Document LpNboNXjEyBGXVO8z0enV69Xd

FILE NAME: Asbestos Mining (ASMI) DATE: 1952 DOC#: ASMI024 DOCUMENT DESCRIPTION: Journal Article - Survey of Some Current British and European Studies of Occupational Tumor Problems hN i L* r . i *V<! j * f* 4 [ir & i* 6 /6 /7 ? SURVEY OF SOME CURRENT BRITISH AND EUROPEAN STUDIES A OF OCCUPATIONAL TUMOR PROBLEMS WILLIAM E SMITH, M D. NEW YORK ? |X J U X F 2S, 1`>50. I sulod troni Xew York u h the object m m - uiiic f viduals engaged in the study <>t oci ujlattonal tumor problems a b t10(1 enee gained trout these \iits pro' idc-s the tiuitetutl o tin.'' lepnii and presented under the following heading-': 1. Shale Oil II. Petroleum P III. Asbesto IV. Dyestuffs V. Sources A Statistical Dala ai ( h t up,it a-nal U n " ! ' in ( 'ukci 1. s m a l l OIL * k Skin cancers in paraffin workers m Hie Niottish shale-"1! indn't.;. acre noted A. as long ago as 1876. In l'LD, a detatlt d 'Huh of this pioblem u h a. n por1 ot (o cases was prepared by Dr. Alexander Scott 1 at the n-i|ue-'t ot the ><.ottidi sham-oil industry. Dr. Scott has continued suae that turn to 'e r \ e a- medica.l consult.ait mr the industry and as works physician. 1 had the pntbege ol \ t'iting lum at tiie Pumpherston Works in MidA.u'der. iscoiland. where I also had me p'ea-uie o, meeting Mr. Alan Anderson, the work' manager. Dr 1-.. Smith, the emef chemist, and Mr. Cromhie. yvorks chemist, Mr. L ronilm- ga\e hv a tour m Ac pla t. lie stated that oil shale, the material taken out m the earth, is re im u d at h 'lt' m 1900 F. at four plants in Scotland to \ ield naphtha. ammonia and m ic e od. I be products are then sent to the I'ltmpberston Work-, where they an piote-'t-u i" yield gasoline, industrial naphthas, parallin, diesel oil. coke, and acid 'Indue ' Da paraffin is obtained by a pressing operation, to be commented mi in more del.a1 later. Presented at a meeting ol the Tarn'cr I V s ia t io n t .mimiiia m \ 'ev. \.,rls t k t Is. D Dr. Smith is Assistant Prohssor, Dcp.u tim-nt m ludu'tn.il Medium. D m *. >. > Medical School, N'ew York University. Travel expenses involved in the iirepai ation of this > m u ) m "'1 ln cm..!' ' - Anna Fuller hand and from New York I n i y v ' i t y 1 Scott, A.: On the Occupation Cancer ot the P.u.illiu and Oil Worker' ,a the ' Shale Oil Industry, British M. J. 2:1108-11(1 (Dec <>> 1922. lh e Oa.natimi l > c ^ - the Paraffin Workers of the Scottish Shale Oil lm!usu>. with a Description ,,i h e Adopted and the Results Obtained at the Periodic F.\amintioiis ol These \\ oi kn-ui. e . Scientific Report. Imperial Cancer Rescarili Fund. London. 192.5. pp. 1-94. shah Oh I m - Occupation and Health, Report No. 242. International Labour Otli.e, (,enev... PC.' ^ 2. A Brief Description of the Operations of the Scottish Shale Oil hidti.'l: >. XoitU'li Ltd., Glasgow, 1948. (32 pp.) Dunne work has he made 1 dermatic which ! s: been e.s pc C,\sr. 1 varying sizThe erytO. C asl 2 in Case 1. scars, the i arms and c 30 years. I Case 3 They were 10 years a. C ase 4 four kerat, skin over hut Dr S< from an c. fading der The latter ob'truetioi They veerthe parafl. had deveh this case l to be emp All i ahnorm: In this n urticii? oil work or arms tumors The >n the j remove is allow sea 1y o paraffin laborer existing On experie been bs r ase of arge n that d y i'vji4a *1 f tg c K i v S ^ ' 'U D L'Sre- f-YQAJ6 % O c c o P A f f o f i M L / i t e . S ': S M I T H -- B R I T I S H A N D E U R O P E A N 'I U MO R P R O B L EM S 2V) He then covered his arm again with