OBJECTIVES: Radon is a ubiquitous occupational and environmental lung carcinogen. We aim to quantify the association between radon progeny and lung cancer mortality in the largest and most up-to-date pooled study of uranium miners. METHODS: The pooled uranium miners analysis combines 7 cohorts of male uranium miners with 7754 lung cancer deaths and 4.3 million person-years of follow-up. Vital status and lung cancer deaths were ascertained between 1946 and 2014. The association between cumulative radon exposure in working level months (WLM) and lung cancer was modelled as the excess relative rate (ERR) per 100 WLM using Poisson regression; variation in the association by temporal and exposure factors was examined. We also examined analyses restricted to miners first hired before 1960 and with <100 WLM cumulative exposure. RESULTS: In a model that allows for variation by attained age, time since exposure and annual exposure rate, the ERR/100 WLM was 4.68 (95% CI 2.88 to 6.96) among miners who were less than 55 years of age and were exposed in the prior 5 to <15 years at annual exposure rates of <0.5 WL. This association decreased with older attained age, longer time since exposure and higher annual exposure rate. In analyses restricted to men first hired before 1960, we observed similar patterns of association but a slightly lower estimate of the ERR/100 WLM. CONCLUSIONS: This new large, pooled study confirms and supports a linear exposure-response relationship between cumulative radon exposure and lung cancer mortality which is jointly modified by temporal and exposure factors.

Colorado School of Public Health Aurora Colorado USA

Dalla Lana School of Public Health University of Toronto Toronto Ontario Canada

Department of Environmental and Occupational Health University of California Irvine Program in Public Health Irvine California USA

Division of Field Studies and Engineering National Institute for Occupational Safety and Health Cincinnati Ohio USA

Epidemiology and Biostatistics University of California San Francisco California USA

Evidence Synthesis and Classification Branch International Agency for Research on Cancer Lyon France

Federal Office for Radiation Protection Germany

Institute for Radiological Protection and Nuclear Safety Fontenay aux Roses France

National Radiation Protection Institute Prague Czech Republic

New Mexico Tumor Registry Albuquerque Mexico USA

Occupational Cancer Research Centre Ontario Health Toronto Ontario Canada

University of New Mexico Albuquerque New Mexico USA

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