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Chen J. A Study on Geographic Correlation between Indoor Radon Exposure and Leukemia Incidence in Canada. Health Phys 2024; 126:315-321. [PMID: 38526250 DOI: 10.1097/hp.0000000000001813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/26/2024]
Abstract
ABSTRACT In Canada, leukemia is diagnosed at a rate of 15 cases per 100,000 persons and accounts for about 3% of all new primary cancers. In this study, geographical correlation between residential radon exposure and leukemia incidence was investigated at a provincial level with more accurate long-term radon measurement data in 21,330 homes and 10-y (2000-2009) age standardized incidence rates per 100,000 population for various subtypes of leukemia. The analyses showed that the incidence rate of non-Hodgkin lymphoma is statistically significantly correlated with average indoor radon (222Rn) concentration for Canadian females (p = 0.01210) but not for males. At a provincial level, the association between average indoor radon level and chronic lymphocytic leukemia incidence rate is statistically significant (p = 0.0167), and the correlation is somewhat stronger for females (p = 0.0043). No correlation was found between indoor radon exposure and any other subtypes of leukemia evaluated in this study.
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Affiliation(s)
- Jing Chen
- Radiation Protection Bureau, Health Canada, 775 Brookfield Road, Ottawa K1A 1C1, Ontario, Canada
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2
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Pulliam HR, Springer SD, Rice DL, Ende GC, Johnson HJ, Willett MP, Wilson TW, Taylor BK. Neurotoxic effects of home radon exposure on oscillatory dynamics serving attentional orienting in children and adolescents. Neuroimage 2024; 292:120606. [PMID: 38604538 PMCID: PMC11097196 DOI: 10.1016/j.neuroimage.2024.120606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 03/20/2024] [Accepted: 04/08/2024] [Indexed: 04/13/2024] Open
Abstract
Radon is a naturally occurring gas that contributes significantly to radiation in the environment and is the second leading cause of lung cancer globally. Previous studies have shown that other environmental toxins have deleterious effects on brain development, though radon has not been studied as thoroughly in this context. This study examined the impact of home radon exposure on the neural oscillatory activity serving attention reorientation in youths. Fifty-six participants (ages 6-14 years) completed a classic Posner cuing task during magnetoencephalography (MEG), and home radon levels were measured for each participant. Time-frequency spectrograms indicated stronger theta (3-7 Hz, 300-800 ms), alpha (9-13 Hz, 400-900 ms), and beta responses (14-24 Hz, 400-900 ms) during the task relative to baseline. Source reconstruction of each significant oscillatory response was performed, and validity maps were computed by subtracting the task conditions (invalidly cued - validly cued). These validity maps were examined for associations with radon exposure, age, and their interaction in a linear regression design. Children with greater radon exposure showed aberrant oscillatory activity across distributed regions critical for attentional processing and attention reorientation (e.g., dorsolateral prefrontal cortex, and anterior cingulate cortex). Generally, youths with greater radon exposure exhibited a reverse neural validity effect in almost all regions and showed greater overall power relative to peers with lesser radon exposure. We also detected an interactive effect between radon exposure and age where youths with greater radon exposure exhibited divergent developmental trajectories in neural substrates implicated in attentional processing (e.g., bilateral prefrontal cortices, superior temporal gyri, and inferior parietal lobules). These data suggest aberrant, but potentially compensatory neural processing as a function of increasing home radon exposure in areas critical for attention and higher order cognition.
