Document KLEk4gOoJOrN7XxZkDwOnD82

~CJ / / R t. U u j v ' MAY i 0 1373 R, A. p=cni.'nr-- re Ce 1 V t 0 A. E f^TAQN, <4 -DiA Q* H. U L.L received JiJN 06 1978. R. N. WHEEL**, jR, A RATIONAL VIEW OF CANCER IN NEW JERSEY"' Harry 8. Oemopaulos, M.O. Associate Professor of Pathology New York University Medical Center New York, New York RECEIVED SEP 18 ^978 R. N. WHEfcLfcR, jR. In Che interest of in 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 Correnerce 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 are exceptions, and alternate opinions. The follow ing attempts to condense the contemp orary, responsible thoughts on the different aspects of cancer. This AziAlysis was prepared while Dr. Deaopoalos was Director of the Cancer Institute of Hew Jersey ucc 057551 SUMMARY A RATIONAL VIEW OF CANCER IN NEW JERSEY This summary outlines che essential points that are explained in the attached documents. 1. 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 che 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, "ingestionTof'high~fae/low fibre~dietsr'use, of aicrate/nitrite' containingYmeats, consump'cion^of" foodsTwlch 'artifi-~ ['ciiljolors, and other aspects of life-style; the occupational aspects l"df'~the environment are important, but relatively less important. II. How Cancers Start 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 synergistlcally (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 Nitrites/nicraces and artificial colors are cancer causing chemicals (nitrites/nitraces are converted into dangerous nicrosamines when preserved meats are heated), but specific human cancers have not yet been linked to these substances. o Life-styles chat include obesity, and multiple pregnancies, are asso ciated with a greater risk for cancers of the breast and uterus, respectively. -r~ .. .. ......... o The most dangerous.human carcinogens^are cigarettes, alcohol, dietary fats, nitrices/nitrates, and artificial food colors. These are the most widely distributed in che communities, and are proven co be respon sible for che larg sc percentage of cancers, estimated as high as SO" (by Dr. Frank Rauscher, the recenc Director of che National Cancer Inst cute, and Dr. Theodore Cooper, the recent Assistant Secretary for Health in HEW). IV. Specific Problems in New Jersev o There is a complex array of medical, social, geological and geographic factors that 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 rates 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 consider the mobility and shifts in populations from New York City and Philadel phia. These two cities, as well as ocher non-Industrialized urban areas, have death rates as high as Chose 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 142 greater death rate, for white females, compared 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 rates, e.g.. New York City, 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 races 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 face 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 chat 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 rates from lymphomas and leukemias are not above the national average), o Separate studies by Drs. Louria and Demopoulos have suggested thac 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 a3 has been done with the most powerful carcinogenic agent, x-rays. ucc ii 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 to the patient's normal cells, thereby frustrating most attempts to "weed" them out. In order Co put cancer into perspective, so that possible solutions can be evaluated, the major complex aspects must be understood. ucc 057554 DEFINITIONS Cancer -- a malignant grouch, composed of solid masses o? disorganized cells Chat are ever-grouing, and are capable of spreading co organs far from the original site, e.g., breast cancer stares as a lump, and some of ics 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 likely 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 other