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

Implementation of a radon measurement protocol and its communication plan by child care centre managers in Québec

OBJECTIVES

To invite and support managers of child care centres to measure radon concentrations in their buildings. Their ability to carry out a measurement protocol and communication plan was also evaluated as well as the intention of parents and educators to test for radon at home.

PARTICIPANTS

Managers, parents and educators of child care centres.

SETTING

36 child care centres located in two priority investigation areas in Québec.

INTERVENTION

A kit containing radon detectors with installation and recovery instructions was shipped by mail in addition to factsheets intended for parents and educators. Site visits and phone calls were also conducted with a sample of child care centres and participants.

OUTCOMES

The instructions related to detector installation were generally well respected. Afterward, more than half (18) of the 34 parents and educators interviewed said that they had been directly informed of this radon testing by managers or other educators, and not by the factsheet provided. This radon measurement intervention was considered very relevant by 91% of them and a quarter (26%) expressed their intention to test for radon at home, while 6% had already done so. Two child care centres (5.5%) had at least one measurement above the Canadian guideline level of 200 Bq/m3.

CONCLUSION

This intervention has demonstrated the ability of child care centre managers to carry out this type of autonomous procedure, which can be centralized to minimize costs. This type of intervention may influence parents to become more familiar with this contaminant and measure their family's exposure at home.

An Exploratory Analysis of Public Awareness and Perception of Ionizing Radiation and Guide to Public Health Practice in Vermont

Exposure to ionizing radiation has potential for acute and chronic health effects. Within the general public of the United States, there may be a discrepancy between perceived and actual health risks. In conjunction with the Vermont Department of Health, a survey designed to assess public perception and knowledge of ionizing radiation was administered at 6 Vermont locations (n = 169). Descriptive and inferential statistical analyses were conducted. Eighty percent of respondents underestimated the contribution of medical imaging tests to total ionizing radiation exposure. Although only thirty-nine percent of participants were confident in their healthcare professional's knowledge of ionizing radiation, most would prefer to receive information from their healthcare professional. Only one-third of individuals who received a medical imaging test in the past year were educated by their healthcare professional about the risks of these tests. Those who tested their home for radon were twice as likely to choose radon as the greatest ionizing radiation risk to self. Although respondents had an above-average education level, there were many misperceptions of actual risks of exposure to ionizing radiation, particularly of medical imaging tests. Educating healthcare professionals would therefore have a profound and positive impact on public understanding of ionizing radiation.

Lung cancer risk from radon in Ontario, Canada: how many lung cancers can we prevent?

Purpose

To calculate the burden of lung cancer illness due to radon for all thirty-six health units in Ontario and determine the number of radon-attributable lung cancer deaths that could be prevented.

Methods

We calculated the population attributable risk percent, excess life-time risk ratio, life-years lost, the number of lung cancer deaths due to radon, and the number of deaths that could be prevented if all homes above various cut-points were effectively reduced to background levels.

Results

It is estimated that 13.6 % (95 % CI 11.0, 16.7) of lung cancer deaths in Ontario are attributable to radon, corresponding to 847 (95 % CI 686, 1,039) lung cancer deaths each year, approximately 84 % of these in ever-smokers. If all homes above 200 Bq/m³, the current Canadian guideline, were remediated to background levels, it is estimated that 91 lung cancer deaths could be prevented each year, 233 if remediation was performed at 100 Bq/m³. There was important variation across health units.

Conclusions

Radon is an important contributor to lung cancer deaths in Ontario. A large portion of radon-attributable lung cancer deaths are from exposures below the current Canadian guideline, suggesting interventions that install effective radon-preventive measures into buildings at build may be a good alternative population prevention strategy to testing and remediation. For some health units, testing and remediation may also prevent a portion of radon-related lung cancer deaths. Regional attributable risk estimates can help with local public health resource allocation and decision making.

Epidemiology of lung cancer: Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines

BACKGROUND

Ever since a lung cancer epidemic emerged in the mid-1900 s, the epidemiology of lung cancer has been intensively investigated to characterize its causes and patterns of occurrence. This report summarizes the key findings of this research.

METHODS

A detailed literature search provided the basis for a narrative review, identifying and summarizing key reports on population patterns and factors that affect lung cancer risk.

RESULTS

Established environmental risk factors for lung cancer include smoking cigarettes and other tobacco products and exposure to secondhand tobacco smoke, occupational lung carcinogens, radiation, and indoor and outdoor air pollution. Cigarette smoking is the predominant cause of lung cancer and the leading worldwide cause of cancer death. Smoking prevalence in developing nations has increased, starting new lung cancer epidemics in these nations. A positive family history and acquired lung disease are examples of host factors that are clinically useful risk indicators. Risk prediction models based on lung cancer risk factors have been developed, but further refinement is needed to provide clinically useful risk stratification. Promising biomarkers of lung cancer risk and early detection have been identified, but none are ready for broad clinical application.

CONCLUSIONS

Almost all lung cancer deaths are caused by cigarette smoking, underscoring the need for ongoing efforts at tobacco control throughout the world. Further research is needed into the reasons underlying lung cancer disparities, the causes of lung cancer in never smokers, the potential role of HIV in lung carcinogenesis, and the development of biomarkers.

Radon, smoking, and lung cancer: the need to refocus radon control policy

Exposure to radon is the second leading cause of lung cancer, and the risk is significantly higher for smokers than for nonsmokers. More than 85% of radon-induced lung cancer deaths are among smokers. The most powerful approach for reducing the public health burden of radon is shaped by 2 overarching principles: public communication efforts that promote residential radon testing and remediation will be the most cost effective if they are primarily directed at current and former smokers; and focusing on smoking prevention and cessation is the optimal strategy for reducing radon-induced lung cancer in terms of both public health gains and economic efficiency. Tobacco control policy is the most promising route to the public health goals of radon control policy.

Radon measurement in schools located in three priority investigation areas in the province of Quebec, Canada

The purpose of this study was to measure radon concentration in public primary schools located in priority investigation areas, with the aim of decreasing occupants' exposure to radon in public buildings where concentrations exceed the Canadian Federal guidelines (i.e. 200 Bq m(-3)). In addition, the association between radon levels, substratum geological characteristics and schools' structural characteristics were investigated. The results showed that radon concentrations measured in the 65 investigated schools are generally below the Federal guideline levels. Eleven schools (17 %) had at least one measurement above the Federal guideline, while one had a level above 600 Bq m(-3). On average, targeted schools' occupants are exposed to radon concentrations of 56 Bq m(-3). Although statistical analysis, which was limited by the sample size, did not show any link between aggregated radon measurements and geochemical or radiological signatures of investigated sites, the geological evidence that led to the choice of the studied regions remains relevant.