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Affiliation(s)
- Haley R Pulliam
- Institute for Human Neuroscience, Boys Town National Research Hospital, Boys Town, NE, USA; Center for Pediatric Brain Health, Boys Town National Research Hospital, Boys Town, NE, USA
| | - Seth D Springer
- Institute for Human Neuroscience, Boys Town National Research Hospital, Boys Town, NE, USA; College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Danielle L Rice
- Institute for Human Neuroscience, Boys Town National Research Hospital, Boys Town, NE, USA; Center for Pediatric Brain Health, Boys Town National Research Hospital, Boys Town, NE, USA
| | - Grace C Ende
- Institute for Human Neuroscience, Boys Town National Research Hospital, Boys Town, NE, USA; Center for Pediatric Brain Health, Boys Town National Research Hospital, Boys Town, NE, USA
| | - Hallie J Johnson
- Institute for Human Neuroscience, Boys Town National Research Hospital, Boys Town, NE, USA
| | - Madelyn P Willett
- Institute for Human Neuroscience, Boys Town National Research Hospital, Boys Town, NE, USA
| | - Tony W Wilson
- Institute for Human Neuroscience, Boys Town National Research Hospital, Boys Town, NE, USA; Center for Pediatric Brain Health, Boys Town National Research Hospital, Boys Town, NE, USA; Department of Pharmacology and Neuroscience, Creighton University, Omaha, NE, USA
| | - Brittany K Taylor
- Institute for Human Neuroscience, Boys Town National Research Hospital, Boys Town, NE, USA; Center for Pediatric Brain Health, Boys Town National Research Hospital, Boys Town, NE, USA; Department of Pharmacology and Neuroscience, Creighton University, Omaha, NE, USA.
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Menakuru S, Dhillon V, Ali M, Salih A, Hanna N. EPR24-112: Lung Cancer in Never Smokers: The Role of Radon Exposure and Public Knowledge. J Natl Compr Canc Netw 2024; 22:EPR24-112. [PMID: 38580258 DOI: 10.6004/jnccn.2023.7148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2024]
Affiliation(s)
| | | | - Marriam Ali
- 1Indiana University School of Medicine, Muncie, IN
| | - Ahmed Salih
- 1Indiana University School of Medicine, Muncie, IN
| | - Nasser Hanna
- 2Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, IN
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4
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Mphaga KV, Utembe W, Rathebe PC. Radon exposure risks among residents proximal to gold mine tailings in Gauteng Province, South Africa: a cross-sectional preliminary study protocol. Front Public Health 2024; 12:1328955. [PMID: 38525346 PMCID: PMC10957527 DOI: 10.3389/fpubh.2024.1328955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 02/15/2024] [Indexed: 03/26/2024] Open
Abstract
Gold mine tailings, a legacy of the mining industry, harbors significant amount of radon gas, a classified human carcinogen. Radon exposure, especially near tailings, is a significant public health threat, potentially leading to increased risk of lung cancer, leukemia, and chronic obstructive pulmonary disease (COPD). These health problems are often associated with lower survival rates and significant financial burdens. This ongoing research aim to evaluating the relationship between indoor radon exposure and lung cancer, leukemia, and COPD risks among residents proximal to gold mine tailings in Gauteng Province, South Africa. This cross-sectional preliminary study focus on two distinct groups: Riverlea (exposed group, <2 km to Gold mine tailings) and Orlando East (unexposed group, >2 km to Gold mine tailings). Indoor radon levels is measured using AlphaE monitors, while health risks (lung cancer, leukemia, and COPD) linked to exposure are evaluated through interview-administered questionnaire and secondary data from Gauteng Health Department. Of the 476 residents randomly selected for this study, 300 have already participated, with balanced representation from both the exposed and unexposed groups. The study will compare indoor radon levels and health outcomes between the two groups. This study's results could aid in creating targeted interventions and policies to mitigate indoor radon exposure risks and safeguard vulnerable communities from this significant public health hazard.
