Residential radon and cancer mortality in Galicia, Spain

Domestic radon exposure and childhood cancer risk by site and sex in 727 counties in the United States, 2001-2018

BACKGROUND

Childhood cancer has few established risk factors and environmental influences are underexplored. This ecologic study investigated the association between domestic radon exposure and childhood cancer risk in a large sample of United States (U.S.) counties.

METHODS

Monthly ZIP code-level basement radon estimates from a geographic machine learning model were aggregated annually to counties, analyzed as continuous and dichotomized (cut point: 74 Bq/cubic meter (Bq/m3) or 2.0 picocuries/L (pCi/L)) versions, and lagged by one year. Annual county-level counts of sex- and site-specific (all, leukemia, brain and central nervous system [CNS], and other sites) incident cancer diagnoses among those 0-19 years from 2001 to 2018 were obtained from the National Cancer Institute's Surveillance, Epidemiology, and End Results Program database. Sex- and site-specific counts were modeled as zero-inflated Poisson distributions in a Bayesian spatiotemporal framework and sequentially adjusted for random and fixed confounder effects.

RESULTS

In 727 counties across 14 states, the average population aged 0-19 years was 41,599 people at baseline. Results from fully adjusted spatiotemporal statistical models indicated 1.05 (95% credible interval, CrI: 1.00, 1.09) times higher relative risks (RRs) of leukemia among both sexes and a RR of 1.06 (95%CrI: 1.00, 1.12) in males from a 50 Bq/m3 (1.35 pCi/L) increase in radon concentration the year prior. For radon exposures ≥74 Bq/m3 (2.00 pCi/L) the year prior, RRs were 1.08 (95%CrI: 1.02, 1.15) for both sexes and 1.12 (95%CrI: 1.04, 1.22) for females. No associations were found with other cancer sites or sexes from prior year radon exposures.

CONCLUSIONS

County-level childhood leukemia risk in both sexes were associated with average radon levels below U.S. Environmental Protection Agency guidelines recommending mitigation (148 Bq/m3 or 4.00 pCi/L). These findings warrant further investigation using population-based and individual-level study designs.

Radon exposure and potential health effects other than lung cancer: a systematic review and meta-analysis

Context and objective

To date, lung cancer is the only well-established health effect associated with radon exposure in humans. To summarize available evidence on other potential health effects of radon exposure, we performed a comprehensive qualitative and quantitative synthesis of the available literature on radon exposure and health effects other than lung cancer, in both occupational and general populations.

Method

Eligible studies published from January 1990 to March 2023, in English and French languages, were identified in PubMed, ScienceDirect, Scopus, ScieLo and HAL. In the meta-analysis, we estimated average weighted standardized incidence ratios (metaSIR), standardized mortality ratios (metaSMR), and risk ratio (metaRR) per 100 unit (Bq/m3 or Working level Month) increase in radon exposure concentration by combining estimates from the eligible studies using the random-effect inverse variance method. DerSimonian & Laird estimator was used to estimate the between-study variance. For each health outcome, analyses were performed separately for mine workers, children, and adults in the general population.

Results

A total of 129 studies were included in the systematic review and 40 distinct studies in the meta-analysis. For most of these health outcomes, the results of the meta-analyses showed no statistically significant association, and heterogeneity was only present among occupational studies, especially between those included in the metaSIR or metaSMR analyses. However, the estimated exposure-risk associations were positive and close to the statistical significance threshold for: lymphohematological cancer incidence in children (metaRR = 1.01; 95%CI: 1.00-1.03; p = 0.08); malignant melanoma mortality among adults in the general population (metaRR = 1.10; 95%CI: 0.99-1.21; p = 0.07); liver cancer mortality among mine workers (metaRR = 1.04; 95%CI: 1.00-1.10; p = 0.06); intestine and rectal cancer mortality combined among mine workers (metaRR = 1.02; 95%CI: 1.00-1.04; p = 0.06).

Conclusion

Although none of the exposure-risk associations estimated in the meta-analyses reached statistical significance, the hypothesis that radon may have other health effects apart from lung cancer could not be ruled-out and call for additional research. Larger and well-designed studies are needed to further investigate this question.

Systematic review registration

https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023474542, ID: CRD42023474542.

An overview on the relationship between residential radon and lung cancer: what we know and future research

We aim to provide an overview of the research available on indoor radon and lung cancer, with a special focus on Spanish investigations. Early studies on underground miners established the link between radon and lung cancer, which was later confirmed for the general population by residential case-control studies. Spain contributed with extensive evidence, including 5 multicentric, hospital-based, case-control studies in the last 30 years, exploring diverse aspects, such as radon's effect on never-smokers, molecular pathways linking radon exposure to lung cancer risk, survival rates, mortality burden, and occupational exposure. There is a well-established causal association between radon with lung cancer. Despite pioneering research performed in our country by the Galician Radon Laboratory, particularly on driver genes, the evidence on the potential molecular pathways which makes radon a carcinogen is sparse. Also, relevant questions on the potential association of radon exposure with the induction of other diseases are still pending.

