RADON AND CANCERS OTHER THAN LUNG-CANCER IN UNDERGROUND MINERS - A COLLABORATIVE ANALYSIS OF 11 STUDIES
RADON AND CANCERS OTHER THAN LUNG-CANCER IN UNDERGROUND MINERS - A COLLABORATIVE ANALYSIS OF 11 STUDIES
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DOI：
10.1093/jnci/87.5.378
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发表时间：
1995-03-01
影响因子：
10.3
通讯作者：
YAO, SX
中科院分区：
文献类型：
--
作者：
DARBY, SC;WHITLEY, E;YAO, SX
背景资料：最近，在国内氡暴露的地理相关性研究和职业暴露矿工的个人队列中，暴露于放射性气体氡及其子体（Rn-222及其放射性衰变产物）与肺癌以外的各种癌症有关。目的：本研究旨在进一步描述肺癌以外癌症的风险（即，非肺癌）。研究方法：在对11组地下矿工的数据进行协作分析时，对非肺癌的死亡率进行了检查，这些矿工中已确定与氡有关的肺癌过量。该研究纳入了64，209名男性，他们在矿山工作的平均时间为6.4年，平均累积暴露时间为155个工作水平月（WLM），平均随访时间为16.9年。结果如下：对于所有非肺癌合并而言，死亡率接近矿山周围地区死亡率的预期值（观察到的死亡与预期死亡的比率[O/E] = 1.01; 95%置信区间[CI] = 0.95-1.07，基于1179例死亡），死亡率并未随着累积暴露的增加而增加。在28种癌症中，胃癌死亡率在统计学上显著增加，（O/E = 1.33; 95% CI = 1.16-1.52）和肝脏（O/E = 1.73; 95% CI = 1.29-2.28），舌癌和口腔癌的统计学显著降低观察到（O/E = 0.52; 95% CI = 0.26-0.93）、咽部（O/E = 0.35; 95% CI = 0.16-0.66）和结肠（O/E = 0.77; 95% CI = 0.63-0.95）。对于白血病，死亡率在开始工作后不到10年的时间内增加（O/E = 1.93; 95%CI = 1.19-2.95），但随后没有增加。这些疾病的死亡率均与累积接触量无显著关系。在其余的非肺癌个体类别中，死亡率仅与胰腺癌的累积暴露有关（根据WLM计算的超额相对风险= 0.07%; 95% CI = 0.01-0.12），以及在自就业开始后不到10年的时间内，其他和未指明的癌症（根据WLM的超额相对风险= 0.22%; 95%CI = 0.08-0.37）。结论：胃癌、肝癌和白血病死亡率的增加不太可能是氡造成的，因为它们与累积暴露无关。累积接触与胰腺癌之间的关联似乎是偶然发现，而累积接触与其他和未指明的癌症之间的关联是由被证明可能由肺癌引起的癌病（全身广泛扩散的癌症）导致的死亡引起的。因此，这项研究提供了相当多的证据，证明空气中高浓度的氡不会导致肺癌以外的癌症死亡的重大风险。影响：氡的保护标准应继续仅基于对肺癌风险的考虑。
Background: Exposure to the radioactive gas radon and its progeny (Rn-222 and its radioactive decay products) has recently been linked to a variety of cancers other than lung cancer in geographic correlation studies of domestic radon exposure and in individual cohorts of occupationally exposed miners. Purpose: This study was designed to characterize further the risks for cancers other than lung cancer (i.e., non-lung cancers) from atmospheric radon. Methods: Mortality from non-lung cancer was examined in a collaborative analysis of data from 11 cohorts of underground miners in which radon-related excesses of lung cancer had been established. The study included 64 209 men who were employed in the mines for 6.4 years on average, received average cumulative exposures of 155 working-level months (WLM), and were followed for 16.9 years on average. Results: For all non-lung cancers combined, mortality was close to that expected from mortality rates in the areas surrounding the mines (ratio of observed to expected deaths [O/E] = 1.01; 95% confidence interval [CI] = 0.95-1.07, based on 1179 deaths), and mortality did not increase with increasing cumulative exposure. Among 28 individual cancer categories, statistically significant increases in mortality for cancers of the stomach (O/E = 1.33; 95% CI = 1.16-1.52) and liver (O/E = 1.73; 95% CI = 1.29-2.28) and statistically significant decreases for cancers of the tongue and mouth (O/E = 0.52; 95% CI = 0.26-0.93), pharynx (O/E = 0.35; 95% CI = 0.16-0.66), and colon (O/E = 0.77; 95% CI = 0.63-0.95) were observed. For leukemia, mortality was increased in the period less than 10 years since starting work (O/E = 1.93; 95% CI = 1.19-2.95) but not subsequently. For none of these diseases was mortality significantly related to cumulative exposure. Among the remaining individual categories of non-lung cancer, mortality was related to cumulative exposure only for cancer of the pancreas (excess relative risk per WLM = 0.07%; 95% CI = 0.01-0.12) and, in the period less than 10 years since the start of employment, for other and unspecified cancers (excess relative risk per WLM = 0.22%; 95% CI = 0.08-0.37). Conclusions: The increases in mortality from stomach and liver cancers and leukemia are unlikely to have been caused by radon, since they are unrelated to cumulative exposure. The association between cumulative exposure and pancreatic cancer seems likely to be a chance finding, while the association between cumulative exposure and other and unspecified cancers was caused by deaths certified as due to carcinomatosis (widespread disseminated cancer throughout the body) that were likely to have been due to lung cancers. This study, therefore, provides considerable evidence that high concentrations of radon in air do not cause a material risk of mortality from cancers other than lung cancer. Implications: Protection standards for radon should continue to be based on consideration of the lung cancer risk alone.