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Affiliation(s)
- Khathutshelo Vincent Mphaga
- Department of Environmental Health, Faculty of Health Sciences, Doornfontein Campus, University of Johannesburg, Johannesburg, South Africa
| | - Wells Utembe
- Department of Environmental Health, Faculty of Health Sciences, Doornfontein Campus, University of Johannesburg, Johannesburg, South Africa
- National Health Laboratory Service, Toxicology and Biochemistry Department, National Institute for Occupational Health, Johannesburg, South Africa
| | - Phoka Caiphus Rathebe
- Department of Environmental Health, Faculty of Health Sciences, Doornfontein Campus, University of Johannesburg, Johannesburg, South Africa
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Dosh RJ, Abojassim AA. Assessment of radiological risk associated with thoron gas at primary schools in Al-Najaf city, Iraq. Appl Radiat Isot 2024; 205:111154. [PMID: 38142543 DOI: 10.1016/j.apradiso.2023.111154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 11/24/2023] [Accepted: 12/18/2023] [Indexed: 12/26/2023]
Abstract
Children spend considerable time at home and school, so school is likely to be a second source of natural radionuclide exposure after home. This study evaluates the radiological risk associated with thoron gas in the air within the building of one hundred primary schools in Al-Najaf City, Iraq, using a CR-39 detector. The results of the average value of thoron concentration detector, the annual effective dose (AED), Excessive Lifetime Cancer Risk (ELCR) × 10-3, and Lung Cancer Case (LCC) × 10-9 measured in the building of the schools were 7.47 ± 2.85 Bq/m3, 0.03 ± 0.01 mSv/y, 0.11 ± 0.04, and 0.54 ± 0.20, respectively. All the results of indoor thoron were below the global average limit. The results of the radiological survey due to thoron concentrations for studied primary schools suggest that the radionuclides and their radiological hazard indexes in all studied schools in AL Najaf city, Iraq, do not impose a health hazard.
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Affiliation(s)
- Rukia Jaber Dosh
- Department of Physics, Faculty of Science, University of Kufa, Al-Najaf, Iraq
| | - Ali Abid Abojassim
- Department of Physics, Faculty of Science, University of Kufa, Al-Najaf, Iraq.
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6
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Kreuzer M, Sommer M, Deffner V, Bertke S, Demers PA, Kelly-Reif K, Laurier D, Rage E, Richardson DB, Samet JM, Schubauer-Berigan MK, Tomasek L, Wiggins C, Zablotska LB, Fenske N. Lifetime excess absolute risk for lung cancer due to exposure to radon: results of the pooled uranium miners cohort study PUMA. Radiat Environ Biophys 2024; 63:7-16. [PMID: 38172372 PMCID: PMC10920468 DOI: 10.1007/s00411-023-01049-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 11/09/2023] [Indexed: 01/05/2024]
Abstract
The Pooled Uranium Miners Analysis (PUMA) study is the largest uranium miners cohort with 119,709 miners, 4.3 million person-years at risk and 7754 lung cancer deaths. Excess relative rate (ERR) estimates for lung cancer mortality per unit of cumulative exposure to radon progeny in working level months (WLM) based on the PUMA study have been reported. The ERR/WLM was modified by attained age, time since exposure or age at exposure, and exposure rate. This pattern was found for the full PUMA cohort and the 1960 + sub-cohort, i.e., miners hired in 1960 or later with chronic low radon exposures and exposure rates. The aim of the present paper is to calculate the lifetime excess absolute risk (LEAR) of lung cancer mortality per WLM using the PUMA risk models, as well as risk models derived in previously published smaller uranium miner studies, some of which are included in PUMA. The same methods were applied for all risk models, i.e., relative risk projection up to <95 years of age, an exposure scenario of 2 WLM per year from age 18-64 years, and baseline mortality rates representing a mixed Euro-American-Asian population. Depending upon the choice of model, the estimated LEAR per WLM are 5.38 × 10-4 or 5.57 × 10-4 in the full PUMA cohort and 7.50 × 10-4 or 7.66 × 10-4 in the PUMA 1960 + sub-cohort, respectively. The LEAR per WLM estimates derived from risk models reported for previously published uranium miners studies range from 2.5 × 10-4 to 9.2 × 10-4. PUMA strengthens knowledge on the radon-related lung cancer LEAR, a useful way to translate models for policy purposes.
