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Original research
PUMA – pooled uranium miners analysis: cohort profile
  1. Estelle Rage1,
  2. David B Richardson2,
  3. Paul A Demers3,
  4. Minh Do3,
  5. Nora Fenske4,
  6. Michaela Kreuzer4,
  7. Jonathan Samet5,
  8. Charles Wiggins6,7,
  9. Mary K Schubauer-Berigan8,9,
  10. Kaitlin Kelly-Reif9,
  11. Ladislav Tomasek10,
  12. Lydia B Zablotska11,
  13. Dominique Laurier1
  1. 1 Institute for Radiological Protection and Nuclear Safety (IRSN), PSE-SANTE, SESANE, Fontenay-aux-Roses, France
  2. 2 University of North Carolina, Chapel Hill, North Carolina, USA
  3. 3 Cancer Care Ontario, Toronto, Ontario, Canada
  4. 4 Federal Office for Radiation Protection, Department of Radiation Protection and Health, Neuherberg, Germany
  5. 5 Colorado School of Public Health, Aurora, Colorado, USA
  6. 6 University of New Mexico, Albuquerque, New Mexico, USA
  7. 7 New Mexico Tumor Registry, Albuquerque, New Mexico, USA
  8. 8 International Agency for Research on Cancer, Lyon, France
  9. 9 National Institute for Occupational Safety and Health, Cincinnati, Ohio, USA
  10. 10 National Radiation Protection Institute, Prague, Czech Republic
  11. 11 University of California, San Francisco, San Francisco, California, USA
  1. Correspondence to Estelle Rage, Institute for Radiological Protection and Nuclear Safety (IRSN), Fontenay-aux-Roses, France; estelle.rage{at}


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.

  • Radon
  • low-level ionising radiation
  • uranium miners
  • cancer
  • cardiovascular

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  • Contributors DBR and DL initially contributed to the conception of the study. ER, DBR, PAD, MD, NF, MK, MKSB, KKR, LT and LBZ provided data. ER was responsible of the data management and conducted the data analyses. ER and DBR drafted the manuscript. ER, DBR, PAD, MD, NF, MK, JS, CW, MKSB, KKR, LT, LBZ and DL contributed to the interpretation of the data, critically revised the manuscript and approved the final version.

  • Funding This work was partly funded by the Centers for Disease Control and Prevention (R03 OH010946). The construction of the French cohort was partially supported by The Institute for Radiological Protection and Nuclear Safety (IRSN).

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Approved by the Office of Human Research Ethics at the University of North Carolina (study number 15-2436). This submission was reviewed by the Office of Human Research Ethics, which has determined that this submission does not constitute human subjects research as defined under federal regulations (45 CFR 46.102 (d or f) and 21 CFR 56.102(c)(e)(l)) and does not require IRB approval.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement No data are available. For reasons of ethics and permissions from different agencies, the data are maintained at the Institute for Radiation Protection and Nuclear Safety (Paris, France); it is not possible to send the individual data outside of the Institute. Data can not be exchanged between study participants under an individual format, but are exchanged under a tabulated format defined according to variable categories homogenised among cohorts. Proposals for possible collaborations in further analyses of the data should be addressed to Dr Dominique Laurier and will be reviewed by the PUMA consortium.