Response to Lubin's proposed explanations of our discrepancy

A preliminary study for conducting a rational assessment of radon exposure levels

The aim of this study was to determine the factors that go into a highly reliable estimate of radon exposure levels for use in setting up the case-control study. To this end, the present study conducted a multi-faceted investigation of the distribution of radon concentrations in the bedrooms and living rooms of 400 households in the target areas during the winter months from December 2014 to February 2015. We determined that taking the mean value of the radon concentration levels detected in the bedroom and living room as the representative value of residential concentration is appropriate, given the usability of previous research data and the difference in the concentration levels between the two. In terms of detector placement, we found that detectors should not inconvenience residents or be affected by an air current. Further, we found that housing type should distinguish between regular housing (single-detached, row, and multiplex housing) and apartments but that the building type was not a key factor in the assessment of radon exposure levels. Houses should be classified into those constructed with soil (red clay) and those with constructed with general building materials for the assessment of radon exposure levels.

Lung cancer in Oregon

Factors thought to be related to lung cancer include smoking, radon, and educational attainment. These factors were analyzed in the present ecological study for Oregon with correlation and linear regression statistics. A moderate, inverse, and statistically significant correlation was found with educational attainment while surprisingly, negligible and statistically insignificant correlations were found with smoking and radon. More rigorous research such as case-control study designs, are indicated to verify or refute these findings.

Test of the linear-no threshold theory: rationale for procedures

A tightly reasoned justification is presented for the procedures used in our test of the linear-no threshold theory of radiation carcinogenesis by comparing lung cancer rates with average radon exposure in U.S. counties. A key point is its dependence on ecological variables rather than on characteristics of individuals and the principal problems involve treatment of potential confounding factors (CF). The method of stratification is introduced and shown to be preferable to multiple regression for evaluating effects of confounding. Utilizing numerous available CF reduces the problem of representing a complex confounding relationship by the average value of a single CF. The requirements on a CF for affecting the results are quantified in terms of its correlations with lung cancer rates and radon levels and it is shown that the existence of an unknown confounder satisfying these requirements is highly implausible. Effects of combinations of confounding factors are treated and shown not to be important. The problem of confounding factors on the level of individuals is resolved. Consideration of plausibility of correlations is used in several applications, including treatments of uncertainty in smoking prevalence, within county differences in radon exposure between smokers and non-smokers, variations in intensity of smoking, differences between measured radon levels and actual exposures, etc. Examples are presented for all applications. The differences between our study and case-control studies, and the advantages of each for testing the linear-no threshold theory, are discussed.

Residential radon exposure and lung cancer risk: commentary on Cohen's county-based study

The large United States county-based study () in which an inverse relationship has been suggested between residential low-dose radon levels and lung cancer mortality has been reviewed. While this study has been used to evaluate the validity of the linear nonthreshold theory, the grouped nature of its data limits the usefulness of this application. Our assessment of the study's approach, including a reanalysis of its data, also indicates that the likelihood of strong, undetected confounding effects by cigarette smoking, coupled with approximations of data values and uncertainties in accuracy of data sources regarding levels of radon exposure and intensity of smoking, compromises the study's analytic power. The most clear data for estimating lung cancer risk from low levels of radon exposure continue to rest with higher-dose studies of miner populations in which projections to zero dose are consistent with estimates arising from most case-control studies regarding residential exposure.

Epidemiological associations among lung cancer, radon exposure and elevation above sea level--a reassessment of Cohen's county level radon study

Inhalation of radon (222Rn) decay products by persons living in homes has been associated with increased risk of lung cancer. Some epidemiological studies have shown a positive association between radon exposure and lung cancer rates. However, a large U.S.-wide ecological study (Cohen 1995) has shown a clear inverse association between average county radon concentration in homes and average lung cancer rates in the county. Cohen's strong inverse association between radon and lung cancer is surprising since there is no plausible biological reason for an inverse causal relationship between the two. We plot the county average lung cancer rate vs. the elevation above sea level (altitude) and show an inverse association between county average lung cancer rate and elevation. The elevation used for each county is the altitude of the most populous place in the county. We postulate that the decrease in lung cancer rates with higher elevations is caused by the carcinogenic effect of higher absolute oxygen concentration in the inspired air at lower elevations. Stratifying Cohen's lung cancer vs. radon data into ten groups of counties with similar elevations removes some, but not all, of his inverse association between radon and lung cancer.

The potential for bias in Cohen's ecological analysis of lung cancer and residential radon

Cohen's ecological analysis of US lung cancer mortality rates and mean county radon concentration shows decreasing mortality rates with increasing radon concentration (Cohen 1995 Health Phys. 68 157-74). The results prompted his rejection of the linear-no-threshold (LNT) model for radon and lung cancer. Although several authors have demonstrated that risk patterns in ecological analyses provide no inferential value for assessment of risk to individuals, Cohen advances two arguments in a recent response to Darby and Doll (2000 J. Radiol. Prot. 20 221-2) who suggest Cohen's results are and will always be burdened by the ecological fallacy. Cohen asserts that the ecological fallacy does not apply when testing the LNT model, for which average exposure determines average risk, and that the influence of confounding factors is obviated by the use of large numbers of stratification variables. These assertions are erroneous. Average dose determines average risk only for models which are linear in all covariates, in which case ecological analyses are valid. However, lung cancer risk and radon exposure, while linear in the relative risk, are not linearly related to the scale of absolute risk, and thus Cohen's rejection of the LNT model is based on a false premise of linearity. In addition, it is demonstrated that the deleterious association for radon and lung cancer observed in residential and miner studies is consistent with negative trends from ecological studies, of the type described by Cohen.

Radiation hormesis: challenging LNT theory via ecological and evolutionary considerations

Ecological and evolutionary considerations suggest that radiation hormesis is made up of two underlying components. The first (a) is background radiation hormesis based upon the background exposure to which all organisms are subjected throughout evolutionary time. The second and much larger component (b) is stress-derived radiation hormesis arising as a protective mechanism derived from metabolic adaptation to environmental stresses throughout evolutionary time especially from climate-based extremes. Since (b) > > (a), hormesis for ionizing radiation becomes an evolutionary expectation at exposures substantially exceeding background. This biological model renders linear no-threshold theory invalid. Accumulating evidence from experimental organisms ranging from protozoa to rodents, and from demographic studies on humans, is consistent with this interpretation. Although hormesis is not universally accepted, the model presented can be subjected to hypothesis-based empirical investigations in a range of organisms. At this stage, however, two consequences follow from this evolutionary model: (1) hormesis does not connote a value judgement usually expressed as a benefit; and (2) there is an emerging and increasingly convincing case for reviewing and relaxing some recommended radiation protection exposure levels in the low range.

Radon exposure and the risk of leukemia: a review of epidemiological studies

Since the 1990's, several authors estimated that radon inhalation may deliver a small amount of irradiation to the red bone marrow, and consequently may increase the risk of leukemia in humans. The objective of this review is to conduct a critical analysis of epidemiologic results currently available concerning the relationship between radon exposure and the risk of leukemia. Nineteen ecological studies, six miner cohort studies, and eight case-control studies published between 1987 and 2000 are included in this review. The limitations associated with each of these studies are discussed. The results of the ecological studies are relatively concordant and suggest an association between radon concentrations and the risk of leukemia at a geographic level. But these ecological studies present important limitations, and some are only crude analyses. Moreover, the results of the cohort and case-control studies, based on individual data, do not show any significant association between radon exposure and leukemia risk. Our conclusion is that the overall epidemiologic results currently available do not provide evidence for an association between radon exposure and leukemia.