Radon prevalence in domestic water in the Ría de Vigo coastal basin (NW Iberian Peninsula)

The Ría de Vigo catchment is situated in the largest radon-prone area of the Iberian Peninsula. High local indoor radon (²²²Rn) levels are the preeminent source of radiation exposure, with negative effects on health. Nevertheless, information on radon levels of natural waters and the potential human exposure risks associated with their domestic use is very sparse. To elucidate the environmental factors increasing human exposure risk to radon during domestic water use, we undertook a survey of local water sources, including springs, rivers, wells, and boreholes, over different temporal scales. Continental waters were highly enriched in ²²²Rn: activities ranged from 1.2 to 20.2 Bq L^-1 in rivers and levels one to two orders of magnitude higher were found in groundwaters (from 8.0 to 2737 Bq L^-1; median 121.1 Bq L^-1). The geology and hydrogeology of local crystalline aquifers support one order of magnitude higher ²²²Rn activities in groundwater stored in deeper fractured rock compared to that contained within the highly weathered regolith at the surface. During the mean dry season, ²²²Rn activities nearly doubled in most sampled waters in comparison to the wet period (from 94.9 during the dry season to 187.3 Bq L^-1 during wet period; n = 37). Seasonal water use and recharge cycles and thermal convection are postulated to explain this variation in radon activities. The high ²²²Rn activities cause the total effective dose of radiation received from domestic use of untreated groundwaters to exceed the recommended 0.1 mSv y^-1. Since more than 70% of this dose comes from indoor water degassing and subsequent ²²²Rn inhalation, preventative health policy in the form of ²²²Rn remediation and mitigation measures should be implemented prior to pumping untreated groundwater into dwellings, particularly during the dry period.

Potential role of melatonin in prevention and treatment of lung cancer

Lung cancer is the second most common cancer and the most lethal cancer worldwide. Melatonin, an indoleamine produced in the pineal gland, shows anticancer effects on a variety of cancers, especially lung cancer. Herein, we clarify the pathophysiology of lung cancer, the association of circadian rhythm with lung, and the relationship between shift work and the incidence of lung cancer. Special focus is placed on the role of melatonin receptors in lung cancer, the relationship between inflammation and lung cancer, control of cell proliferation, apoptosis, autophagy, and immunomodulation in lung cancer by melatonin. A review of the drug synergy of melatonin with other anticancer drugs suggests its usefulness in combination therapy. In summary, the information compiled may serve as a comprehensive reference for the various mechanisms of action of melatonin against lung cancer, as a guide for the design of future experimental research and for advancing melatonin as a therapeutic agent for lung cancer.

Assessment of Seasonal Radon Concentration in Dwellings and Soils in Selected Areas in Ga East, Greater Accra Region of Ghana

Seasonal radon levels have been studied in dwellings and soils in selected areas in Ga East, Greater Accra Region of Ghana using LR-115-type II (SSNTDs). This study was conducted to determine the seasonal correlation between soil and dwelling radon concentrations. Detectors were exposed from January to March and April to June, for dry and wet seasons, respectively. Overall, indoor radon was 133.4 ± 6.7 Bqm-3 and 72.1 ± 3.6 Bqm -3 for wet and dry seasons. The estimated annual effective dose to the lung received by the occupants at Paraku Estate, Dome, and Kwabenya was 6.9 ± 0.4, 7.2 ± 0.5, and 9.8 ± 0.8 mSvy-1 for the wet season and 3.8 ± 0.2, 4.3 ± 0.2, and 4.6 ± 0.3 mSvy-1 for the dry season. On average, the soil radon concentration was found to be 0.96 ± 0.07 kBqm-3 and 2.24 ± 0.01 kBqm-3 for wet and dry seasons. To determine the correlation between soil and dwelling radon, a positive Pearson correlation coefficient value R = (0.74) and R = (0.66) was obtained representing the dry and wet seasons. To test the statistical significance between soil and dwelling radon, P < 0.05 was obtained, indicating a statically significant relationship between the two.

Metal and metalloid levels in topsoil and municipal cardiovascular mortality in Spain

The role of metals and metalloids beyond arsenic, copper, lead and cadmium in cardiovascular disease is not entirely clear. The aim of this study was to assess the association between 18 metal or metalloid levels in topsoil (upper soil horizon) with all-cause and specific cardiovascular mortality endpoints in Spain. We designed an ecological spatial study, to assess cardiovascular mortality in 7941 Spanish mainland towns from 2010 to 2014. The estimation of metals and metalloids concentration in topsoil came from the Geochemical Atlas of Spain from 13,317 soil samples. We also summarized the joint variability of the metals using principal components analysis (PCA). These components (PCs) were included in a Besag, York, and Mollié model to assess their association with cardiovascular mortality from all causes, coronary heart disease, cerebrovascular, hypertension, and conduction disorders. Our results showed, both in men and women, that at the lowest component scores range, PC2 (mainly reflecting Al, Be, Tl and U) was positively associated with coronary heart disease and cerebrovascular mortality. At medium/highest scores range, PC4 (mainly reflecting Hg) was positively associated with cerebrovascular mortality. For PC3 (reflecting Se), the association with coronary heart disease mortality was positive only in men at the highest PC scores range. For PC1 (partly reflecting metals such as Pb, As, Cu or Cd), we observed a strongly suggestive positive association with all-cause cardiovascular diseases mortality. Our ecological results are consistent with the available evidence supporting a cardiovascular role of excessive exposure to Se, Hg, Pb, As, Cu and Cd, but also identify Al, Be, Tl and U as potentially novel cardiovascular factors. Additional research is needed to confirm the biological relevance of our findings.

