Document pmmD5Ze8NgOrDmbVM8e2VK99d

7- / ~~ RtCUiVu MAY i 0 1373 R. A. P=C^:nr * c7 A. D _ ' ' ;o~D&* . Q, HULL RECEIVED JUN 06 1978. R N. WHEELER, jR A RATIONAL VIEW OF CANCER IN NEW JERSEY""' by Harry 8. Oemopoulos, M.D. Associate Professor of Pathology New York University Medical Center New York, New York RECEIVED SEP 18 1978 R. N- WHEtLtR, JR. In Che interest of an informed approach to the problem of cancer in new Jersey this paper has been reproduced, with permission of the author, by: New Jersey State Chamber of Coiranerce S Commerce Street Newark, New Jersey 07102 Additional copies are available upon request. ucc 057550 The following document contains simplifications for ease of understanding. As In most aspects of human disease, chart ara excapcions, and alternate opinions. The follow* Ing attempts to condense Che contemp orary , responsible thoughts on the different aspects of cancer. This Analysis was prepared while Dr. Damopoulos was Director of Che Cancer Institute of New Jersey ucc 057551 SUM M ARY A RATIONAL VIEW OF CANCER IN NEW JERSEY This summary outlines the essential points that are explained in the attached documents. I. Definitions o A major distinction is made between mortality and incidence rates. Mortality rates simply represent statistics reported from death certi ficates and provide insufficient data for any solutions; incidence rates are the numbers of new cases/year and relate to living patients. The status of New Jersey as "the number one cancer state" is based on mortality rates. o The difference between industrial and environmental cancer is' stressed. Industrial exposures in the "work place" cause a minor number of can cers, and there is an even smaller number attributable to industrial carcinogens that "have escaped into the community" (less than 0.00001* of cancer deaths). Environmental cancer refers to cancers induced by an individual's personal environment which includes cigarette smoking, excess alcohol consumption, 'in'gestionT/df~~high~fa.illow fibre diets ,use~. of`nitrate/nitrite'containing'meats', - consumption oif~foods-wi th artifi- rcialjcoloirs, and other aspects of life-style; the occupational aspects *'"of"eh environment are important, but relatively less important. II. How Cancers Start o Normal cells have repair mechanisms to undo the damage caused by chemi cal and physical agents. However, these repair systems can be over loaded. o Cancer-causing agents generally take 20-25 years to produce a cancer. The example of the Hiroshima and Nagasaki survivors is given. ' This 2025 year period is known as the "lag phase" in carcinogenesis. o Many substances can act together, either in an additive way or synergiatically (the sum total of the effect is greater than just additive). III. The Causes of Human Cancers ucc 057552 o Specific cancers have been linked with definite agents, but the major lethal cancers, lung and large bowel, are linked to personal habits. Only a small percent of cancers are industry-related, o Nitrices/nitrates and artificial colors are cancer causing chemicals (nitrites/nitrates are converted into dangerous nitrosamines when preserved meats are heated), but specific human cancers Have not yet been linked to these substances. o Life-styles that include obesity, and multiple pregnancies, are asso ciated with a greater risk for cancers of the breast and uterus, respectively. .. _____ ... :o The most dangerous . human carcinogens^are^cigarettes, alcohol, dietary _L fats, nitrites/nitrates, and artificial food colors. These are the most widely distributed in the communities, and are proven co be respon sible for the largest percentage of cancers, estimated as high as SO" (by Dr. Frank Rauscher, the recent Director of the National Cancer Insti cute, and Dr. Theodore Cooper, the recent Assistant Secretary for Health in HEW). IV. Specific Problems in New Jersey o There is a complex array of medical, social, geological and geographic factors that must enter into any analyses and solutions for New Jersey's cancer problems, e.g., the dense urban population in N.J., inadequate educational and medical leadership in the past, etc. The sensitive area of "the quality of medical care in New Jersey" may explain a por tion of the high cancer mortality rates during the period covered by the mortality study. o New Jersey's unfortunate prominence as the "number one cancer state" is based solely on mortality data from 1950-1969 and does not consider the mobility and shifts in populations from New York City and Philadel phia. These two cities, as well as other non-industrialized urban areas, have death races as high as those of New Jersey. The density of the urban population of New Jersey confounds any analyses of the data available. V. New Jersey Industry and Cancer o New Jersey had a 17Z greater death rate, for white males, and a 14Z greater death race, for white females, compared to the rest of the country. This is the basis of New Jersey's Infamy, o Ocher urban centers, even with light industry, share New Jersey's death rates, e.g.. New York City, its Northern Westchester suburb, its Eastern Nassau suburb, and San Francisco. The state of New Jersay, when com pared to ocher states, ranks number one. If, however, only populations are compared and stats boundaries are ignored, then New Jersey's rates are equal to the rates of urban areas in other parts of the country. The-problem lies however in the fact that even the rural areas of New Jersey have "urban rates"; this is the heart of the problem and requires further study. The answer may be as simple as the fact that many New Jersey rural dwellers, who died in 1950-1969, may have been city inhab itants from New York and Philadelphia at some time in the past and carried their damaged cells with them when they moved, o The types of cancers chat are typically "industry-related" do not account for New Jersey's excess 2,000 cancer deaths each