Calculation of lifetime lung cancer risks associated with radon exposure, based on various models and exposure scenarios

Lifetime Risks for Lung Cancer due to Occupational Radon Exposure: A Systematic Analysis of Estimation Components

Lifetime risk estimates play a key role in many areas of radiation research. Here, the focus is on the lifetime excess absolute risk (LEAR) for dying from lung cancer due to occupational radon exposure based on uranium miners cohort studies. The major components in estimating LEAR were systematically varied to investigate the variability and uncertainties of results. Major components of the LEAR calculation are baseline mortality rates for lung cancer and all causes of death, risk model and exposure scenario. Sex-averaged mortality rates were chosen from a mixed Euro-American-Asian population, in addition to mortality rates to represent heavy and light smokers. Seven radon-related lung cancer risk models derived from different uranium miners cohorts were compared. As exposure scenarios, occupational exposure of two working level months (WLM) from age 18-64 years was considered, and three scenarios from the German uranium miners cohort. Further components were modified in sensitivity analyses. The LEAR was compared to other lifetime risk measures. With a range from less than 0.6 × 10-4 to over 8.0 × 10-4, LEAR per WLM estimates were influenced heavily by the choice of risk models. Notably, mortality rates, particularly lung cancer mortality rates, had a strong impact on LEAR per WLM across all models. The LEAR per WLM exhibited only low variation to changes in exposure scenarios for all risk models, except for the BEIR VI model fitted on the pooled 11 miners study. All assessed lifetime risk measures displayed a monotonically increasing relationship between exposure and lifetime risk at low to moderate exposures, with minor differences between ELR, REID, and LEAR (all per WLM). RADS yields the largest lifetime risk estimates in most situations. There is substantial variation in LEAR per WLM estimates depending on the choice of underlying calculation components. Reference populations and mortality rates should be selected with care depending on the application of lifetime risk calculations. The explicit choice of the lifetime risk measure was found to be negligible. These findings should be taken into consideration when using lifetime risk measures for radiation protection policy purposes.

Apportioning radon contamination sources in underground spaces using a grey-box model

The management of radon in indoor environments is essential owing to its carcinogenic risk, with the main sources being gaseous radon from advection and aqueous radon from degassing. However, methods for apportioning indoor radon sources are limited, due to gaps between preliminary physical information and site-specific measurement. This study proposes a method for apportioning sources utilizing a grey-box model that integrates physical theories with data information. Monitoring of indoor air conditioning was conducted and a grey-box model for indoor radon contamination was established using a signal processing system and a physical-based model. Based on the optimized grey-box model, sources of indoor radon were apportioned. The average radon concentration during the monitoring period was 1104 Bq/m³, which was 7.5 times higher than 148 Bq/m³ , the action level recommended by EPA. The grey-box model showed good performance for predicting indoor radon concentrations. Degassing of aqueous radon was identified as the main source of indoor radon. The estimations provided by the grey-box model showed its potential to assess the contribution of each transport mechanism. Apportioning sources through grey-box modeling is a promising method for developing optimized mitigation strategies and bridging data gaps between the preliminary conceptual site model and site investigation.

Radon and lung cancer: Current status and future prospects

Beyond tobacco smoking, radon takes its place as the second most significant contributor to lung cancer, excluding hereditary and other biologically related factors. Radon and its byproducts play a pivotal role in exposing humans to elevated levels of natural radiation. Approximately 10-20 % of lung cancer cases worldwide can be attributed to radon exposure, leading to between 3 % and 20 % of all lung cancer-related deaths. Nevertheless, a knowledge gap persists regarding the association between radon and lung cancer, impeding radon risk reduction initiatives globally. This review presents a comprehensive overview of the current state of research in epidemiology, cell biology, dosimetry, and risk modeling concerning radon exposure and its relevance to lung cancer. It also delves into methods for measuring radon concentrations, monitoring radon risk zones, and identifying priorities for future research.

