Document KqYV9k2YeZ2n9jQxOLORqO72

FILE NAME Insurance Industry INS DATE 1953 DOC INS057 DOCUMENT DESCRIPTION Journal Article - Possible Etiologic Factors in Lung Cancer J) dediONILYd J LUNOS NOLUISdG aeHKA Lise WY ee UICIEH MNU Journal Chicago meting IlinosA4H0LS39NIS @ Year Transactions of Location LOWER ODYSE ENABLEDENABLED XVI XVI Directors America AUT SOUli| XXXVII THANK SIOUI] COL ODYSEY ENABLED 1953Pages ODYSEY PG137 THANKTHANKYOU na Charge 15.01FM 15.01FM 15.01FM ON Directors America Guny Lung Title Etio1l8g27cal436 ONEIDOSsyY Number 62625577222 PJosiOble WAXX ayy TN Tampa Tampa Klay Printing ILLiad Number 18271436 Ly] ILiad | sopy QOUBINSU| Bunjaow IAXX 4emou0g ueaAsyuoW Guipusy 1uded jeusnor OH]jenue -OUINOA Faasctior]s Factors Lung jo BOLEUy jertHojny 40 S14/SOd UOYNY SIOJSUIT] SPL SHV {EOIPOW SIS JQ0UeD Edwardsvile Ilinois 618-650-2381 618-650-2381 146.163.157.4 146.163.157.4 siuel@siue.d -AeQuIN uduy TH =2 MLN NANT S2"9M2 PAT TT] OBeoryD stourpyJyo ANsuealuy) OD POSSIBLE Orb ye re ' woot ie rn oa . e ae s LUNG CANCER ETIOLOGIC FACTORS IN E. CUYLER HAMMOND SC D. aed ; . a Director of Statistical Research Section ; Department Medical and Scientific American Cancer Society pT! se New York New York : on Biometry Professor of Yale University ES New Haven Connecticut poo The annual number of cancer deaths inin the United States is steadily growth increaising ncreasing but thisis duein largemeasure to the and aging of our population After adjusting for age it seen . *: that the cancer death rate among females has been going down . | since about 1936. We have reason to believe that this is attrib- utable to a combination of more effective therapy and earlier . diagnosis made possible through public health education the other hand among males adjusted cancer death rates arerising Most of thisincrease howeveris due to the surprisinglyrapid increase in deaths from cancer of the lung A few decades ago *: " the occurrence of bronchiogenic carcinoma was seldom . observed but by 1942 it claimed the lives Americans Only ten ~ *: years later it is estimated that 21,000 of our people died of this ;: upward shows cause The most alarming fact that the every indication of continuing a trend wat pa For the present at least the problem is is more serious among | ~ men than among women About 2,200 women died of lung can comparison By , cer in 1942 and 3,600 in 1952. the lung cancer in death figures for men were 6,600in1942 to 17,400in increasing s age 1952. The highest incidence rates males occurs in authogrritoiueps 60 to 70 andin femalesin age group 70 to 80. Most the has impression are under the increase that almost all of carcinoma 800 1 Ten Rn beenin ee eg . incidence these epidermoid type higher of City dwellers seem to have a much a : tumors than do inhabitants of districtsAmong males the . by Hammond thatnhemeeting ae areasat death rate is more than twice as highiinn urban a Dr. Condensation of the of the paper presented Dr. Associationthe iin n rural 138 SECOND ANNUAL MEETING areas However it should be noted that these figures are based upon death certificate reports The possibility exists that the differences noted above are due to errors in diagnosis and errors in specifying place of residence which combined may perhaps result in reporting in rural areas There is evidence that some cases of lung cancer have resulted from the exposure of industrial workers to dust or vapors con- taining such substances as arsenic nickel chromate asbestos radioactive substances and coal tar fumes However there is little indication that occupational exposure to such substances has caused many cases of lung cancer in the United States It seems most unlikely that industrial exposure could account for any large proportion of the lung cancers now occurring . To account for the tremendous increase in this type of malig- nant neoplasm it seems that we must look for some factor or combination of factors which affect the general population rather than only a few highly specialized occupational groups i Furthermore it would seem logical to be most suspicious of certain factors in the environment to which the public has been increasingly ex- _ posed during the last several decades In addition we might look for substances to which city people are more heavily exposed than country people and to which males are more exposed than females We must also remember that there may be a delay time of as much as twenty years between exposure and clinical ap- pearance of the disease . Since we are dealing with a disease of the lungs most atten- tion has been given to substances which are inhaled Among the numerous factors which have been suggested at one time or another the following four stand out most prominently Coal tar and certain oils contain chemical agents of known carcinogenic properties capable of producing cancer in experimental animals The concentration of exhaust fumes from auto- increasing mobiles has been greatly ever since 1900 practically the entire populationis exposed to some degree and city dwellers are more heavily exposed than country dwellers However this does not necessarily explain the question of sex difference - The same can be said of the dust from tarred roads which is ~ increasing and contains carcinogenic agents te n ETIOLOGIC FACTORS IN LUNG CANCER ~' 139 Air pollution in the form of dust and fumes from coal and oil. furnaces as well as from certain industrial processes has become . a first rate nuisance in many communities and the degree of ex- - - posure is greater in the urban thanin the rural populations.. The three suspects named above are all being intensively studied in laboratories but the real question is whether or not the con- centrations actually inhaled by human beings are sufficient to cause cancer of the lung and this can only be discovered by epidem- - iologic studies on human population groups Such investigations are both very difficult and very costly but several are now getting . under way It will be a number of years before the probably results are knownin the