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FILE NAME Industrial Hygiene Foundation IHF DATE 1957 DOC IHF039 DOCUMENT DESCRIPTION Memo - Proposed Epidemiological Study of Lung Cancer in Asbestos Workers for the Quebec Asbestos Mining Association with Cover Letters PHILALENTA j ASTEN MFG CO PHILADELPHIA 29 PA April 26 1957 Asten TRADE MARK Dryer Felt Dr. Daniel C. Braun Medical Director Industrial Hygiene Foundation of America Mellon Institute 4400 Fifth Avenue Pittsburgh 13 Pennsylvania Inc. Dear Dr. Braun The Air Hygiene Committee of the Asbestos Textile Institute has had two memorandums from your institute under study for about a year now At the last meeting of the Air Hygiene Committee in Philadelphia on March 7th it was the opinion of the Committee that both of these memorandums were to be dropped at . this time The first was a memorandum regarding the Environmental Dust Survey for the Asbestos Textile Institute This memorandum was forwarded from your office on February 29 1956. The second memorandum was entitled Epidemiological Study of Lung Cancer in Asbestos Workers Both of these proposals were rejected at this time for various reasons and therefore the writer as Chairman of the Committee was instructed to inform you of the decision of the Committee on these two memorandums If at a later date it is the Committee's desire to reopen either of these memorandums you will be so informed Very truly yours DRH fk D. R. Holmes Chairman Air Hygiene Committee Asbestos Textile Institute RARER Vee he Wey IAS eget IN Me trea Ee eg Ted CRC Cat Te VY OnE GON a Sc er ee a wr? aah August 23 1957 | . Mr. Hugh M. Jackson Manager Industrial Health Program Corporation Manville 22 East 40th Street i New York 16 New York - . Dear Hugh } letter August regarding meeting ATI of | Thank you for your 19 tember of the . f the Sep- ; As a matter of fact having completedtheliterature search . it is apparent to us that the possibility of an association between lung cancer and asbestosis is much more likely to exist in asbestos factories . than in mining operations For exampleof 99 cases which had been re- ported up to 1955 at least 80 appear to have occurredinasbestos workers other than miners A number were women and the occupations given lagger bagger pipe carder were weaver spinner etc. mattress maker coverer Two specific articles which mention the type of exposureand the job that by Doll and that by Isselbacher al2 Seventeen cases studied by Gloyne and 31 reported by Merewether as well as thres mentioned by Harrison and one each by Carston and Owen occurred in England If my information is correct there is no mining of asbestos in England and these must all have been workers in contile 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 Isselbacher's cases involved a contractor's . helper engaged in cutting and sawing asbestos board and sorter in an asbestos Mr. Hugh M. Jackson -2- ~ August 23 1957 The QAMA final stages the slowest study is in the which are of course All of the statistical analysis has been completed and the a report is 99 written What remains is mainly minor revisions typing > the manuscript and proofing It should go to the print shop by the end of . this month you meeting supplies the I hope this you with what need for If there is anything further please let me know and I will try to get it to - you in time | _ Sincerely yours DCB Enclosure Daniel C. Braun M.D. Medical Director References | 1. Doll .: Mortality from Lung Cancer in Asbestos Asbestos Workers 2. Isselbacher K. .; Klaus .; and Hardy H. .: Asbestosis and November Bronchogenic Carcinoma Am J. Med 15 721-732 1953 ; 3. Doll .: Bronchial Carcinoma Incidence and Actiology Milroy J. 521-527 Lectures abridged Brit M. 2 _ 585-590 Sept. 12 1953 Sept. 5 1953 _ INDUSTRIAL HYGIENE FOUNDATION OF AMERICA INC MELLON INSTITUTE 4400 FIFTH AVENUE PittsburgH 13. PA Memorandum on March 16 1956 PROPOSED EPIDEMIOLOGICAL STUDY OF LUNG CANCER IN ASBESTOS WORKERS for the QUEBEC ASBESTOS MINING ASSOCIATION . INTRODUCTION Reports of the occurrence of cancer of the lung in patients with | asbestosis have been accumulating since about 1935 Lynch and Smith | Angrist Desmoules et al Cartier Gloyne Merewether Kennaway and Konnaway Doll and others According to Husper such cases now total about a hundred Many of the above authors refer to asbestosis cancer of the lung and claim to show a definite relationship between the two conditions Up to the present time all attempts at correlation appear to have been limited to lung cancer with asbestosis although a connection between cancer and mere exposure to asbestos has been inferred Pub- lished reports together with the occurrence of some fifteen cases in the towns of Thetford Mines and Asbestos led the industry to consult the Industrial Hygiene Foundation regarding the possibility of a study having ~ * HYGIENE te JETRIAL HYGIENE HYGIENE FOUNDATION OF AMERICA INC ned Memorandum for the A.M. A. - ~ a 2 as its objective to prove or disprove if possible 1. Whether there is a relationship between asbestosis and lung cancer and 2. Whether a relationship exists between exposure to asbestos and lung cancer It is believed that persons having any considerable exposure to asbestos should be included in any study because eventually claims of lung cancer