1
|
Kreuzer M, Sommer M, Deffner V, Bertke S, Demers PA, Kelly-Reif K, Laurier D, Rage E, Richardson DB, Samet JM, Schubauer-Berigan MK, Tomasek L, Wiggins C, Zablotska LB, Fenske N. Lifetime excess absolute risk for lung cancer due to exposure to radon: results of the pooled uranium miners cohort study PUMA. RADIATION AND ENVIRONMENTAL BIOPHYSICS 2024; 63:7-16. [PMID: 38172372 PMCID: PMC10920468 DOI: 10.1007/s00411-023-01049-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 11/09/2023] [Indexed: 01/05/2024]
Abstract
The Pooled Uranium Miners Analysis (PUMA) study is the largest uranium miners cohort with 119,709 miners, 4.3 million person-years at risk and 7754 lung cancer deaths. Excess relative rate (ERR) estimates for lung cancer mortality per unit of cumulative exposure to radon progeny in working level months (WLM) based on the PUMA study have been reported. The ERR/WLM was modified by attained age, time since exposure or age at exposure, and exposure rate. This pattern was found for the full PUMA cohort and the 1960 + sub-cohort, i.e., miners hired in 1960 or later with chronic low radon exposures and exposure rates. The aim of the present paper is to calculate the lifetime excess absolute risk (LEAR) of lung cancer mortality per WLM using the PUMA risk models, as well as risk models derived in previously published smaller uranium miner studies, some of which are included in PUMA. The same methods were applied for all risk models, i.e., relative risk projection up to <95 years of age, an exposure scenario of 2 WLM per year from age 18-64 years, and baseline mortality rates representing a mixed Euro-American-Asian population. Depending upon the choice of model, the estimated LEAR per WLM are 5.38 × 10-4 or 5.57 × 10-4 in the full PUMA cohort and 7.50 × 10-4 or 7.66 × 10-4 in the PUMA 1960 + sub-cohort, respectively. The LEAR per WLM estimates derived from risk models reported for previously published uranium miners studies range from 2.5 × 10-4 to 9.2 × 10-4. PUMA strengthens knowledge on the radon-related lung cancer LEAR, a useful way to translate models for policy purposes.
Collapse
Affiliation(s)
- M Kreuzer
- Federal Office for Radiation Protection (BfS), Munich (Neuherberg), Germany.
| | - M Sommer
- Federal Office for Radiation Protection (BfS), Munich (Neuherberg), Germany
| | - V Deffner
- Federal Office for Radiation Protection (BfS), Munich (Neuherberg), Germany
| | - S Bertke
- National Institute for Occupational Safety and Health, Cincinnati, OH, USA
| | - P A Demers
- Occupational Cancer Research Centre, Toronto, Canada
| | - K Kelly-Reif
- National Institute for Occupational Safety and Health, Cincinnati, OH, USA
| | - D Laurier
- Institute for Radiological Protection and Nuclear Safety (IRSN), Fontenay-aux-Roses, France
| | - E Rage
- Institute for Radiological Protection and Nuclear Safety (IRSN), Fontenay-aux-Roses, France
| | | | - J M Samet
- Colorado School of Public Health, Aurora, CO, USA
| | | | - L Tomasek
- National Radiation Protection Institute, Prague, Czech Republic
| | - C Wiggins
- University of New Mexico, Albuquerque, NM, USA
- New Mexico Tumor Registry, Albuquerque, NM, USA
| | | | - N Fenske
- Federal Office for Radiation Protection (BfS), Munich (Neuherberg), Germany
| |
Collapse
|
2
|
Kreuzer M, Deffner V, Sommer M, Fenske N. Updated risk models for lung cancer due to radon exposure in the German Wismut cohort of uranium miners, 1946-2018. RADIATION AND ENVIRONMENTAL BIOPHYSICS 2023; 62:415-425. [PMID: 37695330 PMCID: PMC10628028 DOI: 10.1007/s00411-023-01043-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 08/18/2023] [Indexed: 09/12/2023]
Abstract
UNSCEAR recently recommended that future research on the lung cancer risk at low radon exposures or exposure rates should focus on more contemporary uranium miners. For this purpose, risk models in the German Wismut cohort of uranium miners were updated extending the follow-up period by 5 years to 1946-2018. The full cohort (n = 58,972) and specifically the 1960 + sub-cohort of miners first hired in 1960 or later (n = 26,764) were analyzed. The 1960 + sub-cohort is characterized by low protracted radon exposure of high quality of measurements. Internal Poisson regression was used to estimate the excess relative risk (ERR) for lung cancer per cumulative radon exposure in Working Level Months (WLM). Applying the BEIR VI exposure-age-concentration model, the ERR/100 WLM was 2.50 (95% confidence interval (CI) 0.81; 4.18) and 6.92 (95% CI < 0; 16.59) among miners with attained age < 55 years, time since exposure 5-14 years, and annual exposure rates < 0.5 WL in the full (n = 4329 lung cancer deaths) and in the 1960 + sub-cohort (n = 663 lung cancer deaths), respectively. Both ERR/WLM decreased with older attained ages, increasing time since exposure, and higher exposure rates. Findings of the 1960 + sub-cohort are in line with those from large pooled studies, and ERR/WLM are about two times higher than in the full Wismut cohort. Notably, 20-30 years after closure of the Wismut mines in 1990, the estimated fraction of lung cancer deaths attributable to occupational radon exposure is still 26% in the full Wismut cohort and 19% in the 1960 + sub-cohort, respectively. This demonstrates the need for radiation protection against radon.
