A cohort study in southern China of tin miners exposed to radon and radon decay products

Occupational arsenic exposure and genitourinary cancer: systematic review and meta-analysis

BACKGROUND

Existing evidence suggests that ingestion of high doses of arsenic through drinking water is associated with an increased risk of genitourinary cancers, while systematic evidence on workers exposed to arsenic is lacking.

AIMS

The aim of this study is to systematically review the evidence on the association between occupational exposure to arsenic and genitourinary cancer risk and mortality.

METHODS

A systematic literature search was carried out on Pubmed, Web of Science and Embase by including cohort and case-control studies. Study-specific relative risks (RRs) and the corresponding 95% confidence intervals (CIs) were pooled using Mandel-Paule random-effects model. Contour-enhanced funnel plot and Egger's test were used to assess the occurrence of publication bias.

RESULTS

A total of 17 studies were included in the meta-analysis, 7 on cancer incidence (n = 161,244 individuals) and 10 on cancer mortality (n = 91,868). Most of them were cohort (71%) and industry-based studies (59%). The meta-analysis failed to detect an increased risk of genitourinary cancers among workers exposed to arsenic, except for a suggestive but not significant positive association for bladder cancer incidence (RR: 1.26, 95% CI: 0.89, 1.80), although this estimate was based on only three studies. No compelling evidence of publication bias was found (P = 0.885).

CONCLUSIONS

Our findings did not show an association between occupational exposure to arsenic and genitourinary cancers, although further high-quality studies with detailed exposure assessment at the individual level are needed to clarify this relationship.

Circulatory system disease mortality and occupational exposure to radon progeny in the cohort of Newfoundland Fluorspar Miners between 1950 and 2016

OBJECTIVES

Exposure to ionizing radiation may increase the risk of circulatory diseases, including heart disease. A limited number of cohort studies of underground miners have investigated these associations. We previously reported a positive but non-statistically significant association between radon progeny and heart disease in a cohort of Newfoundland fluorspar miners. In this study, we report updated findings that incorporate 15 additional years of follow-up.

METHODS

The cohort included 2050 miners who worked in the fluorspar mines from 1933 to 1978. Statistics Canada linked the personal identifying data of the miners to Canadian mortality data to identify deaths from 1950 to 2016. We used previously derived individual-level estimates of annual radon progeny exposure in working-level months. Cumulative exposure was categorized into quantiles. We estimated relative risks and their 95% confidence intervals using Poisson regression for deaths from circulatory, ischemic heart disease and acute myocardial infarction. Relative risks were adjusted for attained age, calendar year, and the average number of cigarettes smoked daily.

RESULTS

Relative to the Newfoundland male population, the standardized mortality ratio for circulatory disease in this cohort was 0.82 (95% CI 0.74-0.91). Those in the highest quantile of cumulative radon progeny exposure had a relative risk of circulatory disease mortality of 1.03 (95% CI 0.76-1.40) compared to those in the lowest quantile. The corresponding estimates for ischemic disease and acute myocardial infarction were 0.99 (95% CI 0.66-1.48), and 1.39 (95% CI 0.84-2.30), respectively.

CONCLUSIONS

Our findings do not support the hypothesis that occupational exposure to radon progeny increases the risk of circulatory disease.

Radon exposure and risk of cerebrovascular disease: a systematic review and meta-analysis in occupational and general population studies

Although it is biologically plausible, findings relating radon exposure to the risk of cerebrovascular disease (CeVD) are inconsistent and inconclusive. To investigate whether radon exposure was associated with the risk of CeVD, we qualitatively and quantitatively summarized the literature on radon and CeVD in both occupational and general populations. A search of PubMed, Embase, Scopus, and Web of Science was performed for peer-reviewed articles published through March 2022. Studies were excluded if radon exposure was not assessed separately from other ionizing radiation. In the meta-analysis, excess relative risks (ERRs) were converted to relative risks (RRs), and the pooled RRs and 95% confidence intervals (CIs) were determined using the random-effects model (DerSimonian and Laird). In the systematic review, nine eligible studies were summarized. Six occupational studies indicated inconsistent associations between cumulative radon exposure and CeVD mortality among mine workers. With available data from four updated occupational studies (99,730 mine workers and 2745 deaths), the pooled RR of radon exposure with CeVD mortality showed a non-significant association (1.10, 95% CI 0.92, 1.31). Three studies (841,270 individuals and 24,288 events) conducted in general populations consistently demonstrated a significant inverse relationship between residential radon exposure and risk of CeVD. The existing literature suggested a potential link between radon exposure and CeVD risk in general population. The inconsistent association in occupationally exposed populations may be explained by different methods of radon assessment and other methodological issues. Since radon exposure is a common public health issue, more rigorously designed epidemiologic studies, especially in the general population are warranted.

Lung Cancer and Radon: Pooled Analysis of Uranium Miners Hired in 1960 or Later

BACKGROUND

Despite reductions in exposure for workers and the general public, radon remains a leading cause of lung cancer. Prior studies of underground miners depended heavily upon information on deaths among miners employed in the early years of mine operations when exposures were high and tended to be poorly estimated.

OBJECTIVES

To strengthen the basis for radiation protection, we report on the follow-up of workers employed in the later periods of mine operations for whom we have more accurate exposure information and for whom exposures tended to be accrued at intensities that are more comparable to contemporary settings.

METHODS

We conducted a pooled analysis of cohort studies of lung cancer mortality among 57,873 male uranium miners in Canada, Czech Republic, France, Germany, and the United States, who were first employed in 1960 or later (thereby excluding miners employed during the periods of highest exposure and focusing on miners who tend to have higher quality assessments of radon progeny exposures). We derived estimates of excess relative rate per 100 working level months (ERR/100 WLM) for mortality from lung cancer.

RESULTS

The analysis included 1.9  million person-years of observation and 1,217 deaths due to lung cancer. The relative rate of lung cancer increased in a linear fashion with cumulative exposure to radon progeny (ERR/100 WLM = 1.33 ; 95% CI: 0.89, 1.88). The association was modified by attained age, age at exposure, and annual exposure rate; for attained ages < 55    y , the ERR/100 WLM was 8.38 (95% CI: 3.30, 18.99) among miners who were exposed at ≥ 35   years of age and at annual exposure rates of < 0.5 working levels. This association decreased with older attained ages, younger ages at exposure, and higher exposure rates.

DISCUSSION

Estimates of association between radon progeny exposure and lung cancer mortality among relatively contemporary miners are coherent with estimates used to inform current protection guidelines. https://doi.org/10.1289/EHP10669.

