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Radon and lung cancer in the pooled uranium miners analysis (PUMA): highly exposed early miners and all miners
  1. Kaitlin Kelly-Reif1,
  2. Stephen J Bertke1,
  3. Estelle Rage2,
  4. Paul A Demers3,4,
  5. Nora Fenske5,
  6. Veronika Deffner5,
  7. Michaela Kreuzer5,
  8. Jonathan Samet6,
  9. Mary K Schubauer-Berigan7,
  10. Ladislav Tomasek8,
  11. Lydia B Zablotska9,
  12. Charles Wiggins10,11,
  13. Dominique Laurier2,
  14. David B Richardson12
  1. 1Division of Field Studies and Engineering, National Institute for Occupational Safety and Health, Cincinnati, Ohio, USA
  2. 2Institute for Radiological Protection and Nuclear Safety, Fontenay-aux-Roses, France
  3. 3Occupational Cancer Research Centre, Ontario Health, Toronto, Ontario, Canada
  4. 4Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
  5. 5Federal Office for Radiation Protection (BfS), Munich (Neuherberg), Germany
  6. 6Colorado School of Public Health, Aurora, Colorado, USA
  7. 7Evidence Synthesis and Classification Branch, International Agency for Research on Cancer, Lyon, France
  8. 8National Radiation Protection Institute, Prague, Czech Republic
  9. 9Epidemiology and Biostatistics, University of California, San Francisco, California, USA
  10. 10University of New Mexico, Albuquerque, New Mexico, USA
  11. 11New Mexico Tumor Registry, Albuquerque, Mexico, USA
  12. 12Department of Environmental and Occupational Health, University of California, Irvine, Program in Public Health, Irvine, California, USA
  1. Correspondence to Dr Kaitlin Kelly-Reif, Division of Field Studies and Engineering, National Institute for Occupational Safety and Health, Cincinnati, Ohio, USA; kkelly-reif{at}


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.

  • Cancer
  • Radon
  • Miners
  • Radiation

Data availability statement

Data are available on reasonable request.

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Data availability statement

Data are available on reasonable request.

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  • Contributors KK-R, DBR, ER, DL, JS, PAD, LT, LBZ, MKS-B and MK developed the research questions and designed the study. ER and DL worked on provision of the French data; MKS-B and KK-R worked on provision of the US Colorado Plateau data; JS and CW worked on provision of the US New Mexico data; LBZ worked on provision of the Canadian Eldorado data; PAD worked on provision of the Canadian Ontario data; and VD and NF worked on provision of the Wismut data. SJB, ER, KK-R and DBR were responsible for data management and processing. KK-R produced the initial draft of the manuscript, which was revised and approved by all authors. KKR is the author acting as guarantor.

  • 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). IRSN thanks ORANO for its cooperation in the elaboration of the French cohort. For the US contribution, funding was provided by the National Institute for Occupational Safety and Health. LBZ work was funded and supported by the Centers for Disease Control and Prevention (CDC) in association with the National Institute for Occupational Safety and Health (NIOSH) Grant (R21OH011452). For the Czech cohort, funding was provided by the National Radiation Protection Institute (SURO), grant MV25972-2/OBV.

  • Competing interests None declared.

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

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.