Failures And Critique Of The BEIR-III Lung Cancer Risk Estimates*

I.INTRODUCTION The B E I R-III Report (NAS-1980) introduces large increases in the estimated health effects of radon as compared with previous work (NAS-1972). It is the purpose of this paper to point out some important failures of these new BEIR-III estimates, to offer a general critique of the procedures used in obtaining them, and to offer more rational estimates. In Sec. II we use the BEIR-III model to calculate the risk to non-smokers from environmental radon, and show that it predicts more than twice the total lung cancer rate actually experienced by nonsmokers. In Sec. III we review the histological evidence which shows that no more than about 10% of the lung cancers among non-smokers can be due to radiation. In Sec. IV, we discuss alternative causes of lung cancer, which further reduces the fraction that can be caused by radiation, and in Sec. V we summarize and conclude that the BEIR-III model over-estimates the lung cancer rate in nonsmokers due to environmental radon by at least a factor of 40. In Sec. VT we review the evidence on risk of radon exposure to smokers, and conclude that it is probably not more than four times the risk to non-smokers; this means that the BEIR-III model over-estimates the risk of low level radon exposure to smokers by at least a factor of 10. In Sec. VII, we consider the reasons for the large over-estimates in the BEIR-III. Report. II. BEIR-III LUNG CANCER RATES DUE TO ENVIRONMENTAL RADON AND COMPARISON WITH TOTAL LUNG CANCER RATES AMONG NON-SMOKERS The BEIR-III Report gives the following estimates of the lung cancer risk from low-level radon exposure in terms of working-level-months (WLM): age 35-49, risk = 10 x 10-6 /yr-WLM 50-64, 20 >65, 50 where ages refer to age at death. For latent periods between exposure and onset of these risks it gives age 0-14, latent period = 25 years 15-34, 15-20 years (we use 17 yr) >35, 10 years where ages refer to age at exposure. This is a clear and unambiguous model which is readily usable for deriving numerical estimates. We begin by using it to calculate lung cancer rates due to environmental radon. *This is an abridged version of a paper scheduled to appear shortly in Health Physics. The first step in this process is to estimate the environmental exposures; this was done in a recent paper (Cohen-1981) which concluded that these are about 0.22 WLM/year. In Table 1, this is used to calculate the BEIR-111 predictions for radoninduced lung cancer rates in the U.S. (Col. (5)), and by combining these with population statistics, it is shown (Col.(7)), that it predicts about 24,500 fatalities per year, almost one-third of all U.S. lung cancers. The comparison between the age-specific expected rates from Col. (5) of Table 1 and observed rates among non-smokers is shown in Table 2. The recent paper by Garfinkel (1980) presents the results of a 12 year follow-up on one million Americans in a study by the American Cancer Society. The paper by Hammond (1966) gave the results of the first four years of that study. The paper by Kahn (1966) is based on the so-called "Dorn Study" of 293,000 U.S. veterans of World War II who carry government health insurance. It represents 8 and 1/2 years of follow-up. A recent update on that study (Rogot-1980) does not give absolute lung cancer rates, but the age-standardized ratio between smokers and non-smokers has remained the same which indicates that there has probably not been an important change in the rates for either. The paper by Hammond and Horn (Ha-1958) was an early study by American Cancer Society. It is immediately evident from Table 2 that the BEIR-III estimates for lung cancer induced by environmental radon exceed the [total] lung cancer rates due to [all] causes among non-smokers by about a factor of two at every age. It is only fair to point out that this does not represent a direct discrepancy with the BEIR-III Report since the latter states that its estimates for non-smokers may be too high by a factor ranging from 1 to 6, favoring a factor intermediate between these. Comparisons can also be made with total lung cancer incidence for all ages. A paper by Hammond and Seidman (Hammond-1980) gives the rate for ages above 40 to be 177 x 10-6/year for men and 124 x 10-6/year for women, whereas the rate calculated in Table 1 from BEIR-III for ages above 40 is 309 x 10-6, a factor of two higher. For all ages, the rate among women was reported as 36 x 10-6/year (Hammond 1958) as compared with 114 x 10-6/year calculated from BEIR-III in Table 1, a discrepancy of well over a factor of two. All of the data we have presented are basically from three study groups, but in all three cases the BEIR-III estimates for lung cancer induced [by environmental radon alone] are a factor of two higher than actual [tota] lung cancer rates among non-smokers. Another approach to comparing the BEIR-III pre-