year. All types of cancer deaths are Increased, and in some cases there is a negative correlation (benzene causes lymphomas and leukemias, and benzene is a prominent industrial pollutant - yet, the mortality races from lymphomas and leukemias are not above the national average), o Separate studies by Drs. Lourla and Dcmopoulos have suggested Chat only 600 of Che 14,000 deaths in New Jersey might be "industry-related". VI. The List of Carcinogens in S-3035. Section 6 o The list includes a mix of substances; some are no longer in use, same are not carcinogens, some are strong and others are weak carcino gens. Apparently, at the present time, all are being handled with ade quate precautions. o Asbestos and vinyl chloride are weak carcinogens. o Research is required to determine permissible exposure levels as has been done with the most powerful carcinogenic agent, x-rays. ucc ii 057553 A PATIONAL VIEW OF CANCER IN NEW JERSEY New Jersey has unfortunately achieved infamy because statistics from a National Cancer .nstitute study reveals that New Jersey had the highest mortality rate, per 100,000 general population, in America in the period 1950-1969. This rmans one of two things: a) if you developed cancer'and lived in New Jersey at that time, you were more likely to die of it because your cancer has been detected at a more advanced stage than in ocher states, and/or the complicated treatment that was needed was not as available as in other parts of the country; b) the risk of developing a lethal form of cancer was greater in New Jersey than in other states. It is not possible to deter mine which of these two reasons, or what combination- is the truth because reliable incidence data does not exist throughout New Jersey. The data that is available is mortality data, which only shows how many people die each year from cancer. The mortality data, although very Inadequate, has triggered massive controversies regarding: o industry-related cancer o environmental cancer o the personal environment o life-styles and cancer o inadequate health resources o toxic substances o dietary factors o banning of so-called carcinogens o politics o early detection o financial aspects of cancer o possible solutions Cancer is the most complicated disease process, compared to the other major killers such as heart disease, strokes and accidents. There are over a hundred different forms of cancer, and they start in different organs of the body, in different types of individuals, and under poorly understood circumstances. No other disease process Is so Intricately interwoven with the very fabric of society; as chough to emphasize their perplexing, intri cate nature, cancer cells remain very similar to the patient's normal cells, thereby frustrating most attempts to "weed" them out. In order to put cancer into perspective, so that possible solutions can be evaluated, the major complex aspects must be understood. ucc 057554 definitions Cancer - a malignant growth, composed of solid masses of disorganized cells that are ever-growing, and are capable of spreading to organs far from the original sice, e.g., breast cancer starts as a lump, and some of its component cells will microscopically invade the blood stream which will carry them to the lungs, bones, liver, and brain. Metastasis - the term used to refer to the spread of cancer cells from its site of origin, to ocher organs. Early Detection - the process of detecting the cancerous mass while It is still small and therefore less likely to have metastasized. Radical Surgery - the principal weapon in use today for creating cancer; the surgeon cuts widely around the cancerous mass hoping that none of the cancer cells have microscopically metastasized; the surgeon and ocher cancer experts generally have no way of .knowing whether an Individual case has already spread microsccpically; however, the smaller the original cancar mass, the less liksly it is to have spread. Mortality Rate - the number of people dying as a result of cancer each year; It is generally given as the number of cancer deaths per 100,000 general pop ulation. In America, Che average figure is about 170/100,000. Incidence Rate - the number of new cases that are diagnosed each year, again given per 100,000; in America the average figure is about 340/100,000; about one-half of this number will eventually die of their disease, but over'a period of 2-8 years; the other half of the newly diagnosed cancer cases will live out a normal life expectancy and die of some other cause. Industry-Related Cancer - a cancer whose cause can be, at least in part, traced back to a distinct exposure to a chemical or sometimes a physical agent that was present in the "work-place"; this generally encompasses employees and, more rarely, members of their families who are exposed to the employees "contaminated" work clothes. Environmental Cancer - refers to most cancers, possibly 80Z; however, the term "environment" is all-encompassing and relates mostly to the personal environmenc that results from lifs-styles, habits, and dietary factors; occupa tional exposures, and industry-related events comprise a minor component of "environmental cancer". Carcinogen - an agent, chemical or physical, that is capable of initiating Irreparable damage to a cell, such chat the cell may be unelmately trans formed into a cancer cell. Co-Carcinogen - a chemical which by itself is incapable of causing cancer, but in combination with small doses of carcinogens (doses too small to cause cancer) will cause the development of cancers. Epidemiology - the science of studying what disease occurs in which types of people, and under what circumstances - it constitutes medical detective work. ucc -2- 057555 II. HOW CANCERS START Cancer cells are no longer "self-controlled", the way normal cello are. Of the many trillions of cells in our bodies, many of them divide and multiply in order to replace "worn