Document jmQgXK08KK1zbR4XMN7dQ9ze2

FILE NAME: Kent (KNT) DATE: 1949 DOC#: KNT113 DOCUMENT DESCRIPTION: Editorial - Asbestos and Cancer of the Lung The Journal of the American Medical Association Barry Castleman's Kent File CD-ROM Document # Kent Type of Document DATE Undated=0 published report from peer-reviewed journal published article from trade publication published article from newspaper proceedings from annual meeting published abstract from conference unpublished report unpublished presentation meeting agenda minutes report letter memo government report standard government warning information industry warning information legal UH - n i ; Ik e Journa Ir 'I r' I I K. I E dited for the A ssociation U nder the D irection of the Board of T rustees by i i . M O R R IS F I S H B E I N . i\4.D. r yLUME 140 vO <-y r~ 3$ - AUGUST 1949 i AMERICAN MEDICAL ASSOCATON. CHICAGO 10, 1949 ( \ . y . . 1M\V lf.-T .^ '. . .* :,* EDITORIALS 121? y . ' o Z V ) ) , a c c e ie ra fe H in ' the m agnetic field of the J ( a SBESTQ SIS AND CANCER OF T H E LUNG y c l^ o n , strike the-target of the machine. . . . . . . { U ntil recently the coexistence of asbestosis and can- --eeently, on the.b'asis of acute experiments with ii .ie assumption was granted that neutrons were 6 're than five times as effective as roentgen rays ai .logic- purposes. Recent work * and the sad expe- ieuce of these young physicists point to the probability hat a grave underestimate was made and that for cer- ain organ systems, such as the lens and the gonads, eufrons may have, four to.eight times the effectiveness riginallv suspected. Unfortunately for. the physicists, protection pro.edures and exposure limits, were based on the earlier .ssumption. Once again,' as in the past with roentgeri ays and radium, people have, unwittingly been injured >cfore an adequate understanding of a hazardous agent vas had. Furthermore, even now. dosimetric methods or neutrons are unsatisfactory. An understanding the mechanism of interaction )i radiation with the components of biologic matter leccmes important.' In the case of roentgen rays the mergy is first given to electrons, which move at highmeed through the tissue. These electrons "in turn' dissipate their energy by collision with biologic matter,, causing chemical alterations. However, the damage to an. e cell by one-electron is relatively small. ^.."e case of neutrons the energy' is principally disjip .d by collision'with the hydrogenous component o! -ue. The high speed protons thus set in motion liberate a large amount of energy per unit length of oath. Thus the passage of one high energy proton .hrough a. cell may produce sufficient destruction to injure it permanently. There is evidence that roentgen rays are relatively effective only against dividing cells, while neutrons may cer of the. lung was considered by many investigators a coincidence. Since 1935, 23 such cases were recorded by American, English and German physicians. W cdler12 noted If- cases of asbestosis cancer in a series of 52 necropsies on patients with asbestosis, or about 15 per cent of cancer of th lung in persons who died from this industrial disease. The exposure time ranged from 3 to 27 years (average 15 years). The ages :n 17 cases were 35 to. 75 veers 'averr-e 5? vr.Until now the question of a causal reJatron between asbestosis and cancer o f the lung has been an open one. The recently published Annual Report of the Chief Inspector of Factories in England for 1947 provides additional data on the actual existence of such interrelations.1 During 23 years, 1924 to 1946 inclu sive, 235 deaths, either caused by asbestosis or in which asbestosis had been established at necropsy, were reported to the Chief Inspector. Cancer of the lungs or pleura was tcund in 31 of these cases (13.2 cer cent). Of the 128 male deaths in this group 22 (17.2 per cent) were 'complicated b y cancer of the lung, while of the-107 female deaths 9 (S.4 per cent) were similarly affected. The mean age at death from asbes tosis complicated by cancer of the lung was 52.1 years. A causal relation between asbestosis and cancer of the lung is supported by the following observations : The incidence rate of