... the beginning of this particular story, which can be traced back to the end of the Middle Ages:
Toxicological Sciences 64, 4-6 (2001)PROFILES IN TOXICOLOGY
A Short History of Lung Cancer
Hanspeter Witschi
ITEH and Department of Molecular Biosciences, School of Veterinary Medicine, University of California, Davis, California 95616
... There was, however, one lung cancer where it had been obvious for a long time that it might be caused by an external agent. As early as 1500, attention was called to this particular condition. In two regions of Germany and Czechoslovakia, Schneeberg and Joachimsthal, there were productive mines, yielding first silver, later nickel, cobalt, bismuth, and arsenic. The word "dollar" actually stems from the word "Thaler;" coins minted from the pure silver of Joachimsthal were called "Joachimsthaler" (i.e., originating from Joachimsthal) or, abbreviated, "Thaler." The miners working these mines developed almost invariably a deadly disease, called "Bergkrankheit" (mountain sickness). Between 1876 and 1938, 60 to 80% of all miners died from the disease which, on average, lasted 25 years. Certain regions of the mines were known as "death pits," where all workers got sick. As a result, lung cancer in miners was recognized as an occupational disease—and the miners therefore entitled for compensation—in 1926 in Germany and in 1932 in Czechoslovakia. While it was thought that chemical constituents of the ore that was produced, most notably arsenic, might be involved in the etiology of these lung cancers, it was early on suspected that "radium emanation" was the main culprit. Measurements published in 1924 in a German physics journal confirmed that the air in the mines contained high concentrations of radon gas, the highest more than 18,000 picocuires per liter ...
By WWII, it was completely clear that radon was involved:
Am J Ind Med. 1993 Feb;23(2):355-68Schneeberg lung disease and uranium mining in the Saxon Ore Mountains (Erzgebirge).
Schuttmann W.
Faculty of Industrial Hygiene, Department of Health, Berlin-Biesdorf, Germany
The so-called Schneeberg lung disease is a form of bronchial or alveolar carcinoma caused by the effects of the radioactive gas radon and of its radioactive short half-life daughter products. This type of radiation-induced occupational cancer is the most common and the most important radiation injury among workers occupationally exposed to ionizing radiation. There have been many deaths from lung cancer, especially in the Soviet uranium mines in the Erzgebirge of Saxony in the former German Democratic Republic. The history of disease in these miners extends over five centuries; the first observations of their health hazard start in the Middle Ages. The discovery of the lung cancer component was made toward the end of the nineteenth century, and the suspicion that a connection might exist between this cancer type and exposure to ionizing radiation was voiced at the beginning of the twentieth century. In the first half of this century, further research was carried out on this disease in the Schneeberg area of the Erzgebirge. Before the end of World War II, guidelines were set up to define the acceptable limits of radon exposure in the ore mines of Saxony ...
The old Atomic Energy Commission, however, with its eye fixed on warheads and power plants, and lacking any mandate to safeguard worker health, was not terribly interested in the topic:
ACHRE ReportACHRE Report
Chapter 12: The Uranium Miners
... In 1942, Wilhelm C. Hueper, a German émigré who was founding director of the environmental cancer section of the National Cancer Institute (NCI), one of the National Institutes of Health, published a review in English of the literature on the European miners suggesting that radon gas was implicated in causing lung cancer. He eliminated nonoccupational factors because excess lung cancer showed up only among miners. He also eliminated occupational factors other than radon because these other factors had not caused lung cancer in other occupational settings. Among Hueper's peers, dissenters, such as Egon Lorenz, also of the NCI, focused on contaminants other than radon in the mine, the possible genetic susceptibility of the population, and the calculated doses to the lung, which seemed too low to cause cancer because the role of radon daughters--which the radioactive polonium, bismuth, and lead decay products of radon gas are known as--was not yet understood.
At the time its own program began, the AEC had many reasons for concern that the experience of the Czech and German miners portended excess lung cancer deaths for uranium miners in the United States. The factors included the following: (1) No respected scientist challenged the finding that the Czech and German miners had an elevated rate of lung cancer; (2) these findings were well known to the American decision makers; (3) as Hueper points out, genetic and nonoccupational factors could be rejected; and (4) radon standards existed for other industries, and there was no reason to think that conditions in mines ruled out the need for such standards. Moreover, as soon as the government began to measure airborne radon levels in Western U.S. uranium mines, they found higher levels than those reported in the European mines where excess cancers had been observed ...