Quantitative evaluation of radon, tobacco use and lung cancer association in an occupational cohort with 27 follow-up years

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.

Arsenic, tobacco use, and lung cancer: An occupational cohort with 27 follow-up years

BACKGROUND

We explored the shape of the exposure-response relationship of arsenic-related lung cancer and the interaction between arsenic and tobacco use.

METHODS

A total of 3278 tin miners with at least 10 years of arsenic exposure were enrolled since 1992 and followed up for 27 years. After excluding radon-exposed miners and former smokers, 1620 miners were included into the sub-cohort. Lung cancer risks were estimated by modeling total exposure and intensity of arsenic exposure.

RESULTS

The cohort experienced 73,866 person-years and 414 lung cancer cases. Firstly, the ERR/mg/m3-year was 0.0033 (95% CI: 0.0014-0.0045) in arsenic concentration <3 mg/m³ and 0.0056 (95% CI: 0.0035-0.0073) in arsenic concentration ≥3 mg/m³. After adjusting for cumulative arsenic exposure, and the ERR/mg/m³ increased with increasing intensity (0.129 (95% CI: 0.039, 0.189)). Secondly, an unique aspect of this population was the early age at first arsenic exposure for workers. Results showed that lung cancer incidence risk from exposed in childhood (<13 years) was non-significantly greater than those in other age groups (13-17 and ≥ 18 years). Finally, the most likely joint effects of inhaled arsenic and tobacco use was sub-multiplicative.

CONCLUSION

This study enlightened us that for fixed cumulative arsenic exposure, higher concentration over shorter duration might be more deleterious than lower concentration over longer duration. Substantial reductions in the lung cancer burden of smokers exposed to arsenic could be achieved by reductions in either exposure.

PUMA - pooled uranium miners analysis: cohort profile

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.

The Disease Burden of Lung Cancer Attributable to Residential Radon Exposure in Korean Homes

BACKGROUND

Residential radon exposure is known to be an important risk factor for the development of lung cancer. The objective of this study was to calculate the disease burden of lung cancer attributable to residential radon exposure in Korea.

METHODS

We calculated the national exposure level using Korean national radon survey data from 2011 to 2014, and house structure distribution data from each administrative region. Using the exposure-risk function, the population attributable fraction (PAF) was calculated and applied to calculate the disease burden for lung cancer attributable to residential radon exposure.

RESULTS

Residential radon exposure levels were the highest, at 116.4 ± 50.4 Bq/m³ (annual mean radon concentration ± standard deviation) in detached houses, followed by 74.1 ± 30.0 Bq/m³ in the multi-family dwellings, and 55.9 ± 21.1 Bq/m³ in apartments. The PAF for lung cancer, due to long-term radon exposure in Korean homes, was 6.6% and 4.7% in men and women, respectively. The total disease burden of lung cancer attributable to residential radon exposure was 14,866 years of life lost (YLL) and 1,586 years lost due to disability (YLD) in 2013. Overall, 1,039 deaths occurred due to residential radon exposure, of which 828 were in men and 211 in women.

CONCLUSION

The smoking rate of men in Korea exceeded 70% in the 1990s, and is still near 40%. Although the size of the effect varies depending on the estimation method, it is a critical aspect as a risk factor of lung cancer because of the synergistic relationship between smoking and radon exposure. Because the Korean society is rapidly aging, population who were formerly heavy-smokers are entering a high-risk age of lung cancer. Therefore, it is necessary to inform the public about the health benefits of reduced radon exposure and to strengthen the risk communication.

Radon exposure and lung cancer: risk in nonsmokers among cohort studies

Eleven cohorts of miners occupationally exposed to relatively high concentrations of radon showed a statistically significantly high risk of lung cancer, while three cohorts from the general population showed a relatively low concentration, but the results were not statistically significant. However, the risk of lung cancer tended to increase with increased radon exposure. The risk is likely to have been underestimated due to low statistical power. Therefore, additional well-designed studies on the risk of lung cancer in nonsmokers in the general population with relatively low concentrations of radon exposure are needed in the future. In addition, country-specific preventive policies are needed in order to actively reduce radon exposure and lung cancer incidence in nonsmokers.

An updated review of case-control studies of lung cancer and indoor radon-Is indoor radon the risk factor for lung cancer?

Lung cancer is a leading cause of cancer-related death in the world. Smoking is definitely the most important risk factor for lung cancer. Radon (²²²Rn) is a natural gas produced from radium (²²⁶Ra) in the decay series of uranium (²³⁸U). Radon exposure is the second most common cause of lung cancer and the first risk factor for lung cancer in never-smokers.

Case–control studies have provided epidemiological evidence of the causative relationship between indoor radon exposure and lung cancer. Twenty-four case–control study papers were found by our search strategy from the PubMed database. Among them, seven studies showed that indoor radon has a statistically significant association with lung cancer. The studies performed in radon-prone areas showed a more positive association between radon and lung cancer. Reviewed papers had inconsistent results on the dose–response relationship between indoor radon and lung cancer risk.

Further refined case–control studies will be required to evaluate the relationship between radon and lung cancer. Sufficient study sample size, proper interview methods, valid and precise indoor radon measurement, wide range of indoor radon, and appropriate control of confounders such as smoking status should be considered in further case–control studies.

Occupational radon exposure and lung cancer mortality: estimating intervention effects using the parametric g-formula

BACKGROUND

Traditional regression analysis techniques used to estimate associations between occupational radon exposure and lung cancer focus on estimating the effect of cumulative radon exposure on lung cancer. In contrast, public health interventions are typically based on regulating radon concentration rather than workers' cumulative exposure. Estimating the effect of cumulative occupational exposure on lung cancer may be difficult in situations vulnerable to the healthy worker survivor bias.

METHODS

Workers in the Colorado Plateau Uranium Miners cohort (n = 4,134) entered the study between 1950 and 1964 and were followed for lung cancer mortality through 2005. We use the parametric g-formula to compare the observed lung cancer mortality to the potential lung cancer mortality had each of 3 policies to limit monthly radon exposure been in place throughout follow-up.

RESULTS

There were 617 lung cancer deaths over 135,275 person-years of follow-up. With no intervention on radon exposure, estimated lung cancer mortality by age 90 was 16%. Lung cancer mortality was reduced for all interventions considered, and larger reductions in lung cancer mortality were seen for interventions with lower monthly radon exposure limits. The most stringent guideline, the Mine Safety and Health Administration standard of 0.33 working-level months, reduced lung cancer mortality from 16% to 10% (risk ratio = 0.67 [95% confidence interval = 0.61 to 0.73]).

