Document qdJJ8Z41wz1gD6bbvKB33Y6BR

FILE NAME: New York State & NY Times (NY) DATE: 1951 Oct DOC#: NY103 DOCUMENT DESCRIPTION: NY Dept of Labor Monthly Review - Occupational Cancer Newlibrk State Department o^Labor MONTHLY REVIEW Xa>? (D ivisio n o fIn d u stria lH ygiene & S a fety Stan dards V o l. 30 OCTOBER, 1951 OCCUPATIONAL CANCER* rf m d ic a , No. Ao A Challenge to the Physician 0Cr S O 2J5j; f t fie i ? revent,101! f ^ "P ^ o n a l diseases we have a v -5, e , 1 wh,ch ,the practicing physican can make a ital contribution in the course of his regular work. It is unique in that the data required cannot be developed in a research laboratory or in a university. It must come from he physicians who actually -see .cancer cases or cases of suspected cancer, either in their own private offices in cancer-screening clinics, or in the hospital. It is thus a m ad T i, pr? WT [ ef rardnary importance practically devlr f ^ ^ f r the buS7 Practitioner who is willing to te the few extra minutes necessary to take a careful ccupational history on his cancer patients; and report for urther investigation, cases suspected of having been ex Yf IT? posed to carcinogenic agents in industry. & o e Practicing physician in this matter, the New ork State Occupational Cancer Committee has prepared this information. The tables provide a few useful clues aern tt found V he Cbe'hical suhstances and physical sussppeecctteedd of having car^cinoWgehnlCihc p^ropearttieths,e aPnrdestehnet ttyimpees, will n ^ d o KteVei t0 i 6 Caused.V them.' Further stH J ' ubt, add others to this list; some now on the T hhee TtaabblellToffTp,recaBnecderroPups el,des"ionnsCWtogdeatthaebreCwOitmhe tahveahoacbclue-. fthheemm,n iis iinnartthheengeattnuSre of aWtehniCtahtievXePcehrieecnkc-elisht aosnasthsoecibaatseids present information. A copy of the form used by nhvsi m n s in New York State, exclusive of New York CitV for reporting cancer cases is also included. f ,te p s,ibU f -, sz : `y ; r `iZr7. * ,yte f mrt provide a basis for prognosis. i-- - * make available, under State Compensation Laws, financial 3 ?assistance to the esta-blish statistical patient data as and his family. " to incidence, y . distribution and trak 7y' Cancer C0m m k t " b^ ' TM r. ] ' yb Y" rK State Occupational 2 S S S U I? Department of S S ' ',, " S If called upon by ^'physiciaYififefes,. cooperating m this program, the New" York State Otf ipational Cancer Committee is prepared to follow any suspec'ted` else" of occupational cancer in New York State into the workroom where ,t is believed that it had originated, and to make all necessary technical investigations of the environmental fac tors which might have been responsible. Such investigations TMurements, chhemicali anaal,nyasilsySoirf aifr mcoantetarmialisn>anratds iianhothnemfoerams dus.ts, gases, fumes, dust counts, or any other techniques as indicated In thus tracing back the occupational exposures of cancer patients it is hoped that occupational factors not k8 sp c,usi" 8 c,ncet *h" ebi' >* of b . I l T A 'i S,;i,e the professional slai of the Division of Industrial Hygiene and Safety Standards may be called pon at all times for consultations and study of these prob- heT bh ^^ the scientific evaluation o fa n y health hazards which may be present, and practical J - sistance with control measures. All such requests should be addressed to Dr. Leonard Greenburg, Director DN^ion of Industrial Hygiene and Safety Standards New York U N Y aftment f Lab r' 80 Centre Street> New The medical profession is well aware of the extent to esponsiiblte ffor ktih0eWulnedsateisfafctothrey sbtaastiec ocfauosur oprfopcahnyclearctiics and therapeutic approach to this problem. We do know be leenta c .w rdatl nshiP has been definitely established between cancer and exposure to certain chemical and physical agents in industry. Thus, exposure of the skin to certain types of oil, tar or pitch V k n o w n t o cancer On the other hand, epitheliomata of the b adder a e definitely known to result from exposure to certain of the Ip h fh " < Z i i " n" facture of s" h baffling disease. Too little attention has, however L e n paid tfl'J Z ` f " An appreciable ,, J b " t J S c unrecogmzed as to occupational etiology. ' t a w n o fPthe S fc ' g 17 \ The material on this page was copied from the collection of the National Library of Medicine by a third party and may be protected by U.S. Copyright law. MONTHLY REVIEW of the D iv isio n o f I n d u s t r ia l H y g ie n e and Sa fety Standards NEW YORK STATE DEPARTM ENT'OF LABOR 80 C en t er Str eet N ew Y o rk 13, N. Y . EDWARD CORSI Industrial Commissioner THOMAS F. MOORE, JR. 1st Deputy Industrial Commissioner EDWARD A. NYEGAARD Deputy Industrial