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FILE NAME Kent KNT DATE 1955 DOC KNT138 DOCUMENT DESCRIPTION Book Excerpt - Diseases of the Chest Industrial Aspects of Bronchiogenic Neoplasms -Asbestos Workers Pg 424 of thte he CHEST CHEST CHEST ne | | - . : .e VOLUME VOLUME VOLUME XVII XXVIIXIXVIII VOLUME X VI IXVII JULYJULY DECEMBER 1955 19515 955 TheThe GeorgeGeorge on e . Industrial Aspects of Bronchiogenic LESTER BRESLOW BRESLOW M.D. Berkeley California Neoplasms Medical students usually learn as the classical cancer that scrotal example of occupational England Their cancer occurred among chimney sweepisn 18th century attention would perhaps more readily be attracted the story of lung cancer among miners in the to mines The fact that Schneeberg and Joachimsthal the latter approximately half of all deaths among miners in area resulted from lung cancer establishes the origin of this disease in at least occupational some cases Furthermore the striking increase in frequency of lung cancer and the millions of in the several 20th persons employed century occupations now suspected of having a relation- ship to the disease confirm the importance of this subject Lung cancer now causes more than 18,000'deaths today States Even adjusting for the annually in the United aging of our population this represents haaf veour increase during the past two decades Diagnostic techniques improved tremendously But the fact that lung among males has been rising much cancer mortality dicates that more rapidly than among females in- we are dealing with a real increase in the disease accounts for more deaths than tuberculosis in It now many states Recently attention has focused on cigarette smoking as 7 cancer Several studies based a cause of lung cancer patients and upon interviews with a series of lung a matched group of controls have demonstrated a greater frequency of cigarette smoking especially heavy cigarette smok- ing among the lung cancer patients As a further investigation of this ing histories from 518 question we obtained cigarette smok- lung cancer patients and a like number of matched net controls in 11 California hospitals The control 16m, tients admitted to the same hospitals for group consisted of pa- + other than chest conditions other than cancer and a matched for age sex and race with the cancer patients Tables and 1 indicate the lung in respect to biological characteristics similarity of our two groups smoking especially in The greater frequency of cigarette excessive amounts among lung cancer patients as compared with controls is shown in Table 1. In Table IV one that several other measures of the degree of may observe which began inhaling and cigarette smoking at lung cancer patients smoking before breakfast confirm that smoked cigarettes to greater extent than did the control group Of particular interest to rette cough occurred physicians is that called ciga- among approximately fifth of the lung cancer patients this usually antedated the onset of illness by many years One Chief Bureau of Chronic Diseases California State Berkeley California This paper is based Department of Public Health 9047 from the National Cancer on study supported by a research grant partment of Health Education and Welfare WIelnfsarteitute Public Healdi Service U. S. De- Presented at the 20th Annual Meeting American Francisco California June 16 1954 College of Chest Physicians San 421 eeUC Nen0he Acero a Wy Syreme . we fre. pretnite mh ay * sormina sete ti ban tnaeeste m th alary + a bord SOHN rd Boe tls . %,walt Wa pt)-ON *. 