CONCLUSIONS

This work illustrates the utility of the parametric g-formula for estimating the effects of policies regarding occupational exposures, particularly in situations vulnerable to the healthy worker survivor bias.

Considerations in deriving quantitative cancer criteria for inorganic arsenic exposure via inhalation

The inhalation unit risk (IUR) that currently exists in the United States Environmental Protection Agency's (US EPA's) Integrated Risk Information System was developed in 1984 based on studies examining the relationship between respiratory cancer and arsenic exposure in copper smelters from two US locations: the copper smelter in Anaconda, Montana, and the American Smelting And Refining COmpany (ASARCO) smelter in Tacoma, Washington. Since US EPA last conducted its assessment, additional data have become available from epidemiology and mechanistic studies. In addition, the California Air Resources Board, Texas Commission of Environmental Quality, and Dutch Expert Committee on Occupational Safety have all conducted new risk assessments. All three analyses, which calculated IURs based on respiratory/lung cancer mortality, generated IURs that are lower (i.e., less restrictive) than the current US EPA value of 4.3×10(-3) (μg/m(3))(-1). The IURs developed by these agencies, which vary more than 20-fold, are based on somewhat different studies and use different methodologies to address uncertainties in the underlying datasets. Despite these differences, all were developed based on a cumulative exposure metric assuming a low-dose linear dose-response relationship. In this paper, we contrast and compare the analyses conducted by these agencies and critically evaluate strengths and limitations inherent in the data and methodologies used to develop quantitative risk estimates. In addition, we consider how these data could be best used to assess risk at much lower levels of arsenic in air, such as those experienced by the general public. Given that the mode of action for arsenic supports a threshold effect, and epidemiological evidence suggests that the arsenic concentration in air is a reliable predictor of lung/respiratory cancer risk, we developed a quantitative cancer risk analysis using a nonlinear threshold model. Applying a nonlinear model to occupational data, we established points of departure based on both cumulative exposure (μg/m(3)-years) to arsenic and arsenic concentration (μg/m(3)) via inhalation. Using these values, one can assess the lifetime risk of respiratory cancer mortality associated with ambient air concentrations of arsenic for the general US population.

[A cohort study on risk factors of lung cancer in Yunnan tin miners]

背景与目的

吸烟是肺癌的主要病因, 在矿工肺癌病因的研究中发现, 职业暴露因素也起重要作用。本研究旨在分析氡暴露、吸烟等危险因素对云锡矿工肺癌的影响, 为预防和控制肺癌高发提供科学依据。

方法

利用前瞻性队列研究方法, 对云锡矿工肺癌高危人群暴露因素对肺癌死亡的影响进行Cox多因素分析; 分析矿工肺癌危险与初始氡暴露年龄及氡暴露率的关系, 分析不同吸烟、氡暴露水平下肺癌死亡的危险, 并对吸烟和累积氡暴露量之间的交互作用进行分析。

结果

进入研究时的年龄、吸烟量、累积氡砷暴露、既往慢性支气管炎为云锡矿工肺癌的独立危险因素, 教育程度是矿工肺癌的保护性因素; 肺癌危险与氡暴露率间存在逆剂量率效应, 但与初始氡暴露年龄无明显关联; 吸烟和氡暴露对肺癌危险有显著的相加交互作用。

结论

云锡矿工肺癌高死亡率是多种因素共同作用的结果, 危险因素间的交互作用值得进一步深入研究。

Systematic review with meta-analysis of the epidemiological evidence in the 1900s relating smoking to lung cancer

BACKGROUND

Smoking is a known lung cancer cause, but no detailed quantitative systematic review exists. We summarize evidence for various indices.

METHODS

Papers published before 2000 describing epidemiological studies involving 100+ lung cancer cases were obtained from Medline and other sources. Studies were classified as principal, or subsidiary where cases overlapped with principal studies. Data were extracted on design, exposures, histological types and confounder adjustment. RRs/ORs and 95% CIs were extracted for ever, current and ex smoking of cigarettes, pipes and cigars and indices of cigarette type and dose-response. Meta-analyses and meta-regressions investigated how relationships varied by study and RR characteristics, mainly for outcomes exactly or closely equivalent to all lung cancer, squamous cell carcinoma ("squamous") and adenocarcinoma ("adeno").

RESULTS

287 studies (20 subsidiary) were identified. Although RR estimates were markedly heterogeneous, the meta-analyses demonstrated a relationship of smoking with lung cancer risk, clearly seen for ever smoking (random-effects RR 5.50, CI 5.07-5.96) current smoking (8.43, 7.63-9.31), ex smoking (4.30, 3.93-4.71) and pipe/cigar only smoking (2.92, 2.38-3.57). It was stronger for squamous (current smoking RR 16.91, 13.14-21.76) than adeno (4.21, 3.32-5.34), and evident in both sexes (RRs somewhat higher in males), all continents (RRs highest for North America and lowest for Asia, particularly China), and both study types (RRs higher for prospective studies). Relationships were somewhat stronger in later starting and larger studies. RR estimates were similar in cigarette only and mixed smokers, and similar in smokers of pipes/cigars only, pipes only and cigars only. Exceptionally no increase in adeno risk was seen for pipe/cigar only smokers (0.93, 0.62-1.40). RRs were unrelated to mentholation, and higher for non-filter and handrolled cigarettes. RRs increased with amount smoked, duration, earlier starting age, tar level and fraction smoked and decreased with time quit. Relationships were strongest for small and squamous cell, intermediate for large cell and weakest for adenocarcinoma. Covariate-adjustment little affected RR estimates.

CONCLUSIONS

The association of lung cancer with smoking is strong, evident for all lung cancer types, dose-related and insensitive to covariate-adjustment. This emphasises the causal nature of the relationship. Our results quantify the relationships more precisely than previously.

Chapter 6: Lung cancer in never smokers: epidemiology and risk prediction models

In this chapter we review the epidemiology of lung cancer incidence and mortality among never smokers/nonsmokers and describe the never smoker lung cancer risk models used by the Cancer Intervention and Surveillance Network (CISNET) modelers. Our review focuses on those influences likely to have measurable population impact on never smoker risk, such as secondhand smoke, even though the individual-level impact may be small. Occupational exposures may also contribute importantly to the population attributable risk of lung cancer. We examine the following risk factors in this chapter: age, environmental tobacco smoke, cooking fumes, ionizing radiation including radon gas, inherited genetic susceptibility, selected occupational exposures, preexisting lung disease, and oncogenic viruses. We also compare the prevalence of never smokers between the three CISNET smoking scenarios and present the corresponding lung cancer mortality estimates among never smokers as predicted by a typical CISNET model.