Collapse
Affiliation(s)
- M Kreuzer
- Federal Office for Radiation Protection, Ingolstaedter Landstr. 1, 85764, Neuherberg, Germany.
| | - V Deffner
- Federal Office for Radiation Protection, Ingolstaedter Landstr. 1, 85764, Neuherberg, Germany
| | - M Sommer
- Federal Office for Radiation Protection, Ingolstaedter Landstr. 1, 85764, Neuherberg, Germany
| | - N Fenske
- Federal Office for Radiation Protection, Ingolstaedter Landstr. 1, 85764, Neuherberg, Germany
| |
Collapse
|
3
|
Kelly-Reif K, Bertke SJ, Rage E, Demers PA, Fenske N, Deffner V, Kreuzer M, Samet J, Schubauer-Berigan MK, Tomasek L, Zablotska LB, Wiggins C, Laurier D, Richardson DB. Radon and lung cancer in the pooled uranium miners analysis (PUMA): highly exposed early miners and all miners. Occup Environ Med 2023; 80:385-391. [PMID: 37164624 PMCID: PMC10369304 DOI: 10.1136/oemed-2022-108532] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 04/20/2023] [Indexed: 05/12/2023]
Abstract
OBJECTIVES Radon is a ubiquitous occupational and environmental lung carcinogen. We aim to quantify the association between radon progeny and lung cancer mortality in the largest and most up-to-date pooled study of uranium miners. METHODS The pooled uranium miners analysis combines 7 cohorts of male uranium miners with 7754 lung cancer deaths and 4.3 million person-years of follow-up. Vital status and lung cancer deaths were ascertained between 1946 and 2014. The association between cumulative radon exposure in working level months (WLM) and lung cancer was modelled as the excess relative rate (ERR) per 100 WLM using Poisson regression; variation in the association by temporal and exposure factors was examined. We also examined analyses restricted to miners first hired before 1960 and with <100 WLM cumulative exposure. RESULTS In a model that allows for variation by attained age, time since exposure and annual exposure rate, the ERR/100 WLM was 4.68 (95% CI 2.88 to 6.96) among miners who were less than 55 years of age and were exposed in the prior 5 to <15 years at annual exposure rates of <0.5 WL. This association decreased with older attained age, longer time since exposure and higher annual exposure rate. In analyses restricted to men first hired before 1960, we observed similar patterns of association but a slightly lower estimate of the ERR/100 WLM. CONCLUSIONS This new large, pooled study confirms and supports a linear exposure-response relationship between cumulative radon exposure and lung cancer mortality which is jointly modified by temporal and exposure factors.