Predictors of indoor radon levels in the Midwest United States

Radon (Rn) is a natural and toxic radioactive gas that accumulates indoors, mainly in low-ventilated underground floors and basements. Several factors make prediction of indoor Rn exposure in enclosed spaces challenging. In this study, we investigated the influence of soil, geology, topography, atmospheric variables, radiation, urbanization, community economic well-being, and monthly and yearly variations on indoor Rn concentrations. We analyzed 7,515 monthly indoor Rn measurements in 623 zip codes from two U.S. States (Michigan and Minnesota) during 2005-2018 using a random forest model. Using Shapley Additive exPlanations (SHAP) values we investigated the contribution of each factor using variable importance and partial dependence plots. Factors that predict indoor Rn differed between states, with topographical, geological and soil composition being most influential. Cross-validated Pearson correlation between predictions and measurements was 0.68 (RMSE = 47.8 Bq/m³) in Minnesota, and 0.67 (RMSE = 52.5 Bq/m³) in Michigan. Our results underline the importance of soil structure for radon exposure, presumably due to strapped Rn in soil. The differences across states also suggest that Rn studies performing model development should consider geographical variables, along with other factors. As indoor Rn levels are multifactorial, an understanding of the factors that influence its emanation and build up indoors will help better assess spatial and temporal variations, which will be useful to improve prevention and mitigation control strategies.Implications: Radon exposure has become a year-round problem as people spend most of their time indoors. In North America, radon exposure is increasing over time and awareness related to its health effects remains low in the general population. Several factors make prediction of indoor radon exposure in enclosed spaces challenging. In this study, we used random forest to investigate the influence of factors on indoor radon in the Midwest United States. We found that topography, geology, and soil composition were the most influential factors on indoor radon levels. These results will help better assess spatial and temporal variations, which will further help better prevention and mitigation control strategies.

Residential radon exposure and leukemia: A meta-analysis and dose-response meta-analyses for ecological, case-control, and cohort studies

INTRODUCTION

In this study, the authors conducted a comprehensive systematic review and meta-analysis (including a dose-response meta-analysis) for a possible causal association between residential radon exposure and leukemia. All 3 types of study design, including ecological, case-control, and cohort studies, were included in this study. In particular, different measurement units of radon exposure among studies were dealt with and analyzed thoroughly.

METHODS

A medical librarian searched MEDLINE (PubMed), EMBASE, and the Cochrane Library (from January 01, 1970 to November 05, 2020). For ecological studies, a conventional meta-analysis and subgroup analyses with meta-ANOVA analyses were conducted. For case-control and cohort studies, a two-stage dose-response meta-analysis was conducted.

RESULTS

A total of 8 ecological, 9 case-control, and 15 ecological-cohort studies were analyzed. For ecological studies, the pooled correlation coefficient was 0.48 (95% CI 0.41-0.54). In the meta-analysis of variance (ANOVA) analyses, the age group (childhood vs. adult) showed a statistically significant result (Q = 7.93 and p = 0.019) with the pooled correlation coefficient for childhood, adult, and all age group of 0.67 (95% CI 0.53-0.77), 0.46 (95% CI 0.05-0.74), and 0.44 (95% CI 0.36-0.51), respectively. For case-control studies, the dose-response meta-analysis showed the pooled OR increase of 1.0308 (95% CI 1.0050-1.0573) for each 100 Bq/m³ increase of radon dose. The pooled OR increase was 1.0361 (95% CI 1.0014-1.0720) for each 100 Bq/m³ increase of radon dose for lymphoid leukemia subgroup and 1.0309 (95% CI 1.0050-1.0575) for each 100 Bq/m³ increase of radon dose for childhood leukemia subgroup. Because of the inclusion of ecological studies with larger exposure assessment units, the pooled RR from ecological-cohort studies should be interpreted conservatively (a tendency towards a higher risk estimate). The overall pooled RR increase for each 100 Bq/m³ increase of radon dose was 1.1221 (95% CI 1.0184-1.2363). The pooled RR increase was 1.2257 (95% CI 1.0034-1.4972) for each 100 Bq/m³ increase of radon dose for the myeloid leukemia subgroup and 1.2503 (95% CI 1.0233-1.5276) for each 100 Bq/m³ increase of radon dose for adult leukemia subgroup.

DISCUSSION

A number of epidemiologic concepts, including the issue of sample size justification, the possibility of differential participation selection bias for case-control studies, the possibility of random and systematic errors in radon measurement, ecological fallacy for ecological studies, were discussed. The effect of age group, socioeconomic status, and gamma radiation exposure was also discussed. Future more accurate and conclusive large-scale case-control and cohort studies are needed.

