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Kaler AK, Patel K, Patil H, Tiwarekar Y, Kulkarni B, Hastak M, Athikari N, Rane S, Nikam A, Umarji S, Shaikh I, Goyle S, Mistry R. Mutational Analysis of EGFR Mutations in Non-Small Cell Lung Carcinoma-An Indian Perspective of 212 Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:758. [PMID: 36613084 PMCID: PMC9819110 DOI: 10.3390/ijerph20010758] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 12/17/2022] [Accepted: 12/27/2022] [Indexed: 06/17/2023]
Abstract
Lung cancer is the world's leading cause of cancer-related deaths. Epidermal growth factor receptor (EGFR) is one of the critical oncogenes and plays a significant role in tumor proliferation and metastasis. Patients with sensitizing mutations in the EGFR gene have better clinical outcomes when treated with tyrosine kinase inhibitors (TKI). This study expands our knowledge of the spectrum of EGFR mutations among lung cancer patients in the Indian scenario. This is a retrospective descriptive study of all newly diagnosed patients with lung cancer in tertiary care hospital in India. All the samples were subjected to real-time PCR (q-PCR) analysis and confirmation of rare novel mutations was done using Sanger sequencing. Clinicopathological characteristics, mutational EGFR status, and location on the exon and metastatic sites were evaluated. An analysis of total 212 samples showed mutations in 38.67% of cases. Among these, five (5.9%) samples had mutations in exon 18, 41 (48.8%) samples had mutations in exon 19, 12 (14.28%) samples had mutations in exon 20, and 26 (30.95%) samples had mutations in exon 21. Eleven (13.41%) were found to be uncommon EGFR mutations. Additionally, six (21.4%) samples that had EGFR mutations were also positive for brain metastasis. Future testing on bigger panels will help to characterize the incidence of genetic mutations and to determine the appropriate targeted treatment choices for NSCLC patients.
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Affiliation(s)
- Amrit Kaur Kaler
- Department of Molecular Pathology and Genomics, Kokilaben Dhirubhai Ambani Hospital, Mumbai 400053, India
| | - Khushi Patel
- Department of Molecular Pathology and Genomics, Kokilaben Dhirubhai Ambani Hospital, Mumbai 400053, India
| | - Harshali Patil
- Department of Molecular Pathology and Genomics, Kokilaben Dhirubhai Ambani Hospital, Mumbai 400053, India
| | - Yash Tiwarekar
- Department of Molecular Pathology and Genomics, Kokilaben Dhirubhai Ambani Hospital, Mumbai 400053, India
| | - Bijal Kulkarni
- Department of Pathology, Kokilaben Dhirubhai Ambani Hospital, Mumbai 400053, India
| | - Meenal Hastak
- Department of Pathology, Kokilaben Dhirubhai Ambani Hospital, Mumbai 400053, India
| | - Nivetha Athikari
- Department of Pathology, Kokilaben Dhirubhai Ambani Hospital, Mumbai 400053, India
| | - Samrudhi Rane
- Department of Molecular Pathology and Genomics, Kokilaben Dhirubhai Ambani Hospital, Mumbai 400053, India
| | - Ankita Nikam
- Department of Molecular Pathology and Genomics, Kokilaben Dhirubhai Ambani Hospital, Mumbai 400053, India
| | - Smita Umarji
- Department of Molecular Pathology and Genomics, Kokilaben Dhirubhai Ambani Hospital, Mumbai 400053, India
| | - Imran Shaikh
- Department of Oncology, Kokilaben Dhirubhai Ambani Hospital, Mumbai 400053, India
| | - Sandeep Goyle
- Department of Oncology, Kokilaben Dhirubhai Ambani Hospital, Mumbai 400053, India
| | - Rajesh Mistry
- Department of Oncology, Kokilaben Dhirubhai Ambani Hospital, Mumbai 400053, India
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Ngoc LTN, Park D, Lee YC. Human Health Impacts of Residential Radon Exposure: Updated Systematic Review and Meta-Analysis of Case-Control Studies. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:ijerph20010097. [PMID: 36612419 PMCID: PMC9819115 DOI: 10.3390/ijerph20010097] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 12/13/2022] [Accepted: 12/19/2022] [Indexed: 05/27/2023]
Abstract
This study investigated the impact of residential radon exposure on human cancers (i.e., lung cancer and childhood leukemia) through a systematic review and meta-analysis of case−control studies. A total of 9724 articles obtained from electronic databases were assessed; however, only 55 case−control studies were eligible after manually screening and eliminating unnecessary studies. The causal associations were addressed by determining the meta-analysis’s estimated size effects (i.e., ORs/RRs) of the meta-analysis. Residential radon was revealed to significantly increase the incidence of lung cancer and childhood leukemia with pooled ORs of 1.38 [1.19; 1.60] (I2 = 90%; p < 0.00001) and 1.43 [1.19; 1.72] (I2 = 0% and p = 0.51), respectively. In addition, subgroup analyses were performed to reduce the heterogeneity of the initial meta-analyses. The results provided strong evidence that inhaling radon in the indoor environments is closely associated with the development of lung cancer and childhood leukemia in patients living in Europe and areas with high radon levels (≥100 Bq/m3).
