Document a8OdzmMO17DpX55zn47N07Jb

FILE NAME: Oil Industry and American Petroleum Institute (API) DATE: 1948 DOC#: API065 DOCUMENT DESCRIPTION: NY State Dept of Health Report - Occupational Cancer f API 07944 t j > Iliirfi rtfV n fc iri^ iirrte ft* lHirn Early recognition of the possible occupational will: etiology of cancer H give us information as to type of work the patient must avoid in the future. H provide a basis for prognosis. | make available, under State Compensation Laws, financial assistance to the patient and his family. H establish statistical data as to incidence, distribution, and causative agents,--information now practically non-existent. C opyright 1949. New York S tate D epartm en t o f H ealth > API 07945 I I I o m m i D U l , CANCER c/u t/ie n ^ e fo A e fiA y & lc la n Jr-'Si Sponsored by: Medical Society of the State of New York New York Stale Department of Health New York State Department of Labor Published by Office of Public Health Education, Neu York State Department of Health [ API 07946 V '~ > \ I 1 iseases we have a fertile held to which the ^tribution in the course of his regular work, not be developed in a research laboratory or in a university. It must come from the physicians who actually see cancer cases or cases of suspected cancer, either in their own private offices, in cancer-screening clinics, or in the hospital. It is thus a research problem of extraordinary importance prac tically made to order for the busy practitioner who is willing to devote the few extra minutes necessary to take a careful occupational history on his cancer patients; and report, for further investigation, cases suspected of having been exposed to carcinogenic agents in industry. To assist the practicing physician in this matter, the New York State Occupational Cancer Committee has prepared this leaflet The table provides a few useful clues, including a list of the chemical substances and physical agents found in industry, which are, at the present time, suspected of having carcinogenic properties, and the types of > A P I 0 7 9 4 7 J cancer believed to be caused by them. Further study will, no doubt, add others to this list; some now on the list may very well be dropped as new data become available. The table of precancerous lesions together with the occupational carcinogens with which experience has associated them, is in the nature of a tentative check-list on the basis of present information. A copy of the form used by physicians in New York State, exclusive of New York Qty, for reporting cancer cases is also included. If called upon by any physician interested in cooperating in this program, the New York State Occupational Cancer Committee is prepared to follow any suspected case of occupational cancer in New York State into the workroom where it is believed that it had originated, and to make all necessary technical investigations of the en vironmental factors which might have been responsible. Such investigations will include chemical analysis of materials, radiation measurements, chemical analysis of air con taminants in the form of dusts, gases, fumes, dust counts, or any other techniques as indicated. In thus tracing back the occupational exposures of cancer patients, it is hoped that occupational factors not now suspected of causing cancer will thereby be brought to light. In New York State, the professional staff of the Division of Industrial Hygiene and Safety Standards may be called upon at all times for consultation and study of these problems in particular plants; the scientific evaluation of any health hazards which may be present, and practical assistance with control measures. All such requests should be addressed to Dr. Leonard Greenburg, Director, Division of Industrial Hygiene and Safety Standards, New York State Department of Labor, 80 Centre Street, New York 13, N. Y. I API 07949  r ''v -**:y- . . The New York State Occupational Cancer Committee an unofficial agencjr with the following membership: i May B. Mayen, M IL, New York State Dn e t f a t of Labor, Chairman ; Austin V. Deibert, M IL, U.S. Public Health S a