Simultaneous measurements of radon, thoron and thoron progeny and induced cancer risk assessment in Djeno, Pointe-Noire, Republic of Congo

In this study, the activity concentrations of radon (222Rn), thoron (220Rn) and thoron progeny were measured simultaneously in Djeno (Pointe-Noire, Republic of Congo) using RADUET detectors to evaluate the air quality and the radiological risks due to the inhalation of these radionuclides. Activity concentrations of radon progeny were calculated from those of radon. Indoor radon, thoron and progenies followed a lognormal distribution ranging between 20 and 40, 6 and 62, 8 and 17.6 and 0.4 and 19.6 Bq m-3 for radon, thoron, radon progeny and thoron progeny, respectively. Mean values for radon were lower than the worldwide values estimated by the United Nation Scientific Committee on the Effects of Atomic Radiation (UNSCEAR), which are 40 Bq m-3 (arithmetic mean) and 45 Bq m-3 (geometric mean). Radon concentrations in the dwellings under study were below the World Health Organization and the International Commission on Radiological Protection recommended reference levels, which are, respectively, 100 and 300 Bq m-3. The mean concentration of thoron was twice the world average value of 10 Bq m-3 estimated by UNSCEAR. Thoron progeny mean concentration was sharply greater than the typical value (0.3 Bq m-3) for indoor atmosphere provided by UNSCEAR. Annual effective dose ranges were 0.40-0.87 mSv (arithmetic mean, 0.57 ± 0.11 mSv) for radon and 0.10-4.14 mSv (arithmetic mean, 0.55 ± 0.77 mSv) for thoron. The mean value for radon was lower than the value (1.15 mSv) estimated by UNSCEAR, while the mean value for thoron was five times higher than the UNSCEAR value (0.10 mSv). The study showed that the use of the typical equilibrium factor value given by UNSCEAR to compute effective dose led to an error above 80%. Finally, the results of this study showed that the excess relative risk of radon-induced cancer was low, below 2% for the population under 55 y. The results presented in the present study prove that the population of Djeno is exposed to a relatively low potential risk of radon- and thoron-induced cancer.

Lung cancer mortality attributable to residential radon: a systematic scoping review

After smoking, residential radon is the second risk factor of lung cancer in general population and the first in never-smokers. Previous studies have analyzed radon attributable lung cancer mortality for some countries. We aim to identify, summarize, and critically analyze the available data regarding the mortality burden of lung cancer due to radon, performing a quality assessment of the papers included, and comparing the results from different countries. We performed a systematic scoping review using the main biomedical databases. We included original studies with attributable mortality data related to radon exposure. We selected studies according to specific inclusion and exclusion criteria. PRISMA 2020 methodology and PRISMA Extension for Scoping Reviews requirements were followed. Data were abstracted using a standardized data sheet and a tailored scale was used to assess quality. We selected 24 studies describing radon attributable mortality derived from 14 different countries. Overall, 13 studies used risk models based on cohorts of miners, 8 used risks from residential radon case-control studies and 3 used both risk model options. Radon geometric mean concentration ranged from 11 to 83 Becquerels per cubic meter (Bq/m3) and the population attributable fraction (PAF) ranged from 0.2 to 26%. Studies performed in radon prone areas obtained the highest attributable mortality. High-quality publications reported PAF ranging from 3 to 12% for residential risk sources and from 7 to 25% for miner risk sources. Radon PAF for lung cancer mortality varies widely between studies. A large part of the variation is due to differences in the risk source used and the conceptual description of radon exposure assumed. A common methodology should be described and used from now on to improve the communication of these results.

Ionizing radiation, cerebrovascular disease, and consequent dementia: A review and proposed framework relevant to space radiation exposure

Space exploration requires the characterization and management or mitigation of a variety of human health risks. Exposure to space radiation is one of the main health concerns because it has the potential to increase the risk of cancer, cardiovascular disease, and both acute and late neurodegeneration. Space radiation-induced decrements to the vascular system may impact the risk for cerebrovascular disease and consequent dementia. These risks may be independent or synergistic with direct damage to central nervous system tissues. The purpose of this work is to review epidemiological and experimental data regarding the impact of low-to-moderate dose ionizing radiation on the central nervous system and the cerebrovascular system. A proposed framework outlines how space radiation-induced effects on the vasculature may increase risk for both cerebrovascular dysfunction and neural and cognitive adverse outcomes. The results of this work suggest that there are multiple processes by which ionizing radiation exposure may impact cerebrovascular function including increases in oxidative stress, neuroinflammation, endothelial cell dysfunction, arterial stiffening, atherosclerosis, and cerebral amyloid angiopathy. Cerebrovascular adverse outcomes may also promote neural and cognitive adverse outcomes. However, there are many gaps in both the human and preclinical evidence base regarding the long-term impact of ionizing radiation exposure on brain health due to heterogeneity in both exposures and outcomes. The unique composition of the space radiation environment makes the translation of the evidence base from terrestrial exposures to space exposures difficult. Additional investigation and understanding of the impact of low-to-moderate doses of ionizing radiation including high (H) atomic number (Z) and energy (E) (HZE) ions on the cerebrovascular system is needed. Furthermore, investigation of how decrements in vascular systems may contribute to development of neurodegenerative diseases in independent or synergistic pathways is important for protecting the long-term health of astronauts.