the lubricating oil, bui thi- time nilibc-1 it off with cotton soaked in a colorless technical grade of wlnt< oil. Almost all tlx- fluores- ience was thus removed, only a little remaining in a \cry u-v -tain red hair mllith-". Or. Cruickshank stated that he had not iound dermatitis to r<-uh m human "km washed repeatedly with white oil. prm ided the -Kin m e lxalth> m -tan with. <an " of irritation occurred when the oil was applied under dressings I e itlx r d>-cii-moii , i wavs to protect the skin against oils is contain d m m; -iitioii on ''haw f >'> Dr. Cruickshank and Prof. Squire ha\e de-enhed wart- that nieurred on the skin of 33% of a group of 138 machine-tool operators cxpo-d to -pi a; s <-i a - uitmg ml which thev found capable of inducing skin tumors in amii al- ' I nad au opportunitv to examine many excellent photograph' of t hc - ( i m p " o h x - !l.( '< were flat, white keratoses . others were rat-ed. rugo-i sections showed the latter to he papilloma-. 1h:>. ma: of which I -aw. Photographs of his arms -hov ed ha: prof. I. W. Cook, at the C m \e r-it\ of Cla-c" " a id pic urn,, ' ,a< :t -, r o t a 1 citili or. ; r\i,/i I -i.i.'lH It.- j-1)')!- - ar< nm'wg 'o ' ' t ,<jtr chemical nature of the carcinogen- u the petro Oil- V Birmingham. Prof, t o o k was aw a; iron: C a - g o .1 cr: ; 1' ,abo f but the work was dc.-cribed co me lg in- a- o.iit. Ur n vr.cuuni rlist,ilntion. chromatograph;, -m a s acid, thev have i-o.ated a chr; -<: ' ' it-, d general procedure i- to extract t!>e on- :tn .s alumina columns, an 1 c-.ute with petro.eum crvstallir.e compound-, a- . et t.i.iue; ime-.. ' IS ha? been obtamt-l m -ufnciet.t ; lu.i't; hand. Thev hate -aded to r:.o ben/p. rer.e : aromatics with stiiiurtc acio. reger.'T-.ie e \mJ#' . ' * P- 1 250 I N D U S T R I A L H Y G I E S E A N D OCCUR A I l().\ . !L MEDI CI NF. %f Dr. Merewether referred to the governmental report published in 1030 by hii,. self and C. W. Price.17" This report showed that asbestosis developed in XOG men employed 20 or more years in the industry 171' and that in variou- group- ' i rt workers the percentage in which asbestosis developed varied directly with the d i f ness of the process in which the groups were engaged.171-' These finding-, :e-; ' the adoption of laws requiring ventilation of asbestos work rooms in Great Ur-::. (Asbestos Industry Regulations, 1921). Detailed specifications for safeti eqf nient are contained in Factory Orders. 1944. It should he noted that there >- k mining of asbestos in England. Hence, the British figures refer only to in d iv id y A engaged in weaving or other manufacturing or handling operations 5 A first problem was whether the apparent association of lung cancer and athe tosis means merely that workmen's compensation procedures tunneled all Gudiseases into one group. This possibility cannot be supported, h o u e w r. for ' such high incidence of lung cancer has been found m ca.-cs of -lhco-i-, ulu d i a:> likewise reported to and reviewed by the Pneumoconiosis Board. Cancer of the lungor the pleura was noted in only 91 (1.32(4') of i>.884 cases of silico.-is recorded, fr;11 1930 through 1946."' The incidence of cancer wa- thus 10 times great'-r in u?l>e-totic lungs than in silicotic lungs Data on the average age at death in tin- -identic group were not given, hut the same report listed a -cries of l.1'37 -dicotic- who died at an average age of 58.2 years, compared with a group of pit) a-he-mtic- who died at an average age of 17.5 years. Therefore, the duicrence in <auct-r incidence in the two diseases could not be attributed to death of -dicot,c- before the;, reached the "cancer age'' ; in fact, the silicotic?