6 my . as O44 + ars Sy ek -Wane . Ae e- han ery Se sP*y we,oe a TO A wSf.ay ess wt te . Fhe ducal hh . - : 4veh - o. om, Masmenr . . . es, ae e oat LS * ~ - ry a er , oe rs {i it a * ke or ns . te cop i mi) _ a i" er F a8 20 we dy Fra dh es 2 2. Pf t" Rss oy. te) i } ' * ay re , ae eer} fous a4 gf <8 e ae Sy 4 et hoe Senne a aA: ts>, e ra. oo. : abe . yar . oe . ay , ff +. em fe #y' tt : : 3,ar : . ^'s . - ar aa - Sey a ae mt Moe. . % ie oe, S54 ore Oey oe set cara *f Sains ng en ; a ; nes :. ey; een! es .- ug. ae por dk omy +3 + ay ne ST. 14 yo rN: A bon . . . : 4d, as 7 : +1.7 LESTER BRESLOW October 1985 hundred twenty of twenty five years or more the patients stated whereas only 39 of that they had noted a cough for similar the control group gave a similar history These data consistent with the other recent controlled investiga- tions of the subject demonstrate a substantial correlation of cigarette smoking and lung cancer This correlation increases steadily with the amounotf cigarette smoking Levin has most assembletd he find- ings of these several studies and using a method developed by Cornfield compared the relative prevalence of lung cancer among cigarette smokers and smokers Table Vindicates Vindicates that for men aged 50-59 years lung cancer is four to 11 times as prevalent among smokers as among non- smokers and seven to 27 times as common among heavy smokers as among smokers . Medi- One must accept the conclusion conclusion of the New New England Journal of Medi- cine that the evidence cigarette smoking as a factor in lung cancer is so strong as to be considered proof within the every day meaning of the word , 1 ,: a) || Pel > : ; : TABLE 1 . AGE DISTRIBUTION OF LUNG CANCER ; PATIENTS AND CONTROLS wo eee Adirne Age carcinuma Total 46 Under 40-49 Hy 50-59 | 60-69 ee ee ee ee 70 and over 19 14 ere 4 CASES Other Types af Carrinoma 472 oo , Tutat 518 2 25 56 62 194 213 154 : 46 wee 168 ee 50 CONTROLS . i : Tetni 518 ; 26 500 213 169 oe 51 ar li ; tit TABLE HI ; . SEX AND RACE DISTRIBUTION OF _ LUNG CANCER PATIENTS AND CONTROLS 7 - oo _ . Sex and Race Adonis enreitionta CASES Other Tynes of Carcinoma ~ Total CONTROLS : = : Total : - oe Total Total Male - White Lo | Negro Other 46 - 42 41 rs we 1 472 451 4220 .- 20 11 518 518 er 493 493 ta 461 i . com oe 20 20 12 12 Total Female 4 21 25 25 : White 8 15 18 18 Negro ~ Other I _- 3 1 4. i - - woot V~ XXVIII BRONCHIOGENIC NEOPLASMS 128 TABLE HII , AMOUNT OF CIGARETTE SMOKING DURING TWENTY YEARS PRIOR TOSTUDY REPORTED BY LUNG CANCER PATIENTS AND CONTROLS_ CASES CONTROLS Packnges Cigarettes Total Nummer Per Cent . Number 518 100 Per l'at 3410 None 7 124 24 a a oa a ~ 19 oo 71 | 304 ,, 50 30 : , a 305 20 199 more 1 a ee recorded 10 18 et emr a TABLE IN T (egt ar AGE OF BEGINNING CIGARETTE SMOKING SMOKING HABITS AND CIGARETTE COUGH en REPORTED BY LUNG CANCER PATIENTS AND CONTROLS CASES CONTROLS ; coe Cigarette Smoking Smoking Cigarette Smoking Characteristics oe Nuniber Per Cent ... Cigarette Smukera ~ Per Cent Batsont fl ~ Numer Per l'ent Hasel un Cigarette Smokers 7 Per Cent Busest 1024 . Only Total Only Total Total 518 100 518 100 sw ~ 394 cigarette Total se smokers 484 100 93 100 76 10d 15-24 Began 15 yearsof age 166 34 32 116 2 (Daum Began 15-24 280 59 55 243 G2 47 Vevmdaesbie 25 years 7 ahi Began of age 32 G 35 9 7 heed 2tite.ts tM ie Inhale 449 87 327 83 63 93 tehe Smoke before breakfast 373 373 77 72 229 - 58 44 o Begeatle fem west beasts CigaretteCigarette rough 204 42 39 112 ' 28 22 ory Picepanti hdl Ser However it is not the sole cause Some persons with lungcancer deny YB) ever having smoked cigarettes Levin estimates on the basis of our data .