cancer of the lung in this group is excessive, since the normal death rate from cancer of the lung among adults examined at, necropsy at present is about 1 per cent of all necropsies. Moreover, there is a distinct shift in the sex distribution of cancer of the lung in the scries of asbestosis cancers reported from England. The male-female sex ratio is 2.4:1, while it is 5 :1 for cancers of the lung- in general. "jure the cel! at an)- chase. Thus the biologie cffcots produced by neutrons may be .both quantitatively and quaiilatively different from the effects of the roentgen ray. The urgency for research in this relatively unex plored field is evident. In a broader sense, the experience of these young physicists points to the tremendous 'responsibility devolving on those--both the physicist-engineers and the agencies supporting their work--who are concerned with exploring'th new frontiers of. the physical sciences. It is not enough to dismiss the responsibility witlj. the mere warning that a danger may exist or to rapolate,'as was done with the neutron, from in^'p.^jate analogies. The biologic implications of the n< j^nknowns should be subjected to investigation pr ^el with their physical implications and with equal vlb .. : S S A n e , il. S .: Kculron T herap/ and Specific Jcaiiatim . 'Am. J. 5 0 ) 7 7 1 - (June) .1 . Evans, T . C.: T he Effect! of SaaJI Daily' D otes o f Vase Kfutraa an Xilet* R ieialaav fw> * a t.a ia tosis group, tending :c equalize the incidence rate oi cancer of the lung for both sexes. Recent experimental observations support this interpretation of clinical evi dence. Nordmann and Sorge 1 exposed mice to inhala tion of asbestos'dust and found that in 20 per cent of the surviving animals there developed squamous cell cancer' originating from the bronchial mucosa, while .other types of epithelial proliferation were present in 42 to 57-per cent of .these animals, in addition to diffuse or nodular fibrosis of the lung. The histologic character of the cancers (squamous cell cancer instead of adeno carcinoma seen in the spontaneous eancer of the lung of mice) and the histogenetic derivation of the tumors (bronchial mucosa instead of alveolar epithelium of the spontaneous type) indicate that a specific factor of 1. Wrdter, H . W .: AibcstM a on Lungenkreba.. Deutsche mcd. Webn- seh r. <M>:S7S, IW 3. 2. Extract (ram Annua] Report- o f the C hiet Inspector o( Factor! for the Year >9(7; Medical Section, London, H is M ajcatr's Stationer/ O/Kcc, IM 7, |>P. 1I 1f -17... 1 I*.. . * ............................ 1220 CURRENT COMMENT J. A Au. exogenous origin, represented by the inhaled asbestos dust, v.as responsible for the bronchial cancers obsSr^ed. . .: Since some 20,000 workers are employed in the asbes tos-producing industries of this country and Canada and; many additional thousands in various asbestos consuming industries, increased attention to this prob able occupational hazard of'cancer oE the. lung by the medical profession is desirable. Cytologic examinations of the bronchial secretion may well be included in the periodic examination of workers exposed' to asbestos dust whenever clinical or roentgenologic evidence indi cates, the possible existence of a pulmonary cancer. l.i. aiiau.e ivmer-.^c s,:o>*._> .i.al .r.e occuri c.... of cancer of the lung is related to pulmonary asbestosis .and is-not merely" a possible sequela of. exposure to asbestos dust, in all fatal, cases of asbestosis there should be postmortem- examination with detailed histo logic analysis. The anatomic lesions produced by asbestos dust in the lungs make difficult at times dis tinction by clinical and roentgenologic diagnostic methods between changes of pneumoconiotic nature and those that might indicate a cancerous growth. Carrent Comment NODULAR PA N N ICU LITIS--W EBERCHRISTIAN DISEASE Weber-Christian's disease, or nonsuppurative noduiar panniculitis, is characterized by. recurring episodes of fever and the development of numerous painful and slightly tender subcutaneous nodules. In only 3 of 33 recorded cases was death apparently due to the disease. In the case reported by Kritzler,1 in which necropsy was done, the nodular lesions were limited