Indoor exposure to 222Rn: a public health perspective

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.

COHERE - strengthening cooperation within the Canadian government on radiation research

PURPOSE

Canadian Organization on Health Effects from Radiation Exposure (COHERE) is a government initiative to better understand biological and human health risks from ionizing radiation exposures relevant to occupational and environmental settings (<100 mGy, <6 mGy/h). It is currently a partnership between two federal agencies, Health Canada (HC) and the Canadian Nuclear Safety Commission (CNSC). COHERE's vision is to contribute knowledge to reduce scientific uncertainties from low dose and dose-rate exposures. COHERE will advance our understanding by bridging the knowledge gap between human health risks and linkages to molecular- and cellular-level responses to radiation. Research focuses on identifying sensitive, early, and key molecular events of relevance to risk assessment.

CONCLUSIONS

The initiative will address questions of relevance to better apprize Canadians, including radiation workers and members of the public and Indigenous peoples, on health risks from low dose radiation exposure and inform radiation protection frameworks at a national and international level. Furthermore, it will support global efforts to conduct collaborative undertakings and better coordinate research. Here, we describe a historical overview of the research conducted, the strategic research agenda that outlines the scientific framework, stakeholders, opportunities to harmonize internationally, and how research outcomes will better inform communication of risk to Canadians.

Attributable mortality to radon exposure in Galicia, Spain. Is it necessary to act in the face of this health problem?

Background

Radon is the second risk factor for lung cancer after tobacco consumption and therefore it is necessary to know the burden of disease due to its exposure. The objective of this study is to estimate radon-attributable lung cancer mortality in Galicia, a high emission area located at the Northwest Spain.

Methods

A prevalence-based attribution method was applied. Prevalence of tobacco use and radon exposure were obtained from a previously published study of the same area. Attributable mortality was calculated for each of six possible risk categories, based on radon exposure and smoking status. Two scenarios were used, with 37 Bq/m³ and 148 Bq/m³ as the respective radon exposure thresholds. As the observed mortality we used lung cancer mortality for 2001 from the Galician mortality registry.

Results

Mortality exclusively attributable to radon exposure ranged from 3% to 5% for both exposure thresholds, respectively. Attributable mortality to combined exposure to radon and smoking stood at around 22% for exposures above 148 Bq/m³. Applying the United States Environmental Protection Agency (EPA) action level, radon has a role in 25% of all lung cancers.

Conclusions

Although the estimates have been derived from a study with a relatively limited sample size, these results highlight the importance of radon exposure as a cause of lung cancer and its effect in terms of disease burden. Radon mitigation activities in the study area must therefore be enforced.

Assessment of the effectiveness of radon screening programs in reducing lung cancer mortality

The present study was aimed at assessing the health consequences of the presence of radon in Quebec homes and the possible impact of various screening programs on lung cancer mortality. Lung cancer risk due to this radioactive gas was estimated according to the cancer risk model developed by the Sixth Committee on Biological Effects of Ionizing Radiations. Objective data on residential radon exposure, population mobility, and tobacco use in the study population were integrated into a Monte-Carlo-type model. Participation rates to radon screening programs were estimated from published data. According to the model used, approximately 10% of deaths due to lung cancer are attributable to residential radon exposure on a yearly basis in Quebec. In the long term, the promotion of a universal screening program would prevent less than one death/year on a province-wide scale (0.8 case; IC 99%: -3.6 to 5.2 cases/year), for an overall reduction of 0.19% in radon-related mortality. Reductions in mortality due to radon by (1) the implementation of a targeted screening program in the region with the highest concentrations, (2) the promotion of screening on a local basis with financial support, or (3) the realization of systematic investigations in primary and secondary schools would increase to 1%, 14%, and 16.4%, respectively, in the each of the populations targeted by these scenarios. Other than the battle against tobacco use, radon screening in public buildings thus currently appears as the most promising screening policy for reducing radon-related lung cancer.

