Residential radon exposure and lung cancer risk: commentary on Cohen's county-based study.

The large United States county-based study () in which an inverse relationship has been suggested between residential low-dose radon levels and lung cancer mortality has been reviewed. While this study has been used to evaluate the validity of the linear nonthreshold theory, the grouped nature of its data limits the usefulness of this application. Our assessment of the study's approach, including a reanalysis of its data, also indicates that the likelihood of strong, undetected confounding effects by cigarette smoking, coupled with approximations of data values and uncertainties in accuracy of data sources regarding levels of radon exposure and intensity of smoking, compromises the study's analytic power. The most clear data for estimating lung cancer risk from low levels of radon exposure continue to rest with higher-dose studies of miner populations in which projections to zero dose are consistent with estimates arising from most case-control studies regarding residential exposure.

[1]  E. G. Letourneau,et al.  A Combined Analysis of North American Case-Control Studies of Residential Radon and Lung Cancer , 2006, Journal of toxicology and environmental health. Part A.

[2]  B. Cohen.  The Puskin observation on smoking as a confounder in ecologic correlations of cancer mortality rates with average county radon levels. , 2004, Health Physics.

[3]  W. R. Pelt.  Epidemiological associations among lung cancer, radon exposure and elevation above sea level--a reassessment of Cohen's county level radon study. , 2003 .

[4]  S. Darby,et al.  Health effects of residential radon: a European perspective at the end of 2002. , 2003, Radiation protection dosimetry.

[5]  J. Puskin.  SMOKING AS A CONFOUNDER IN ECOLOGIC CORRELATIONS OF CANCER MORTALITY RATES WITH AVERAGE COUNTY RADON LEVELS , 2003, Health physics.

[6]  J. Lubin.  The potential for bias in Cohen's ecological analysis of lung cancer and residential radon. , 2002, Journal of radiological protection : official journal of the Society for Radiological Protection.

[7]  S. Greenland.  Ecologic versus individual-level sources of bias in ecologic estimates of contextual health effects. , 2001, International journal of epidemiology.

[8]  R. Doll,et al.  Radon: a likely carcinogen at all exposures. , 2001, Annals of oncology : official journal of the European Society for Medical Oncology.

[9]  B. Cohen.  TESTING A BEIR-VI SUGGESTION FOR EXPLAINING THE LUNG CANCER vs. RADON RELATIONSHIP FOR U.S. COUNTIES , 2000, Health physics.

[10]  G. Pershagen,et al.  Parallel analyses of individual and ecologic data on residential radon, cofactors, and lung cancer in Sweden. , 1999, American journal of epidemiology.

[11]  Brian J. Smith,et al.  Residential 222Rn Exposure and Lung Cancer: Testing the Linear No‐Threshold Theory with Ecologic Data , 1998, Health physics.

[12]  B. Cohen.  Response to criticisms of Smith et al. , 1998, Health physics.

[13]  B. Cohen.  Response to Lubin's Proposed Explanations of Our Discrepancy , 1998, Health physics.

[14]  Brian J. Smith,et al.  Ecologic Bias revisited, A rejoinder to Cohen's response to “Residential 222Rn exposure and Lung Cancer: Testing the Linear no‐Threshold theory with Ecologic Data” , 1998 .

[15]  J H Lubin,et al.  On the Discrepancy Between Epidemiologic Studies in Individuals of Lung Cancer and Residential Radon and Cohen's Ecologic Regression , 1998, Health physics.

[16]  Jay H. Lubin,et al.  Rejoinder: Cohen's Response to “On the Discrepancy between Epidemiologic studies in individuals of Lung Cancer and Residential Radon and Cohen's Ecologic Regression” , 1998 .

[17]  J. Neuberger,et al.  Lung cancer risk from residential radon: meta-analysis of eight epidemiologic studies. , 1997, Journal of the National Cancer Institute.

[18]  B. Cohen,et al.  Test of the linear-no threshold theory of radiation carcinogenesis for inhaled radon decay products. , 1995, Health physics.

[19]  Gilbert Es.  Smoking as an explanation for the negative relationship between exposure to radon and certain types of cancer. , 1994 .

[20]  J. Robins,et al.  Invited commentary: ecologic studies--biases, misconceptions, and counterexamples. , 1994, American journal of epidemiology.

[21]  S. Piantadosi.  Invited commentary: ecologic biases. , 1994, American journal of epidemiology.

[22]  B. Cohen,et al.  Invited commentary: in defense of ecologic studies for testing a linear-no threshold theory. , 1994, American journal of epidemiology.

[23]  J. Robins,et al.  Accepting the Limits of Ecologic Studies: Drs. Greenland and Robins Reply to Drs. Piantadosi and Cohen , 1994 .

[24]  B. Cohen.  Relationship between exposure to radon and various types of cancer. , 1993, Health physics.

[25]  J M Samet,et al.  A review of ecologic studies of lung cancer and indoor radon. , 1993, Health physics.

[26]  B. Cohen.  Variation of radon levels in U.S. homes correlated with house characteristics, location, and socioeconomic factors. , 1991, Health physics.

[27]  A. Marcus,et al.  Prevalence of cigarette smoking in the United States: estimates from the 1985 current population survey. , 1989, Journal of the National Cancer Institute.

[28]  Richard Doll,et al.  A parallel analysis of individual and ecological data on residential radon and lung cancer in south‐west England , 2001 .

[29]  R. Field,et al.  A Review of Residential Radon Case-Control Epidemiologic Studies Performed in the United States , 2001, Reviews on environmental health.

[30]  G. Colditz,et al.  Tests of the linear-no threshold theory for lung cancer induced by exposure to radon. , 1994, Environmental research.