Environmental/Occupational Exposure to Radon and Non-Pulmonary Neoplasm Risk: A Review of Epidemiologic Evidence

Although Radon (Rn) is a known agent for lung cancer, the link between Rn exposure and other non-pulmonary neoplasms remains unclear. The aim of this review is to investigate the role of Rn in the development of tumors other than lung cancer in both occupational and environmental exposure. Particularly, our attention has been focused on leukemia and tumors related to brain and central nervous system (CNS), skin, stomach, kidney, and breast. The epidemiologic literature has been systematically reviewed focusing on workers, general population, and pediatric population. A weak increase in leukemia risk due to Rn exposure was found, but bias and confounding factors cannot be ruled out. The results of studies conducted on stomach cancer are mixed, although with some prevalence for a positive association with Rn exposure. In the case of brain and CNS cancer and skin cancer, results are inconclusive, while no association was found for breast and kidney cancers. Overall, the available evidence does not support a conclusion that a causal association has been established between Rn exposure and the risk of other non-pulmonary neoplasms mainly due to the limited number and heterogeneity of existing studies. To confirm this result, a statistical analysis should be necessary, even if it is now not applicable for the few studies available.

Analysis of Indoor Radon Data Using Bayesian, Random Binning, and Maximum Entropy Methods

Three statistical methods: Bayesian, randomized data binning and Maximum Entropy Method (MEM) are described and applied in the analysis of US radon data taken from the US registry. Two confounding factors-elevation of inhabited dwellings, and UVB (ultra-violet B) radiation exposure-were considered to be most correlated with the frequency of lung cancer occurrence. MEM was found to be particularly useful in extracting meaningful results from epidemiology data containing such confounding factors. In model testing, MEM proved to be more effective than the least-squares method (even via Bayesian analysis) or multi-parameter analysis, routinely applied in epidemiology. Our analysis of the available residential radon epidemiology data consistently demonstrates that the relative number of lung cancers decreases with increasing radon concentrations up to about 200 Bq/m³, also decreasing with increasing altitude at which inhabitants live. Correlation between UVB intensity and lung cancer has also been demonstrated.

Monitoring Radon Levels in Hospital Environments. Findings of a Preliminary Study in the University Hospital of Sassari, Italy

Background: The aim of this preliminary study was to measure radon concentrations in a hospital in order to verify to what extent these concentrations depend on various environmental variables taken into consideration, and consequently to determine the urgency to implement mitigation actions. Methods: The rooms where the concentration of the gas was potentially highest were monitored. Investigators adopted a Continuous Radon Monitor testing device. Qualitative and normally distributed quantitative variables were summarised with absolute (relative) frequencies and means (standard deviations, SD), respectively. As regards environmental variables, the difference in radon concentrations was determined using the rank-based nonparametric Kruskal–Wallis H test and the Mann–Whitney U test. Results: All measurements, excluding the radiotherapy bunkers that showed high values due to irradiation of radiotherapy instruments, showed low radon levels, although there is currently no known safe level of radon exposure. In addition, high variability in radon concentration was found linked to various environmental and behavioural characteristics. Conclusions: The results on the variability of radon levels in hospital buildings highlighted the key role of monitoring activities on indoor air quality and, consequently, on the occupants’ health.

Investigation of Radon Sources, Health Hazard and Risks assessment for children using analytical and geospatial techniques in District Bannu (Pakistan)

PURPOSE

Radon (Rn) is a radioactive, odorless, and colorless gas which has a half-life of 3.83 days. One of the main sources of Rn which is directly consumed by the population is Groundwater (Tube well, Bore well, Hand pump). Rn gas is found naturally in rock, soil and water and can be considered as main health risk factor in terms of lung cancer, stomach diseases, leukemia and childhood cancer. The objective of this study was to determine the concentration of Rn in the drinking water sources, appraisal of health risk for children in District Bannu, Pakistan.

MATERIAL AND METHOD

Total of 98 drinking water samples were analyzed by using RAD-7 detector. The experimental data was statistically analyzed by using Pearson's test. The experimental and epidemiological data of the study area are shown on map using ArcGIS version 10.5.

RESULTS

The analytical results show that Rn in drinking water was found varying from 10.1 Bq/l to 53.1 Bq/l with the average highest and lowest depth of 60 ft to 550 ft respectively. Pearson's test was used to show the concentration of Rn verses the depth of the water sources so +1 positive linear correlation was observed among the depth of water sources and the concentration of Rn. Out of 98 drinking water samples 40 sample were above the maximum contaminant level of 11.1 Bq/l (MCL) set by WHO, 2002. The effective doses (AED and DE_ing) for children ranges from 0.00001 to 3.792 mSv/y which exceeds the Permissible Exposure Limit (PEL) of Rn (0.1mSv/y) in 30 drinking water samples . On the basis of analytical results Rn high concentration areas are shown on the map using IDW model of interpolation and health risks were shown in areas where Rn content was above the maximum contaminant level. High correlations of diseases related to Rn were observed amongst the residence of the study area. Gastrointestinal diseases, brain tumor, lung cancer and kidney diseases were observed among the children of the study area.

CONCLUSION

From the overall analysis it was observed that high Rn concentration in drinking water may cause substantial health damage in children after long term exposure.

Development of an Automatic Low-Cost Air Quality Control System: A Radon Application

Air pollution is the fourth-largest overall risk factor for human health worldwide. Ambient air pollution (outdoors) and household air pollution (indoors) cause about 6.5 million premature deaths. The World Health Organization has established that between 3% and 14% of lung cancer cases are due to radon gas, making it the most important cause of lung cancer after smoking. This work presents a fully automated, low-cost indoor air quality control system that can monitor temperature, pressure, humidity, total volatile organic compounds (TOVC), and radon concentration. Using the radon concentration as an air quality measure, we created a prediction algorithm. The system uses those predictions to control a ventilation system automatically. We tested the algorithm for different prediction windows and compared the results with those without the ventilation system in a radon research room. In this room, the radon concentration is high 100% of the time, reaching a level eleven times higher than the recommended limit. The results show that the system can achieve an 86% reduction of the radon concentration, maintaining it low 90% of the time while having the ventilation system on during only 34% of the time. This work demonstrates that we can control air quality using low-cost resources, keeping a household or workplace safe but comfortable.