- that 70 per cent of all lung cancer may be attributable to smoking tenn rete o m Application of the same method of estimation to other data gives a range of 56 to 92 per cent attributable to smoking ere u In the present and justified concern about cigarette smoking as a cause nam of lung cancer too little note has been taken of evidence that several occu- 10m pations may likewise be involved in the etiology of the disease Unlike ; the infectious diseases where specific organisms have been identified . Tas as the cause sine qua non cancer appears to result from a variety of rary . exogenous agents ew The classical studies of the and Joachimsthal miners do not Schneeberg stand alone Machle and Gregorious found that those employed in eer- were?" ~ Sebati"!bes Duarhialke Fat 4 i - a ae ms <4 are e xb t ' "* . Cre >. eel or es ., , + mt were ot sub. ie eet .. seme BER EAs gS Pe tee eee np teghee bs ft, ry =, eM Abs od 4 Ree ee 4 SFa3 or Cada eumfai P32 ry aes le se he ya 3 a oe | ee mn Ae,pares VE 4 : a 8 < Ea N4e og e rene teat sry oo te ome me Lele e at -e? te egad * Wet a o- le en a. Via ide - .. ; be peg ot - ee ieVaitgs eowm, elie Peg yoray+) Tw 4 2 - ie soe eye . he yey a4.veeasy - a ~ Bn ee 0ae2?va a yt ay + + E my E * 1+ a at . nr aeOA pel shag rye + 1p 4 oi vei Pee ter xf ng 4s! we iF we Gg Lg * ve w=, 7 Rope5 o@ . ee oa a, Fy I rs . -* Ae Bote.ae nag af @ ~ so = fy adte ie ee nn rs ed ete ee mee eee me ee eo. ae TAT anO ... 424 LESTER BRESLOW October 1 tain chromate ore operations in the United States experienced 16 tim re greater mortality for lung same age distribution cancer than did the general population of Kennaway and Kennaway using death c . tificate data for England and Wales noted that metal grinders worke 7 exposed to road dust coal gas and tar asbestos workers cabinet make -_- and painters were reported as occupations more frequently among lui _cancer_patients _cancer_tphantiweonutlsd be expected from the general mortality TABLE V we : ESTIMATED PREVALENCE RATES OF LUNG CANCER PER 100,000 MALE OF SELECTED AGES AND VARIOUS CIGARETTE SMOKING HISTORIES : ESTIMATED PREVALENCE RATES QUANTITY NUMBER SMOKED DAILY me ma 1.une l'Auerr Covent toed Heavye All Quantities None Ly : RELATIVF PREVALENC | to it i! : Patients aged 50 to 59 years Doll and Hilf Wynder and Grabham Sadowsky Gilliam . and Cornfield Breslow Honglin Rasmussen and Abrams Roswell Park Memorial Institute Patients aged 60 and 69 years Doll and Hill Wynder and Graham Sadowsky Gilliam and Cornfield . Breslow Hoaglin Rasmussen and Abrams * Roswell Park Memorial Institute 276 258 198 213 1781 197 187 76 168 197 275 210 208 213 657 60 71 169 675 94 25 - 515 137 25 515 . RT 44 12 -- , 102 : $ 7 17 141 1099 15 5 187 138 44 433 479 8 70 71 280 " 5 a) . 4 H) 17 25 50 9 11 11 s j 4 : c : rae } F : 15 4 i | 5 Estimated according to the method of Cornfield All data appearing in this table except for Roswell Park Memorial Institute figures Breslow are taken from the paper by Breslow Breslow et al Quantity smoked daily except for the present study pressed as cigarettes with pipes and eigars converted rettes as follows is all forms of smoking exi to their equivalents in eiga i Doll and Hill ounce tobarco = 4 cigarettes a day Wynder and Graham eigar = 5 cigarettes 1 pipeful = Sadowsky Gilliam and Cornfield cigar = 20 cigarettes 10 cigarettes 21 cigarettes 1 ounce pipe tobacci For the Breslow et al study quantity smoked daily includes only cigarette smoking Relative prevalence are the following ratios heavy z rate among heavy smokers date among smokers all quantities = rate among smokers among non smokers : Heavy smoking is defined as the following number of cigarettes or equivalents of cigarettes per day Bull and Hill 50 or more Wynder and Graham 35 or more Sadowsky Gilliam and Cornfield or more Breslow et al 40 or more presci study 20 or more Source Levin M. L. Etiology of Lung Cancer Med 54 p 770 Mar. 15 1954 Present Status New York State J ae : Vol XXVII BRONCHIOGENICI NEOPLASMS 425 perience Information obtained by interview with hospitalized patients in St. Louis and elsewhere in the United States studied by Wynder and Graham disclosed that painters and hot metal workers stood out as excessive among lung cancer patients as compared with a control group f Mortality experience among industrial policy holders in the Metropolitan Life Insuraner Company indicated according to Lew several occupa- a tions with a higher than average rate from cancer of the lung Table VI TABLE VIT MORTALITY EXPERIENCE AMONG WHITE MALE WAGE EARNERS EARNERS INSURED UNDER INDUSTRIAL POLICIES IN THE METROPOLITAN LIFE INSURANCE COMPANY 1987-1989 OCCUPATIONS WITH PROBABLY AVERAGE DEATH RATES FROM CANCER OF THE LUNGS Deaths From Cancer of lunes Veruputional Group Deaths From All Catron All Wage Earners Blacksmiths - Brick and Stone Masons 112,991 50 : Donths From All Furitia of L'atwer ; Number . 13,858 75 4 1,682 11 124 18 Percentage Relative to Deuths From All Causes Relative in Deaths Frotu All Formis of Vanevr 1.5 2.2 12.1 14.7 2.5 14.5 Hotel and Restaurants Coppersmiths Tinsmiths Etc. Not Roofer-Rofer- Engravers Metal and Photoengravels Laundry Workers Except Laborers Mail Carriers Miners Underground excluding Coal Miners Painters and Varnishers House Shop ele Plasterers Plumbers Steamfitters and Gasfitters Roofers and Slaters Slaughter and PackingHouse Operatives * Street Cleaners | Tannery Operatives Tailors and Other Clothing Workers Traveling Salesman Welders 345 402 81 81 zee 242 . 222, 2,821 190 1,178 *** 279 aa 227 1,564 1,564 7 74 216 48 61 61 " " 57 57 20 : " g 5 5 7 6 866 31 62 5 156 oy - 20 5 41 64 , . ; q # 5 . 228 52 446 52 24 t , 2.3 . fl fl 16.7 14.8 , 6.0 33.3 2.3 2.9 18.5 17.1 2.7 30.0 --2.6 16.9 JG.1 2.5 -4 18.6 16.1 2.5 2.7 22 17.1 14.1 15.2 2.4 2.7 3.2 16.2 21.7 29.2 In these occupations the mortality from all forms of cancer was somewhat higher than average as follows Brick and Stone Masons 1551 of average Cooks and Restaurant 119 of average Coppersmiths Tinsmiths Not Roofers 1237 of average Plumbers Steam Fitters and Gas Fitters 110 of average Roofers and Slaters 112 of average Welders 126 of average Lew E. A. Use of Life Insurance Company Records for Cancer Studies Arch of Ind Hyg and Occup Med 199-203 Mar. 1952 ry oesoeieiol 7 eo? a We os Fw a ary She eekMefae a +4 Gagegel ifu. e - . , waeogee + pean ge oe wv Mee . 7 we oe ee ewanen aneyes 0 , ee .s. +8 IS oe, pe TOwe te eRe LaTee 2 lanes ataeieiat + nateaan a. 7. oe he . cg i Aah Wiens ene Por : ra rti MAREE - ho revtye We ys eenal Oo ay ~~ Po HED beFa : ohare Le Pe me o- arse} boahe 1 & aw+s late ts ce weern ows gare ot ws e Pt Gey 4 ed ry a oie bang vere EVPeWS at or +g - NEAnePree agpty % ' oe behts ign . re eer gdp eT t Ln @ <a, ee mE atef we wig, ; te aw OREadWe . lpe te om '. wwPps D owa? om a Oe eurGNA < te wr Tau. muh +A 4e 84. * > ee Fe . + v wiv! Me a<ottao.tes siee psDk etare Syne OSOT mt eATES Agr ae Fe ANE rr @ Op , S8 . ae gem a. ide Me * at a & iow 07 wee 2 EOS igsae esr ie ad s ry - 8 4 ay : 43&. \ Wy ae a oat - Fs F ft. 6. . Al Ls 9g! ^' v : e aes We arige 426 . LESTER BRESLOW Detola 1958 TABLE VI CASES AND CONTROLS EMPLOYED FOR AT LEAST SELECTED OCCUPATION GROUPS --- - ar ^' r. gE? | _-_ e _ Re PERSONS EMPLOYED IN OCCUPATION AT LEAST . 