Commissioner tn Charge The Division Leonard H. Greenburg, Director M ay R M ayers, Medical Bureau W illiam J. Burke, Chemical Bureau George P. Keogh, Code Bureau Arthur Stern, Engineering Bureau Leonard A. Perrin, Engineering Unit ' Building Plans earmarks which immediately suggest an occupational etiol ogy, or even a specific occupational exposure; or that they present medical syndromes so distinctive as to clearly dif ferentiate them from non-occupational diseases. This may occur, but it is relatively rare. Whether one is dealing with cancer or with other systemic diseases, such as hepatitis, nephrosis or aplastic anemia, resulting from exposure to toxic agents in industry, as clinical diseases entities, they provide no specific clues as to etiology. In many cases, the occupational etiology is unsuspected. In order to acquire new data as to the environmental factors -- suspected as well as unsuspected -- which are responsible for cancer cases, it is necessary to know pre cisely what the patient s occupational exposure was; what chemical substances he came in contact with; what other environmental factors were present in the workroom. Since cancer will usually develop only after a great many years of exposure, and even many years after exposure to ani occupational carcinogen had ceased, the occupational his tory of the patient must be carefully studied all the way back to his first job. This is difficult. But it will be re warding. At any rate, it is the only way to get the necessary data. Frequently, however, the patient will not know or remember the precise chemical substances, for example, with which he worked. Or he may forget to mention the only exposure which happens to be significant in his case. The names and addresses of the plants where the patient had worked are more readily obtained. This information alone can be a useful guide for a technical investigation of the patient's occupational exposure over the years. The importance of the occupational history form thus cannot be overemphasized, since a complete occupational history is indispensable to developing any useful data with reference to occupational cancer. History taking, whether it is the clinical history or an occupational history, is very time-consuming. The occupational history, however, is less familiar to the medical practitioner and so it always seems to present the greater hurdle. For that reason, the suggested Occupational History Form has been made as simple as possible. N o matter how carefully and intelligently the case has been worked up, or how accurate the diagnosis, the possi bility of an occupational etiology must not be overlooked. Recognition of an occupational etiology, where it exists, will provide invaluable information as to the type of work the patient must avoid in the future; it will provide a basis for prognosis; and it will make possible assistance to the patient and his family under the Compensation Laws of the State in which he lives, providing them with much-needed finan cial assistance during a period of disability. Recognition of the occupational etiology of cancer cases, where it exists, will provide statistical data as to incidence, TOWN 'VILLAGE/CITY (Legal Residence of Patient) PATIENT'S NAME (Please Print) COUNTY PRESENT AGE- DIST. NO YEAR OF BIRTH: PATIENT'S LEGAL ADDRESS: USLTAL OCCUPATION TRADE: Date First Symiptom of This Tumor ( I f Institution Inmate, Give Previous Legal Address) __________________IN D U S T R Y : Date of First Visit for This Tum or to Physician Reporting CLINICAL DIAGNOSIS: SEX: COLOR: MARITAL STATUS: W as P rior V isit M ade to Another Physician for this T u m o r t PATH. DIAGNOSIS PRIMARY SITE (Tissue of Orgin) STAGE OF U lbbA Sb When First Diagnosed l By Physician Reporting: J Now 1 1Early Advanced I N.oral Local I I J__ j Regional Nodes 1--- 1 D istant Involved j__ J ' M etastasis j j |___| Recurrent j----1 REFERRED BY: REPORTED BY- Ho?PItal Phvsician DATE OF THIS REPORT- . HERMAN E. HILLEBOE, M.D. Commissioner F o im C .C I . 9-51 50M (SL-43) (Name) Address or Institution : If Now Hospitalized, Name of Hospital or Institution MALIGNANT NEOPLASM CONFIDENTIAL REPORT New York State Department of Health BUREAU OF CANCER CONTROL 38 ---------- ----------- Tumor Clinic Patient Check here if you wish more report cards D Name of Clinic or Hospital: ...... Address: .............. _..v........................ Name of Patient: ..........._.............. Address: .......................................... Diagnosis: ..................................... NAME OF PLANT Present Occupation Each preceding occupation SUBSTANCES - vC ......Date: ........... : cd OC l O ..M co Z) >, _Q ............................... Age at Commencing Work: ............ .......... Present Age: .............. "O O OCCUPATIONS (List in chronological order) o Cl 02 PRODUCT TIM E EMPLOYED -O MONTH -- YEAR >- ADDRESS M ANUFACTURED PR EC ISE JO B TH ERE FROM TO CD E "cO (D CHECK-LIST OF EXPOSURES 1 IN D U STR IES O C C U PA T IO N S YEARS IN EACH ' -- The natenai on this page was copied from the collection of the National Library of Medicine SKIN LESIO N Alopecia Atrophy Eczema K eratosis Hyperkeratosis Verrucae Ulceration Leukoderma Leuko-melanoderma M elanoderm a Scleroderm a NASAL PASSAGES Papillomas Polyps Perforation Ulceration BLADDER Hemorrhage, submucosal P apillom as EYES P ap illo m as BONES AND BONE MARROW Blood dyscrasias TABLE I Description o f Selected Lesions Which M ay Be A ssociated With O ccupational Cancer Producing A gents D ESCRIPTIO N Spotty loss of hair. Skin grossly thinned and glistening in patches, associated with keratotic areas. D ry seborrheic patches on skin. * Flat, discrete, scaly area on skin with raised pearly borders ! Usually on iparts o f skin exposed to carcinogen, but may occur in unexposed parts, particularly about sweat glands with, arsenic. Rough, fissured keratotic plaques with small, hard, wart-like / horns, usually on hands and soles. M ay become nodular and ulcerate. Form of hyperkeratosis. Breakdown of keratotic lesions - Absent pigmentation alone. -, Patchy increased and absent pigmentation o f skin. Most common in areas o f highest pigmentation, and m ay involve oral mucosa. 3 Increased pigmentation alone D ry scaiy pardim ent-hke skin, with enlarged po.es, asso ciated with leukomelanoderma Develop in antrum, ethmoid cells, and turbinates Nasal septum. Nasal mucosa. V arying size with telangcectasis. Located mainly m trigone! and about ureteral onfies. I Polypous or villous pedunculated or sessile, often multiple f about trigone and ureteral orifices. J ETIOLOGIC AGENT Arsenic, radio-active substances, radiation. Pitch, tar, asphalt, radio-active substances radiation (including ultraviolet rays) Arsenic, asphalt, pitch, soot, tar. Anthracene, arsenic, asphalt, creosote, crude m ineral oil, crude paraffin, pitch, sodium nitrate, soot, tar, radioactive substances, radiation (including ultraviolet rays) Anthracene, arsenic, asphalt, creosote, crude m ineral oil, crude paraffin, pitch, tar, radio active substances, radiation (including ultra violet rays). Crude m ineral oil, crude paraffm , radio-actn e substances, radiation. Nickel carbonyl. Chrome salts. Chrome salts. A d erivtiveT Z1<Une' ^ napth>,Iamme and Pedunculated, develop mainly on lids, occasionally on eyeball. A rsenic, asphalt, creosote, crude mineral oil ray s) tar> ra^ iat*on (including ultraviolet H y ifp la stic , hypoplastic, aplastic or hemolytic anemia. l a r g e c | OCyt0pemC purpura with sPleen not m arkedly en- Peri-osteitis. Beradiitfonn d eriva,ives' radio-active substances, distribution, causative agents, etc., now practically non existent. Very few people realize how little reliable infor mation there is, at the present time, as to the incidence of any of the occupational diseases. Occupational cancers, as a rule, result from prolonged exposure to physical or chemical carcinogenic agents in the working environment. Such exposures may be continuous or intermittent over a period of many years. There may be a long latent period before the first evidence of cancer begin to manifest themselves. During all or part of this period, there may be no contact whatever with the carcinogenic agent originally responsible for the cancer. In the case of radium, for example, this latent period may be as long as 20-30 years. , Individual' susceptibility probably plays an important role here as in all other diseases, occupational or non occupational. N o doubt, when more is known about the many metabolic and biochemical factors involved in cancer formation generally, it will be found that some of these same factors are operative in cases of occupational cancer. It is a matter of great practical importance, for the present purpose,. that the industrial environment is essen tially a man-made artificial one peculiarly susceptible of scientific measurement and medical evaluation from the standpoint of hazards to health -- including the production of occupational cancer as well as other occupational di seases. O f equal importance is the fact that these environ mental factors in industry responsible for injury to health, once recognized, can be successfully controlled. Fortunately, the techniques for the control of the industrial environment and the prevention of occupational diseases are highly developed at the present time. As a guide to the physician who, for purposes of pre vention, is interested in investigating the role