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COMMENTS FOR OPENING OF DISCUSSION ON “NEOPLASTIC EFFECTS”

These significant observations in occupational cancer and related health effects constitute a remarkable tribute to the scientists who have conducted this work under very difficult circumstances and within a span of a few months. Their very commendable efforts have established the basis and direction for further investigation and we are all indebted to them. The significant medical observations now reported, on a single chemical complex and type of industrial exposure, have focused on several areas of national need and scientific interest and the methods and resources available for investigation. The first and immediate pressing question is whether the cancers observed will be confined to the manufucturing process or will also occur in successive lower grades of exposure in the processing and use of vinyl chloride and polyvinyl chloride and whether still other types of cancer may subsequently be identified. The potential magnitude of the cancer problem, however, does not rest on vinyl chloride alone, but rather on its role as a possible index cancer chemical, an indicator to a large group of similarly structured chemicals and polymers. Should any of these chemicals prove to be carcinogenic, then the magnitude of the risk would extend to an ever-widening circle of industries, processes, and exposed populations. The degree of validity of these various possibilities must be identified and resolved. The second area of concern is: What is the nature and extent of the industrial medical surveillance in the industries throughout the country for the identification of the employee population at risk and for the early detection of patterns of illness and causes of death, which may be associated with specific chemicals and occupational exposures at each plant? What system exists for the identification of the in-plant use of hazardous chemicals and the provision of toxicological information? What is the nature and extent of the environmental surveillance? Basic to these questions is the need for accurate and complete records of personnel and employment and of medical and environmental measurement data for each of the air-borne contaminants in the respective work areas-all chronologically recorded and linked together for correlation evaluation of health effects and work exposures. In the final analysis, all of these questions on industrial medical surveillance come back to the basic source: What is the nature and quality of the industrial medical and environmental programs in the small and large plants throughout the country? Unfortunately, the necessary industrial medical and environmental programs to recognize effectively occupational illnesses and occupational cancers do not exist within the small plants or even in some of the larger companies. The basic point raised is, How many thousands of occupational illnesses and