Document NQqkwn3pQQxOL7K6RZg16wNw

Ref. : XTVth Sept. International Congress 16-21,^1965, Vol. II. of Occupational Health, Madrid, Tnt-.or.nfl.'Mnnal r.nngress Series 62 Excerpta Medica Foundation. THE ASSOCIATION OF CERTAIN CANCERS WITH ASUESTOS1S W. D. BUCHANAN H.M. Deputy Senior Medical Inspector of Factories, 19 Sc James' Square, London, Croat Britain Introduction Asbestos!* it essentially an occupational ditcato of this century and prior to 1930 when the con* duion war first included in a Scheme for compen sation in Great Britain, relatively few autopsy studies had been made. The first ease of lung cancer as a possibly associated condition was described by Lynch and Smith (1935) from the United States. Tnc first large scries suggesting that tho associ ation of asbatons and lung cancer was moro than one of simple chance was published in 1949 by Merewctbcr, then H. M. Senior Medical Inspector of Factories in Great Britain. The series included 128 males and 107 females whose deaths were duo cither to asbestosis or where asbestosis was proved to be present at autopsy. The incidence of lung cancer in these two groups is shown in Table 1, reproduced from the Annual Report of the Chief Inspector of Factories for that year. In 22 of the male scries and in 9 of the female series, cancer of tho lungs was found to bo present. TABLE 1 Analytic of Atbcttotit and Cancer ofLung as at 1947 Age in Years 15-34 35-34 35-44 45-54 55-64 65 and over Toul Asbestosis 3 9 30 36 37 13 128 Males Asbestosis aad Cancer of lung -- 9 11 2 22 per cent w 25.0 29.7 15.4 17.2 AaK^tftcit 6 33 41 17 6 4 107 Females Asbestosis aad Cancer of lung 2 4 i e-- 2 9 per ce&t 6.1 9.8 5.9 _ 50.0 8.4 The study was brought up to date in 1954 and again in 1955. By the latter year, the number of then known deaths from asbestosis covering both series had risen sharply to 365 while, of much significance, the percentage of this group in which lung cancer was found had also risen from 13.2% to 17.8%. an increase occurring in both eases. TABLE 2 Atdeitntlt aad Cancer ofthe Lung at at 19SS Diagnosis Male Number Percentage Female Number Percentage Toul Number Percentage Asbestosis ail cases 222 100 143 100 365 100 Asbestosis and Cancer of the Lung 48 21 . 17 11.9 <5 17.8 * An additional 15 deaths have subsequently been allocated to the period up to 1955. . <17 DUP 1141929 W. B. SUOUJULN Doll (1925) hat investigated the cause of death as determined at autopsy or 105 persons em ployed at one large asbestos works, hung cancer was found in IS of these, including 15 in association with osbestosis. A statistical study indicated that the risk of contracting lung cancer was of the order often times that experienced by the general population at that time. Considerable interest has been expressed in these observations which do not seem to have been reported to a similar extent in other European countries or from America although South African experience is in greater harmony, Tht frtstnt Study . rUUSONAKY CANCCX British experience has been brought up to date to the end of 1962 in this paper. This has boon possible, as in earlier studies reported in Annual Reports of the Chief inspector of Factories, because in Great Britain asbestosis is a compeneatable industrial disease formerly under a Workmen's Compensation Scheme, now os part of the National Insurance Scheme. Death benefit is also payable to eligible dependents. In practice, this means that a high proportion of cases are reoognisod during life and. In the event of death, there is an autopsy examination. The diagnosis of osbestosis is then recorded on the death certificate and a study of these afiords an unusually accu rate means of determining the number of deaths from asbestosis and any associated pathology found at autopsy. Between 1956 and the end of 1962, a further 169 deaths in which asbestosis featured, 155 males and 34 females, have been identified. In nearly every instance an autopsy was made and the clinical diagnosis confirmed. Fifty of the 135 new male cases also had a bronchogenic or lung cancer and 6 of the 34 female cases, percentage incidences of 37.0 and 17.6, respectively, These totals in this letter period exclude $ coses diagnosed as mesothelioma of the pleura, all males. The grand total