Document p225jLdXQjZYDXL5mqEvpBBpa

FILE NAME Kent KNT DATE 1942 DOC KNT108 DOCUMENT DESCRIPTION Book Excerpt - Occupational Tumors and Allied Diseases OCCUPATIONAL TUMORS AND ALLIED DISEASES BY W. C. HUEPER M.D. ASSISTANT DIRECTOR AND PRINCIPAL PATHOLOGIST WARNER INSTITUTE FOR THERAPEUTIC RESEARCH NEW YORK CITY CHARLES C THOMAS - PUBLISHER SPRINGFIELD ILLINOIS - BALTIMORE MARYLAND EASES ry capacity is he pulmonary | often enlarged the decreased used by the heart becomes ination of the honeycombcause a filmyground glass anced stages c'examination sreveals the runken blue- in the lower urface shows tissue There dhesions and nd brownish ie interstitial iodes These needle and I to 12 golden or le body may orboth ends | ft is often a ral filament fa hoe or a characteristic |. tThe iron .- needles The decomposed of alteration supposed to CANCERS OF THE RESPIRATORY SYSTEM 403 They occur moreover in the peribronchial lymph nodes within the walls of the sinuses and embedded in fibrous areas In the alveoli they are surrounded by phagocytic mononuclear cells and foreign body giant cells massed especially around the larger bodies The interstitial tissue shows a diffuse fibrous thickening and scarring The asbestosis is thus an indurative interstitial diffuse fibrosis of the lung increasing in degree from the apex to the base Asbestosis and Carcinoma of the LungLung It is only in very recent years that serious consideration has been given to the possibility of a cancerigenic action of asbestosis upon the lungs In an analysis of 18,280 death certificates for cancer of the lung and larynx in males from England and Wales from 1921 to 1932 Kennaway and Kennaway did not find any cases of lung cancer in asbestos workers Since 1935 an appreciable number of cases of asbestosis associated with carcinoma of the lung have been reported from England Germany and the United States Lynch and Smith Lynch Gloyne Wood Horning Nordmann and Egbert and Geiger The incidence of lung cancer among workers in whom an asbestosis was found at autopsy is relatively high ranging from 17 per cent Nordmann 2 out of 17 cases to 20 per cent Wood 2 or possibly 3 out of 12 cases Teleky noted that there exists a minimum of 39 and a maximum of 78 autopsies in fatalities from asbestosis the records not being clear in this respect Teleky only knows of 6 cases of pulmonary cancer with asbestosis and feels that this ratio is high in comparison to the number of necropsies Koelsch mentioned the occurrence of 12 cases Lynch 3 Egbert and Geiger 1 Gloyne 2 Dominici 2 Baader 1 Nordmann 2 Wood 3 and Horning ] Lynch and Smith found among 35 autopsies with asbestosis 2 cases of pulmonary malignancy six per cent whereas there was an incidence of only 0.3 per cent of this type of neoplasia among approximately 2,300 autopsies of the general population The period of occupational exposure to asbestos dust ranged for five cases from 7 to 21 years but in an additional case only a year and a half In several instances the lung tumor became manifest several years 10 to 12 after cessation of the work in asbestos Fifteen to twenty years elapsed average 18 years between the first exposure to asbestos and the death from asbestosis with carcinoma of the lung The age at death depended upon the age of the individual at the time of the first exposure The workers dying in the more advanced age groups entered an occupation with an asbestos hazard later in life while those who died at an early age started to work in asbestos plants when still young There was no evidence of a called old age predisposition as two of these cases died at the age of 35 years and a third was 41 years old The majority of neoplasms were cornified squamous carcinomas Only one case was an adenocarcinoma and a second was an anaplastic round carcinoma The latest case reported by Lynch and Smith showed squamous cellular and glandular carcinomatous structures This numerical distribution between the different histologic types of carcinomas varies distinctly from 404 OCCUPATIONAL TUMORS AND ALLIED DISEASES that usually observed Nordmann but agrees with the shift toward a more frequent occurrence of the cancroids noted in recent years by Probst in pulmonary malignancies of unknown genesis A multicentric development of malignant growths in asbestos lungs was found by Nordmann and Gloyne and it is considered by Nordmann as a characteristic feature of this type of lung cancer A multifocal sprouting of squamous cells lining the bronchial walls was seen by Nordmann who regards these changes as precancerous in nature A diffuse proliferative thickening of the bronchial epithelium was recorded by Gloyne who believed that this constituted a continuous prolongation