cancer experts generally have no way of .knowing whether an Individual case has already spread microscopically; 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 802; however, the term "environment" is all-encompassing and relates mostly to the personal envirorusent 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 co cause cancer) will cause the development of cancers. Epidemiology - the science of studying what disease occurs in which types of people, and under what circumstances - it constitutes medical dececcive work. ucc -2- 057555 II. HOW CANCERS START Cancer calls are no longer "self-controlled", the way normal calls are. Of the many trillions of cells in our bodies, many of them divide and multiply in order to replace "worn out" cells. Host remarkable is that the normal re placements are exactly like the worn-out ones. Cancers start as a result of some cells losing their normal control mechanisms. This happens as a result of damaging the genetic material and the delicate membranes of a cell bevond 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 DNA, 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 agent3 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, li 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 cue 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 chan just additive. III. THE CAUSES OF HUMAN CANCERS The causes of many cancers are known and are listed below. The numbers In parentheses represent the percent of total cancer deaths caused by that particular type of cancer. Type of Cancer o lung cancer (Z of Deaths) (20%) Causes cigarette smoking* o mouth cancer (2%) cigarette smoking* plus excess alcoholism** plus Inadequate mouth care o larynx cancer ("voice box") (1%) cigarette smoking* plus excess alcoholism** o esophagus cancer ("food tube") (5%) cigaret .e smoking* plus excess alcoholism** o colon and rectal (16*) high dietary fat plus low dietary fibre o liver cancer (ordinary type) (0.5%) excess alcoholism** o urinary bladder cancer (5%) unrestricted use of certain chemicals used in dye production o mesothelioma (0.001%) unrestricted use of asbestos o hemangiosarcoma (a special type of liver cancer) (0.001%) unrestricted use of vinyl chloride From the preceding list, it is clear that we know what causes over 50% of cancer deaths. There are several major cancer types whose causes are not known and account for a total of 30% of the deaths; these are cancers of the breast, ovaries, pancreas, and prostate. In some of these cancers, we know a spectrum of associated findings that add up to a greater risk, as in cancer of the breast, but this does not mean that 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 that are consumed In significant quantities (milligrams/day) by the 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 than one pack/day ** generally oore than three ounces of distilled liquor/day, or more chan sixteen ounces of wine/day -4- ucc 057557 suspected of causing several different types of cancers. They nay act as co carcinogens, or act synergiscically. o nitrites/nitrates - are converted to dangerous nitrosamines when preserved neats, such as frankfurters, ham, etc., are heated artificial food colors - some colors chat 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 associated with breast, colon and rectal cancer o multiple pregnancies coupled with inadequate gynecologic care associated with cancer of the 'uterine cervix o repetitive sun exposure causes cancer of the skin Added to all of the above are many ocher agents that are carcinogenic, but they are either weak, sparsely distributed, or not well delineated. This includes: o hormones used to relieve symptoms of the menopause associated with cancer of 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 those carcinogens that 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 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; Che 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 75% 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 