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Affiliation(s)
- M Kreuzer
- Federal Office for Radiation Protection (BfS), Munich (Neuherberg), Germany.
| | - M Sommer
- Federal Office for Radiation Protection (BfS), Munich (Neuherberg), Germany
| | - V Deffner
- Federal Office for Radiation Protection (BfS), Munich (Neuherberg), Germany
| | - S Bertke
- National Institute for Occupational Safety and Health, Cincinnati, OH, USA
| | - P A Demers
- Occupational Cancer Research Centre, Toronto, Canada
| | - K Kelly-Reif
- National Institute for Occupational Safety and Health, Cincinnati, OH, USA
| | - D Laurier
- Institute for Radiological Protection and Nuclear Safety (IRSN), Fontenay-aux-Roses, France
| | - E Rage
- Institute for Radiological Protection and Nuclear Safety (IRSN), Fontenay-aux-Roses, France
| | | | - J M Samet
- Colorado School of Public Health, Aurora, CO, USA
| | | | - L Tomasek
- National Radiation Protection Institute, Prague, Czech Republic
| | - C Wiggins
- University of New Mexico, Albuquerque, NM, USA
- New Mexico Tumor Registry, Albuquerque, NM, USA
| | | | - N Fenske
- Federal Office for Radiation Protection (BfS), Munich (Neuherberg), Germany
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7
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Montañez-Reyes AT, Sajo-Bohus L, Martinez-Ovalle SA. Radon activity concentration RnCA and workers lung cancer risks in SENA coal mines, Colombia. Appl Radiat Isot 2024; 205:111158. [PMID: 38159450 DOI: 10.1016/j.apradiso.2023.111158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 11/07/2023] [Accepted: 12/19/2023] [Indexed: 01/03/2024]
Abstract
The risk of lung cancer or pneumoconiosis mortality, increases with radioactive radon gas exposures. This article report health risk for underground workers exposed to radioactive gas and radon daughters carried by airborne dust at the coal mining in the Central Mountainous Region of Colombia. A set of 33 measurement points located in that mine galleries were selected to monitor radon gas concentration activity, by passive LR-115 detectors, during two months. Resulting values provided radon concentrations, absorbed dose, environmental equivalent dose and the effective dose; miners increased risk of contracting lung cancer is included. It is concluded that the mine ventilation system satisfies the conditions required by the current radiological protection of the miners. Our study point out that Colombia can effectively address the potential risks associated with radon exposure and ensure a safer living environment for its citizens.
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Affiliation(s)
- A T Montañez-Reyes
- Universidad Pedagógica y Tecnológica de Colombia, Tunja, Boyacá, Colombia, CP 150003
| | - L Sajo-Bohus
- Universidad Simón Bolívar, Baruta Ap.do 89000, Caracas, Venezuela YV-1080A; Alba Regia Technical Faculty, Óbuda University, 8000 Szekesfehervar, Hungary
| | - S A Martinez-Ovalle
- Universidad Pedagógica y Tecnológica de Colombia, Tunja, Boyacá, Colombia, CP 150003; Centro de Cancerología de Boyacá, Tunja, Boyacá, Colombia, CP 150003.
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8
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Khan SM, Pearson DD, Eldridge EL, Morais TA, Ahanonu MIC, Ryan MC, Taron JM, Goodarzi AA. Rural communities experience higher radon exposure versus urban areas, potentially due to drilled groundwater well annuli acting as unintended radon gas migration conduits. Sci Rep 2024; 14:3640. [PMID: 38409201 PMCID: PMC10897331 DOI: 10.1038/s41598-024-53458-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 01/31/2024] [Indexed: 02/28/2024] Open
Abstract
Repetitive, long-term inhalation of radioactive radon gas is one of the leading causes of lung cancer, with exposure differences being a function of geographic location, built environment, personal demographics, activity patterns, and decision-making. Here, we examine radon exposure disparities across the urban-to-rural landscape, based on 42,051 Canadian residential properties in 2034 distinct communities. People living in rural, lower population density communities experience as much as 31.2% greater average residential radon levels relative to urban equivalents, equating to an additional 26.7 Bq/m3 excess in geometric mean indoor air radon, and an additional 1 mSv/year in excess alpha radiation exposure dose rate to the lungs for occupants. Pairwise and multivariate analyses indicate that community-based radon exposure disparities are, in part, explained by increased prevalence of larger floorplan bungalows in rural areas, but that a majority of the effect is attributed to proximity to, but not water use from, drilled groundwater wells. We propose that unintended radon gas migration in the annulus of drilled groundwater wells provides radon migration pathways from the deeper subsurface into near-surface materials. Our findings highlight a previously under-appreciated determinant of radon-induced lung cancer risk, and support a need for targeted radon testing and reduction in rural communities.
