Decades ago it was established that the risk of lung cancer was causatively associated not only with the independent use of tobacco products, but also with the possible synergistic effect of
Arsenic
In 1820, Paris first described the development of skin carcinoma among smelter workers in England who were exposed to arsenic. The relationship between lung carcinoma and arsenic was subsequently described by Saupe in 1930. It is estimated that 1.5 millon workers in the United States are occupationally exposed to arsenic in industries which manufacture glass, pigments, pesticides, and paints. It has been suggested that the site of arsenic related lung cancer is more common in the upper lobes, distribution of cell types is similar to that in the general population.
Asbestos
Asbestos dust is the most common and most important occupational risk factor for the development of lung carcinoma. A cigarette smoker has an eleven times greater chance of dying from lung cancer than a non-smoker. When cigarette smoking is combined with asbestos exposure, the chance of developing lung carcinoma is 92 times greater than the non-smoking population. All forms of asbestos have been demonstrated to produce lung cancer and mesothelioma. The incidence of lung cancer in the non-smoking patient population exposed to asbestos is also significantly increased.
Chloroethyl Ether (CMME)
Chloroethyl ether (CMME) and the more potent carcinogen bis-chloroethyl ether (BCME) have been shown to produce lung carcinoma in mice by inhalation of as little as 0.1 PPM. The incidence of lung carcinoma is increased among workers exposed to chloroethyl ethers.
Chromium
Lung carcinoma in association with chromium was first reported by Pfeii in 1935. Since that time, several investigations have shown that chromate workers in the United States have an increased risk of developing lung carcinoma. The weird experiences in chromate induced lung cancer has been summarized by Hueper. Hueper reported 123 cases in which the pathology was known. Sixty-six of these cases were anaplastic carcinoma, 46 were squamous cell and 11 were adenocarcinoma. Upper and lower lobes were equally affected. The latent period from onset od exposure to development of lung cancer ranges from three to fifty-eight years with a mean of 24 years.
Isopropyl Alcohol
Isopropyl alcohol is manufactured from crude isopropyl oil. The exact carcinogenic nature of isopropyl oil is not fully understood. However, there may be a 20 fold increase in lung cancer following a significant exposure to isopropyl oil.
Mustard Gas
Mustard gas (bis(alpha-chloroethyl)sulfite) was one of several poisonous gases used during World War I. Case and Lea first suggested an association between mustard gas and lung carcinoma in a study of british soldiers after World Was I. In 1959, Yamada reported a definite relationship between industrial manufacture of mustard gas and the development of lung cancer in exposed workers. Approximately 50% of the cases were squamous cell carcinoma. The rates were found to be 16 times greater in exposed workers than in the central group.
Nickel
During the process of nickel purification, a gaseous compound, nickel carbonyl is formed. The increased incidence of lung carcinoma in workers exposed to nickel or nickel carbonyl has been documented as far back as 1930. The precise carcinogenic compound and biological mechanism are still unknown.
Radioactive Ore
The increased incidence of lung carcinoma in miners of radioactive ore was first noticed in Central Europe. The time from onset of exposure to development of lung carcinoma is approximately twenty years. In the United States, analysis of workers from colorado uranium mines and in Canadian uranium mines in Newfoundland have also shown a significant increased risk of developing lung carcinoma. Both the United states and Canadian sites have a high level of contamination with radon daughters, which are a natural decay product of uranium. The pathology of radiation associated lung cancers has been well studied and small cell carcinoma predominates. Cigarette smoking synergistically increases the risk of developing lung carcinoma. However, studies of non-smoking Navajo Indians who worked on the Colorado Plateau also have a significant increased risk for lung cancer over the normal population.
Vinyl Chloride
Vinyl chloride has been implicated in the production of a wide variety of tumors. There are published reports of increased incidence of lung cancer after fifteen years of exposure. The majority of cases are large cell undifferentiated carcinoma.