Document aJOyjoMgp4d21jMjrBQXEaJeB

A' SU**V | EXHBfK ]{ X/+/=?l August 23, 1957 Mr. Hugh M. Jackson, Manager Indus trial Health Program Johns-Manvilla Corporation 22 .East 4001 Street New York 16, New York Dear Hugh: . Thank you for your letter of August 19 regarding the Sep-* tamber meeting of the ATI. As a matter of fact, having completed tho literature search, it Is apparent to ua that tho possibility of an association between lung cancer and asbestos!* is much more likely to exist in asbestos factories than in mining operations. Tor example, of 99 cases which had bean re ported up to 1955, at loaat SO appear to have occurred la asbestos workers other than miners. A number woro women, end the occupations givon - wr: weaver, carder, mattress maker, lagger, bagger, pipe covsrer, spinner, etc, h , u Two specific articles which mention tho type of exposure and the job (s that by Doll (l)-and that by IssolbAcher, ejt,al.(2). Seventeen cases studied by Gloyna and 31 reported by Mor&y/ethor, as well as three mentioned by Harrison and ono each by Ccroton and Owen occurred in LngLand, If my information io correct, there is no mining of nsbostos in Lngland, and these must all have be<?n workers In textile or similar jobs. In this country, the ten cases reported were apparently all in textile workers. The first case, reported in 1935 by Lynch and Smith was a weaver in an asbestos factory for 21 years. Isoolbachnr1 s cases involved a contractor's helper engaged in cutting and sawing asbestos board and sorter in an asbestos mill. Mr, Hugh M. Jackson -2- August 23, 1957 The QAMA study is ia the final stages which are, of course, tha slowest. All of the statistical analysis has bean computed, and the report is 99% written. What remains ia mainly minor revisions, typing the manuscript and proofing. It should go to the print shfrp by the end of this month. I hope this supplies you with what you need for the meeting. U there ia anything further, please let me.know and I will try to get it to you in time. Sincerely yours, DCD:1a Enclosure Daniel C. Braun, M.D. Medical Director .Reference* 1, Doll, .R,i Mortality from Lung Cancer in Asbestos 'Workers. Brit. J. Indust. Mod. 12, 31-86, 1955, 2. iflsolbachor, K. J.; Klaus, H. ; and Hardy, H. L.i Asbostosis and Bronchogenic Carcinoma. Am. J, Med. 15, 721*732, Novembc 1953. 3* Doll, R.: Bronchial Carcinoma: Incidence and Aetiology {Mllroy Lectures, abridged) Bjrit. M. J,, ,521-527, Sept. 5, 1953; 585-590, Sept. 12, 1953. 4 i * ion NS - M AW I U. !: ( -Olil't)WATinN rvt ( v rv run ).a.-> mu. I'II'.tii miiitt a-j:u >mi<k n 'i ) \! i i i i' i t '1`i n r<* December 30, 1957 "r * 1van Saoourin St. Johns Quebec bear Ivan: i .. Re: I.H.F. Survey . Hugh Jackson and I have reviewed tine condensation of the survey which yo- sent us. tie nave noted deletion of all references to the association of asoestosis and lung cancer in this condensation* While we believe that this in formation is of great scientific value, we car. understand the desire of the Q.A.K.A. to eaipnasize the exposure of the asbestos miner and not the cases of asl-estosis. We also are in agreement with the deletion of the reference to smoking and lung cancer. It must be recognized, however, that*this report will be subjected to criticism when publisnea because all other authors today correlate lung cancer anu cases of asbestosis. If we are to restrict this condensation to asbestos miners, greateremphasis should be placed on tho choice of words used in defin ing the conort.; The fact tnat all members of tne cohort had 5 or inore years of exposure to asoestos should be reiterated. * Following are comments on certain paragraphs of the condensation. Rape 9 Vie believe the first sentence in paragraph 2 should read "Perhaps no one nac written so extensively Page IL* In the-" third sentence of paragraph 2 the definition of cohort should be expanded to emphasize tnat ncn-xposed personnel were not included in the sample. It..s might oe dene by aoding a sentence similar to the following: "office and other non-expesed personnel, regardless of length of employment were not included in tne conort". . Pace Id To further emphasize the exposure aspect of the miners tne second sentence of paragraph 2 might read, "All workers with more titan 5 yearu of ex posure were placed in one of three categories". it mient be auvj.sable to add another sentence at the end of tnis para graph, "A previously noted workers with no exposure were not induced in tho c.ata". , *Mr. Ivan Sabourin 2 December 30, 1--5? Page 23 In the fourth sentence reference is mane to ''the 952 level of signifi cance". This phrase was. explained clearly and thoroughly on Pages 23 to 2$ in toe section on Statistical Methods of the original survey. Because this vnoie section was deleted in the condensation ve feel it nignt be advisable to explain by foot note the meaning of "the 95* level of significance". We feel that the fifth sentence right be made stronger by the following change. "However, having found just 12 cases, we arc not above this level, and therefore the hypothesis that asbestos miners do not have a higher mortality from lung cancer than does the general population cannot be rejected". Page hi The' table in the center of the page shows a rate of 271 in the h5 - 5b age group. In the original survey this rate was 27. Puce lid ' In'the last sentence of tne first paragraph. we would like to suggest the substitution of the word "undertaken" for the word "commissioned". In the second, sentence of paragraph 3 we would like to suggest tna.t the elements of the cohort definition be repeated. "A cohort was defined as a group of asbestos miners having at least 5 years of exposure in the inastry and who were in the industry during 1950* Only those workers who met these criteria were in cluded in the study". Page 19 ;' In the last sentence of paragrch 1 vs would like to suggest the dele tion of the -phrase "voich have been explained in some detail" since such explanation was deleted in the condensation. This publication should form the ba3iu for future'surveys and reports, hr. hiruun should be asked to establish the framework of reporting for Doctors Grainger and Cartier so that each year the status of every member of the original cohort could be reported to too industrial Hygiene Foundation and the continuing study be analyzed by their experts. We cannot emphasize this point too strongly because nowhere*in.the.literature today is there reported a study which is so valuable and which approximates this magnitude. We agree.with Doctors Cartier and Braun inat a certain number of workers probably have^.some usbestotic fibrosis vnich cannot bo diagnosed by x-ray. Un fortunately, we cannot take lung biopsies on all workers and ve have no other means of making a diagnosis before there axe x-ray changes. Therefore toe annual study of all exposed asbestos workers becomes increasingly important. . We feci that Dr. Braun and :iis staff are to be congratulated heartily for this very valuable contribution to our medical knowledge. We trust that their efforts will be rewarded in the near future by the publication of this work in a recognized journal, / Sincerely, Ciig!-- Kenneth W. Saiith, M.D. Medical Director .