Susceptibility and Resistance to Environmental Carcinogens in the Development of Carcinoma of the Lung

Our plain-English summary of Susceptibility and Resistance to Environmental Carcinogens in the Development of Carcinoma of the Lung, by G. Saccomanno, V.E. Archer, O. Auerbach, et al (1973).

The study

• Authors: G. Saccomanno, V.E. Archer, O. Auerbach, R.P. Saunders
• Published: Human Pathology, Volume 4 No4. December 1973
• Type of article: Journal article
• Our copy: from Johns-Manville's own medical library. The article is still under copyright, so we describe it here rather than post it.

In plain English

This case series concerned lung cancer in uranium workers, not asbestos. The authors presented eight cases selected from about 8000 uranium miners and mill workers under sputum study since 1957, about 200 of whom had developed lung cancer. The known carcinogens were radon daughters and cigarette smoking. One patient, who had never smoked and had no known radon daughter exposure but had worked in a hard-rock mine and a uranium mill, had adenocarcinoma. Patients who developed tumors were aged 37 to 62. One miner had a lobe removed and was still alive. A heavy smoker had epidermoid cancer cells in the sputum for six years before a small cell tumor appeared. A never-smoking miner had oat cell carcinoma at autopsy. Another miner developed a small cell tumor after short radon daughter exposure. A miner with the highest radon daughter exposure and a high smoking index had never shown abnormal cells. The authors concluded that the first seven patients lacked protective mechanisms some workers show, and that the immune processes involved need further study. They noted that not all carcinogens involved were known.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case series of eight selected patients, followed with periodic sputum cytology and, in some cases, autopsy
• Who was studied: Eight cases selected from about 8000 uranium miners and mill workers under sputum cytology study since 1957. About 200 lung cancers had developed in that population.
• Exposure: The known carcinogens were radon daughter exposure, measured as total working level months (WLM), and cigarette smoking, expressed as a smoking index (cigarettes per day times years smoked). One case had never smoked and had no known radon daughter exposure, but had worked in hard-rock tungsten mining and a uranium mill. The authors said the carcinogenic factors from those jobs were less well defined. Asbestos was not studied.
• Main results:
  • The patients who developed malignant lung tumors ranged in age from 37 to 62.
  • Case 1: a tumor was found in the upper lobe of the left lung and the lobe was removed. The patient was still alive.
  • Case 2: a heavy smoker (smoking index 1880) had epidermoid tumor cells in all sputum samples for another six years and then developed a small cell tumor in 1971. At autopsy, the small cell tumor was in the right lower lobe and an invasive epidermoid carcinoma was in the left lower lobe. Cases 2 and 3 developed small cell tumors and died.
  • Case 5: a miner with 520 WLM who had never smoked cigarettes had a lesion at the right lung hilum at autopsy that was oat cell carcinoma.
  • Case 6: a man who had never mined uranium or smoked, but had worked in a tungsten hard-rock mine and a uranium mill, had adenocarcinoma on bronchial biopsy.
  • Case 7: a small cell (oat cell) tumor developed after a short radon daughter exposure.
  • Case 8: a miner with the highest radon daughter exposure and a high smoking index had never shown abnormal sputum cells, and chest X-rays showed no abnormalities.
• The authors' conclusion: The authors concluded that the first seven patients lacked the protective mechanisms or resistance shown by some workers, such as Patient 8. They said the immune systems involved in lung neoplasia are poorly understood and deserve further study.
• Limitations the authors state:
  • The authors stated that not all carcinogenic agents involved in these cases were fully evaluated or known. The cases were judged only on known exposures.
  • For Case 6, the authors said the carcinogenic factors from hard-rock mining and uranium mill work were less well defined.
  • For Case 7, the authors noted that an earlier unknown exposure to unidentified carcinogens could not be ruled out.

Topics

Medical terms in this study, explained in our Lexicon: Carcinoma, Lung Cancer, Sputum, Adenocarcinoma, Small Cell Lung Cancer, Autopsy.

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