Status of radon exposure in Bangladeshi locations and dwellings

Potentially higher cancer risk due to exposure from natural background radiation was indicated for the Bangladeshi population by estimations based on the countrywide study. Several regions with elevated natural background exhibited higher soil radium and thorium contents than the world average. Being the decay products of these radioactive elements, natural radon isotopes could constitute environmental risk factors for internal radiation exposure to the lungs of people living in these areas. Although lung cancer is one of the most prevalent types of cancer in Bangladesh, its status and features are still unclear. To clarify the present status of one of the potential risk factors for lung cancer in the country, this review intends to ascertain the countrywide radon exposure, and its pathways by types of local dwelling and by regions, which would provide an indication of the internal exposures in areas of elevated natural background radiation and radionuclides of soil as well as an understanding of the preliminary contribution of environmental radon on the country's lung cancer prevalence. In this review, countrywide monitored air radon exposures for Bangladeshi dwellings and workplaces are organized from peer-reviewed published papers. Radon has been identified as one of influential sources of radiation dose in Bangladesh with its higher radon exhalation and emanation rate from soil. A novel nationwide depiction of the overall assessed indoor and soil radon levels for Bangladesh has been made through radiation maps. This would be helpful for designing future systematic radon/radiological monitoring and research on the country's lung cancer prevalence.

Seasonal Variation of Radon Concentrations in Russian Residential High-Rise Buildings

Assessment of the annual radon concentration is often required in indoor radon surveys of territories and individual dwellings for comparison with reference levels, studying factors affecting radon accumulation in dwellings, assessment of exposure in epidemiological studies, etc. The indoor radon surveys were carried out in multistorey buildings in eight Russian cities using solid state nuclear track detectors with an exposure period of three months. For these surveys, the estimation of annual indoor radon concentration was required to compare radon levels in buildings of high- and low-energy-efficiency classes located in different cities. To develop approaches to seasonal normalization in high-rise buildings, long-term one-hour radon concentration series obtained applying radon-monitors in 20 flats were analyzed. The dependency of indoor radon concentration on the indoor–outdoor temperature difference was studied taking into account the known natural, technogenic and anthropogenic factors affecting radon levels. The developed model of seasonal variations in multistorey buildings includes winter, summer, and demi-season periods, which differ both in ventilation intensity and dependency of radon concentration on the temperature difference. The developed model allows to estimate annual radon concentration taking into account the actual distribution of outdoor temperatures during the exposure of the track detectors.

A 10-year follow-up study of yearly indoor radon measurements in homes, review of other studies and implications on lung cancer risk estimates

Uncertainty on long-term average radon concentration has a large impact on lung cancer risk assessment in epidemiological studies. The uncertainty can be estimated by year-to-year radon concentration variability, however few data are available. In Italy a study has been planned and conducted to evaluate year-to-year radon variability over several years in normally inhabited dwellings, mainly located in Rome. This is the longest study of this kind in Europe; repeat radon measurements are carried out for 10 years using LR-115 radon detectors in the same home in consecutive years. The study includes 84 dwellings with long-term average radon concentration ranging from 28 to 636 Bq/m³. The result shows that year-to-year variability of repeated measurements made in the same home in different years is low, with an overall coefficient of variation of 17%. This is smaller than most of those observed in studies from other European countries and USA, ranging from 15% to 62%. Influencing factors that may explain the differences between this study and other studies have been discussed. Due to the low yearly variability estimated in the present 10-year study, a negligible impact on lung cancer risk estimate for the Italian epidemiological study is expected.