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Affiliation(s)
- Le Thi Nhu Ngoc
- Department of Industrial and Environmental Engineering, Graduate School of Environment, Gachon University, 1342 Seongnam-daero, Seongnam-si 13120, Republic of Korea
| | - Duckshin Park
- Korea Railroad Research Institute (KRRI), 176 Cheoldobakmulkwan-ro, Uiwang-si 16105, Republic of Korea
| | - Young-Chul Lee
- Department of BioNano Technology, Gachon University, 1342 Seongnam-daero, Seongnam-si 13120, Republic of Korea
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Zablotska LB, Lane RSD, Randhawa K. Association between exposures to radon and γ-ray radiation and histologic type of lung cancer in Eldorado uranium mining and milling workers from Canada. Cancer 2022; 128:3204-3216. [PMID: 35766801 PMCID: PMC9545258 DOI: 10.1002/cncr.34351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 04/25/2022] [Accepted: 04/28/2022] [Indexed: 11/08/2022]
Abstract
Background The authors assessed the association between radon decay products (RDP) exposure and histologic types of incident lung cancer in a cohort of 16,752 (91.6% male) Eldorado uranium workers who were first employed from 1932 to 1980 and were followed through 1969–1999. Methods Substantially revised identifying information and RDP exposures were obtained on workers from the Port Radium and Beaverlodge uranium mines and from the Port Hope radium and uranium refinery and processing facility in Canada. Poisson regression was conducted using the National Research Council's Biological Effects of Ionizing Radiation (BEIR) VI–type models to estimate the risks of lung cancer by histologic type from RDP exposures and γ‐ray doses. Results Lung cancer incidence was significantly higher in workers compared with the general Canadian male population. Radiation risks of lung cancer for all histologic types (n = 594; 34% squamous cell, 16% small cell, 17% adenocarcinoma) increased with increasing RDP exposure, with no indication of curvature in the dose response (excess relative risk per 100 working level months = 0.61; 95% confidence interval, 0.39–0.91). Radiation risks did not differ by histologic type (p = .144). The best‐fitting BEIR VI–type model included adjustments for the significant modifying effects of time since exposure, exposure rate, and attained age. The addition of γ‐ray doses to the model with RDP exposures improved the model fit, but the risk estimates remained unchanged. Conclusions The first analysis of radiation risks of lung cancer histologic types in the Eldorado cohort supported the use of BEIR VI–type models to predict the future risk of histologic types of lung cancer from past and current RDP exposures. Lay summary Lung cancer survival depends strongly on the cell type of lung cancer. The best survival rates are for patients who have the adenocarcinoma type. This study included 16,752 Eldorado uranium workers who were exposed to radon and γ‐ray radiation during 1932–1980, were alive in 1969, and were followed for the development of new lung cancer during 1969–1999. One third of all lung cancers were of the squamous cell type, whereas the adenocarcinoma and small cell types accounted for less than 20% each. Radiation risks of lung cancer among men increased significantly with increasing radon exposure for all cell types, with the highest risks estimated for small cell and squamous cell lung cancers.
Risks of incident lung cancer in male workers increased significantly with increasing radon exposure, with no indication of curvature or differences in dose response between histologic types. The highest risks were observed for the small cell and squamous cell types of lung cancer.
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Affiliation(s)
- Lydia B Zablotska
- Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, San Francisco, California, USA
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Li J, Wei X, Gu L, Qiu L, Xiang M, Zhang H, Xia L, Pan W, Yang Z, Zhou X, Zeng D, Jiang J. Elevated air quality index and fine particulate matter levels contribute to the poor prognosis and progression of nonsmall-cell lung cancer: A cohort study combined with external validation. Cancer Med 2022; 11:3272-3281. [PMID: 35312179 PMCID: PMC9468439 DOI: 10.1002/cam4.4701] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 02/16/2022] [Accepted: 03/13/2022] [Indexed: 12/20/2022] Open
Abstract
Background Poor air quality can result in a variety of respiratory disorders. However, the air quality index (AQI) and the level of fine particulate matter (PM2.5) on the progression and prognosis of nonsmall‐cell lung cancer (NSCLC) are unclear. Methods We launched a cohort study focused on the relationship between air quality and overall survival as well as progression, incorporating data from 590 patients with NSCLC in our medical center between November 1, 2013 and March 1, 2016. Forty‐nine patients from Sichuan Cancer Hospital were used for validation. Results Cases with poorer AQI 6 months before NSCLC diagnosis were more likely to progress to stage III to IV NSCLC than controls (OR = 2.61, 95% CI 1.35–5.24, p = 0.005). Similarly, if exposed to high levels of PM2.5 during these 6 months, overall survival was poor (HR [95% CI] = 1.53 [1.13, 2.07], p = 0.006). According to multivariate analysis, age, gender, KPS, PM2.5, hyperlipemia, and NSCLC stage were independent risk factors of overall survival. A predictive model developed by these factors above yielded a favorable agreement (C‐index = 0.758) on the calibration curve. External validation was conducted by 46 patients from Sichuan Cancer Hospital displaying an AUC of 0.724 (0.684–0.763). Conclusions PM2.5 and AQI levels affect disease progression and long‐term survival in NSCLC patients. An overall survival prediction model based on the PM2.5 level can help clinicians predict the risk of death in NSCLC.
