Document 82GMw35pjdoro7J6RO523ydOd

FILE NAME: Saranac 7th Symposium (SSY) DATE: 1952 DOC#: SSY059 DOCUMENT DESCRIPTION: Transcript of Presentation by Dr. Vorwald Pneumoconiosis and Pulmonary Cancer ------ 527G t _ k k k k s s i s *::s 7 W . ; * n c ^ . Ch*ir=t=> C. y. r i 9 i * . K* c * Fhidoa h T ef s le iM tU tle * i?--U ed " Korton L* L e rin , )' i/iC*ofi8ioa G arterd Beviev V. C. I:ue?er, !' P isc u ssio n /.EleEt9E !'in e rt v / ? t u l C a r tie r , !' *> Disc\r>eioa ` Asl?octos Ve&Tfers ZerSiSt l !'. i.7r,cr* ** . . v_ - r . A. ::cro v 3t r . e r , -' * X^scuEEioz, let. ty -- -- A* ' VJ. . . ,v i -_ *ie icC t tlr.c "*~i ue^--* i.&diei and :er.tle-6 -o * * - 4 f , * s - tw trr* rila-toc* .' -= ?c ta a - vC v;e,r.e Vchind E c,.e -u e * > ^ of * ^ v i l l -proceea \p th is tine c -rW ~ e c" v? . ,. v itt t_r.O CieE-.' . j v : U . * * * i f . . v e r7 t i S * -- ^ . *' ^""! CLr'm T e_ t r ,1 ve t *' the or oor ehE.ir.3eh, I - - com pile- e le c tiv e fo r todev. s . t . r,, r.r= r ve Vt3ir. != '-'-? V'5 r: " * 3 ' . , .i _ t ^ it nt^.e* t* CE--* ^*0-r tf ;e r .- s Cv t^notr.cenenU ^ ^ " . ty-.i-rrov r.c. a--*' **'' tio n to V:* b ^ t - e t **" e* " I I r. O VI I-* oX M > n* & 1 M U oU Iv.. O c t r< >o* 5 o o u M (K o r* f*t* t* 4 M t* If t o V 0rr rV rP fc li % r* f*. %- !t <* ft i. U O U *0> ot; M .t 1 - X (9 n O f 1 U *: -* t* n *u rt M u <0 ID (O 1#' 1 * o *- r* ti mO r. a r* *4 II ot f. J I 9 *1 a i* tl O rf 0 !u/ ft v * - ItIt I" 0t; ol- o Kr u in 1 - 1 i - Vo1 t J o r: a fIJt fftt rr- I-** IS I*t p <rt p <1* ft- M it j ro.* ft 0 If r* o <ft ti < w M * s tit o 0 o o o H a & $ < * fe* 0 0 P t V P * t fi v o 0 t0f o M P* c- 1* e 5 u; tr 9 3 ct fOc IoI ct *: %. c& o P a3 O Ic*t t *- y cf i* u ati rf rr t*? &o I i; ?i c* t; wO ocl> oI V* tpt o ip; r-ft r` u o r* 1 " t O > o oIV w ot Vtrf i J? II is tf - :I* * 1* : li r*- fe Oo S'* V .r1t l- rr * y p \\ o 0 o *.i r; ; aj -:nj l I o 1 o o t o 3 li fU. i* M 11 t ft O Cl i:. t> M vo i *! r rM* \of u - n f, o R u t o i: t i I !i f:. o p* t t ct j-H> mCO Co vet: *1 cn k KECEIVED F.H.H&S PATE: JUL 3 i 1579 ... B.E.M nuch p u b licised p o sitio n o f 4 1r * e t r, th s t unhsooe type o f ln d is id u s l tr y la c to yersu sd e o r th re s te n ia iiT id - u ls to do vfcst b* tfclabr they ouyht to d o . Ee tiw tr s fin d e .l scry d if f ic u lt indeed, of course, i f not ln p o s title . how ever, I v e t eery fctppj to be so le to sc ce p t t o c to r V o rw sld 's i r s i t e t i o n , b eesu so in o u r .r o w * ~ 5r croups ssso e ie te d w ith u s , neve core certs.!/. c rp sctc of v o r i w h ic h p e r t a i n , I t h i r d : , t o y o u r - - U r i * t r '': t 0 ^ f ie ld o f pu iao n cry e e n e e r. I ttv e no eor.cents lr. the f i e i o f s t a t i s t i c s , end so v i i l le ts e th a t i-:?o rto r.t to p ic to tie s e vho v i l l p re se n t p tp c rs . I V S . ir tr e e sed, heuever, v i t h the ? ro : rs.-., to observe v ast seen, to be s tfro n fly inclined point of tie '. tov:srd tbo su rely to d o e irU l beaerd aspect of t- is t o i l e r tnd perhaps le rs stter.tio r. riser, to d is-r.o st.e, t..:.e ? e -. end experlnentdl cone id e r a tio n s, wirier, -erheps ?1*T = "** terestin^ role* U ntil ve cer., tnro u y i your e f f o r ts , iinir.& te t c u e . of th is v .ry s e r io u s e o n d itio r., vo -os*, consider uv.e ecr. be done b e t t e r to handle i t once i t has occurred. ve have beer, in te re s te d , ir. our ir.E tit-tio r., -r the development cf tech n iq u es. Ve p e rr.it lr--y o. fc**6 p e u tic oroblens r e l e t i r . r to puinontry end o th e r env t l lT in d e e d can cer. V'e ere very heppy, cor.e y ea r: o. d'ef**1**- for doctor Vi l l le t Sr.Lt'.: RECEIVED F.H.H4 S ' O M lJ U L S 1 _fC7E _ -237. . - TR.LM - ^ as^ vr_icl have perm itted the development of hi.-hly pr^eise tn i g a tisfa eto ry techniques fo r carcinogenic principals* TOny - here f e l t th a t th a t e n te r p r is e su b se- q u cn tlr conducted a t I?ev York T r lv e r s it y , in ii r a d ic a l Ic p a r tn e n t, has provided im portant data, ir.uoeu p r -n c .p a ls vl-.ich nam le n d then s e lv e s to stu d y o f pulmonary nr v e i l a.E other envirom ental types cancers. I refer, of course, to the rtudy of th a t forr. o f cancer induced ir. experim ental aninair and con ceivab ly in nan, by the p o sitiv e a ctio n of w -h tenoerature ca ta ly tic acents, fu el oil* d o cto r rr.ith and h is a s s o c ia t e s were c o le to demon:- tr ate tho cause o f th ese a c t i v i t i e s o f th ese com pounds o f t h is m a te r ia l, and o f c e r ta in compounds con tain ed th e r e in . There are stror.- a u ; e stio n s th a t no one pure compound indwees the n e o p la s t ic chanye, b u t ra th er a combin a tio n o f s e v e r a l. There vas a ls o stror.: evidence that th is com bination o f m a teria ls v i l l induce cancer in tne prim ate, vh ich 1 recard as an im portant advance* I f ve have, then, tn e p r in c ip a l of p o ssib le m-j.- t ip le o ricir. or whole c arc ino cones i s , th a t provides at le a s t le a d s f o r fu r th e r in v e e t ic a t i o n . We have eI so been happy te have w ith us d o cto r V in te r uho cane eubsecuent to h is tm^o- o b serv a tio n c w ith S ecto r /bnes in I t . h a u ls . 1 a:; a ^ dmcrc_rj'fl.cr* __Oj*i >. . ^m. **i ^a#c- i v**** i yo * ^ lS * C. - - o t i c and r e l i a b l e v e r ie r . I am a-,-are th a t h it s n a t i r t i c s \ * D---r---- y.j\ KMVEJj.FM.HiS K J L J I U L J i & cW..W J3 5 ._ hte have bees brought in to quvetiv:., t u t dfctt, w ith those of o th e rs , would se:a to. :-a=T z * ~ ^ p rovide adequate evidence to su sp e c t --c d e l e t i o n of tobacco saoke fror- c ig a re tte s as t p a rtitip e tir.;; e tia lo ^ o a l f a c t o r in pulnonary n e o p la s tic disease* ..0 0 *0. : n ev e r, as f a r as I )c o v , claim ed th a t ti-.Lt *-ss tno =--7 f a c t o r , b u t only t h a t i t i s *r. i...'O r tur.t one c.. ,,w. .^ ,, .e f u r t h e r study* We nave bee:. fo rt-r-u tc to - w* ,L-- *' s e r r a tio n s which we t-iinh nay j i v e technique:. sv._.;rt-r.y tho p o s s ib ility of fu rth e r stud;-, both of e titc o y ic , of a p ro p h y llactic and a th e re ? * -tic n atu re . 2 have the f i r s t s lid e , please? 2 &r. jo in s to show j u s t a few s lic e s which in d ic a te c e r ta in a?