- would appear to have had greater oppor tunity by a full decade to Held cancer.- Similarly, the average duration of employ ment in these two groups could not account for the difference 34 3 \ ears foi the silicotics against 14 9 years for the asbestotic.-. A measure of the rate at which lung cancer occurs m the general population o; England and Wales can be found in the Registrar General's Stati-tiial Renew (1949). Employing the data given on page? 3 and 145 of the Renew one can calculate that 1.30(4 of all deaths in the three year- from 1943 to 1945 were reported as due to cancer of the lung, the bronchus, or the pleura. It is of interest to note that the percentage of deaths attributed to lung cancer in the general population is almost identical with the figure of 1.32(4 for the finding of lung cancer in a large group of silicotic lungs. Documentation of the cases of coexistent lung cancer and a-besto-i- became 1m next endeavor. For this purpose, I visited Dr. 8. Roodhouse Gl-guie at the Insti tute for Social Medicine in ( Lxford. Dr. G louie'- -tudies of the p.ul.olog\ m' asbestosis are well known.11' For mam \e a r- he has received lung.- lor review oi. matters of compensation. Dr. Glouie geuerou-b gave me penni'-m n to cite tin data in Table 1, which he assembled irum lung- that he pcr.-oua!I\ examined in in gress and microscopically, ll is to lie hoped that a lull account ot them will 1 17. (u) Merewether, E. E. A., ami Price, C. \ \ : R e p u t on F.ficct- ut V.-K-to- iHi-t - n f Lungs and Bust Suppression in the Asbestos liulu-try, London. Ifi- M a je-n 's M u n u i e u i 'fm 1930 (summarized in J. Indust. Hyg. & Toxicol. 12:117. PMO, and m T u lm c li 5 ; e,0-81. U' 118, and 152-159, 1933-1934) : (/>) ibid., p. 10. Table 3. 0 ) ibid. p. 14, Table 7 18. Gloyne, S. : The Morbid -\natotm and llistolopv ot V-hi-to-io Tuhcre'e 14:445-4. 493-497, and 550-558, 1932-1933. Asbestosis. in Sibcosi- and X-Ik-iom-, ubted h> I ,ui/.i. \ J New York, Oxford University Piess, 1938. pp. 225-244. r-T 00 p u b lis h e d d e a t h .10 in add 169 perso th o s e m e lt g ro s- or a sb e -to tic ( 19 m en, t o b e -1 n incidence -ex ratio It whi without p conioses for the gi found tn T IBLF 1.-- Iron PotCoal MOO Asbe describee thi- elev continuein his sc scattered The t(is gn tube rod l,T-lu cai er" bn- A. fen i " 1 ' SMITH--BRITISH A SD EUROPHAS TUMOR PROB!.EMS 251 published from a manuscript that was in preparation at the time of his recent death.19 In addition to the material of Table 1. Dr. Gloyne also examined the lungs of lo9 persons without pneumoconiosis but employed in the same set ol industries as rhose included in Table 1. Among these, he found 14 who had primary lung cancer (S 3 % ) . The lungs of 11 asbestos workers who had no .asbestosis feither in the gioss or microscopically) were negative for carcinoma. The 7 cases of cancer in asbestotic lungs (Table 1) were about equally distributed Ik tween men and women i '.0 men, 7 women), whereas m the normal population in Kngland the ratio is said to be 4 men to every woman with cancer of the lungs. In addition to the higher incidence of cancer in asbestotic lungs. Dr. Glovne lelt that this dilterence in the sex ratio afforded evidence for an occupational factor. It will be apparent that the lung cancer rate of 8.3(7; tound in the HD individuals without pneumoconiosis and the rates of 5.1 to 8.9% in the groups with pneumo conioses other than asbestosis are much higher than the rate oi 1.3(>% estimated for the general population on the basis of death certincates and the rale of 1.32% found from pathological examination of the large group ol sihcotics previously T able 1.