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FILE NAME Kent KNT DATE 1956 Nov DOC KNT147 DOCUMENT DESCRIPTION Journal Article - Environmental Causes of Cancer of the Lung Other than Tobacco Smoke - Diseases of the Chest ulosis ve weor 3 JOURN Session - Scattle Washington November 25-26 1956 NUMBER 2 AUGUST 1.956 Entered us Second by Copyright 1956 OFFICE CHICAGO ILLINOIS CHESTNUT CHESTNUT at the Postoffice at Chicago Illinois perican College of Chest Physicians fhe ion of geons rk for Environmental Causes of Cancer Other Than Tobacco Smoke W. C. HUEPER M.D. Bethesda Maryland The recognized or strongly suspected environmental causes of cancer of the respiratory system form an important segment of the environmental carcinogenic spectrum 1. With one exception all so far known exogenous were discovered during the last 25 years Table 1 period in which a remarkable remarkable and progressive rise frequency of cancers of the lung was observed in respiratory carcinogens that is during the in the number and most industrialized countries Fig 1 2. The various respiratory carcinogens are more or less well defined chemical or physical agents and are associated with distinct occupational activities engaged in by circumscribed workers groups Table II 3. The clinical epidemiologic pathologic and experimental observations related to these agents all of which act through the respiratory route TABLE I OCCUPATIONAL RESPIRATORY CARCINOGENS CARCINOGENS AND CANCERS RECORDED Petroleum Oils Radioactive Number of Recorded Casca ULKA Countries Total 7 23 ~ 1932 ae 140 Lease 84 84 Nasal Sinus se Lung Q $ 51 ~ 53 - Lung and 1936 33 40 Larynx 4 Larynx Nasal Sinus 6 Lung 1879 National Cancer Institute National Institutes of Health Public Health Service 1. S. Department of Health Education and Welfare Presented at a Symposium 21st Annual Meeting American College of Chest Physicians Atlantic City New Jersey June 2 1955 141 W. C. HUEPER August 1966 & ENGLAND WALES y MALES f 7 COMPARATIVE TRENDS TRENDS TRENDS IN | s+ = RESPIRATORY CANCER 1924-1950 SWITZERLAND MALESMALES ENGLAND FEMALES WALES FEMALES FEMALES 1936 1940 FIGURE 1 1944 1948 1950 TABLE SPECIFIC WORKER GROUPS WITHSPECIFIC RESPIRATORYRESPIRATORY CANCER HAZARDS Worker Groups , handlers handlers and users of arsenical arsenic smelter workers taxidermists copper smelter workers Chromium ~ Nickel maintenance workers copper matte refinery Arsenic coa 800 Petro Deri oil Vol XXX ENVIRONMENTAL CAUSES OF CANCER factual evidence available on causation represent the only reliable tract Table II Although of cancers cancers in different parts of respiratory observations suggest that some eccupational medicinal and experimental contact with respiratory pulmonary carcinogenesis may ensue ensue after a hereditary or pulmonary valid evidence incriminating carcinogens there exists no of human lung cancer factors as primary primary causal agents cancers endogenous that the total number of occupational pulmonary Despite the fact comparatively high cancer attack rates on record is relatively small the weighty studied provide the different worker groups observed among actual causal associations between an exposure evidence in favor of development of respiratory respiratory specific agents and the subsequent of occupational respiratory Table IV TThhee reported number of cases total number which only a fraction of the cancers doubtlessly represent Arsenic TABLE JI ENVIRONMENTAL LUNG CANCER SCORE BOARD Population Type of ; Affected Affected Evidence e Circumstanil Other organs ' Bone Conn tissue Bone Conn Hemal Diesch engine ; X Gasolme Epoxides X 7 x Conn tissue etc. Skon Conn tissue SSkkiin n OSV RS Ta 144 W. C. HUEPER August 1956 RESPIRATORY TABLE