in this group will undoubtedly be made SOURCES OF INFORMATION During the week of February 20 1956 a preliminary survey of potential sources of information was made with the help of Dr. Kenneth W. Smith Medical Director of Manville Corporation Dr. Paul Cartier Director of the Thetford Industrial Clinic and Mr. Ivan Sabourin General Counsel for the Quebec Asbestos Mining Association Conferences with representatives of the Health Departmenotf the city of Montreal the Deputy Minister of Health for the Province of Quebec representatives 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 population group under study Morbidity data although limited is potentially available from such sources as the hospitals in Montreal and Quebec city and some of the 13 cancer 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 STRIAL HYGIENE FOUNDATION OF AMERICA INC 7 Memorandum ... for the A.M. . 3 Simultaneously the various categories of information relating to the asbestos workers were explored with Dr. Cartier at Thetford Mines and Dr. Granger at Asbestos From these conferences it was apparent that extensive and detailed information is obtainable with respect to this group . \ N 1. Medical data including serial ray examinations of the chest extend over a period of about 20 years 2. In Asbestos it will be possible to obtain through insurance among company records information on the diagnoses and causes of death the insured workers 3. Hospitals in Sherbrook and Arthabaska serve most of the people in Asbestos and records in these institutions should be obtainable 4. Finally autopsy findings exist on most of the cases of lung - cancer from the Thetford Mines area PROPOSAL PROPOSAL Obviously several possibilities 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 DUSTRIAL HYGIENE FOUNDATION OF AMERICA INC a 4, Memorandum for the A. M. | and kind of available information and of its probable reliability in con- sultation with biostatisticians has led to the conclusion that a study of this problem is feasible and should result in statistically valid deductions The details of procedure including the decision as to which data should be utilized and in which order the available information should be studied await must 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 industry study selecting industry years a group which entered the asbestos from 10 to 20 ago Such a cohort of workers could then be followed according to their subse- quent exposure to asbestos as well as to the subsequent development of asbestosis cohort The precise incidence of lung cancer in the would be determined by detailed study of the experience of these various groups as reflected in insurance company records and careful analysis of the medical and ray examinations This method would approximate as nearly as possible the controlled conditions of an actual experiment and information derived therefrom should be of prime importance The next logical procedure would be a comparison of the experi- determined asbestos ence among workers as by the previous phase and among suitable the general population of the Province of Quebec or a 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 Megantiancd Richmond counties ci eaDen Synge RF eOn R Om CESS RNR EN HE Le RELA CE TS a STRIAL STRIAL HYGIENE FOUNDATION OF AMERICA INC . Memorandum for the M. 5 Afo ra 2 in Arthabaska county and in Montreal and Quebec city It would also re- quire careful investigation of the mortality rates developed in the office of Dr. Parrot Extensive individual checking of hospital records and death certificates and thorough follow of individual cases would 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 if necessary could be supplemented by figures in possession of the respective national cancer societies The cost of the proposed study will be 20,000 20,000 U. S. currency including all travel expenses and the cost of preparing and printing the report -- oo August 26 1955 Mr. Hugh M. Jackson Manager Industrial Health Program Manville Corporation 22 East 40th Street New York 16 New York Dear Hugh The enclosed letter is explanatory We did not feel that we could reply in correspondence to Mr. Kane and therefore invited him to the Institute for a conference We notified him of the fact that much information is available on the safe handling and use of practically all insulating materials and we supplied him with sufficient data to allay his fears Some time in the future I would like to discuss this mat- ter with you Sincerely yours C. Richard Walmer M. Managing Director CRWidh Enclosure | Letter August 13 1955 from Mr. John W. Kane Corresponding Secretary International Association of Heat and Frost Insulators and Asbestos Workers - DH INTERNATIONAL ASSOCIATION OF HEAT AND FROST INSULATORS AND ASBESTOS WORKERS ~ Affiliated with the American Federation of Labor and a Building and Construction Trades Department Writer's address 36 Perry Lane Local Union No. 2 City Pittsburgh 29 Pa Dear Sir . August 13 1955 I have and always will continue to have the greatest respect for the Mellon Institute and the really great people who staff her And so it is with little wonder that I urgently appeal to you people for possible help in the light of the many many advancements made by the Institute in the examination of air