5 YEARS Occupation . Lam Controls _ REE me sheet } Welders and metal workers doing welding 14 2 ny . - 7 ; - Ey 2 Steamfitters boilermakers asbestos workers 10 y BRT ee i 4. Occupations in the extraction of lead zine and copper ore . e 3 me , 5 Marine engineers fireman nilers and wip~ ers oe 12 6 SE 7 or e G Construction and maintenance painters oy ~~ oo 12 oo ~~ . 7 Cooks commercial excluding cannery rooks 35 21 STE Occupation groups based on regrouping according to common occupational exposures after detailed examination of records shows these occupations Hueper,,mentions several exposures suspected of being involved in lung cancer Interviews with lung cancer patients and a control series in our study included long occupational histories taken by persons skilled in occupa- tional analysis Information about every occupation in which the person had engaged was so detailed that the session often lasted two hours or more It covered an exact description of the work the industry the dura- tion of employment known exposures to toxic materials and other factors Interviewer bias as to the occupational data can be practically ruled out inasmuch as both lung cancer patients and the controis mentioned hundreds of occupations none which was suspected by the interviewers Although the information included type of industry and exposure to known toxic agents efforts to analyze these were not productive There- fore major emphasis in the analysis went to occupation itself ended ac- cording to the United States Dictionary of Occupational Titles Second Edition Washington D. .: U. S. Employment Service 1949. This lists cmgwares 367 categories Table VII presents a list of apparently significant occupations based upon our study This tabulation was developed by first observing the rela live frequency of occupations in which individuals of the case and control series had spent at least five years This gave leads for further study Thereafter since the code used was not designed to reflect common occu- pational exposures analysis was carried to the examination of records of individual cases and controls Regrouping of occupations based upon common exposures resulted in Table VII It appears that exposure to metallic particles or fumes asbestos paint and other materials appear to play some role Similarity of this list to other studies particularly that & seg of Lewis is immediately apparent . Comparability of the findings in four studies is shown in Table VIII These separate investigations extending over a year period and two etal cat on ah te Yul XXVIII BRONCHIOGENIC NEOPLASMS 127 countries utilized general mortality statistics life insurance interviews with hospitalized patients The fact insurance statistics and that such varied data analyzed in different ways consistently identify certain their probable significance in the occupations occupations attests occupations listed development of lung cancer Besides the repeatedlyrepeatedly in Table fitting painting metal worksteam welding and other and other asbestos additional types of work are mentioned frequently in the findings of studies of aspects of lung cancer These include furnace occupational exposed to petroleum and men engineers workers petroleum combustion carpenters cabinet makers and wood workers generally Thus several types types of employment may constitute lung cancer The most clear evidence pertains etiologic factors in ndage Joachimsthal mines and to chromate to the Schneeberg and ete in fact one ore operations in