50%, while in Cali fornia, this number is 5Z; 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-councy 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 rates 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 noc 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 Co pro vide an overview of the scope of the cancer problem in the nation and nothing more. The reasons that che 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 Che 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, nacure 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 ially 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 ob' ious - many Miami residents are retired Northeastemers 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 rates of other 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 St. 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 that predisposed to cancer and when the population shift out of the cities occurred, these individuals carried their irreparably damaged 0NA 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 AND CANCER Th.e county-by-county death statistics of 1950-1969 are divided by anatomic site and by sex. The overall death races 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 death rate from cancer was 174/100,000 (for white maJ.es), while in New Jersey, it was 205/100,000, a 173 Increase. In females, the national average was 130 and, in New Jersey, 148/100,000 about a 143 increase. These are the increases that have precipi tated the current 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 sw Jersey incidences and .mortalities. These are given in appendix B. The conclusions pertaining Co New Jersey are as fallows: 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 103) for white males and for white females (Appendix A). 2. Cancer categories in which the mortality, proportional to population, is higher in New Jersey than in any other state: o Rectal cancer (males and females combined) The rating 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. Thi3 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 comer -- Sussex and Warren Counties -- ranks with the worst in the country. Mortality figures are nearly as high among women in Bergen, Morris,.and Passaic Counties. This causes the mortality figures for women in northern New Jersey in this cancer classification to be worse than for any ocher 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 the 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 3raast 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, cocLtned, comprise the worst single area in the U.S. for mortality figures in this category. The rate for females in northern New Jersey is above the national average. This is generally caused by a combination of cigarette smoking and excessive alcoholism. In addition, women v*th rare benign esophageal problems are predis posed to cancer of this organ. It is not generally regarded as being Indus try-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" (l.e., industrial substances contribute together with other 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" types - this is not Che 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 Che: 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 -9ucc 051562 the highest: in the nation, yet the cancer chat should be caused by benzene, such as lymphomas and leukemias, occur at the lower national rates. 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 8.31 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 that 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 chan 600 of the 14,000 cancer deaths could be industry-related, among th deaths reported in 1950-1969; this report was given by Dr. Demopoulos to the "Skevin Coaalttee" in testimony on November 5, 1976. These two independent analyses therefore indicate that 4.32 of the total cancer deaths in New Jersey could be "industry-related". These percentages ar important and yet it is essencial to realize that these analyses are based on insufficient data and represent the highest possible 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 IX. 