Collapse
Affiliation(s)
- Kaitlin Kelly-Reif
- Division of Field Studies and Engineering, National Institute for Occupational Safety and Health, Cincinnati, Ohio, USA
| | - Stephen J Bertke
- Division of Field Studies and Engineering, National Institute for Occupational Safety and Health, Cincinnati, Ohio, USA
| | - Estelle Rage
- Institute for Radiological Protection and Nuclear Safety, Fontenay-aux-Roses, France
| | - Paul A Demers
- Occupational Cancer Research Centre, Ontario Health, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Nora Fenske
- Federal Office for Radiation Protection (BfS), Munich (Neuherberg), Germany
| | - Veronika Deffner
- Federal Office for Radiation Protection (BfS), Munich (Neuherberg), Germany
| | - Michaela Kreuzer
- Federal Office for Radiation Protection (BfS), Munich (Neuherberg), Germany
| | | | - Mary K Schubauer-Berigan
- Evidence Synthesis and Classification Branch, International Agency for Research on Cancer, Lyon, France
| | | | - Lydia B Zablotska
- Epidemiology and Biostatistics, University of California, San Francisco, California, USA
| | - Charles Wiggins
- University of New Mexico, Albuquerque, New Mexico, USA
- New Mexico Tumor Registry, Albuquerque, Mexico, USA
| | - Dominique Laurier
- Institute for Radiological Protection and Nuclear Safety, Fontenay-aux-Roses, France
| | - David B Richardson
- Department of Environmental and Occupational Health, University of California, Irvine, Program in Public Health, Irvine, California, USA
| |
Collapse
|
4
|
Brobbey A, Rydz E, Fenton S, Demers PA, Ge CB, Peters CE. Characterizing occupational radon exposure greater than 100 Bq/m 3 in a highly exposed country. Sci Rep 2022; 12:21323. [PMID: 36494406 PMCID: PMC9734100 DOI: 10.1038/s41598-022-25547-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 11/30/2022] [Indexed: 12/13/2022] Open
Abstract
Radon is an established lung carcinogen concentrating in indoor environments with importance for many workers worldwide. However, a systematic assessment of radon levels faced by all workers, not just those with direct uranium or radon exposure, has not previously been completed. The objective of this study was to estimate the prevalence of workers exposed to radon, and the level of exposure (> 100-200 Bq/m3, 200-400 Bq/m3, 400-800 Bq/m3, and > 800 Bq/m3) in a highly exposed country (Canada). Exposures among underground workers were assessed using the CAREX Canada approach. Radon concentrations in indoor workplaces, obtained from two Canadian surveys, were modelled using lognormal distributions. Distributions were then applied to the susceptible indoor worker population to yield the number of exposed workers, by occupation, industry, province, and sex. In total, an estimated 603,000 out of Canada's 18,268,120 workers are exposed to radon in Canada. An estimated52% of exposed workers are women, even though they comprise only 48% of the labour force. The majority (68%) are exposed at a level of > 100-200 Bq/m3. Workers are primarily exposed in educational services, professional, scientific and technical services, and health care and social assistance, but workers in mining, quarrying, and oil and gas extraction have the largest number of exposed workers at high levels (> 800 Bq/m3). Overall, a significant number of workers are exposed to radon, many of whom are not adequately protected by existing guidelines. Radon surveys across multiple industries and occupations are needed to better characterize occupational exposure. These results can be used to identify exposed workers, and to support lung cancer prevention programs within these groups.
Collapse
Affiliation(s)
- A. Brobbey
- grid.17091.3e0000 0001 2288 9830CAREX Canada, School of Population and Public Health, University of British Columbia, Vancouver, BC Canada ,grid.22072.350000 0004 1936 7697Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB Canada
| | - E. Rydz
- grid.17091.3e0000 0001 2288 9830CAREX Canada, School of Population and Public Health, University of British Columbia, Vancouver, BC Canada ,grid.22072.350000 0004 1936 7697Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB Canada
| | - S. Fenton
- grid.17091.3e0000 0001 2288 9830CAREX Canada, School of Population and Public Health, University of British Columbia, Vancouver, BC Canada ,grid.22072.350000 0004 1936 7697Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB Canada
| | - P. A. Demers
- grid.512212.7Occupational Cancer Research Centre, Ontario Health, Toronto, ON Canada ,grid.17063.330000 0001 2157 2938Dalla Lana School of Public Health, University of Toronto, Toronto, ON Canada
| | - C. B. Ge
- grid.4858.10000 0001 0208 7216TNO, The Hague, The Netherlands
| | - C. E. Peters
- grid.17091.3e0000 0001 2288 9830CAREX Canada, School of Population and Public Health, University of British Columbia, Vancouver, BC Canada ,grid.22072.350000 0004 1936 7697Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB Canada ,grid.418246.d0000 0001 0352 641XBCCDC, Vancouver, BC Canada ,BC Cancer, Vancouver, BC Canada
| |
Collapse
|
5
|
Mo W, Xu W, Hong M, Yang T, Shi Y, Jiao Y, Nie J, Cui F, Cao J, Zhang S. Proteomic and miRNA profiling of radon-induced skin damage in mice: FASN regulated by miRNAs. JOURNAL OF RADIATION RESEARCH 2022; 63:706-718. [PMID: 35791446 PMCID: PMC9494515 DOI: 10.1093/jrr/rrac037] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 09/21/2021] [Indexed: 06/15/2023]
Abstract
Radon is a naturally occurring radioactive gas and considered as a serious carcinogen to humans. Continuous radioactive decay of this gas emits high-energy alpha particles. Long-term radon exposure induces oxidative stress and inflammatory response, which results in chronic lung diseases. However, biological effects after radon exposure in other organs have been rarely reported. As the outermost organ of the human body, the skin suffers from environmental damage to agents such as air pollution. Epidemiological studies indicated that areas with high level of radon had a high incidence of skin cancer. However, whether radon exposure induces skin damage has not been reported yet. In this study, we established a radon-exposed mouse model and found that radon exposure affected the structure of skin tissues, which was manifested by inflammatory cell infiltration and skin atrophy. Using proteomic approach, we found 45 preferentially expressed proteins in 60 Working Level Months (WLM) group and 314 preferentially expressed proteins in 120 WLM group from radon-exposed skin tissues. Through microRNA (miRNA) sequencing profiling analysis, 57 dysregulated miRNAs were screened between the control and radon-treated mouse skin. By integrating the dysregulated proteins and miRNAs, radon-induced fatty acid synthase (FASN) was investigated in greater detail. Results showed that FASN was regulated by miR-206-3p and miR-378a-3p and involved in the pathogenesis of radon-induced skin damage. Overexpression of FASN inhibited the proliferation, and induced in WS1 cells. Our present findings illustrate the molecular change during radon-induced skin damage and the potential role of FASN during this process.