A high-throughput screen for alpha particle radiation protectants

Alpha-particle-emitting elements are of increasing importance as environmental and occupational carcinogens, toxic components of radiation dispersal devices and accidents, and potent therapeutics in oncology. Alpha particle radiation differs from radiations of lower linear energy transfer in that it predominantly damages DNA via direct action. Because of this, radical scavengers effective for other radiations have had only limited effect in mitigating alpha particle toxicity. We describe here a simple assay and a pilot screen of 3,119 compounds in a high-throughput screen (HTS), using the alpha-particle-emitting isotope, ²²⁵Ac, for the discovery of compounds that might protect mammalian cells from alpha particles through novel mechanisms. The assay, which monitored the viability of a myeloid leukemic cell line upon alpha particle exposure, was robust and reproducible, yielding a Z' factor of 0.66 and a signal-to-noise ratio of nearly 10 to 1. Surprisingly, 1 compound emerged from this screen, epoxy-4,5-α-dihydroxysantonin (EDHS), that showed considerable protective activity. While the value of EDHS remains to be determined, its discovery is a proof of concept and validation of the utility of this HTS methodology. Further application of the described assay could yield compounds useful in minimizing the toxicity and carcinogenesis associated with alpha particle exposure.

Health effects of radon: a review of the literature

PURPOSE

Radon is natural radioactive noble gas that can be found in soil, water, outdoor and indoor air. Exposure to radon accounts for more that 50% of the annual effective dose of natural radioactivity. The purpose of the current review is to summarize recent literature and evaluate the weight of evidence on the adverse health effects of radon.

CONCLUSIONS

Radon is an established human lung carcinogen based on human epidemiological data supported by experimental evidence of mutagenesis studies in cell culture and laboratory animals. Extrapolation from cohort studies on miners suggested that radon is the second leading cause of lung cancer death after tobacco smoke. The majority of studies on the relationship between radon and other types of cancers showed weak or no association. Low levels of radon can be found in drinking water; however, radon released during water usage adds small quantities to indoor radon concentration. Studies showed that the risk of stomach cancer and other gastrointestinal malignancies from radon in drinking water is small. Studies of the genetic and cytogenetic effects of indoor radon yielded equivocal results; while radon exposure in miners induces gene mutations and chromosomal aberrations. Numerous in vitro cytogenetic studies demonstrated that radon induces different types of genetic and cytogenetic damage that is likely to play a role in radon lung carcinogenesis.

Association between sputum atypia and lung cancer risk in an occupational cohort in Yunnan, China

BACKGROUND

Individuals with cytologic atypia in sputum may be at high risk for the development of lung cancer.

METHODS

A prospective cohort study was conducted among occupational tin miners in Yunnan, China, based on an annual lung cancer screening program. Sputum samples were collected prospectively at baseline and the following seven annual screenings. The associations between risk factors and sputum cytology were analyzed by univariate and multivariate logistic regression. A proportional hazard model was used to analyze the association between the baseline sputum results and the incidence of lung cancer. The effect of consecutive sputum cytology on the increase of lung cancer risk was analyzed by logistic regression.

RESULTS

Sputum cytologic atypia was associated with age, smoking, occupational radon and arsenic exposure, and asthma. Sputum cytologic atypia was an independent risk factor for lung cancer with an adjusted hazard ratio (HR) of 3.82 (95% confidence interval [CI], 2.82 to 5.18) in comparing normal to moderate or worse atypia. Compared to the lung cancer risk associated with normal sputum, the risk was significantly higher according to the degree of atypia for squamous carcinomas, small cell lung cancer and central lung cancer, with adjusted HRs of 5.70 (95% CI, 3.78 to 8.59), 3.32 (95% CI, 1.31 to 8.45), and 4.93 (95% CI, 3.51 to 6.92), respectively.

CONCLUSIONS

Sputum atypia is associated with an increased risk of lung cancer. Sputum cytologic examination combined with other screening examinations may play an important role in the early detection of lung cancer or in the selection of the optimal target population for more intensive lung cancer screening among this occupational cohort or similar population.

Mechanism of selenium-induced inhibition of arsenic-enhanced UVR carcinogenesis in mice

BACKGROUND

Hairless mice that ingested arsenite in drinking water exhibited more than a 5-fold enhancement of ultraviolet radiation (UVR) carcinogenesis, whereas arsenite alone was carcinogenically inactive. Dietary organoselenium blocked the cancer enhancement effect of arsenic but not cancer induction by UVR.

OBJECTIVE

In this study we sought to explain selenium blockage of As enhancement by establishing the extent that As and Se tissue distributions are coincident or divergent.

METHODS

We used the X-ray fluorescence microprobe at the Advanced Photon Source (Argonne National Laboratory) to probe sections of skin and liver from hairless mice exposed to a) UVR, b) UVR + As, c) UVR + organoselenium, or d) UVR + As + organoselenium.

RESULTS

We found elevated levels of As in the skin epithelium (hair follicles and epidermis) and diffusely in the liver of mice exposed to UVR + As. Arsenic was entirely absent in skin in mice exposed to UVR + As + organoselenium, but a diffuse low level was seen in the liver. As and Se locations were consistently divergent in skin; As was more diffusely distributed, whereas Se was strongly associated with membranes. X-ray absorption near-edge spectra are consistent with the presence of the seleno-bis(S-glutathionyl) arsinium ion in the liver.

CONCLUSIONS

Supplemental Se was uncommonly effective at preventing even a trace of As in skin at 14 or 196 days of continuous exposure to As in drinking water. Traces of the seleno-bis(S-glutathionyl) arsinium ion in the liver suggested that formation of this compound was more likely to be responsible for the As-blocking effect of Se than was a mechanism based on antioxidation.

A study on lung cancer mortality related to radon, quartz, and arsenic exposures in German uranium miners

Between 1946 and 1990 uranium mining was undertaken on a large scale in East Germany. This study evaluates the proportional lung cancer risk of German uranium miners from radon, quartz, and arsenic exposure during mining operations at the WISMUT Corporation. The database of the WISMUT tissue repository and a comprehensive job-exposure matrix were used to compare exposure levels of lung cancer cases with deaths from diseases of the circulatory system for risk analysis. In addition, the ratio of lung cancer cases was compared to cases from diseases of the circulatory system to the corresponding ratio in the general population. The proportional lung cancer mortality of German uranium miners was 2.9-fold higher than in the general population of East Germany. Cumulative radon, quartz, and arsenic exposure were determined as risk factors for lung cancer among German uranium miners, where silicosis modified the risk of cumulative radon and quartz exposure. Silicotics were exposed to higher levels of quartz, radon, and arsenic than nonsilicotics. Because selection of the study population was based on a tissue repository, the results need to be interpreted with caution.