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Affiliation(s)
- Jing Li
- Department of Medicine, Respiratory, Emergency and Intensive Care Medicine, The Affiliated Dushu Lake Hospital of Soochow University, Suzhou, China
| | - Xiaoying Wei
- Department of Medicine, Respiratory, Emergency and Intensive Care Medicine, The Affiliated Dushu Lake Hospital of Soochow University, Suzhou, China
| | - Ling Gu
- Department of Medicine, Respiratory, Emergency and Intensive Care Medicine, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Linya Qiu
- Gusu District Center for Disease Control and Prevention, Soochow, People's Republic of China
| | - Mengqi Xiang
- Department of Medical Oncology, Sichuan Cancer Hospital, Medical School of University of Electronic Science and Technology of China, Chengdu, China
| | - Huachuan Zhang
- Department of Thoracic Surgery, Sichuan Cancer Hospital, Medical School of University of Electronic Science and Technology of China, Chengdu, China
| | - Lei Xia
- Department of Medicine, Respiratory, Emergency and Intensive Care Medicine, The Affiliated Dushu Lake Hospital of Soochow University, Suzhou, China
| | - Wenying Pan
- Department of Medicine, Respiratory, Emergency and Intensive Care Medicine, The Affiliated Dushu Lake Hospital of Soochow University, Suzhou, China
| | - Zhenyu Yang
- Department of Medicine, Respiratory, Emergency and Intensive Care Medicine, The Affiliated Dushu Lake Hospital of Soochow University, Suzhou, China
| | - Xiaoli Zhou
- Department of Medicine, Respiratory, Emergency and Intensive Care Medicine, The Affiliated Dushu Lake Hospital of Soochow University, Suzhou, China
| | - Daxiong Zeng
- Department of Medicine, Respiratory, Emergency and Intensive Care Medicine, The Affiliated Dushu Lake Hospital of Soochow University, Suzhou, China
| | - Junhong Jiang
- Department of Medicine, Respiratory, Emergency and Intensive Care Medicine, The Affiliated Dushu Lake Hospital of Soochow University, Suzhou, China
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Cheng ES, Egger S, Hughes S, Weber M, Steinberg J, Rahman B, Worth H, Ruano-Ravina A, Rawstorne P, Yu XQ. Systematic review and meta-analysis of residential radon and lung cancer in never-smokers. Eur Respir Rev 2021; 30:30/159/200230. [PMID: 33536262 PMCID: PMC9488946 DOI: 10.1183/16000617.0230-2020] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 10/28/2020] [Indexed: 12/26/2022] Open
Abstract
Background Globally, radon is the leading risk factor for lung cancer in never-smokers (LCINS). In this study, we systematically reviewed and meta-analysed the evidence of the risk of LCINS associated with residential radon exposure. Methods Medline and Embase databases were searched using predefined inclusion and exclusion criteria to identify relevant studies published from 1 January 1990 to 5 March 2020 focused on never-smokers. We identified four pooled collaborative studies (incorporating data from 24 case–control studies), one case–control study and one cohort study for systematic review. Meta-analysis was performed on the results of the four pooled studies due to different measures of effect and outcome reported in the cohort study and insufficient information reported for the case–control study. In a post hoc analysis, the corresponding risk for ever-smokers was also examined. Results Risk estimates of lung cancer from residential radon exposure were pooled in the meta-analysis for 2341 never-smoker cases, 8967 never-smoker controls, 9937 ever-smoker cases and 12 463 ever-smoker controls. Adjusted excess relative risks (aERRs) per 100 Bq·m−3 of radon level were 0.15 (95% CI 0.06–0.25) for never-smokers and 0.09 (95% CI 0.03–0.16) for ever-smokers, and the difference between them was statistically insignificant (p=0.32). The aERR per 100 Bq·m−3was higher for men (0.46; 95% CI 0.15–0.76) than for women (0.09; 95% CI −0.02–0.20) among never-smokers (p=0.027). Conclusion This study provided quantified risk estimates for lung cancer from residential radon exposure among both never-smokers and ever-smokers. Among never-smokers in radon-prone areas, men were at higher risk of lung cancer than women. Globally, radon is the leading cause of lung cancer in never-smokers. Yet its quantified link with lung cancer risk among never-smokers is not known. This study computes the risk estimate of lung cancer from residential radon exposure among never-smokers.https://bit.ly/32frCbq
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Affiliation(s)
- Elvin S Cheng
- Cancer Research Division, Cancer Council NSW, Sydney, Australia .,School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Sam Egger
- Cancer Research Division, Cancer Council NSW, Sydney, Australia
| | - Suzanne Hughes
- Cancer Research Division, Cancer Council NSW, Sydney, Australia.,School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Marianne Weber
- Cancer Research Division, Cancer Council NSW, Sydney, Australia.,School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Julia Steinberg
- Cancer Research Division, Cancer Council NSW, Sydney, Australia.,School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Bayzidur Rahman
- School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
| | - Heather Worth
- School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
| | - Alberto Ruano-Ravina
- Dept of Preventive Medicine and Public Health, University of Santiago de Compostela, Santiago de Compostela, Spain.,Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP, Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública), Madrid, Spain.,Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Patrick Rawstorne
- School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia.,Equal contribution as last author
| | - Xue Qin Yu
- Cancer Research Division, Cancer Council NSW, Sydney, Australia.,School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.,Equal contribution as last author
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Li C, Wang C, Yu J, Fan Y, Liu D, Zhou W, Shi T. Residential Radon and Histological Types of Lung Cancer: A Meta-Analysis of Case‒Control Studies. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17041457. [PMID: 32102460 PMCID: PMC7068370 DOI: 10.3390/ijerph17041457] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 01/13/2020] [Accepted: 02/11/2020] [Indexed: 12/20/2022]
Abstract
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.