*** * .tudy, d of t o ^ t =ty c-.y-.iry U . * s ; i t * * U dicu*io=. 1 prr.= tb i y c . i * -?* ;s ~ ** `r t : c l * of t > . v.,iyi. * i:. * 1 * * -- * ' " L" ' Jo u rn al or CsiiMr* I f r - iiV e r' s *> ' ZT -r t ~ t t '"' * throw i t b efo re you, because i t docs <--y-- . ......... of the in d iv id u a ls who have eo-n concerns - -- ` ...o ..--w - e tio lo jic and pulmonary canceratio-* This i s the c h a rt of tr.e L-cnncr. areas a . , . , __ very ttrc r.o ly a c o r.c o n tra n -.. ?<------ -- * ----- ir. tn --s & fcre&i h o tv ilr c c r.tr-i-rte L . ----- - -0aC toward the areas to which the prevuiuir.. vi:.u u* #_ #Ay 0*+ r. *-^ - 4r \: 1.r * 5CLTJi l C *-.w*~* nay, ir. tne ocir._on o. . RECEIVED F.H.HiS 4M.aEt.eMj k z u l Z is z~l - 551-- , i t t m * b i k j the evidence, provide tn additional f t s r to the one r e f e r r e d to t j t io e e coae.rr.ed w ith e i Cc--ette , a<* l a c . And I would liire to er.pharioe e ; t i = t--.e p o r c i '.i i l t r 0f a u itip le facto rs I d tie etiology of p iiao r.tr; r- p its t i c chan?** io c to r V.later allowed =8, rin c ; ^ 2 ^ p 8, to p re re n t one ex etv l* * ^tncer in tS* experi * r .t- t l er.ir.a2, induced v i t a the pr auction of tuo Vurnisc o: c ig a re tte s under cireura tencee v ^ c n tre c-- e- t- r e la te d or reasonably clo se to tnoso v;.*c- * * -ru e cancer now has to er, induced t j these p r lle c r tad i t nstare of css ir.vol voi ir. t-s -lr c * evidence ^. *p ^ tre node c i i t r produe, lericr-i t..src-7 c-.vred, cen fco had, Vut th is i s & true cancer ir. t..s tr.lnEa, caused by c ic u re tte onoued te r . llov, ve nave an im portant t r o t ir. tic early d i ^ c o s ts , ta d I h-'P* t h a t th o se concerned w ith p u b lic - e a - t_ o t u t n i , Doctor le v in ta d ed it?* , w ill re fe r to tnc t - * tie r, of how w ell ve can p ic k up tr e a ta b le d isease i f nass su rv ey . I d out own er.?erier.ee of slew , one nunores . . . to two ii_ncred p a tie n ts t y ear, w ith pu-r.onarr fin d th a t the pieh-up th a t cones to us iro n tU t KECE;VD f.h m s J ^ -- *0A.{T.; J U L I E S U n ited . but there i t very eetive Pici-u? f r o n tm e d eerviee eianinotione and fror. e xoainations ir. t o doctors1 office* or tbe h o sp itsl* Thit c u rre s ts so^e p ra c tic e s ir. tr+o^r*Z t-e-s. ^ e p ra c titio n e r, the importance of con. f e r in e n e c C actic e;-a=;e ar e tio lo le , a t p o selb ly tu sp ic ic u a of t x j ? ----a-` r? a c tio n , one I do hope we v l i i ieo rr. a c re o f e - i ~ ^ Z - c o s i t by rsesns o f n e ts e u rv e j te c h -H u e s . K elt t i l d e . Od e o u ree. in our p a r tic u la r i r .t e r - e t t . . ere to .p l? concerned w ith ie ttlr .C e t - a p t o t i c tre a ta b le e r.d v e 're vfcrj d ise a se in ft * t s : e vnere i t 's f t * -- * ht5?T to be able to re p o rt th a t stead ily the incidence o f operable d i .e e t . in c re a se s, in p o rt because of the .-reetcr cortpebeaee of the eur;eoa end to tone ex ten t perl-hpc, be-^ ce-uee of the e a rly r e n d itio n because or adequate d i c . - o t t i c -- a:-ur e> era *--'-n&esscc *e--re** v e r r in o or tar. t - -o *o. t standpoint of the lif e of t o effected individual. So, v e ftre now v e r i t y ^ r t y percent of the p a t i e a t t who p re se n t p u la o n e rr le c l o n t . Sow, vary h a p p ily , w. hare beer, ab le to define - to devise and apply a n o r. ra d ic a l technique of eu ry ic sl rer-ovel. For nary *c i-.50e . 'ie to Ettfcc*: the l e i ions y e a r s , I t ves r e c tr a e a M . involved, and, of course, i t is th e ir i n v o l v e d which render? t o pure ra te so low in p u lr.a u u .c c rc e . . . have d e v is e d a p ro ced u re now Hand, Vetson ar.a a s s o c ia te - , --  RECEIVED F.H.H&S -M K J V L MI.fi! i n re n e ra l u re , which include* in the rod lin e , ac cessib le n e d ia s tin e l nodes and tone f l i t ? p a tie n ts have teen i n jected to th is ra d ic a l d ire c tio n , applying tne p rin cip al, the eana p rin c ip a l of h i-e e c tic n which has been ao success fu l in X-ray fu r ie cl p a tie n ts ir. cancer. And* ve are able to r e p o r t a t th is ti n e , a one eu~~estior. o f to what e x te n t th is r.oy be an tcvanco. - t 'c c o t a very en p h atic s u ^ e s t i o n , and ve hero nc ioea whet w ill be the f a c to r a t tine end of the fiv e -y e a r p e rio c , t - t ve are s a t i s f i e d , a* t e s t i f i e d by the s l i c e , th a t once tr.e disease had gone beyond the nodes d ire c tly contiguous to pulnonary tis s u e , i t is. hardly worthwhile to carry out thee elaborate bisections. On th e o th e r hand, ve are s a t i s f i e d tn a t t i e r - i s pood reaso n , a t - l e a s t , a t p re s e n t, to tttc .n p t to re.nove d ir e c tly c o n tlr - ,J* involved nodes, because ve do have th ese four in d iv id u a ls vho, otherw ise, would hr. vs beer. f a t a l i t i e s , who scy v e i l have been b o n e fitte d ly th is r a ta e r rad ical operative process. Kext s lid e , p le a se . I have been very nuen con cerned and ay a s s o c ia te , Doctor Southan, in th e whole cues tio a of p o te n tia l heaotherapy of pulmonary can cer. As Doctor Varyas renarhod to no, i t is conventional to i t , i t is cancer end nothing to be done. Of course, i t i t t r . th a t i t ia not tre a ta b le , the p atien t v:iil rot to c~cd> * RECEIVED F.H.H&S D A TL^U LX yS Zi HEXM D*-S i .' 2 uhn & sea eones to you desperate w ith dyspnea* deeply cyanotic, because of superior aed iastir.al pressure rrcc h is lu n g can cer, he ift cT*t i ? i # 4 aa4 th an h fu l i f j 5- ^ pro v id e h i s even ft few sonthe o r weeks of r e li e f * Tsie can be done i s ratny i n s ttn e e t to d ay , v i t h those ar.ver.tior.1 th e ra p e u tic a l - h e n o th v ra p e u tic a l agents of the t r i - r i l l irae te r s e rv ic e , which you are e l l f i a i l i s r w ith , and I a ia o ly throw on th e se e lid e s to in d ic a te the evidence th a t th e re i s ft tr a n s ie n t th e ra p e u tic r e s u l t to be o b tain es and t h is should not be sneered ftt* Ir. one ser.so, i1t4, ji.an.rx*ii.c*.*c ft'*uf fi v*i *--~ rcr*--0.*f.u l c n r c ,, Vi ct-1 e:-.i9V0 seto-ar t o - r t p e u t ie r e r i - t t , e= i c-eew --V, too .p s s s itilH y o f r e l i e f s * d ? e r ite t ita t t ie a for v .o is or nonths, should be cons,cored* We have a l l been seek in g netnoae by v.