rtia Konrad Dobriner, MDn Sloan-Kcttcring lim itate, New York Qty t Harold F. Dora, PhJX, US. Pablic Health Sw iiw . C. H. Gchruisnn, M.D., Mannisctnring Chenisti Association ' Paal R. Gerhardt, MJX, New York Stale DapartaMnt of Health : Hyman Goldstein, F k D , New York State Department ef Health Leonard Greenburg, MIL, New York State Department of Labor Arthnr E. Hoag, M IL, Meatbor, Alaericen Petroleum InsHtntc Leroy S. Home, MIL, Tnmor Clinic Aneciatinn of the State of New York W. C Hneper, MD-, U.S. Public Health Service Louis C Kresa, M.D-, Roswell Park Manorial Institute, Badalo. N.Y. Anthony J. L ana, MJD., BeUerne Medical Center, New York City Morton L Levin, M J)., New York State Department of Health George T. Pack, MD_, Medical Society of the State of New York For further information with reference to this program, please communicate with: _ May R. Mayen, MD. Diriaioe of Indnttrial Hygiene and Safety Standards New York State Department of Labor 80 Centre Street New York 13, New York Telephone : CO 7-9600, Ext. 685 API 07950 TJLhe medical profession is well aware of the extent to which lack of knowledge of the basic causes of cancer is responsible for the unsatisfactory state of our prophylactic and therapeutic approach to this problem. We do know that a causa] relationship has been defi nitely established between cancer and exposure to certain chemical and physical agents in industry. Thus, exposure of the kin to certain types of oil, tar or pitch are known to cause skin cancer. On the other hand, epitheliomata of the bladder are definitely known to result from exposure to certain of the intermediates in the manufacture of aniline dyes, such as beta naphthylamine. This small group of cancer cases for which an occupational etiology has been established thus offers a rather unique point of departure for the further study of this baffling disease. Too little attention has, however, been paid to these occupational cancers; too little is known of the environmental factors responsible for their production. An appreciable number of such cases have, no doubt, gone unrecognized as to occupational etiology. This is true not only of occupational cancer, but of many Other occupational diseases nwell. It is a common fallacy to believe that occupational diseases have certain clinical ear marks which immediately suggest an occupational etiology, or even a specific occupational exposure; or that they present medical syndromes so distinctive as to clcarh differentiate them from non-occupalional diseases. This may occur, but it is relatively rare. ^ hether one is dealing with cancer or with other systemic diseases, such as hepatitis, nephrosis or aplastic f> API 07951 I anemia, resulting from exposure to toxic agents in industry, as clinical diseases entities, they provide no specific clues as to edclogy. In many cases, the occupational etiology is unsuspected. In order to acquire new data as to the environmental factors--suspected as well as unsus pected--which are responsible for cancer cases, it is necessary to know precisely what the patient's occupational exposure was; what chemical substances he came in contact with; what other environmental factors were present in the workroom. Since cancer will usually develop only after a great many years of exposure, and even many years after exposure to an occupa tional carcinogen had ceased, the occupational history of the patient must be carefully studied all the way back to his first job. This is difficult. But it will be rewarding. At any rate, it is the only way to get the necessary data. Frequently, however, the patient will not know or remember the precise chemical substances, for example, with which be worked. Or he may forget to mention the only exposure which happens to be significant in his case. The names and addresses of the plants where the patient had worked are more readily obtained. This information alone can be a useful guide for a technical investigation of the patient's occupa tional exposure over the years. The importance of the occupational history form thus cannot be overemphasized, since a