Document mpnVoMVp99g69Eq8Zz34gD90J

FILE NAME: New York State & NY Times (NY) DATE: 1952 DOC#: NY002 DOCUMENT DESCRIPTION: Journal Article - The Program of the NY State Occupational Cancer Committee A . M . A . ,\a'i //, /, ARCHIV Industrial HE S y OF gien elori > i) . 1 ; / , >/// A , Occupationaandl Medicin// ei \ editorial board PHILIP DRINKER, Chief Editor 55 Shattuck Street, Boston 15 THEODORE F. HATCH, Pittsburgh OSCAR A. SANDER, Milwaukee FEXX E. POOLE, Glendale, Calif. FRANK PRINtCI, Cincinnati WILLIAM A. SAWYER, Rochester, N. Y. HERBERT E. STOKINGER, Cincinnati JAMES H. STERNER, Rochester, N. Y. RICHARD J. PLUNKETT, M.D., Chicago, Managing Editor Volume 5 1952 PUBLISHERS AMERICAN MEDICAL ASSOCIATION CHICAGO 18, ILL. THE PROGRAM OF THE NEW YORK STATE OCCUPATIONAL CANCER COMMITTEE MAY R. MAYERS, M.D. NEW YORK f 'H E NEW YORK State Occupational Cancer Committee was organized in 1947 as an outgrowth of a conference called by the Division of Industrial lygiene and Safety Standards for the purpose of reviewing, with a group of experts, <ie prevention of bladder cancer and the effectiveness of existing control measures n two aniline-dye plants in New York State. The discussion of how to control ertain known carcinogenic hazards in industry very naturally led to a consideration other occupational causes of cancer, of the fact that there might very well be in d.hmeei,nadnudsthrioawl eonnveirwonomuledngt ocaarbcoinuotgfeinndsinwghitchhema.re not even suspected at the present There was so much interest on the part of those present that the New York ^tate Occupational Cancer Committee was formally organized to study these prob lems. Its membership was as follows: May R. Mayers, M.D., chairman, Division of Industrial Hygiene and Safety Standards, NTew York State Department of Labor, New York. Austin V. Deibert,*1 M.D., Cancer Control Branch, National Cancer Institute, Bethesda, Md. Konrad Dobriner, M.D., Sloan-Kettering Institute for Cancer Research, New York. Harold F. Dorn, Ph.D., Biometrics Section, National Cancer Institute, Bethesda, Md. by DG.r.HA. lGleenhrJm. Fanlenm, Min.gD).., Manufacturing Chemists Association, Wilmington, Del. (represented AlbPanauy,l NR.. YG.erhardt, M.D., Division of Cancer Control, New York State Department of Health' HeaHltyhm, aAnlbaGnoyl,dsNte.inY,2. Ph.D., Division of Cancer Control, New York State Department of Leonard Greenburg, M.D., Division of Industrial Hygiene and Safety Standards, New York State Department of Labor, New York. Arthur E. Hoag, M.D., Socony-Vacuum Oil Company, Inc., New York. LeRoy S. House, M.D., Tumor Clinic Association, New York State. MdW. . C. Hueper, M.D., Cancer Control Branch, United States Public Health Service, Bethesda', Louis C. Kress, M.D., Roswell Park Memorial Institute, Buffalo. Anthony J. Lanza, M.D., Institute of Industrial Medicine, New York University-Bellevue Medical Centre, New York. Morton L. Levin, M.D., New York State Department of Health, Albany, N. Y. George T. Pack, M.D., Medical Society of the State of New York. Dec.A3d, d1r9e5s1s. presented at a meeting of the Cancer Prevention Committee in New York on Dr. Mayers is Chief of the Medical Unit, Division of Industrial Hygiene and Safety Stand aCradnsc, eNr eCwomYmoriktteSet.ate Department of Labor, and Chairman of the New York State Occupational 1. Dr. Deibert is now with the Economic Cooperation Association, Washington, D. C. 2. Mr. Goldstein is now with the National Institute of Mental Health, Washington, D. C. 279 INDUSTRIAL HYGIENE AND OCCUPATIONAL MEDICINE The first activity erf the Committee (and its most concrete accomplishment to ^ate) was the preparation and distribution of an educational publication, entitled tory tend, Occupational Cancer: A Challenge to the Physician." In this, an effort was made meni to capture the^ interest of the medical profession; to stress the importance of an occupational history; to provide the practicing physician with concrete data as to even occupational carcinogens, either known or suspected, together with the precancerous soni, lesions associated therewith, and to stimulate more complete and more accurate reporting of cancer deaths. This publication, sponsored by the Medical Society of ever; t e State of New York, the New York State Department of Health, and the New of bt York State Department of Labor, was distributed to every physician in the state. ll dItishtraisbusitniocen.beIetnhraesprailnstoedbebeynthreepCrionmtemd iitnteevaarnidoucsonmtienduiecsaltojohuarvnealas.w3*ide on-request conti size mi.ttAeet, thplrsovPiodemdt>tthhee nNeacteisosnaaryl Cfuanndcesr fIonrstaituptielo, talsrteuaddyy orfeporcecsuenpatetidonoanl tchaeusCesomof 1 patic 'kin csianncceerbeeAn