pollution that Sir is our problem seven of the last nine of the members of our Union the Asbestos Workers pipe covers have died of lung disorders It is believed by many of us to be an occupational disease although am familiar with the fact that asbestosis is the number 2 occupational disease I do not believe we are Hindered to any great extent as we are not subjected to breathing in great amounts of it in confined areas But I as all others also be- lieve that our new hazards are found in our comparatively newer matertals all of these are fiberous they are fiberglas foamglas and other glass type insulations mineral wool the loose type wool which Has the addition of formaldehyde to it When working with these materials in confined areas it'so it'so pollutes the air that it seems to remain suspended in the air and visibility is not great where it is used extensively One of the results of this action is that it slows the men down as though they Mellon Insti- were not receiving enough oxygen These materials are also irritating to the skin of some and itchy to all Although I know the tute is not a social organization I was in deep hope that you may give us some information and practices that we may adopt for instance our men do not wear respirators in the application of these materials They claim they slow them down and provide improper breathing We would appreciate any information you could give us on these materials and what dangers they could create We are interested both in a measure of prevention if any and control of the air pollution which if ever gauged for density would most certainly be declared contaminated am sure . that you as thoughtful human beings will help us make a deep cut in the preventable cases by giving the proper knowledge and safety factors we may practice C Y Sincerely s John W. Kane Corresponding Secretary an F ___ to = Ns ; a: F . Wi . t, J. M Aba September 23 1948 Mr. J.P. Woodard Director of Personnel Policies Manville Corporation 22 Bast 40th St. New York 16 N.Y. Dear Mr. Woodard We have made a copy of the French article Asbestosis and Pulmonary Tuberculosis as it appears in the British Journal of Industrial Medicine for April 1948. You will note that this is an abstract of the Franch article but is longer than the abstract which we published in the Industrial Hygiene Digest We have been unable to locate the full name and addreus of the French publication It is simply identified as Sem Hop Paris I suggest that you can probably secure this article through G.X. Stechert & Co. 31 E. 10th St. New York W.Y. Another source for foreign publications is the H.W. Wilson Co. 950 University Ave. New York N.Y. Finally in case you wish to write to the British Journal of Industrial Medicine their address is British Medical Assoc Tavistock Square W.C. 1 London England Very truly yours John F. McMahon Managing Director a 7 a foe Some Remarks on Asbestosis Quelques considerations sur l'amiantose l'amiantose ) Rousseau L. 1947 Sem Hop Paris 23 1811 Experimental Asbestosis Pathognomonic Value of the Asbestos Body Amiantose experimentale Valeur pathognomonique du Corps d'Amiante . Giroux M. 1947 Sem Hop Paris 23 1814 Asbestosis and Pulmonary Tuberculosis Amiantose et tuberculose pulmonaire) Des1818meules , R. Giroux M. and Richard P. 1947 Som Hop Paris 23 Asbestosis and Cancer of the Lung Amiantose et cancers pulmonaires) Desmoules R. Rousseau L. Giroux M. and Sirois A. 1947 Sem Hop These four papers come from Quebec Canada where several workers in the asbestos mines have been studied The Quebec school disagrees with the statements of Gardner that pneumoconiosis due to asbestosis is not an important factor in the production and progress of pulmonary tuberculosis and that the presence of asbestos bodies in the sputum has no value in the diagnosis of asbestosis Rousseau gives brief descriptions of four patients some of whom are also reported in the following papers One had worked in the asbestos industry for 18 years and experienced res- piratory symptoms only during the last three He complained of cough and an asthma- like dyspnea Asbestos bodies were found in his sputum but no tubercle bacilli Radiography is said to have shown a ground appearance in his lungs unfortunately the illustration is too poor to demonstrate this This is the only case seen at this hospital in which it has been possible to make a diagnosis of asbestosis during life Another patient who had been exposed to hsbestos dust for 25 years and who died from some unrelated cause showed no clinical or radiological signs of any abnormality in his lungs during life Giroux exposed guinea rabbits and a dog to crude asbestos dust in a chamber daily for several months The rabbits killed after periods of from three to 12-1 months had no asbestosis and no asbestos bodies The dog showed no lesions after 10 months exposure only the guinea showed lesions in the lungs and asbestos bodies In these animals he traces the stages of formation of asbestos bodies fibres reaching the alveoli are rapidly covered by phagocytic cells ; ~ ~ at 2. ed movement of the the haemoglobin fibres results in microscopic bleeding from from the liberated red cells is taken up by damaged alveolar walls the phagocytes which already enclose the asbestos fibres Subcutaneous or intratesticular