of epithelial growth from some unknown starting point rather than a series of isolated proliferative units These epithelial prolongations were hollow in places showing a degenerating layer of cells surrounding a central empty space and in turn being enveloped by rings of keratinized squamous cells The carcinomas of three cases were very small Gloyne 2 and Nordmann 1 and had not produced any metastases For this reason two during of these cases Gloyne represented coincidental observations made the mortem examination The other cases were large tumors with extensive metastatic deposits in remote organs An evaluation of the evidence presented reveals certain features connected with these cases which are suggestive of an occupational causation There is an incidence of lung cancer in asbestosis of the lung which is definitely excessive The relatively small number of necropsies on which this conclusion is based represents an urgent indication for more extensive mortem examinations in cases of asbestosis especially considering that pulmonary malignancies seen in previously reported cases were in several instances very small and were coincidental observations A second point favoring an industrial origin is the young age of an appreciable portion of the cases thus far recorded and the relationship existing between the time of exposure to asbestos dust and the manifestation of the neoplasms throughout the entire series The third factor consists in the shift of the histological types observed in the direction of a predominance of cancroids and in the multicentric de- velopment of two Nordmann and Gloyne and possibly even three Lynch and Smith of these pulmonary neoplasms The existence of the cutaneous warty lesions suggests that asbestos needles embedded in epithelial tissue are apparently capable of eliciting inflammatory epithelial proliferations Nothing is known about the actual causative mechanism through which asbestosis may produce such epithelial lesions and may transform them subse- quently into malignant growths The assumption of a chronic irritation of nonspecific nature or of specific silicotic character such as proposed by Lynch is scarcely acceptable and satisfactory in view of the negative evidence available in this respect One of the cases reported by Nordmann in association with Horning showed symptoms of a marked and generalized allergic disposi tion bronchial asthma and hematic eosinophilia which may have played a contributory bodies conta that points carcinoma . reported do experience miners and lated cases large numb Medico included in The eviden exposed to and extens _ incidence an view of the not include is even mor control of pertinent a potentialitie nificance W examination multiple ne losis Lync Sanitary reduce the ,, fication of t introduction of an exter workrooms by moving offering litt tion of ope from those engaged in tion of hur hazard is 1 which the filling room Siderosis Occupati ASES ard a more obst in pullopment of nd Gloyne his type of e bronchial ancerous in helium was nuous pro- oint rather ations were ig a central 1 squamous 2 and reason two ade during swith ex- connected ion There definitely conclusion mortem pulmonary ring an in- cases thus xposure to the entire observed in centric de- ee Lynch cutaneous lial tissue . liferations which as- t^msubseritation of - Savailable - ation with disposi- idisposi- Explayed a CANCERS OF THE RESPIRATORY SYSTEM 405 contributory role in the development of the neoplastic response Asbestos bodies contain a considerable amount of iron and there exists some evidence that points to a possible causative interrelation of pulmonary siderosis and carcinoma The relatively small number of asbestosis carcinomas of the lung reported does not disprove an occupational origin of this condition Previous experience with other industrial neoplasms lung cancer of the Joachimsthal miners and lung cancer of the chromate workers has shown that such isolated cases may represent the first warning of a subsequent appearance of large numbers of similar tumors of undeniable occupational derivation Medico and Social Aspects Asbestosis carcinoma of the lung is not included in any group of occupational tumors recognized by any country The evidence presented is sufficiently serious and the number of persons exposed to the suspected causative agent large enough to indicate a thorough and extensive clinical statistical and experimental investigation of the incidence and causative interrelation of asbestosis and pulmonary carcinoma In view of the fact that several of the states with many large asbestos plants do not include asbestosis among compensatory occupational diseases this study is even more urgent