Further evidence against a direct genotoxic mode of action for arsenic-induced cancer

Arsenic in drinking water, a mixture of arsenite and arsenate, is associated with increased skin and other cancers in Asia and Latin America, but not the United States. Arsenite alone in drinking water does not cause skin cancers in experimental animals; therefore, it is not a complete carcinogen in skin. We recently showed that low concentrations of arsenite enhanced the tumorigenicity of solar UV irradiation in hairless mice, suggesting arsenic cocarcinogenesis with sunlight in skin cancer and perhaps with different carcinogenic partners for lung and bladder tumors. Cocarcinogenic mechanisms could include blocking DNA repair, stimulating angiogenesis, altering DNA methylation patterns, dysregulating cell cycle control, induction of aneuploidy and blocking apoptosis. Arsenicals are documented clastogens but not strong mutagens, with weak mutagenic activity reported at highly toxic concentrations of inorganic arsenic. Previously, we showed that arsenite, but not monomethylarsonous acid (MMA[III]), induced delayed mutagenesis in HOS cells. Here, we report new data on the mutagenicity of the trivalent methylated arsenic metabolites MMA(III) and dimethylarsinous acid [DMA(III)] at the gpt locus in Chinese hamster G12 cells. Both methylated arsenicals seemed mutagenic with apparent sublinear dose responses. However, significant mutagenesis occurred only at highly toxic concentrations of MMA(III). Most mutants induced by MMA(III) and DMA(III) exhibited transgene deletions. Some non-deletion mutants exhibited altered DNA methylation. A critical discussion of cell survival leads us to conclude that clastogenesis occurs primarily at highly cytotoxic arsenic concentrations, casting further doubt as to whether a genotoxic mode of action (MOA) for arsenicals is supportable.

Radon Exposure Assessment and Dosimetry Applied to Epidemiology and Risk Estimation

Epidemiological studies of underground miners provide the primary basis for radon risk estimates for indoor exposures as well as mine exposures. A major source of uncertainty in these risk estimates is the uncertainty in radon progeny exposure estimates for the miners. Often the exposure information is very incomplete, and exposure estimation must rely on interpolations, extrapolations and reconstruction of mining conditions decades before, which might differ markedly from those in more recent times. Many of the measurements that were carried out-commonly for health protection purposes-are not likely to be representative of actual exposures. Early monitoring was often of radon gas rather than of the progeny, so that quantifying exposure requires an estimate of the equilibrium fraction under the conditions existing at the time of the reported measurement. In addition to the uncertainty in radon progeny exposure, doses from gamma radiation, inhaled radioactive dust, and thoron progeny have historically been neglected. These may induce a systematic bias in risk estimates and add to the overall uncertainty in risk estimates derived from the miner studies. Unlike other radiogenic cancer risk estimates, numerical risk estimates derived for radon from epidemiology are usually expressed as a risk per unit exposure rather than as a risk per unit dose to a target tissue. Nevertheless, dosimetric considerations are important when trying to compare risks under different exposure conditions, e.g. in mines and homes. A recent comparative assessment of exposure conditions indicates that, for equal radon progeny exposures, the dose in homes is about the same as in mines. Thus, neglecting other possible differences, such as the presence in mines of other potential airborne carcinogens, the risk per unit progeny exposure should be about the same for indoor exposures as observed in miners. Results of case-control studies of lung cancer incidence in homes monitored for radon are reasonably consistent with what would be projected from miner studies. Measurements of exposure in these indoor case-control studies rely on different types of detectors than those used in mines, and the estimates of exposure are again a major source of uncertainty in these studies.

Arsenic exposure and cardiovascular disease: a systematic review of the epidemiologic evidence

Arsenic exposure is a likely cause of blackfoot disease and a potential risk factor for atherosclerosis. The authors performed a systematic review of the epidemiologic evidence on the association between arsenic and cardiovascular outcomes. The search period was January 1966 through April 2005. Thirteen studies conducted in general populations (eight in high-arsenic areas in Taiwan, five in other countries) and 16 studies conducted in occupational populations were identified. Exposure was assessed ecologically in most studies. In Taiwan, relative risks comparing the highest arsenic exposure category with the lowest ranged from 1.59 to 4.90 for coronary disease, from 1.19 to 2.69 for stroke, and from 1.66 to 4.28 for peripheral arterial disease. In other general populations, relative risks ranged from 0.84 to 1.54 for coronary disease, from 0.69 to 1.53 for stroke, and from 0.61 to 1.58 for peripheral arterial disease. In occupational populations, relative risks ranged from 0.40 to 2.14 for coronary disease mortality and from 0.30 to 1.33 for stroke mortality. Methodologic limitations, however, limited interpretation of the moderate-to-strong associations between high arsenic exposure and cardiovascular outcomes in Taiwan. In other populations or in occupational settings, the evidence was inconclusive. Because of the high prevalence of arsenic exposure, carefully performed studies of arsenic and cardiovascular outcomes should be a research priority.

Doses from radon and its decay products to children

This paper considers doses from radon and decay products when inhaled or ingested by one year old infants and by ten year old children. Doses from decay products deposited on skin are also discussed. For inhalation and ingestion, the general pattern of doses to organs is broadly similar to that in adults. Much the largest doses are received by the organ of intake (respiratory tract and stomach respectively). Otherwise, tissues with higher fat content tend to receive somewhat higher doses from radon gas than other tissues. Dose coefficients (dose per unit intake factors) for children are generally larger than those for adults. However, total annual doses are more similar across the age groups because of smaller intakes of air and water by children. Radon decay products deposited on skin may be able to induce skin cancer. However, the location of the sensitive cells is not known with certainty and they may lie too deep to receive significant dose. If they are irradiated, it is likely that doses to children would be larger than for adults. The radiological significance of doses to children is discussed.