-.ich ve eoulc extend the e ffic ie n c y of h eao th erap eu tic a tta c k . This nas involved tone procedure which would allow r e p r o d u c e d ex perim ents on huaan pulmonary cancer* In our la b o ra to ry , d o cto r Tool or. has been su c c e ssfu l in drawing ? - 5j-4 canoer of nan of a v a rie ty and type, in the experim ental technique, and applying th is technique exploring e s s e n tia lly su c c e ssfu l henother& peutic method:-. . Thic ( s lid e ) i s a low power of a bronchogenic f r o s ru n as removed in the- o p eratin g rooa* *--f ^ i s a high power -- IT - t h i r l i n g of no p ro fe ssio n a l chagneri: 5 - ;3o RECEIVED F.H.H4 S . _ . DATE:__JUL-3-1 ISM M.E.M - end b o re , e f t a r two w eeks o f c x p o rin e a ta l a r .in c l, low . >ver, an d th e n e x t e l i d e , th e sa^e p r e p a r e tlc c h l^ o pow er, two w eeks in th e a n in a l* T his cer. he done q u ite re g u la rly and lends i t s e l f candidly to v a rio u s fee to re arc techniques* Uov, th is i s an exam ple o f hoc a y id c rn o id c c r.c e r, th is is n o t a lu n g - ir. the e rp e rire r.ttl a n in tl, c a re e r p lan toe in the rtc lo rrc p h , c m te d estro y * - c -r.p le te ly c l th c r by h o n e th o re p e v tic o r v i r a l nsur.5* i*--r i J cfet" tro y ed in p la r t of r.u rtr e.cioom oid c a n c e . S i n l l c r l y , we c r o n a k i r . g r e e t e f f o r t s t o grow hunar. p u lro n try and o th e r fe rn s of e p id e m o id d ise a se in t i s s u e c u l t u r e . I t cer. b e d one n o t a s w e l l a s we w o u ld lilt* end tr .it U en i* e ? id r= 5id d i c e e t t , b u t n o t - ? u l o a & r r , X9V i i = t i t F - s t &* ^ a ten-day p e rio d . And t h is ( s l i d e ) i t - th is is the tre a te d c u lrc re , the f i r s t , th e one b efo re the c o n tro l, in fe c te d v- -- " us s u ita b ly adapted to t:>e d e s tru c tio n o f c e r ta in forms of human cancer under a r t i f i c i a l ccnu-tio.iE , a.*- c~ eerve th a t the cancer c e lls have beer, destroyed leaving the normal c e l l s . This can n o t be done in every form o: .v-n^n cancer, b u t i t can be done w ith a pood nany and ve hope th a t they w ill cone to liy fct tcu'ouyh the csveloprer.t of these techniques, with b e tte r diagnostic, b a tte r ih e rtp a -tle RECC VtO t-.H.H&S , , . _____________________________ w ^ - ' J U L ? l M.E.M B*thod> and th an w i l l w a it to r you g en tleae a to give us prevention of the disease e n tire ly . How, the f i r s t p ip e r i s Poet** L e v in 's . You're a l l f M i l i a r w ith h is g re a t c o n trib u tio n to th is f ie ld , enc 1 personally have waited w ith g reat in te re s t, h is an aly sis o f the d ata which b ear on the environm ental pulmonary c an c er. D octor L evin. uv ppcTOR LEVXK: Thank you, D octor Rhoads. Ladies and gentlemen, I arc supposed to t a l k to you on the philosophy o f the b io s t a t i s t i c s of environm ental pulmonary cancer, ana I have n e v e r been su re , up u n t i l th is moment, whether I was sup posed to concentrate on p h ilo s o p h y or b io s ta tis tic s or environm ental pulmonary cancer. I s h a ll probably try to do a l l th re e , and succeed in n e ith e r of them or not one. I c e rta in ly would l i k e very much to second the . remarks of Doctor Rhoads as made and pernaps x can ao so and make some comments on some of the th in g s he has s a ia , t y t e l l i n g you what my own p o in t of view is in t h is m atte I t is p rim arily th a t of an epidem iologist which i s the f i e l d in which I re c e iv e d most of my m edical t r a i n in g . An e p id e m io lo g ist, as you probably know, is n o t a s t a t i s t i c i a n n e c e s s a rily , alth o u g a he has to kno.* so n et... about s t a t i s t i c s and use them and know when he is in tro u_b_le , some,, - s. o. vne ecoenn cgwo to someone who is a s t a t i s t i * RECEIVED F.H.H&S ' r PATE: J U L - g 1 WS M.LM I n e p id e m io lo g is t Is* p r i m a r i l y , * f e llo w who is I n t e r e s t e d i n two q u e s t i o n s , f i r s t o f e H ,* h a t h a r & c e r w _ n g roup o f p e o p le a c tu a lly do o r do s o t have more o f a c e r t a i n d is e a s e fe e s o th e r cro u p s do h a v e . He*s in te r e s te d in k n o v i n ; w h e th e r t h a t * * r e a l l y t o , a n d o he i t r a t h e r c r i t i c a l of th in g s w hich nay lo o k l ik e t h a t , and n e v e rth e le s s e re n o t r e a lly ci e v id e n c e , and he is in te rs :-te d in know- i n c , i f t h a t i s a o , v h a t th e re a s o n s n i g h t t e , nr.u -- e r e a s eng fo r th o se in te r e s ts are q u ite p r& cticE l, tec au se he is t h e n a n v h o i s - u s u a lly c a l l e d u p o n to n ako c e r t a i n d e c i s io n s or to c iv s certain advice as to w hether c e rta in th ird s s h o u ld o r s h o u ld n o t be done i n a r-iTM ~ s i t u a t i o n . How, i t ju s t happens t h s t h i s t o r i c a l l y , th a t type of q u estio n u su ally arose w ith our epidemic d iseases ar.d t h a t 's why, I suppose, th e term e p ic e -.ie io -j, ic u c u a lly thourht o f E-S re fe rr e d to w ith people vho deal w ith in fe c tio u s d ise a se s, b ut p re cisely the sane question ccn arise in alm ost any type o f d is e a s e , end c e r ta in ly they do a ris e in industry. Row, the e . idenioleyist *s p o in t cf view on y u l- nontry cancer and the evidence resp ectin y various o tlo lo - ie e i ;e.-.t U , I would. =*. c rltlc e i. Tit Is, " v* sr* .wore fre n Ion: e.-.?erie=ce, ti:*t e lo t el v .iu ; which look lik e otiolO lccl re la tio n sh ip s arc not r.ecesa a r ily such. yhe o th e r p o in t of view, I would cay, oer.x? received f.h.h&s J? cr -jr' .' DATE. JIH V ] HP: M.E.M - ........-- -- would aeen to you to be o p p o site , t u t I would o r f c r to you a s the r e s u l t o f la r e f l e c t i o n on the p a r t of a doou many p e o p le . Ve ep id em io lo g ists su sp e c t th a t, from th e sta n d p o in t o f the causation o f pulmonary cancer, our t e r . czoerin e n ta l m in a l nay be nan r a t h e r than any sr.in sl wo can stu d y I n e la b o ra to ry . Kov, can is r*ot a very ^ooc ex p erim en tal anim al, b u t i t eeens a t I f in can cer, he nay be our only one i n cone form s, and the lab o rato ry nay or nay n o t confirm whet ve fin d in a m , t u t ve have a s tro n ; f e e lin t h a t we are r i s s i n c a p r e tty food b e t in not studying nuch none in te n s iv e ly , p o ssib le re la tio n s h ip s which nay be e tio lo y ie e l to nan. ' Ve hare about tw en ty -fiv e trousanc cases c* puInonary ccneer each y ear in t h is c cuntry-, ana i t s e a .