Indoor radon in Kuwait

Indoor radon measurements were carried out in 300 dwellings in Kuwait using duplicate sets of charcoal detectors. Measurements were made at three different locations in the dwellings: living rooms, bedrooms, and basements. The results show that the radon concentration in the dwellings of Kuwait was found to vary in the range of 4.0-241.8 Bq m(-3) with a mean value of 32.8 Bq m(-3), and most values are confined within the range of 10-50 Bq m(-3) for all locations with few cases above the value of 100 Bq m(-3). Overall results show that the indoor radon concentration levels in Kuwait are relatively low, which is attributed to the use of air conditioning in summer and possible natural ventilation in winter. The radon concentration in basements was found to be relatively higher when compared to other rooms of the dwellings.

Health implications of radon distribution in living rooms and bedrooms in U.K. dwellings--a case study in Northamptonshire

Environmental radon exposure of residents of domestic premises in the United Kingdom (UK) and elsewhere in Europe is estimated on the basis of the measured radon concentrations in, and the relative occupancies of, the principal living room and bedroom. While studies on radon concentration variability in the individual units in apartment blocks in various countries have been described, little data has been reported on variability in two-storey single-family dwellings, and the majority of extant studies consolidate living room and bedroom data early in the analysis. To investigate this further, detailed analysis was made of radon concentration data from a set of thirty-four homes situated in areas of Northamptonshire known to exhibit high radon levels. All homes were of typical UK construction of brick/block/stone walls under a pitched tile/slate roof. Approximately 50% of the sample were detached houses, the remainder being semi-detached (duplex) or terraced (row-house). Around 25% of the sample possessed cellars, while 12% were single-storey dwellings (bungalows), reflecting the typical incidence of this type of dwelling in England. In the two-storey homes, all monitored bedrooms were on the upper floor. Distribution of the ratios of bedroom/living room radon concentrations (BR/LR ratio) in individual properties was left-skewed (mean 0.67, median 0.73, range 0.05-1.05) with a tail extending to just above 1.0. The mean is consistent with the outcome of earlier extensive studies in England, while the variability depends principally on the characteristics of the property, and not on seasonal factors. In a small set of homes, the BR/LR ratio was anomalously low, (mean 0.3). BR/LR ratios in single-storey homes clustered around a value of 1.0, indicating that house design, rather than lifestyle, is the dominant factor in determining bedroom radon concentrations. Homes with higher mean annual radon concentrations showed lower BR/LR ratios, supporting our proposal that, in some homes, radon emanation from building materials may comprise a significant component of the overall radon level.

Mortality due to lung cancer in Mexico

The highest mortality due to cancer worldwide for both genders corresponds to lung cancer (1,179,000 deaths). In Mexico, the crude mortality rate due to lung cancer was of 5.01 per 10(5) inhabitants in 1979. The most important risk factor is smoking. The present study was aimed at analyzing the mortality due to lung cancer in Mexico, assessing data from each of the states constituting the Mexican Republic during the 1998-2004 period. Data were obtained from the National Institute of Statistics, Geography and Informatics (INEGI, for its initials in Spanish) corresponding to deaths due to lung cancer (1998-2004). We estimated the mean annual mortality rate (MAMR) for each of the 32 states of Mexico. We used the "World Population Standard". The MAMR was standardized according to age (ARS) direct method, and the standard error was determined by Poisson's approximation at a 95% confidence interval. To know the excess risk due to mortality, we calculated the standardized mortality ratios (SMRs) of ARS for each federal state, using the national rate as reference. In this period, 397,400 deaths due to malignant neoplasms were recorded, corresponding 45,578 (11.5%) to lung cancer; for men, 31,025 (68.1%) with MAMR of 8.9 and the respective ARS of 13.2 both x10(5) inhabitants. For women, results were 4553 (31.9%) deaths with MAMR of 4.1 and ARS of 5.4 both x10(5) inhabitants. The highest mortality rates due to lung cancer in both genders were observed in the north of Mexico, whereas for women this was observed in the central states. Although smoking is the main risk for lung cancer, there are other factors such as environmental pollution or exposure to toxicants that could be associated to this cancer. The years potentially lost due to lung cancer were 258,550 for men and 133,315 for women, with a total of 391,865 according to histopathology registry neoplasm malignant RHNM (1985-1995). Studies focused on the characterization and measurement of polluting agents would be a good start to determine the level of participation of air pollution in the development of lung cancer.