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Affiliation(s)
- Cong Li
- Hubei Provincial Center for Disease Control and Prevention, 6 Zhuodaoquan North Road, Wuhan 430079, Hubei, China;
- Department of Preventive Medicine, School of Health Sciences, Wuhan University, Donghu Road 115, Wuhan 430071, Hubei, China; (C.W.); (J.Y.); (Y.F.); (D.L.)
| | - Chunhong Wang
- Department of Preventive Medicine, School of Health Sciences, Wuhan University, Donghu Road 115, Wuhan 430071, Hubei, China; (C.W.); (J.Y.); (Y.F.); (D.L.)
| | - Jun Yu
- Department of Preventive Medicine, School of Health Sciences, Wuhan University, Donghu Road 115, Wuhan 430071, Hubei, China; (C.W.); (J.Y.); (Y.F.); (D.L.)
| | - Yongsheng Fan
- Department of Preventive Medicine, School of Health Sciences, Wuhan University, Donghu Road 115, Wuhan 430071, Hubei, China; (C.W.); (J.Y.); (Y.F.); (D.L.)
| | - Duanya Liu
- Department of Preventive Medicine, School of Health Sciences, Wuhan University, Donghu Road 115, Wuhan 430071, Hubei, China; (C.W.); (J.Y.); (Y.F.); (D.L.)
| | - Wenshan Zhou
- Hubei Provincial Center for Disease Control and Prevention, 6 Zhuodaoquan North Road, Wuhan 430079, Hubei, China;
- Correspondence: (W.Z.); (T.S.)
| | - Tingming Shi
- Hubei Provincial Center for Disease Control and Prevention, 6 Zhuodaoquan North Road, Wuhan 430079, Hubei, China;
- Correspondence: (W.Z.); (T.S.)
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Lipfert FW, Wyzga RE. Longitudinal relationships between lung cancer mortality rates, smoking, and ambient air quality: a comprehensive review and analysis. Crit Rev Toxicol 2020; 49:790-818. [DOI: 10.1080/10408444.2019.1700210] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Lorenzo-González M, Torres-Durán M, Barbosa-Lorenzo R, Provencio-Pulla M, Barros-Dios JM, Ruano-Ravina A. Radon exposure: a major cause of lung cancer. Expert Rev Respir Med 2019; 13:839-850. [DOI: 10.1080/17476348.2019.1645599] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- María Lorenzo-González
- Service of Preventive Medicine, University Hospital Complex of Ourense, Ourense, Spain
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Santiago de Compostela, Spain
| | | | | | | | - Juan Miguel Barros-Dios
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Santiago de Compostela, Spain
- 5CIBER de Epidemiología y Salud Pública CIBERESP, Santiago de Compostela, Spain
- Service of Preventive Medicine, University Hospital Complex of Santiago de Compostela, Spain
| | - Alberto Ruano-Ravina
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Santiago de Compostela, Spain
- 5CIBER de Epidemiología y Salud Pública CIBERESP, Santiago de Compostela, Spain
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Abstract
Radon is a naturally occurring radioactive material that is formed as the decay product of uranium and thorium, and is estimated to contribute to approximately half of the average annual natural background radiation. When inhaled, it damages the lungs during radioactive decay and affects the human body. Through many epidemiological studies regarding occupational exposure among miners and residential exposure among the general population, radon has been scientifically proven to cause lung cancer, and radon exposure is the second most common cause of lung cancer after cigarette smoking. However, it is unclear whether radon exposure causes diseases other than lung cancer. Media reports have often dealt with radon exposure in relation to health problems, although public attention has been limited to a one-off period. However, recently in Korea, social interest and concern about radon exposure and its health effects have increased greatly due to mass media reports of high concentrations of radon being released from various close-to-life products, such as mattresses and beauty masks. Accordingly, this review article is intended to provide comprehensive scientific information regarding the health effects of radon exposure.
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Affiliation(s)
- Jin Kyu Kang
- Dongnam Radiation Emergency Medical Center, Busan, Korea
- Department of Radiation Oncology, Dongnam Institute of Radiological & Medical Sciences, Busan, Korea
| | - Songwon Seo
- National Radiation Emergency Medical Center, Korea Institute of Radiological & Medical Sciences, Seoul, Korea
| | - Young Woo Jin
- National Radiation Emergency Medical Center, Korea Institute of Radiological & Medical Sciences, Seoul, Korea.
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10
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Gogna P, Narain TA, O'Sullivan DE, Villeneuve PJ, Demers PA, Hystad P, Brenner DR, Friedenreich CM, King WD. Estimates of the current and future burden of lung cancer attributable to residential radon exposure in Canada. Prev Med 2019; 122:100-108. [PMID: 31078163 DOI: 10.1016/j.ypmed.2019.04.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Radon is widely recognized as a human carcinogen and findings from epidemiologic studies support a causal association between residential radon exposure and lung cancer risk. Our aim was to derive population attributable risks (PAR) to estimate the numbers of incident lung cancer due to residential radon exposure in Canada in 2015. Potential impact fractions for 2042 were estimated based on a series of counterfactuals. A meta-analysis was conducted to estimate the relative risk of lung cancer per 100 Becquerels (Bq)/m3 increase in residential radon exposure, with a pooled estimate of 1.16 (95% CI: 1.07-1.24). The population distribution of annual residential radon exposure was estimated based on a national survey with adjustment for changes in the population distribution over time, the proportion of Canadians living in high-rise buildings, and to reflect annual rather than winter levels. An estimated 6.9% of lung cancer cases in 2015 were attributable to exposure to residential radon, accounting for 1741 attributable cases. If mitigation efforts were to reduce all residential radon exposures that are above current Canadian policy guidelines of 200 Bq/m3 (3% of Canadians) to 50 Bq/m3, 293 cases could be prevented in 2042, and 2322 cumulative cases could be prevented between 2016 and 2042. Our results show that mitigation that exclusively targets Canadian homes with radon exposures above current Canadian guidelines may not greatly alleviate the future projected lung cancer burden. Mitigation of residential radon levels below current guidelines may be required to substantially reduce the overall lung cancer burden in the Canadian population.