- very u n lik e ly th a t those tw en ty -fiv e thousand pcopue co n o t have a yood ro-ny c h a r a c te r is tic s which d is tin g u is h th en fro n t h e i r fe llo w s, which nay have aoroe relations.-*:? to te . f te t i t Involve, lung eeae.r, ib f :t viicb * .t l l l 4 e n o t taiWo' very nuch* Kov, y ac to r Rhoads mentioned the re la tio n s h ip to smoking tobacco, e s p e c ia lly c ig a r e tte s . I knou of r.o oh- s e rv a tio n which would in y ly or im plicate any t ^ r t;-ye o. smoking, and I mentioned the wore o. one _ . . c ^ a * o * r a th e r two, '..'inter and graham. *-o-, - - to -- RECEIVED f.H.HES P>tC. JU L ? 1 g g SZ'Z'S JtlSl - -- ---------- ^ 7< V is t e r and I lik e h i - 2 7 awch, end 2 ai-ree w ith 2 =ta r F,hoads estim ate o f him a t a very e n e rg e tic , * capable and a s e n th u s ia s tic chap* The kind of o b se rv a tio n , however, which V is t a r and Graham nada about r e la tio n s h ip between arsofcins and cancer ie p re c is e ly the kind of o b serv atio n vnieb you v i l l fin d in tb s li te r a t u r e fo r the lo s t twenty years* I f 70 - look up one of the e a r l i e s t m u lti,ra n k s on 1'ua^ c a n c e r p u b l i s h e d a b o u t 1 9 3 2 , 7'- V* H t;'out *~-r p ^ Ce : d e v o te d t o t h e r e l a t i o n s h i p t o t n o h i n : c i f a r e t t e t * Kow, those o b serv a tio n s were never taken eericu s ly , and they wore never picked up, p ro c ise ly boceuse of tu n e r i t i c a l , ver-enthusiea t i e type of a n a ly sis or. which they were based, in o th er words, they were based on in sc e - t - . t e c o n tro ls , they ware s tu d ie d ir. such a way th a t one could eee th a t the person r.ahin: the study he* a p re tty e t r o n r b ia s in t hW** l i*rm*r, *V p la c e , as to what ho would fin d . I t 's not the e o rt of evidence which re a lly t e l l s yo- th a t you can r e ly on* Sow, i t happens th a t the o bservation of V inter E.nd Graham have been confirm ed as to th e ir fe n e ra l te n o r. j,g a re la tio n s';-!? wetween sno.-.inc in ioracco* ie a c,raet difference in the quantitative observation:. - ve are to believe the observations of V inter and Granin, pulmonary cancer i s o x tren e ly ra re in people who co not cnoko c i^ a re tto e , about th ree percent of luny careers, 5S9 DECEIVED F.H.H&S DAT:_3UL.3iJS75--- ft M.E.M according. to t b t i r d ata, thro# to fiv e ? rceat, occur in people *h do n o t cnoka c i g a r e t t e s . That i s n o t in accordance v lth oservatiO -r vL-c^. ve have nsde, and I , fra n k ly , doubt vbether i t is in accord v i t h v h a t th e fa c te a r e . I th in k th a t i s one o f the cru e ia l questions vhich re n tia s to be proven or to be fu rth er tested * Kovever, I did n o t in te n d to r e a lly C- *r-t0 the <iusti5a of th a t p a rtic u la r observation, because th at la r.ot mir to p ic . Vhat I thought I would do i t to r ic e you ton* Cenerel q u a n tita tiv e beekpround re r t h l t whole q-oeatier, or lu a - ear-car w rieh would serve as t o r t o r a te c ld rc ? r a the papara which are to cone, r i r a t or a l l , the inoortanee or th ia to p ic , t r i e rc r= o r c a re e r aa a huncr tu-.x-. liar I hate the r i r c t elide? e- l i s i a irp lr the c h a ra c te ristic ape curve or eeae.r, th a t la in cidence o r c a re e r bp ape a r e r c " o le : cr.c i-neap r e n _ e . a t u su a llp oceurc ir. Sow York S ta te wh.ro. a t you f e w . can ear la a rep o rtab le d iaeasa. These are a l l casaa reported fro n a l l sources ro r v ario u s p erio d s or t i n e , put on ar. annual b c e la . That i s a verp i n t e r .! d i r .; curve, r o r one th in e , because i t does not ro llo w the tppe o.' curve t - r t . pou would expect in n o st fen-h or cancer which koept ^ - - Z up w ith ape. Most fo m s of cancer s t a r t in le v e r . r o - . ; e r are group: and keep p o ire c tra d ri.t up. !r. 1'ur.; cancer. RECEIVED f.H.HiS ---------------]Q7c M.E.M 5CS0 - X s. - a fte r about f if ty - f ir s , tie ra te drops. There a re t number o f t h ir d s which c*n be ea ld about th a t o b se rv a tio n , end I don' t propose to c ia to t i l e f the p o ssib le e x p la n a tio n s, b u t i t eoos n e c r, one th in e , i t does s u r e s t one t h i n * t h a t f o r tor.o reaso n , people who were bom , th is is 1X 5 roughly, and people a*ed sLxt~ - 1 9 1 5 , were to m in lS5, ** *7 t r i t h a s t i c in fc m c no. r e -? le b o m b efo re 1&65. f o r *one I* 6831'*' h*f l3F htve leE lu n r cancer thao people b o m a t an e n r l i e r a :e . an a t e a r lie r period. m a t nay not be se lf-e -rld e rt to you, but I t r e l ieve fro = a f u r t i e r a n a ly sis of tbooo tu ree s which thov t h a t vd.er. you analyte these cu rv et by t o yea.- of M r * ., they te e ? on yoir.y s t r a i . h t up, and t o y te e ? or. C9i=5 ? ^ n u e i h ly b o r feehior, depending or, when toe person was born, m a t is not t o e o rt of to ln y th a t you would er.oeet In t ctreln o .-en , I f I t Is t cercin ey en , which occurs c e n e ra lly , ,u to as a earclnoyen In the a i r . I f . apparently oonstolr.C v b le t o le ts out c e rta in aces and not o th ers. Kov, in Rost - the in y o rta n t p o in t t . h . - v to b rin y out in t . i s slid e Is to s t you co u ld n 't analyte any two cro u p , o f people, tty toe number of lu n y cancers 1-n two f a c t o r i e s , or toe number of luay cancers Ir, cr.e factor;- to compared v lto too nunber of luny cancers In t o r - r e u n i i r . co u n try sid e, unless you to o t in to account t ic aye fa c to r, ror< MCEIVEOf.H'H&S ------------toTE:mj y 2 1 j97s------------ 3 U.E.M '-- L S ** because obvioualy i f you did have a lo t of people in tele a^e group, you vould have ncrs or le ss cancer than i f you had a l o t of people in th is ^e ff'ou? or t z l t aye ra :? . You would c e r ta in ly have to a d ju s t f o r ty e , and i t ' r w p risin g to find th a t sone o tu files to not even taus