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 ohvious 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 chat their cancer case workload has Increased by 502 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 BILL .NO. S-3035. SECTION 6 The list 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 chat they cause. Excessive concerns 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 Co 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 other 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 that workers who were exposed to 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-dimethyl 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 Projecc (building the A-Bomb during World War XI) 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 that 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 GANCES INSTITUTE MORTALITY STUDY 1950 - 1969 EXHIBIT 1 - New Jersey Cancer Mortality 1950-1969 EXHIBIT 2 - New Jersey Cancer Mortality 1950-1969, by County EXHI3IT 3 - states With Highest Cancer Mortality, 1950-1969 EXHIBIT 4 - All Malignant Neoplasms 1950-1969, by State ucc 05156$ CANCER MORTALITY 1950-1969 APPENDIX A- EXHI3 All Malignant Neoplasms (All cancer categories) causing mortality (Male, Female Combined) Total deaths, United States Total deaths. New Jersey Number Annual (per 100,000 pop. Rate whites only) 2,572,03s - M 2,253,232 - F* 174.04 - M 130.10 - F 106,900 - M 93,379 - F 205.01 - M 147.92 - F Highest Rates bv New Jersey Counties Hudson 14,049 - M 231.3 - M 11,004 - F 153.5 - F Middlesex 6.SSS - M 5,251 - F 220.3 - M 149.2 - f Essex 16,975 - M 15,258 - F 215.1 - M 154. S - F Highest Number by New Jersey counties: Essex 16,975 - M 215.1 - M 15,253 - F 154. S - F Hudson 14,049 - M 11,004 - F 231.3 - M 153.5 - F Bergen 7., ^ i4 12,363 - M 11,894 - F 202.1 - M 143.1 - F ^a 1 f*^*^#** 7 Q 7 Q^O ucc 057566 APPENDIX A - EXHIBIT L* A'LL MALIGNANT NEOPLA ,S (all cancer categories, causing mortality New Jersey, by counties White Non-white Male Total Rate Female Total Rate Male Total Rat e Female Total Rat e Atlantic Bergen 3,213 195.3 12,863 202.1 2,897 145.2 11,894 143.1 598 220 .1 373 281 .4 484 ISO .8 344 192 .2 Burlington 2,692 188.5 2,395 139.9 196 216 .3 138 141 .0 Camden Cape May Cumberland 6,329 1,264 1,683 204.7 194.7 1 131.4 5,647 148.4 1,037 142.9 1,551 140.0 586 228 .0 72 184 .2 150 155 .8 520 177 .1 78 176 .8 141 144 .2 Essex 16,975 215.1 15,258 154.5 l2,385 219 .2 2,155 154 .6 Gloucester 1,935 191.1 1,674 141.8 132 183 .1 142 146 .0 Hudson 14,049 231.8 11,004 153.5 645 289 .7 571 197 . 3 Hunterdon 1,025 175.7 32 o 143.3 17 297 ,1 19 303 .2 Mercer Middlesex 4,639 205.4 S ,556 220.8 3,973 145.2 l! 5,251 149.2 422 282 203 .5 279 .0 351 150 .1 223 208 .2 Monmouth 5,754 199.0 5,340 147.S 515 225 .4 360 135 .3 Morris 3,851 179.2 3,606 135.5 109 248 .6 98 170 .1 Ocean Passaic Salem Somerset Sussex 2,577 185.5 7,981 209.5 848 185.9. 2,151 182.8 923 180.8 2,028 137.2 6,631 147.8 731 148.6 1,820 135.7 797 140.5 69 265 .3 64 231 .6 l 355 271 .5 ; 302 182 .7 147 232 .0 97 1S1 .5 74 226 .9 66 228 .5 18 913 .3 12 465 .4 Union Warren New Jersey 8,311 1,281 106,900 203.4 j 189.3 i t 205.01 i 7,757 1,162 93,379 151.6 147.7 147.9 620 15 7,830 Rates indicated axe annual per 100,000 population Total deaths, for the period, 1950-1969, are given. 252 .2 | 534 166 .3 274 .2 i( 10 137 .7 230 .33 |S,709 163 .41 Ucc 057567 j 1st IT I ju IB 1-11 {mzoai jtHRINSlS ciiirofiaii COLORADO COMB CCTICOT DtllWlRE DISTRICT or COLDABII rtOBIDl 101110 [ILLIUOIS .IBDUB1 Jiom .mails JIEETUCKT 'Louisnm jaiiat iuihihd IMlSSICHUSZTTS Ibicuigib niiarsoTi Irississippi aissousi {korti.'i* jicemsm ]H(VICI iKER HAMPSHIRE NEW J5PSET (aiU MEXICO !KLU 10BK JRORTH CieOLIHi 'RORT H Cl ROT! jOKIO :ORllKOr.i jOI ICON PEURSIlf1SI1 RHC02 ISLltlD SOUTH Cl 801.1 Hi SOUTH D1 HOT 1 TCHHESSCE t ms UT1H VERMONT vipci*:i hish::i;tos VEST TS3GISH ivisccssia O 5^ cn c~ o o i iUSITIO 571TES VHITl Mi Li NUMBER BITS 29066 152.44 14762 156.19 22197 144.14 216761 171.39 21616 144.19 44S01 195.68 5691 179.75 7915 203.75 76659 162.56 21499 153.77 8546 * 139.02 162612 182.81 67625 164.24 46697 156.60 20949 143.89 26612 146.39 22662 190.39 17792 178.53 29157 192.43 95772 192.23 111216 182.42 54422 158.24 18050 156.40 70822 164.55 10201 153.07 22955 157.48 4050 167.39 1 1944 189. 