CALCULATION OF DOSE CONVERSION FACTORS BASED ON THE RESULTS OF GEOMETRIC MIXTURE MODELS FOR RISK ASSESSMENT OF RADON EXPOSURE

The results of the geometric mixture model by Tomasek (2011, 2013) were applied for the calculation of radiation risk at radon exposure at the assessment of dose conversion factors (DCF; mSv/WLM) from radon exposure to the effective dose-by-dose conversion convention approach for cohorts with different smoking status. It is shown that the use of a geometric mixture model results in a better agreement between DCF values for men and women.

An assessment of uncertainty using two different modelling techniques to estimate the cost effectiveness of mitigating radon in existing housing in Canada

The burden of lung cancer associated with residential radon in existing housing can be reduced by interventions to screen and mitigate existing housing having radon levels above a mitigation threshold. The objective of this study is to estimate the cost effectiveness of radon interventions for screening and mitigation of existing housing for the 2016 population in Canada and to assess the structural uncertainty associated with the choice of model used in the cost-utility analysis. The incremental cost utility ratios are estimated using both a Markov cohort model and a discrete event simulation model. A societal perspective, a lifetime horizon and a discount rate of 1.5% are adopted. At a radon mitigation threshold of 200 (100) Bq/m³, the discounted ICERs for current rates of screening and mitigation of existing housing are 72,569 (68,758) $/QALY using a Markov cohort model and 84,828 (76,917) $/QALY using discrete event simulation. It appears that minimal structural uncertainty is associated with the choice of model used for this cost-utility analysis, and the cost effectiveness would improve at increased rates of radon testing and mitigation. The mitigation of radon in existing housing is estimated to be a practical policy option for reducing the associated lung cancer burden in Canada.

Combined effect of alpha particles and cigarette smoke on human lung epithelial cells in vitro

Purpose: The combined toxicity of alpha particles and cigarette smoke to the critical cells in the lungs was investigated to assess the risk of smoking workers who handle naturally occurring radioactive materials. Materials and methods: The toxicity of alpha particles and cigarette smoke extract (CSE) was evaluated in terms of DNA double-strand break (DSB) induction and clonogenic cell death of human lung epithelial cells in vitro. The cells were exposed to alpha particles at doses of up to 0.25 Gy for gamma-H2AX assay and from 1.25 Gy to 5 Gy for clonogenic assay. CSE exposure of the cells was facilitated in the culture medium at CSE concentrations ranging from 1% to 12%. Additional experiments were performed using mouse endothelial cells for comparison. Results: The increases in the levels of DNA DSBs were linearly dependent on radiation dose and CSE concentration. The CSE-treated cells also responded with a linearly increasing number of DNA DSBs to the radiation dose. Both human lung epithelial cells and mouse endothelial cells showed exponential decreases in clonogenic surviving fraction as the dose from alpha particle exposure increased. Both cells responded with the clonogenic surviving fractions decreasing in a linear proportion to the CSE concentration in the culture medium. Conclusion: In our experimental in vitro setup, CSE treatment and alpha particle exposure affected the cells in an additive manner either for DNA DSB production or for clonogenic cell death induction.

The burden of cancer attributable to modifiable risk factors in Canada: Methods overview

Up-to-date estimates of current and projected future cancer burden attributable to various exposures are essential for planning and implementing cancer prevention initiatives. The Canadian Population Attributable Risk of Cancer (ComPARe) study was conducted to: i) estimate the number and proportion of cancers diagnosed among adults in Canada in 2015 that are attributable to modifiable risk factors and ii) project the future avoidable cancers by 2042 under various intervention targets. We estimated the population attributable risk (with 95% confidence intervals) and the potential impact fraction of cancers associated with selected lifestyle, environmental, and infectious factors. Exposure-specific sensitivity analyses were also completed where appropriate. Several exposures of interest included active and passive smoking, obesity and abdominal adiposity, leisure-time physical inactivity, sedentary behaviour, alcohol consumption, insufficient fruit and vegetable intake, red and processed meat consumption, air pollution (PM2.5, NO₂), indoor radon gas, ultraviolet radiation (UVR), hepatitis B and C virus, Helicobacter pylori, Epstein-Barr virus, human papillomavirus, human herpesvirus type 8 and human T-cell lymphotropic virus type 1. We used the 2015 cancer incidence data for 35 cancer sites from the Canadian Cancer Registry and projected cancer incidence to 2042 using historical data from 1983 to 2012. Here, we provide an overview of the data sources and methods used in estimating the current and future cancer burden in Canada. Specific methodologic details for each exposure are included in the individual articles included as part of this special issue.