into to* count such a ayzpla and obvious v a ria b le vr--cn nas Ct t * he adjusted* tow, when you tak e th is type of cu rv e, th a t i t the nunber of cases which occur by are in one year and ap ply to an ordinary l i f e ta b le , which is the oxpoctaaey, the expectancy of liv in g . a t various ages ir. the duration o f l i f e , you w i l l g et a ta b le such as the next s l i d e , which t e l l you about how rstny cares of cancer of various types one s ig h t expect to occur in the population tode.. th roughout the r e e t of t h e i r liv e s * These f i;u r e s are aul based on an a base o f one, th a t i t t : i ? top fic u re ives you the p ro b a b ility of shin cancer occurring in ra le s throughout l i f e , and the fig u re .02 no ant th a t two out of a h -n d red , two p e rc e n t of a l l r*ales,aur:oct tvo tno a ~e p e rc e n t o f a l l B ales, u sin g the type of c c ta which I have ju s t described, th a t is the actual incidence of cancer rs d e te m in e d by r e p o r tin g 'ap p lied to the lif e ta b le , tvo out of a hundred nalos th o u g h out the re s t of th e ir lives w ill develop co.'ie f o m of skin cancer* How, f o r lu n g , th e f i g u re i s ju t A** one pence RECEIVED F.K.H&S -- PATL- 5i -3575 --- i M.E.M about one p ero en t o f a l l a a le i accorllr.g to He* York S tate fiaU , *7 be expected to develop lung ca n c e r. l a s t nay b considered a s o r t o f backdrop o f t i l t whole problem. I t i t a ?roblea*fcicfc, a t a r.inirruu, v ill e ffe c t one percent of the s a le p o p u latio n . I*d lik e to e tress ti point th at th a t ic a n ia is a s . T ^ s t of all,- these f i f \^ o s sro based on the d a ta fo r *1*2, *U;. ^.cc then, tne ra to s fo r lung cancer, have cone u? and the deaU r a te s fro n a l l causee cone dovr., vfcich a e a ^ th a t the opportunity fo r developing lu n g cancer Lae in c re a se d and the r a ie a t vh ich i t develops has a lso in c re a se d , to th a t f if v r e one p ercen t i t d e f in ite ly rlrhurur., b u t i t is a t l e a s t one percent of the general population. !lay I have the next suide nov; *.-- * -- t i --.e 1 1 a p ip er s lid e ir. between th e re - r.e-: 1 have the T i n t of the peper e lid e s ther.t 1 d o n 't h = whether -oe ee= see th is . I think thiE is another of tie L v crtu r.t ccser%a- tio n e about l.ung can_ce__r ,w> c_-v ve .``*jL.vveb t*o=> r-ensribur conce*" l a C t h i s whole pro.tle_r-., e_na t-.e . <*r t-e i.riC2^St-SS VT C-- -<E,,c occurred over the p e s t two o r th re e d ec id e s. ' ^ C s s s ere the e c tu n l n o r t t i i t - r t t e e ir. "dev Verb . s t i t e between 1931 m d 191,5 in fe = tle s cad in s t l s s . * * dirdised for the*. I t the e f t fe c to r has boor, b o p t j o r , . t e a t in the two p e rio d s . S s-.ribir.i; t h i n : l e w is difference in the increese in the seres. In fe-.ele:. the ----- --- BREtTCEiIVSEDUfl.Hi.nHEsS? ; -- - - M.E.M in c rs a a e h u bsen ab a at fro n 2 ,5 to i*.*3 deaths ?*? h a n d e d thousand per year, as' increase of about seventy percent, l a n s l e s , th e in c re a se has te e n I r o n h*7 to 19 ? e r tunured thousand, an increase of over three hundred p ercent. Kov, an in c re a se in lur.y in ar.y fo m ci cancer, as you know, nay be sue and o f to n i s a ttr ib u te d to the f a c t t h a t our a ia c n o s tic procedures are none e f f o c tiv e . I f v.nat I s the ex p lan atio n f o r th is in c re a s e , then ve would hsve to asl: o u rselv es why, d ia g n o stic procedures were th re e hun.r e d p e rc e n t r.ore e f f e c tiv e now as c o h e re d w ife 1931 in n a le c , b u t only seventy percent aore effectiv e than in fo realec# 2 would say th a t c e r ta in ly th a t causes or c a rta co n sid e r a b le dovfc t on th e enplane t i on th a t sucu ar. *ncrea-e esa t e due to d ia g n o s tic procedures alone er.d * U ! i t s> t-c n e ly probable th at th ere t i t beer. a re a l L-.creteo ih lung cantor over tl.it. period, probably i n t o -- se-.es. Another t i t of evidence -- r.ay X have tic r.er.t d id o - which leads in t i e . d ire c tio n , is tie d if f e r e n t way which the eges neve beer, e ffe c te d ir. t r i e e r e t s e . How, t e a t '* th e s lid e t h i t y e t tio v ed , the l o s t e lid e th a t you chowed b efo re th is one. I n e t 's i t . I . th is is the m o rtality ra te in the m i ted St-aUs. 1 eel! your a tte n tio n to the upper l e f t , your -upper le ft-h a n d cor. ner here which elves you the tee sp e c ific r o r tc iity rc te a . RECEIVEDF.H.H&S PATF W L ? 1197? * HEM This ic age dovn her# 1-- '3^ t~`~ you v i l l n o tice th a t the inere&ce has te=r. nore narked ^ tre i s the Riddle p erio d than here in the :** p erio d s, widch E-cin conic idee v ith the observation th a t there ie eonethir^ happening ir. these people around eixtpi e??a:-nt.r ic n o t happening n e s rly so n a k e d ly ^ people who are o ld e r to u , t h e t . Thet n c d r. i the s o r t of tti= C t l .s t er.e v : i ,,t .* n o ct to ee i f th is were purely 1 ?h9' ~ 9' cca* There is no reason to suppose tn a t die. l a d i.e e e e v i t h fcifc c .s e .- .t c l i t y euch c : ct-ocer o. t i e laac e. obould w * . = * d iffer.n o . oeeordinj to ti.e 6*. t i i d .n o . roc.'-, = crl'ed differ.--.-. ece=rd'_-.t to t d o n e , to t r e t ? u ttir .r these Cete to g e th e r, one v o ..c - j *v*. ___ t : . t or.e c o ----------------.---,-5no_.M*^ *>f ^c - .^ * -* -- at l e a d t o th e c w . * c v***`v t i U in e re ts e v u purely e .- t i f : e i e i =i d'oo to the fee*- th e t ve found none l s a c cc-toer, or.e would c e rta in -!' h.TM *" e.E-o-te th e t th e re wee e very . t r e a t p ro h e h ility tv.et t h i . var acne th in g r e a l. sow, one o f the p o in t, th e t or., e u r.ehe .to u t re e l c h e a t.. in c e n te r Incidence over tin e , i* . " e rvef-.r of fe e t, they are fe c to r. in in c id e n c e lr. U S ' d i ^ 9 <"* - U r e avl , *thve.y- are np~. cbcD'ctl^ya due t o cone er.v ir o n - re n t c l The recson fo r t h e t coec t i to one o f tne of ( o n e ti c ., i f you v i l l r e r e r .tr r your y e n e tie c . re c e ll th et, eccoriir.