Lung Cancer in a Nonsmoking Underground Uranium Miner
Mulloy, Karen B., James, David S., Mohs, Kim, Kornfeld, Mario, Environmental Health Perspectives
Working in mines is associated with acute and chronic occupational disorders. Most of the uranium mining in the United States took place in the Four Corners region of the Southwest (Arizona, Colorado, New Mexico, and Utah) and on Native American lands. Although the uranium industry collapsed in the late 1980s, the industry employed several thousand individuals who continue to be at increased risk for developing lung cancers. We present the case of a 72-year-old Navajo male who worked for 17 years as an underground uranium miner and who developed lung cancer 22 years after leaving the industry. His total occupational exposure to radon progeny was estimated at 506 working level months. The miner was a life-long nonsmoker and had no other significant occupational or environmental exposures. On the chest X-ray taken at admission into the hospital, a right lower lung zone infiltrate was detected. The patient was treated for community-acquired pneumonia and developed respiratory failure requiring mechanical ventilation. Respiratory failure worsened and the patient died 19 days after presenting. On autopsy, a 2.5 cm squamous cell carcinoma of the right lung arising from the lower lobe bronchus, a right broncho-esophageal fistula, and a right lower lung abscess were found. Malignant respiratory disease in uranium miners may be from several occupational exposures; for example, radon decay products, silica, and possibly diesel exhaust are respiratory carcinogens that were commonly encountered. In response to a growing number of affected uranium miners, the Radiation Exposure Compensation Act (RECA) was passed by the U.S. Congress in 1990 to make partial restitution to individuals harmed by radiation exposure resulting from underground uranium mining and above-ground nuclear tests in Nevada. Key words: mining, lung cancer, occupational lung disease, radon. Environ Health Perspect 109:305-309 (2001). [Online 5 March 2001]
A 72-year-old Navajo male with a 2-3 month history of increased cough, shortness of breath, decreased appetite, and an 18-pound weight loss was admitted to a rural Indian Health Service hospital. His diagnosis at the time of admission was right lower-lobe pneumonia (Figure 1). After 10 days of broad-spectrum antibiotics and with progressing infiltrates, a computed tomography scan of the chest revealed a right lung abscess, a tracheo-esophageal fistula, and a right pleural effusion. Worsening respiratory distress (Figure 2) required intubation and ventilatory support, and the patient was transferred to the University Hospital, Albuquerque, New Mexico.
Because the patient spoke only Navajo, his history was obtained through translation from his son. The patient's past medical history included hypertension, degenerative joint disease, hypercholesterolemia, history of a positive PPD (purified protein derivative; tuberculin) skin test, no surgical history, and no drug allergies. His only current medication was lisinopril. He had been treated with isoniazid in 1972 for an unknown length of time, and retreated in 1974 and in 1986 due to the uncertain duration of isoniazid therapy. The patient was a lifelong nonsmoker, he did not use other tobacco products, and he had no history of alcohol abuse. His family history was noncontributory.
The patient lived alone in housing without running water or electricity in an isolated area of the Navajo Reservation in Arizona. His son reported that the patient had started to experience significant emesis after eating approximately 6 months before his hospitalization. He had lost 30-40 pounds from the time these symptoms began. The patient at first remained active and often herded sheep in the hills near his home. His family thought his weight loss was due to his lack of nutritious food when he was herding. The patient had been a uranium miner for 17 years from 1950 to 1968. …