of deaths in which asbestosis was knowr to be present during life or deter mined at autopsy to the end of 1962 is now 549, made up of 364 males and lt5 females. These totals have been broken down in Table 3 into decades with the first period up to 1930 and the last to include the most recent period 1961-1962 Period 1924-1930 1931-1940 1941-1950 1951-1960 1961-1962 1924-1962 TABLE 3 Incidtitet of Atbtsioiit and Asbtttotii mtd Lung Canctr 1934-1962 Males Asbestosis V. All and Cancer with Cancer Asbestosis of lung of lung Females Asbestosis V. All and Cancer with Cancer Asbestosis oflung of lung 13 -- Nil 7 -- Nil 66 12 1S.2 62 3 6.1 92 20 21.6 144 45 31.3 45 4 8.9 40 u 27.5 49 22 44.9 11 2 1B.2 364 99 27.2 165 22 11.9 The point which immediately attracts attention ii the riling percentage of cases in both sexes who had an aaaoeiatod lung canecr. The first lung cancers (one in each sex) were recorded in 1932, some time before those described by Lynch and Smith. The faliing-off in the total of female deaths in which asbestosis was present is alto noteworthy. Many of these females had employ ment relating back many years to post employ ment os mattress beaters before the hazard was properly appreciated. b. OTHER CANCEXS Thirty coses in this complete series of 349 eases had a cancer found tt autopsy arising from some other organ than the lung or bronchus. 61S DUP I Ml930 TO. SSSOCISTION OP CEATliM CAUCUS WITH ASUUTOtlS Jill, The distribution of these cancers was as population. 7.4% of male deaths were due to > o. follows: -- imra-thoracic cancer and 1.3% of female deaths. Siom.ieh 5 eases It is tempting to speculate on a possible cause Bowel 6 Cases for this increased incidence. In Great Britain Bruin jgy Testis l case 1 case three main types of asbestos fibre are used chrysotile, crocidollte and amositc. Crocidolitc and amostte are iron-containing types of asbestos 'Abdomen', and ovary plus one ease imported from bouth Africa. U ts understood described as'malignant peritonitis* 8 eases they arc much less used in North America where Pleura ormesothelioma 9 cases the cancer association is less evident. T here is also in ~ __ 20 cases an increased incidence of occupational tumour lid of the lung in chromate manufacturers (Btdsirup, r-5 Four of the mcsothcliomata of the pleura were 1956). while the existence of a causal relationship n g found in the period 1961-62. between pulmonary siderosis and primary lung ge cancer has been mootod by several investigators Diteutiion (Hueper, 1942). The possibility that in all ihcso Mil It seems beyond question that there is a eon* groups a common type of carcinogen may be all sidcrably Greater risk of dying from lung cancer operating and that this substance is an iron or mesothelioma of the pleura or (possibly) the compound appears an attractive hypothesis iit .r- peritoneum if asbestosis is jpKIcnt. The data, however, fives no informatioiTwheihcr there is although dearly there arc weighty objections to accepting iron itself as the carcinogentc agent. .9, also an increased risk among workers using or *C exposed to asbestos who do not have evidence of 10 asbestosis. The risk of aequiiing an intra- REFERENCES lie thoracic neoplasm has apparently risen steadily Bidstmup, P. L. and Cass, R. A. M.: Brit. J. over the period reviewed and the most recent industr. Med. 1956. 13 (260). group, the 49 males dying with asbestosis, con Chief Inspector of Factories: Annual Report for firmed during 1961 and 1962 included 26 or 53% 1947. London; Her Majesty's Stationery with u lung tumour or mosothulioma. This Office. increase must, however, be considered against a ibid.: Annual Report far 1954. rising incidence of lung cancer in the population in general. Nevertheless, the proportion of males in the wholo series in whom lung cancer was present amounted to 27.2 % and offemales 11.9% ibid.: Annual Report fur 1955. Doll, R.: Brit. J. Induitr. Med. 1955, 12 (81). Husptx, W. G: Occupational Tumorj and Allied Dacuict. Springfield, 111. Chat, C Thomas, Publisher 1942. or By comparison, in 1961, which year represents Lynch, K_ M. and Ssuth, W. A.; Amer. J. the highest incidence yet recorded in the general Cancer 1935, 24 (56). Returnee, Abetract, Rfrumt), Vol. IV, No. 166 i- (19 DUP 1141931