Collapse
Affiliation(s)
| | | | - Min Hong
- School of Radiation Medicine and Protection, State Key Laboratory of Radiation Medicine and Protection, Soochow University, Suzhou 215123, China
| | - Tingyi Yang
- West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, Chengdu 610041, China
| | - Yuhong Shi
- Second Affiliated Hospital of Chengdu Medical College, China National Nuclear Corporation 416 Hospital, Chengdu 610051, China
| | - Yang Jiao
- School of Radiation Medicine and Protection, State Key Laboratory of Radiation Medicine and Protection, Soochow University, Suzhou 215123, China
| | - Jihua Nie
- School of Radiation Medicine and Protection, State Key Laboratory of Radiation Medicine and Protection, Soochow University, Suzhou 215123, China
| | - Fengmei Cui
- School of Radiation Medicine and Protection, State Key Laboratory of Radiation Medicine and Protection, Soochow University, Suzhou 215123, China
| | - Jianping Cao
- Corresponding authors. Zhang S, Second Affiliated Hospital of Chengdu Medical College, China National Nuclear Corporation 416 Hospital, Chengdu 610051, China. Tel./Fax: +8628-85502429; E-mail: ; Cao J, No. 199 Ren’ai Rd, Medical College of Soochow University, Suzhou 215123, China. Tel./Fax:+86-512-65880037; E-mail:
| | - Shuyu Zhang
- Corresponding authors. Zhang S, Second Affiliated Hospital of Chengdu Medical College, China National Nuclear Corporation 416 Hospital, Chengdu 610051, China. Tel./Fax: +8628-85502429; E-mail: ; Cao J, No. 199 Ren’ai Rd, Medical College of Soochow University, Suzhou 215123, China. Tel./Fax:+86-512-65880037; E-mail:
| |
Collapse
|
6
|
Folesani G, Galetti M, Ranzieri S, Petronini PG, La Monica S, Corradi M, Cavallo D. Interaction between occupational radon exposure and tobacco smoke: a systematic review. Expert Rev Respir Med 2022; 16:787-800. [PMID: 35912519 DOI: 10.1080/17476348.2022.2108795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION : The risk of lung cancer from radon exposure was small compared to tobacco smoking (BEIR VI), but the relationship between these two carcinogenic agents has yet to be quantitatively estimated. The objective of this systematic review was to evaluate the last evidences on the role of radon occupational exposures and tobacco smoke on lung cancer risk. AREAS COVERED : Thirteen articles were selected using two different databases, PubMed and Scifinder, and were limited to those published from 2010 to 2021. The reference list of selected studies was reviewed to identify other relevant papers. EXPERT OPINION : Seven papers included in this systematic review did not deal with the multiplicative or the additive type of interaction between radon exposure and smoking habit. Six papers discussed the nature of this interaction with a prevalence of the sub-multiplicative model compared to the additive one. Altogether, smoking adjustment did not change significantly lung cancer risk. The included studies might constitute a starting point for updating the models for risk assessment in occupational and residential scenarios, promoting concomitantly the exposure reduction to radon and other cofactors, as recently introduced by Italian Legislative Decree number 101 of 31 July 2020, an application of Euratom Directive 59/2013.