of occupaiton in cancerous or pre-cancerous lesions presented by his patients, Tables I and II are appended; also a selected bibliography of literature having a direct bearing on these problems. Table I presents a description of selected lesions which have been found, as a result of experience, to be associated with agents in the occupational environment which are known to be carcinogenic. Table II lists, alphabetically, for reference purposes, some of the more common substances or conditions in the occu pational environment which are recognized as being cancerproducing or suspect. With each such agent the organ or system usually involved, is presented together with a clas sification in the right-hand columns, indicating whether the etiological relationship is doubtful (Class^ D ) or estab lished (Class E ). The New York State Occupational Cancer Committee would greatly appreciate the cooperation of practicing phy sicians in reporting any information they develop as to the possible relation of occupation to the pathological lesions, malignant or benign, which they find in their patients. The New York Siale Occupational Cancer Committee is an unof ficial agency with the following membership : May R. Mayers, M.D., New York State Department of Labor, Chairman Austin V. Deibert, M.D., U.S. Public Health Service Konrad Dobriner, M.D., Sloan-Kettering Institute, New York City Harold F. Dorn, Ph.D., U.S. Public Health Service G. H. Gehrmann, M.D., Manufacturing Chemists Association Paul R. Gerhardt, M.D., New York State Department of Health Hyman Goldstein, Ph.D., New York State Department of Health Leonard Greenburg, H.D., New York State Department of Labor Arthur E. Hoag, M.D., Member, American Petroleum Inst. Leroy S. House, M.D., Tumor Clinic Association of the State of New York W. C. Hueper, M.D., U.S. Public Health Service Louis C. Kress, M.D., Roswell Park Memorial Institute, Buffalo, N. Y. Anthony J. Lanza, M.D., New York University, Post-Graduate Medical School, New York City Morton L. Levin, M.D., New York State Department of Health George T. Pack, M.D., Medical Society of the State of New York ( Continued in the November, 1951 issue') TABLE II A lphabetical Listing o f Recognized and Suspected O ccupational Cancer Producing A gents, With Sites C haracteristically Affected SU BSTA N C ES OR C O N D IT IO N S Aniline and derivatives . . . Aromatic organic ORGAN OR SYSTEM Bladder, ureter, kidney .. CLASS D* D D D D D Benzidine and derivatives Bladder, ureter, kidney .. D Blood forming organs .. Blood forming organs . . D Chlorinated hydrocarbons.. D D D D D D D D Napthylamine-- alpha ......... Bladder, ureter, kidney . . D Bladder, ureter, kidney .. * iD--Reported cases-- etiology still doubtful, t E-- Established etiology. CLASS Et E E E E E E E E E E E E E E SU BSTA N CES OR C O N D IT IO N S Nickel carbonyl Paraffin, crude Pitch .................. R adiant heat ......................... Radio active substances . . Roentgen rays S h ale oil . ............................ Sodium nitrate, c r u d e '... Soot ........................................ Spindle oils, aromatic .. T a r .......................................... Traum a, chemical Traum a, physical Ultraviolet rays 1 ORGAN OR SYSTEM CLASS D* R espiratory tract .............. D Skin ........................................ Skin ........................................ L ip ...................................... D B lad der .................................. D Eye ........................................ Skin ........................................ D Skin ........................................ L u n gs .................................... Blood forming organs . . . B o n e ........................................ Skin ........................................ Blood forming organs .. . Subepithelial connective tissues ............................... Eye ........................................ Skin ........................................ D Skin ........................................ Skin ........................................ B ladder ................................. D Skin ........................................ Lip .......................................... Skin ........................................ R espiratory system ........... D Bladder .................................. Blood forming organs . . . D D Eye ........................................ Skin ........................................ D Skin ........................................ Blood forming organs . . . DD Mesenchymatous tissues . D Eye ........................................ D Skin ........................................ Eye ........................................ CLASS Et E E E E E E E E E E E E E 17 E E E E. E 40