out" cells. Most remarkable is that the normal re placements are exactly like the worn-out ones. Cancers start as a result of some cells losing their normal control mechanisms. This happens as a result of damaging the genetic material and the delicate membranes of a cell bevond repair. It is important to realize that from conception, i.e., when a sperm and egg cell have united to form a unique individual, that single cell and all of its subsequent dividing cells are constantly barraged by damaging agents such as viruses, chemicals, and ionizing radiation. In the overwhelming majority of damaging Insults, our cells repair themselves. When repair is inadequate, we see the development of birth defects, cancer, or death. The genetic oacerlal of the nucleus, the DNA, has incredible repair machinery, and the membranes of a cell, in spite of their extraordinary delicacy and complexity, are undergoing incessant replacement, 24 hours a day, 365 days a year. In short, evolution has given us resilient cells so that our bodie; can take a certain amount of damage. However, the repair systems can be overloaded and some damaging agents can specifically attack the repair systems. It is clear that there are certain tolerance limits, and if exceeded, the results may be birth defects, cancer or cell death. Most cancers are the result of a complex sequence of damaging events that have not been repaired. However, the damage need not be expressed; there Is a need to have other factors.which will "bring out" the cancerous damage. In some Instances, it may take 20-25 years to "bring out" the cancerous damage. This Is referred to as the "lag phase" and la best exemplified by the survivors of the atomic blasts at Hiroshima and Nagasaki. These large amounts of radia tion caused Irreparable damage to cells, but the cancerous nature of the damage was not expressed as a lump of uncontrolled cells until 20-25 years later. In these and a few other instances, there are exposures to a single damaging agent and clear cut blame can be affixed to that agent. In the overwhelming majority of cancers, there are multiple agents which Interact and cause cumulative damage. While there are many hundreds of dam aging agents, there are only a few different types of parts in a cell; hence, the same type of cell part may be damaged by several different substances. We can therefore see additive effects, and sometimes synergism, wherein the result is more than just additive. -3- i ucc os7556 III. THE CAUSES OF HUMAN CANCERS The causes of many cancers are known and are listed below- The numbers in parentheses represent the per cent of total cancer deaths caused by chat particular type of cancer. Type of Cancer o lung cancer (2 of Deaths) (20%) Causes cigarette smoking* o mouth cancer (2%) cigerette smoking* plus excess alcoholism** plus inadequate mouth care o larynx cancer ("voice box") (12) cigarette smoking* plus excess alcoholism** o esophagus cancer ("food tube") (52) cigaret .e smoking* plus excess alcoholism** o colon and rectal (162) high dietary fat plus low dietary fibre o liver cancer (ordinary type) (0.52) excess alcoholism** o urinary bladder cancer (52) unrestricted use of certain chemicals used in dye production o mesothelioma (0.0012) unrestricted use of asbestos o hemangiosarcoma (a special type of liver cancer) (0.0012) unrestricted use of vinyl chloride From the preceding list. It Is clear that we know what causes over 50% of cancer deaths. There are several major cancer types whose causes are not known and account for a total of 30% of the deaths; these are cancers of the breast, ovaries, pancreas, and prostate. In some of these cancers, we know a spectrum of associated findings chat add up to a greater risk, as in cancer of the breast, but this does not mean chat a causal factor(s) that can be con trolled has been discovered. In addition to the above known causes of cancer, the following substances have been identified as potent carcinogens chat are consumed in significant quantities (mllligraos/day) by the majority of Americans; these substances have not yet been linked as causative factors to a specific type of cancer, as in the case of cigarette smoking and lung cancer, but they are nonetheless * generally more than one pack/day ** generally acre than three ounces of distilled liquor/day, more than sixteen ounces of vine/day -4- ucc 057557 suspected of causing several different types of cancers- They may act as cocarcinogens, or act synergis tically- o nitrites/nitrates - are converted to dangerous nitrosamines when preserved neats, such as frankfurters, ham, etc., are heated artificial food colors - some colors that are widely used in a ultitude of foods and beverages are powerful carcinogens Some aspects of particular lifestyles are associated with a greater risk for developing cancer and include: o obesity associated with breast, colon and rectal cancer o multiple pregnancies coupled with inadequate gynecologic care associated with cancer of the uterine cervix o repetitive sun exposure causes cancer of the skin Added to all of the above are many ocher agents that are carcinogenic, but they are either weak, sparsely distributee, or not well delineated. This includes: o hormones used to relieve symptoms of the menopause o pharmacologic drugs used to treat high blood pressure associated with cancer of the endometrium associated with cancers of the breast and colon o high benzene levels capable of causing leukemias o varied organic com pounds in the work place thought capable of causing cancers of the skin, stomach, liver, lungs and urinary bladder The conclusion that should be reached at this point is that everyone is exposed to some combination of carcinogenic substances every day and the most significant ones are uncontrolled. Many agents are carcinogenic and there is a desparate need to study and define which of these agents should be brought under more