Low doses of ionizing radiation and circulatory diseases: a systematic review of the published epidemiological evidence

Recent analyses of mortality among atomic bomb survivors have suggested a linear dose-response relationship between ionizing radiation and diseases of the circulatory system for exposures in the range 0-4 Sv. If confirmed, this has substantial implications. We have therefore reviewed the published literature to see if other epidemiological data support this finding. Other studies allowing a comparison of the rates of circulatory disease in individuals drawn from the same population but exposed to ionizing radiation at different levels within the range 0-5 Gy or 0-5 Sv were identified through systematic literature searches. Twenty-six studies were identified. In some, disease rates among those exposed at different levels may have differed for reasons unrelated to radiation exposure, while many had low power to detect effects of the relevant magnitude. Among the remainder, one study found appreciable evidence that exposure to low-dose radiation was associated with circulatory diseases, but five others, all with appreciable power, did not. We conclude that the other epidemiological data do not at present provide clear evidence of a risk of circulatory diseases at doses of ionizing radiation in the range 0-4 Sv, as suggested by the atomic bomb survivors. Further evidence is needed to characterize the possible risk.

Role of oxidative damage in the genotoxicity of arsenic

Arsenic is a well-established human carcinogen and is ubiquitous in the environment. For decades, arsenic has been considered to be a nongenotoxic carcinogen because it is only weakly active or, more often, completely inactive in bacterial and mammalian cell mutation assays. In this review, evidence is presented that when assayed using model systems in which both intragenic and multilocus mutations can readily be detected, arsenic is, indeed, found to be a strong, dose-dependent mutagen which induces mostly multilocus deletions. Furthermore, the roles of reactive oxygen and reactive nitrogen species in mediating the genotoxic response are presented in a systematic and logical fashion in support of a working model. The data suggest that antioxidants may be a useful interventional treatment in reducing the deleterious effects of arsenic.

The U.S. Environmental Protection Agency's assessment of risks from indoor radon

The U.S. Environmental Protection Agency has updated its assessment of health risks from indoor radon, which has been determined to be the second leading cause of lung cancer after cigarette smoking. This risk assessment is based primarily on results from a recent study of radon health effects (BEIR VI) by the National Academy of Sciences. In BEIR VI, the National Academy of Sciences fit empirical risk models to data from 11 cohorts of miners, and estimated that each year about 20,000 lung cancer deaths in the U.S. are radon related. A summary, abstracted from the technical report, is given of the EPA's risk assessment results and methods, including some modifications and extensions to the approach used in BEIR VI. Results include numerical estimates of lung cancer deaths per unit exposure, which had not been provided in BEIR VI.

Exposition à l’uranium et risque de cancer : une revue des études épidémiologiques

OBJECTIVE

At the end of 2000, certain diseases including leukemia were reported among soldiers who participated in the Balkan and in the Gulf wars. Depleted uranium used during these conflicts was considered as a possible cause. Its radiotoxicity is close to that of natural uranium. This paper reviews the epidemiological knowledge of uranium, the means of exposure and the associated risk of cancer.

METHODS

The only available epidemiological data concerns nuclear workers exposed to uranium. A review of the international literature is proposed by distinguishing between uranium miners and other workers of the nuclear industry. French studies are described in details.

RESULTS

In ionizing radiation epidemiology, contamination by uranium is often cited as a risk factor, but the dose-effect relationship is rarely studied. Retrospective assessment of individual exposure is generally insufficient. Moreover, it is difficult to distinguish between uranium radiotoxicity, its chemical toxicity and the radiotoxicity of its progeny. A causal relation between lung cancer and radon exposure, a gas derived from the decay of uranium, has been demonstrated in epidemiological studies of miners. Among other nuclear workers exposed to uranium, there is a mortality deficit from all causes (healthy worker effect). No cancer site appears systematically in excess compared to the national population; very few studies describe a dose-response relationship.

CONCLUSION

Only studies with a precise reconstruction of doses and sufficient numbers of workers will allow a better assessment of risks associated with uranium exposure at levels encountered in industry or during conflicts using depleted uranium weapons.

Arsenite is a cocarcinogen with solar ultraviolet radiation for mouse skin: an animal model for arsenic carcinogenesis

Although epidemiological evidence shows an association between arsenic in drinking water and increased risk of skin, lung, and bladder cancers, arsenic compounds are not animal carcinogens. The lack of animal models has hindered mechanistic studies of arsenic carcinogenesis. Previously, this laboratory found that low concentrations of arsenite (the likely environmental carcinogen) which are not mutagenic can enhance the mutagenicity of other agents, including ultraviolet radiation (UVR). This enhancing effect appears to result from inhibition of DNA repair by arsenite. Recently we found that low concentrations of arsenite disrupted p53 function and upregulated cyclin D1. These results suggest that the failure to find an animal model for arsenic carcinogenesis is because arsenite is not a carcinogen per se, but rather acts as an enhancing agent (cocarcinogen) with a genotoxic partner. We tested this hypothesis with solar UVR as carcinogenic stimulus in hairless Skh1 mice. Mice given 10 mg/l sodium arsenite in drinking water for 26 weeks had a 2.4-fold increase in yield of tumors after 1.7 KJ/m(2) UVR three times weekly compared with mice given UVR alone. No tumors appeared in mice given arsenite alone. The tumors were mostly squamous cell carcinomas, and those occurring in mice given UVR plus arsenite appeared earlier and were much larger and more invasive than in mice given UVR alone. These results are consistent with the hypothesis that arsenic acts as a cocarcinogen with a second (genotoxic) agent by inhibiting DNA repair and/or enhancing positive growth signaling.

Radon: a likely carcinogen at all exposures

BACKGROUND

Radon is a well-established lung carcinogen that has been extensively studied. Very high concentrations can occur in some underground mines. Concentrations also tend to build up in homes.

MATERIALS AND METHODS

Epidemiological studies of radon-exposed miners and of residential radon and lung cancer are reviewed. Quantitative estimates of the risk of lung cancer, based on the experience of the miners, are applied to residential radon exposures in the United Kingdom. Strategies for the prevention of lung cancer induced by residential radon are discussed.

RESULTS

Estimates are uncertain, but residential radon is probably responsible for about 2000 lung cancer deaths per year in the United Kingdom, or around 6% of the total, making it the second biggest cause after smoking. Over 80% of the deaths are estimated to occur at ages less than 75 and over 80% in smokers or ex-smokers. Around 90% of radoninduced deaths in the United Kingdom probably occur as a result of exposures to radon concentrations below the currently recommended action level of 200 Bq m(-3).

CONCLUSIONS

Further work is needed to obtain more reliable estimates of the risk of lung cancer associated with residential radon and on the cost-effectiveness of various intervention strategies before the most appropriate policies can be developed for managing exposure to this natural carcinogen.