to the subcutaneous fat. However, fat emboli were found in the lungs and there was widespread acute necrosis of the liver and spleen. In the case examined at necropsy by Spain and Foley,1*necrotic areas were found not only in the subcutaneous fat but ;n -hi mesenteric, omental and p r e t r a c h e a l tat. r a t o: : : were not found in the lungs, nor were areas c; necrosis observed in the liver or spleen. However, foci of fat necrosis were present in the region of the pancreas. A third case investigated at necropsy was that o Mostofi and Engleman,*' in which nonsuppurative pan niculitis involved the skin, the epicardium and the peripancreatic, periadrenal, perirenal and mesenteric tissues. The nodules in the fat are of variable appearance. The earliest lesions consist cf small accumulations of fat-laden macrophages. Later, there are some what larger lesions that present small areas of central necrosis in the immediate vicinity of which are lympho cytes, polynuclear leukocytes and fat-laden macro phages. In still older nodules, the necrotic material is decreased or absent and the lesions are partially or completely replaced by fibrous tissue. In Spain and I. KrilIr. R .: A C u e a f W cbtr.C hfittian'a DIk i k , Prac. N w York Path. Sac.. :9 4 0 .|9 4 l. a. 47. t. Spain, D . 3 (., and Fv)/, J. M .: N an-Soppnraliv Paim iculili, Am. J. Path. 20: 7SJ, 1944. 1. Muitofc. F. K - and Enpttnian. Fatal Rtlapai* Febrile Non- Suppurativa l*aniv<ujUi^Arth.,Path.. t3 : 4l 7 (Aprjl) 1947. .V Foley'5 patient, who was an alcohol addict, there changes indicating a late stage of chronic giorr nephritis, and death occurred with the symptc uremia. Such changes in the kidney are perhap interpreted as .accidental necropsy findings direct relationship to the syndrome under disa A disease in rabbits apparently analogous to t nonsuppurative panniculitis in man has been cie; by Duran-Reynals 4 and others. The cause cf V Christian's disease is unknown. CRISIS' IN . SCIENTIFIC RESEARCH Further evidence that the medical-.'-orefe'.r.i.-n coordinate and intensity its crotectiur. ct the r: carry on experimental studies on animals in 1. tories is provided in a report on this type of 1egis in the District of Columbia. Representatives twenty-six national. health and science groups, hospitals, lay groups and governmental agencies united behind Senate bill 1703, providing for k tory use of the 7,000 to 10,000 unclaimed dogs destroyed each year in the District pound. The frenzied distortion and political pressure by r.r sectionists have placed the bill in jeopardy, acccrc the National Society tor Medical Research, society quotes Dr. A. C. Ivv, its secretary-trea to the effect that members of the special Senate niittee to which the bill was referred are persona favor of it but the bill probably will not'be rep out. Dr. Ivy has issued an appeal that interestec sons write letters of endorsement to Senator J. He McGrath, of Rhode Island, who introduced the sure, and Senator Margaret Chase Smith, of ? chairman of the subcommittee. Some such cone action is necessary at state as well as national to beat back efforts of a small, misguided eroi obstruct the'advancement of science. FIRST TELEVISION NETWORK HEALT SHOW The first health' education program ever -.-.re- June 16. Transmuted as far.,.west as Chicago program, titled "Your Good Health and the M Atom," was arranged through the Bureau of b Education of the American Medical Associatior produced under the supervision of Mrs. H Hester, radio coordinator for the Bureau. The gram dealt with the use of radioisotopes in men particularly radioactive iodine. Dr. Paul C. Aebe Chief, Radio-isotopes Division, United States A Energy Commission, Oak Ridge, Tenn., was viewed by an NBC announcer o n . the. principl radioactivity. With a Geiger counter specially a fied. Dr. Acbecsold demonstrated first how radioac caivbe traced and atoms identified, Later, with a p furnished by Div.Sidney C. Werner, Columbia C of Physicians and Surgeons and Presbyterian Ho: he demonstrated concentrafioiv of radjoactive iodi the thyroid. ____________ 4. Durau-Rtjrnal. F .: A Nverwiii* '* * * * ' * Far ami Muteular TImum^ Safe J.. U>oL Sc Hot. 1 8 : 1S3. 194*