Predictors of Lung Cancer Risk: An Ecological Study Using Mortality and Environmental Data by Municipalities in Italy

Lung cancer (LC) mortality remains a consistent part of the total deaths occurring worldwide. Its etiology is complex as it involves multifactorial components. This work aims in providing an epidemiological assessment on occupational and environmental factors associated to LC risk by means of an ecological study involving the 8092 Italian municipalities for the period 2006-2015. We consider mortality data from mesothelioma as proxy of asbestos exposure, as well as PM2.5 and radon levels as a proxy of environmental origin. The compensated cases for occupational respiratory diseases, urbanization and deprivation were included as predictors. We used a negative binomial distribution for the response, with analysis stratified by gender. We estimated that asbestos is responsible for about 1.1% (95% CI: 0.8, 1.4) and 0.5% (95% CI: 0.2, 0.8) of LC mortality in males and females, respectively. The corresponding figures are 14.0% (95% CI: 12.5, 15.7) and 16.3% (95% CI: 16.2, 16.3) for PM2.5 exposure, and 3.9% (95% CI: 3.5, 4.2) and 1.6% (95% CI: 1.4, 1.7) for radon exposure. The assessment of determinants contribution to observed LC deaths is crucial for improving awareness of its origin, leading to increase the equity of the welfare system.

Water and Soil Pollution: Ecological Environmental Study Methodologies Useful for Public Health Projects. A Literature Review

Health risks at population level may be investigated with different types of environmental studies depending on access to data and funds. Options include ecological studies, case-control studies with individual interviews and human sample analysis, risk assessment or cohort studies. Most public health projects use data and methodologies already available due to the cost of ad-hoc data collection. The aim of the article is to perform a literature review of environmental exposure and health outcomes with main focus on methodologies for assessing an association between water and/or soil pollutants and cancer. A systematic literature search was performed in May 2019 using PubMed. Articles were assessed by four independent reviewers. Forty articles were identified and divided into four groups, according to the data and methods they used, i.e.: (1) regression models with data by geographical area; (2) regression models with data at individual level; (3) exposure intensity threshold values for evaluating health outcome trends; (4) analyses of distance between source of pollutant and health outcome clusters. The issue of exposure assessment has been investigated for over 40 years and the most important innovations regard technologies developed to measure pollutants, statistical methodologies to assess exposure, and software development. Thanks to these changes, it has been possible to develop and apply geo-coding and statistical methods to reduce the ecological bias when considering the relationship between humans, geographic areas, pollutants, and health outcomes. The results of the present review may contribute to optimize the use of public health resources.

Indoor radon exposure and excess of lung cancer mortality: the case of Mexico-an ecological study

Radon is a radioactive gas that can migrate from soils and rocks and accumulate in indoor areas such as dwellings and buildings. Many studies have shown a strong association between the exposure to radon, and its decay products, and lung cancer (LC), particularly in miners. In Mexico, according to published surveys, there is evidence of radon exposure in large groups of the population, nevertheless, only few attention has been paid to its association as a risk factor for LC. The aim of this ecological study is to evaluate the excess risk of lung cancer mortality in Mexico due to indoor radon exposure. Mean radon levels per state of the Country were obtained from different publications and lung cancer mortality was obtained from the National Institute of Statistics, Geography and Informatics for the period 2001-2013. A model proposed by the International Commission on Radiological Protection to estimate the annual excess risk of LC mortality (per 10⁵ inhabitants) per dose unit of radon was used. The average indoor radon concentrations found rank from 51 to 1863 Bq m^-3, the higher average dose exposure found was 3.13 mSv year^-1 in the north of the country (Chihuahua) and the mortality excess of LC cases found in the country was 10 ± 1.5 (range 1-235 deaths) per 10⁵ inhabitants. The highest values were found mainly in the Northern part of the country, where numerous uranium deposits are found, followed by Mexico City, the most crowded and most air polluted area in the country. A positive correlation (r = 0.98 p < 0.0001) was found between the excess of LC cases and the dose of radon exposure. Although the excess risk of LC mortality associated with indoor radon found in this study was relatively low, further studies are needed in order to accurately establish its magnitude in the country.

Design and Development of a New Methodology Based on Expert Systems Applied to the Prevention of Indoor Radon Gas Exposition Risks

Exposure to high concentration levels of radon gas constitutes a major health hazard, being nowadays the second-leading cause of lung cancer after smoking. Facing this situation, the last years have seen a clear trend towards the search for methodologies that allow an efficient prevention of the potential risks derived from the presence of harmful radon gas concentration levels in buildings. With that, it is intended to establish preventive and corrective actions that might help to reduce the impact of radon exposure on people, especially in places where workers and external users must stay for long periods of time, as it may be the case of healthcare buildings. In this paper, a new methodology is developed and applied to the prevention of the risks derived from the exposure to radon gas in indoor spaces. Such methodology is grounded in the concurrent use of expert systems and regression trees that allows producing a diagram with recommendations associated to the exposure risk. The presented methodology has been implemented by means of a software application that supports the definition of the expert systems and the regression algorithm. Finally, after proving its applicability with a case study and discussing its contributions, it may be claimed that the benefits of the new methodology might lead on to an innovation in this field of study.

