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High domestic and occupational radon exposures: a comparison
Letters to the Editor
High domestic and occupational radon exposures: a comparison SiR-Tomasek and colleagues (April 10, p 919) report on cumulative radon exposure and lifetime risk for twenty-eight sites and types of cancer among uranium miners in West Bohemia. There was no evidence in these miners that a radon-rich atmosphere increased the risk of any cancer other than lung cancer. Possible exceptions were cancer of the gallbladder, extrahepatic bileducts, and multiple myeloma. A radon-related excess of lung cancer is well established. The applicability of such data derived from uranium miners to the general population is central to the radon issue. The unusually high indoor radon levels measured in Umhausen1,2 (2600 inhabitants, Western Tyrol, Austria) led to lifetime radon exposures of the same order of magnitude as those reported for the uranium miners in West Bohemia. We have compared the cancer mortalities of the two populations. We used measurements of the seasonal course of indoor radon concentrations (296 houses, 51 % of total housing stock) to calculate the mean annual radon concentrations (ca) on the first floor of the houses: TotalI Median ca
(Bq/m’)
Lung cancer death exp*/obs
Area A
861
1868
182
13/50
66/41
63/9
The radon concentrations are not distributed evenly over the village but show a clustering of very high radon concentrations in an area situated between two rivers (area A, median Ca = 1868 Bq /M3) . Geologically, this area is an alluvial fan of a giant rock slide of granitic gneisses. The radon concentration in the rest of Umhausen is lower by a factor of 10 (area B, median ca = 182 Bqjm3). Areas A and B have roughly equal numbers of inhabitants. The lifetime radon exposure were calculated according to BEIR IV.3 The median lifetime radon exposure is 242 working-level-months (WLM) in area A, 23 WLM in area B, and 111 WLM in the total area of Umhausen: WLM* 95% CI Obs/exp* (110-149) (210-325) 23 (<110)
111 242
3 85 (3 66) 6 17 (623) 143(307)
The measurements
2 9-5 1 44-84 4 07-2 7
*Data shown as WLM and as observed/expected ratio of lung cancer deaths in Umhausen 1970-91 as age-and-sex standardised ratio (with data for uranium miners in italic type, 95% CI not available).
The high lifetime exposure in area A coincides with a clustering of observed lung cancer deaths. The lifetime radon exposure of 242 WLM in area A is comparable to the category 210-329 WLM for uranium miners in West Bohemia. Equally high domestic lifetime radon exposures are rarely found. They permit a comparison between the ratio of observed to expected deaths from lung cancer in Umhausen and among uranium miners in West Bohemia (area A 6-17, uranium miners 6-23). The agreement between the figures is surprisingly high. The lifetime exposure in area B is only moderately increased at 23 WLM and is comparable with the category less than 110 WLM for uranium miners. Smoking habits and alcohol consumption were not considered in either study. Can data on radon exposure and cancer risks in uranium
were
financially supported by the Tyrolean
Government.
O Ennemoser, W Ambach Institute of Medical Physics, University of Innsbruck, A-6020 Innsbruck, Austria
P
Brunner, P Schneider
Department of Radiation Protection and Nuclear Technology, Innsbruck
W Oberaigner Cancer Registry of Tyrol, Innsbruck
1
Ennemoser O, Ambach W, Brunner P, Schneider P, Oberaigner W. Exposure to unusually high indoor radon levels. Lancet 1993; 341:
2
Hoppichler F. Indoor radon and lung cancer.
3
1405-06. BEIR IV
Area B
*From total population of Tyrol. Exp/obs expected/observed.
Total area Area A AreaB
miners be applied to the general population? The inhabitants of area A of Umhausen have about the same lifetime radon exposures as one category of uranium miners in West Bohemia; given about equal levels of lifetime exposure, the ratio of observed to expected lung cancer deaths is about the same; and mortality from cancers other than lung cancer is not significantly raised. We conclude that the cancer risks per unit dose to the population in Umhausen and the uranium miners in West Bohemia do not differ considerably.
828-29. Lancet 1992; 339:
Report. Health risks of radon and other internally deposited alpha-emitters. Washington, DC: National Academy Press, 1988.