Such a condition militates against an effective hygienic control of an important industrial hazard and impedes the collection of pertinent and essential information in regard to the incidence nature and potentialities of an occupational disease growing steadily in general sig- nificance Workers dying from asbestosis should be subjected to a mortem examination including a histological study of the pulmonary lesions as multiple neoplastic manifestations in asbestosis may be mistaken for tubercu. losis Lynch D4 Sanitary Measures The following measures may be taken to eliminate or Sak}, TI reduce the existing hazard caused by the inhalation of asbestos dust humidi- fication of the asbestos matter and the air to decrease the production of dust introduction of a closed production system wherever possible establishment of an extensive and efficient exhaust ventilation frequent cleaning of the workrooms to remove the accumulated dust prevention of air currents caused by moving machinery parts construction of rooms machinery and pipelines offering little opportunity for deposition and accumulation of dust separation of operations in which the production of dust can be eliminated entirely from those which this is not possible wearing of respirators by workers engaged in dusty operations and mechanization of operations under elimination of human labor to reduce the number of workers exposed The dust hazard is most pronounced in store rooms for raw material in rooms in which the raw fibers are handled and in spinning weaving mixing and filling rooms Siderosis Occupational siderosis of the lung is of the black type which is caused 426 OCCUPATIONAL TUMORS AND ALLIED DISEASES various sources Kennaway pointed out that there had been a pollution of air with soot for a long time before the increase in the incidence of pulmonary . malignancy was noted The rarity of this type of neoplasm among chimney .. sweeps one case among 65 cases of chimney sweep cancer 1920-1923 was cited by Kennaway in confirmation of his contention Fischer - mentioned that the tar and pitch workers who inhale considerable amounts - of tar dust suffer rarely from lung cancer in spite of the fact that they :: develop cutaneous carcinomas from their occupational exposure to this carcinogenic agent A similar statement was made by Barnewitz and Behring in regard to the low incidence of lung carcinoma among the pitch and tar workers in the Ruhr district - Habitual Exposure to Tarry Substances The tobacco smoking habit provides an additional source through which tarry substances of known car- cinogenic quality may enter the respiratory system It has been suggested by investigators that this rapidly spreading habit especially in regard to cigarettes may have some relation to the increase and production of pulmo- nary malignancy Bogen and Loomis Sch^...rchand Winterstein Hruby and < Sweany Roffo McNally Lickint Brockbank M^...ller and others It is contended that not only persons who smoke but also those who inhale tobacco smoke because of environmental reasons over prolonged periods waiters housewives etc. show an excessive liability to lung carcinom~ Editorial J.A.M.A. The amount of tarry substances introduced into the respiratory tract by a heavy smoker is in the opinion of Lehmann much greater than that inhaled by an automobilist travelling on a tarred road The occurrence of pulmonary malignancy in two heavy smokers was reported by Campbell Similar observations on a large series of lung cancers 96 were reported by M^...llerLickint asserted that carcinomas of organs which are situated in the called smoke lips oral cavity larynx trachea bronchi lung are found more frequently in smokers than in smokers This investigator sees in the exposure to tobacco tar the reason for the numerical discrepancy in the incidence of lung cancer among the two sexes and | for the more rapid increase of this type of cancer among men than among | women It may be added that this argument is open to question in view of the increase of this habit during the last two decades among the female sex Jackson and Jackson presented in 1941 statistical data indicating a small but _ progressive yearly increase in the incidence of laryngeal cancer probably caused by smoking The proportion of men to women with this lesion was . 10 and 95 per cent of the men were smokers Occupational Atmospheric Mineral Oil There exists also some evidence incriminating the respiratory contact with carcinogenic oils for the develop ment of malignant tumors of the respiratory organs A relatively high ratio of laryngeal cancer was found by Kennaway and Kennaway in mule- spinners who during their work inhale a mist of a carcinogenic shale oil used -