared, versus the numbers of cancers developed, then asbestos and vinyl chloride are weak carcinogens. The idea of a comprehensive ban on all carcinogens would lead to the restriction of many activities and substances. Radiation, by x-rays, is the most powerful carcinogenic agent. There are methods for converting physical carcinogens into chemical equivalents, and when this is done, x-rays are quite potent. When the Manhattan Project (building the A-Bomb during World War II) was in full swing, the Department of Pathology at Rochester University was given the job of determining the ill-effects of radiation. There were some individuals who were so impressed by the pathologic changes chat they decreed a "Zero-expo sure". When subsequent, rational studies were done, it was found chat small doses of radiation could be tolerated, even chough the effects were cumulative over a life time. This type of exacting research has made it possible to use x-rays for medical use, nuclear plants for energy, etc. The same type of informa tion must be obtained for chemicals. ucc 057564 APPENDIX A NATIONAL CANCER INSTITUTE MORTALITY STUDY 1950 - 1969 EXHIBIT 1 - New Jersey Cancer Mortality 1950-1969 EXHIBIT 2 - New Jersey Cancer Mortality 1950-1969, by County EXHIBIT 3 - States With Highest Cancer Mortality, 1950-1969 EXHIBIT 4 - All Malignant Neoplasms 1950-1969, by Stats ucc 057565 CANCER MORTALITY 1950 - 1969 APPENDIX A- EXHIBIT 1.k. Ail Malignant Neoplasms (All cancer categories) causing mortality (Male, Female Combined) Total deaths, United States Number 2,572,035 - M Annual (per 100,000 pop. Rate whites only) 174.04 - M 2,253,232 - F' 130.10 - F Total deaths, New Jersey 106,900 - M 205.01 - M 93,379 - F 147.92 - F Highest Rates by New Jersey Counties: Hudson 14,049 - M 231.8 - M 11,004 - F 153.5 - F Middlesex 6.556 - M 5,251 - F 220.3 149.2 -M -r Essex 16,975 - M 15,256 - F 215.1 - M 154.5 - F Highest Number by New Jersey count! es: Essex 16,975 - M 215.1 - M 15,253 - F 154.5 - F Hudson 14,049 - M 11,004 - F 231.3 - M 153.5 - F Bergen 12,363 - M 11,894 - F 202.1 143.1 -M -F sw* ... ucc 057566 APPENDIX A - EXHIBIT ALL MALIGNANT NEOPLA .5 (all cancer categories, causing mortality New Jersey, by counties White Non-white Male Total Rate Female Total Rat e Male Total RatJ9 Female Total Rat_e Atlantic 3 ,213 195 .3 2 ,897 145 .2 598 220 .1 484 150 . 8 Bergen 12 ,863 202 .1 11 ,894 143 .i 373 281 .4 344 132 .2 Burlington Camden 2 ,632 183 .5 S ,329 204 .7 2 ,395 5 ,647 139 9 148 .4 196 216 .3 586 228 .0 138 141 .0 520 177 .1 Cape May Cumberland 1 ,264 1 ,683 194 .7 1 181 .4 1 ,037 142 .9 1 ,551 140 .0 72 184 .2 150 155 .8 78 176 .8 141 144 .2 Essex 16 ,975 215 .1 15 ,258 154 .5 2 ,385 219 .2 2,155 154 .6 Gloucester Hudson Hunterdon Mercer Middlesex Monmouth Morris Ocean Passaic Salem Somerset 1 ,935 191 .1 14 ,049 231 .8 1 ,025 175 .7 4 ,639 205 .4 S ,S5S 220 .8 s ,754 199 .0 3 ,851 179 .2 2 ,577 185 .5 7 ,981 209 .5 848 185 .9. 2 ,151 182 . 8 1 ,674 11 ,004 925 3 ,973 5 ,251 5 ,340 3 ,606 2 ,028 6 ,631 141 .8 182 153 .5 14 3 .3 ! Ii i 645 17 14 5 .2 143 .2 147 .6 135 .5 i 422 i 282 i 1 i 515 i 1 109 137 .2 69 !147 .8 355 731 146 .6 147 1 ,820 135 .7 74 183 .1 142 146 .0 289 .7 571 197 .3 297 .1 19 303 .2 203 .5 351 150 .1 279 .0 223 208 .2 225 .4 380 135 .3 248 .6 98 170 .1 265 .3 64 231 ,s 271 .5 ' 302 132 .7 232 .0 226 .9 ! - 1S1 .5 66 228 .5 Sussex 923 180 .8 797 140 . 