Indoor radon exposure increases tumor mutation burden in never-smoker patients with lung adenocarcinoma

OBJECTIVES

Radon, a natural radiation, is the leading environmental cause of lung cancer in never-smokers. However, the radon exposure impact on the mutational landscape and tumor mutation burden (TMB) of lung cancer in never-smokers has not been explored. The aim of this study was to investigate the mutational landscape of lung adenocarcinoma in never-smokers who were exposed to various degrees of residential radon.

MATERIALS AND METHODS

To investigate the effect of indoor radon exposure, we estimated the cumulative exposure to indoor radon in each house of patients with lung cancer with a never-smoking history. Patients with at least 2 year-duration of residence before the diagnosis of lung adenocarcinoma were included. Patients were subgrouped based on the median radon exposure level (48 Bq/m³): radon-high vs. radon-low and targeted sequencing of tumor and matched blood were performed in all patients.

RESULTS

Among 41 patients with lung adenocarcinoma, the TMB was significantly higher in the radon-high group than it was in the radon-low group (mean 4.94 vs. 2.6 mutations/Mb, P = 0.01). The recurrence rates between radon-high and radon-low group did not differ significantly. Mutational signatures of radon-high tumors showed features associated with inactivity of the base excision repair and DNA replication machineries. The analysis of tumor evolutionary trajectories also suggested a series of mutagenesis induced by radon exposure. In addition, radon-high tumors revealed a significant protein-protein interaction of genes involved in DNA damage and repair (P <  0.001).

CONCLUSIONS

Indoor radon exposure increased the TMB in never-smoker patients with lung adenocarcinoma and their mutational signature was associated with defective DNA mismatch repair.

Projected lifetime cancer risks from occupational radiation exposure among diagnostic medical radiation workers in South Korea

BACKGROUND

Timely assessment of cancer risk from current radiation exposure among medical radiation workers can contribute to the development of strategies to prevent excessive occupational radiation exposure. The purpose of the present study is to estimate the lifetime risk of cancers induced by occupational radiation exposure among medical radiation workers.

METHODS

Using estimated organ doses and the RadRAT risk assessment tool, the lifetime cancer risk was estimated among medical radiation workers who were enrolled in the Korean National Dose Registry from 1996 to 2011. Median doses were used for estimating the risk because of the skewed distribution of radiation doses. Realistic representative exposure scenarios in the study population based on sex, job start year, and occupational group were created for calculating the lifetime attributable risk (LAR) and lifetime fractional risk (LFR).

RESULTS

The mean estimated lifetime cancer risk from occupational radiation exposure varied significantly by sex and occupational group. The highest LAR was observed in male and female radiologic technologists who started work in 1991 (264.4/100,000 and 391.2/100,000, respectively). Female workers had a higher risk of radiation-related excess cancer, although they were exposed to lower radiation doses than male workers. The higher LAR among women was attributable primarily to excess breast and thyroid cancer risks. LARs among men were higher than women in most other cancer sites. With respect to organ sites, LAR of colon cancer (44.3/100,000) was the highest in male radiologic technologists, whereas LAR of thyroid cancer (222.0/100,000) was the highest in female radiologic technologists among workers who started radiologic practice in 1991. Thyroid and bladder cancers had the highest LFR among radiologic technologists.

CONCLUSIONS

Our findings provide an assessment of the potential cancer risk from occupational radiation exposure among medical radiation workers, based on current knowledge about radiation risk. Although the radiation-related risk was small in most cases, it varied widely by sex and occupational group, and the risk would be underestimated due to the use of median, rather than mean, doses. Therefore, careful monitoring is necessary to optimize radiation doses and protect medical radiation workers from potential health risks, particularly female radiologic technologists.

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.

Global Estimate of Lung Cancer Mortality Attributable to Residential Radon

BACKGROUND

Radon is the second most important cause of lung cancer, ranked by the World Health Organization as the fifth leading cause of mortality in 2010. An updated database of national radon exposures for 66 countries allows the global burden of lung cancer mortality attributable to radon to be estimated.

OBJECTIVE

Our goal was to estimate the global population attributable burden of lung cancer mortality in 2012 from residential radon.