meantime the lung cancer | death rate continues to rise , ro , 8 By far the greatest attention has been given to fourth factor 7 namely tobacco smoking On the face of it this seems to meet most of the requirements for a first rate criminal suspect The consumption of cigarettes has been increasing dramatically ever since World War I. The habit as an almost universal custom started first among men and spread to women at later date The ' tarry products of tobacco smoke have been used to produce malignant tumors when rubbed on the skin of experimenta.l. animals However I must add that such circumstantial evidence 1 alone should not necessarily lead to a conviction and that - other more direct evidence has been accumulatinginrecent years Massachusetts In 1928 Lombard and Doering of the State Health Department conducted a study in which patients were of questioned about their smoking habits A larger percentage heavy smokers was found among patients with cancer of groups the2 buccal cavitythan was found among other No mention was made of lung cancer probably because itwas arelativel;y Bats Ay ir relatively rare disease at that time = va coca Raymond The next significant study was made by Pearl of the . Johns Hopkins Universityin 1938. By quitea different_ of investigation obtained evidence which seemed to indicate that heavy smoking produces an appreciable shortening of life expectP analysis ancy The volume of material was not sufficient to makean 7 by cause of death surprising subjectdiminreissuhletding periotdhe from this After an initial report interest in of excitement . ve ' . 7 . %. a c a try 140 SECOND ANNUAL MEETING In 1945 the results of a second study of smoking in relation to cancer were published from the Massachusetts State Health Department This time they found a much larger percentage of heavy smokers among lung cancer patients than among other groups 5 By 1950 the lung cancer death rate had increased to such pro- portions that it stimulated a renewal of interest in the problem and in that year the results of five major and independent studies were published All of these investigations were conducted by : the same method as that used in the original Massachusetts study This is known as the historic method of investigation All of them showed that upon questioning a larger percentage of lung cancer patients report a history of heavy smoking than do con- trol series of persons who do not have lung cancer However differed the order of magnitude of the correlation between the studies considerably For certain technical reasons some investigators among them not convinced that the methods of procedure used in these studies can be counted upon to yield valid unbiased results Most particularly I am uncertain whether the order of only magnitude of the correlationis so small as to be of academic interest or so large as to be of great practical importance Principally for this reason we are undertaking a very large investigation of the problem using an entirely different method of approach It may be described as the : from the historic follow method as distinguished researchers Between January and June 1952 volunteer of the American Cancer Society obtained smoking histories on 204,000 white men between the ages of 50 and 69. Each of these men is being followed at annual 1+ intervals For each death reported the cause is ascertained from the death certificate The first follow was done about a year ago and the volunteers success- . fully traced 99.4 per cent of the men originally questioned If should this efficiency can be maintained we mation to yield a conclusive answer in about nb have enough infor- and half one half - to two and years from now n | analysis a Although our major concern is lung cancer an will be made for all major causes of death cr Perhaps the most im- CANCER ETIOLOGIC FACTORS IN LUNG 141 ' o portant finding will be the effect if any of smoking on the general death rate If cigarette smoking proves to be seriously harmful it is fair to assume that the tobacco companies will under- take research to discover the injurious ingredients and remove people them from the product otherwise at least some cide to give up the habit t may de- a unlikely that It is entirely possible and indeed seems not a combination of factors rather than a single factoris responsible for the increasingly high death rate from lung cancer Until the final answer is found all reasonable possibilities should be in- vestigated The problem is much too serious to risk concentrating investigation though the all our efforts on a single line of even moment it may appear to be the most promising at . PRESIDENT BONNETT - Thank you Dr. Hammond The number of persons applying for insurance and giving a history of a nervous disorder or current nervous manifestations is increasing daily Perhaps as a result of the unprecedented recognition of psychiatry by the armed services during the war a general acceptance somewhat later by the medical profession and now by the population in increasing numbers people are willing to admit that they are nervous and to seek help When psychiatric treatment is admitted on an application we are frequently at a loss as to its significance or to the real nature of the disturbance . psychiatry Until all of our examiners are basically trainedin shall continuteo have this growing problem we | GE Fortunately the death rate is not excessive but we have the problem of separating from among numerous applicants with nervous manifestations those who are potential suicides and thosea who are not Those who are not are almost certainly standard -: risks Dr. Peter G. Denkeris well known to this audience He | has an excellentinsurance background andis keenly aware of this to problem We are particularly fortunate in having him here = Neuropsychiatric discussThe Evaluation and Classification of Disorders ae se ee Dr. Denker is Assistant Professor of Clinical Neurology at ; most Cornell University Medical College and an old friend of us here Itis good to welcome you back Dr. Denker _ Sa of of tes ^' oe