Temporal Patterns of Lung Cancer Risk from Radon, Smoking and their Interaction

Studies of uranium miners conducted since the late 1960s demonstrated that the risk depends on cumulated exposure in terms of working level months (WLM) integrating both duration of exposure and concentration of radon. It has been also demonstrated that the risk from radon decreases with time since exposure. The objective of the work is to study temporal patterns of lung cancer risk from occupational and residential radon and from smoking. The present analysis of temporal changes of relative risk is based on a model, where the total individual exposure is partitioned into components in dependence on time. Exposure to radon is studied in a cohort of 9411 Czech uranium miners with 766 cases of lung cancer and in a residential study of 1 803 inhabitants exposed to radon in houses with 218 cases. Temporal patterns of smoking are analyzed in a case-control study of patients from a major Prague hospital including 566 cases. for both carcinogens, the relative risk decreases with time since exposure. In comparison to period with exposure before 5-19 years, the risk from exposures before 20-34 years is 36% and 34% for smoking and randon, respectively. The effect of exposures from more distant periods 35-49 is only 5% for smoking and 14% for radon in comparison to 5-19 years. Combined effect of smoking and radon is studied by a nested case-control approach including 434 cases and 962 controls. Analyses of the joint effects of smoking and radon, conducted in the occupational and the residential studies, suggest a sub-multiplicative interaction. The relative risk from radon among non-smokers is higher by a factor of 2-3 in comparison to smokers, suggesting different patterns of lung deposition and clearance among smokers and non-smokers. (Author) 13 refs