Radon and risk of extrapulmonary cancers: results of the German uranium miners' cohort study, 1960-2003

Data from the German miners' cohort study were analysed to investigate whether radon in ambient air causes cancers other than lung cancer. The cohort includes 58 987 men who were employed for at least 6 months from 1946 to 1989 at the former Wismut uranium mining company in Eastern Germany. A total of 20 684 deaths were observed in the follow-up period from 1960 to 2003. The death rates for 24 individual cancer sites were compared with the age and calendar year-specific national death rates. Internal Poisson regression was used to estimate the excess relative risk (ERR) per unit of cumulative exposure to radon in working level months (WLM). The number of deaths observed (O) for extrapulmonary cancers combined was close to that expected (E) from national rates (n = 3340, O/E = 1.02; 95% confidence interval (CI): 0.98- 1.05). Statistically significant increases in mortality were recorded for cancers of the stomach (O/E = 1.15; 95% CI: 1.06-1.25) and liver (O/E = 1.26; 95% CI: 1.07-1.48), whereas significant decreases were found for cancers of the tongue, mouth, salivary gland and pharynx combined (O/E = 0.80; 95% CI: 0.65-0.97) and those of the bladder (O/E = 0.82; 95% CI: 0.70-0.95). A statistically significant relationship with cumulative radon exposure was observed for all extrapulmonary cancers (ERR/WLM = 0.014%; 95% CI: 0.006-0.023%). Most sites showed positive exposure-response relationships, but these were insignificant or became insignificant after adjustment for potential confounders such as arsenic or dust exposure. The present data provide some evidence of increased risk of extrapulmonary cancers associated with radon, but chance and confounding cannot be ruled out.