||Excess lung cancer risk has been associated with exposure to alpha particle radiation from inhaled radon daughter products among uranium miners in Czechoslovakia, Canada, the United States, and elsewhere, and with exposure to gamma rays and neutrons from the atomic bombings of Hiroshima and Nagasaki, Japan. Differences in distribution by histological type, as well as certain epidemiological differences, suggest the possibility of differences in the causation of radiation-induced lung cancer. An epidemiological analysis is summarised of results from a blind pathology panel review of tissue slides from lung cancer cases diagnosed in 108 Japanese A bomb survivors and 92 American uranium miners selected on the basis of radiation exposure, smoking history, sex, age, and source and quality of pathology material. Consensus diagnoses were obtained with respect to principal sub-type, including squamous cell cancer, small cell cancer, adenocarcinoma, and less frequent sub-types. The results were analysed in terms of population, radiation dose, and smoking history. As expected, the proportion of squamous cell cancer was positively related to smoking history in both populations. The relative frequencies of small cell cancer and adenocarcinoma were very different in the two populations, but this difference was adequately accounted for by differences in radiation dose (more specifically, dose-based relative risk estimates based on published risk coefficients). Data for the two populations conformed to a common pattern, in which radiation-induced cancers appeared more likely to be of the small-cell sub-type, and less likely to be adenocarcinomas. No additional explanation in terms of radiation quality (alpha particles or gamma rays), uniform or local irradiation, inhaled as against external radiation source, or other population differences, appeared to be required. One possible interpretation of the finding is that radiation-related lung carcinogenesis may depend heavily on interactions with inhaled promoter/progressor agents, such as smoke. Thus, even though ionising events from external gamma rays and inhaled radon decay products are very differently distributed within the lung, the spatial distribution, and cell types, of any resulting cancers may be determined largely by the action of other agents deposited within the bronchi.