-- Incidence of Primary [.mu Cancer in iinnifs uith l a/ants / \pc.s (Data of S. Roodhtutsc (iloynci / a, noun niosn Oeeuputionul Group I r o n a u d sreei w o r k e r s ................................. ...... P o t t e r y w o r k er s .................................................................... C o a l m i n e r s ................................................................................ S t o n e m a s o n s ............................................................................ AsbestOa w orker s ...................................................................... [VlMtH" w ith I'nutunui nii io- i' To'til .Number \ lHI11' ' with IPniDirv Ltmt: ......... with P n u m tj Liint; < :nct*r ^ 11(1 1,1 `Hl " ' ^ ^ 11 described. It is thus probable that the higher rates reflect closer stud\ Despite this elevation of the base line for comparison, the rate m the asbestosis group continued to stand out. Dr. C.lovne stated that of the total number of lung cancers in his series, 7.5% were discovered only on microscopic examination I hese were scattered through the various groups. The type of cancer -u and the degree of asbestosis in the 17 cases of the asbes tosis group are given in Table 2. Only one individual ( M S ) had evidence of tuberculosis.. In the 922 cases comprising the whole of the pneumoconiosis group lia b le 1), 20% showed tuberculosis. Dr. G knne made a special search for pre cancerous changes in asbestotic lungs and did not detect a m . Desquamation of bronchial epithelium was occasionally seen, but squamous cell metaplasia was not found save in the cancers themselves. It will be noted from 1 able 2 that the degree i') A brief posthumous publication has appeared (Gloyne, S R . . Pni'umoomwsis A His : ,, ,d Survey of Necropsy Material in 1.205 Cases. Lancet l:X10-Xl.> 1051 i " T limuidi the courtesy of Or. K. F. W. Hinson, of the London Chest H o s p i t a l , we have o . , I,,||CS fr,,m sjx lunpx of Or Gloyne's series. This material was examined by Or Douglas 1 underlain!, of Memorial Hospital, New York. Two cases (C. \ \ . and J \ \ ) classified as V|U. nous cell earner by Or Gloyne were interpreted as terminal hronchiolar ("alveolar cell" ) can inoma by Or. Sunderland X 1^'.jYf1A^' 252 INDUSTRIAL HYGIENE AND OCCUPATION Al. MEDICINE "LtensiVe'^ i n ' e v f 6 gr UP f CanCerous !lings was recorded as " moderate" or degerreeee oof aa-slbeesttosi?s w"as"made m every instance b^y the"msaMme"obTsheerverN'aDtri oGn looyfnteh)e were k, T ^ C XlStent Iun* cancer `TMd asbestosis studied by Dr. Gloyne ere assembled over a period of 20 tears (1929 to 1949). All had their exposure o asbestos p n o r to 1932, the year modern exhaust ventilation devices were n contormance with government regulations. The majority were employed at a p an handling Ivhodes.an blue and South African (also blue) asbestos. Both these t>pes are more brittle than Canadian white asbestos, hence give rise to more d u T east one patient (J. I.), however, was stated to have been exposed only to Canadian white asbestos. F u only to I next vis,ted Prof. E. J. King at the British Post-Graduate Medical School in mndon, where I had the opportunity to examine protocols