A comparison between the localization of lung tumors in uranium miners and in nonminers from 1947 to 1991.

BACKGROUND: Lung cancer was noted to be increased in cigarette smoking miners and nonminers. Carcinogen particulates deposit differentially in the central, middle, and peripheral zones of the bronchial tree depending on the size of the particle. The object of this study was to evaluate the incidence of tumors; their cell types; and the relationship of particulate size to their position in the bronchial tree. METHODS: Tumor position in the bronchial tree was studied for a cohort of 467 uranium miners and 311 nonminers with lung cancer. RESULTS: An examination of all histologic subtypes showed that the proportion of lung cancers in the central zone was significantly greater in miners than in nonminers presumably due to the deposition of radon decay products attached to the silica dust particles. The higher percentage of central tumors in the miners was primarily due to the distribution of a greater proportion of squamous cell and small-cell tumors. The ratio of 0.75 for the central to middle and peripheral location for adenocarcinomas was much lower than for squamous cell and small-cell carcinomas with ratios of 1.4 and 7.3, respectively. In the mining cohort, there were ten times as many small-cell tumors in the central area as in the middle and peripheral regions, whereas, for the nonminers there were only five times as as many centrally located small-cell tumors as middle and peripheral (chi square is 7.0 degrees, P < 0.01). These data suggest that radon may be deposited preferentially to the central region of the lungs in uranium miners. CONCLUSIONS: Based on our observations of the differential positions of lung tumors in the bronchial tree for miners and nonminers and previous studies by others regarding size-dependent deposition of particulates in the bronchial tree, it is concluded that inhaled dust, radon, and cigarette smoke combine to form large particulates that deposit in the central bronchial tree. Filtered cigarette smoke or other small carcinogens from smaller particulates that deposit more peripherally.

Relationship of radioactive radon daughters and cigarette smoking in the genesis of lung cancer in uranium miners.

This article documents the study of 383 cases of lung cancer in uranium miners and presents for the first time the relationship of radioactive radon gas and cigarette smoking. There is evidence that alpha radiation from radon gas at exposure levels above 465 working level months (WLM) is a strong contributor to the development of lung cancer. Cigarette smoking plays the most significant role in causing lung tumor; this is also noticed in nonminers who smoke cigarettes. A synergistic or additive effect of these two carcinogens is strongly suggested. The data indicate that small cell tumors develop in younger nonsmoking miners exposed to radon levels above 465 WLM. Lung cancers develop in smoking miners at lower levels of radon exposure than in nonsmoking miners. Based on an average mining experience of 15 years, there is substantial evidence that the present maximum allowable limit of 0.3 working levels (WL), or 4 working level months (WLM) per year, is safe, representing a margin of safety of approximately 10:1. Furthermore, a comparison of these data with the radon levels in some homes, averaging in the neighborhood of 0.025 WL, would indicate that health risks at these levels are negligible. It is suggested that 20 picocuries/liter, which equals 0.10 WL, be the maximum allowable level in homes.

Histologic findings in the tracheobronchial tree of uranium miners and non-miners with lung cancer.

The remaining tissue of the tracheobronchial tree from 210 men who died from lung cancer was studied to compare the histologic alterations leading to further sites of primary cancer. These men were uranium miners matched with nonminers for age and smoking habits. In the examination of a total of 28,928 cross-sections carcinoma in situ was found in 96% of the miners and in 92% of the nonminers. The number of slides from miners showing degree 2 or 3 atypia in areas of carcinoma in situ was about double the number found from the nonminers. Although the difference was not statistically significant, 32% of the miners had at least one section showing early primary invasive carcinoma compared with 22% of the nonminers. The data indicate that the synergistic effect of the exposure to uranium dust along with cigarette smoking increases the risk of lung cancer and that in addition to a main tumor mass, other sites of tissue alterations leading to tumor development are frequently already present in the lung.