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Affiliation(s)
- Selim M Khan
- Department of Biochemistry & Molecular Biology, Robson DNA Science Centre, Arnie Charbonneau Cancer Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Oncology, Arnie Charbonneau Cancer Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Dustin D Pearson
- Department of Biochemistry & Molecular Biology, Robson DNA Science Centre, Arnie Charbonneau Cancer Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Oncology, Arnie Charbonneau Cancer Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Evangeline L Eldridge
- Department of Earth, Energy and Environment, Faculty of Science, University of Calgary, Calgary, AB, Canada
| | - Tiago A Morais
- Department of Earth, Energy and Environment, Faculty of Science, University of Calgary, Calgary, AB, Canada
| | - Marvit I C Ahanonu
- School of Architecture, Planning, and Landscape, University of Calgary, Calgary, AB, Canada
| | - M Cathryn Ryan
- Department of Earth, Energy and Environment, Faculty of Science, University of Calgary, Calgary, AB, Canada
| | - Joshua M Taron
- School of Architecture, Planning, and Landscape, University of Calgary, Calgary, AB, Canada.
| | - Aaron A Goodarzi
- Department of Biochemistry & Molecular Biology, Robson DNA Science Centre, Arnie Charbonneau Cancer Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
- Department of Oncology, Arnie Charbonneau Cancer Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
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Viñolas N, Mezquita L, Corral J, Cobo M, Gil-Moncayo F, Paz-Ares L, Remon J, Rodríguez M, Ruano-Raviña A, Conde E, Majem M, Garrido P, Felip E, Isla D, de Castro J. The role of sex and gender in the diagnosis and treatment of lung cancer: the 6th ICAPEM Annual Symposium. Clin Transl Oncol 2024; 26:352-362. [PMID: 37490262 DOI: 10.1007/s12094-023-03262-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 06/20/2023] [Indexed: 07/26/2023]
Abstract
The incidence and mortality of lung cancer in women are rising, with both increasing by 124% between 2003 and 2019. The main risk factor for lung cancer is tobacco use, but indoor radon gas exposure is one of the leading causes in nonsmokers. The most recent evidence demonstrates that multiple factors can make women more susceptible to harm from these risk factors or carcinogens. For this consensus statement, the Association for Lung Cancer Research in Women (ICAPEM) invited a group of lung cancer experts to perform a detailed gender-based analysis of lung cancer. Clinically, female patients have different lung cancer profiles, and most actionable driver alterations are more prevalent in women, particularly in never-smokers. Additionally, the impact of certain therapies seems to be different. In the future, it will be necessary to carry out specific studies to improve the understanding of the role of certain biomarkers and gender in the prognosis and evolution of lung cancer.
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Affiliation(s)
- Nuria Viñolas
- Department of Medical Oncology, Barcelona Clinic Hospital, Translational Genomics and Targeted Therapies in Solid Tumours, IDIBAPS, C. de Villarroel, 170, 08036, Barcelona, Spain.