IV CANCER ATTACK RATES ENVIRONMENTAL CARCINOGENS BY Agents Aromatic hydrocarbons Coal tar Petroleum fumes oils Carbon and silicon polymers Isopropyl Isopropyl Asbesto Incidence in Population Attack Rates Percent of All Morbidity Nate Mortality Kate re Cancer Cancer Cancer Deaths Per 100,000 Lung Lung % 100,000 100,000 55 Paranasal 1 sinuses Larynx Lung 100 0 seseeenneees ee becetee 134.5 normal 6.0 0 seaeenes we % asbes- tosis autopsied 0.8-2.4 normal Metals Arsenic Chromates Nickel Nickel Nickel Ionizing radiation Radioactive area Lung ceceeeeeeese 000 eeeeates eter ttre Pamanasal sinuses 329 |. of 574 574 ! 100,000 10,00 100,000 100,000 wecesees 42x normal 145.7 males 10.9 normal 146-338 Lung occurred Some of the lung cancers were certainly mistaken for tubercu- losis pulmonary abscesses silicosis asbestosis siderosis or other forms of chronic pulmonary disease Another portion of these tumors was recognized as of occupational origin but not made a matter of public record while a third fraction developed in workers many years after they had left the hazardous occupation sustained exposus occupation and when the causal relations to their previously had been obscured by the passage of time Table V. Page 156 The almost exclusive occurrence of occupational lung cancers in male LATENT LATENT PERIODS OF TABLE VI ENVIRONMENTAL RESPIRATORY CANCERS Nasal Sinuses . Agent Asbestos Average Latent Period 18 Range of Latent Period 15-48 Latent Period a Range of Latent Period .5-47 we 8-30 11 3-26 9-23 . Vol XX work emplo excep work besto indic ENVIRONMENTAL CAUSES OF CANCER 143 workers is in good agreement with the fact that males are predominantly eraployed in occupations having lung cancer hazards One exceptions in this respect are the lung cancers found in female The female ratio of lung cancers among workers known asbestos with bestosis cancer of the lung is for this reason at the low level of 23 indicating that with an equalization ofthe degree of exposure there CANCER OF LUNG 1921-30 ETO MALES AOIS 25 AND OVER Per Actual mortalityper cent of that expected from the distribution : of populationpopulation by age and class of district Under 70 85 - 100 - 115 - - 130 145 yt be ANT including Counties County Boroughs ot FIGURE 2 Reproduced by permission of the British Empire Cancer Campaign ) HISTOLOGIC TYPES OF OCCUPATIONAL RESPIRATORY CANCERS HISTOLOGIC Agent Organ Lung Lung Lung Spamous Cull Carcinoma With or Without CornificaCorntifiicatioon nCornification Bound Cell or Cat Cell wees 3 a Asbestos Radioactive Nares and Sinus develops a tendency toward an equalization of liability to lung cancer Several Several types of industrial lung cancers such as those caused by radio- substances substances chrome pigments and coal tar fumes show a definite younger age groups than those observed in cancers of the lung medicin medicin medicin Since th but she RE LATTER CANCER WITTE KALEO UNITED STATES 1996 White : EDWARD A. LEW Age Adjusted Death Mateo por 100,000 White Mais Populatias but characteristic of cancers of occupational Occupational respiratory cancers moreover have long latent periods other cancers of known industrial or environmental origin Table VI prevail- The relatively massive exposure to carcinogens not infrequently - under occupational conditions may perhaps occount for several types of occupational aquestosis cancer and radioactive cancer is not infrequently Pulmonary Pulmonary Pulmonary fibrosis associated with silicosis in radioactive ore with siderosiderosiss is in hematite miners sems seems to decrease the individual liability to cancerous developments in the lungs thus affected While many occupa- onal lung cancers inmature or round are cell of squamous cell