etxwteon-ydeeadrfostruadythwirdasanodriglainstalylyearc,owntheimchplaistesdo.onHtooweexvpeirre, . the grant has dies, it is Preliminary to the formulation of a definite program, the Committee gave long and careful thought to the complexities of the industrial environment and par not.1 dive: ticularly to the many problems involved in any effort to discover unsuspected car the i cinogenic agents that might be present therein. Certain basic considerations, such term uaspothne: following, largely determined the type of study which was finally agreed envii diag: reco' increase in the incidence of cancer--particularly, lung cancer-has apparently coincided with advances in technological research and development in this country, and causal cane di ab relation must be considered a possibility. are . . 2' .The increasing complexity of the industrial environment has exposed workers to an ever- lncreasing number and variety of physical and chemical agents-particularly to chemical con- Occ Tnd'the like 6 ^ ^ 5n the form of nox!ous dusts- ^ses, fumes, vapors, mists, invc 3. The multiplicity of abnormal environmental factors to which any individual worker may e exposed m the course of a long working life is further complicated by his great mobility (i. e,, pati job. e is apt to drift from one industry to another) and by the fact that the principle of synergism a y ,* ,, ,, e a,, .,,,,or,an. role, ,,.Hicalarly when ,he ,, t e r t a boon oLl.anoonoly , x ,,oied The hist to more than a single toxic agent. font 4. Individual chemical and physical agents in the industrial environment are not necessarily actn or even usually pathognomonic for particular industries or occupations. They may be found widely distributed among many totally unrelated types of work. Common denominators of his vielt a*extp5o+suCrenvienrsienldy;usatrPyaratslcaulwarhojloeb, tchlaesrseiffoicraet,ioanssudmoees gnroetatnescigenssifaircialyncper. ovide precise information the m in s r t t T T 6 1 CCUpat,Tnal exposure' To ^ a worker is a "foundryman," for example, tin i dry sand whWethePr huePUproPurSse'moltemnakmSeta"l gcofenattaindiifnfegrelenaCde oWr ho6tthheerr thoexiics ma amteorUiaelrs;wwhohehthaenrdlhees wel is a sandblaster, or operates a crane. was of ,A " Urat,e and comP'ete occupational histories of patients are difficult to obtain because cou f the technical complexities of the materials handled and the failure of patients to present the w o e s ory, ven a well-informed chemist who contracts an occupational disease in his labora- logi that 3` New _York State Occupational Cancer Committee Presents a Program on Occu pational Cancer Compens. Med. 3:9 (Sept.-Nov.) 1950; Occupational Cancer: A Challenge to be i stat t e Physician, Month. Rev., New York State Dept, of Labor 30:37 (Oct.) and 44 (Nov.) 1951. tion 282 INDUSTRIAL HYGIENE AND OCCUPATIONAL MEDICINE of the grant-in-aid approaches, approximately 4,500 patients have been interviewed and about 750 noncancer controls have been obtained. As the interviews were completed, they were forwarded each week to the Division of Industrial Hygiene and Safety Standards, where, with the assistance of two industrial-hygiene chemists, under the direction of the Committee's chairman, each occupation given by each patient was carefully evaluated from an industrial hygiene viewpoint. Supplementary data were appended to each patient's record, indicating the abnormal environmental exposures known to specialists in the field of industrial hygiene as being commonly associated with each job. This work has now been completed* The patients' completed records have been forwarded to Dr. Gerhardt, director of the Division of Cancer Control, New York State Department of Health. Under his direction, these data are now being coded and put on punch cards to be run through I. B. M. machines. Statistical analysis of the data is still in progress. What this study will ultimately contribute in the way of extending present knowledge of the occupational causes of cancer is for the future to decide. There was no thought to get definitive data at this time but, rather, to get leads for more intensive study later on. Within the more limited canvass provided by such leads, it is hoped, field investigations--including chemical air analyses and dust counts, when necessary--will provide more detailed information with reference not only to suspected carcinogenic agents in the occupational environment but also to duration and intensity of exposures in relation to the development of occupational cancer. The industrial hygiene slant which has characterized the study in New York State has resulted in the development of a considerable volume of data--never before collected--with reference to specific physical and chemical agents to which cancer patients had been