- te the vey the rer.e: o n e rc te , th e ir - U l <w ~ -- w*w J -- J S ,---------- p ro p o rtio n fro a one generation to another remains constant under n o st circum stances, so th a t i f Ctlc A c to rs, i f c o n e titu tio n o l f a c to r s were th e ones which o b tain s c, we would not expect the incidence o f the disease to chance fro n y ea r to y e s r . I f we f in d a r e a l charge, ve should su sp e c t some environm ental cause r a th e r than sov.e genetic cause as the roason fo r th a t cha.fc_e* So 2 would f e e l s a fe , from the p hilosophic view- here, = e ;S 4 e :;io lo ;ie t ta c t ve bate r n u t s to f i r s t , t t t th e re ber beer. r* U cte*S* l c aun ee-icer ta d , second, th e t th e t c h s n .. is p rsb ih lr due to sonethinc in the ea v ircaaer.t. th ite v e r th e t ney be, of course, remains to te seen* ^ov would we go s to u t s*-c. , -- e jo-s*-i.e rela tio n sh ip of lunr cancer to various env-rounoutal fac to r s ! Kow, W I have the next s l i d e . I have - s e e d on t h i s n ex t s lid e , a h yp theties! s i t u a t io n in a - * (*5- 't know w hether you can see th is or n o t. I have here a s ta te o r a p o p u latio n croup in vfcich th ere are fiv e m illio n males i n whom nine hundred cases o f lung cancer occur in a y e a r, and we have in t h a t sane p o p u latio n group en in d u stry , c a l l In d u stry A. which has te n thousand males arnng vhou nine cases o f lung cancer occur in a year, so th at in , a t l r e cveu?, t h a t is to tae s a t i r e t t . t s , . . -- s *- ^ , t a t e ve 'r e ta lb la c , c b o -t, t . s r c are atoe a - . i r c - cac r._-.e RmEtCEvI.VEDJUFL.H.3H11S197S M.E.M o *-_ O -y?> c is ts of lu n can cer in one y e a r. IIov, suppose one wanted to e t-d y -funs cancer as to jthp I t r o lc U d to , tt-:, :=> ? a r tie u l* r lr.i-iit r y . *eoor41= to - v . could u o . i t l o u t two ^ t i o d c v -ic l to e tile d * " tr s l3 ,' tlT * In eidcnec s o tlo d . could t i l . t i l rln o tu r.iro d i r d r.lr.o e a se i or 1 unc can cer, 1( ve r*n*>ov..a.,..*.*.e.,. --T.i Ve COUld tS h t C-.. p a r a b l e a s t e r o f c o n t r c l c , wo t a h e c. th o u * s r.d c o n t r o l , u d i f ve w ere i n t e r e s t e d i n I n d u s ^ A. i f vc had re a so n to s u tp e e t In d u s try A, v e ' d f in d o u t hov nany o f th e se n in e h u n d re d an d n in e l u r e c a n c e r c a s e s w ere ..o o p lo who v e r^ e a l a lo d u o ter A. Id w* C>t e l l e - r e u . s , v c th e re were nifne c,,fr tee... 0c.0---'*- i - crjj* c o n tro l oroup, which s h o u l d h^ e r e p r e s e r . -a -*vvse ao .' th e t o t a l m ale p o p u l a t i o n , ve s h o u ld fin d tee sane **a -- o# p r o ,,- . *.-=>- =>- In d u s t r y* A w orkers as ter. thousand is to fiv e n -- -e.., t_ a . ** n ale p o p u latio n to n ales in in d u stry A. How, t e n tn o u c ^ n d Wta .-**e. r. ai l--l i o r . is two per thousand, s o we 'c f-n d rc ga -r ece- ,. t--wo p^eo*p le who vorweo * v #v - --- . y t s rune t h a t Industry A in <^r controls. --k-- ' * . - *, > - i -- *>- have th e s e r.Lnc hun ve d o n 'tknow th ese f a c - s . -c - d r e d a n d n i.n e c a s e s a--,> vve* t n* e, ian.-t*e*r-e*s t e d i n v h e t.n o r t~~ t.h ! W=7`d-.i=L , . .., tv *------ c'^esr* *0 C.0 k - - C-- C O .. Iftn at ** v - _ ^ l > - a t t i r . ' a l l r .i r o ------ e v e d i d , a n d we w e re swcco* - a- I -- w - _. , / and n in e l u n ; c a n c e r cases e-- - a . - r r oup s - RECEIVED F.H.H&S -D&IL. .W I U J S 7 S UW properly selected , in other words, i t w asn't biased ir. ruth & way as to a c c id e n ta lly drop o u t these two In d u stry A c a s e s or i f our lung eaneer cases were poorly s e le c te e so we n ig h t n o t - ve nay hare n ie se d these nine c a se s a other words, i f our experim ent were p e rfe c t, we'e fin e t.'.at th e re was one percor.t Indus try A people in the cancer cases and two p er thoucana in d u s try a pew,e *--e oar. t r o l s , which amounts to a r a t i o of fiv e to one, t - a . -s ore p e rc e n t i s fiv e tin e s as much cc two te n tk s e f one p e rc e n t. This gives you fiv e to one. Uov, i f you 0 hack to our p o stu la te d p o p u la tio n , t h i s i s a n ethod, nine hundred M*d fiv e n l l li o n is a r a of ninety per hundred thousand and nine per U:. thousand i s a r a te of e ig h te e n , i t ' s J u s t - i t 's Ju st the o t l - . t r way around. This i s eig h teen per hundred thousand and th is nine should te here and the re la tio n between E~`" n in ety is fiv e to one, which is e x a c tly -a t you vouuc find in your ease nethod. In o th er words, your case netnou, i- i t were p ro p e rly per.'or.-Md world E*TM J u t i e fence i l u s t i e r . wl- ro sp e c t to t i e Incidence o r In n : cor.cer 1= is ^ c ts c - " eon?e--ed to t i e p o p u la tio n . I f t i e r e was riv e Ur.ee as rrcei lun cancer in Induetry A as in t_e population. ts euninE. of course, t i e t tio ere fe c to r to : oU er ?c! -- J! t a r i a i l e s w ilc i s l s i tt ee ff ff oe cett lluunagc eaneer ^ l " -- : U , ~ 5ZS5 RECEIVED F.H.H&S -DA^:=JU1-5 fTt7q~ - M.E.M c o n s id e ra tio n , Z an assuming t o t t o t h** been done, t o o th e r way i which you n i_ L t do th a t would he t o r e t r o a c t i v e incidence o eth o d . You take ten je e r s of Indus try A end Low aeny eases o f lung cancer occurred ir. te n y e a rs . Eow, i f nine ccsec occurred in one y e a r; in ten y e a rs, ninety cases cou2d he espected to occur in the ten y e a r s , and t o y 'd he - y o ^ d have to ask y o u rs e lf, how nary cases do occur ir. t h a t p e rio d , end one of t o ways in v h ich you n ig h t answer t h a t Q uestion i s , ,w-*y, wou--d a t, I expect or would expect the oarae cu rher Oj. case- *-.at would occur i f industry A had t o sane incidence as t o g eneral male p o p u la tio n , t o t would give you ten y ea rs tin e s ten thousand s a le s , which i s t o sane th in g as a hun dred thousand and one, and an incidence 0- e*c-. e.. ?e. bur.dred vc-ulc* .,0fc* cR*** 0y*'* ct-SZ. C of eig h teen c a re s , i*r. tiVh (is. ? e .- cG#*, Vv*--"1^Cc~** Ciaf*i-Tl VO-<*C* ** ra tio cf five to one. Sow, Id l i k e to c a l l your a tte n tio n to t o f a c t t h e t i f t i l e p a r tic u la r c a te n e tte d were dor.e os h a lf the au rie r of eatos, i f lnoteod or n = a l t-- a l a . e .a e s , you i>ti co tter, h a lf of thoce. tier, these two observations would r o t be e i f n i r i e e r t l r d iffe re r-t fro-. o th e r fror. the standpoint of eher.ee v a r i a t i o n . T h a t is they would be the kind s f d iffe re n c e th a t would eccwr o-'r. v r chase* a la n e , to th a t or.e c o u ld n 't bo t h e bust V xt war RECEIVED F.H.H&S W.E.M a re a l difre.