complete occupational history is indispensable to developing any useful data with refer ence to occupational cancer. History taking, whether it is the clinical history or an occupa tional history, is very time-consuming. The occupational history, however, is less familiar to the medical practitioner and so it always seems to present the greater hurdle. For that reason, the suggested Occupational History Form has been made as simple as possible. No matter how carefully and intelligently the case has been worked up, or how accurate 7 API 07952 1 i. the diagnosis, the possibility of an occupational etiology must not be overlooked. Recog nition of an occupational etiology, where it exists, will provide invaluable information as to the type of work the patient must avoid in the future; it will provide a basis for prognosis; and it will make possible assistance to the patient and his family under the Compensation Laws of the State in which he lives, providing them with much-needed fi nancial assistance during a period of disability. Recognition of the occupational etiology of cancer cases, where it exists, will provide statistical data as to incidence, distribution, causative agents, etc., now practically non-existent. Very few people realize how little reliable information there is, at the present time, as to the incidence of any of the occupational diseases. Occupational cancers, as a rule, result from prolonged exposure to physical or chemical carcinogenic agents in the working environment. Such exposures may be continuous or inter mittent over a period of many years. There may be a long latent period before the first evi dences of cancer begin to manifest themselves. During all or part of this period, there may be no contact whatever with the carcinogenic agent originally responsible for the cancer. In the case of radium, for example, this latent period may be as long as 20-30 years. Individual susceptibility probably plays an important role here as in all other diseases, occupational or non-occupational. No doubt, when more is known about the many metabolic and bio-chemical factors involved in cancer formation generally, it will be found that some of these same factors are operative in cases of occupational cancer. It is a matter of great practical importance, for the present purpose, that the industrial environment is essentially a man-made artificial one peculiarly susceptible of scientific ineas- 8 i I API 07953 urement fend medical evaluation from the standpoint of hazards to health --including the production of occupational cancer as well as other occupational diseases. Of equal importance is the fact that these environmental factors in industry responsible for injury to health, once recognized, can be successfully controlled. Fortunately, the techniques for the control of the industrial environment and the prevention of occupational are highly developed at the present time. As a guide to the physician who, for purposes of prevention* is interested in investigating the role of occupation in cancerous or pre-cancerous lesions presented by his patients, Tables 1 and II are appended; also a selected bibliography of literature having a direct bearing on these problems. Table I presents a description of selected lesions which have been found, as a result of experience, to be associated with agents in the occupational environment which are known to be carcinogenic. Table II lists, alphabetically, for reference purposes, some of the more common substances or conditions in the occupational environment which are recognized as being cancer-producing or suspect. With each such agent the organ or system usually involved, is presented together with a classification in the right-hand columns, indicating whether the etiological relationship is doubtful (Class D) or established (Class E). The New York State Occupational Cancer Committee would greatly appreciate the cooperation of practicing physicians in reporting any information they develop as to the possible relation of occupation to the pathological lesions, malignant or benign, which they find in their patients. i 9 API 07954 ) TABLE I Description of Selected Lesions which may be Associated with Occupational Cancer Producing Agents Lsuon DascairnoM SKIN Alopecia Spotty loss of hair. Atrophy Skin grossly thinned and glistening in patches, associated with keratotic areas. EnoLotgic Aosnt i* Arsenic, radio-active substances, radiation. Pitch, tar, asphalt, ra dio-active substances, radiation (including ul- ~ traviolet raye). s FfMmi . - . 