5 18 913 .3 12 465 .4 Union Warren New Jersey 8 ,311 1 ,281 106 ,900 203 .4 7 ,757 S 1139 .3 ,162 l 205 .01 i 93 ,379 151 .6 147 .7 620 15 i7147 .92 ,830 Rates Indicated are annual per 100,000 population Total deaths, for the pesriod, 1950-1969, are given. 252 .2 534 1SS .3 274 .2 i1 10 230 .33 | S,709 137 .7 163 .41 ucc 057567 STATE aLAB AHA ksiioai JmKAHSAS fcmroasn totoaido Eomhccticot jprilSABE .filSTSICT OP COLOHBIX TLOSID1 ac tcscii IDAHO jlLLIMQIS <1 SSI IS 1 jiosi KlStSAS iSESTUCKI 'lOUlSIiNl Jhiihs RAlVLAHD IB ASSACHUSETTS RICHIG1M rimesota 'rJSSISSIPPI isissousi jxOHTtBl jtitekiSKi Ismci lltCH HlRPSHISE !SES JESSE! ,st nexico jKEU IOBS :SOSTH Ci SOLI Ml 'SOSTH Cl son (OHIO 'OXllHOr.l |OStGO PEtJMSI IT IS 11 sticor is la uo SOUTH ClSOLItll SOUTH 01LOTl tcsttcssec TEXAS UTAH !CSHOCT VIRGINIA O ^ hish::i;tqs ,wjst viigixia qo isisccssih uics::;j 1 jUSlTID STATES c O O SHITS HALE HORSES BATE 29066 152.44 1178 2 156.19 22197 144.14 216761 171.39 21016 144.19 U4S01 195.66 5691 179.75 7915 203.75 76659 163.56 31499 153.77 8546 - 139.02 162672 162.81 67635 164.24 tt 68 97 156.60 30949 143.89 38813 146.39 32662 190.39 17793 178.53 39157 192.43 95772 192.23 113)16 182.42 54422 158.24 18050 156.40 70822 164.55 10201 153.07 23955 157.48 4050 167.39 11944 189. 19 106900 205=01 . 7689 136.30 307997 199.24 36533 140.11 9039 144.34 146265 178.41 34295 155.95 28314 155.12 189018 183.08 164)4 203.17 16754 154.96 10513 36156 ' 149.86 146.28 107557 150.51 6)69 133.14 6901 173.02 38216 157.5) 45015 164.20 26025 65376 154.62 166.23 3953 138.93 2572035 174.04 HOHUIIITS HALE HOBBES KATE 10156 140.24 1062 128.83 4915 132.13 15086 170.77 620 169.99 .. 14)9 1100 231.75 235.97 6190 264.55 10683 179.76 11546 152.23 103 123.67 15012 216.77 4139 210.85 516 1644 213.55 189.14 422Q 193.50 14576 193.68 47 154.11 8099 224.64 1971 215.92 960Q 210.58 5)9 176.18 90ii 136.74 7094 211.58 227 140.69 576 219.93 17 *J 136.61 17 7 03*1 130.20 210.33 39 U 95.50 21572 227.69 105C1 147.17 97 12 ST 3 143. 57 i 226.35 2936 144.80 471 158.47 15016 236.89 342 2)6.56 7135 145.59 252 137.79 7 17 4 163.79 15021 167.5) 190 152.86 18 207.22 11531 189.62 12*. 2 169.72 mi 131.2a 191.54 fw 123.16 | | | 1 *| | | | | .t | | | | | | ) | | | | J | | | | | | 1 | | 1 1 | | | | | 1 | | 1 | | | 1 | 1 | 26c K'i 184.20 ' ) Vtl IT 8 KUH3C9 25643 mat 17726 195171 20219. 38333 5171 8123 St-75 30381 6647 142394 621 11 42106 28094 36016 246 1 1 16135 35366 90506 92946 47219 150 10 63213 7453 207 36 2654 106 55 9 3179 6915 273)16 33864 7084 1304 U 28878 2)148 170851 14770 15295 8384 357 6) 90072 723) 6551 35279 36251 2224 1 56098 2962 PER ALE RATE 113.88 110.48 108.03 128.09 117.29 138.64 134.42 141.71 110.54 111.27 110.IS 137.78 130.60 124. 14 115.08 121.61 118.98 140.46 138.66 139.47 135.63 127.05 113.03 125.58 119.28 123.75 118.79 140.20 147.92 115.10 148.01 106.97 119.45 136.25 116.0) 119.27 140.26 143. 37 111.59 119.98 115.95 113.34 102.06 136. 41 119.12 121.43 123.75 132.35 109.09 2251292 130, 10 HOH SHITE HOBS EE 10915 811 4660 10785 462 1047 774 5445 8959 12652 73 13040 3408 380 1286 3580 12466 48 6080 1480 7830 380 10146 5882 207 482 180 16 6709 352 18920 10701' 110 9762 2904 307 11528 212 7647 302 7796 13452 101 11 9254 773 1 373 7 07 52 ?Ifl ALE HATE 127.17 111.76 121.99 124.10 116.17 119.19 162.57 166.05 133.14 130.90 109.27 160.98 157.97 151.28 14 1 154. i 143.77 16 1.70 154.73 141.86 151.26 128.98 129.44 159.07 157.24 175.99 148.97 110.02 161.41 96.48 152.80 124.39 165. 