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Affiliation(s)
- Priyanka Gogna
- Department of Public Health Sciences, Queen's University, Kingston, Canada
| | - Tasha A Narain
- Department of Public Health Sciences, Queen's University, Kingston, Canada
| | - Dylan E O'Sullivan
- Department of Public Health Sciences, Queen's University, Kingston, Canada
| | - Paul J Villeneuve
- Department of Health Sciences, Carleton University, Ottawa, Ontario, Canada
| | - Paul A Demers
- Occupational Cancer Research Centre, Toronto, Ontario, Canada
| | - Perry Hystad
- College of Public Health and Human Sciences Oregon State University, Corvallis, OR, USA
| | - Darren R Brenner
- Department of Cancer Epidemiology and Prevention Research, CancerControl Alberta, Alberta Health Services, Calgary, Alberta, Canada; Departments of Oncology and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Christine M Friedenreich
- Department of Cancer Epidemiology and Prevention Research, CancerControl Alberta, Alberta Health Services, Calgary, Alberta, Canada; Departments of Oncology and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Will D King
- Department of Public Health Sciences, Queen's University, Kingston, Canada.
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- Departments of Oncology and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Malinovsky G, Yarmoshenko I, Vasilyev A. Meta-analysis of case-control studies on the relationship between lung cancer and indoor radon exposure. RADIATION AND ENVIRONMENTAL BIOPHYSICS 2019; 58:39-47. [PMID: 30535840 DOI: 10.1007/s00411-018-0770-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 12/03/2018] [Indexed: 06/09/2023]
Abstract
Indoor exposure to natural radon is a factor that influences lung cancer risk worldwide. The present study includes a meta-analysis of epidemiological data on the relationship between lung cancer and indoor radon. Altogether, 31 case-control studies with 20,703 cases, 34,518 controls and 140 individual odds ratio (OR) estimates are included in the meta-analysis. Weighted median OR was calculated for five radon intervals. The following parameters were used for the weighting: standard error of OR, duration of radon concentration measurement, and relative number of controls in reference intervals. The dependence of the weighted median OR on the radon concentration was estimated applying linear non-threshold and threshold models. The results obtained suggest a significant linear no-threshold exposure-effect relationship for radon concentrations above 100 Bq/m3, with a slope of 0.14 (95% confidence interval 0.08-0.21) per 100 Bq/m3.
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Affiliation(s)
- Georgy Malinovsky
- Institute of Industrial Ecology UB RAS, 20, Sophy Kovalevskoy Str., Yekaterinburg, 620219, Russia.
| | - Ilia Yarmoshenko
- Institute of Industrial Ecology UB RAS, 20, Sophy Kovalevskoy Str., Yekaterinburg, 620219, Russia
| | - Aleksey Vasilyev
- Institute of Industrial Ecology UB RAS, 20, Sophy Kovalevskoy Str., Yekaterinburg, 620219, Russia
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Seo S, Ha WH, Kang JK, Lee D, Park S, Kwon TE, Jin YW. Health effects of exposure to radon: implications of the radon bed mattress incident in Korea. Epidemiol Health 2019; 41:e2019004. [PMID: 30754959 PMCID: PMC6446066 DOI: 10.4178/epih.e2019004] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 02/12/2019] [Indexed: 12/12/2022] Open
Abstract
Radon is a naturally occurring radioactive material formed by the slow decay of uranium and thorium found in the earth's crust or construction materials. Internal exposure to radon accounts for about half of the natural background radiation dose to which humans are exposed annually. Radon is a carcinogen and is the second leading cause of lung cancer following smoking. An association between radon and lung cancer has been consistently reported in epidemiological studies on mine workers and the general population with indoor radon exposure. However, associations have not been clearly established between radon and other diseases, such as leukemia and thyroid cancer. Radiation doses are assessed by applying specific dose conversion coefficients according to the source (e.g., radon or thoron) and form of exposure (e.g., internal or external). However, regardless of the source or form of exposure, the effects of a given estimated dose on human health are identical, assuming that individuals have the same sensitivity to radiation. Recently, radiation exceeding the annual dose limit of the general population (1 mSv/yr) was detected in bed mattresses produced by D company due to the use of a monazite-based anion powder containing uranium and thorium. This has sparked concerns about the health hazards for mattress users caused by radiation exposure. In light of this event, this study presents scientific information about the assessment of radon and thoron exposure and its human implications for human health, which have emerged as a recent topic of interest and debate in society.