Collapse
Affiliation(s)
- Giuseppina Folesani
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL - Italian Workers' Compensation Authority, Via Fontana Candida 1, 00078 Monte Porzio Catone, Rome, Italy
| | - Maricla Galetti
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL - Italian Workers' Compensation Authority, Via Fontana Candida 1, 00078 Monte Porzio Catone, Rome, Italy
| | - Silvia Ranzieri
- Department of Medicine and Surgery, University of Parma, Viale Gramsci 14, 43126 Parma, Italy
| | - Pier Giorgio Petronini
- Department of Medicine and Surgery, University of Parma, Viale Gramsci 14, 43126 Parma, Italy
| | - Silvia La Monica
- Department of Medicine and Surgery, University of Parma, Viale Gramsci 14, 43126 Parma, Italy
| | - Massimo Corradi
- Department of Medicine and Surgery, University of Parma, Viale Gramsci 14, 43126 Parma, Italy.,Center of Excellence for Toxicological Research (CERT) at University of Parma, Viale Gramsci 14, 43126 Parma, Italy
| | - Delia Cavallo
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL - Italian Workers' Compensation Authority, Via Fontana Candida 1, 00078 Monte Porzio Catone, Rome, Italy
| |
Collapse
|
7
|
Gulan L, Forkapić S, Spasić D, Živković Radovanović J, Hansman J, Lakatoš R, Samardžić S. Identification of high radon dwellings, risk of exposure, and geogenic potential in the mining area of the "TREPČA" complex. INDOOR AIR 2022; 32:e13077. [PMID: 35904385 DOI: 10.1111/ina.13077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 06/18/2022] [Accepted: 07/04/2022] [Indexed: 06/15/2023]
Abstract
This study was performed to investigate radon levels in dwellings in the mining area near the town of Kosovska Mitrovica. The Passive radon technique based on the charcoal canister test kit conducted in summer and autumn 2019 showed unexpected results. The reference level of 300 Bq/m3 for indoor radon concentration was exceeded in 15 of 26 dwellings. Preliminary measurements of gamma dose rate in some dwellings built from local stone showed values from 0.30 to 0.45 μSv/h, while 75% of measurements in dwellings with stone foundations had radon above the reference level. The highest radon concentration (22 500 ± 220 Bq/m3 ) was measured in the cellar of one family house. The RAD7 device (Durridge Company, Inc.) was used to measure radon concentrations in water and nearby soil of some dwellings. Indoor radon concentration fluctuated significantly over two days; over a one-day time scale, radon varied from 2843 ± 217 Bq/m3 at midnight to 1449 ± 104 Bq/m3 in the morning at one site, and abruptly decreased from a maximum of 2146 ± 262 Bq/m3 in one day to a minimum of 21 Bq/m3 the next day at another site. The influence of geological substrate on radon exposure was discussed through the estimation of geogenic radon potential, which varies from low the high radon index despite to high permeability of soil.
Collapse
Affiliation(s)
- Ljiljana Gulan
- Department of Physics, Faculty of Sciences and Mathematics, University of Priština in Kosovska Mitrovica, Kosovska Mitrovica, Serbia
| | - Sofija Forkapić
- Department of Physics, Faculty of Sciences, University of Novi Sad, Novi Sad, Serbia
| | - Dušica Spasić
- Department of Physics, Faculty of Sciences and Mathematics, University of Priština in Kosovska Mitrovica, Kosovska Mitrovica, Serbia
| | - Jelena Živković Radovanović
- Department of Physics, Faculty of Sciences and Mathematics, University of Priština in Kosovska Mitrovica, Kosovska Mitrovica, Serbia
| | - Jan Hansman
- Department of Physics, Faculty of Sciences, University of Novi Sad, Novi Sad, Serbia
| | - Robert Lakatoš
- Faculty of Technical Sciences, University of Novi Sad, Novi Sad, Serbia
| | - Selena Samardžić
- Faculty of Technical Sciences, University of Novi Sad, Novi Sad, Serbia
| |
Collapse
|
8
|
Su Z, Jia XH, Fan YG, Zhao FH, Zhou QH, Taylor PR, Qiao YL. Quantitative evaluation of radon, tobacco use and lung cancer association in an occupational cohort with 27 follow-up years. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2022; 232:113233. [PMID: 35093810 DOI: 10.1016/j.ecoenv.2022.113233] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 01/20/2022] [Accepted: 01/21/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Occupational radon cohorts provide important information about exposure at residential level, which are difficult to observe prospectively. However, evidence about radon-related lung cancer risks from initial exposure in childhood or interaction between radon and smoking is still limited. METHODS A total of 6017 tin miners with at least 10 years of underground radon exposure were enrolled beginning in 1992 and followed for up to 27 years. Lung cancer risks were estimated by modeling total and intensity of radon exposure. RESULTS A total of 933 lung cancer cases occurred in this cohort over 89,092 person-years of follow up. Excess relative risk increased by 0.96% per cumulative working level month (WLM). A unique aspect of this population was the early age at first radon exposure for workers. Results showed that lung cancer risk from initial radon exposure in childhood (<13 years old) was greater than risk when first exposure occurred at later ages (13-17, 18-24, and ≥ 25 years old). Moreover, risk declined with years since last exposure and attained age, but increased with age at last exposure. Importantly, these patterns were stable after adjustment for tobacco use or arsenic exposure. For joint effects of radon and other agents, our results support sub-multiplicative as the most likely model for interaction between radon and tobacco use or arsenic exposure. CONCLUSION This study highlights the possible importance of radon exposure in childhood in cancer etiology and suggests another potential strategy to mitigate the global lung cancer burden.