| | - Laura Mezquita
- Department of Medical Oncology, Barcelona Clinic Hospital, Translational Genomics and Targeted Therapies in Solid Tumours, IDIBAPS, C. de Villarroel, 170, 08036, Barcelona, Spain
| | - Jesús Corral
- Department of Medical Oncology, Jerez de la Frontera University Hospital, Cádiz, Spain
| | - Manuel Cobo
- Department of Medical Oncology, Virgen de la Victoria University Hospital, Málaga, Spain
| | - Francisco Gil-Moncayo
- Department of Psycho-Oncology, Catalan Institute of Oncology-Hospitalet, Barcelona, Spain
| | - Luis Paz-Ares
- Department of Medical Oncology, 12 de Octubre University Hospital, Madrid, Spain
| | - Jordi Remon
- Department of Medical Oncology, HM Nou Delfos Hospital, Barcelona, Spain
| | - María Rodríguez
- Department of Thoracic Surgery, Clínica Universidad de Navarra, Madrid, Spain
| | - Alberto Ruano-Raviña
- Department of Medicine and Public Health, Santiago de Compostela University, Santiago de Compostela, Spain
| | - Esther Conde
- Pathology Department, 12 de Octubre University Hospital, Universidad Complutense de Madrid, Research Institute 12 de Octubre University Hospital (Imas12), CIBERONC, Madrid, Spain
| | - Margarita Majem
- Department of Medical Oncology, Santa Creu y Sant Pau University Hospital, Barcelona, Spain
| | - Pilar Garrido
- Department of Medical Oncology, Ramón y Cajal University Hospital, Madrid, Spain
| | - Enriqueta Felip
- Department of Medical Oncology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Dolores Isla
- Department of Medical Oncology, Lozano Blesa University Clinical Hospital, Saragossa, Spain
| | - Javier de Castro
- Department of Medical Oncology, La Paz University Hospital, Madrid, Spain
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Dessemon J, Perol O, Chauvel C, Noelle H, Coudon T, Grassot L, Foray N, Belladame E, Fayette J, Fournie F, Swalduz A, Neidhart EM, Saintigny P, Tabutin M, Boussageon M, Gomez F, Avrillon V, Perol M, Charbotel B, Fervers B. Survival of bronchopulmonary cancers according to radon exposure. Front Public Health 2024; 11:1306455. [PMID: 38328545 PMCID: PMC10847230 DOI: 10.3389/fpubh.2023.1306455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 12/18/2023] [Indexed: 02/09/2024] Open
Abstract
Introduction Residential exposure is estimated to be responsible for nearly 10% of lung cancers in 2015 in France, making it the second leading cause, after tobacco. The Auvergne-Rhône-Alpes region, in the southwest of France, is particularly affected by this exposure as 30% of the population lives in areas with medium or high radon potential. This study aimed to investigate the impact of radon exposure on the survival of lung cancer patients. Methods In this single-center study, patients with a histologically confirmed diagnosis of lung cancer, and newly managed, were prospectively included between 2014 and 2020. Univariate and multivariate survival analyses were carried out using a non-proportional risk survival model to consider variations in risk over time. Results A total of 1,477 patients were included in the analysis. In the multivariate analysis and after adjustment for covariates, radon exposure was not statistically associated with survival of bronchopulmonary cancers (HR = 0.82 [0.54-1.23], HR = 0.92 [0.72-1.18], HR = 0.95 [0.76-1.19] at 1, 3, and 5 years, respectively, for patients residing in category 2 municipalities; HR = 0.87 [0.66-1.16], HR = 0.92 [0.76-1.10], and HR = 0.89 [0.75-1.06] at 1, 3, and 5 years, respectively, for patients residing in category 3 municipalities). Discussion Although radon exposure is known to increase the risk of lung cancer, in the present study, no significant association was found between radon exposure and survival of bronchopulmonary cancers.