the United States Pee can hardly doubt the causative role of work ay groups Other studies including our exposure in these ph pations shown in Table VIII own strongly implicate the occu- giah. painting welding and other work involving hot metals commercial cooking metal why asbestos mining steam fitting and other work iy We are now engaged in another type type of investigation firm or refute the hypothesis that these designed to con- sive risk for lung This these latter occupations carry an exces- cancer involves obtaining information about ployment from persons engaged in suspect occupations It will em- cigarette smoking history as well as details about include tion of employment in it Such type of work and dura- information is being assembled for for mately 10,000 persons in the approxi- the age range 35-64 now employed in each of suspect occupations listed in Table VII will observe the mortality experience of thDeusering the next few years we groups through checking etr TABLE VII ve: CORRESPONDENCE OF FOUR STUDIES IMPLICATING . we SELECTED OCCUPATIONS IN LUNG CANCER Oe Kennawng Wander Graham Lei? Wander Le ae Breslow et al OH Painters Painters pane . Painters and Construction and Fw varnishers- maintenance 1 house shop etc. painters wep Metal . grinders Welders foundry and steel Welders copper- Welders and sheet- workers and other smiths tin- metal workers doing ee smiths etc. hot metal workers blacksmiths welding Electrie bridge crane- age operators metal oe industry 1 Cooks Cooks commercial ee and restaurant excluding cannery fe cooks Asbestos workers Miners underground excluding miners Plumbers steam- . fitters and gasfitters Occupations in the extraction of lead zine and copper ore Steamfitters boilermakers as- bestos workers oes ae ser e t Ne fe * 1 / we ow am ye twe BOwe eo ate e e 8 ae ee - hts . t? " ONS CPPa . wm efi = to ~ MoSme.enen t% tay . erwmet a Pe. be hy Heeae Eg hy 7 cerigi Sus ey a Ou " * 2 Bfi reat Ca he So ws~ wee AF.~*~ ~- ~ sahWO oy g > ere kane s we wa Menewt se, Pun 1 ~ LESTER BRESLOW Detaker 1955 for with the vital statisticsstatistics index of the California State Department of Public Health for Thus the actual lung cancer mortality rates will be persons in occupations occupations identified by previous determined etiologic significance studies as possibly having - population Comparison of the state state of the rates rates with that of the general the degree of excessive excessive corrected age distribution risk if will indicate 7 ; Jung cancer mortality mortality any in occupational groups rate substantially substantially exceeds the rate for If their population one may conclude conclude that the general Thereafter it will be some occupational exposure is involved agent and undertake necessary to determine the precise environmental preventive measures As occupations are identified as causative factors factors in lung cancer we will be in a better position to establish establish control of this prevention but also by intensive disease not only by finding efforts in high risk groups SUMMARY a4 Lung cancer has increased increased cy * 7. letwae *7 og more than 18,000 strikingly in recent years it now causes deaths annually in the United States ia, e ot evidence incriminates cigarettecigarette Although much aor ean et it is not the sole cause Previosumsoking as a major factor in the disease dine occupational studies are cited to indicate the role Oe s > exposure Interviews with guter a like number of cancer patients in California hospitals and oe non cancer control patients masons frequency of cigarette cigarette smoking