title: A combined analysis of North American case-control studies of residential radon and lung cancer.
abstract: Cohort studies have consistently shown underground miners exposed to high levels of radon to be at excess risk of lung cancer, and extrapolations based on those results indicate that residential radon may be responsible for nearly 10-15% of all lung cancer deaths per year in the United States. However, case-control studies of residential radon and lung cancer have provided ambiguous evidence of radon lung cancer risks. Regardless, alpha-particle emissions from the short-lived radioactive radon decay products can damage cellular DNA. The possibility that a demonstrated lung carcinogen may be present in large numbers of homes raises a serious public health concern. Thus, a systematic analysis of pooled data from all North American residential radon studies was undertaken to provide a more direct characterization of the public health risk posed by prolonged radon exposure. To evaluate the risk associated with prolonged residential radon exposure, a combined analysis of the primary data from seven large scale case-control studies of residential radon and lung cancer risk was conducted. The combined data set included a total of 4081 cases and 5281 controls, representing the largest aggregation of data on residential radon and lung cancer conducted to date. Residential radon concentrations were determined primarily by a-track detectors placed in the living areas of homes of the study subjects in order to obtain an integrated 1-yr average radon concentration in indoor air. Conditional likelihood regression was used to estimate the excess risk of lung cancer due to residential radon exposure, with adjustment for attained age, sex, study, smoking factors, residential mobility, and completeness of radon measurements. Although the main analyses were based on the combined data set as a whole, we also considered subsets of the data considered to have more accurate radon dosimetry. This included a subset of the data involving 3662 cases and 4966 controls with a-track radon measurements within the exposure time window (ETW) 5-30 yr prior to the index date considered previously by Krewski et al. (2005). Additional restrictions focused on subjects for which a greater proportion of the ETW was covered by measured rather than imputed radon concentrations, and on subjects who occupied at most two residences. The estimated odds ratio (OR) of lung cancer generally increased with radon concentration. The OR trend was consistent with linearity (p = .10), and the excess OR (EOR) was 0.10 per Bq/m3 with 95% confidence limits (-0.01, 0.26). For the subset of the data considered previously by Krewski et al. (2005), the EOR was 0.11 (0.00, 0.28). Further limiting subjects based on our criteria (residential stability and completeness of radon monitoring) expected to improve radon dosimetry led to increased estimates of the EOR. For example, for subjects who had resided in only one or two houses in the 5-30 ETW and who had a-track radon measurements for at least 20 yr of this 25-yr period, the EOR was 0.18 (0.02, 0.43) per 100 Bq/m3. Both estimates are compatible with the EOR of 0.12 (0.02, 0.25) per 100 Bq/m3 predicted by downward extrapolation of the miner data. Collectively, these results provide direct evidence of an association between residential radon and lung cancer risk, a finding predicted by extrapolation of results from occupational studies of radon-exposed underground miners.
authors.affiliation: Department of Epidemiology and Community Medicine, Faculty of Medicine, McLaughlin Centre for Population Health Risk Assessment, Institute of Population Health, University of Ottawa, Ottawa, Ontario, Canada. dkrewski@uottawa.ca
authors.forename: Daniel
authors.initials: D
authors.lastname: Krewski
authors.forename: Jay H
authors.initials: JH
authors.lastname: Lubin
authors.forename: Jan M
authors.initials: JM
authors.lastname: Zielinski
authors.forename: Michael
authors.initials: M
authors.lastname: Alavanja
authors.forename: Vanessa S
authors.initials: VS
authors.lastname: Catalan
authors.forename: R William
authors.initials: RW
authors.lastname: Field
authors.forename: Judith B
authors.initials: JB
authors.lastname: Klotz
authors.forename: Ernest G
authors.initials: EG
authors.lastname: Létourneau
authors.forename: Charles F
authors.initials: CF
authors.lastname: Lynch
authors.forename: Joseph L
authors.initials: JL
authors.lastname: Lyon
authors.forename: Dale P
authors.initials: DP
authors.lastname: Sandler
authors.forename: Janet B
authors.initials: JB
authors.lastname: Schoenberg
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Steck
authors.forename: Jan A
authors.initials: JA
authors.lastname: Stolwijk
authors.forename: Clarice
authors.initials: C
authors.lastname: Weinberg
authors.forename: Homer B
authors.initials: HB
authors.lastname: Wilcox
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000396:Air Pollutants, Radioactive / Q000009:adverse effects*; D016902:Air Pollution, Indoor / Q000009:adverse effects*; D002274:Carcinogens, Environmental / Q000009:adverse effects*; D016022:Case-Control Studies; D004781:Environmental Exposure / Q000009:adverse effects*; D005260:Female; D006798:Housing; D006801:Humans; D008175:Lung Neoplasms / Q000453:epidemiology / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D009381:Neoplasms, Radiation-Induced / Q000453:epidemiology / Q000209:etiology*; D009656:North America / Q000453:epidemiology; D011886:Radon / Q000009:adverse effects*; D018570:Risk Assessment
chemical_list: D000396:Air Pollutants, Radioactive; D002274:Carcinogens, Environmental; D011886:Radon