type many others display an type or exhibit glandular structures In fact several different histologic types of cancers may occasionally occur in the asems have tory mass Table VII Thus no special histologic type any fixed relation to any specific causal factor Occupational cancers critically studied exhibit a general symptomatic respirapattern contion to and characteristic of environmental cancers 4. Many of the agents incriminated in occupational respiratory carcino- such as arsenicals radioactive substances coal tar and petroleum renesis such of occupational and oils had previously been known as important causes medicinal cancers of the skin developing developing usually upon cutaneous exposure the mucosa of the respiratory tract may be considered as an inverted Since outer lining of the but specialized specialized entodermal extension of the ectodermal RESPIRATORY SYSTEM CANCER DEATH RATES Population Urban States and Rural States United AND States 1949 i 12 12 URBAN URBAN URBAN . MALE MALE MALE . i | | = a fey 4 . / Yo : - FN AT t a N RURAL MALE ae URBAN wee ae gt pee L 1 A $ i , N, L 510tas 510tas urban ND Miss W.Ve population with less than 40 urban population called population called Rural states SD SOURCE Vital Statistics of the United States 1949 rural . and states with more than Urbon statas , Mass NY NJ Colit DC STATISTICAL RESEARCH SECTION AMERICAN CANCER SOCIETY 53 1950 Population Census of the United States FIGURE 4 148 Name Chemicals Soot Coal Coal Tar W. C. HUEPER August 1956 TABLE VIII DISCOVERIES OF OCCUPATIONAL CANCERS fected Nature of Exposure 1892 1910 Zweig Skin Scrotum Sxin Occupational Occupational Occupational Occupational Occupational Occupational Occupational Petroleum Occupational Occupational Shale Lubricating Benzol Aromatic Amines Intermediates Isopropyl Oil ; Mustard Cas Chemicals Inorganic Arsenic Blood Forming Occupational Occupational 1895 1946 1953 Rehn Bladder Kidney Hale and Hueper Yamada & Hirose Miyamishi Miyamishi Miyamishi Miyamishi & Miyamishi Nasal Sinuses Larynx Lung Lung Occupational Occupational Occupational 1822 1887 Paris Hutchinson Saupe Occupational NasalCavity & Sieuses Lung Occupational Occupational Occupational Radiation Radioactive Substances 1923 1923 _ Frieben Wyes Von Jagic Schwartz & von Siebenrock Beck Haerting & Hesse McNeal Ward & Willis Loewy Skin Blood Forming 1931 Occupational Environmental Occupational Medicinal Occupational Medicinal Occupational Occupational Occupational Occupational Not XXX con MEL XXX ENVIRONMENTAL CAUSES OF CANCER INDUSTRIAL FOR SEVEN 7 1947 AMONG 5,309 INDUSTRIAL GROUPS IN OHIO 5,309 MALE CANCER DEATHS MANCUSO Industry Iron and steel Transportation Agriculture Respiratory Respiratory ferrous metal 3.22 149 development of cancers from these structures following a respira- Although the existing factual data on occupational respiratory car- cinogens are at present limited to relatively restricted worker groups and apply to a comparatively small a a considerable number of cancers of the respiratory organs circumstantial evidence suggests that identical or similar respiratory cancer hazards may prevail for much larger worker groups having occupational contacts with the known carcinogens Epidemi- ologic studies on lung cancer death rates made in this courtry and Europe have shown the existence of marked variations in the liability to lung cancer for different large occupational groups The TX Some of them revealed - definitely excessive frequency of pulmonary cancer Table X XI and XII as well as of cutaneous cancer The possible significance of these observa- tions in terms of occupational lung cancer hazards is evident from the fact that there are over 5,000,000 employed in American