restrictive control. Logic would direct imaediate attention, at this time, to those carcinogens that cause the greatest number of cancer deaths, and are also widely used. This would result In a list, in order of importance, as follows: o cigarettes o alcohol o dietary fat and fibre o nicrices/nitrates o artificial food colors ucc 057558 IV. SPECIFIC PROBLEMS IN NEW JERSEY The State of New Jersey is characterized statistically in a number of areas that have a relevance to the high cancer mortality rates, and which may also be involved in the solutions: o Most densely urbanized population o Lowest average land elevation with respect to sea-level o Highest unemployment rates o Reliance on local water sources of household consumption, in contradistinction to other states where water sources are not derived from the water table or rivers found in the concentrated urban areas. o Ranks 46th among the states in money spent far higher education per capita. o Until recent years lacked any credible medical schools; the two existing ones are developmental and reportedly rank 85th and 37th out of the approximate 100 American Schools according to the average scores of the students on the National Medical Board Examinations. o 752 of the interns and residents In the hosp `.tals are foreign medical school graduates; this is the highest in the country; in New York, the second highest, the figure is 502, while in Cali fornia, this number is 52; the reliance on foreigners is directly traceable to the absence of a large enough pooL of graduating medical students who have a dasire to undertake or continue their training in New Jersey hospitals. The intermingling of medical, social, geographic, and geological factors listed above, provide clues for analyzing New Jersey's complex cancer problems, and the thought that is required for the solutions. There is no simple approach, and to highlight this, a critical examination of the New Jersey cancer data is in order. The National Cancer Institute, under a program directed by Dr. Fraumeni, conducted a nationwide councy-by-county study of cancer death rates per 100,000 general population. This was done by transcribing what was written on the death certificates. The medical records of the patients were not examined. The death rates from 1950-1969 were catalogued from death certificates, and were classified by anatomic site, and sex. Hence, the number of deaths from cancer of the mouth, or of che stomach, in males or females, in Atlantic County, or Essex County, and other such numbers became available. These num bers are interesting, and, in general, there is no county in New Jersey that could be considered "safe" according to these data. The 1950-1969 mortality study was not designed by Dr. Fraumeni to provide information for definitive solutions. To employ this type of data for direct ing conclusive solutions is a frank misuse. The study was conducted to pro vide an overview of the scope of the cancer problem in the nation and nothing more. The reasons that che Fraumeni data of 1950-1969 cannot be used to dir ect any solutions stem from the lack of medical records data such as: o Size of cancer and extent of disease when the patient was first admitted and diagnosed in che hospital. These two ucc 057559 factors, size and extent of disease at time of diagnosis, are the principal determinants of the patient's prognosis as to life or death; if the cancer is large, chances are very high chat the cancer cells have already metastasized, o No treatment data is available to judge adequacy of therapy, and of long tens, dedicated follow-up. o No patient histories with respect to dangerous habits, nature of the diet, previous places of residence, occupation, income and educational level. If the Fraumeni data were to be used for a direct attack on the cancer problem, without any further extensive studies, several false leads would be pursued based simply on mobility and shifting of the population, espec ial' y in the years from 1950-1969. Miami, Florida has cancer death rates equal to those of New Jersey. With a moment's careful thought, the reason becomes ob' ious - many Miami residents are retired Northeasterners who have come from crowded urban settings. It is critical to remember that a 20-25 year lag period is required to develop a cancer from the numerous environmental exposures (in cluding cigarettes and alcohol). Further examination of the N.C.I. mortality studies reveals the following death races of ocher urbanized areas and their suburbs. o New York City o Westchester County (a Northern suburb of New York Clcy) -- o Nassau County (an Eastern suburb of New York City) o Philadelphia o Chicago o St. Louis City, Missouri o San Francisco 215/100,000 200/100,000 212/100,000 221/100,000 206/100,000 220/100,000 206/100,000 Since New Jersey received former dwellers of New York City and Philadelphia during the post-war years of suburban expansion, circumstances in these two cities may ultimately be responsible. Westchester and Nassau Counties may be high in mortality races for Che same reason chat New Jersey is, i.e., the city duellers led life-styles chat predisposed Co cancer and when the population shift out of the cities occurred, these individuals carried their irreparably damaged DNA and altered cell parts with them. If many of these individuals were in the lag phase (20-25 years), this could explain, at least in part, the findings. This Is a similar explanation for the high races in Miami, Florida. There are many other confounding factors that preclude conclusions, and these are as follows: o While the population was shifting into the suburbs, Including into New Jersey, industry also continued to grow in the state, o In the 1930's-1940's (the period of time when people were being exposed in order to develop their cancers and live 20-25 years later in 1950-1969), industry and government were largely ignorant of chemical