19 106900 205.01 7689 136.30 107997 199.24 26522 140.11 9029 144.34 146265 176.41 14295 155.95 26214 155.12 189016 183.08 16424 203.17 16754 154.96 10512 149.86 28256 146.26 107557 150.51 6169 131.14 6961 173.02 382 18 157.53 45015 164.20 26025 154.62 65376 166.23 3951 138.93 2572025 174.04 HQHUIIITS BILE X0OBE| RITE 10156 140.24 106 2 128.8] 4915 132.12 15086 170.77 620 169.99 . 1419 1100 221.75 215.97 6790 264.55 10683 179.78 11546 152.23 103 15012 122.67 216.77 4139 210.85 516 1644 212.55 189.14 4220 198.50 14576 193.68 47 154.11 8(399 224.84 1971 215.92 9800 210.58 519 176.18 96iw 136.74 7094 212.58 227 140.69 576 17 9 219.9) 136.61 17 7 U10 120.20 210.2) 3911 95. 50 21572 227.69 1054 7 147.17 97 142. 57 12 5.`3 r 226.35 2936 144.80 47 1 158.47 15 0c 6 236.89 342 2)6.56 7135 145. 59 252 137.79 7974 163.79 15 H 2 1 167.5) 190 152.86 18 207.22 1UJ1 J89.62 SIO 169.72 1^71 191.28 * :~>h 191.54 6 4 123.16 264105 184.28 | | | J | | J | | | | | t | | | | | I | | j | ) | | } | 1 1 | | | | | | | j J J | J | | 1 | j | | | UHITB RUM8 EH 2564 3 11301 17726 195171 2 0219. 38333 5171 812 3 4j -* ") S 3018) 6647 142394 621 11 42106 28094 36016 246 11 16135 35366 90506 92946 47219 150 30 6321J 7453 20736 2654 10655 93179 69 15 273316 33864 7004 1304 1 1 28878 23148 170851 14770 15295 8384 3576 3 90072 7233 6551 352 79 36251 2224 1 56898 2962 rinur RITE 113.88 110.48 108.03 128.09 117.29 138.64 134.42 141.73 110,54 11 1.27 110.IS 137.78 130.60 124.14 115.08 121.61 118.98 140.46 138.66 139.47 135.63 127.05 113.03 125.58 119.28 123.75 118.79 140.20 147.92 115.10 148.01 106.97 119.45 136.25 116.03 119.27 140.26 143. 37 111.59 119.98 115.95 113.34 102.06 136. 41 119.12 12).4) 123.75 132.35 109.09 2253292 130. 10 hohrhite ROBBER 10915 811 4660 10785 462 1047 774 5445 8959 12652 73 13040 3408 380 1286 3580 12466 48 080 1480 7830 380 10146 5682 207 482 180 16 6709 352 18920 1070 1 110 9762 2904 307 11528 212 7647 302 7796 13452 101 11 9254 773 1 373 707 52 2EJ1ALZ RITE 127. 17 111.76 121.99 124.10 116.37 139.39 162.57 166.05 133.14 130.90 109.27 360.98 157.97 151.28 14 1 154. i 143.77 161.70 154.73 141.86 151.26 128.98 129.44 159.07 157.24 175.99 148.97 1 10.02 161.41 96.48 152.80 124.39 165. 14 159 10 13- 1 122.88 157.10 133.64 123.97 184.07 14J.51 128.45 108.96 119.06 138.94 129.30 149.77 140.97 130.09 226561 139.19 APPENDIX B AMERICAS CANCER SOCIETY MORTALITY AND INCIDENCE ESTIMATES 1974 ucc 057569 State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Dirt, of Columbia Florida Georgia Hawaii Idaho lllinoir Indiana Iowa Kanaa Kentucky Louisiana Maine Maryland Mnachuaara Michigan Minnesota Misisappi Missouri Monnna Nebraska Nevada New Hampshire New Jsrrav New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tenons** Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming United State* Estimated Cancer Deaths for All Sites, Plus Major Sites, by State -- 1974 APPENDIX 8 - EXHIBIT All Sim Number of Deaths Death Rata per 100,000 Population 5,400 200 2.500 3,500 33,200 2,300 5,400 300 1,500 14,500 155 62 134 175 153 122 157 152 199 197 5,300 900 1,100 19,300 5,500 5,200 4,000 5,400 5,900 2,200 130 110 150 172 158 182 175 165 158 212 5,400 1U00 14.500 6,500 3,600 8^00 1,300 2,800 750 1,500 14,000 r 1,200 37,700 6,300 1,100 19,000 4,500 3,700 23,500 2,000 150 189 155 i63 162 184 185 185 133 189 184 115 200 132 181 172 170 166 197 204 .3,500 uoo 5,300 17,100 1,100 850 8,800 5,600 3.400 7,800 500 132 182 155 144 97 182 139 154 201 169 . 