One important hole in Hueper's argument was that the calculated dose of radiation from the radon in European mines did not seem high enough to cause cancer. But when William Bale of the University of Rochester and John Harley, a scientist at the AEC's New York Operations Office (NYOO) who was working toward his doctorate at Renssaelear Polytechnic Institute, were able to show and explain in 1951 the importance of radioactive particles that attached to bits of dust and remained in the lung, the discovery had a tremendous impact. When doses to the lung were recalculated using Bale and Harley's models, they increased 76 times, making them high enough to explain the observed cancer rates. Recognizing the importance of radon daughters also explained why animal experiments using pure radon gas had not caused cancer.
In the absence of Atomic Energy Commission willingness to press for relatively safe tolerance levels for radon in U.S. mines and to institute an effective program of mine ventilation to reduce the hazard, and a mixed, but mainly unsatisfactory response from the states, the stage was set for intergovernmental buck passing and decades of study, a course that resulted in the premature deaths of hundreds of miners. An analysis of eleven underground miners' studies published in 1994 by the National Cancer Institute supports the view that radon daughters are responsible for an even greater number of lung cancers than previously believed ...
The discovery of the magnitude of residential doses surprised folks:
History... Elevated levels of radon in homes were not recognized as a potential public health threat until the mid-1980's. Mr. Stanley Watras, a worker at the Limerick Nuclear Power Plant located in eastern Pennsylvania, set off a radiation detector upon entering the nuclear power plant. At the time the nuclear power plant was under construction and had not received its nuclear fuel. The utility discovered extremely elevated levels of radon in his new home. The Commonwealth of Pennsylvania began testing homes for radon and found elevated levels of radon in them as well ...
There have been a number of large epidemiology studies since then. Here's one:
THE IOWA RADON LUNG CANCER STUDYPhase I Completed
The Iowa Radon Lung Cancer Study was a large-scale epidemiology study initiated in 1993 and funded by the National Institute of Environmental Health Sciences (NIEHS). The study assessed the risk posed by residential radon exposure. The 5-year study was performed in Iowa and the participants were women throughout Iowa who lived in their current home for at least 20 years. Over a thousand Iowa women took part in the study. Four hundred and thirteen of the participants were women who had developed lung cancer, the remaining 614 participants were controls who did not have lung cancer. The study was limited to women, because they historically tend to spend more time at home and they have less occupational exposure to other lung carcinogens.
The epidemiologic study was performed in Iowa for several reasons. Iowa has the highest average radon concentrations in the United States. In addition, women in Iowa tend to move less than most other states, which makes calculation of their past radon exposure easier. Iowa was also selected because it has a quality National Cancer Institute SEER cancer registry, which helped us identify women who developed lung cancer. Close to 60% of the basement measurements for both cases (participants with lung cancer) and controls (participants without lung cancer) exceeded the EPA's action level. Twenty-eight percent of the living areas for the controls and 33% of the living areas for the cases exceeded the EPA's action level of 4 pCi/L ...
The Iowa Radon Lung Cancer Study had several strengths. First, independent pathologic review was performed for 96 percent of the cases. Second, the study was carried out in Iowa, which has the highest mean radon concentrations in the United States. Third, the high radon concentrations in conjunction with a strict quality assurance protocol contributed to accurate and precise radon measurements. Fourth, the IRLCS criteria requiring occupancy in the current home for at least the last 20 years eliminated the need to impute radon measurements from missing homes. Fifth, the linkage between radon measurements and retrospective participant mobility allowed for a refined exposure estimate ...
Release: May 25, 2000
UI study: Residential radon exposure poses significant lung cancer riskIOWA CITY, Iowa -- ... Even at the EPA action level of 4 pCi/L, an approximate 50 percent excess lung cancer risk was found among the women in the study after correcting for the impact of smoking, according to Charles Lynch, UI professor of epidemiology and the study's principal investigator.
"What this indicates is that residential radon exposure is a significant cause of lung cancer," Lynch said ...
Yes, epidemiologists consider newer, better analyses to be news:
Radon Risk for Lung Cancer Back in the SpotlightSecond Leading Cause of Lung Cancer in US
... Darby and colleagues calculated that lung cancer risk increases by 8.4% for every 100 becquerels per cubic meter (Bq/m3) of radon indoors. The US Environmental Protection Agency (EPA) recommends taking action to lower indoor radon when the gas reaches concentrations of 4 picocuries per liter (pCi/L), which is equivalent to 148 Bq/m3.
"These results are consistent with those of earlier studies, including one from the United States," said Elizabeth Ward, PhD, director of surveillance research for the American Cancer Society. "But this study has larger numbers of people resulting in greater statistical power and better ability to separate the results of radon exposure from the results of smoking" ...
I afraid Bernie's name isn't coming up much in this long history of people trying to sort out the "Bergkrankheit."
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