carcinogens, hence fewer safeguards may have been used in this period. ucc -7- 057560 V. NEW JERSEY INDUSTRY AMD CANCHR The couaty-by-councy death statistics of 1950-1969 are divided by anatomic site and by sex. The overall death rates for white males was the highest in the country, but this was not the case for females or non-whites. This can lead to a great deal of speculation, but the data is insufficient for reach ing a solution. The Fraumeni numbers indicate that the national average death rate from cancer was 174/100,000 (for white males), while in Sew Jersey, it was 205/100,000, a 17X Increase. In females, the national average was 130 and, in New Jersey, 148/100,000 about a 14Z increase. These ere the increases that have precipi tated the current controversy. The increases are significant and were consis tent through the 19 years (1950-1969) of the study. More detailed numbers are presented in appendix A. Adding to this data are the estimates of the American Cancer Society, regarding New Jersey incidences and .mortalities. These are given in appendix B. The conclusions pertaining to New Jersey are as follows: 1. General Findings on New Jersey: Proportionally, New Jersey's figure on cancer mortality is greatar than that of any other state in America. Nearly all of New Jersey falls into the highest decile in the U.S. (top 10X) for white males and for white females (Appendix A). 2. Canes* categories in which the mortality, proportional to population, is higher in New Jersey than in any ocher state: o Rectal cancer (males and females combined) The rating of New Jersey as having the worst concentration of mortality from rectal cancer is based largely on the extremely high death races among both men and women in northern New Jersey, the Trenton-Princeton area included. This would not be classified as an industry-related cancer by cancer specialists. o Bladder cancer (males only - women not significantly different from the rest of the United States) A proportion of these are industryrelated. o Cancer of the ovary - The mortality figures among the woman of New Jersey's northwest comer -- Sussex and Warren Counties -- ranks with the worst in the country. Mortality figures are nearly as high among women in Bergen, Morris,.and Passaic Counties. This causes the mortality figures for women in northern New Jersey in this cancer classification to be worse than for any other single concentrated area in the netion. This would not be classified as an industryrelated cancer. 3. Cancer categories in which the mortality rates for the state of New Jersey rank approximately wlch the worst statewide records in the nation: o Cancer of the large intestine (males and females combined) New Jersey ranks with Rhode Island as the worst in the nation. This is not regarded as industry-related. ucc 057561 -8- o Cancer of the Trachea, Bronchus, and Lung - Mortality figures among New Jersey males rank as the highest in Che U.S., along with the mortality among males in Louisiana and Florida. A small proportion of these are industry-related, o Breast Cancer among females -- The record in this category is worst in New York, with New Jersey, Rhode Island and Massachusetts jusc behind. This is not classified as industry-related. 4. Cancer categories in which mortality for portions of New Jersey ranks with the worst areas in the nation. o Cancer of the Esophagus (males only) -- Northern New Jersey, Connecti cut, New York City, Long Island, and cha Greater Philadelphia Area of Pennsylvania, cocLined, comprise the worst single area in the U.S. for mortality figures in this category. The rate for females in northern New Jersey is above the national average. This is general I'/ caused by a combination of cigarette smoking and excessive alcoholism. In addition, women w*th rare benign esophageal problems are predis posed to cancer of this organ. It is not generally regarded as being Industry-related. o Cancer of the Larynx (males only) - The highest concentrations of mortality from this type of cancer are In northern New Jersey, New York City, Long Island, the Greater Philadelphia Area and the Pittsburgh area. A small proportion of these are industry-related, but generally are caused by a combination of cigarette smoking and excessive alcoholism. If an attempt is made to correlate the types of cancers that are known to be "industry-related" (i.e., industrial substances contribute together with other factors to the development of cancer), with the types of cancers occur ring in New Jersey, it would be expected that most of the excess cancer deaths in New Jersey would fall into the "industry-related" types - this is not the case. There are about 14,000 deaths each year in New Jersey, and about 26,000 new cases each year (from appendix B, estimates for 1974). If New Jersey had average U.S. rates, these numbers would be 12,000 and 22,000, respectively. The excess 2,000 deaths each year and the excess 4,000 new cases each year should fall into the classical "industry-related" categories which include a small portion of cancers of the: o Urinary bladder o Respiratory system o Liver o Skin o Lymph organs and bone marrow (lymphomas and leukemias) Instead, the "excess" 2,000 deaths are spread across all of the anatomic sites In the N.C.I. mortality study (lip, salivary glands, nasopharynx, mouth, esophagus, stomach, large intestine, rectum, liver, pancreas, upper and lower respiratory tracts, breast, uterine cervix, body of uterus, ovaries, prostate, testis, kidneys, urinary bladder, skin, eye, brain, endocrines, bones, and connective tissues). Further, there are some negative correlations, e.g. benzene is reportedly an industrial pollutant in New Jersey and supposedly is -9- ucc 057562 the highest in the nation, yet the cancer that should be caused by benzene, such as lymphomas and leukemias, occur at the lower national rates. o Lymphomas N.J. (White males) U.S. (White