149 Breast 425 15 225 225 3400 275 500 70 175 uoo 550 60 90 1400 800 500 375 425 475 175 600 1,200 1,400 600 275 800 100 250 60 150 1,400 100 4,000 600 90 1,300 350 325 2,300 200 300 80 550 1,400 100 70 650 500 250 800 40 ColonRectum 550 20 300 400 4400 400 '30 125 200 1.900 50 90 125 ,800 1,300 850 550 700 600 300 8SO 1,700 1400 950 400 1400 150 425 30 250 2,200 125 5,800 700' 150 2,700 550 500 3,600 350 375 175 750 1,800 150 150 800 700 400 1,200 60 Lung 1400 so 550 850 7400 500 1.000 225 325 3,500 1,500 150 175 4,100 1,800 950 750 1,200 1,500 425 1,600 2,200 3,100 1,100 750 2,100 200 475 200 325 3,000 200 7,400 1,400 175 4,100 350 850 4,500 400 750 200 1.400 4,000 175 175 1,500 1,200 850 1,300 75 Major Sites Oral 125 5 70 75 750 60 175 25 SO 350 150 30 20 450 175 100 30 ISO 150 40 175 300 300 125 70 175 25 60 15 30 300 20 3C0 175 15 425 30 30 500 60 80 20 150 375 20 20 175 125 70 175 10 Leu Uterus Prostate Stomach Pancreas kemia 250 10 50 100 1,000 70 125 20 50 400 325 10 150 250 1,400 175 250 30 80 800 175 10 100 125 1,400 100 250 30 SO 600 325 10 150 200 1,800 175 275 50 80 700 200 10 125 200 1,400 - 150 250 30 40 SCO 275 375 20 30 25 80 700 1,000 325 450 125 350 125 275 200 300 200 325 60 125 250 350 90 70 40 70 850 1,100 250 450 175 250 100 225 ISC 325 250 300- 90 100 275 50 70 900 350 27S 200 275 250 80 ZOO 300 200 300 475 525 425 750 525 125 450 300 125 250 ISO 275 550 275 3Q 70 50 70 175 100 20 25 10 50 30 40 325 200 600 400 700 550 375 275 225 200 475 400 80 60 175 150 50 30 30 70 400 30 1,000 300 25 550 125 100 750 50 550 ------- S5" 1,500 375 70 900 300 200 1,100 80 650 50 1,700 225 60 700 150 125 950 100 700 --------7T~ 2,000 375 70 900 275 200 1,200 90 500 50 1,400 350 50 750 200 200 950 60 150 200 100 200 150 40 100 50 90 80 225 375 200 350 275 800 800 650 950 900 30 30 50 SO SO 30 50 30 SO 40 250 375 225 375 275 ISO 300 225 325 275 125 ZOO 125 ZOO 125 200 450 350 400 325 10 40 15 30 20 355,000 167 33,000 48,000 75,000 3,000 11,000 18,000 14,000 i 19,000 | 15.000 ucc 057570 Estimated New Cancer Cases for All Sites, Plus Major Sites, fay State -- 1974 APPENDIX 3 - EXHIBIT 2 ucc State Alabama Alaska Arizona Arftirmi California Colorado Connecticut tliwara Din. of Columbia Florida Georgia Hewaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota ^^issppt Montana Nebraska Nevada New Hampshire Hew Jersey New Mexico New York North Carolina North Oakota Ohio Oklahoma Oregon Penniyhnnia Rhode Island South Carolina South Oakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming AH Sites* Number of Casas 10,000 300 4,300 6,400 61,000 5,400 10,000 1,700 3,100 27,000 12,000 1,700 2.100 37,000 16,000 9,500 7,300 10,000 11,000 3,500 12,000 21,000 27,000 12,000 6,600 16,000 2,000 5,300 1,300 2,300 25,000 2,200 70,000 13,000 2,000 35,000 3.200 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 aoo Breast 1,100 50 600 600 8,700 750 1,400 200 500 3,300 1,500 ISO 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 3,300 250 10,800 1,600 250 4,900 950 900 5,300 550 800 250 1,S0Q 3,800 300 200 1,800 1,400 700 2,200 100 oo Colon* Rectum 1,100 50 600 800 8,700 800 1,700 300 400 3,900 1,400 250 5,800' 2,700 1,800 1,100 1,400 uoo 600 1.300 3,500 3,900 Z.OOQ 800 2.500 300 900 150 500 4,500 250 12,000 1,400 300 5.S0O 1,100 1,000 7,400 700 750 350 1,600 3.700 300 300 1,700 1,500 800 2,500 100 Lung 1,300 60 700 1,000 8,100 550 1,100 250 350 3,900 1,700 200 200 4,500 2,000 1,000 800 1,300 1.700 450 UOO 2,400 3.400 U00 800 2,300 250 550 250 350 3,200 250 3,200 1,600 200 4,500 UOO 950 5,100 4SO 350 250 1,500 4.400 200 200 1,700 1,400 300 1.400 90 Mejor Sites Oral 350 15 150 200 2,300 ISO 500 70 200 UOO 450 so 50 1,400 500 300 300 450 450 125 500 900 900 400 200 500 70 ISO 50 90 900 60 2,500 500 50 1,300 250 250 1,500 200 250 50 450 1,100 SO 60 500 400 200 500 20 Uterus (Invasive) 1,000 20 350 500 3,300 350 550 100 250 1,600 1,100 80 100 2,700 1,300 650 650 900 850 250 900 UOO 1,800 600 700 UOO ISO 300 SO 200 1,600 150 4,300 1,200 80 2,500 $00 500 2,300 200 700 150 1,000 2,300 200 100 1,100 700 600 850 60 Prostate 950 30 450 750 UOO 550 750 90 250 2,400 Stomach 300 15 150 