A new radon prediction approach for an assessment of radiological potential in drinking water

Inhaled radon from groundwater used for domestic purposes is one of the sources of natural radioactivity into indoor air. Due to uranium-bearing minerals occurrences, hydrogeochemical conditions, tectonic structures, and hydraulic circuits, the radon pathway from rocks to groundwater is quite unpredictable. High radon potential from bedrocks is not always associated with high radon levels in groundwater. Besides, inhaled radon from domestic use may also increase the exposure toindoor radon levels. This innovative methodology using hydrogeochemical conditions and groundwater flow transport was used for radon predictions in the underground to ensure safe drinking water ingestion and inhalation. This innovative radon prediction methodology is based on classic hydrogeochemical analyses (Eh-pH, Piper, Schöeller and Gibb's diagrams) and multivariate statistical analyses (Principal Component Analysis and Pearson's correlation). High dissolution of major ions does not imply high radon mobilization from rocks to groundwater. The travel time was estimated to developed a flow transport of contaminated groundwater. Radiological results show that of the 25 sampled springs, five of them contained radon concentrations above the Portuguese imposed limit (²²²Rn = 500 Bq·L^-1), and 16 of them with values above the WHO recommended limit (²²²Rn = 100 Bq·L^-1). Overall, this new approach of radon prediction showed that uranium enrichment in rocks at ideal hydrochemical conditions and emanation coefficient, and shallow circuits, are responsible for radon increasing in drinking water. The proposed approach allow to predict the areas with high radon potential groundwaters, being a tool to be used by water planners and policy makers for corrective and preventive measures in shallow groundwater flows. To safeguard clean water within the predefined deadline of Sustainable Development Goals (2030) and to ensure human health in compliance with WHO guidelines for safe drinking water, should be established priority water protection policies to reduced radon in this contaminated springs (n = 16).

Residential Radon and Histological Types of Lung Cancer: A Meta-Analysis of Case‒Control Studies

Epidemiological studies on residential radon exposure and the risk of histological types of lung cancer have yielded inconsistent results. We conducted a meta-analysis on this topic and updated previous related meta-analyses. We searched the databases of Cochrane Library, Embase, PubMed, Web of Science and Chinese National Knowledge Infrastructure for papers published up to 13 November 2018. The pooled odds ratio (OR) and 95% confidence interval (CI) were calculated using fixed and random effects models. Subgroup and dose‒response analyses were also conducted. This study was registered with PROSPERO (No. CRD42019127761). A total of 28 studies, which included 13,748 lung cancer cases and 23,112 controls, were used for this meta-analysis. The pooled OR indicated that the highest residential radon exposure was significantly associated with an increased risk of lung cancer (OR = 1.48, 95% CI = 1.26–1.73). All histological types of lung cancer were associated with residential radon. Strongest association with small-cell lung carcinoma (OR = 2.03, 95% CI = 1.52–2.71) was found, followed by adenocarcinoma (OR = 1.58, 95% CI = 1.31–1.91), other histological types (OR = 1.54, 95% CI = 1.11–2.15) and squamous cell carcinoma (OR = 1.43, 95% CI = 1.18–1.74). With increasing residential radon levels per 100 Bq/m³, the risk of lung cancer, small-cell lung carcinoma and adenocarcinoma increased by 11%, 19% and 13%, respectively. This meta-analysis provides new evidence for a potential relationship between residential radon and all histological types of lung cancer.

Estimation of soil gas permeability for assessing radon risk using Rosetta pedotransfer function based on soil texture and water content

Radon is a natural source of radioactivity and it can be found in all soils and rocks in the Earth. The presence of radon gas in indoor environments implies a serious risk for human health, already listed as carcinogenic by the World Health Organization. The most relevant methods to infer the risk for radon exposure are based on soil radon concentration and gas permeability that describe the effective radon movement in the soil. However, they neglect crucial soil properties and water content in soil, which can affect greatly soil permeability to gases. Additionally, soil permeability measurement remains expensive, difficult and time-consuming. In this paper we show a new and simple methodology to infer radon risk based on Rosetta3 pedotransfer function as well as soil texture and water content. We also determine the influence of soil texture both on the gas permeability variation in dependence on water content and on the parameter n of the van Genuchten -Mualem model, which establishes the shape of the relative permeability curves. We show that radon risk exposure may change importantly for the same soil with different soil water contents. We finally apply and validate the proposed method using radon permeability data from the Canadian component of the North American Soil Geochemical Landscapes Project (NASGLP). Results highlight that the proposed methodology provides reliable estimations of the gas permeability and reveal that the presence of water content may cross the boundary between two radon risk categories, and consequently, may change the radon risk category to safer situations.