relating to the lungs T__A_B_L_E___2_-___Pathoh ieal (/-'a/a of hooahuus"c' o(wrieouvncw)i,h Ashcs,osls and ^ Ppfree of Vsuesiosig Extensive KUdDSIVi- Moderate -Model a t e Moderate Modra te Modra te Moderate MotJei a te Mild Extensa e Extensive Metier re Model ate -Modet a to Moderate Modeiate Type of Cancer " O a t C'e.r* " Oar CeT* S q u a m o u s Cell Squamous ('ell S q u a m o u s Cell Sq uamous. Cell .Squamous Cell S q u a m o u s (''ell S q u a m o u s Cell "Oat Cel/' S q u a m o u s Cell Squamou*. Cell S q u a m o u s Cell Squamous cell " O u t Cell ' " O a t Cell ' Adeiiocar. inomu Th P ` of ' ad ,,Ct`n en,|,,OVwl a Pla"< using Canadian white asbestos. were made by Dr C. A'. H arrison. Varvmg degrees tr a s h e s o s . were noted m 8 of these 11 lu n g ,; there were 3 cancer's, all amono ! >Cy tlL llln^ - Ail -a t ce ll' cancer was found in lungs of one patient patients u n a le s? " r " A " aplaStic ^ m o m a s were described m two other the -il t " C ^ U ' ni the (lejin;e of aslje.stosis was moderate; in the c m ? i ^ t h c T .S,S. WaS/ " ,n,nK . THe asheS" WiS rat* ed fro- t e n s i v e to mod . um.nniu^ utients m whom this disease was not complicated bv cancer. Combnnng the data of Dr. Glojne and Dr. Harrison, one fimlsMhat ir : exi" Z c - u. a" d a'SbeStOSiS' the * * of asbestosis was mo<lt`raU` !n ,3 ' a,,d "mild" or "minimal" in 2 The cancer TW " "' "r Ce" '' 1,1 anaP'astlc " 2. ^ d adenocarcinoma in 1. i next T m` m? etWee'' tyPe f CanCer and de&rcc of asbestosis. . , . ' ul'Crt W yers' the medical officer for a companv m Enffiand - ugage, ... m a.uilact.iring asbestos products from blue asbestos mined in Rhodesia f the ne). oyne sure ipted at a hese lust, v to ol in angs SMITH--BRITISH AND EUROPEAN or South Africa Dr Wvers is the author of a valuable clinical study of asbestosis H e S e d that asbestosis was recognized in 1900 and that the industry grew to major stature in tth,e war oNf 110911-14-1199118S. DDrr. Wvvvyetrrss hnaas seen only- two deaths wtrhoemn asbestosis in people who started to work m the industry after 193-, the yc devices were install]. In en tr e e ,, he tad ; 11 * * I d l i n g asbestosis in persons employed before IW2. lie thru in regard to safety conditions in the asbestos industry are thereiore a great trnin p " S e n 1 medidne The din,inr,tint, in the severity of the rhse.se n, terms or eP , mb^ of pe so" affec.ed ,s inrther borne on, by lessened sever,,, ,n the ! L , d . l c a s e s V i o r to 1932 the Z ^ I n t e j r e a ^ T X s r o s t s seen by D o found in 17. Dr. Gloyne examined the lungs m these 1/ ea , . P diagnoses of the tumors ha\e been gi\en aboie. lipfnre AlToi the 17 individuals wtth a.!,eslos,s and h,,,s cancer were exposed he or , ,, , f t c `r(line Dr. Merewetlier. .he additional 3 cancer patterns stud, d by 19JZ. According to MK>dlicallv inquired ot Dr. 1be.tween 11Q9c1 o; danndd 11 9--4+50. T11his single case might will ht cxpc, ctc.emap. loIyed m the "normal" incidence of lung cancer in any group u= Urge . 1 . asbestos industry. , . - summary, t.ten, I was able bud some ^^*.,,1 rhf -M nersons ^ ^ with coexistent lung cancel and a.-Ttsi - , , , ]0 .nlients making under conditions now prevailing in the industry. 1he ad 1.1no;ual 1 ^ . up the total ot 31 described in .he Annua. Report o, - - " dries (or the year 1947 had all her,, exposed poor to 19.12 and I dtd no, atte , locate autopsy protocolsf 'j!" r Z , m > r U s e r ., and Dr. Mercwether tha, the Tf woe consensus ot 19i. \.jlo\ue, 1 , . 