Radon and risk of extrapulmonary cancers: results of the German uranium miners' cohort study, 1960–2003

Data from the German miners' cohort study were analysed to investigate whether radon in ambient air causes cancers other than lung cancer. The cohort includes 58 987 men who were employed for at least 6 months from 1946 to 1989 at the former Wismut uranium mining company in Eastern Germany. A total of 20 684 deaths were observed in the follow-up period from 1960 to 2003. The death rates for 24 individual cancer sites were compared with the age and calendar year-specific national death rates. Internal Poisson regression was used to estimate the excess relative risk (ERR) per unit of cumulative exposure to radon in working level months (WLM). The number of deaths observed (O) for extrapulmonary cancers combined was close to that expected (E) from national rates (n=3340, O/E=1.02; 95% confidence interval (CI): 0.98–1.05). Statistically significant increases in mortality were recorded for cancers of the stomach (O/E=1.15; 95% CI: 1.06–1.25) and liver (O/E=1.26; 95% CI: 1.07–1.48), whereas significant decreases were found for cancers of the tongue, mouth, salivary gland and pharynx combined (O/E=0.80; 95% CI: 0.65–0.97) and those of the bladder (O/E=0.82; 95% CI: 0.70–0.95). A statistically significant relationship with cumulative radon exposure was observed for all extrapulmonary cancers (ERR/WLM=0.014%; 95% CI: 0.006–0.023%). Most sites showed positive exposure–response relationships, but these were insignificant or became insignificant after adjustment for potential confounders such as arsenic or dust exposure. The present data provide some evidence of increased risk of extrapulmonary cancers associated with radon, but chance and confounding cannot be ruled out

Analgesics use and ESRD in younger age: a case-control study

<p>Abstract</p> <p>Background</p> <p>An ad hoc peer-review committee was jointly appointed by Drug Authorities and Industry in Germany, Austria and Switzerland in 1999/2000 to review the evidence for a causal relation between phenacetin-free analgesics and nephropathy. The committee found the evidence as inconclusive and requested a new case-control study of adequate design.</p> <p>Methods</p> <p>We performed a population-based case-control study with incident cases of end-stage renal disease (ESRD) under the age of 50 years and four age and sex-matched neighborhood controls in 170 dialysis centers (153 in Germany, and 17 in Austria) from January 1, 2001 to December 31, 2004. Data on lifetime medical history, risk factors, treatment, job exposure and intake of analgesics were obtained in a standardized face-to-face interview using memory aids to enhance accuracy. Study design, study performance, analysis plan, and study report were approved by an independent international advisory committee and by the Drug Authorities involved. Unconditional logistic regression analyses were performed.</p> <p>Results</p> <p>The analysis included 907 cases and 3,622 controls who had never used phenacetin-containing analgesics in their lifetime. The use of high cumulative lifetime dose (3^rdtertile) of analgesics in the period up to five years before dialysis was not associated with later ESRD. Adjusted odds ratios with 95% confidence intervals were 0.8 (0.7 – 1.0) and 1.0 (0.8 – 1.3) for ever- compared with no or low use and high use compared with low use, respectively. The same results were found for all analgesics and for mono-, and combination preparations with and without caffeine. No increased risk was shown in analyses stratifying for dose and duration. Dose-response analyses showed that analgesic use was not associated with an increased risk for ESRD up to 3.5 kg cumulative lifetime dose (98 % of the cases with ESRD). While the large subgroup of users with a lifetime dose up to 0.5 kg (278 cases and 1365 controls) showed a significantly decreased risk, a tiny subgroup of extreme users with over 3.5 kg lifetime use (19 cases and 11 controls) showed a significant risk increase. The detailed evaluation of 22 cases and 19 controls with over 2.5 kg lifetime use recommended by the regulatory advisors showed an impressive excess of other conditions than analgesics triggering the evolution of ESRD in cases compared with controls.</p> <p>Conclusion</p> <p>We found no clinically meaningful evidence for an increased risk of ESRD associated with use of phenacetin-free analgesics in single or combined formulation. The apparent risk increase shown in a small subgroup with extreme lifetime dose of analgesics is most likely an indirect, non-causal association. This hypothesis, however, cannot be confirmed or refuted within our case-control study. Overall, our results lend support to the mounting evidence that phenacetin-free analgesics do not induce ESRD and that the notion of "analgesic nephropathy" needs to be re-evaluated.</p

Abschlussbericht zum Forschungsvorhaben ''Stichprobenerhebung und Auswertung von Personaldaten der Wismut'', fuer den Hauptverband der Gewerblichen Berufsgenossenschaften e.V