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Affiliation(s)
- Songwon Seo
- National Radiation Emergency Medical Center, Korea Institute of Radiological and Medical Sciences, Seoul, Korea
| | - Wi-Ho Ha
- National Radiation Emergency Medical Center, Korea Institute of Radiological and Medical Sciences, Seoul, Korea
| | - Jin-Kyu Kang
- National Radiation Emergency Medical Center, Korea Institute of Radiological and Medical Sciences, Seoul, Korea
| | - Dalnim Lee
- National Radiation Emergency Medical Center, Korea Institute of Radiological and Medical Sciences, Seoul, Korea
| | - Soojin Park
- National Radiation Emergency Medical Center, Korea Institute of Radiological and Medical Sciences, Seoul, Korea
| | - Tae-Eun Kwon
- National Radiation Emergency Medical Center, Korea Institute of Radiological and Medical Sciences, Seoul, Korea
| | - Young Woo Jin
- National Radiation Emergency Medical Center, Korea Institute of Radiological and Medical Sciences, Seoul, Korea
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Vaiserman A, Koliada A, Zabuga O, Socol Y. Health Impacts of Low-Dose Ionizing Radiation: Current Scientific Debates and Regulatory Issues. Dose Response 2018; 16:1559325818796331. [PMID: 30263019 PMCID: PMC6149023 DOI: 10.1177/1559325818796331] [Citation(s) in RCA: 107] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 07/30/2018] [Accepted: 07/31/2018] [Indexed: 12/31/2022] Open
Abstract
Health impacts of low-dose ionizing radiation are significant in important fields such as X-ray imaging, radiation therapy, nuclear power, and others. However, all existing and potential applications are currently challenged by public concerns and regulatory restrictions. We aimed to assess the validity of the linear no-threshold (LNT) model of radiation damage, which is the basis of current regulation, and to assess the justification for this regulation. We have conducted an extensive search in PubMed. Special attention has been given to papers cited in comprehensive reviews of the United States (2006) and French (2005) Academies of Sciences and in the United Nations Scientific Committee on Atomic Radiation 2016 report. Epidemiological data provide essentially no evidence for detrimental health effects below 100 mSv, and several studies suggest beneficial (hormetic) effects. Equally significant, many studies with in vitro and in animal models demonstrate that several mechanisms initiated by low-dose radiation have beneficial effects. Overall, although probably not yet proven to be untrue, LNT has certainly not been proven to be true. At this point, taking into account the high price tag (in both economic and human terms) borne by the LNT-inspired regulation, there is little doubt that the present regulatory burden should be reduced.
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Rodríguez-Martínez Á, Torres-Durán M, Barros-Dios JM, Ruano-Ravina A. Residential radon and small cell lung cancer. A systematic review. Cancer Lett 2018; 426:57-62. [PMID: 29654890 DOI: 10.1016/j.canlet.2018.04.003] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 04/04/2018] [Accepted: 04/06/2018] [Indexed: 11/17/2022]
Abstract
Residential radon exposure is considered the second cause of lung cancer and the first in never smokers. Nevertheless, the association between the different histological types of lung cancer and radon is not completely clear, and radon effect on small cell lung cancer is not completely understood. We aim to asses the effect of residential radon exposure on the risk of small cell lung cancer (SCLC) in general population and miners through a systematic review applying predefined inclusion and exclusion criteria. 16 studies were included. Most of them point to a relationship between indoor radon and SCLC, though some investigations show no association. When comparing the risk of SCLC due to radon exposure with NSCLC, it can be observed that an increased risk for SCLC is present. Small cell lung cancer seems to be the histological type of lung cancer most tightly related with residential radon.
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Affiliation(s)
- Ángeles Rodríguez-Martínez
- Service of Medical Oncology, University Hospital Complex of Pontevedra, Spain; Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Spain
| | - María Torres-Durán
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Spain; Service of Neumology, University Hospital Complex of Vigo, Spain
| | - Juan M Barros-Dios
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Spain; CIBER de Epidemiología y Salud Pública, CIBERESP, Spain; Service of Preventive Medicine, University Hospital Complex of Santiago de Compostela, Spain
| | - Alberto Ruano-Ravina
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Spain; CIBER de Epidemiología y Salud Pública, CIBERESP, Spain.
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Dobrzyński L, Fornalski KW, Reszczyńska J. Meta-analysis of thirty-two case-control and two ecological radon studies of lung cancer. JOURNAL OF RADIATION RESEARCH 2018; 59:149-163. [PMID: 29186473 PMCID: PMC5950923 DOI: 10.1093/jrr/rrx061] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Indexed: 05/04/2023]
Abstract
A re-analysis has been carried out of thirty-two case-control and two ecological studies concerning the influence of radon, a radioactive gas, on the risk of lung cancer. Three mathematically simplest dose-response relationships (models) were tested: constant (zero health effect), linear, and parabolic (linear-quadratic). Health effect end-points reported in the analysed studies are odds ratios or relative risk ratios, related either to morbidity or mortality. In our preliminary analysis, we show that the results of dose-response fitting are qualitatively (within uncertainties, given as error bars) the same, whichever of these health effect end-points are applied. Therefore, we deemed it reasonable to aggregate all response data into the so-called Relative Health Factor and jointly analysed such mixed data, to obtain better statistical power. In the second part of our analysis, robust Bayesian and classical methods of analysis were applied to this combined dataset. In this part of our analysis, we selected different subranges of radon concentrations. In view of substantial differences between the methodology used by the authors of case-control and ecological studies, the mathematical relationships (models) were applied mainly to the thirty-two case-control studies. The degree to which the two ecological studies, analysed separately, affect the overall results when combined with the thirty-two case-control studies, has also been evaluated. In all, as a result of our meta-analysis of the combined cohort, we conclude that the analysed data concerning radon concentrations below ~1000 Bq/m3 (~20 mSv/year of effective dose to the whole body) do not support the thesis that radon may be a cause of any statistically significant increase in lung cancer incidence.