injections into guinea of suspensions of asbestos in olive oil resulted in the production of granulomatous lesions but no asbestos bodies | When however the suspension vas injected into an area into which 1 ml of blood had been injected immediately immediately before asbestos bodies were found after a month He considers that the presence of asbestos bodies in sputum has significance since it implies tissue damage in the lungs | Desmoules Giroux and Richard report a patient , aged 44 years in whose family there was no history of tuberculosis He had worked as a bagger of asbestos for 20 years after 10 years he began to experience dyspnea on effort , accompanied by cough and expectoration He became more severely ill some nine months before his the death which was due to asbestosis preceded and | tuberculosis and asbestosis The authors argue that paved the way for the tuberculosis , but admit that they have no proof of this The association of tuberculosis and asbestosis is generally . admitted in Britain but is doubtful in the United States Desmoules Rousseau Giroux and Sirois record brief details of two patients who had asbestosis and cancer of the lung The claim that carcinoma of the lung with asbestosis has been recorded before in only one case cannot be allowed Nor will there be general agreement with the statement that silicosis is admitted to play an important part in the pathogenesis of pulmonary carcinoma) - Taken directly from British Industrial Medicine Vol p 100 April 1948 Journal of 5 No. 2 Yr > : . NO. EXECUTIVE OFFICES MANVILLE CORPORATION TWENTY EAST FORTIETH STREET NEW YORK 16 N. Mr. Ivan Sabourin Quebec Dear Ivan ; et December 30 1957 : . Q.A.M.A. to asbestosis smoking and emphasize the exposure of We also are in agreement lung cancer the asbestos miner and not the cases of with the deletion of the reference to It must be criticism when recognized however that this report will be published because all other authors subjected to and cases of asbestosis If we are to today correlate lung cancer miners greater emphasis should be restrict this condensation to asbestos ing the cohort The fact placed on the choice of words used in defin- exposure to asbestos shouldthabet ralelitmeermabteerds of the cohort had 5 or more years of : Following are comments on certain paragraphs of the condensation Page 9 We believe the first sentence in one has written so extensively ~ ~ . 1, paragraph 2 should read Perhaps no Page 14 other exposed in the cohort personnel regardless of length of employment were not included Page 18 ._ To further emphasize the sentence of exposure aspect of paragraph 2 might read All workers with posure were placed in one of three categories the miners the second more than 5 years of ex- graph As previously noted workers with no exposure were not included in the data BR ,Mr. Ivan Sabourin Page 23 -2 w December 30 1957 In the fourth sentence reference is cance This phrase was explained made to the 95 level of signifi- section on Statistical Methods of clearly and thoroughly on Pages 23 to 25 in the the original survey Because this whole nwoatse dteheleted in the condensatiowne feel it might be advisable to section meaning of the 95 level of significance explain by foot- be We feel that the fifth sentence might be made stronger by the following change However having found just 12 therefore the hypothesis that cases we are not above this level and lung cancer than does asbestos the general miners do not have a higher mortality from population cannot rejected Page 41 | ele a ee The table in the center of the age group In the original survey this raptaegewasshow2s7 a rate of 271 in the 45 - 54 Page 48 In the last sentence of the first substitution of the word undertaken for thepawroargdrapchomwmeiwsosuilodnleidke to suggest the In the second sentence of elements of the cohort definition paragraph be 3 we would like to suggest that the of asbestos miners repeated A cohort was defined as a in the having at least 5 years of exposure in the group industry during 1950. cluded in the study Only those workers who met indstry and who were these criteria were in- 49 Page 4 In the last sentence of tion of the phrase which have paragraph 1 we would like to suggest the dele- was deleted in the been explained in some detail since such condensation explanation Dr. This publication should form the basis for Braun should be asked to establish the future surveys and reports Grainger and Cartier so that framework of reporting for Doctors cohort could be each year the status of every member of reported to the Industrial Hygiene Foundation the original study be analyzed by their experts We and the continuing because nowhere in the literature cannot emphasize this point too strongly valuable and which approximates thitsodmayaginsittuhdeere reported a study which is so probably have some asbestotic fibrosis which fortunately we cannot take cannot be diagnosed by ray Un- means of making a diagnosis bleufnogrebitohpesrieesaroen all workers and we have no other study of all exposed asbestos workers ray changes Therefore the annual becomes increasingly important publication for this very valuable contribution to congratulated heartily will our medical knowledge We trust that their of this work in a Kenneth W. Smith M.D. Medical Director