industries sustain- ing various degrees of exposure to combustion distillation products of coal petroleum and other carbonaceous matter and cracking soot carbon Continued uut joge 155 TABLE X CANCER FREQUENCY AMONG OPERATING AND OPERATING OPERATING RAILROAD WORKERS Period 1940 - 1950 Total No. Lung Cancers Lung Cancers Operating RR Workers oem No. Per Lung Cancers Operating Lung Cancers Undetermined Workers There were four times as many operating RR workers in one company as operating ones who represented train personnel round house and track workers 150 W. C. HUEPER August 1956 TABLE XI OCCUPATIONAL GROUPS WITH AN EXCESSIVE LUNG CANCER INCIDENCE Group Occupational Potential Respiratory lubrienting Tobacco Tobacco dust insecticides insecticides soot Borst Turner Kennaway McLaughlin Wynder Grace Mueller and Vane Wynder Dublin and Graham; al Borst Borst Kenna- machinists mechanics Engineers , machinists plumbers etc. Metal dust soot iubricating oil dyes paints solvents paints asphalters paviours Stokers patepntatent fuel workers furnace foundry laborers railers etc. men Tar and pitch pitch fumes and dust soot Report_of_the Report_of_the Report_of_the British Empire Cancer Campaign Mueler BECC 1944 Dublin and VaneVane Fulton Kennaway and KennawayKennawaKeynnawa; y Fulton BECC 1952 Regis- General 1938 ; McLaughlin McLaughlin TABLE XII MORTALITY SEVERAL LUNG CANCER MORTALITY COUNTIES OF MONTANA IN AND WALLACH County and Total Total Population Lung Major a Total Cancer Per Cent Long -srs Annual Lung Cancer Death Rate per 100,000 process process among white males in the entire und in ore mining and smelting inhale dust and fumes of copper are and released as a by- waste product during the Vol XXX Coun Othe re encase Vol XXX ENVIRONMENTAL CAUSES OF CANCER 151 LUNG CANCER MORTALITY RATES IR.N J.HERBICH AND AUSTRIA AUSTRIA PER NEUBOLD 1,000 DEATHS Community Vienna Cities Cities 60.000 60.000 1,000,000 1,000,000 1,000,000 Cities 20,000 - 60,000 Rest of Austria Total 32.7 18.2 18.4 10.3 Males 59.0 31.6 32.3 1.7.3 5.0 8.9 3.7 TABLE XIV CANCER OF THE LUNG AND LARYNX ENGLAND AND WALES 1946-1949 KENNAWAY AND KENNAWAY i | I 5 Type ofCommunityCommunity Greater London Number of Persons Producing One Death Maie Female 100 Larynx Cancer Number of . Producing One Male Female Female 100 100 County Borough 137 125 56 Other Urban Districts Rural Districts 283 TABLE XY STANDARDIZED OF STANDARDIZED MORTALITY RATIOS FOR LUNG CANCER SELECTED SITES IN URBAN ANDRURAL COUNTIES OF OHIO WHITE MALES 25-64 YEARS MANOUSO Th F. MACFARLANE E. M. AND PORTERFIELD MORTALITY COUNTIES PORTERFIELD Iung 1947-1951 Counties Right Metropolitan Seven Other Counties Urbanized Rural Counties **** 122.0 81.8 ** Metropolitan County Counties with cities of 100,000 or more in 1950 91 per : cent urban Urban County Counties with with cities with populations between in 1950 66.2 per cent urban 50,000 and 100,000 Kural County Counties with communities with populations below 50,000 in 1950 41.4 per cent urban comprising 78 counties W. C. HUEPER August 1956 TABLE STATES OF THE UNITED STATES LUNG LUNG 1946 1948 DEATH DEATH PER 100,000 INDUSTRIALIZED INDUSTRIALIZED INDUSTRIALIZED INDUSTRIALIZED INDUSTRIALIZED INDUSTRIALIZED INDUSTRIALIZED INDUSTRIALIZED INDUSTRIALIZED INDUSTRIALZED STATES 1946 1948 111.1.11 Rhode STATES WITH REGIONAL INDUSTRIALIZATION 1986 AGRICULTURAL STATES Carolina Dakota 3.1 The death rates Inc. 1949 Cancer for the year produced by the National My 4.0 Society : ENVIRONMENTAL CAUSES OF CANCER LUNG CANCER MORTALITY AND POPULATION DENSITY Groups Groups of adjacent occupieodccupied dwellings dwellings 200,000 Suburban Area 7 : : Birmingham and Suburban Area ManchesteMancrhester and Suburban Area cecee