Factors underlying residential radon concentration: results from Galicia, Spain

Radon causes lung cancer when inhaled for prolonged periods of time. A range of factors influence residential radon concentration and this study therefore sought to ascertain which dwelling-related factors exert an influence on radon levels. A cross-sectional study was conducted from 2001 to 2003 which analyzed 983 homes of as many subjects randomly selected from the 1991 census. Sampling was carried out by district and stratified by population density to ensure that more detectors were placed in the most heavily populated areas. Radon concentration and different dwelling characteristics were measured in each of the homes selected. Bivariate and multivariate analyses were performed to ascertain which factors influenced radon concentration. The geometric mean of radon concentration was 69.5 Bq/m3, and 21.3% of homes had concentrations above 148 Bq/m3. Factors shown to influence radon concentration in the bivariate analysis were: age of dwelling; interior building material; exterior building material; and storey on which the detector was placed. Explanatory variables in the multivariate analysis were: age of dwelling; number of storeys; distance off floor; and interior building material. The model was significant, but the variability explained was around 10%. These results highlight the fact that the study area is an area of high radon emission and that factors other than those directly related with the characteristics of the dwelling also influence radon concentration.

Monitoring and modelling of indoor radon concentrations in a multi-storey building at Mumbai, India

Radon (Rn(222)) levels in an indoor atmosphere of a multi-storey building at Mumbai have been measured for one year covering all the four seasons. Monitoring was carried out using the time-integrated passive detector technique, using Kodak-115 type Solid State Nuclear Track Detector (SSNTD) films of 2.5x2.5 cm size. Measured indoor radon levels showed a decreasing trend with height with concentration ranging from 41 Bq m(-3) at ground floor level to 15 Bq m(-3) at 19th floor level. Using the dose conversion factors, the inhalation dose due to breathing of radon gas is estimated to be 1.03 mSv y(-1) at the ground floor to 0.38 mSv y(-1) at the 19th floor level. Measured indoor radon concentrations on each floor were compared with the computed values using a mathematical model. The agreement between measured values and calculated values of indoor concentrations at different floors was very good within the limitations of various field parameter values.

Quality control of mitigation methods for unusually high indoor radon concentrations

The present study's objective was to control the quality of different mitigation methods for unusually high indoor radon (222Rn) concentrations of up to 274,000 Bq m(-3) in a village (Umhausen, 2,600 inhabitants) in western Tyrol, Austria. Five years after mitigation, five different remedial actions were examined on their quality by means of measuring indoor radon concentrations with charcoal liquid scintillation radon detectors and with a continuously recording AlphaGuard detector. Mitigation method in house 1--a mechanical intake and outlet ventilation system with heat exchanger in the basement, combined with a soil depressurization system--was characterized by long-term stability. With most favorable air pressure (+100 Pa) in the basement, mean basement radon concentrations in the winter were reduced from 200,000 Bq m(-3) to 3,000 Bq m(-3) by this method 5 y after mitigation. Acting against experts' instructions, the inhabitants had switched off the ventilation system most of the time to minimize power consumption although it had been proven that ventilation reduced mean basement radon concentration by a factor of about 3 in the winter and about 15 in the summer. Mitigation method in house 2-soil depressurization with two fans and loops of drainage tubes to withdraw radon from the region below the floor and outside the basement walls, and from soil below that part of the house with no basement-had been the most successful remedial measure until the winter of 1999 (i.e., 6 y after mitigation), when micro-cracks opened and consequently mean basement radon concentration increased from 250 Bq m(-3) to 1,500 Bq m(-3). Measures to block these microcracks and to minimize soil drying are being developed. Five years after mitigation, the remedial method used in house 3--a multilayer floor construction, where a fan was used to suck radon from a layer between bottom slab and floor-reduced winter mean radon concentration from 25,000 Bq m(-3) to 1,200 Bq m(-3), with the ventilation on and the basement door open. Mitigation method in house 4--a basement sealing technique--was unsuccessful with almost identical radon concentrations during all the five years since mitigation had started. Mitigation method in house 5--a waterproof basement technique especially for future homes--reduced mean basement radon concentration below 300 Bq m(-3) and mean ground floor radon concentration below 200 Bq m(-3), which is the Austrian action level for newly constructed buildings. These findings indicate that even in areas with extremely high radon concentrations, effective mitigation of indoor radon can be achieved provided that house-specific long-term, stable mitigation techniques are applied.