1 1 10^9 Tf \vrm the concensus tiuit <x iuug ^llllAl existed" in th " mdustn- in < * B r tta . ta . that tl.e.e is no evidence to -hoyc ita. ' I a hasard continues to exist under the working comlmons now p i c U ` l i d he further noted tha, in .he 11H7 factory ;; -- " ,.,,,ployment u, the 19.W. are rherelore only nor " D : r :::i ' . ,lld, ,, ,,cm ought be expected to appear The s,,.e r,, . 1 - .... the but d m ,, has d m s far prodded only a settle eas, . ` " ,, ...... asbexins.s argues dial an , long tumor hasard has been . . o . u ; dr, leas, in ........ of ....... . h e , he, ih em will he anv Sign,bean, ......... ............... S S s s - r iit w 21. Wyers, H. : Ashestobis. I'uiim.i'l M I Zfl:o U <'.9 1 1,0 MM 254 IN D U S T R I A L II Y(,IIL X L A \ l> O U ' l PA'l 10S A L M E D IC IN E in either <>l two series <>| tests. I examined histrIoical sections of rat lungs that ii:u! received intratracheal instillations of asbestos fibers. Studies of these lungs have been published.-'-' Erof. King stated that he had found no difference in the response of rat lungs to Canadian as contrasted with Rhodesian fibers, nor had am epithelial changes been evident. A few pulmonary adenomas were present in the slides shown me, hut these tumors are known to occur spontaneously in rats and cannot he attributed to the instillation of asbestos fibers. In regard to the animals chosen for experimental work, Dr. Gloyne stated that he had found rabbits and guinea pigs more susceptible to asbestosis than rats. He had not tested mice. fSee "Abstract of Discussion" at end of this paper for further comments on lung cancer m relation to asbestosis.) n the light ol the evidence that bladder tumors are caused by beta-naphthvlamme m the d\e-mauulacttiriiig industry, production of this chemical was reportedly discontmued as ot April, l 'b u , by Imperial Chemical Industries and by the Clavton Aniline Company, the largest British d>e producers. They are said now to make sulfonic acids n subonating beta-naphthol and animating it later, thus avoiding ie stage at winch beta-naplulnlanime is produced This change in the manufac turing process should not unit protect workers the plants but also remove the potential hazard n, distribution of free beta-naphthylanime as a contaminant of food d_\es consumed bv the public. The question wbether benzidine presents an occupational tumor hazard has long been debated A recent paper In Barsotti and Yigliani presents an impressive series ot cases ot bladder tumors attributed to benzidine exposure in an Italian dve-works. t tv claimed that a majority ot the patients bad not been exposed to beta-naphth\ 1- dnniK. , translation ol this Italian studv appears in an accompanying paper.-3 * I-r Kenneth Baker, of the (A n to n Aniline Company, .Manchester. F rH a n d described experiments Blowing that benzidine itself ,s not carcinogenic but that men exposed to ben/,dme excrete in their urine a in droxylated derivative, 3.3'-dihy- c roxv-4.4 -diamniudiplient 1. a compound winch he demonstrated does evoke bladder tumors m nme.