-ence, to tb * t the actual nac.r.itude, the actual cu-aber or easas t e a t y o u 'd atudy i s an in d u stry or t e s . yWi. d study of th ia kind, i f as im portant as tea s e le c tic r. of tee cases thenselvss. how, l e t us aso-irae, h o -e e s r. t l . i t we have done th is study i s t i . i t way and we de f in d a i i p i f i e e r . t d i f f e r ence, ir. other words, w. fin d th a t there are five tin es a . - r - j Cites in In d u stry A at l a the r * n e r ii p o p u latio n , s U f tc to r e U in held c o n tte r.t. hoes th a t near, n eeo sssriiy th a t In d u stry A, th ere i s to n eth lr.g in In tu s try A vu. c - causes lu rr cancer? Kov, in ry view te a t does r.ot n eeessr.rily ncsn t h a t . I th in k th a t one or tee i r ? r ta n t p r in c ip a ls . Oiop.-ioai p r in c ip a ls , to r . r r * . r in s tu d ie s of t h i . hhnd i s th a t d ata do n et t e l l you any none tear. ht they a c tu a l .i *7 S.rr.ae; ijhg. t*f*e'"-*i * ou tnet* . 0. **----- - r r in in d u stry A t e r . developed fiv e t i n t . ^ - ci* ^ 6E people in the c e n tr a l p o p u la tio n . Tnat - c- tw the fact t.* t there is tone thine in industry A Cte" eE lu n can cer. I t nay be due to e o . e t - n r e ls e , fo r t e s t a e , i f ve v ere studyir.r. * f a c +to r ee"-ecd~' ^ac t-h*e o rer.ar.ee of cin f l n - e r . or. one hand r a th e r thar. f iv e , and found th a t one ^ ' in d u stry had fiv e tin e s as aany people lil'-c th a t as v su .e be expected in the f n e r a l p o p u la tio n , I th in * one w :u ld ^ th in h twice b efore one a t t r i b u t e - u.at t - - - . c - - RECEIVED F.H.KtS _ r ,.Tc. Illl 3 1 1919 - t t t t t -------------------------- ----- i n d u s t r y . One m ig h t , n o r m a l l y , i f t h a t i * C . t i c ' r ^ i t , one n ig h t vender w hether th e owner of the i a ^ try bed six f in g e r * end w h e th e r he h ad many a e th e r * o f h i* f c z i l y w orking fo r h is . The p o in t i th a t one can not a u to m a tic a lly a.'--? fpor. asso cia tio n o f th ie kind to cau satio n . Causation nay he the fa c to r or i t may n o t. Whether o r not it * causa tio n depend* on o th e r e tid e r.e e , depends on what e ls e ve know about the d is e a s e . I f we d ie n o t know th a t ta rio u s duets can produce lung pathology, th a t *t is po.~-.wle to produce lung cancer in anim als by the a p p lic a tio n of c e r ta in chem icals, I th in k ve would be le s s apt to suspect th at an observation lik e th is actu ally indicated a cause of the e ffe c t. . Kev, a c tu a lly . th e re ere sr.ly c few v a -t ir. r a r th a t I to o . e f , v h o tto r - or te a t I ear. th irh o f. ir. . ceur.ee t ion, th a t can a c tu a lly prere c a u e c tio r to er.e' t s a t i s f a c t i o n . One l i by th ie ooeoad noU od .were which I have c a lle d .x p e r ia e n ta l Indue t i e s . I r-eer. i f ore swepecUd a c e r ta in cubatsaee in tfci* in d u stry and cne a p p lie d i t e ith e r to non. vhleh. of c o u rts, i t e a tr .r e l - improbably although i t has teen suggested, and as a m atter cr fec v . a x . i i r . t e n U t l t o plane alor.r th a t d ir e c tlc r .. i f cne ap p lied to nar. oranim als and a c tu a lly got the d l.^ c -e q u e stio n , I th in k one vould hevo cone a d d itio n a l e '--B~ e  r * OcA'JL RECEIVED -teTC r-JU l-li^SZS- - W.E.M t h a t t h a t was an e t i o l o g ic a l agent* However, I 'd l ik e to c a l l your a tte n tio n to tie f a c t t h a t i f one d i d n 't do t h a t , one w o u ld n 't have evidence th a t i t wasn't an e tio lo g ic a l ag en t, because u n fo rtu n ately , there are nany thing* o r a t le a s t th ere are tone things vs:ich w ill cause cancer in nan th a t w ill not cause i t in a n In a ls , ao the negative evidonee is not conclusive nega tively# Tae o th e r way you can t e s t i t i s ty tne p ro te c t-v e t e s t , by a c tu a l prevention* I n e tn i f we a c tu a lly nade sane e le n e n t in In d u stry A which was a f a c to r and tnen stu d ied the in cid en ce l a t e r on, the p ro te c tiv e incidence and found o u t I t had dropped, I th in k we would litvo scrse ed citio r.al evidence to the etio lo g ical re la tio n sh i? , but i t seenr to ne th a t one or the o th er o f those t e s t s has got to be ap p lie d in a ll of our presumed data regarding etio lo g ic - e t iology in pulmonary cancer, environm ental etio lo g y , before wc are a b so lu te ly c e r ta in th a t what we think is etio lo g y i s or actuelly is* Kow, I don' t know whether I ' n running too rruch over ny ti n e . I had some d ata which, from the p h ilo so p h ical p o in t o f view seemed to ne to be in te r e s tin g u to h ^ ' im p o rta n t environmentalj esp ecially occupational cancer r.-gnt be in America, b u t we r i g h t keep t h a t , pernapc , f o r --e d is c u s s io n , !ir* C haim an* RECEIVED F J .M S ___ .^JL BATET U L ? ! 157S M.E.M EV DXTOr. RHOAJSt You have t-Vy**fe rainute** EY POCTOB LSViy* J do h&ve tLroe n ic u te s f V e il, n7 - 0 t e l i d e ? T te e e y - e = ' - * o f e a r d t l * T`-*r i ~ Z t " e r < l e t l o n s h i ? b etw een e i r .e r e t t e er.oV.ln; and c a n c e r , tv s fw M ef cancer, cancer of tU 1C * ef T ilt I t s lip I f t i e proper tier, of cates of cancer of t-.e a --e and cancer of tn . le r f i* vio v e r. e ic c ro w . tn o ie re . i f a ;e , compared w ith two t - ? . s o f c o n tro ls . dr. t i e po?ultio n . This i_s our - 4tu'-ea s***^*D3 i'Ot t r o l t were p a tie n ts who had no n a i l - a i t tH ccn* f-ro r and p a t.e n ts v ie have o th er tvpes of ear.cer tie r. 1 m , or larvr-n. V w ill note one tn i.n e vn*..I-_c- ter ?- L- .c, ..e .h -t S TOt b*r. siz e d very r.ucbv* bYuvtt vvv..iicc~v we rjave C5n firr.e e t f *"** ^ <8* tfradj of tie cane pieno.nenen. It a-parcr.tav tnere I t n-acl re la tio n s h ip between c lf a r e tt.. sroVtin: and l a n T i can- car as between c lf a r e tto caohln; and lun cancer. ^ ^ You v l l l n o tic e , a le o , the l n t e r e e t l i ; : " i n is th a t the c ih a - e tte c r o h .r is one of the V-infs which drops . t>- cEUsed ~ one of tne Off v i t b in cre te in c . Ge * - c " ve* tn ln ^ e * -.