The epidemiological study on the residents of the high background radiation areas in Yangjiang, China was started by Chinese scientists in 1972 and continued until 1986. In 1991, Japanese scientists recognized the importance of the work and a joint feasibility study was conducted with revised protocols. The feasibility study matured to a cooperative project involving both Chinese and Japanese scientists in 1992, which currently is still in progress. The project was divided into three phases; the first being from 1992 to 1995, the second from 1995-1998 and the third from 1998 to 2001. The results of the first phase were reported previously in 1996. The present paper is a historical overview of the studies before the cooperation and the first two phases. Remarks are made on the detailed data on dosimetry, cytogenetic studies and cancer epidemiology of a series of the papers in this supplemental issue. Some problems such as paradoxical observations between cytogenetic results and cancer mortality, and the importance of the high background study in risk assessment are discussed.

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As a part of the China-Japan cooperative research on natural radiation epidemiology, we have carried out a dose-assessment study to evaluate the external exposure to natural radiation in the high background radiation areas (HBRA) of Yangjiang in Guangdong province and in the control areas (CA) of Enping prefecture since 1991. Because of the difficulties in measuring the individual doses of all inhabitants directly by personal dosimeters, an indirect method was applied in which the exposed individual doses were estimated from the environmental radiation doses measured by survey meters and the occupancy factors of each hamlet. We analyzed the dose in the hamlets and the variation in the occupancy factors to obtain the parameters of dose estimation on the inhabitants in selected hamlets; Madi and several hamlets of different dose levels in HBRA and Hampizai hamlet in CA. With these parameters, we estimated individual dose rates and compared them with those obtained from direct measurement using dosimeters carried by selected individuals. The results obtained are as follows. 1) The environmental radiation doses are influenced by the natural radioactive nuclide concentrations in building materials, the age of the building and the arrangement of the houses in a hamlet. There existed a fairly large and heterogeneous distribution of indoor and outdoor environmental radiations. The indoor radiation doses were due to exposure from the natural radioactive nuclides in the building materials and were about two times as large as the outdoor radiation doses. The difference between indoor and outdoor doses was not observed in CA. 2) The occupancy factor was influenced by the age of individuals and by the season of the year. The occupancy factor was higher for infants and aged individuals than for other age groups. This lead to higher dose rates of exposure to those age groups. 3) A good correlation was observed between the dose assessed indirectly and that measured directly and the correlation factor was 0.97.

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For the renewal of dose estimation from internal irradiation in the high background radiation areas (HBRA) of Yangjiang, the measurements of radon, thoron and their decay products in the environmental air were conducted, including: (1) integrating measurements of Rn-222 and Rn-220 concentrations; (2) equilibrium factor F for Rn-222 and alpha-potential energy value of Rn-220; (3) external gamma radiation in places where radon measurements were undertaken; (4) cumulative exposure to indoor radon for each family in a case-control study on lung cancer. The Rn-Tn cup monitor method was used for the integrating measurement of Rn-222 and Rn-220 concentration. An alpha track detector was used for the integration measurement of Rn-222 concentration in the case-control study on lung cancer. The results of measurements show that although the investigated areas are located between the Equator and the Tropic of Cancer, and that people live in well-ventilated dwellings, the concentrations of radon, especially of Rn-220 are significantly higher in the indoor air of HBRA than those in the control area. The value of equilibrium factors for Rn-222, the alpha potential energy of decay products from Rn-222 and Rn-220 are determined.

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The objective of the present study was to estimate cancer risk associated with the low-level radiation exposure of an average annual effective dose of 6.4 mSv (including internal exposure) in the high background-radiation areas (HBRA) in Yangjiang, China. The mortality survey consisted of two steps, i.e., the follow-up of cohort members and the ascertainment of causes of death. The cohort members in HBRA were divided into three dose-groups on the basis of environmental dose-rates per year. The mortality experiences of those three dose groups were compared with those in the residents of control areas by means of relative risk (RR). During the period 1987-1995, we observed 926,226 person-years by following up 106,517 subjects in the cohort study, and accumulated 5,161 deaths, among which 557 were from cancers. We did not observe an increase in cancer mortality in HBRA (RR=0.96, 96% CI, 0.80 to 1.15). The combined data for the period 1979-95 included 125,079 subjects and accumulated 1,698,316 person-years, observed 10,415 total deaths and 1,003 cancer deaths. The relative risk of all cancers for whole HBRA as compared with the control area was estimated to be 0.99 (95% CI, 0.87 to 1.14). The relative risks of cancers of the stomach, colon, liver, lung, bone, female breast and thyroid within whole HBRA were less than one, while the risks for leukemia, cancers of the nasopharynx, esophagus, rectum, pancreas, skin, cervix uteri, brain and central nervous system, and malignant lymphoma were larger than one. None of them were significantly different from RR=1. Neither homogeneity tests nor trend tests revealed any statistically significant relationship between cancer risk and radiation dose. We did not find any increased cancer risk associated with the high levels of natural radiation in HBRA. On the contrary, the mortality of all cancers in HBRA was generally lower than that in the control area, but not statistically significant.