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Affiliation(s)
- Ludwik Dobrzyński
- National Centre for Nuclear Research (NCBJ), ul. A. Sołtana 7, 05-400 Otwock-Świerk, Poland
- Corresponding author. National Centre for Nuclear Research (NCBJ), ul. A. Sołtana 7, 05-400 Otwock-Świerk, Poland. Tel: +48-22-273-1612; Fax: +48-22-77-93-481;
| | - Krzysztof W Fornalski
- PGE EJ 1, ul. Mysia 2, 00-496 Warszawa, Poland
- Ex-Polon Laboratory, ul. Podleśna 81a, 05-552 Łazy, Poland
| | - Joanna Reszczyńska
- National Centre for Nuclear Research (NCBJ), ul. A. Sołtana 7, 05-400 Otwock-Świerk, Poland
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Cao X, MacNaughton P, Laurent JC, Allen JG. Radon-induced lung cancer deaths may be overestimated due to failure to account for confounding by exposure to diesel engine exhaust in BEIR VI miner studies. PLoS One 2017; 12:e0184298. [PMID: 28886109 PMCID: PMC5590909 DOI: 10.1371/journal.pone.0184298] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Accepted: 08/21/2017] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND EPA reported that radon is the second leading cause of lung cancer in the United States, killing 21,100 people per year. EPA relies on the BEIR VI models, based on an evaluation of radon exposure and lung cancer risk in studies of miners. But these models did not account for co-exposure to diesel exhaust, a known human carcinogen recently classified by IARC. It is probable then that a portion of the lung cancer deaths in the miner cohorts are originally attributable to the exposure to diesel rather than radon. OBJECTIVE To re-evaluate EPA's radon attributable lung cancer estimates accounting for diesel exposure information in the miner cohorts. METHODS We used estimates of historical diesel concentrations, combined with diesel exposure-response functions, to estimate the risks of lung cancer attributable to diesel engine exhaust (DEE) exposure in the miner studies. We re-calculated the fatal lung cancer risk attributable to radon after accounting for risk from diesel and re-estimated the number of U.S. deaths associated with radon in the U.S. using EPA's methodology. RESULTS Considering the probable confounding with DEE exposure and using the same estimate of baseline mortality from 1989-91 that the EPA currently uses in their calculations, we estimate that radon-induced lung cancer deaths per year are 15,600 (95% CI: 14,300, 17,000)- 19,300 (95% CI: 18,800, 20,000) in the U.S. population, a reduction of 9%-26%. The death estimates would be 12,900-15,900 using 2014 baseline vital statistics. CONCLUSIONS We recommend further research on re-evaluating the health effects of exposure to radon that accounts for new information on diesel exhaust carcinogenicity in BEIR VI models, up-to-date vital statistics and new epidemiological evidence from residential studies.
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Affiliation(s)
- Xiaodong Cao
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Piers MacNaughton
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Jose Cedeno Laurent
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Joseph G. Allen
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
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Sheen S, Lee KS, Chung WY, Nam S, Kang DR. An updated review of case-control studies of lung cancer and indoor radon-Is indoor radon the risk factor for lung cancer? Ann Occup Environ Med 2016; 28:9. [PMID: 26949535 PMCID: PMC4778293 DOI: 10.1186/s40557-016-0094-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 02/18/2016] [Indexed: 01/21/2023] Open
Abstract
Lung cancer is a leading cause of cancer-related death in the world. Smoking is definitely the most important risk factor for lung cancer. Radon (222Rn) is a natural gas produced from radium (226Ra) in the decay series of uranium (238U). Radon exposure is the second most common cause of lung cancer and the first risk factor for lung cancer in never-smokers. Case–control studies have provided epidemiological evidence of the causative relationship between indoor radon exposure and lung cancer. Twenty-four case–control study papers were found by our search strategy from the PubMed database. Among them, seven studies showed that indoor radon has a statistically significant association with lung cancer. The studies performed in radon-prone areas showed a more positive association between radon and lung cancer. Reviewed papers had inconsistent results on the dose–response relationship between indoor radon and lung cancer risk. Further refined case–control studies will be required to evaluate the relationship between radon and lung cancer. Sufficient study sample size, proper interview methods, valid and precise indoor radon measurement, wide range of indoor radon, and appropriate control of confounders such as smoking status should be considered in further case–control studies.