cee ccectee tee eener rec tanienes Liverpool and Suburban Area - : : : ; of 6 towns with 50,000 Aggregate of 3 towns with 40,000 40,000 - 107 occupied dwellings vee. 104 Aggregate of 29 towns with less than 20,00020,000 occupied dwellings dwellings INCIDENCE OF MORBIDITY RATES FOR XVIII TABLE RESPIRATORY CANCER 1947 1937 AND NINE METROPOLITAN CENTERS BY SEX 100,000 PERPER 100,000 POPULATION : i Males Females Total Primary Site and Per cent Bronchus and Lung DeDenvernver Denver Denver Detroit 8.5 Biometrics Section National Cancer Institute oe ce s te * EVEMENTSARTH EVMENTSARTH EVEMENTSARTH EVEMENTSARTH = nr cr rte rere gin mney JO HO sonwetLLwHisy SON FOONFDSygus78 3CAN0CER(ANZ ABORT SECA OF CANCER OF CANCER SNS rs NS comact wee Ul Vol XXX ENVIRONMENTAL CAUSES OF CANCER 155 155 155 TABLE XIX PROMATIC HYDROCARBON ESTIMATED IN MINUTE SAMPLES OF WITH VARYING DIESEL EXHAUST SPEED WITH LOAD AND ENGINE REVOLUTION FUELINJECTION INJECTION INJECTION INEFFICIENCY P. KOTIN Anth- anthrene . i i 0 ne, Compression Release Compression Release Compresion Compression Release Compression Release Compression Release a Compression Release Compression Release ~~ CompressionCompression Release Compression Compression Release 1400 0 Compression Release Lit 1/2 3/1 Compression Compression Release Compression CompressionRelease Compression Release 175 640 772 1320 42 ~ 121 610 43 223 7 208 639 - 0 876 0 3206 70 257 a448 888 | - 1912 ru 278 488 614 47 437 432 1706 10 24 197 . 930 320 976 044 1.88 30 0 20 78 177 56 - 0 76 13721372 368 69 734 702 892 1071 577 blacks tar fumes and dust pitch and asphait dust and fum lubricating eating oil mists and fogs engine exhausts over 2,000,000 with and metal fumes vapors for occupational dusts and many thousands of others occupational carcinogens such occupational Since some of recognised respiratory agents agentsagents the among found industrialized and the local and general air pollutants particularly areas people living and working in such have particularly ain beyond any doubt an attenuated form of exposure to i ese carcino- . While inhalation contact with chromium compounds chromite ore chromates chrome pigments beryllium compounds arsenicals and asbes- is usually of local character and depends upon the release of specific certain industrial antirusting by certain pesticdes or the use of certain chemicals for agents respiratory exposure to pollutants polycyclic air pollutants such as polycyclic hydrocarbons contained other carcinogens exhaust fumes of gasoline and diesel engines and fumes from industrial furnaces oxidized unsaturated aliphatic hydocarbons from evaporated evaporated or combusted gasoline acted upon by atmospheric oxidants and radioactive matter is of more or less generalized nature Although the atmospheric concentrations of carcinogens encountered under these conditions are considerably below those prevailing with occu- 156 W. C. HUEPER August 1956 ENVIRONMENTAL CANCER OF LUNG IN FORMER CHROMATE WORKERS Vol XXX AROMAT GASOL ; i : : i i ; WHO WORKED A MINIMUM LATENT AND HAD A LATENT OF 4 YEARS OR MORE 20 WORKERS CANCER OF THE LUNG TABLE V TRENDS [~ INDEX 600 i IN SELECTED ENVIRONMENTAL FACTORS United States 1900-1953 1924-1926-100 1924-1926-100 E.G. HAMMOND : STATE ASPHALT 2 HIGHWAYS MOTOR FUCL CONSUMPTION 400... i ; 1 t 200- r 101 one PETE oo is COCNOSNUSMUPTMIPOTNION ADULT FVEL OIL GALES vy MOTOR VEHICLE REGISTRATION REGISTRATION REGISTRATION ; are a ! a Se aiane san Pegs, en A Set at aya? - | ene COAL CONSUMPTION La a td 1950 | ieee Some y factors except enviroenviro rates the in ductio Vol XXX ENVIRONMENTAL CAUSES OF CANCER ; 157 AROMATIC MYDROCARBONS ESTIMATED IN MINUTE SAMPLES OF GASOLINE EXHAUST WITH WITH VARYING ENGINE