males) o Leukemias N.J. (White males) U.S. (White males) 4.93 4.89 8.74 8.81 Analyses performed by Dr. Donald Louria, Chairman of the Department of Preventive Medicine and Community Health, New ."ersey Medical School, Newark, and presented under the title of "Cancer in New Jersey: An Overview" at the "Seminar for Physicians: Cancer Risk Identification within New Jersey, and Methods of Cancer Control", May 12, 1976, in Cherry Hill, found chat only 600 of the 14,000 cancer deaths in New Jersey might by industry-related. A different analytic study conducted by Dr. Harr* B. Demopoulos, former Director of the Cancer Institute of New Jersey, also revealed the same types of numbers, i.e., no more than 600 of the 14,000 cancer deaths could be industry-related, among the deaths reported in 1950--1969; this report was given by Dr. Demopoulos to the "Skevin Committee" in testimony on November 5, 1976. These two independent analyses therefore indicate that 4.3Z of the total cancer deaths in New Jersey could be "industry-related". These percentages are Important and yet it is essential to realize that these analyses are based on insufficient data and reprasant the highest possible number of "industryrelated" exposures. This does not mean chat Industrial pollutants were solely responsible. If an analysis Is attempted of how many cancer deaths were caused s laly by Industrial pollutants, the data Is found to be totally inadequate and very soft estimates yield fractions of IX. While the cited studies and analyses refer to past events, there is meager data since 1969. The American Cancer Society estimates do not provide sufficient information to answer the obvious question - are cancer mortality rates and inci dences in New Jersey the same, better, or worse than for the period 1950-1969? Current, but inadequate, "samples" from hospitals that have excellent Tumor Registries indicate chat their cancer case workload has increased by 50Z in the past 5 years, and that Che average age of the cancer patient is younger by 5-6 years. This type of data is fragmentary and may reflect changes In referral patterns to some hospitals, or it may indicate a worsening of the New Jersey cancer problems. ' Clear cut answers require far more data. -10- UCC 057563 VI- THE LIST OF CARCINOGENESIS IN BILL NO. S-3Q35. SECTION 6 The list includes a mix of substances o Some are no longer in use, e.g., 4 Aminodiphenyl o Some are not carcinogenic, e.g., alpha naphchylamine - its carcinogenicity was proven to be due to contamination of alpha naphthylamine o Some are very potent carcinogens, e.g., benzidine o Some are rather weak carcinogens, e.g., asbestos and vinyl chloride o All are currently handled with precautions that le?. to low expo sures of workers such chat cancers will not develop. Asbestos and vinyl chloride are censed weak carcinogens on the basis of careful analyses of the cancers chat they cause. Excessive eC'.cems over asbestos as a carcinogen has been prompted by cases such as chat of a 14 year old boy who developed mesothelioma; he apparently was exposed Co this when he was helping his father to smooth down the joints of the newly replaced plaster board walls in their home. Asbestos was in the joint material, not In the plaster board. There was no ocher known asbestos exposure, and Che father did not other wise work with it. Cases such as this are exceedingly rare and form an inade quate data base. Mesothelioma does occur in nature, without asbestos exposure, and ic cannot be ascertained whether this 14 year old boy would have been a "Natural" victim, or whether the asbestos was indeed causal. Far more numbers are needed for statistically valid studies in such unusual cases. The relative weaknesses of asbestos and vinyl chloride are borne out by the fact chat workers who were exposed ta very large, uncontrolled levels devel oped relatively few cancers as s result. This is in contrast to a powerful car cinogen such as 3,4-dimechyl 4-aminodiphenyl, wherein 15-20Z of exposed workers developed urinary bladder cancer in a short lag phase (7-8 years). When the amounts of asbestos, vinyl chloride, and 4-aminodiphenyl are compared, versus the numbers of cancers developed, then asbestos and vinyl chloride are weak carcinogens. The idea of a comprehensive ban on all carcinogens would lead to the restriction of many activities and substances. Radiation, by x-rays, is the most powerful carcinogenic agent. There are methods for converting physical carcinogens into chemical equivalents, and when this is done, x-rays are quite potent. When the Manhattan Project (building the A-Bomb during World War II) was in full swing, the Department of Pathology at Rochester University was given the job of determining the 111-effects of radiation. There were some individuals who were so impressed by the pathologic changes chat they decreed a "Zero-expo sure". When subsequent, rational studies were done, it was found that small doses of radiation could be tolerated, even chough the effecta were cumulative over a life time. This type of exacting research has made it possible to use x-rays for medical use, nuclear plants for energy, etc. The same type of informa tion must be obtained for chemicals. t ucc 057564 APPENDIX A NATIONAL CANCER INSTITUTE MORTALITY STUDY 1950 - 1969 EXHIBIT 1 - New Jrsy Cancar Mortality 1950-1969 EXHIBIT 2 - New Jersey Cancar Mortality 1950-1969, by County EXHIBIT 3 - States With Highest Cancar Mortality, 1950-1969 EXHIBIT 4 - All Malignant Neoplasms 1950-1969, by State ucc 051565 CANCER MORTALITY 1950-1969 APPENDIX , - EXHIBIT 1 All Malignant Neoplasms (All cancer categories) causing mortality (Male, Female Combined) Total deaths, United States Total deaths, New Jersey Number 1 Annual (per 100,000 pop Rate whites only) 2,572,035 - M 2,253,232 - F' 174.04 - M 130.10 - F 106,900 - M 93,379 - F 205.01 - M 147.92 - F Highest Rates by New Jersey Counties * Hudson 14,049 - M 231.8 - M 11,004 - F 153.5 - F Middlesex 6.SSS - M 5,251 - F 220.3 149.2 -M -; Essex 16,975 - M 15,258 - F 215.1 - M 154.5 - F Highest Number by New Jersey counties: Essex 16,975 - M 215.1 - M 15,253 - F 154.5 - F Hudson 14,049 - M 11,004 - F 231.8 - M 153.5 - -F 3 s Is g o n <m 12,363 - M 11,894 - F 202.1 - M 148.1 - F ^ **) 1 OAO ucc 057566 APPENDIX A - EXHIBIT ALL MALIGNANT NEOPLa .5 (all cancer categories, :ausing mortality New Jersey, by counties White Non-white Atlantic Male Total Rate 3,213 195.3 Female Total Rate Male Total Rate 2,897 145.2 1 598 220.1 Female Total Rate 484 150.8 Bergen 12,863 202.1 11,894 148.1 373 281.4 344 192.2 Burlington 2,692 188.5 2,395 139.9 196 216.3 138 141.0 Camden Cape May Cumberland 6,329 204.7 1,264 194.7 1 1,683 181.4 5,647 148.4 1,037 142.9 1,551 140.0 586 228.0 72 184.2 150 155.8 520 177.1 78 176.8 141 144.2 Essex Gloucester Hudson Hunterdon 16,975 215.1 1,935 191.1 14,049 231.8 1,025 175.7 15,258 1,674 11,004 925 154*5 2,385 j 141*8 i 153.5 ] . 182 645 143.3 jj 17 219.2 2,155 154.S 183.1 142 146.0 289.7 571 197.3 297.1 19 303.2 Mercer 4,639 205.4 3,973 145.2 422 203. S 351 150.1 Middlesex 6,556 220.8 5,251 149.2 282 279.0 223 208.2 Monmouth 5,754 199.0 5,340 147; S 515 225.4 350 135.3 Morris Ocean Passaic 3,851 179.2 2,577 185.5 7,981 209.5 3,606 135.5 | ' 109 2,028 137.2 j 69 6,631 147.8 | 355 248.6 98 170.1 265.3 j 64 231.6 1 271.5 1 302 182.7 Salem Somerset Sussex Union Warren New Jersey 848 185.9. 731 146.6 147 2,151 182.8 923 180.9 1,820 135.7 ! 797 140.5 j 74 18 8,311 203.4 7,757 151.6 1 620 1,281 106,900 139.3 ! 1.162 i 205.01 j 93,379 147.7 15 147.92 7,830 Rates indicated are annual per 100,000 population Total deaths, for the period, 1950-1969, are given. 232.0 226.9 " 161.5 66 228.5 913.3 12 485.4 252.2 | 534 166.3 274.2 ! i11 10 230.33 >6,709 187.7 163.41 UCC 057567 IT 1TB IL1BIIU juiioai taiusis :uiro8*n roLoaioo :ohnecticot atuuxit pxsTiict or coiombii Vlobidi jCtCICIl .ID 1110 [ILLINOIS il NDI IN 1 110*1 KISS IS IENTUCKI Uouisimi .mm HilYUHD jMlSS1CH0SETTS MICDIG IN HlfcSESOT 1 'iiississirri jklSSOUSI EQBTiHl jlEEBlSKl In i vie i iNEM H1MPSHIBE !ne JERSEY ,N(W MCI ICO !)! YOBK :NOBTH Cl BOLT HI 'NOSTH Cl NOT! {OHIO oiiiHOr.i j08lG0 PEMMSILV IN 11 RHODE ISL1H0 SOUTH ClBOLIHI SOUTH 01 HOT1 TENNESSEE TCY1S UT HI VERMONT virgin:* viSHi:t;Tos ,U!ST `UIGISU ; VISCCSSIN o <jy c o VI o o> CD uics::;; RKITI MILE Noaaea BITE 29066 152.66 14782 156.19 22197 166.16 216761 171.39 21816 166.19 44501 195.68 5691 179.75 7915 203.75 76B59 163.58 31499 151.77 8566 ' 139.02 162672 182.81 67635 166.26 U6897 156.60 30969 163.89 38813 166.39 32662 190.39 17793 178.53 39157 192.63 95772 192.23 113318 182.62 56622 158.26 18050 156.60 70822 166.55 10201 153.07 23955 157.68 6050 167.39 11966 189. 19 106900 205.01 7689 136.30 107997 199.26 36533 160.11 9039 166.36 166265 178.61 36295 155.95 28316 155.12 189018 183.08 16636 203.17 16756 156.96 10513 169.86 38156 ' 166.28 107557 158.51 B369 133.16 6901 173.02 38218 157.53 65015 166.20 26025 156.62 65376 156.23 1953 138.93 NOHU1IITS HUE MOHSES 10156 BITE 160.26 1062 128.8J 6915 132.13 1508 170.77 620 169.99 . 1639 231.75 1100 235.97 6790 266.55 10683 179.70 11566 152.23 103 121.67 15012 216.77 6139 210:85 516 213.55 1666 189.16 6220 199.50 16576 193.6B 67 156.11 8099 226.B6 1971 215.92 9800 210.58 539 176.IB 9866 136.76 7096 211.5B 227 160.69 576 219.93 179 116.61 17 110.20 703*1 110,13 3VI) 95.50 21572 227.69 10561 167.17 97 161.57 125.-1 > 226.35 2V36 166.BO 67 1 158.61 1S0c6 236.89 362 216.56 71 35 165.59 252 117.79 7-176 163.79 15H21 167.51 190 152.86 18 207.22 115 31 J89.62 ! 3*. 7 1 9.72 1 "*7 1 191.28 S15 191.56 fo 123.16 | | | | '| | | -| | | | | | | | | | | I | | | | | | | | | l | | ) | | | | | | | | | | | ( | | | | ( 266105 184.28 | UHITB Munata 25663 11301 17726 195 171 2 0219 38333 5171 8123 iL.7S 30181 6667 162396 62111 62106 28096 36016 266 11 16135 35366 90506 92966 67219 150 30 63213 7653 20736 2656 10655 93179 6915 273316 33866 7086 130611 28878 23168 170851 16770 15295 8386 357 6 3 90072 7233 6551 35219 36251 222U 1 56898 2962 EEHUE SITE 111.88 110.68 108.03 128.09 117.29 118.66 116.62 161.73 (10.56 111.27 110.15 137.78 130.60 126.16 115.08 121.61 118.90 160.66 138.66 139.67 135.63 127.05 113.03 125.58 119.28 123.75 118.79 160.20 167.92 115.10 168.01 106.97 119.65 136.25 116.01 119.27 160.26 163. 37 111.59 119.98 115.95 111.16 102.06 136.61 119.12 121.61 121.75 132.35 109.09 2253292 130.10 KOMVHITE MOBBED 10915 811 6660 10785 662 1067 776 5665 8959 12652 73 13060 3608 180 1286 3500 12666 68 080 1680 7830 380 10166 5882 207 682 180 16 6709 352 18920 10701 ' 110 9762 2906 107 11528 212 7667 302 7796 13652 101 11 9256 773 1 371 707 52 /IflUl BITE 127.17 111.76 121.99 124. 10 116.17 139.39 162.57 166.05 131.16 130.90 109.27 160.98 157.97 151.28 16 1 < 156. i 163.77 16 1.70 156.73 161.86 151.26 1 28.98 129.66 159.07 157.24 175.99 148.97 1 10.02 161.41 96.48 152.80 124.39 165.14 159 TO 11* 1 122.88 157. 10 131.64 121.97 184.07 12.5t 120.45 108.96 119.06 118.94 179. 19 149.77 1U0.97 110.09 226561 119. 19 APPENDIX B AMERICAN CANCER SOCIETY JCRIALITY AND INCIDENCE ESTIMATES 1974 ucc 057569 Stats Alabama Alaska Arizona Arkanaj California Colorado Connecticut Oelawart Din. of Columbia Florida Gacrgie Hawaii Idaho Illinois . Indiana Iowa Kanas Kentucky Louisiana Mains . Maryland Massachuatts Michigan Minntsota Miaispopi Missouri Montana Nsbraska Nevada New Hampshire New Jersey Maw Mexico Nsw York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode island South Carolina South Dakota Tinnosaa Taxis Utah Virmont Virginia Washington West Virginia Wisconsin Wyoming United Stuas . Estimated Cancer Deaths for All Sites, Plus Major Sites, by State - 1974 APPENDIX B - EXHIBIT A 1 Silts Numbar of Deaths Otath Rata par 100,000 Population 5,400 200 2,600 3,500 33,200 2,300 5,400 900 1,600 14,600 155 62 134 175 153 122 167 152 193 197 6,300 900 1,100 19,900 3,600 5,200 4,000 5,400 5,900 2,200 130 110 150 172 15S 182 175 165 156 212 6,400 11,200 14,500 6,500 3,600 8,900 1,300 2,800 750 1,500 150 189 155 >63 162 184 185 185 133 139 14,000 1,200 37,700 6,900 1,100 19.000 4,500 3,700 23,500 2,000 184 115 200 132 181 172 170 166 137 204 3,500 uoo 6,300 17,100 1.100 350 6,300 5,600 3,400 7,800 500 132 182 155 144 97 182 139 154 201 159 . 