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Affiliation(s)
- Seungsoo Sheen
- Department of Pulmonary and Critical Care Medicine, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Keu Sung Lee
- Department of Pulmonary and Critical Care Medicine, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Wou Young Chung
- Department of Pulmonary and Critical Care Medicine, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Saeil Nam
- Department of Humanities and Social Medicine, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Dae Ryong Kang
- Department of Humanities and Social Medicine, Ajou University School of Medicine, Suwon, Republic of Korea
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Ruano-Ravina A, Prini-Guadalupe L, Barros-Dios JM, Abal-Arca J, Leiro-Fernández V, González-Silva AI, Golpe-Gómez A, González-Barcala FJ, Pena C, Montero-Martínez C, Martínez-González C, Mejuto-Martí MJ, Veres-Racamonde A. Exposición a radón residencial y cáncer de pulmón en nunca fumadores. Resultados preliminares del estudio LCRINS. Arch Bronconeumol 2012; 48:405-9. [DOI: 10.1016/j.arbres.2012.05.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2012] [Revised: 05/18/2012] [Accepted: 05/29/2012] [Indexed: 12/13/2022]
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Barros-Dios JM, Ruano-Ravina A, Pérez-Ríos M, Castro-Bernárdez M, Abal-Arca J, Tojo-Castro M. Residential radon exposure, histologic types, and lung cancer risk. A case-control study in Galicia, Spain. Cancer Epidemiol Biomarkers Prev 2012; 21:951-8. [PMID: 22539606 DOI: 10.1158/1055-9965.epi-12-0146-t] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Lung cancer is an important public health problem, and tobacco is the main risk factor followed by residential radon exposure. Recommended exposure levels have been progressively lowered. Galicia, the study area, has high residential radon concentrations. We aim (i) to assess the risk of lung cancer linked to airborne residential radon exposure, (ii) to ascertain whether tobacco modifies radon risk, and (iii) to know whether there is a lung cancer histologic type more susceptible to radon. METHODS A hospital-based case-control design was conducted in two Spanish hospitals. Consecutive cases with histologic diagnosis of lung cancer and controls undergoing trivial surgery not tobacco-related were included. Residential radon was measured using standard procedures. Results were obtained using logistic regression. RESULTS Three hundred and forty-nine cases and 513 controls were included. Radon exposure posed a risk even with a low exposure, with those exposed to 50 to 100 Bq/m(3) having an OR of 1.87 [95% confidence interval (CI), 1.21-2.88] and of 2.21 (95% CI, 1.33-3.69) for those exposed to 148 Bq/m(3) or more. Tobacco increased appreciably the risk posed by radon, with an OR of 73 (95% CI, 19.88-268.14) for heavy smokers exposed to more than 147 Bq/m(3). Less frequent histologic types (including large cell carcinomas), followed by small cell lung cancer, had the highest risk associated with radon exposure. CONCLUSIONS The presence of airborne radon even at low concentrations poses a risk of developing lung cancer, with tobacco habit increasing considerably this risk. IMPACT Public health initiatives should address the higher risk of lung cancer for smokers exposed to radon.
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Affiliation(s)
- Juan Miguel Barros-Dios
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Santiago de Compostela, Spain
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Schmid K, Kuwert T, Drexler H. Radon in indoor spaces: an underestimated risk factor for lung cancer in environmental medicine. DEUTSCHES ARZTEBLATT INTERNATIONAL 2010; 107:181-6. [PMID: 20386676 PMCID: PMC2853156 DOI: 10.3238/arztebl.2010.0181] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2009] [Accepted: 08/14/2009] [Indexed: 01/18/2023]
Abstract
BACKGROUND Occupational medicine has long recognized radon to be a cause of lung cancer, especially among miners working under ground. Until recently, however, little scientific evidence was available about the risk to the general population caused by indoor radon. METHODS The authors analyzed literature that they found by a selective search in the light of the recently published S1 guideline of the German Society of Occupational and Environmental Medicine (Deutsche Gesellschaft für Arbeitsmedizin und Umweltmedizin) and a recent publication of the German Commission on Radiological Protection (Strahlenschutzkommission). RESULTS Exposure to indoor radon and its decay products is a major contributor to the radiation exposure of the general population. In Germany, the mean radiation exposure due to radon in living rooms and bedrooms is about 49 Bq/m(3). It is well documented in the scientific literature that indoor radon significantly increases the risk of lung cancer, probably in a linear dose-response relationship with no threshold. Every 100 Bq/m(3) increase in the radon concentration is estimated to increase the relative risk for lung cancer by 8% to 16%. After cigarette smoking, radon is the second main cause of lung cancer in the general population without occupational exposure. CONCLUSIONS From the point of view of preventive environmental medicine, it is important to identify buildings with high radon concentrations, initiate appropriate measures, and minimize radon exposure, particularly in new buildings.
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Affiliation(s)
- Klaus Schmid
- Institut für Arbeits-, Sozial- und Umweltmedizin der Universität Erlangen- Nürnberg, Erlangen, Germany.
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Abstract
PURPOSE Radon is natural radioactive noble gas that can be found in soil, water, outdoor and indoor air. Exposure to radon accounts for more that 50% of the annual effective dose of natural radioactivity. The purpose of the current review is to summarize recent literature and evaluate the weight of evidence on the adverse health effects of radon. CONCLUSIONS Radon is an established human lung carcinogen based on human epidemiological data supported by experimental evidence of mutagenesis studies in cell culture and laboratory animals. Extrapolation from cohort studies on miners suggested that radon is the second leading cause of lung cancer death after tobacco smoke. The majority of studies on the relationship between radon and other types of cancers showed weak or no association. Low levels of radon can be found in drinking water; however, radon released during water usage adds small quantities to indoor radon concentration. Studies showed that the risk of stomach cancer and other gastrointestinal malignancies from radon in drinking water is small. Studies of the genetic and cytogenetic effects of indoor radon yielded equivocal results; while radon exposure in miners induces gene mutations and chromosomal aberrations. Numerous in vitro cytogenetic studies demonstrated that radon induces different types of genetic and cytogenetic damage that is likely to play a role in radon lung carcinogenesis.
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Affiliation(s)
- Mustafa Al-Zoughool
- McLaughlin Center for Population Health Risk Assessment, University of Ottawa, Ottawa, Canada.
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