METHODS

Estimates of the population attributable risk (PAR) of lung cancer mortality from radon were determined using the attributable fraction approach, using three models for excess relative risk of lung cancer from radon.

RESULTS

The estimates of the median PAR of lung cancer mortality from residential radon in 2012 for the 66 countries having representative national radon surveys were consistent, as 16.5%, 14.4%, and 13.6% for the exposure-age-concentration (EAC) model (BEIR VI), the Hunter model, and the Kreuzer model, respectively. The mean PAR using the EAC model ranged from 4.2% (95% CI: 0.9, 11.7) for Japan, to 29.3% (95% CI: 22.9, 35.7) for Armenia, with a median for the 66 countries of 16.5%. Radon-attributable lung cancer deaths for all 66 countries totaled 226,057 in 2012 and represent a median of 3.0% of total cancer deaths.

CONCLUSIONS

Consistent findings between the three models used to estimate excess relative risks of lung cancer from radon, and between the attributable fraction methodology and the life table analysis, confirm that residential radon is responsible for a substantial proportion of lung cancer mortality worldwide. https://doi.org/10.1289/EHP2503.

Factors Modifying the Radon-Related Lung Cancer Risk at Low Exposures and Exposure Rates among German Uranium Miners

It is still not fully understood whether and how factors such as time, age and smoking modify the relationship between lung cancer and radon at low exposures and exposure rates. Improved knowledge is necessary for the dose conversion of radon in working level month (WLM) into effective dose, as currently discussed by the International Commission on Radiological Protection (ICRP). An update of the German uranium miner cohort study (n = 58,974 men) with a 10-year extension of mortality follow-up (1946-2013) was used to further examine this issue. Internal Poisson regression was applied to estimate the excess relative risk (ERR) for lung cancer mortality per unit of cumulative radon exposure in WLM with exponential time-related effect modifiers. In the full cohort restricted to <100 WLM the estimated overall ERR/WLM was 0.006 [95% confidence interval (CI): 0.003; 0.010] based on 1,254 lung cancer deaths and 1,620,190 person-years at risk. Both age at and time since exposure turned out to be important modifiers of the ERR/WLM and were included in the final model. Here, the ERR/WLM centered on age at exposure of 30 years, and 20 years since exposure was 0.016 (95% CI: 0.008; 0.028). This value decreased statistically significantly by approximately 40% and 60% for each 10-year increase in age at exposure and time since exposure, respectively. The joint effect of smoking and radon exposure was investigated in the sub-cohort of miners hired in 1960 or later, which includes data on smoking status. The centered ERR/WLM was slightly higher for non/light smokers compared to moderate/heavy smokers (0.022 versus 0.013). The current findings provide evidence for an increased lung cancer risk at low radon exposures or exposure rates that is modified by age and time. The observed risk is lower, but statistically compatible to those of other miner studies at low exposures or exposure rates. These findings reject an additive- and support a sub- to (supra-) multiplicative interaction between smoking and radon.

Quantitative Health Risk Assessment of Indoor Radon: A Systematic Review

Exposure to radon is a well-established cause of lung cancer in the general population. The aim of the present work is to identify and summarize the results of studies that have assessed the risk of lung cancer due to indoor radon, based on a systematic review of relevant published studies. Sixteen studies from 12 different countries met eligibility criteria. Large differences in radon concentrations were noted between and within individual countries, and variety of risk models used to estimate the attributable fraction. Calculating again the attributable fraction in each of these studies using the same model (coefficient of 16% per 100 becquerels per cubic meter (Bq/m3) derived from the European residential radon study), the new attributable fraction of these selected studies ranged from 3% to 17%. Radon remains a public health concern. Information about radon health risks is important and efforts are needed to decrease the associated health problems.

Population attributable risk associated with lung cancer induced by residential radon in Canada: Sensitivity to relative risk model and radon probability density function choices: In memory of Professor Jan M. Zielinski

Indoor radon has been identified as the second leading cause of lung cancer after tobacco smoking. The Population Attributable Risk (PAR) estimates the proportion of lung cancer cases associated with indoor radon exposure. Different relative risk (RR) models have been used in the literature to calculate PAR. The aim of this study is to assess how sensitive PAR is to the relative risk model and radon probability distribution functions choices.