* -. ?ro-bi Lcv_iv.. .v.cltyyc to fin e to enoiE-i-- ti..- - ^ curve In etn eer -i t -o.^o-- nc v---'c h urotoed off v -tr. -"*c- c~ t Ic u e t fct p re se n t, tue ol5sr rf , a wan i , M.E.M the le e s l ik e ly be i* to be ft c ig a r e tte cr.akcr. tow, th a t's & very in te re s tin c observation. In s t i * , f tr tln , ftf Doctor Rhoads in d ic a te d , cr.i 2 t : i r ^ ve v i l l a l l a g re e , th is 6oe6 n o t n e c e s s a rily n5Er* taoklar- causes lung ctaco r, tnouc- th at c l - fere`*'te b: sin;ly ts ftdcod e f f e c t o r fa c to r* I t *t=:-ly nears ~*ero cancer aronc cig arette snokers tuar. there is e taJ- ciyarett siackera. . l ie In te re e tla r cues tier, i t v i t t ie e t t .tt ic t-t-i- lT n ets free, tie stL ri.'o ir.t o ' nur*rt, q u e st:te tie e ly ? Arc th ere are various ways of dolr./ t u a i , tr.c - t try to Co in to t i e a rith m e tic of i t , t u t on the > r . t s l i d , , 1 he.ve J o tte d down sane conclusions vaiefc a r is e from o -r d a ta . They do n o t a r is e , in c id e n ta lly , .rc r. -ats r-c- ta has been induced by w in ter and iraruu-, - ec data is rig h t, pnact_ccJ.-.` - * " - c *-Cw * * snokers r.e t, 1 ' ^ cancer ar---*- -tr-*a.<r-r-.-,-t wtru e according our date a t all* ? i i r i ? - r i TM p ercer.t o ' i-un; e e -c o r eases are as*. c ig a re tte snokers according to our fiyvros. -- to&tt are c o r r e c t, throughout l i f e , t u i r is t.*c _ .c-.e.-ce 1 ^ ca-ncer. In non-snokers, fiv e per ^ o u te rd , t - i r is t - r c ^ h o u t l i f e , icind you. In heavy ar.e.'.srr, - is ...o* . c ig a re tte smokers, t:-ts - ............... ' a day, it s s ix t i r e s as r.uch or th ir ty p ;r tr.ousa.,u, t -- uC .'.'Vr; 'j*t? -- ------------------------------------- --- RECEiVED F .R H E S ^ -- dauJ U V Il E - M.E.M thr p e rc e n t* You w ill r e c a l l t h a t th e l i e f t i r * ex p ectan cy th e g e n e ra l a a l e p o p u la tio n I s one p e r c e n t * sd t i l e Is th ree tin e s as nuch. Bov# a c c o rd in g t o a r e c e r .t p a p e r I n Fus-luc u v a l t a R ep o rts by B rita in # F r a s ie r and Covon, it* e is ny o p in io n th a t th a t ag rees a t l e a r t in g e n e ra l w ith the csca of K achle and G regorius on chrom ate w orker c a re e r; those a re c o t the fig u re s giver. by B r ita in , F ra s ie r asc Coven, they a re e is p iy ay i n t e r p r e t a t i o n o f th e n , a t to hov much lu n g can cer those w orkers acy be ex p ected to develop ir. tw entyfiv e y e a rs i f th e ir data are c o rre c t, per thousand Aaong w hite n a lo s , th e re sh o u ld be s in ty -^ -v e c a se s in tw e n ty -fiv e y e a rs in chrom ate w orkers and anorc n c n - v h i t e , two h u n d red and t . . i r r y - f i v e . l^w# - - ' . a a r i t h m e t i c i s v e r y , v e r y f a r o f f , t-*i: n o a r.t c.ie t r . -- p o s s ib ly two, c e r ta in ly th a t c ig a rc -tte sn o /ir.g , i f i t us a carcinogen is a p re tty m ild one, sin ce i t in creases the e n e r a l i n c i d e n c e th r o u g h o u t l i f e o n ly b y a f a c t o r or- +viee i f such an o ccu p atio n al fa c to r as cnroncto dus * is a c a rc in o g e n , i t a p p a re n tly , when i t does w ork, is e p r e tty stro n g one, sin c e i t nay in c re a se i t by a very nuen fa c to r* T hat it# tw e r.ty -tL re e p e rc e n t o f a l l the :-ule w o rk ers, in tw e n ty -fiv e y e a rs , nay t e ex p ected to develop Iv n g c a n c e r i f the d a ta p u b lis n e u uy th o se vorkw r. s^--- up ana are re p re s e n ta tiv e of the tru e p ic tu r e . RECpVEDF.H^S \A W.E.W.- so ts^ t W. h er. o??s--.= tlj. * te e ftC U "* ^ T* t our d iep o t 1 . " ea ro ly on, two e h ie f types o. e s . e--* o.= . tfeieh - r t r o e M l , m o re o th e rs , t .e s u s . I t o t e - t e o n s l i . r . 4 C. n . l e n v iro n n e n tsl d u st. or., * . i * U holTI enokinc. which 1 . w ^ n t l y r y week. srd or., of fc ls type vhoee lneldoneo d o n 't knw oiaee wo d o n 't mow s l l the o e c u p .tio n il ee rcin o y en s, t u t which when i t does occur, i t perJicps ?*ry tr S I th in k 1 hove n o r . - one n o r . s l i d . , > i-e b p e r . h e p s p u t s t i l s 1= n u m b e rs . n. o^-6 percent tu-1o- " * ** 5 ,, t lif e ficure to the sever.tp-flee, ip p rw im te ly sever.tr- flv e r i l l Ion n s l . s in the `i n i to 4 S U te s , throughout t i r l i f . t m e . seven hundred end f i f t y t . ---- -.e o- t- ^ develop lunp ee-ncer. Of th o s e , e l i l o le s s then t i u f or r s t h e r ecn eth in y l i k e e t h i r d , two hundred tw enty-five th o u tu d , w ill be n o n -srohers. Zr-e-rest v i a - s ..o s e .., t u t sin ce th .ro is no u to suppose s h it jo k e r s ire - wh. ljarraae to t i e T .'luencests thenor.-srskors, -r--**" we cm ^ . . i.v<r *r.sver, thoui and or only a ttrib u te t o e e buncred and ~ - r . those esses to tr.oV.lnc p er se . to t . _ t w -.t ^ ln subs to n e ., to io t h i s . t i n t over. I f sr.o k in ; r.ets ^ c r e d it, ve have c* to, account fo r tb o u . thousand. casee . o v. n r cancer -",o tve r cwausesv h ic - , -* ` , ___ u_? __i z^.Z y th a y tr o en T iro n n o n.ta-i c-ac. < - ir t C r ^ OCCujtu-Oji-Ai----------- _ we've co.t to rfiinn"w* aa l o t ::!ore occupational ca-.re * 't>--- RECEIVED F.H. date'W I-* M.E.M q u e stio n in one r e p o r t, th e incidence of lung cancer in in d iv id u a ls in c itie s of over one hundred thousand, is such g r e a te r than in r u r a l com m unities. I d o n 't know how v a lid th ese h in ts a r e , b u t they j u s t i f y f u r th e r d is c u s s io n . Are th e re f u r th e r comments on D octor L ev in 's paper? (lfo response)* I f n o t, w e'l l proceed to the next paper. Doctor Eueper needs no in tro d u c tio n . You know n is long continued c o n trib u tio n s to the f i e l d of environm ental cancer. Ky acquaintance w ith him d ates over many y e a rs . I t has always been most s tim u la tin g . He i s one who has stuck to his guns in th is im portant problem, and I happen to know, in some in s ta n c e s , under d i f f i c u l t circum stances, and has given us much knowledge of th is im portant fie ld * Doctor Hueper. BY DOCTO?. HTSP2H: (Doctor Kueper re a d a prepared paper, -which is or. f i l e a t the Saranac L aboratory).