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Affiliation(s)
- Juliette Dessemon
- Département Prévention Cancer Environnement, Center Léon Bérard, Lyon, France
- Faculté de Médecine Lyon Est, Université de Lyon, Lyon, France
| | - Olivia Perol
- Département Prévention Cancer Environnement, Center Léon Bérard, Lyon, France
- Inserm UMR1296, “Radiation: Defense, Health Environment,” Center Léon Bérard, Lyon, France
| | - Cécile Chauvel
- Center of Excellence in Respiratory Pathogens (CERP), Hospices Civils de Lyon, Lyon, France
- Centre International de Recherche en Infectiologie (CIRI), Inserm U1111, CNRS UMR5308, ENS de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Hugo Noelle
- Département Prévention Cancer Environnement, Center Léon Bérard, Lyon, France
- Faculté de Médecine Lyon Est, Université de Lyon, Lyon, France
| | - Thomas Coudon
- Département Prévention Cancer Environnement, Center Léon Bérard, Lyon, France
- Inserm UMR1296, “Radiation: Defense, Health Environment,” Center Léon Bérard, Lyon, France
| | - Lény Grassot
- Département Prévention Cancer Environnement, Center Léon Bérard, Lyon, France
- Inserm UMR1296, “Radiation: Defense, Health Environment,” Center Léon Bérard, Lyon, France
| | - Nicolas Foray
- Inserm UMR1296, “Radiation: Defense, Health Environment,” Center Léon Bérard, Lyon, France
| | - Elodie Belladame
- Département Prévention Cancer Environnement, Center Léon Bérard, Lyon, France
- Inserm UMR1296, “Radiation: Defense, Health Environment,” Center Léon Bérard, Lyon, France
| | - Jérôme Fayette
- Département de Cancérologie Médicale, Center Léon Bérard, Lyon, France
| | - Françoise Fournie
- Département Interdisciplinaire de Soins de Support du Patient en Oncologie, Center Léon Bérard, Lyon, France
| | - Aurélie Swalduz
- Département de Cancérologie Médicale, Center Léon Bérard, Lyon, France
| | | | - Pierre Saintigny
- Département de Cancérologie Médicale, Center Léon Bérard, Lyon, France
| | - Mayeul Tabutin
- Département de Chirurgie Cancérologique, Center Léon Bérard, Lyon, France
| | - Maxime Boussageon
- Inserm UMR1296, “Radiation: Defense, Health Environment,” Center Léon Bérard, Lyon, France
| | - Frédéric Gomez
- Département de Santé Publique, Center Léon Bérard, Lyon, France
| | - Virginie Avrillon
- Département de Cancérologie Médicale, Center Léon Bérard, Lyon, France
| | - Maurice Perol
- Département de Cancérologie Médicale, Center Léon Bérard, Lyon, France
| | - Barbara Charbotel
- Université de Lyon, Université Lyon 1, Université Gustave Eiffel-Ifsttar, Umrestte, UMR, Lyon, France
- CRPPE-Lyon, Center Régional de Pathologies Professionnelles et Environnementales de Lyon, Center Hospitalier Lyon Sud, Hospices Civils de Lyon, Lyon, France
| | - Béatrice Fervers
- Département Prévention Cancer Environnement, Center Léon Bérard, Lyon, France
- Inserm UMR1296, “Radiation: Defense, Health Environment,” Center Léon Bérard, Lyon, France
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Anthony KM, Collins JM, Love SAM, Stewart JD, Buchheit SF, Gondalia R, Schwartz GG, Huang DY, Meliker JR, Zhang Z, Barac A, Desai P, Hayden KM, Honigberg MC, Jaiswal S, Natarajan P, Bick AG, Kooperberg C, Manson JE, Reiner AP, Whitsel EA. Radon Exposure, Clonal Hematopoiesis, and Stroke Susceptibility in the Women's Health Initiative. Neurology 2024; 102:e208055. [PMID: 38170948 PMCID: PMC10870742 DOI: 10.1212/wnl.0000000000208055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 10/30/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Studies suggest that clonal hematopoiesis of indeterminate potential (CHIP) may increase risk of hematologic malignancy and cardiovascular disease, including stroke. However, few studies have investigated plausible environmental risk factors for CHIP such as radon, despite the climate-related increases in and documented infrequency of testing for this common indoor air pollutant.The purpose of this study was to estimate the risk of CHIP related to radon, an established environmental mutagen. METHODS We linked geocoded addresses of 10,799 Women's Health Initiative Trans-Omics for Precision Medicine (WHI TOPMed) participants to US Environmental Protection Agency-predicted, county-level, indoor average