Age Factor In Histological Type Of Lung Cancer Among Uranium Miners, A Preliminary Report

INTRODUCTION Excess bronchogenic carcinoma has been demonstrated among underground uranium miners in the United States, Czechoslovakia, and Canada (Archer 1981). This excess cancer is attributed largely to radiation from the alpha particles delivered to the tracheobronchial epithelium by the decay of short-lived daughters of radon. Interaction between the radiation and cigarette smoking has been demonstrated in production of the excess cancer (Archer 1973). The distribution of histologic types of bronchogenic cancer among uranium miners was established as different from that in other men in 1964 when an analysis of the first 51 cases among United States uranium miners was published (Saccomanno 1964). It was confirmed five years later by Yugoslavian studies (Horacek 1969). A later analysis, using a relative frequency method, indicated that oat cell and other small cell undifferentiated carcinomas increased markedly with increasing exposure to radiation in uranium mines (Saccomanno 1971). A subsequent analysis used only cases from an epidemiological study so as to enable calculation of expected numbers. It showed that there was an elevation in incidence of epidermoid, adenocarcinomas, and possibly other types, as well as small cell undifferentiated carcinomas (Archer 1974). At that time, it was felt that the histological distribution of cancer among uranium miners was well established. However, one of the authors (GS) has noted that fewer oat cell carcinomas were appearing among uranium miners in recent years. In his material the fraction of oat cell carcinoma, in successive 5 year periods between 1960 and 1980 was 59, 46, 37, and 22 percent. The association with calendar years is almost certainly spurious, reflecting some other factor associated with time. From the standpoint of tumor biology such a change must be important. This is a preliminary report which attempts to determine the cause of that change. POSSIBLE REASONS FOR OBSERVED CHANGE IN CELL TYPES 1) It might reflect a decrease in radiationinduced carcinomas, so that most of the ones being seen now are cigarette-induced. This appears to be a possibility because radiation levels in mines had been markedly reduced in the early 1970s, and because most of the uranium miners now developing carcinoma had quit mining during the 1965-1975 period. 2) It might represent a change in interpretation by the pathologists involved. 3) It might represent a real change in distribution as a result of increased latency, an aging population, cessation of smoking, increasing pack years of cigarettes, or other factors which have changed with time. Each of these possibilities is being checked. Dr. Waxweiler, later in this conference, is presenting an updated mortality analysis of United States underground uranium miners. His data indicate that lung cancer incidence among the Study Group of uranium miners is still quite high, but the ratio of observed to expected is falling somewhat. It is apparent that decreasing exposures in uranium mines is not yet reflected in normal lung cancer mortality rates. Reason #1 is therefore very unlikely. Thirty-five percent of the histologic types of carcinomas in this study were classified by a panel of three pathologists, 45% were classified by one of the panel members, and 20% were classified by a number of