REVOLUTION SPEEDS P. KOTIN RPM Benzpyrene Expressed in PyrenePyrene Quantities CPD Benzperlene Anthanthrene 1500 2000 : 1500 507 266 142 346 127 4315 40 25 36 - 73 70 geographi- pational exposures numerous epidemiologic observations on the pational distribution of lung cancer suggest that they are nevertheless carcino- genically effective In fact the first observations on an appreciable rise in the frequency lung cancer were reported from the highly industrialized cities of donsely populated Saxony during the first two decades of this century lung Some years later it was found that high cancer rates existed population of the industrialized territory of the Ruhr valley valley valley existed for the they while they were below average for the agricultural region of the Main valley A similarly irregular distribution pattern of lung cancer frequency rates was recently established for industrializedindustrialized and of Austria England and the United States Table XIII England and United Fig 2 Fig 3 There is morcover evidence from England rural regions XIV XV XVI the increase States showing that in general the lung cancer death rates increase with ( the size of the community and the population density > XVII and therefore display a certain amount of parallelism between these two factors and the presumptive degree of air pollution However definite exceptions to this rule have also been noted indicating that the of quality pollutants air still unknown may play play a role and that additional environmental factors may be active in controlling lung ae rates on a local level Table XVIII It is finally noteworthy that pet urban distribution pattern of lung cancer death rates conforms with exposure of urban populations to known environmental in- related carcinogens and their progressively increased use and pro- duction particularly in urban areas Tables XIX XX Figs 4 5 5A CONCLUSIONS 1. The evidence presented definitely establishes the fact that some well defined exogenous physical and chemical agents areare causally involved in the production production of occupational cancers of the respiratory system of members of certain restricted worker 2. Since epidemiologic groups studies ofvarious large worker groups and of the their membership of special occupations have shown marked differences in their lung cancer death rates and in view of the fact that excessive lung cancer death rates have been found in occupational groups with occupational exposure to known industrial respiratory carcinogens it is likely that inrelated factors account for a much larger number of lung cancers than that on record 3. The demonstration of recognized environmental respiratory carcino- gens in the atmosphere especially of urban areas and of consistently and markedly higher lung cancer death rates for urban populations over rural populations strongly suggests that industry air pollutants may play a causal role in the causation of lung cancer and its recent consider- able increase in frequency in practically all industrialized countries 4. While occupacional and industry carcinogenic air pollutants seem to play an important role in the causation causation of lung cancer and its recent increase in frequency it is obvious they are not the only factors responsible for pulmonary carcinogenesis etiology 5. Research on the the etiology etiology of lung cancer therefore should be conducted on a broad basis including only inhalants but also agents entering the body through respiratory respiratory routes RESUMIN 1. La evidencia evidencia que que se presenta definidamente asienta el hecho de que agentes algunos agentes exogenos f^>sicosy qu^>micosdeterminados influyen causal- mente en la producci^nde