14 159 "0 13" ) 122.U8 157.10 133.64 123.97 184.07 142.51 128.45 108.96 119.06 138.94 159.39 U9.77 140.97 130.08 226561 119.19 APPENDIX B AMERICAN CANCER SOCIETY M3RTAL1TY AND INCIDENCE ESTIMATES 1974 ucc 057569 Stats Alabama Alaska Arizona Ariunaa California Colorado Connactieut Delaware in. of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas , Kentucky Louisiana Mains , Maryland Masachuaans Michigan MinntaoO Missisrippi Misauri Montana Nebreika Ntvada Nsw Hampshire New Jersey flaw Mexico New York Nonh Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Ahod*Island South Carolina South Dakota Ttnnesssa Texas Utah Vtrmont Virginia Washington West Virginia Wisconsin Wyoming United Stats* Estimated Canear Deathi for All Sites, Plus Major Sites, by State -- 1974 APPENDIX B - EXHIBIT All Sitss Number of Deaths Diath Rata par 100,000 Population 5,400 200 2,500 3,500 33,200 2,900 5,400 900 1,600 14,600 155 62 134 175 153 122 167 152 199 197 6,300 900 1,100 19,900 3,600 5,200 4,000 5,400 5300 2300 130 110 150 172 153 182 175 165 156 212 6,400 11300 14,500 6,500 3,600 8,300 1,300 2,300 750 1,500 >50 189 155 (63 162 184 135 185 133 189 14.000 1.200 37,700 6,900 1,100 19,000 4,500 3,700 23,500 . 2,000 184 115 200 132 131 172 170 166 197 204 3,500 1300 6.300 17,100 I.10Q 850 6,300 5,600 3,400 7,500 500 132 182 155 144 97 182 139 154 201 169 . 149 Srnrt 425 15 225 225 3300 275 500 70 175 1300 550 60 90 1,300 800 500 375 425 475 175 600 1300 1,400 600 275 800 100 250 60 150 1,400 100 4,000 600 90 1,800 350 325 2.300 200 300 80 550 1,400 100 70 650 500 250 800 40 Colon* Rectum Lung 550 20 300 400 4300 400 '30 125 200 1,900 1300 50 650 850 7300 500 1,000 225 325 3,500 50 90 125 .800 1,300 850 550 700 600 300 1,500 150 175 4,100 1,800 950 750 1300 1,500 425 850 1,700 1300 950 400 1300 150 425 30 250 1,600 2,200 3,100 1,100 750 2.100 200 475 200 325 2300 125 5,800 700' 150 2,700 550 500 3,600 350 3,000 200 7,400 1,400 175 4,100 950 850 4,600 400 375 175 750 1,800 150 150 800 700 400 1,200 60 750 200 1,400 4,000 175 175 1,500 1,300 850 1,300 75 Major Sites Oral 125 5 70 75 750 60 175 25 60 350 150 30 20 450 175 100 90 150 150 40 175 300 300 125 70 175 25 60 15 30 300 20 800 175 15 425 30 30 500 60 80 20 150 375 20 20 175 125 70 175 10 Uterus Prostata Stomach Pancreas 250 10 50 100 1,000 70 125 20 so 400 325 10 150 250 1.400 175 250 30 80 800 175 10 100 125 t,400 100 250 30 50 500 325 10 150 200 1,800 175 275 50 30 700 275 375 20 30 25 80 700 1.000 325 450 125 350 125 275 200 300 200 325 60 1Z5 250 350 90 70 40 70 850 1,100 250 450 175 250 100 225 150 325 250 300 90 100 200 300 200 325 300 475 525 600 425 750 525 700 125 450 300 375 125 250 150 225 275 550 275 475 30 70 50 80 70 175 100 175 20 25 10 50 50 30 40 80 400 30 1,000 300 25 650 125 100 750 50 --55s0 r 1,500 375 70 900 300 200 U0Q 80 550 50 1,700 225 60 700 150 125 9S0 100 700 --nr 2,000 375 70 900 275 200 1,200 90 150 200 100 40 100 50 225 375 200 600 800 650 30 30 50 30 50 30 250 375 225 ISO 300 225 125 200 125 200 450 350 10 40 15 200 30 350 950 50 50 375 325 200 4QQ 30 Leukemia 200 10 125 200 1,400 150 2S0 20 40 5C0 275 so 70 900 350 275 200 275 250 SO 20Q 400 550 275 200 4QQ so 150 30 70 500 50 1,400 350 50 75Q 200 200 950 SO 150 80 275 900 50 40 275 275 125 325 20 355,000 167 33,000 48.000 75,000 3,000 11,000 