- Mice were given repeated subcutaneous injections of olive-oil suspensions benzidine or ,>f hvdroxriated derivative 3 .3 -dihvdroxv-4 4'- (laminodipheiiG. Nine mice were given the hydroxylated compound, and bladder papillomas de\ doped , live and a bladder carcinoma in one. Xo bladder tumors olive oil alone' ' r in e n n t n '! aninials g>'en injections of 1''orgianna lioiiser. Leeds Adversity, England, kindly summarized for n V 'T r'n n :ll'" nU r>' The airi,n,s abil'ty of beta-naphthvlamine o call lortli 1 adder tumors man and in <logs but not in other species has led th:,t 'l' l';irc,n,,enic aaion '"`V o some metabolic change I","' * 1 ' 1 -1 an<l V : Elicit of Asbestos, and of Asbestos and Aluminium mi the I.unys ol k.ihbiis. Thorax 1:188-197, 1<146. ' I O - T V m a ? '- r ' V,Khr'" ' h " ,iladllcr U "',ons fni"' Aromatic Amines, Med. lavoro ' K"l,sl' lra," li,,lu" ^ A M A Arch. Indnst Hyg.. tins issue, 2.34) '' V ' ,K' Activity of Dihydroxy Benzidine, Acta Umo mternat contra caiieruin 7( I't. 11:46-51. 1950, nucrnai. >u> / \ i n \ / A7 // m u i n . \ / ; . l . \ n ( X . X D C A T I O N A L M F .D IC IN E July. ll)50. a conference was held at Oxford dealing with cancer in relation to .sociological and environmental factors other than occupation. Proceedings of n K conference have been published/'1 \BSTRACT OF DISCUSSION D r. P u l Carhkr, L 'Annonciation, Que., Canada: I have been asked to describe our e\n. . enee at the Thetford Industrial Clinic in Quebec, where we see men engaged in the ashi -i ... mining industry in Canada. Table .3 presents data on eight cases of primary cancer of the ha,e which we have detected among 4.(XXI asbestos workers between 1940 and 1950. In addition to those listed m the table, there was a case in which there was quite a dem.iu clinical and radiological history of cancer of the lung but for which, unfortunately, io autopse i u . performed Also there were three other cases with a strong suspicion in favor of a can.. of the lung hut for which no sutliucnt data are available On anahving these data it seems obvious that many points would need discussion benre anyone will he able to establish a caudal relationship between these pathological findings .mp the asbestos factor. Is it not more logical to think that the same causal faetur will produce thesame type m tnnior. and, lliemtore, why do we obs.-iwe such a variety of malignant tumors J T \Bi.r ,3.--(use; nl Carcinoma of the Lungs Detected Among 1,000 Asbestos barkers 1<>10-1<DO Purl,*nt i \ A \ \ J I o i I. ! o r n W ( Vi'jus of f- Mmsiire an IX 11 la 2 None Mgmilt iinl Norm V e.in in I/H Ill'll v H l, 21 ' !7 14 `7 .v Vge n r Heath 71 *,i M o') 04 hi j Dogioc of A-hcstOst.s Minimal Minimal Advance! None Minimal None None Type of Tumor Bronchogenic carcinoma Bronchogenic carcinoma M ed ia sti n al 1> .upho s.irco ir uith puimonaiy mecasta: Brom.hogonie carc.noma Pleural mesothelioma* Bronchogenic eurcincina Bronchogenic carcinoma (thoi acotomy; Pleural mesothelioma* * s i a n , | r , 1 X. >io.Ti el n 11 a f O' [Ii s m s , iin.l O p e r a t i o o s " p u P l ' - f t c i Py t h e \ m e u . a i n M o i i . a l A s s o c i a t i o n N .u 'I 'f k 'P u PI t u i n p a r n , 1`ij.y ugiie'jt!* tile1 t e i m ' i i n w u India! s a r c o m a " If i'M a muiiuiit we ma\ assume That the a ^ b es to fibers might produce a bronchogenic carLtrionu in .isbc-ti ,nr u n p l m i u s with igiiihcant exposure, then only tw o casus of the m ries would sur\i .m r u d u u e h u a u s e the U ha m mesothelioma "r lymphosarcoma and ca>e-> without i-'in' m w iili'iiii asbestosi** do not h a \e the conditions inquired 1 f'l't K i ' i i i b it v..uld app.,n :k`u''.'dr\ that aim <tutstic; on occupational cancer ot the ini'L', i" bv viin iu -u e, 'iiMidd induatc the [nemoc \anet> or lung cancer. M:< b nn \ I-! w, \ i w ^ ork 'fin: d iitd m ice in the frequency of lung cancer in person* \wl, a'iu *im| h hinu* ,i' c-unparid with tin lurm group of iilicoiies piovided by the Pncumu f\iin<i'i- I'..ud 'tfin-v nnpiessiw H n \ \ c u t . mu nuent w in d er whether the two groups had bee (.