County-level indoor radon concentration mapping and uncertainty assessment in South Korea using geostatistical simulation and environmental factors

This paper presents a geostatistical simulation approach to not only map the county-level indoor radon concentration (IRC) distributions in South Korea, but also quantify the uncertainty that can be used as decision-supporting information. For county-level IRC mapping in South Korea, environmental factors including geology, radium concentration in surface soil, gravel content in subsoil, and fault line density, which are known to be associated with the source and migration of radon gas, were incorporated into IRC measurements using multi-Gaussian kriging with local means. These four environmental factors could account for about 36% of the variability of noise-filtered IRCs, implying that regional variations of IRCs were affected by these factors. Sequential Gaussian simulation was then applied to generate alternative realizations of county-level IRC distributions. By summarizing the multiple simulation results, we identified some counties that lay on the great limestone series showed elevated IRCs. In addition, there were some counties in which the proportion of grids exceeding the recommended level was high but the uncertainty was also large according to the analysis of several uncertainty measures, which indicates that additional sampling is required for these counties. From the local cluster analysis in conjunction with simulation results, we found that the counties with higher levels of IRC belonged to the statistically significant clusters of high values, and these counties should be the prime targets for radon management and in-depth survey. The geographical distributions of IRC and uncertainty measures presented in this study provide guidance for effective radon management if they are consistently combined with both future IRC measurements and a geogenic radon potential map.

County-level radon exposure and all-cause mortality risk among Medicare beneficiaries

BACKGROUND

Radon is an inert gas formed from the decay of naturally-occurring materials in the earth's crust. It infiltrates into homes from soil, water, and construction materials. Its decay products are radionuclides, which attach to ambient particles. Residential radon is one of the leading risk factors for lung cancer. The scarce evidence for associations with other mortality causes originates mostly from occupational studies.

METHODS

In a cohort study with 14 years of follow-up (2000-2013), we evaluated the association between chronic radon exposure and all-cause mortality, and explored whether there are subpopulations who are more vulnerable to radon effects. We included 87,296,195 person-years of follow-up from all Medicare beneficiaries in the Mid-Atlantic and Northeastern U.S. states. We examined the association between the logarithm of county-averaged radon (ln(Rn)) and mortality and assessed effect modification by chronic conditions.

RESULTS

An interquartile range increase in the ln(Rn) was associated with a 2·62% increase (95% CI 2·52%; 2·73%) in mortality, independent of PM2.5 exposure. Larger mortality risks were observed among individuals with respiratory, cardiovascular and metabolic diseases, with the highest associations observed among those with diabetes (4·98% increase), heart failure (4·58% increase), and chronic obstructive pulmonary disease (4·49% increase).

CONCLUSION

We found an increased risk for all-cause mortality associated with increased radon exposure. The risk was enhanced among susceptible individuals with chronic conditions. We believe this is the first cohort study to identify populations at higher risk for non-malignant health consequences of radon exposure. Due to the limitations in exposure assessment and availability of individual confounders, these findings should be interpreted with caution.

Investigation of sub-slab pressure field extension in specified granular fill materials incorporating a sump-based soil depressurisation system for radon mitigation

Design of bearing layers (granular fill material layers) is important for a house with a soil depressurisation (SD) system for indoor radon mitigation. These layers should not only satisfy the bearing capacity and serviceability criteria but should also provide a sufficient degree of the air permeability for the system. Previous studies have shown that a critical parameter for a SD system is the sub-slab pressure field extension in the bearing layers, but this issue has not been systematically investigated. A series of two-dimensional computational fluid dynamic simulations that investigate the behaviour of the sub-slab pressure field extension developed in a SD system is presented in this paper. The SD system considered in this paper consists of a granular fill material layer and a radon sump. The granular fill materials are 'T1 Struc' and 'T2 Perm', which are standard materials for building in the Republic of Ireland. Different conditions, which might be encountered in a practical situation, were examined. The results show that the air permeability and thickness of the granular fill materials are the two key factors which affect the sub slab pressure field extension (SPFE) significantly. Furthermore, the air permeability of native soil is found to be a fundamental factor for the SPFE so that it should be well understood when designing a SD system. Therefore, these factors should be considered sufficiently in each practical situation. Finally, a significant improvement of the pressure field extension can be achieved by ensuring air tightness of the SD system.

Indoor Radon Gas (222Rn) Levels in Homes in Aldama, Chihuahua, Mexico and the Risk of Lung Cancer

Radon (²²²Rn) is an odorless and tasteless gas that is known to cause lung cancer. The objective of this research was to quantify the levels of exposure to radon among people living in an environment rich in uranium (U). Radon concentrations were measured for 3 days in 12 homes in Aldama, Mexico. Homeowners agreed to participate in the study; hence, the sample was non-probabilistic. Radon was measured with a portable AlphaGuard Radon Monitor (Genicron Instruments GmbH), which was placed in a bedroom of each home at a height of 0.74 m. Gas levels were registered in Becquerels (Bq m⁻³), with readings taken every 10 min along with readings of ambient temperature (AT), air pressure (AP), and relative humidity (RH). We found that radon gas levels in Aldama exceed the maximum permissible limits (USA: 148 Bq m⁻³). Levels were higher at night, and were above the maximum permissible level recommended by the International Atomic Energy Agency of the United Nations (<200 Bq m⁻³). Most residents in the area have family histories of lung problems, but it was difficult to establish a strong correlation between ²²²Rn and lung cancer. Federal, state, and municipal governments should take stronger action to reduce the effects of radon gas on communities.