149 Braait 425 15 225 225 3,200 275 500 70 175 uoo 550 60 90 1400 300 500 375 425 475 175 600 uoo 1.400 600 275 800 100 250 60 150 1,400 100 4,000 600 90 1,300 350 325 2.300 200 300 80 550 1,400 100 70 650 500 250 800 40 Colon* Rectum Lung 550 20 300 400 4400 400 *30 125 200 1,900 1400 50 650 850 7400 500 1.000 225 325 3.500 50 90 125 ,800 1,300 850 550 700 600 300 1,500 150 175 4,100 1,800 950 750 1400 1,500 ' 425 850 1.700 1400 950 400 1400 ISO 425 30 250 1,600 2,200 3,100 1,100 750 2,100 200 475 200 325 2.200 125 5400 700ISO 2,700 550 500 3,600 350 3.000 200 7.400 ' 1,400 175 4,100 350 850 4,600 400 375 175 750 1.800 ISO ISO 800 700 400 1,200 60 750 200 1,400 4,000 175 175 1,500 1,200 350 1,300 75 Major Sites Oral 125 5 70 75 750 60 175 25 60 350 150 30 20 450 175 too 90 150 ISO 40 175 300 300 125 70 175 25 60 15 30 300 20 8C0 175 15 425 30 30 500 60 80 20 150 375 20 20 175 125 70 175 to Utirus Prostate 250 10 so 1QO 1,000 70 125 20 60 400 325 10 150 250 1,400 175 250 30 80 800 Stomach 175 10 100 125 1,400 100 250 30 60 SOQ Pancreas 325 10 150 200 1,300 175 275 50 80 700 275 375 20 30 25 80 700 1,000 325 450 125 350 125 275 200 300 200 325 60 125 250 35 Q 90 70 40 70 850 1,100 250 450 175 250 100 225 150 325 250 300 SO 100 200 300 200 300 475 525 425 750 525 125 450 300 125 250 iso 275 550 275 30 70 50 70 175 100 20 25 10 50 80 40 325 600 700 375 225 475 80 175 0 30 400 30 1.000 300 25 650 125 100 750 50 550 Si 1.500 375 70 900 300 200 1,100 80 650 50 1,700 225 60 700 ISO 125 950 100 700 70 2,000 375 70 900 275 200 1,200 90 150 200 100 40 100 50 225 375 200 600 300 650 30 80 50 30 50 30 250 375 225 150 300 225 125 200 125 200 450 350 10 40 15 200 90 350 950 60 50 375 325 200 400 30 Leu kemia 200 10 125 200 1.400 - 150 250 30 40 5C0 275 50 70 900 350 275 200 275 250 SO 200 40Q 550 275 200 40Q 60 150 30 7Q 500 50 1,400 350 50 75Q 20Q 200 950 60 150 80 275 900 SO 40 275 275 125 325 20 355,000 167 ----- --- --- ,, 33,000 48,000 75,000 3.000 11,000 18,000 14,000 19,000 I5.00Q _ ,, . .. --- -------- --------- -- ... . . ------ ucc 057570 Estimated New Cancer Cases for AJI Sites, Plus Major Sites, by State - 1974 APPENDIX B - EXHIBIT ucc State Alabama Alaska Arizona Arkansw California Colorado Connecticut Dtliwari Dirt, of Columbia Florida Georgia Hawaii Idaho Illinois Indiana low* Kansas Kantueky Louisiana Main* Maryland Misacflueera Michigan Minnesota MissisopB* Misouri Montana Nebraska Nevada New Hampshire New Jersey New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Oakota Tennesa* Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming All Sites* i-------------------------------------------------------------------------------------------------------- -- Major Sites Number Ub n n of Casas Breast Colon* Rectum Lung Uterus Leu- Oral (Invasive) Practat* Stomach Pancreas kemia 10.000 300 4,800 6.400 61,000 5,400 10,000 1,700 3,100 27,000 1,100 50 600 600 8,700 750 1,400 200 500 3,300 1,100 50 EDO 800 8,700 800 1,700 300 400 3,300 1,300 60 700 1,000 8,100 550 1,100 250 350 3,900 350 15 150 200 2,300 150 500 70 200 1,100 1,000 20 3S0 500 3,900 350 550 100 250 1,600 950 30 450 750 4,200 550 750 SO 250 2,400 303 15 ISO 200 2,300 150 400 SO 90 1,000 350 10 150 200 1,900 200 300 SO 80 750 300 20 150 300 2,000 200 350 40 SO 700 12,000 1,700 2,100 37,000 16,000 9,500 7,300 10,000 11,000 3,soa 1,500 150 250 5,200 2,200 1,400 1,000 1,200 1,300 500 1,100 200 250 5,8002.700 1,800 1,100 1,400 uoo 600 1,700 200 200 4.500 2.000 1,000 800 1,300 1,700 450 450 SO 50 1,400 500 300 300 450 450 125 1,100 60 100 2,700 1,300 650 650 900 850 250 1,100 SO 250 3,000 1,400 1,100 800 900 950 400 400 ISO 70 1,400 400 300 150 250 400 150 350 70 70 uoo 450 250 250 350 300 100 400 70 100 1,200 500 400 300 400 350 100 12,000 1,600 1,300 uoo 500 900 900 350 350 300 21.000 3.300 3,500 2,400 900 1,200 1,400 -850 BOO 550 y 27,000 3.300 3,900 3.400 900 1,600 2,300 850 750 750 12,000 1,600 2,000 1,200 400 600 uoo 500 400 400 6,600 750 800 800 200 700 750 250 250 300 16,000 2,200 2,500 2,300 500 U00 1,700 450 500 550 2,000 250 300 250 70 150 200 30 80 80 5,300 1,300 700 900 550 150 150 150 250 so 300 500 150 200 200 SO 80 15 50 40 2,800 400 500 350 90 200 250 70 . SO 100 26.000 2,200 70,COO ^ 3,800 250 10,800 4.500 250 12,000 3,300 250 3,200 900 60 2.500 1,600 150 4,300 1,700 ISO 4.500 1.100 80 2.300 7S0 70 2,100 700 70 2,000 13,000 1,600 1.400 1,600 500 1,200 1,100 350 400 500 2,000 250 300 200 SO 80 200 100 70 70 35,000 4,900 5,600 4.500 1,300 2.500 2,700 UOO 950 1,000 8,200 950 1,100 1.100 250 600 900 250 300 300 6,800 900 1,000 950 250 500 600 2GQ 200 300 43,000 6,300 7,400 5,100 1,500 2,800 3,300 1.S00 1,300 UOO 3,700 550 700 450 200 200 300 150 90 SO 6,300 2,200 12,000 31,000 2,100 1.500 13,000 10,000 6.200 14,000 800 800 250 1,500 3,800 300 200 1,800 1,400 700 2,200 100 750 350 1,600 3,700 300 300 1,700 1,500 800 2,500 100 850 250 1,500 4.400 200 200 1.700 1,400 300 1,400 90 250 SO 450 1,100 50 60 500 400 200 500 20 700 150 1,000 2,300 200 100 1,100 700 600 8S0 60 600 300 1,100 2.400 250 ISO 1,100 900 600 UOO 90 ISO 80 300 UOO 30 50 350 350 200 600 20 200 90 350 1,000 SO 50 400 350 200 400 30 200 1QL 400 UOO 30 50 400 400 ISO 453 30 Unitad Statu 655,000 SO,000 99,000 33,000 24,000 46,000 54,000 23,000 20,000 21.000 lnclu<?*.jafti"om*`i'1'w,u ol lh* "twin* ctrvix ar iuc*rticiai jkin cancers. These estimates u* offered u rough quid* *nd rhoufd not b* * *i de mitiv*. They >r uituletH according 10 the distribution qI ecttmered 1974 cancer dcathtby nett. Esptct*iy not* that yea/ to year