METHODS

Using Canadian observed first floor radon data collected by Health Canada during the period October 2010 to March 2011, seven common PAR radon models used for North American miners and dwelling scenarios were applied. The death rates used for this study were from the period 2006-2009. Smoking data (Ever Smoking ES and Never Smoking NS) collected in 2009 was also used in this study. The original discrete radon data for Canada overall and for each of its provinces are estimated using log-normal and Gaussian kernel density estimator distributions. PAR was then calculated for Canada and its provinces using the empirical, log-normal, and Gaussian kernel estimates distributions. Finally, cancer death cases attributable to radon are reported for the constant relative risk model for the three distributions and the reduction in the cases when the action level 200Bq/m³ is applied.

RESULTS

PAR for the Canadian data is sensitive to the model choice, and it varies with a range of 10% for ES and 32% for NS, respectively. There is little difference in results between miners' models and dwelling models. PAR values for ES females are greater than those for ES males, except in Saskatchewan, Northwest Territories, Nunavut, and Yukon. The male-female range overlaps. Gaussian kernel estimator produces PAR estimates similar to the commonly used log-normal distribution.

CONCLUSION

Many lung cancer cases could be prevented in Canada by reducing indoor radon. PAR is sensitive to the choice of RR model. Miners' models can be used for residential radon. Empirical, log-normal, and Gaussian kernel density estimation with support [0,∞) can all be applied to radon data.

PinX1 Is a Potential Prognostic Factor for Non-Small-Cell Lung Cancer and Inhibits Cell Proliferation and Migration

PinX1 has been identified as a suppressor of telomerase enzymatic activity. However, the tumour-suppressive roles of PinX1 in different types of human cancers are unclear. PinX1 expression status and its correlation with clinicopathological features in non-small-cell lung cancer (NSCLC) have not been investigated. Accordingly, in this study, we aimed to evaluate the roles of PinX1 in NSCLC. PinX1 expression status was examined by immunohistochemistry using tissue microarray from a total of 158 patients. Correlations among PinX1 expression, clinicopathological variables, and patient survival were analysed. Furthermore, we overexpressed PinX1 in NSCLC cells and tested telomerase activity using real-time quantitative telomeric repeat amplification protocol (qTRAP) assays. Proliferation and migration of NSCLC cells were examined using the MTS method, wound healing assays, and transwell assays, respectively. Our results showed that negative PinX1 expression was associated with a poor prognosis in NSCLC. Sex, smoking status, lymph gland status, subcarinal lymph node status, pathological stage, and PinX1 expression were related to survival. PinX1 was not an independent prognostic factor in NSCLC. PinX1 overexpression inhibited proliferation and migration in NSCLC cells by suppressing telomerase activity. Our findings suggested that PinX1 could be a potential tumour suppressor in NSCLC and that loss of PinX1 promoted NSCLC progression.

Current knowledge on radon risk: implications for practical radiation protection? radon workshop, 1/2 December 2015, Bonn, BMUB (Bundesministerium für Umwelt, Naturschutz, Bau und Reaktorsicherheit; Federal Ministry for the Environment, Nature Conservation, Building and Nuclear Safety)

ICRP suggested a strategy based on the distinction between a protection approach for dwellings and one for workplaces in the previous recommendations on radon. Now, the Commission recommends an integrated approach for the protection against radon exposure in all buildings irrespective of their purpose and the status of their occupants. The strategy of protection in buildings, implemented through a national action plan, is based on the application of the optimisation principle below a derived reference level in concentration (maximum 300 Bq m(-3)). A problem, however, arises that due to new epidemiological findings and application of dosimetric models, ICRP 115 (Ann ICRP 40, 2010) presents nominal probability coefficients for radon exposure that are approximately by a factor of 2 larger than in the former recommendations of ICRP 65 (Ann ICRP 23, 1993). On the basis of the so-called epidemiological approach and the dosimetric approach, the doubling of risk per unit exposure is represented by a doubling of the dose coefficients, while the risk coefficient of ICRP 103 (2007) remains unchanged. Thus, an identical given radon exposure situation with the new dose coefficients would result in a doubling of dose compared with the former values. This is of serious conceptual implications. A possible solution of this problem was presented during the workshop.