exposed in the course of their work. The large number of vari ables thus introduced has, however, created very real problems for the statisticians. But, these variables are the very essence of the industrial environment which is under investigation, and ultimately they will have to be taken into account. Perhaps, with so many variables, one requires a far larger series of cases than the 4,500 which have become available as a result of the present study. Perhaps, complex data of this type will never serve too well the mass-statistical approach; what may be required is a purely medical evaluation by an astute clinician. Doctors of industrial hygiene, for example, are accustomed to dealing with large numbers of variables per patient in connection with all field studies. Here, analogous data on the occupational environment are collected, and to these are added data derived from occupational and clinical histories, physical examinations, and laboratory and x-ray findings, The number of workers usually included in these studies is rarely large enough for mass-statistical analysis. But clinical analysis has made funda mental contributions to industrial toxicology and has provided a basis for the estab lishment of accepted safe standards for purposes of prevention (so-called maximum allowable concentrations). The independent experience now being developed in the pilot studies which are in progress in the several states may provide an answer. New York State was the first to embark on such a study and the first to receive a grant for this purpose from the National Cancer Institute. Its situation differs from that of the other states in that its study is being carried out by a distinguished M AYERS--N E W YORK STA T E OCCUPATIONAL CANCER COMMITTEE 283 committee, with representatives of various state and federal agencies among the mpaerntitcippraonjtesc.ts.Elsewhere, these studies are being conducted as State Health Depart It is already becoming evident that each of the pilot studies now in progress has ;ts own serious limitations and that all are unexpectedly time-consuming and expen sive. Perhaps, the ultimate approach will be found in starting now to collect cur rently and compile accurate occupational data for analysis 15 or 20 years hence, utilizing such social-security records as unemployment insurance, placement, work men s compensation, sickness insurance, and the like. The "forms" now being used iv social-security agencies and other groups could be so modified as to provide a .ast fund of information for the future, as to the successive environmental exposures a persons in whom cancer ultimately develops. However, whether this vision of uture benefits will be sufficiently inspiring to overcome natural resistance to under taking additional work in the present carries a big question mark. ABSTRACT OF DISCUSSION Dr. E merson Day, New York: Has your group made any effort to contact officials of industries to verify exposures reported by the patients interviewed ? Dr. Mayers : In the beginning the Committee planned to check each patient's occupational history by field visits and even by air analyses and dust counts to get data as to exposure in :mns of dosage. It was soon discovered, however, that this was not practicable. Plants had gone out of business or were found to be operating so differently since the patient worked there as to make the investigation useless. It is hoped that this approach may be utilized when the study is extended to follow up specific leads which may be developed. P rof. E. V. Cowdry, St. Louis: Do your records comprise a considerable variety of industries >r do they tend to be restricted to those industries that happen to be located in the Buffalo area? Dr. Mayers : We have encountered a very wide range of occupations. However, we dis covered that the hospital selected draws most of its patients primarily from Up-State New York, which is largely agricultural, but also has most of our large chemical industries. Dr. Leslie Beard, New York: Have you any data on cancer in urban as compared with rural populations? Dr. Mayers : Information as to residence was an item in the questionnaire and has been coded. Data on this point should come out of the analysis. Dr. E merson Day, New York: I notice that there are several hundred different items in your list of exposures. Do you feel that you have obtained enough histories to provide a sig nificant concentration of data for any particular item or group of items ? Dr. Mayers : The large variety of exposures involved in this study is one of the difficulties which worry our statisticians. These many variables are essential characteristics of the industrial environment and will have to be met ultimately in one way or another.