Radon Gas, Bronchogenic Carcinoma - Ontario Experience

HISTORICAL REVIEW OF BOARD OPERATIONS The Ontario Worker's Compensation Board was established in law enacted by the legislature of the Province of Ontario in 1915. It was designed to pay insurance benefits to injured workers, and at the same time to protect employers from legal suit. It was based upon an enquiry system rather than an adversary system such as that used in the courts process. Initially, the system was designed to pay compensation benefits and subsequently, to pay for the cost of medical treatment and pensions for disability and disease resultant from the effects of traumatic injury. In 1947, the Act was changed to include industrial or occupational generated diseases, not specifically related to traumatology. Such occupational diseases were therefore accepted and benefits paid subsequent to that date. As will be discussed in several minutes, even today the vast preponderance of compensation claims with the Ontario Board continues to be related to the effects of trauma. HISTORICAL REVIEW OF EXPOSURE TO RADON GAS DECAY PRODUCTS In some areas of Ontario, especially in Northern Ontario, there is a natural leaching of radon gas from the underlying rock formation. This constitutes very low levels of radon gas decay product radiation exposure to those persons coming in contact and inhaling these substances. This paper however is designed to discuss the occupational generated types of radon gas exposures. For many years dating back to the 1930's, partially refined ores were being shipped from Northern Canada to a refinery located at Port Hope, Ontario, still in operation and currently operated by Eldorado Nuclear Limited of Canada. Initially, the purpose for the operation was extraction of radium to be sold on world markets for medical treatment purposes. With the advent of World War II, this market collapsed. Subsequent to World War II, the availability of other sources of radiation for medical radio-therapy generally replaced the requirements for radium. During World War II, a new market opened up for the Port Hope refinery however as work into nuclear chain reactions and the development of the atomic bomb identified the need for uranium and enriched uranium. During the period of operations where radium was being extracted at the Port Hope refinery, it is now known that an identifiable radon gas hazard did exist. This hazard disappeared when the production line for extraction of radium ceased operations. In 1954, uranium mining operations opened up in Ontario at two locations, Bancroft and Elliot Lake. At the peak of operations, 16 mines were operational and 11,000 workers were employed in these mining operations. A high level of mining activity continued over a 10 year interval with the Bancroft Mines closing permanently in 1964 following a 10 year life of operation. The other mines in Elliot Lake closed about the same time with the exception of two uranium mine operations which have continued to be operational up to the present time. By 1965, due to a dramatic drop in world demand for uranium, the total work force had fallen to 1/10 of the peak work force, and approximately 1,300 workers remained in employment. It is of interest to note that one significant difference in the work environment between Elliot Lake and Bancroft was the high silica content of the Elliot Lake ore. This gave rise to a number of cases of silicosis developing in relatively short intervals of time in the Elliot Lake miner population. No cases of silicosis were identified from the Bancroft operations. Based upon the experience in investigating and evaluating actual cases of lung cancer in the uranium miners over the years, the medical staff at the Ontario Board also developed the impression that radiation levels were much higher in the Bancroft operations, especially in the earlier years of operation, than at Elliot Lake. This resulted in accumulation of higher levels of Working Level Months (WLM), usually over a shorter exposure interval in many of the cases. This aspect will be further evaluated in this presentation. Subsequent to 1965, the work force remained quite static in numbers until 1975. At that time, there began to develop an increase in the work force, and this increase is continuing at a moderate rate up to the present. INITIAL METHOD OF HANDLING LUNG CANCER CLAIMS The first lung cancer claims in Ontario from uranium mining operations were accepted on the perceived cause-effect relationship. This relationship was based upon the data from the Colorado observations and the Czechoslovakia data. Initially, a series of regression equations on mortality were developed and used to estimate the effect of exposure to low cumulative doses of radon daughters as it might relate to the frequency of occurrence of lung cancer at any particular cumulative exposure level. A probability of cancer being radiation induced as against it being caused from other factors was calculated. This method was discontinued subsequent to 1972 due to problems encountered in carrying out this complex evaluation. Thereafter, each case was dealt with on an individual basis, being based upon whether or not the tumour was of the oat cell type, a cumulative exposure in excess of 120 WLM; latency periods in excess of 10 years, commencement of mining prior to