Analysis of a historical cohort of Chinese tin miners with arsenic, radon, cigarette smoke, and pipe smoke exposures using the biologically based two-stage clonal expansion model

Hazelton, W. D., Luebeck, E. G., Heidenreich, W. F. and Moolgavkar, S. H. Analysis of a Historical Cohort of Chinese Tin Miners with Arsenic, Radon, Cigarette Smoke, and Pipe Smoke Exposures Using the Biologically Based Two-Stage Clonal Expansion Model. Radiat. Res. 156, 78-94 (2001).The two-stage clonal expansion model is used to analyze lung cancer mortality in a cohort of Yunnan tin miners based on individual histories with multiple exposures to arsenic, radon, cigarette smoke, and pipe smoke. Advances in methodology include the use of nested dose-response models for the parameters of the two-stage clonal expansion model, calculation of attributable risks for all exposure combinations, use of both a fixed lag and a gamma distribution to represent the time between generation of the first malignant cell and death from lung cancer, and scaling of biological parameters allowed by parameter identifiability. The cohort consists of 12,011 males working for the Yunnan Tin Corporation, with complete exposure records, who were initially surveyed in 1976 and followed through 1988. Tobacco and arsenic dominate the attributable risk for lung cancer. Of 842 lung cancer deaths, 21.4% are attributable to tobacco alone, 19.7% to a combination of tobacco and arsenic, 15.8% to arsenic alone, 11% to a combination of arsenic and radon, 9.2% to a combination of tobacco and radon, 8.7% to combination of arsenic, tobacco and radon, 5.5% to radon alone, and 8.7% to background. The models indicate that arsenic, radon and tobacco increase cell division, death and malignant conversion of initiated cells, but with significant differences in net cell proliferation rates in response to the different exposures. Smoking a bamboo water pipe or a Chinese long-stem pipe appears to confer less risk than cigarette use, given equivalent tobacco consumption.

Environmental variables in a holistic evaluation of land contaminated by historic mine wastes: a study of multi-element mine wastes in West Devon, England using arsenic as an element of potential concern to human health

Unusual and unexpected concentrations of a number of elements were identified in samples of house dust, that indicated the presence of mine wastes in an area where they were not expected. In pursuing this matter, several other very unusual observations and practices, involving highly contaminated mine wastes, were also identified. Here, using an available, but not a custom-made database, the matter is pursued. In England and Wales, the usual framework within which hazards are assessed, starts with an identification of those levels of exposure to elements which are considered to be safe and acceptable. At the other extreme, levels that are considered to be hazardous are identified together with procedures for dealing with them for different situations; for example, the manner in which contaminated land is to be used. The level at which an identification of sites and their use rests with the Local Authority, such as District Councils. Although new legislation is pending; at present for the non-occupationally exposed population there are no firm values to define which levels are acceptable and those that are not acceptable. One of the elements in the samples is arsenic and, because of its well-known toxicity, this element is selected to be of prime concern. However, simultaneous exposure to the general public is from a number of other elements, such as copper, lead, zinc, antimony, molybdenum, tin, selenium and mercury which are present in the mine wastes. The collective impairment to human health, if it should occur, is far too complex to evaluate, hence a need to focus attention upon arsenic which by any standard is present in some samples at very high concentrations, for example > 1000 mg/kg. Irrespective of any changes in permitted levels of exposure to the general public in the study area, together with those that are occupationally exposed, it is the past exposure that will give rise to the present patterns of morbidity and mortality. Because of a latent period between exposure and effects for the induction of cancers, of between 5 and 20 years, past exposures cannot be ignored. They need to be evaluated before changes are made in legislation. In England and Wales, concern to health is, in practice, invoked when there is clinical evidence of harm. With the exception of a few accidents in the study area of SW England, this is not identified, hence it is accepted, in practice, to conclude that no harm accrues following acute or chronic exposure to the mine wastes. There are reasons for questioning this, but if eventually supported, then the current very high costs for remediation of land may not be necessary and brown field sites can be used for a number of purposes. The primary concern is the lack of adequate scientific and clinical data, in relation to exposure to the wastes for the past 100 years or so. For many elements, compounds and substances, the general public is being made aware of potential risks to health but often the levels are extremely low. Using basic geochemical data for any area, it is possible to evaluate the expected background levels for elements. They should serve to identify levels that are acceptable, i.e. it is impractical or uneconomic to reduce them. Within the environment, simple tests are also available that can be used to rank risks to fauna and flora. There are also well-structured clinical evaluations of harm to humans available, which can also be ranked. All three need to be considered in the establishment of safe levels of exposure. It may not be practical to identify universal levels for exposure, rather each site, area or region needs to be considered separately in order to rank the potential risks. For the study area the exposures can be extremely high; compared with the general population, the number who are exposed is probably small. It is surprising that no effects upon human health have been noted.

Risk factors and early detection of lung cancer in a cohort of Chinese tin miners

PURPOSE

To examine risk factors and establish a biologic specimen and data bank for the study of early markers of lung cancer.

METHODS

We designed a dynamic cohort using an ongoing lung cancer screening program among radon- and arsenic-exposed tin miners in Yunnan China. Through the first four years of the study, 8,346 miners aged 40 years and older with over 10 years of occupational exposure have been enrolled, risk factors have been assessed, annual sputum and chest radiographs have been obtained, and numerous biologic specimens have been collected.

RESULTS

A total of 243 new lung cancer cases have been identified through 1995. Radon and arsenic exposures are the predominant risk factors, but lung cancer risk is also associated with chronic bronchitis and silicosis, as well as a number of exposure to tobacco smoke, including early age of first use, duration, and cumulative exposure. Tumor and sputum samples are being examined for early markers of lung cancer.

CONCLUSION

A cohort of occupationally-exposed tin miners with an extensive biologic specimen repository has been successfully established to simultaneously study the etiology and early detection of lung cancer.

An ecological study of cancer incidence and radon levels in South West England

To investigate the relationship of domestic radon levels and cancer, the incidence of 14 major cancers in Devon and Cornwall were examined in relation to the local radon levels. Cancer registrations for 1989-1992 were provided by the South-Western Regional Cancer Registry. The average radon levels for postcode sectors were sorted into ten categories from low (< 40 Bq/m3) to extremely high (> or = 230 Bq/m3) and age-standardised incidence rates were calculated for each radon category. The incidence rates for lung cancer, where radon has been claimed to be a risk factor, were very similar across all domestic radon categories. Only non-melanoma skin cancers, showed a significant increase in incidence in the high-radon postcode sectors (> or = 100 Bq/m3) compared with the low-radon sectors (< 60 Bq/m3) and this effect was observed for both sexes. The remaining 12 cancer sites showed no significant trend in incidence rates with increasing radon concentration. There was no significant difference in corrected survival rates for any cancer site between the low- and high-radon areas. The possible contribution of confounding factors to the results of this study is discussed.