Collapse
Affiliation(s)
- Zheng Su
- Department of Epidemiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xin-Hua Jia
- Department of Epidemiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; The State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, School of Public Health, Xiamen University, Xiamen, Fujian, China
| | - Ya-Guang Fan
- Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Tianjin Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin, China.
| | - Fang-Hui Zhao
- Department of Epidemiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Qing-Hua Zhou
- Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Tianjin Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin, China; Sichuan Lung Cancer Institute, Sichuan Lung Cancer Center, West China Hospital, Chengdu, Sichuan University, China
| | - Philip R Taylor
- Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - You-Lin Qiao
- Center for Global Health, School of Population Medicine and Public Health Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| |
Collapse
|
9
|
Gaskin J, Whyte J, Zhou LG, Coyle D. Regional cost effectiveness analyses for increasing radon protection strategies in housing in Canada. JOURNAL OF ENVIRONMENTAL RADIOACTIVITY 2021; 240:106752. [PMID: 34628245 DOI: 10.1016/j.jenvrad.2021.106752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 09/16/2021] [Accepted: 09/19/2021] [Indexed: 06/13/2023]
Abstract
The incremental cost effectiveness ratios for implementing a recent recommendation to install a more radon resistant foundation barrier were modelled for new and existing housing in 2016, for each province and territory in Canada. Cost-utility analyses were conducted, in which the health benefit of an intervention was quantified in quality-adjusted life years, to help guide policymakers considering increasing investment in radon reduction in housing to reduce the associated lung cancer burden shouldered by the health care system. Lung cancer morbidity was modelled using a lifetable analysis that incorporated lung cancer incidence and survival time for localized, regional, and distant stages of diagnoses for both non-small cell and small cell lung cancer. The model accounted for surgical or advanced lung cancer treatment costs avoided, and average health care costs incurred for radon-attributable lung cancer cases prevented by the intervention. The incremental implementation of radon interventions in the housing stock was modelled over a lifetime horizon, and a discount rate of 1.5% was adopted. This radon intervention in new housing was cost effective in all but one region, ranging from $18,075/QALY (15,704; 20,178) for the Yukon to $58,454/QALY (52,045; 65,795) for British Columbia. A sequential analysis was conducted to compare intervention in existing housing for mitigation thresholds of 200 and 100 Bq/m3. This intervention in existing housing was cost effective at a mitigation threshold of 200 Bq/m3 in regions with higher radon levels, ranging from $33,247/QALY (27,699; 39,377) for the Yukon to $61,960/QALY (46,932; 113,737) for Newfoundland, and more cost effective at a threshold of 200 than 100 Bq/m3. More lung cancer deaths can be prevented by intervention in new housing than in existing housing; it was estimated that the proposed intervention in new housing would prevent a mean of 446 (416; 477) lung cancer cases annually. The cost effectiveness of increased radon resistance in foundation barriers in housing varied widely, and would support adopting this intervention in new housing across Canada and in existing housing in higher radon regions. This study provides further evidence that the most cost effective way of responding to the geographically variable radon burden is by implementing specific regional radon reduction policies.
Collapse
Affiliation(s)
- Janet Gaskin
- Construction Research Centre, National Research Council, 1200 Montreal Road, Ottawa, Canada; Radiation Protection Bureau, Health Canada, 775 Brookfield Rd, Ottawa, Canada.
| | - Jeff Whyte
- Construction Research Centre, National Research Council, 1200 Montreal Road, Ottawa, Canada
| | - Liang Grace Zhou
- Construction Research Centre, National Research Council, 1200 Montreal Road, Ottawa, Canada
| | - Doug Coyle
- School of Epidemiology and Public Health, 600 Peter Morand Crescent, University of Ottawa, Ottawa, Canada
| |
Collapse
|
10
|
Chen J. A discussion on the potential impact of residential radon exposure on the quality of exposure and risk assessment for former uranium miners. RADIATION AND ENVIRONMENTAL BIOPHYSICS 2021; 60:1-7. [PMID: 33030687 PMCID: PMC7902573 DOI: 10.1007/s00411-020-00875-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 09/25/2020] [Indexed: 06/11/2023]
Abstract
Epidemiological evidence of lung cancer risk from radon is based mainly on studies of underground miners where occupational exposures were, historically, relatively high in comparison to residential indoor exposure. However, radiation protection measures have caused radon levels in uranium mines to decrease significantly in more recent periods. Miners' occupational exposure is limited to their working years while they are exposed to environmental radon at home over their entire lifetime. Even during their limited working years, workers spend much more time at home than in workplaces. The biological effect of radon in mines cannot be distinguished from the biological effect of residential radon. Therefore, for an exposure-risk relationship study of former uranium miners, excess radon-induced lung cancer cases should be related to the combined radon exposure cumulated in workplaces and at homes in excess of the radon exposure of the reference population. This is especially important when residential radon levels differ or vary significantly between miners and the reference population over the course of extended follow-up years. This paper reviews some recent studies on former uranium miners, shares what seems controversial to the author and wonders whether lifetime exposure at home to widely varying radon concentrations can actually impact the quality of exposure assessment, and hence impact the results of the exposure-risk relationship.