c^nceresocupacionales del aparato respiratorio en ciertos grupos limitados de trabajadores 2. Puesto que los estudios epidemiol^gicosde varios grandes grupos de trabajadores han mostrado notables diferencias en la frecuencia de las muertes por c^ncerdel pulm^nen vista de que se han encontrado excesivas proporciones de muertes por c^ncerdel pulm^nen grupos de trabajadores que debido a sus ocupaciones sufren exposici^n a substancias carcinog^'nicas respiratorias industriales es posible que los factores en relaci^ncon la industria tengan mucho mayor n^"merode c^nceresen su haber de lo que se concede 3. La demostraci^n de la existencia de carcin^genosrespiratorios en la atm^sfera especialmente de ^reas urbanas con mucho mayor proporci^n de muertes por c^ncerque en las ^reasrurales fuertemente sugiere que hay poluci^nde aire por las industrias que pue de desempe^-arun papel causal en el c^ncer del pulm^ny su aumento reciente en pr^ticamente todos los pa^>sesindustrializados 4. Si bien los agentes carcinog^'nicosque polucionan el aire en los am- bientes industriales profesionales parecen desempe^-arun papel importante en la g^'nosis del c^ncery en su reciente aumento de frecuencia es obvio que no son los responsables ^"nicosde la carcinog^'nesispulmonar 5. La investigaci^n sobre la etiolog^>adel c^ncer del pulm^npor tanto debe conducirse sobre una base amplia que incluya no s^lo los agentes aqu^'llos aqu^'llos que ingresan en el organismo por otras Vol XX Kr^/ft grupi 3 ae Beru enkre stanc | auf einse ande ; 7 Vil XXX ENVIRONMENTAL CAUSES OF CANCER 159 SCHLUSSFOLGERUNGEN physikalische 1. Die vorgebrachten Belege stellen abschliessend dieTatsache ausser Frage dass einige klar abgegrenzte exogenephysikalische physikalische und chemische Kr^/fte Kr^/fte urs^/chlichbeteiligt sind bei der Entstehung des Berufskrebses des Respirationstraktes von Angeh^rigen bestimmter beschr^/nkter Berufs- gruppen gruppen Nachdem 2. Nachdem epidemiologische Untersuchungen von verschiedengrossen und von Angeh^rigen spezieller Berufe ausgesprochene ergeben haben hinsichtlich ihrer Sterblichkeitszifer and im Hinblickauf die Tatsache dass ^...berm^/ssige keitsziffernan Lungenkrebs bei BerufsgruppenBerufsgruppen gefunden wurdenmitmit beExposition auf bekannte industriellecarcinogene Stoffe der At- mungsorgane ist es wahrscheinlich dass auf die Industrie zu beziehende Faktoren f^...r eine vielviel gr^ssere Zahl von Lungenkrebsen verantwortlicvherantwortlich sind als die ^...berliefertist Der Nachweis von anerkannten durch die Umgebung bedingten carStoffen des Respirationstraktes in der Atmosph^/rebesonders in st^/dtischen Bereichen und von gleichm^/ssig und ausgesprochen h^heren Sterblichkeitsziffern an Lungenkrebs unter der st^/dtischen Bev^lkerung gegen^...berder l^/ndlichenBev^lkerunglegt die Vermutung nahe dass die im Zusammenhang mit der Industric stehenden LuftverunreinigungeLn uftverunreinigungen eine ars^/chliche Rolle spielen k^nnten f^...r das Zustandekommen des Lungenkrebsesund seine k^...rzlichebetr^/chtlicheH^/ufigkeitszunahmein praktischpraktisch allen industrialisierten L^/ndern 4. W^/hrendberufsbedingte und auf die Industrie bez^...gliche LuftverunreinigungeLn uftverunreinigungen eine bedeutende Rolle zu spielen Zustandekommen des Lungenkrebses und seine j^...ngste ahme liegt es auf der Hand dass dies nicht die einzigen verantwortlichen Alandekommen Alandekommen Forschungen Alandekommen von Lungenkrat ^...ber die Actiologie des Actiologie auf Forschungen nicht breiter Basisausgef^...hrtwerden und Faktoren nur einschliessen sondern auch solche Bestandteile die in den anderem Wege als ^...berdie Atmung eindringen H^/ufigkeitszuf^...r das Zusind m^...ssen daher inhalierbare Stoffe K^rper auf