Document dYyw3dzXx3VQmpapm44by31q0

V/EXHIBIT . NO. *<VSE NO. C*A* 78-1117 cor i L HYGIENE FOUNDATION OF AMERICA. INC. MELLON INSTITUTE- *<00 FIFTH AVENUE 'P-J Pittsburgh 13. Pa. MARKED FOR IDENTIFICATION FILED IN EVIDENCE Michael E. Kunz Clerk Warch 16, 1^56 Memorsjadum on >POSXD EPIDEMIOLOGICAL STUDY NG CANCrR IN ASBZSTOS WORKERS /or the QUEBEC ASBESTOS MINING ASSOCIATION INTRODUCTION Report* o/ the occurrence of cancer of the lung in patients with asbestosls have heen accumulating since about 1935 (Lynch and Smith, Angriet, Doemeules t ai, Cartier, Gloyne, Merewether, Kjscaaway and Ke oneway, Doll, and others). According to Hueper, each case* now total about a hundred. Many of the above authors refer to "aebeatoeie cancer" of the lung, and claim to sbo a definite relation ship between the two condition#. Up to the present time, all attempts at correlation appear to have been limited to lung cancer with asbest-osis, although a connection between cancer and mere exposure to asbestos has been inferred.. Pub lished reports, together with the occurrence of some fifteen casts in the town# of Thetiord Mines and /sbestos, led the industry to consult the Industrial Hygiene lounriatloa regarding the possibility of a study having I EXHIBIT I gwu-ncxpaisS | INOU T A l A t. >-C*C/C OUNtTlC/(S (JW AM t UlC A. IK.C. ^Hnoriiuiuin,, .for the G. A. M. A, wy -- 9 2. At it* objective to prove or disprove, if possible, 1. Whether thr it a relationship between asbestos!* And lung cancer, And 2, Whether A relationship exists between exposure to asbestos And lung cancer, IS it belloved that persons bavin} Any considerable erposure to asbestos should be included in any itudy because, eventually, clalmi of lung can- CtT in tbit group will undoubtedly be mad*. SOURCES OF INFORMATION During tbt week of February 20, 1956, a preliminary survey of potential source* of Information was made with the help of Dr. Kenneth V. Smith, Medical Director of Johns-Man ville Corporation. Dr. Paul Cartier, Director of the Thetfurd Industrial Clinic; And Mr. Ivan Sabourin, Central Counsel for the Quebec Aebeetos Mining Association. Conferences with representatives of tbs Health Department of the city of Montreal, the Deputy Minister of Hsalth for the Province of Quebec, representativee of the Canadian Cancer Society, leading clinicians in the field, and many Others indicated that considerable data relating to the general population of the Province can be obtained for purposes of comparison with the popu lation group under study. Morbidity data, although limited, ie potentially available from such source# as the hospitals in Montreal and Quebec city And some of the 13 cancsr detection centers in the Province. Mortality figures, also subject to certain limitations, are available through the Ministry of Health's Vital Statistics Department, headed by Dr. Paul Parrot. . .INOUJST"'**. NYOICNS FOUNDATION Or AMtAICA INC. - Memorandum for the Q. A. M. A. 3. Simultaneously, the various categories of information relating to the asbestos workers were explored with Or. Cartier at Thetford Mines and Dr. Granger at Aabeetoe. From these conferences, U was apparent that extensive and detailed information is obtainable with respect to this group: 1. Medical data, including serial x-ray examinations of the chest, extend over a period of about 20 years. 2. In Asbestos, It will be possible to obtain, through insurance company records, Information on the diagnoses and causes of death among the insured workers. 3. Hospitals in Slier brook and Arthabaska serve meet of the people in Asbestos, and records In these institutione should be obtainable. 4. Finally, autopsy findings exist on most of the cases of lung cancer from the Thetford Mines area. PROPOSAL Obvioualy, several posslbllltle exist for a comparative statistical study between the asbestos workers and either the general population of the Province of Quebec or segments of that population having similar cultural and ethnic characteristics. Careful consideration of the sources 'mOuItmi*!. htoicnc rouNOATiON or amcmica. ihc. 'Memorandum...for th Q. A.hi.A. 4. and kind of available information And of it* probable reliability in con sultation with blostaiisticians has ltd to the conclusion that a study of this problem is feasible and should resuit in statistically valid deductions. The details of procedure, including the decision as to which data should bo utilized and in which order the available information should bo studied, e must await more detailed Investigation. However, it would appear from a review of copious notes assembled at the time of the preliminary survey that a reasonable starting point would be an Intra-lnduetry study, selecting a group which entered the asbestos Industry from 10 to 20 years ago. Such a cohort of workars could then bo followed according to their subsequant exposure to asbestos as wsil as to the subsequent development of asbeelosle. The precise incidence of lung cancer In the cohort would be determined by detailed study of the experience of those various groups as reflected In insurance company records and careful analysis of the medical and x-ray examinations. This method would approximate as nearly as pos eible the controlled conditions of an actual experiment, and information derived therefrom should be of prime importance. The next logical procedure would W a comparison of the experi ence among asbestos workers as determined by the previous phase and among the general population of the Province of Quebec or a suitable seg ment thereof. Our preliminary observations would strongly Indicate that this phase would also be both feasible and meaningful. It would Involve de tailed study of morbidity data at hospitals in kiegastlc and Richmond counJtie NTOlCNC rOUNOATlON * AMIMlCA. INC. % wicmorandum. . .for the Q.A.M.A. 5. la Artfaabaska count/ and in Montreal and Quebec city, ll would also rquire careful In re * ligation of the mortality rate* developed in the office of Dr. Parvoi. Extensive Individual checking of hospital records and death certificates and thorough follow-up of Individual cases wouid be necessary. The third and ultimate phase of the study would be a comparison of data relating to morbidity and mortality as developed in the first two stages for the asbestos workers and the general population of Quebec with similar statistics for the Dominion of Canada and for the United States. It is not anticipated that the statistics for Canada and the United States would be developed during the study since they are available through the public health services of both countries. The most recent published fig ures would be used and, li necessary, could be supplemented by iigurej In possession of the respective national cancer societies. The cost of the proposed study will be .120,000 (U. S, currency) s Including all travel expenses and the coet of preparing and printing the report.