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A study was made on cancer mortality in the high-background radiation areas of Yangjiang, China. Based on hamlet-specific environmental doses and sex- and age-specific occupancy factors, cumulative doses were calculated for each subject. In this article, we describe how the indirect estimation was made on individual dose and the methodology used to estimate radiation risk. Then, assuming a linear dose response relationship and using cancer mortality data for the period 1979-1995, we estimate the excess relative risk per Sievert for solid cancer to be -0.11 (95% CI, -0.67, 0.69). Also, we estimate the excess relative risks of four leading cancers in the study areas, i.e., cancers of the liver, nasopharynx, lung and stomach. In addition, we evaluate the effects of possible bias on our risk estimation.

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The main purposes of this study were to identify the major determinants of nasopharyngeal carcinoma (NPC) in the high-background radiation areas (HBRA) in Yangjiang, China and to evaluate their potential confounding effects on the NPC risk associated with exposure to high background radiation. A matched case-control study was conducted using those who died of NPC during the period 1987-1995. Two controls were randomly selected for each case from those who died from causes other than malignancies and external causes. Cases and their controls were matched with respect to sex and the years of birth and death (±5 years). Study subjects' next-of-kin were interviewed using a standardized questionnaire to collect information on socioeconomic status, dietary habits, tobacco smoking and alcohol consumption, disease history, pesticide use, medical X-ray exposure, the family history of NPC and so on. We succeeded in interviewing 97 cases and 192 controls. Univariate conditional logistic regression analysis showed that NPC risk was associated with the consumption of salted fish, homemade pickles, and fermented soy beans, education levels, the history of chronic rhinitis, and the family history of NPC. Multivariate conditional logistic regression analysis revealed that education levels (Odds ratio (OR) for middle school or higher levels vs. no school education=3.8, 95% CI=1.2 to 11.8), salted fish intake (OR=3.2, 95% CI=1.7 to 6.1), the history of chronic rhinitis (OR=3.6, 95% CI=1.3 to 10.1), and the family history of NPC (OR=14.2, 95% CI=2.7 to 73.4) were independent risk factors of NPC. Tobacco smoking (OR=1.2, 95% CI=0.7 to 2.1), and alcohol consumption (OR=0.9, 95% CI=0.5 to 1.9) were not significantly related to NPC risk. The ORs of NPC risk comparing HBRA and a nearby control area before and after adjustment for the major risk determinants identified in the present study were 0.86 (95% CI=0.50 to 1.50) and 0.87 (95% CI=0.45 to 1.67), respectively. Salted fish intake was a strong risk factor of NPC. Education, the history of chronic rhinitis and the family history of NPC were also related to NPC risk. The exposure to high background radiation in HBRA of Yangjiang was not related to NPC risk with or without the adjustment for those major risk determinants of NPC.

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Chromosomes of 39 healthy family members (3 generations from 13 families) living both in the high-level background radiation areas (HBRA) and the control areas (CA) were studied. Cumulative dose from birth to the time of blood sampling was estimated by calculating measured exposure rate in each individual. The cumulative doses ranged 30.9-358.9 and 6.0-59.2 mGy for HBRA and CA, respectively. Peripheral lymphocyte chromosome preparations were made according to our improved method. Dicentric and ring chromosomes (Dic+Rc) were scored in average 2,527 cells per individual in HBRA and 2,694 cells in CA under a microscope equipped with an automated stage. A positive correlation between Dic+Rc and age was found in HBRA, while no such dose relationship was clear in CA. The frequency of Dic+Rc linearly increases over lifetime due to chronic low dose exposure and it is likely that the activation of repair enzymes is not triggered in the present HBRA. Threshold dose (rate) of the induction of chromosome aberrations, if any, is below the present dose (rate) level.

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We performed a cytogenetical study using chromosome painting analysis on 9 residents of the naturally high background radiation areas (HBRA) and 8 residents of the control areass in southern China. The estimated dose (air kerma) of each resident measured by an electric pocket dosimeter showed 2.20-4.23 mGy/year in HBRA and 0.56-0.70 mGy/year in the control areas. A total of 14,096 cells (1,566 cells/case) in the former and 17,522 cells (2,190 cells/case) in the latter were analyzed. Children, both in HBRA and in the control areas, had translocations at low frequencies. The frequency of translocations among elder individuals varied widely and it was not possible to detect dose effect although it was detected in dicentrics. The effect of radiation on the induction of chromosome aberrations, which have a statistically potential risk of causing malignant or congenital diseases, seems to be less significant than those of metabolic factors and/or mutagenic agents (excluding radiation) even in HBRA in China.

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