among lung confirmed the greater we views also covered lung cancer patients The inter- Sie S, nw, x disclosed that the long occupational occupational history Analysis of this data oe Bot Fg wow tially greater frequency occupational groups appeared with substan- oth) mm e r rar reat pared with the among the lung cancer cancer case histories as controls and sheet metal com- vie AONSe ing electric bridge cranecrane workers doing weld- Rae Pn maintenance painters operators metal industry construction and ey ar Me lead zinc and commercial cooks occupations occupations in the extraction of ad bie se biteay vaPo) nom wl * marine copper ore steamfitters boilermakers asbestos engineers ; firemen oilers and wipers workers woe wh: tae, es . . .- list of occupationsoccupations with those The correspondence of this piesNC+O ane Fe factors in lung cancer cancer is demonsatrirsaitnegd from other studies of occupational sent * eslads Further work is underway underway to confirm Bae Rt th oy occupations or refute the hypothesis that these me . carry an excessive excessive risk for lung cancer wa.mag ok ' ~ RESUMEN pe e sIh, . tf epies te OA Aa El c^ncerdel pulm^nha ahora aumentado notablemente notablemente en los a^-os causa m^sde 18.000 defunciones al a^-olos recientes Aunque existen evidencias evidencias de Estados Unidos sabilidad en la que el fumar fumar cigarrillos tiene gran enfermedad enfermedad no es la ^"nica respon- Existen trabajos anteriores sempe^-a la exposici^n ocupacional que se citan indicando indicando el papel que de- Las entrevistas llevadasllevadas cabo con 518 en los hospitales de California y con un control no cancerosos confirm^la grangran enfermos enfermos de c^ncerdel pulm^n igual de enfermos de frecuencia del c^ncerentre los VOT Ub ew ote VLL XXVHE BRONCH NEOPLASMS 429 fumadores de cigarrillos Las entrevistas incluyeron tambi^'nlas historias ocupacionales de toda la vida El an^lisisde estos datos descubri^que los siguientes grupos de ocupaciones mostraron demodo substancial mayor frecuencia entre las historias de c^ncer del pulm^n en comparaci^n con los controles trabajadores en soldadura enl^mina operadoresde gr^"asel^'ctricas en los puentes industria de metales pintores de construcciones y de mantenimiento cocineros comerciales trabajados en la extracci^n de plomo zine y cobre de los minerales trabajadores ^'n m^quinas de vapor constructores de calderas trabajadores de asbestos maquinistas marinos bomberos engrasadores y limpiadores La correspondencia de esta lista de ocupaciones con las que resultan de otros estudios de factores de ocupaci^nse demuestra Est^en preparaci^nm^s investgaci^n para confirmar o refutar la hip^tesis de que estas ocupa- ciones tienen consigo un riesgo mayor conrespecto al c^ncer RESUME La fr^'quencedu cancer pulmonaire s'est accrue de fa^onfrappante ces derni^res ann^'es Il cause maintenant plus de 18.000 d^'c^spar an aux Etats Bien que de toute ^'videnceon puisse incriminer la fum^'e des cigarettes comme facteur principal de cette affection ce n'est pas l^ la cause unique L'auteur cite les ^'tudesant^'rieures qui ont montr^'le r^le jou^' par certains risques professionnels L'interrogatoire de 518 malades des h^pitaux de Californie atteints de cancer pulmonaire et d'un nombre semblable de malades t^'moins non canc^'reux confirme la plus grande fr^'quence des fumeurs chez les premiers L'interrogatoire porta aussi sur les ant^'c^'dentsprofessionnels de toute leur existence L'analyse de ces donn^'esa d^'montr^q'ue comparativement au groupe t^'moin les professions suivantes figurent avec une fr^'- quence notablement