18,000 14,000 19,000 15,000 UCC 057570 Estimated New Cancer Cases for All Sites, Plus Major Sites, by State -- 1974 APPENDIX B - EXHIBIT a ucc State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Dirt, of Columbia Florida Georgia Hawaii Idaho lllinoi* Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Masachusens Michigan Minnesota ^pissppi Vraourt Montane Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Shod* Island South Carolina South Dakota Tennessee Tex** Utah Vermont Virginia Washington Wen Virginia Wisconsin Wyoming AH Sites4 Number of Casa* 10,000 300 4,300 8,400 61,000 5,400 10,000 1,700 3,100 27,000 12,000 1,700 2,100 37,000 18,000 9,500 7,300 10,000 11,000 3,600 12.000 21,000 27.000 12,000 6,600 16,000 2,000 5,300 1,300 2,800 26.000 2",200 70,000 13,000 2,000 35,000 8,200 6,300 43,000 3.700 6,300 2,200 12,000 31,000 2,100 1.600 13,000 10,000 6,200 14,000 800 Breast 1,100 50 600 600 8,700 750 1.400 200 500 3,300 1,500 150 250 5,200 2,200 1,400 1,000 1,200 1,300 500 1,600 3,300 3.300 1,600 750 2,200 250 700 150 400 3.300 "iso 10,300 1,600 250 4,300 350 300 6,300 550 300 250 1,500 3,800 200 200 1,800 1,400 700 2,200 100 ColonRectum 1,100 50 600 800 3,700 800 1,700 300 400 3,300 1,400 200 250 5,800' 2,700 1,800 1,100 1,400 uoo 600 1,800 3,500 3,900 2,000 800 2,500 300 900 150 500 4,500 250 12.000 1,400 300 5,600 1,100 1,000 7,400 700 750 350 1,600 3,700 300 300 1,700 1,500 8QQ 2,500 100 lung 1,300 60 700 1,000 8,100 550 1,100 250 350 3,300 1,700 200 200 4,500 2,000 1,000 800 1,300 1,700 450 UOO 2,400 3,400 1^00 800 2.300 250 550 250 350 3,300 250 8,200 1,600 200 4,500 1.100 950 5,100 450 350 250 1,500 4.400 200 200 1,700 1,400 900 1,400 90 Mejor Site* Oral 350 IS 150 200 2.300 150 500 70 200 1,100 4S0 SO 50 1,400 500 300 300 450 450 125 500 900 900 40Q 200 500 70 ISO SO 30 900 SO 2,500 500 SO 1,300 250 250 1,500 200 250 so 4 SO 1,100 50 60 500 400 200 500 20 Uterus (Invasive) 1,000 20 350 500 3,900 350 550 100 250 1,600 1,100 SO 100 2,700 1,300 6S0 650 900 850 250 900 UOO 1,800 600 700 uoo ISO 300 60 200 1,600 150 4,300 1,200 80 2,500 600 500 2,300 200 700 ISO 1,000 2,300 200 too 1,100 700 600 850 60 Prortate 950 30 450 750 4,200 55Q 750 90 250 2,400 Stomech 303 15 150 200 24<M 150 400 50 90 1,000 Pancrew 3S0 10 ISO 200 UQO 200 300 50 80 750 1,100 SO 250 3,000 1,400 1,100 800 900 950 400 400 ISO 70 1,400 400 300 150 250 400 150 350 70 70 UOO 450 250 250 350 300 100 900 1,400 2,300 UOO 750 1,700 200 500 80 250 350 -850 850 500 250 450 SO 150 15 70 350 600 750 400 250 500 80 200 50 - SQ 1,700 150 4,500 1,100 200 2,700 900 600 3400 300 1,100 80 2.800 350 100 uoo 250 200 1,600 150 7S0 ----- To 2.igo 400 70 950 300 200 1,300 90 600 300 1,100 2,400 250 ISO 1,100 900 600 UOO 90 ISO 80 300 1,100 SO 50 350 350 200 600 2Q 200 30 350 1,000 SO SO 400 350 200 400 30 Leukemia 300 20 150 300 2,000 200 350 40 50 700 400 70 100 1,200 500 400 300 400 350 100 300 550 750 400 300 550 80 200 40 100 700 7Q 2,000 500 70 1,000 300 300 UOO 30 200 101' 400 uoo 30 SO 400 400 ISO 450 30 ^mttd States 555,000 SO,000 99,000 83,000 24,000 46,000 54,000 23,000 20,000 21,000 Qo not include arcinom*-in-ijtu ol the uterine cervix or superficial skin cancers. These estimate* if* offered u e rough guide end jhould nor be regarded as definitive. They ire calculated according to the distribution of estimated 1374 cancer death* by rtate. Especially note that year to year