Genetic, cytogenetic, and carcinogenic effects of radon: a review

Radon exposure has been linked to lung carcinogenesis in both human and animal studies. Studies of smoking and nonsmoking uranium miners indicate that radon alone is a risk factor for lung cancer at the levels encountered by these miners, although the possibility exists that other substances in the mine environment affect the radon-induced response. The relevance of data from mines to the lower-exposure home environment is often questioned; still, a recent study of miners exposed to relatively low radon concentrations demonstrated a statistically significant increase for lung and laryngeal cancer deaths. In two major series of experiments with rats, the primary carcinogenic effect found was respiratory tract tumors, and evidence for an inverse exposure-rate effect was also noted. Although this inverse dose-rate effect also has been described in underground miner studies, it may not similarly apply to radon in the home environment. This observation is due to the fact that, below a certain exposure, cells are hit once or not at all, and one would not expect any dose-rate effect, either normal or inverse. Because some chromosome aberrations persist in cycling cells as stable events, cytogenetic studies with radon are being performed to help complete the understanding of the events leading to radon-induced neoplasia. Radon has been found to induce 13 times as much cytogenetic damage (as measured by the occurrence of micronuclei) than a similar dose of 60Co. A wide variety of mutation systems have demonstrated alpha-particle mutagenesis; recent investigations have focused on the molecular basis of alpha-induced mutagenesis. Gene mutations are induced by radon in a linear and dose-dependent fashion, and with a high biological effect relative to low-LET irradiation. Studies of the hprt locus show that approximately half of the alpha-induced mutations arise by complete deletion of the gene; the remaining mutations are split between partial deletions, rearrangements, and events not detectable by Southern blot or PCR exon analysis. Although other mutation systems do not show the same spectra as observed in the hprt gene (suggesting that the gene environment affects response), DNA deletions or multilocus lesions of various size appear to be predominant after radon exposure. As data emerge regarding radon-induced changes at the chromosomal and molecular level, the mechanisms involved in radon carcinogenesis are being clarified. This information should increase the understanding of risk at the low exposure levels typically found in the home.

A hybrid likelihood algorithm for risk modelling

The risk of radiation-induced cancer is assessed through the follow-up of large cohorts, such as atomic bomb survivors or underground miners who have been occupationally exposed to radon and its decay products. The models relate to the dose, age and time dependence of the excess tumour rates, and they contain parameters that are estimated in terms of maximum likelihood computations. The computations are performed with the software package EPI-CURE, which contains the two main options of person-by person regression or of Poisson regression with grouped data. The Poisson regression is most frequently employed, but there are certain models that require an excessive number of cells when grouped data are used. One example involves computations that account explicitly for the temporal distribution of continuous exposures, as they occur with underground miners. In past work such models had to be approximated, but it is shown here that they can be treated explicitly in a suitably reformulated person-by person computation of the likelihood. The algorithm uses the familiar partitioning of the log-likelihood into two terms, L1 and L0. The first term, L1, represents the contribution of the 'events' (tumours). It needs to be evaluated in the usual way, but constitutes no computational problem. The second term, L0, represents the event-free periods of observation. It is, in its usual form, unmanageable for large cohorts. However, it can be reduced to a simple form, in which the number of computational steps is independent of cohort size. The method requires less computing time and computer memory, but more importantly it leads to more stable numerical results by obviating the need for grouping the data. The algorithm may be most relevant to radiation risk modelling, but it can facilitate the modelling of failure-time data in general.

Cancer risks from exposure to radon in homes

Exposure to radon and its decay products in mines is a well recognized risk of lung cancer in miners. A large number of epidemiologic studies from various countries are quite consistent in this respect even it the magnitude of the risk differs according to exposure levels. Indoor radon became a concern in the 1970s and about a dozen studies have been conducted since 1979, mainly of the case-control design. From first being of a simple pilot character, the designs have become increasingly sophisticated, especially with regard to exposure assessment. Crude exposure estimates based on type of house, building material and geological features have been supplemented or replaced by quite extensive measurements. Still, exposure assessment remains a difficult and uncertain issue in these studies, most of which indicate a lung cancer risk from indoor radon. Also a recent large scale study has confirmed a lung cancer risk from indoor radon. More recently there are also some studies, mainly of the correlation type, suggesting other cancers also to be related to indoor radon, especially leukemia, kidney cancer, and malignant melanoma, and some other cancers as well. The data are less consistent and much more uncertain than for indoor radon and lung cancer, however; and there is no clear support from studies of miners in this respect.

Life span and cancer mortality in the beagle dog and humans

This study compares the age-dependence and rate of cancer mortality in untreated Beagles over a lifetime with that of Japanese and US white men and women. The purpose of the study was to determine the extent to which there is a linkage between life span and cancer mortality in Beagle dogs and humans. The two human populations were chosen to represent contrasting races and environments. Using the age at 10% survival as the measure of life span, about 5.5 years in humans was equivalent to 1 year of life in Beagles. The age dependence and total cancer mortality was the same in men and male Beagles. The age dependence was the same in female Beagles and women, but the total cancer mortality was somewhat greater in female Beagles due to more breast cancer. Cancer in Beagles, other than breast cancer in females, consisted mostly of sarcomas and lymphomas. There was very little cancer in environmentally exposed tissues (lung and intestine). There was also some contrast between Japanese and Americans in the relative rates of cancer at certain sites. The study provides support for the life span linkage of adult cancer mortality in the two species, in spite of the different patterns of cancer types and environments.

Radon as a risk factor for extra-pulmonary tumours

Exposure to radon in uranium and other mines is a well recognised risk factor for lung cancer. There is also increasing evidence of a risk of lung cancer from indoor radon. An excess of stomach cancer has been observed in some mining populations but the role of radon is unclear. A few correlation studies and a case-control study have indicated that exposure to indoor radon could be of some importance as a cause of other tumours, especially acute myeloid leukaemia, melanoma and kidney cancer. Also prostate cancer and some other cancer types have correlated with estimated radon exposure but the relatively few studies are not quite consistent with each other. Nevertheless, the various observations of extra-pulmonary tumours associated with radon exposure may warrant further studies, especially with regard to childhood exposure and cancers.