Collapse
Affiliation(s)
- Jing Chen
- Radiation Protection Bureau, Health Canada, 775 Brookfield Road, Ottawa, ON, K1A 1C1, Canada.
| |
Collapse
|
11
|
Abstract
Fundamental estimates of radon-associated health risk have been provided by epidemiological studies of miners. In total, approximately 15 studies have been conducted worldwide since the 1960s. These results have contributed directly to radiological protection against radon. The present article summarises the main results, with a focus on analyses of miners exposed more recently, estimates of radon lifetime attributable risk, and interaction between radon and smoking. The potential for the upcoming Pooled Uranium Miner Analysis project to further improve our knowledge is discussed.
Collapse
Affiliation(s)
- D Laurier
- Institute for Radiological Protection and Nuclear Safety, 92262 Fontenay aux Roses Cedex, France; e-mail:
| | | | - E Rage
- Institute for Radiological Protection and Nuclear Safety, 92262 Fontenay aux Roses Cedex, France; e-mail:
| | - L Tomasek
- National Radiation Protection Institute, Czech Republic
| |
Collapse
|
12
|
Rage E, Richardson DB, Demers PA, Do M, Fenske N, Kreuzer M, Samet J, Wiggins C, Schubauer-Berigan MK, Kelly-Reif K, Tomasek L, Zablotska LB, Laurier D. PUMA - pooled uranium miners analysis: cohort profile. Occup Environ Med 2020; 77:194-200. [PMID: 32005674 PMCID: PMC8663280 DOI: 10.1136/oemed-2019-105981] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 12/02/2019] [Accepted: 12/21/2019] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Epidemiological studies of underground miners have provided clear evidence that inhalation of radon decay products causes lung cancer. Moreover, these studies have served as a quantitative basis for estimation of radon-associated excess lung cancer risk. However, questions remain regarding the effects of exposure to the low levels of radon decay products typically encountered in contemporary occupational and environmental settings on the risk of lung cancer and other diseases, and on the modifiers of these associations. These issues are of central importance for estimation of risks associated with residential and occupational radon exposures. METHODS The Pooled Uranium Miner Analysis (PUMA) assembles information on cohorts of uranium miners in North America and Europe. Data available include individual annual estimates of exposure to radon decay products, demographic and employment history information on each worker and information on vital status, date of death and cause of death. Some, but not all, cohorts also have individual information on cigarette smoking, external gamma radiation exposure and non-radiological occupational exposures. RESULTS The PUMA study represents the largest study of uranium miners conducted to date, encompassing 124 507 miners, 4.51 million person-years at risk and 54 462 deaths, including 7825 deaths due to lung cancer. Planned research topics include analyses of associations between radon exposure and mortality due to lung cancer, cancers other than lung, non-malignant disease, modifiers of these associations and characterisation of overall relative mortality excesses and lifetime risks. CONCLUSION PUMA provides opportunities to evaluate new research questions and to conduct analyses to assess potential health risks associated with uranium mining that have greater statistical power than can be achieved with any single cohort.
Collapse
Affiliation(s)
- Estelle Rage
- Institute for Radiological Protection and Nuclear Safety (IRSN), PSE-SANTE, SESANE, Fontenay-aux-Roses, France
| | | | | | - Minh Do
- Cancer Care Ontario, Toronto, Ontario, Canada
| | - Nora Fenske
- Federal Office for Radiation Protection, Department of Radiation Protection and Health, Neuherberg, Germany
| | - Michaela Kreuzer
- Federal Office for Radiation Protection, Department of Radiation Protection and Health, Neuherberg, Germany
| | | | - Charles Wiggins
- University of New Mexico, Albuquerque, New Mexico, USA
- New Mexico Tumor Registry, Albuquerque, New Mexico, USA
| | - Mary K Schubauer-Berigan
- International Agency for Research on Cancer, Lyon, France
- National Institute for Occupational Safety and Health, Cincinnati, Ohio, USA
| | - Kaitlin Kelly-Reif
- National Institute for Occupational Safety and Health, Cincinnati, Ohio, USA
| | | | - Lydia B Zablotska
- University of California, San Francisco, San Francisco, California, USA
| | - Dominique Laurier
- Institute for Radiological Protection and Nuclear Safety (IRSN), PSE-SANTE, SESANE, Fontenay-aux-Roses, France
| |
Collapse
|
13
|
Abstract
Radon is a naturally occurring radioactive material that is formed as the decay product of uranium and thorium, and is estimated to contribute to approximately half of the average annual natural background radiation. When inhaled, it damages the lungs during radioactive decay and affects the human body. Through many epidemiological studies regarding occupational exposure among miners and residential exposure among the general population, radon has been scientifically proven to cause lung cancer, and radon exposure is the second most common cause of lung cancer after cigarette smoking. However, it is unclear whether radon exposure causes diseases other than lung cancer. Media reports have often dealt with radon exposure in relation to health problems, although public attention has been limited to a one-off period. However, recently in Korea, social interest and concern about radon exposure and its health effects have increased greatly due to mass media reports of high concentrations of radon being released from various close-to-life products, such as mattresses and beauty masks. Accordingly, this review article is intended to provide comprehensive scientific information regarding the health effects of radon exposure.