Aus den fuer Sachsen verfuegbaren Grunddaten von Beschaeftigten der Wismut, die unter Tage oder in der Erzaufbereitung gearbeitet haben, wurde eine Stichprobe von ca. 4% gezogen. Eine detaillierte Arbeitsanamnese wurde durch ZeBWis ermittelt. Auf der Basis dieser Arbeitsanamnesen von 2282 maennlichen Beschaeftigten wurde die Exposition gegenueber Radon und seinen Zerfallsprodukten bei den unter Tage und/oder in der Erzaufbereitung ehemaligen Beschaeftigten der Wismut in Sachsen unter Verwendung der 'Richter-Liste' geschaetzt. Die Fluktuation war vor allem in den Anfangsjahren sehr hoch mit 89% der Einstellungen und 60% der Entlassungen vor 1955. Die durchschnittliche Beschaeftigungsdauer lag bei 4 1/2 Jahren (Median 2 Jahre). Fast 2/3 der ehemaligen Beschaeftigten sind 1930 oder frueher geboren. Auf der Basis der Modelle von BEIR IV, JACOBI und LUBIN zum Lungenkrebsrisiko durch Radonfolgeprodukte wurde die Zahl der bereits in der Vergangenheit aufgetretenen und der in Zukunft zu erwartenden Lungenkrebsfaelle geschaetzt. Hierbei wurde die Altersstruktur, die altersspezifische Lungenkrebsinzidenz der Maenner in der DDR sowie die entsprechenden Sterbetafeln beruechsichtigt. Je nach Modellansatz fuehrt die Belastung der Bergleute durch Radon und seine Zerfallsprodukte zu einem Exzess von insgesamt ca. 7.000 - 25.000 Lungenkrebsfaellen. Bezogen auf das Jahr 1995 bedeutet dies eine Zahl von 356 Faellen ohne Beruecksichtigung der Exposition, sowie eine zusaetzliche Zahl von Erkrankungen, die je nach Modellannahme zwischen 134-530 liegt. (orig./HP)From the available basic data on persons employed by the Wismut company in Saxony who worked underground or in ore processing, a sample of some 4 per cent was taken. A detailed work analysis was made by the unit overseeing the Wismut company at the central union of trade associations (''ZeBWis''). On the basis of these work analyses of 2282 male employed persons, exposure to radon and its products of decay of the persons formerly employed by Wismut underground or in ore processing was estimated with the aid of the ''Richter'' list.- Especially during the first years, fluctuation was very high with 89 per cent of engagements and 60 per cent of dismissals before 1955. The average duration of employment was 4 1/2 years (median value 2 years). Almost two thirds of the then employed are born in 1930 or earlier.- On the basis of the models of BEIR IV, JACOBY and LUBIN on the risk of lung cancer due to radon decay products, the number of cases of lung cancer that have occurred in the past and the number of those that are to be expected in the future was estimated. For this purpose the age structure, the age-specific incidence of lung cancer in men in the German Democratic Republic, and the corresponding death tables were taken into account. Depending on the model employed, the miners' exposure to radon and its products of decay leads to an additional number of about 7000 to 25000 cases of lung cancer. With reference to the year 1995, this means a number of 356 cases without taking exposure into account, as well as an additional incidence of cancer ranging from 134 to 530 cases, depending on the model employed. (orig./HP)SIGLEAvailable from TIB Hannover: RO 2674(1995,17) / FIZ - Fachinformationszzentrum Karlsruhe / TIB - Technische InformationsbibliothekDEGerman