200 2,300 150 400 50 90 1,000 Pancreas 350 10 150 200 UOO 200 300 50 80 750 1,100 SO 250 3,000 1.400 UOO 800 900 950 400 400 150 70 1,400 400 300 ISO 250 400 150 350 70 70 uoo 450 250 250 350 300 100 900 1,400 2,300 U00 750 1,700 200 500 80 250 350 -850 850 50Q 250 450 30 150 15 70 350 600 750 400 250 500 80 200 SO . SO 1,700 ISO 4,500 1,100 200 2.700 900 600 3,200 300 1,100 80 2,800 350 100 uro 250 2GQ 1,500 ISO 750 70 2,ICO 400 70 950 300 200 1,300 90 600 300 UOO 2,400 250 150 1,100 3Q0 600 uoo 30 150 30 300 UOO 80 SO 350 3S0 200 600 20 200 90 350 1,000 SO 50 400 350 200 400 30 Leu* kemia 300 20 150 300 2,000 200 350 40 SO 700 400 70 100 1,200 500 400 300 400 350 -100 300 550 750 400 300 550 80 200 40 100 700 70 2,000 500 70 1,000 300 300 UOO 30 200 101 400 uoo SO so 400 400 150 450 20 ^^ffted States 655,000 90,000 S9.0Q0 83,000 24,000 46,000 54 ,C00 23,000 i 20,000 21,000 Com not include arcinome-in-jjtu ol the uterine cervix ar tucerfieial ikin cancers. Thesa estimates ere offered u a rough guide and should nor be regarded as definiiive. They ir calculated according to rh* distribution ol estimated 1974 cancer deaths by nate. Especially nate that yer to year w ',,irr. t TABLE 1 CHEMICALS OR INDUSTRIAL PROCESSES ASSOCIATED HITS CANCER INDUCTION IN MAN (Derived from ref. 8, with Addition of date on worker exposure from ref. 19; see elso footnotes to Teble 3.) Chemical or Industriel Process Main Type of Exposure Aflatoxins 4-Aminobiphenyl Arsenic ^ confounds Asbestos ^ Environmental, occupational0 Occupational Occupational, medicinal, en vironmental Occupational Auramine (manufacture) Benzene u-" Occupational Occupational Benzidine Occupational Bis(chloromethyl) ether Cadmium using industries (7 fmAmi rtm oxide) Occupational Occupational Target Organs in Man Main Route of Exposure1 Liver Bladder Skin, lung, liver Oral, inha lation0 Inhalation, skin, oral Inhalation, skin, oral Lung, pleu ral cavity, g.i. tract Bladder Hemato poietic system Bladder Long Inhalation, oral Inhalation, skin, oral Inhalation, skin Inhalation, skin, oral Inhalation Pro strate, lung Inhalation, oral Estimated No. of iorXers Expo .ad in U.S. d 100 1,500,000* 1,600,000 d 1,900,000 2,200 d 1,400,000 - 30. ucc 057572 Chemical or Industrial Process Main Type of Exposure3 Chlor ampheniool Medicinal Chi ramethyl ethyl ether Chromium (chroate producing industries) Cyclophospha mide Diethylstilbestrol Haematite mining Isopropyl ' oil Melph&lan Occupational Occupational Medicinal Medicinal Occupational Occupational Medicinal Mustard gas 2-Naphthylamine nickel (oxides) Chi rnaphazine Oxymetholone Phenacetin Occupational Occupational Occupational Madicinal Medicinal Medicinal Target Organs in Man Main Route of Exposure*5' Estimated Mo. of Workers Exposed in U.S. Haaatopoietic system Lung Oral, injec tion .Inhalation d d Lung, nasal cavities0 Inhalation Bladder Uterus, vagina Lung Oral, injec tion Oral Inhalation 1,500,000 (chromium oxid s) d d 19,030 Masai cavi ty, larynx Hemato poietic system Lung,* larynx Bladdar Sasal cavi ty, lung Bladdar Inhalation Oral, injec tion Inhalation Inhalation, skin, oral Inhalation Oral ft d d 1,000 1,4 00,000* d Liver Kidney Oral Oral d d 057573 Chemical or Industrial Process Main Type of Exposure* Target Organs in Man Main Route of Exposure** Estimated Mo. of Workers Exposed in U.S. >henytoin Soot, tars and oils Vinyl chlo ride Medicinal Occupational, environmental Occupational Lymphoreti cular tis sues lung, skin, scrotum Liver, brain, lung0 Oral, injec tion Inhalation, skin Inhalation, skin d f 2,200,000 *The main types of exposure mentioned ere those by which the association has been demonstrated. The main routes of exposure given may not be the only ones by which such effects could occur. ^Denotes indicative evidence itot recorded in the survey i exposure very small in all cases except aflatoxins. *HO. of workers exposed to nickel oxide: only about 230 workers exposed to nickel -carbonyl Exposure very large but not characterized numerically 32 ucc 057574