10 Dry seborrheic patches ob skin. . . - Arsenic, usphah, pitch, aoot, tar.- . API 07955 fK eratosis t ! t \ Hyperkeratosis - t, ; 'F lat, discrete, scaly area on akin with raised pearly borders. Usually on parts of sldn exposed to narciiio- ' - geo, h o t may as u it fe ^aampemd parts, particularlyjjsbou ' sweat : , glands, . . - >'.S o ag k , -f im a d km atedc plagues srith sm all, hard, vait-& ke b m , nsoally on bands en d so b s.`May beoome nodular and ulcerate. ; Verrucae Form of hyperkeratosis. U lceration Leukoderma Breakdown of kerstotic lesions. Absent pigmentation alone. Leuko-melanoderata Patchy increased and absent pig mentation of skin. Most common in areas of highest pigmentation, and may involve oral mucosa. Melanoderma Increased pigmentation alone. finOLOMC Ammt Anthracene, arsenic, asphalt creosote, crude m ineral oil, crude paraffin, pitch, sodium nitrate, soot, tar, ra dio-active substances, radiation (including ultraviolet rays). Anthracene, arsenic, asphalt creosote, crude m ineral oil, crude paraffin, pitch, tar, ra dio-active substances, radiation (including ultraviolet rays'). 11 API 07956 Lw on Scleroderma Discs imow Dry, scaly, parchment-like kin, with enlarged pores, associated with leukomelanoderma. Enoioaic Aesm Crude mineral oil, crude parafin, radio active substances, radi ation. NASAL PASSAGES Papillom aa Polyp* Perforation Ulceration . Develop in antrum ethmoid cells, and turbinates. Nasal septum. Nasal mucosa. Nickel carbony^ Chrome salts. | Chrome salts. * BLADDER . . ti. v _. Hemorrhage, -y^- Varying aise with telangiectasis. ubmucoaal . *>: mainly in trigone and '...,'-w 9- . .about ureteral orifices. * ' - Papilla nas ' 12 ^ M jp o a n sillons, pedunculated _t.'aeaslla, often multiple about trigone and urtral orifices f Aniline, bemddine, beta naphthylamine and de rivatives. .?*. * ) API 07957 Bone LUNGS Enotooie A w n Arsenic, asphalt, creo sota, erode mineral oil, pitch, tar, radia tion (including ultra violet rays). cytopanic,puipgra wiih spleen not marinadlyanlaTged.- - . - . Peri-osteitie.-- - - No precanoeroos lesions observed. Bemol and deriva tives, radio-active sub stances, radiation. Chrome salts. 13 API 07958 ) > M i l 5s r i vo W ) Su(STANCES OE CONDITIONS O r san or Ststim Aniline and derivative)......... Anthracene, crude................. Aromatic organic chemicals.. Arsenic .................................. Asbestos ............................... Asphalt, artificial ................. Benzidine and derivatives..... Benzol .................................... Benzol derivatives ............... Burns, thermic ..................... Chlorinated hydrocarbons .... Chromates ............................. Coal ........................................ Creosote ............................... E strogen- ................. Frostbite .................... Iron Inst .................... Irritatio n, chronic .... Bladder, ureter, kidney. Skin ............................... Liver ............................. Skin ............................... Liver ............................. Respiratory system ...... Eyelids ......................... Respiratory system ...... Skin .....'.......................... Eye ............................... Bladder, ureter, kidney. Blood forming organs... Blood forming organs... Skin ............................... Liver ............................. Respiratory system...... Skin ............................... Skin ............................... t ip ................................. Eye ............................... Breast (male) .............. Skin ............................... Lung ............................. Skin ............................... C lass 1C lass D* * Ef n ! F. n : ! F. I) I) F L) E E D E I) E I) E I) E F F I) I) I) I) Mineral oil. midp Naphthylamine--alpha Naphthylamine--beta . Nickrl carlmnyl ........ Paraffin, crude............. Piloti ........................... Uodiant heal ................ Radio active substances. Roentgen rays Shale oil .................... Sodium nitrate, crude. Soot ............................. Spindle oils, aromatic. Tar ............................ Trauma, chemical Trauma, physical Ultraviolet rays *D-Reported cases--etiology still i t E-Established etiology. ) Skin and lip................................. I-'P ................................................... Respiratory system..................... Eye .......................... ................... Bladder, ureter, kidney............... Bladder, ureter, kidney............... Respiratory tract ....................... Skin .............................................. Skin .............................................. 'P ..................................................... Bladder ....................................... Eye .............................................. Skin .............................................. Skin ............................ ]................ Lungs ............ ............................. Blood forming organs................. Bone ............................................ Skin .............................................. Blood forming organs................. Subepithelial connective tissues.. Eye .............................................. Skin ............................................. Skin ..... Skin ..... Bladder Skin ..... Lip ............................. Skin ............................. Respiratory system..... Bladder ....................... Blood forming organs.. Eye ............................. Skin ............................. Skin ................................. Blood forming organs..... Mesenchymatous tissues Eye ................................. Skin ................. ................ Eye ................................. rtul'lfttl. *1 \ Name of Clinic or Hospital:................................................. Date:........ A d d re s s :................................................................................................. Name of Patient:................................................................M............ F. Address: Diagnosis:....................... Age at Commencing Work:........Present Age:........ N a m i or Plant (List in chronological order) A oorrsi P roduct M anuracturrd Prrcur J o i Th r u Timi Emhotid M onth -- Y iar From To Present occupation Each preceding occupation API 07961 4 ) r - 04ECK4JST OF EXPOSURE - . . k.- . . - .. SuiS T A N C tl iN D U iT Ilit OCCUPATIONS Yiam IN EACH Indicate on previous page the plant involved in each significant exposure listed here 17 API 07962 ) ) k A. API 07963 N A M I 0 9 fA IM . lA ftO C A TO tY t ____ iris U LJ f1----11 Q SVAOB o r D lttA B B Whan First Dlapwassd Bv Fhvdctan tsa ad ln ai Nawi _____________ ______ _____ METASTATIC SITti A vanad i --j la c a l Raplana! N sdss n Invalvad Distant Matastasls kaewrant M H I H P >Y| NasMtal BtRORTRD BYi RhysMan D A t l o r THIS BRORTt M tlM A N I. M IllC B O f. M.D. Canaatmtanar f M C C X )4MIMM(U4t) s a il II Maw Hasp* litad, Warna 1 Hasaltal ar InsttM laa Addrasiar Is itH v tlsM MAUONANT NEORUSM C O N f I M N t U i BIROBT N tw Y w t iN r tt D ^ irtww | t f Mm IA ~ BUKAU O r CANCII COHTIOt ri Rallant U Chach Kara )l yaa wish mar I Term and Pathological Diagnoses Included* Under "Cancer and Other Malignant Tumor* and Reportable In Accordance with $25-b. Public Health Law I C A K I N O M A SARCOMA AN O A N Y TERM O F W H ICH OMC ERITHCIIOMA O P THESE W ORD IS A PART. \ KNDOTHCUOMA fO IAN T C IL l TUMOR (Ian * NEUROCYTOMA ACANTHOMA HYRERNCRHROMA O IIO O O E N O R O O U O M A AtTtOCYTOM A HO O O KIN 'S DISEASE R IN E A IO M A SAIN TUMORS LEUKEMIA SYNCYTtOMA CHOMOMA IV M R H O M A S E M IN O M A CH iO R O M A LYMPHOSARCOMA symrathosustom a CHOLESTEATOMA IINITIS R U S T IC A (Slamach) SRONOIOBUSTOM A CMSRTOMA MELANOMA TERATOMA