plus grande dans les cas de cancers soudeurs et ouvriers lamineurs travaillant dans la soudure conducteurs de grue ouvriers de l'industrie m^'tallurgique peintres en b^timents cuisiniers travailleurs s'occupant de l'extraction du plomb du zine ou des minerais cuivreux chaudronniers conducteurs de machines ^ vapeur ouvriers expos^'s ^ y'amiante m^'caniciens de la marine pompiers graisseurs et nettoyeurs Cette liste de professions est en accord avec celles qui ont ^'t^'^'tablies au cours d'autres ^'tudes des facteurs professionnels dans la fr^'quence du cancer . Des travaux ult^'rieurssont en cours pour confirmer ou infirmer Phypo- Phypo- th^seselon laquelle ces professions comportent un risque de cancer extr^"- mement important : , REFERENCES 1 Pott P Chirurgical Observations London 1775. Pp 63-68 2 Rostoski O. Saupe E. and Selmorl G Die Bergkrankheit der Schneeberg im Sachsen Schneeberger Lungenkrebs Ztschr 360 1926 , Erzbergleute im f Krebsforsch 3 Pirchau A. and Sikl .; Cancer of the lung in the Miners of Juchymov Joachimsthalf Am I of Concer 681 1982 . 4 Vital Statisties of the United States 1950. U. S. Department of Health Education and Welfare Puldic Health Service National Office of Vital Statisties Vul p 63 7 al gs wate ln. are ao. eo dyar Hi OEY Tall ys 0. 8 Fol so -. 7 e, pede mek. ting be. owte ot Fate wen 4deen w we we ee, Ow ery ft - os am, bigey AS<2. - oe wnat ea + we Re ee me 1. ey Pe * ee what yah PRP1%, + ey sore heat of aS gefe op wreeee eo ae . a eaetyena? . w e amt, Wee A renin 7, a , > | mara oe.be at Se a5be. ae, ARe, tel fale . . Sten mY eyoge re . : e e] ih ig: re5 f4 MEt.- ays pei 4 iadit . iy a t 2. 4, yo. -e a: al te 4 eistnf er ". ni f. wer: ie ee BAR adel ee . Ln 4 y * -_, x] geste Pathk, 2 er ta tee ag Tet tres bee AAT 430 LESTER BRESLOW , October 1975 | -Vital Statisties of theUnited States 1930.- U S DepartmenotfCommerce Bureau of the Census 1930 Mortality Data p 100 6 Wynder E. L. and Graham E A Tobacco Smoking Possible Etiologic Factor in Bronchiogenic Carcinoma A Study of 664 Proved Cases J.A.M.A. 143 1950. Doll R. and Hill A. B A Study of the Aetiology of Carcinoma of the Lung Brit M. J. 1271 1952. Levin M. L. Goldstein H. and Gerhardt P. .: Cancer and Tobacco Smoking A Preliminary Report J.A.M.A. 336 1950 7 Breslow L. Hoaglin L. Rasmussen G. and Abrams H Occupations and Cigarette Smoking as Factors in Lung Cancer AJ.P.J. AJ.P.J. 171 1954 8 Levin M. .: Etiology of Lung Cancer Present Status New York State J. of | Med 54 770 1954 : 9 Cornfield .; A Method of Estimating Comparative Rates from Clinical Data Application to Cancer of the Lung Breast and Cervix J. Nat Cancer Inst , 1209 1951 . 10 Editorial Cancer of the Lang New England J. Med 249 1953 ; 11 Levin M. L The Occurrence of Lung Cancer in Man Acta International Union | Against Cancer V. IX No. 3 1953 . ' 12 Machle W. and Gregorious .: Cancer of the Respiratory System in the United States producing Industry Pub Health Rep 1134 1948 13 Kennaway N. M and Kennaway E. .: Study of Incidence of Cancer of Lung and Larynx J. Hyg 236 1986. Idem A Further Study of the Incidence of Cancer of the Lung and Larynx Brit J. Cancer 260 1947 14 Wynder E. L. and Graham E. A Etiologic Factors in Bronchiogenic Carcinoma with Special Reference to Industrial Exposures Report of 857 Proved Cases , Arch Indust Hyg & Occup Med 221 1951 15 Lew E. A Use of Life Insurance Company Records for Cancer Studies Arch . of Ind Hyg and Occup Med 199 1952 16 Hueper W. .: Occupational Tumors and Allied Diseases Springfield M awe Charles C Thomas 1942 on te EE tig OW pe: er; Trt tere a ergy