Radon exposure and lung cancer: risk in nonsmokers among cohort studies

Eleven cohorts of miners occupationally exposed to relatively high concentrations of radon showed a statistically significantly high risk of lung cancer, while three cohorts from the general population showed a relatively low concentration, but the results were not statistically significant. However, the risk of lung cancer tended to increase with increased radon exposure. The risk is likely to have been underestimated due to low statistical power. Therefore, additional well-designed studies on the risk of lung cancer in nonsmokers in the general population with relatively low concentrations of radon exposure are needed in the future. In addition, country-specific preventive policies are needed in order to actively reduce radon exposure and lung cancer incidence in nonsmokers.

Radon-induced alterations in p53-mediated energy metabolism of malignantly transformed human bronchial epithelial cells

Radon and its progeny were confirmed to be a category I carcinogenic agent. However, the molecular basis underlying carcinogenesis induced by radon has not been fully elucidated. Expression of p53, a key regulator in glycolysis, is known to be decreased in carcinogenesis. The aim of this investigation was to determine changes in energy metabolism mediated by p53-related metabolic pathway using radon-induced transformation of human bronchial epithelial (HBE) cells. HBE cells were exposed to radon for 20 min at a concentration of 20,000 Bq/m(3) and cultured for 3 d, and exposed again at the same concentration and duration. This was repeated 10 times with culture for 35 passages until malignant transformation occurred. During the culturing process, the levels of lactate and lactate dehydrogenase (LDH) and ratio of NAD(+)/NADH gradually increased between passages. Between passages 30 and 35, p53 target gene synthesis of cytochrome c oxidase 2 (SCO2), TP53-induced glycolysis, and apoptosis regulator (TIGAR) expression were significantly decreased. Data demonstrated that p53-associated metabolic pathways may be altered in radon-mediated malignant transformation.

Residential Radon Exposure and Incidence of Childhood Lymphoma in Texas, 1995-2011

There is warranted interest in assessing the association between residential radon exposure and the risk of childhood cancer. We sought to evaluate the association between residential radon exposure and the incidence of childhood lymphoma in Texas. The Texas Cancer Registry (n = 2147) provided case information for the period 1995–2011. Denominator data were obtained from the United States Census. Regional arithmetic mean radon concentrations were obtained from the Texas Indoor Radon Survey and linked to residence at diagnosis. Exposure was assessed categorically: ≤25th percentile (reference), >25th to ≤50th percentile, >50th to ≤75th percentile, and >75th percentile. Negative binomial regression generated adjusted incidence rate ratios (aIRR) and 95% confidence intervals (CI). We evaluated lymphoma overall and by subtype: Hodgkin (HL; n = 1248), Non-Hodgkin excluding Burkitt (non-BL NHL; n = 658), Burkitt (BL; n = 241), and Diffuse Large B-cell (DLBCL; n = 315). There was no evidence that residential radon exposure was positively associated with lymphoma overall, HL, or BL. Areas with radon concentrations >75th percentile had a marginal increase in DLBCL incidence (aIRR = 1.73, 95% CI: 1.03–2.91). In one of the largest studies of residential radon exposure and the incidence of childhood lymphoma, we found little evidence to suggest a positive or negative association; an observation consistent with previous studies.

The role of the implementation of policies for the prevention of exposure to Radon in Brazil-a strategy for controlling the risk of developing lung cancer

Lung cancer is the leading cause of cancer death in the United States and other industrialised countries. The most important risk factor is active smoking. However, given the increased incidence of lung cancer in non-smokers, it is necessary to improve knowledge regarding other risk factors. Radon (Rn) is a noble gas and is the most important natural source of human exposure to ionizing radiation. Exposure to high levels of this radioactive gas is related to an increased risk of developing lung cancer. The objective of this work is to highlight the importance of measuring indoor concentration of this gas and identify which steps should be taken for achieving radiological protection. A survey was conducted on the websites of the National Health Surveillance Agency (ANVISA), LAMIN (Mineral Analysis Laboratory), CPRM (Geological Survey of Brazil), Ministry of Health and PubMed. Using the words 'radon', 'lung', 'cancer', and PubMed®, 1,371 results were obtained; when using the words 'radon', 'lung', 'cancer', and with 'Brazil' or 'Brazilians', only six results were obtained. We emphasise that lung cancer is a major public health problem and the exposure to Rn indoors should be considered as a risk factor for lung cancer in non-smokers. Buildings or houses with high concentrations of Rn should be identified. However, currently in Brazil-a country with great potential for mineral extraction-there are no specific regulated recommendations to control indoor exposure to Rn.