Development and climate change in Tanzania: focus on Mount Kilimanjaro

This report presents the integrated case study for Tanzania carried out under an OECD project on Development and Climate Change. The report is structured around a three-tiered framework. First, recent climate trends and climate change scenarios for Tanzania are assessed, and key sectoral impacts are identified and ranked along multiple indicators to establish priorities for adaptation. Second, donor portfolios in Tanzania are analyzed to examine the proportion of donor activities affected by climate risks. A desk analysis of donor strategies and project documents as well as national plans is conducted to assess the degree of attention to climate change concerns in development planning and assistance. Third, an indepth analysis is conducted for climate change impacts and response strategies for Mount Kilimanjaro – a critical ecosystem, biodiversity hotspot, and source of freshwater. This part of the analysis draws upon extended field research by a case study consultant in collaboration with national and international partners. Analysis of recent climate trends reveals that climate change poses significant risks for Tanzania. While projected changes in precipitation are uncertain, there is a high likelihood of temperature increases as well as sea level rise. Climate change scenarios across multiple general circulation models show increases in country averaged mean temperatures of 1.3°C and 2.2°C projected by 2050 and 2100, which are broadly consistent, though lower than, projections used in Tanzania’s Initial National Communication. The sectors potentially impacted by climate change include agriculture, forests, water resources, coastal resources, human health, as well as energy, industry and transport. While uncertainties in climate change and impact projections pose a challenge for anticipatory adaptation in any country, Tanzania’s case has several specific characteristics that might suggest the need for a differentiated adaptation strategy. First, the climate change projections which form the basis of national assessments rely on an older generation of climate models which project higher temperature increases than more recent models analyzed in the present study. Updating of climate scenarios and impact projections through the use of multiple and more recent models might therefore be advisable prior to the formulation of aggressive (and potentially expensive) adaptation responses. A second characteristic feature of Tanzania is that certain sectors such as agriculture and water resources are projected to experience both negative and positive impacts under climate change – for example, while production of maize is projected to decline, the production of two cash crops (coffee and cotton) is projected to increase. The implication for adaptation therefore may be to not only cushion adverse impacts, but also to harness positive opportunities. A third key characteristic is that unlike most other countries where the need for adaptation relies on projections of future impacts, some discernible trends in climate and attendant impacts are already underway in Tanzania. Such impacts – as is the case of the Kilimanjaro ecosystem - argue for more immediate adaptation responses as opposed to a “wait and see” strategy. Tanzania receives close to a billion US dollars of Official Development Assistance (ODA) annually. Analysis of donor portfolios in Tanzania using the OECD-World Bank Creditor Reporting System (CRS) database reveals that between 12-25% of development assistance (by aid amount) or 20-30% of donor projects (by number) are in sectors potentially affected by climate risks. However, these numbers are only indicative at best, given that any classification based on sectors suffers from oversimplification the reader is referred to the main report for a more nuanced interpretation. Donor and government documents generally do not mention climate change explicitly, although frequent references are made to the impacts of climate variability and their linkages to economic performance. There is COM/ENV/EPOC/DCD/DAC(2003)5/FINAL 7 however considerable synergy between priorities of at least some national plans and measures that might be required for climate change adaptation, such as water conservation, improving agricultural resilience, and forest conservation. However, some of these goals (such as water conservation) had been articulated, though not successfully implemented in previous plans. Therefore, a key obstacle facing “mainstreaming” is not synergies at the level of planning documents, but rather the successful implementation of such plans. The in-depth sector analysis focuses on the climate change impacts and policy responses on the Mount Kilimanjaro ecosystem. Glaciers on Mount Kilimanjaro have been in a general state of retreat on account of natural causes for over a hundred and fifty years. Due to a decline in precipitation coupled with a local warming trend that has been recorded in the second half of the twentieth century Kilimanjaro’s ice cap is now projected to vanish entirely by as early as 2020. The symbolism of this loss is indeed significant, and furthermore the loss of the ice cap would also imply that valuable records of past climates contained in its ice cores would also be irreplaceably destroyed. From a physical and socio economic perspective however, this analysis concludes that the impact of the loss of the ice cap is likely to be very limited. Much more significant is the enhancement in the intensity and risk of forest fires on Mount Kilimanjaro as a consequence of the increase in temperatures and a concomitant decline in precipitation over the past several decades. Forest fires have resulted in the replacement of the fog intercepting subalpine forest belt by low lying shrub which has already seriously impacted the hydrological balance of the mountain as fog intercepting cloud forests play a key role in the water budgets of high altitude drainage basins. A continuation of current trends in climatic changes, fire frequency, and human influence could result in the loss of most of the remaining subalpine Erica forests in a matter of years. With this, Mount Kilimanjaro will have lost its most effective water catchment. Among the more immediate adaptation responses identified by this report are institutional measures such as the inclusion of the forest belt into the Kilimanjaro National Park and the creation of a paramilitary ranger group to deter logging, as well as better investments in early warning systems, particularly the purchase of one or two aircraft for aerial surveillance. There is also a need to limit cross-border migration of big game from neighbouring Amboseli, which is adding to the stress on the Kilimanjaro ecosystem. In addition to short term solutions there is acritical need to develop a comprehensive and holistic development plan focusing on fire-risk and forest destruction, livelihood needs of the local population as well as on conservation strategies to ensure the long term sustainability of the valuable resources of the Kilimanjaro ecosystem.This document is an output from the OECD Development and Climate Change project, an activity being jointly overseen by the Working Party on Global and Structural Policies (WPGSP) of the Environment Directorate, and the Network on Environment and Development Co-operation of the Development Cooperation Directorate (DAC-Environet)