Hypoglycaemia by inhalation SiR-Drug poisoning can happen in unexpected ways. A 33-year-old man was brought to the emergency room in coma. He had previously been well, except for chronic otitis media. The day before admission he developed an unsteady gait with slight alterations in mood and behaviour. He was taken to another hospital where a diagnosis of vertigo due to otitis media was made, and he was discharged on oral antibiotics. The next morning the patient could not be roused. In the emergency room he appeared deeply comatose: his eyes were closed and he did
not react to
noxious stimuli. Plantar cutaneous reflexes
abnormal, pupils were equal and reacted slowly to light. Temperature was normal, blood pressure was 120/80 mm Hg, heart rate 100 beats per min, and respiratory rate 10 per min. Blood glucose, measured as part of a routine, was 13 mmol/L. 50 mL of glucose 33% was given, with slight improvement in were
neurological picture. There was no personal or family history of diabetes and the relatives denied any access to hypoglycaemic drugs. The patient had never had psychiatric problems or previous admissions for the same symptoms, making the diagnosis of Munchausen’s syndrome unlikely. The patient recovered but needed further glucose infusions for recurring hypoglycaemia and remained somewhat confused for the
the
48 h. An
electroencephalogram showed subcortical alterations. Computed tomography (CT) of the non-specific head was normal. Plasma insulin levels were normal. Pancreatic echography and CT scan were also normal. Further information about the patient was sought. He worked at a pharmaceutical firm processing chlorthalidone and nifednext
47
High domestic and occupational radon exposures: a comparison SiR-Tomasek and colleagues (April 10, p 919) report on cumulative radon exposure and lifetime risk for twenty-eight sites and types of cancer among uranium miners in West Bohemia. There was no evidence in these miners that a radon-rich atmosphere increased the risk of any cancer other than lung cancer. Possible exceptions were cancer of the gallbladder, extrahepatic bileducts, and multiple myeloma. A radon-related excess of lung cancer is well established. The applicability of such data derived from uranium miners to the general population is central to the radon issue. The unusually high indoor radon levels measured in Umhausen1,2 (2600 inhabitants, Western Tyrol, Austria) led to lifetime radon exposures of the same order of magnitude as those reported for the uranium miners in West Bohemia. We have compared the cancer mortalities of the two populations. We used measurements of the seasonal course of indoor radon concentrations (296 houses, 51 % of total housing stock) to calculate the mean annual radon concentrations (ca) on the first floor of the houses: TotalI Median ca
(Bq/m’)
Lung cancer death exp*/obs
Area A
861
1868
182
13/50
66/41
63/9
The radon concentrations are not distributed evenly over the village but show a clustering of very high radon concentrations in an area situated between two rivers (area A, median Ca = 1868 Bq /M3) . Geologically, this area is an alluvial fan of a giant rock slide of granitic gneisses. The radon concentration in the rest of Umhausen is lower by a factor of 10 (area B, median ca = 182 Bqjm3). Areas A and B have roughly equal numbers of inhabitants. The lifetime radon exposure were calculated according to BEIR IV.3 The median lifetime radon exposure is 242 working-level-months (WLM) in area A, 23 WLM in area B, and 111 WLM in the total area of Umhausen: WLM* 95% CI Obs/exp* (110-149) (210-325) 23 (<110)
111 242
3 85 (3 66) 6 17 (623) 143(307)
The measurements
2 9-5 1 44-84 4 07-2 7
*Data shown as WLM and as observed/expected ratio of lung cancer deaths in Umhausen 1970-91 as age-and-sex standardised ratio (with data for uranium miners in italic type, 95% CI not available).
The high lifetime exposure in area A coincides with a clustering of observed lung cancer deaths. The lifetime radon exposure of 242 WLM in area A is comparable to the category 210-329 WLM for uranium miners in West Bohemia. Equally high domestic lifetime radon exposures are rarely found. They permit a comparison between the ratio of observed to expected deaths from lung cancer in Umhausen and among uranium miners in West Bohemia (area A 6-17, uranium miners 6-23). The agreement between the figures is surprisingly high. The lifetime exposure in area B is only moderately increased at 23 WLM and is comparable with the category less than 110 WLM for uranium miners. Smoking habits and alcohol consumption were not considered in either study. Can data on radon exposure and cancer risks in uranium
were
financially supported by the Tyrolean
Government.
O Ennemoser, W Ambach Institute of Medical Physics, University of Innsbruck, A-6020 Innsbruck, Austria
P
Brunner, P Schneider
Department of Radiation Protection and Nuclear Technology, Innsbruck
W Oberaigner Cancer Registry of Tyrol, Innsbruck
1
Ennemoser O, Ambach W, Brunner P, Schneider P, Oberaigner W. Exposure to unusually high indoor radon levels. Lancet 1993; 341:
2
Hoppichler F. Indoor radon and lung cancer.
3
1405-06. BEIR IV
Area B
*From total population of Tyrol. Exp/obs expected/observed.
Total area Area A AreaB
miners be applied to the general population? The inhabitants of area A of Umhausen have about the same lifetime radon exposures as one category of uranium miners in West Bohemia; given about equal levels of lifetime exposure, the ratio of observed to expected lung cancer deaths is about the same; and mortality from cancers other than lung cancer is not significantly raised. We conclude that the cancer risks per unit dose to the population in Umhausen and the uranium miners in West Bohemia do not differ considerably.
828-29. Lancet 1992; 339:
Report. Health risks of radon and other internally deposited alpha-emitters. Washington, DC: National Academy Press, 1988.
Hypoglycaemia by inhalation SiR-Drug poisoning can happen in unexpected ways. A 33-year-old man was brought to the emergency room in coma. He had previously been well, except for chronic otitis media. The day before admission he developed an unsteady gait with slight alterations in mood and behaviour. He was taken to another hospital where a diagnosis of vertigo due to otitis media was made, and he was discharged on oral antibiotics. The next morning the patient could not be roused. In the emergency room he appeared deeply comatose: his eyes were closed and he did
not react to
noxious stimuli. Plantar cutaneous reflexes
abnormal, pupils were equal and reacted slowly to light. Temperature was normal, blood pressure was 120/80 mm Hg, heart rate 100 beats per min, and respiratory rate 10 per min. Blood glucose, measured as part of a routine, was 13 mmol/L. 50 mL of glucose 33% was given, with slight improvement in were
neurological picture. There was no personal or family history of diabetes and the relatives denied any access to hypoglycaemic drugs. The patient had never had psychiatric problems or previous admissions for the same symptoms, making the diagnosis of Munchausen’s syndrome unlikely. The patient recovered but needed further glucose infusions for recurring hypoglycaemia and remained somewhat confused for the
the
48 h. An
electroencephalogram showed subcortical alterations. Computed tomography (CT) of the non-specific head was normal. Plasma insulin levels were normal. Pancreatic echography and CT scan were also normal. Further information about the patient was sought. He worked at a pharmaceutical firm processing chlorthalidone and nifednext
47