Estimates of the Lung Cancer Cases Attributable to Radon in Municipalities of Two Apulia Provinces (Italy) and Assessment of Main Exposure Determinants

Indoor radon exposure is responsible for increased incidence of lung cancer in communities. Building construction characteristics, materials, and environmental determinants are associated with increased radon concentration at specific sites. In this study, routine data related to radon measurements available from the Apulia (Italy) Regional Environmental Protection Agency (ARPA) were combined with building and ground characteristics data. An algorithm was created based on the experience of miners and it was able to produce estimates of lung cancer cases attributable to radon in different municipalities with the combined data. In the province of Lecce, the sites with a higher risk of lung cancer are Campi Salentina and Minervino, with 1.18 WLM (working level months) and 1.38 WLM, respectively, corresponding to lung cancer incidence rates of 3.34 and 3.89 per 10 × 10³ inhabitants. The sites in the province of Bari with higher risks of lung cancer are Gravina di Puglia and Locorotondo, measuring 1.89 WLM and 1.22 WLM, respectively, which correspond to an incidence rate of lung cancer of 5.36 and 3.44 per 10 × 10³ inhabitants. The main determinants of radon exposure are whether the buildings were built between 1999 and 2001, were one-room buildings with porous masonry, and were built on soil consisting of pelvis, clayey sand, gravel and conglomerates, calcarenites, and permeable lithotypes.

Estimation of residential radon exposure and definition of Radon Priority Areas based on expected lung cancer incidence

Radon is a naturally occurring gas, classified as a Class 1 human carcinogen, being the second most significant cause of lung cancer after tobacco smoking. A robust spatial definition of radon distribution in the built environment is therefore essential for understanding the relationship between radon exposure and its adverse health effects on the general population. Using Ireland as a case study, we present a methodology to estimate an average indoor radon concentration and calculate the expected radon-related lung cancer incidence. We use this approach to define Radon Priority Areas at the administrative level of Electoral Divisions (EDs). Geostatistical methods were applied to a data set of almost 32,000 indoor radon measurements, sampled in Ireland between 1992 and 2013. Average indoor radon concentrations by ED range from 21 to 338 Bq m^-3, corresponding to an effective dose ranging from 0.8 to 13.3 mSv y^-1 respectively. Radon-related lung cancer incidence by ED was calculated using a dose-effect model giving between 15 and 239 cases per million people per year, depending on the ED. Based on these calculations, together with the population density, we estimate that of the approximately 2,300 lung cancer cases currently diagnosed in Ireland annually, about 280 may be directly linked to radon exposure. This figure does not account for the synergistic effect of radon exposure with other factors (e.g. tobacco smoking), so likely represents a minimum estimate. Our approach spatially defines areas with the expected highest incidence of radon-related lung cancer, even though indoor radon concentrations for these areas may be moderate or low. We therefore recommend that both indoor radon concentration and population density by small area are considered when establishing national radon action plans.

Indoor Radon Exposure in Italian Schools

Background: The aim of the study was to assess radon concentration in schoolrooms in a city located in the midwest of Italy. Methods: A two-phase environmental study was carried out in 19 school buildings of 16 primary, secondary, and tertiary schools. Results: Median (interquartile range—IQR) indoor radon concentration in schoolrooms was 91.6 (45.0–140.3) Bq/m³. The highest (median 952.8 Bq/m³) radon concentration was found in one (3.6%) classroom, located in a building of a primary school whose median concentration was 185 Bq/m³. Radon concentration was significantly correlated with the number of students and teachers, foundation wall construction material, and with the absence of underground floors. A geopedological survey was performed close to the building with highest radon level, showing the presence of granite and tonalithic granodiorite in the soil. Conclusions: Radon levels should be routinely assessed where individuals live or work. Schools are susceptible targets, because of childhood stay and the long daily stay of occupants. Low-cost interventions, such as implementation of natural air ventilation and school maintenance, can reduce radon levels, limiting individual exposure.

Radon Levels in Indoor Environments of the University Hospital in Bari-Apulia Region Southern Italy

Since 1988, the International Agency for Research on Cancer (IARC) has classified radon among the compounds for which there is scientific evidence of carcinogenicity for humans (group 1). The World Health Organization (WHO) recommends a reference radon level between 100 and 300 Bq/m³ for homes. The objective of this study is to measure the radon concentrations in 401 workplaces, different from the patient rooms, in 28 different buildings of the university hospital in Bari (Apulia region, Southern Italy) to evaluate the exposure of health care workers. Radon environmental sampling is performed over two consecutive six-month periods via the use of passive dosimeters of the CR-39 type. We find an average annual radon concentration expressed as median value of 48.0 Bq/m³ (range 6.5–388.0 Bq/m³) with a significant difference between the two six-month periods (median value: February/July 41.0 Bq/m³ vs. August/January 55.0 Bq/m³). An average concentration of radon lower than the WHO reference level (100 Bq/m³) is detected in 76.1% of monitored environments, while higher than 300 Bq/m³ only in the 0.9%. Most workplaces report radon concentrations within the WHO reference level, therefore, the risk to workers’ health deriving from occupational exposure to radon can be considered to be low. Nevertheless, the goal is to achieve near-zero exposures to protect workers’ health.