\anim<d ior u m i witli equal va n i am miptcssed bv the fact that when different groups ui Mil" -' wre "tudu d In tlu satm "b'-i. t v\ r. 1)i 1 11>\ m,. the <li He i cnees in frequency ot lung cancel wi i e imu li k ' h we u strict our attention mWq!> to h r ( doyne's series, I am not sure that tin dilfm-ih c> ,i:r st,it]s(u.all> significant 1>n \ I I w / \ o \ \ m'k 1 thud i I-* iinpoitant to distinguish betw cen c ise>. of chnii aP n ioiuii/ubh and latal lung cancer, on oiu hand, and iascs m which the diagnosis of lung cancer lias been madi as umre oi less ot an incidental finding at uutnpsv, on the other. Tn e English elann lot an association between lung mincer and asbc'tosm lias been bused, it seems to me, on data obtained Hum lungs tli.it a pathologist has searched with a microscope. I wonder how rnanv 'i < <nii rune <>n (jengraphical Pathology anil Demography ot Cancer, J Mat. Cancer Inst M\( ](E<) on to f this cpcri- .'MOS- lung finite topsy meer store and <e of S M I T H -- B RITIS H A M ) liVROTHAX I l 'MOR PROHJ.hMs (A cases of lung cancer would be found if lungs from any sort of |io|>ulati>m iu rr subjected to tin same minute scrutiny? D r. S m i t h : In regard to Dr. Cartier's query as to the significance of different types of lung cancer, it may be pertinent to note that a diversity of tumors was found in the lungs 0 1 chromate others reviewed by Dr. Anna Baetjer. experimentally, the polycyclic hydrocai hotis evoke a go .1 variety of tumor types. If asbestos is carcinogenic, 1 would not expect to see it produce mb' one type of tumor. I am interested in your observation of two cases oi pleural me-othelii.ina. This is a rather rare tumor. In examining pathological mate' ial sent us from Kiigi.nid by IJr Hinson, we found among six cancerous asbostotic lungs two presenting alveolar cell car cinoma. These tumors are often diagnosed as "pleural mesothelioma." 1 should eery much like to exchange slides with you. in replv to Mr. Lew and Dr. Laura, it was my understanding that the Lnglish cases oi silicosis and their cases of asbestosis were handled m the same general lasluon thiough the l 'licnmocomosis Boat'd and that the lung cancer rate lotind m sdicotics could therefore s m e ,i' a reasonably satisfactory control for the lung cancer rate m cases oi asbestosis In l)r hloynt scries of 81 cases of lung cancer in the several pneumoconiosis groups and in the control group, the tumor was evident m the gross in all except b. Some of his material was destinycd during the bombing of London, but his recollection was that all ot the cancers m a-hestntics were recognizable in the gross. Dr. J o h n L. Pool, New York Have experimental studies thrown any light on the question of lung cancer in relation to asbestosis? Dr. S m i t h : In 1941, Xorumann and Surge m (icnuauy claimed to base produced cancer in the lungs of mice by exposing them lepeatedly to asbestos dust I hen statement that cancer had resulted in 20% oi their exposed animals is oua'ionalh quoted. Actually, their " ib ft" figure referred only to two mice, one of which had a type of tumor that occurs rommoiiL as a simul taneous growth in mice. The other they considered to be a squamous eeil carcinoma, but tfisir photograph does not impress me as that ot epidtrinoid cjriinoma It scents lather to show merely an area of squamous cell metaplasia. aruld out the uns 10- cn of .er the