Collapse
Affiliation(s)
- Jin Kyu Kang
- Dongnam Radiation Emergency Medical Center, Busan, Korea
- Department of Radiation Oncology, Dongnam Institute of Radiological & Medical Sciences, Busan, Korea
| | - Songwon Seo
- National Radiation Emergency Medical Center, Korea Institute of Radiological & Medical Sciences, Seoul, Korea
| | - Young Woo Jin
- National Radiation Emergency Medical Center, Korea Institute of Radiological & Medical Sciences, Seoul, Korea.
| |
Collapse
|
14
|
Shankar A, Dubey A, Saini D, Singh M, Prasad CP, Roy S, Bharati SJ, Rinki M, Singh N, Seth T, Khanna M, Sethi N, Kumar S, Sirohi B, Mohan A, Guleria R, Rath GK. Environmental and occupational determinants of lung cancer. Transl Lung Cancer Res 2019; 8:S31-S49. [PMID: 31211104 DOI: 10.21037/tlcr.2019.03.05] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Lung cancer has become a global problem, from a rare disease to an emerging public health issue. The current data of GLOBOCAN 2018, indicates that this disease has recorded highest mortality among all types of cancer. The etiological factors of lung cancer have become more multiplex because of increasing industrialization and environmental pollution around the world, especially in India. There is a rise in incidence of lung cancer among non-smokers and this can be attributed to environmental and occupational exposure to various kinds of hazardous substances. Target mutations are high in Lung cancer among non-smokers when compared to smokers. Some developed countries have guidelines and policies for prevention and control of risk factors focusing on these issues. Intervention aiming for primary prevention can be an important and cost-effective tool in developing countries to deal with increasing incidence of lung cancer. There is a need to define high risk group among non-smokers after taking into account environmental and occupational determinants as important risk factors. Research on etiology of lung cancer and prevention provides evidence to work on global incidence and prevalence of lung cancer, and for designing cost effective lung cancer prevention strategies. Research in the area of lung cancer prevention should be considered to recognize the areas where action is required to prevent environment and occupation related lung cancer. The government and occupational health and safety organizations have taken many steps in the last few years that can help to protect workers from these exposures. But the dangers are still there, so there is a need to do more to limit these exposures around workplace. This whole situation guides us to advocate population-based intervention along with policy implementation.
Collapse
Affiliation(s)
- Abhishek Shankar
- Preventive Oncology, Dr BR Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, Delhi, India
| | - Anusha Dubey
- Indian Society of Clinical Oncology, Delhi, India
| | - Deepak Saini
- Indian Society of Clinical Oncology, Delhi, India
| | - Mayank Singh
- Medical Oncology (Lab), Dr BR Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, Delhi, India
| | - Chandra Prakash Prasad
- Medical Oncology (Lab), Dr BR Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, Delhi, India
| | - Shubham Roy
- Indian Society of Clinical Oncology, Delhi, India
| | - Sachidanand Jee Bharati
- Oncoanaesthesia and Palliative Medicine, Dr BR Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, Delhi, India
| | - Minakshi Rinki
- Microbiology, Swami Shraddhanand College, Delhi University, Delhi, India
| | - Navneet Singh
- Pulmonary Medicine, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Tulika Seth
- Clinical Hematology, All India Institute of Medical Sciences, Delhi, India
| | | | | | - Sunil Kumar
- Surgical Oncology, Dr BR Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, Delhi, India
| | - Bhawna Sirohi
- Medical Oncology, Max Institute of Cancer Care, Delhi, India
| | - Anant Mohan
- Pulmonary Medicine and Sleep Disorders, All India Institute of Medical Sciences, Delhi, India
| | - Randeep Guleria
- Pulmonary Medicine and Sleep Disorders, All India Institute of Medical Sciences, Delhi, India
| | - Goura Kishor Rath
- Radiation Oncology, Dr BR Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, Delhi, India
| |
Collapse
|