KKNOYMOMA M ENINGIOMA THYMOMA O AN O U O N fUROMA M TC IO M A RAO ET'S DISEASE (Braast) OUOMA M ID U U O B U STOMA W ILM S' TUMOR (Kldnay) O RANUIO SA C t ii TUMOR (O n rr) M ISOTHEUOMA E W IN O 'S TUMOR (Baaa) MIXED TUMOR O R A WITZ* TUMOR (Kldnay) " """ 1 1 , * T 1' 1 .......... Tills ltd It m l aa K aa H a a S a t w s f r i M H*a f ra at a s|arhy of tana* v tu a lly sssd. W H E N THERE IS DOUBT C O N C E R N IN G THE M A U O N A N T NATURE O f A TUMO R, IT SH O U LD RE RERORTCD. r t O ls s l C a ll Tamars a f Sana A ra Usaatty BanI f a, S a l M a y Bataw a M a lig na n t. Iaclamad far Spado l Stady. I BIBLIOGRAPHY GENERAL ARTICLES: H e im , W. C.: . O ccapar isnel 1942 Tum o r* and AIM D iaaam , C. C. Thomas, Spring* eld, Illinois, ; lu d n ttritl M s n peinent a s i O rre p sSi-- af C a a trr, J .A . M .A . 131:738. 1946. , S iamf r ame* a t latm cchai Camcar t> the Prablam af Camcar, Oecapational Med., j 2 :190, 1946. \ B u t w u , J . 1: S u rvey a t Compound* w hich hoar b a n f u M far carcinorm c a rtn -ily, Federal | S ecu rity Agency, U n ited S u te e P n b iu H ealth S en rict, 1941. SKIN: A : mmic M o n o o r a r , H .: A rch. Dermat and Syph. 3 2 :218, 1933. U o n r a o M B T , H . and W i i t a i n , M .: J . I n e a t. Dexm aL 4 :365, 1941. j. f e t r m i m , W . H . and W t u a a u t , L . F .: A rch. D e rssa t and Syph., 4 2 :640, 1940. ' Ta -- Pitch --Asphalt: H i i m , I.: J. Iadustr. H yg., 1 2 :169, 1930. W o a u m , W . H .: A rch . Pathol. 2:533 and 708, 1926. O ' D o no van, W . } . : B r i t J . Dennat. 32:215 and 245, 1920. A rch . D e n n a t and Syph.. 19:595, 1929. H aacanaan, C. D .: Am . J. Cancer, 15:641, 1931. Paraffins and M inssal O ils; W n m , P. R -: The Dermatergoaca. London, H . K . Lew is A Co.. 1928. ' B s o e a n a s s . E . M . and S ro rro a n , J . S .: B r i t Med. J.. 2 :993, 1927. H a n a r , S. A . and Ia vrn a , E . D .: J. H yg. 36 :310, 1936. H a n a e , S. A .: Am . J. Cancer. 3 1 :28, 1937. T w o , J. M . and L r r n , R . J .: H yg. 39 :161. 1939. ChlOSOTt AMD A mTHSACSNE O lL l O 'D o n o v a s, W . J.: A rch . Dermat. and Syph. 19:595. 1929 Soot: i H a n a r, S. A .: Am . J. Cancer, 3 1 :28, 1937. R a n n a w a r, E . L . : J. Industr. Hyg. 7 :69, 1925. Solas and U ltsaviolit Rats; P n i L t i n , C.: Texas S u te J. Med. 3 6 :613. 1941 B u m , H . F .: J. N a t Cancer Inst. 1:397, 1940 S u n O S , R. L . : J. Am . Med. Ass. 6 4 :403, 1915. R oentsem-Rats and Rats of Radioactive Suistances: Saunnaat, T. S. and M o n T c o n a ir , H .: J. Am. Med Ass. 110:23, 1938 H a za n , H . H .: J . Am . Med. Ass. 9 7 :1881. 1931. L a , C. G .: J . Am . Med As. 9 5 :286, 1930 19 API 07964 RESPIRATORY SYSTEM: UROGENIC SYSTEM: HEMATOPOIETIC SYSTEM: BONES: A sbestos: Lykcii, K. M .: J . Am. M ed. Ass. 109:1974. 1937. Am. J . C an cer .16:507. 1939 Nordwank, M.: Ztschr. f. Krcbsforscbg. 47:288, 1938. A rsenic: Goeckermanv, \V. H. and Wiliiei.m, L. F .: A rch. Itennat. and Syph., 42:<* Merewettnt, E. R. A.: Ann. Rep. Chief !nsjcctor of F actories for the Stationary Office, London, 38, 1944. C hromates: Gauss, H.: Angewandte Chcmic. 53:30?, 1940. ' KUn. W ocbcnschr. 15:323, 1936. Alwens, \\\, Bavke, E . C. and Jonas, W .: A rch. F. G ew erbepatb. 7:09, 193< N ickel C arbonyl: raiPCE, J. C. : Ann. Rep. C hief Insj-cetor of Factories of the V ear 1930 Office. London, 1936. Tar: Kawajiata, K.: Gann 32:367, 1938. Radioactive Substances: Sch n eebers: C obalt M ines ttosTusKi, 0 . and Savte, E .: A rch. f. G ew erbepath. 1:731. 1950. Lorenz, E .: J. N at. C ancer In st. 51:1, 1944. Radioactive Substances: J oachim sthal: U ranium M ines Pikciia.v, A ., and Sfckl, II, : Am. J . C ancer 16:682, 1932. A romatic A mines: llutrE, W, C .: A rch. P ath . 25:856. 1938. Gehmmakx, G. H.: J.A .M .A . 107:143o, 1936. Benzol: Erf, L. A. and Rhoads, C. P. : J. In d u str. H yg. 21:421, 1939. R oentgen-Rats and Radioactive Substances: Hensuaw, P. Hawkins. J . W., Meye. H. I... Woodruff, J . an J. National Cancer lnt. 4:339, 1944. Radioactive Substances: Martlam >. H. S. : An:. J. C ancer IS.2435, 1931. 20 7 2^-49-- API 07965