screening radon concentrations, categorized as follows: Zone 1 (>4 pCi/L), Zone 2 (2-4 pCi/L), and Zone 3 (<2 pCi/L). We defined CHIP as the presence of one or more leukemogenic driver mutations with variant allele frequency >0.02. We identified prevalent and incident ischemic and hemorrhagic strokes; subtyped ischemic stroke using Trial of ORG 10172 in Acute Stroke Treatment (TOAST) criteria; and then estimated radon-related risk of CHIP as an odds ratio (OR) and 95% CI using multivariable-adjusted, design-weighted logistic regression stratified by age, race/ethnicity, smoking status, and stroke type/subtype. RESULTS The percentages of participants with CHIP in Zones 1, 2, and 3 were 9.0%, 8.4%, and 7.7%, respectively (ptrend = 0.06). Among participants with ischemic stroke, Zones 2 and 1 were associated with higher estimated risks of CHIP relative to Zone 3: 1.39 (1.15-1.68) and 1.46 (1.15-1.87), but not among participants with hemorrhagic stroke: 0.98 (0.68-1.40) and 1.03 (0.70-1.52), or without stroke: 1.04 (0.74-1.46) and 0.95 (0.63-1.42), respectively (pinteraction = 0.03). Corresponding estimates were particularly high among TOAST-subtyped cardioembolism: 1.78 (1.30-2.47) and 1.88 (1.31-2.72), or other ischemic etiologies: 1.37 (1.06-1.78) and 1.50 (1.11-2.04), but not small vessel occlusion: 1.05 (0.74-1.49) and 1.00 (0.68-1.47), respectively (pinteraction = 0.10). Observed patterns of association among strata were insensitive to attrition weighting, ancestry adjustment, prevalent stroke exclusion, separate analysis of DNMT3A driver mutations, and substitution with 3 alternative estimates of radon exposure. DISCUSSION The robust elevation of radon-related risk of CHIP among postmenopausal women who develop incident cardioembolic stroke is consistent with a potential role of somatic genomic mutation in this societally burdensome form of cerebrovascular disease, although the mechanism has yet to be confirmed.
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Affiliation(s)
- Kurtis M Anthony
- From the Department of Epidemiology (K.M.A., J.M.C., S.-A.M.L., J.D.S., R.G., E.A.W.), Gillings School of Global Public Health, University of North Carolina, Chapel Hill; Brown University (S.F.B.), Providence, RI; Department of Population Health (G.G.S.), University of North Dakota School of Medicine & Health Sciences, Grand Forks; Department of Neurology (D.Y.H.), School of Medicine, University of North Carolina, Chapel Hill; Program in Public Health (J.R.M.), Stony Brook University, Stony Brook, NY; Division of Oncological Sciences (Z.Z.), Knight Cancer Institute, Oregon Health & Science University, Portland; Department of Cardiology (A.B.), Medstar Washington Hospital Center, Washington, DC; Department of Medicine (A.B.), Georgetown University, Washington, DC; Division of Hematology and Oncology (P.D.), Weill Cornell Medicine, New York; Department of Social Sciences and Health Policy (K.M.H.), Wake Forest University School of Medicine, Winston-Salem, NC; Cardiology Division (M.C.H.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics (M.C.H., P.N.), Broad Institute of Harvard and MIT, Cambridge, MA; Department of Pathology (S.J.), Stanford University School of Medicine, CA; Cardiovascular Research Center and Center for Genomic Medicine (P.N.), Massachusetts General Hospital, Boston; Department of Medicine (P.N.), Harvard Medical School, Boston; Division of Genetic Medicine (A.G.B.), Department of Medicine, Vanderbilt University Medical Center, Nashville, TN; Division of Public Health Sciences (C.K., A.P.R.), Fred Hutchinson Cancer Center, Seattle, WA; Department of Medicine (J.E.M.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Epidemiology (A.P.R.), University of Washington, Seattle; and Department of Medicine (E.A.W.), School of Medicine, University of North Carolina, Chapel Hill
| | - Jason M Collins
- From the Department of Epidemiology (K.M.A., J.M.C., S.-A.M.L., J.D.S., R.G., E.A.W.), Gillings School of Global Public Health, University of North Carolina, Chapel Hill; Brown University (S.F.B.), Providence, RI; Department of Population Health (G.G.S.), University of North Dakota School of Medicine & Health Sciences, Grand Forks; Department of Neurology (D.Y.H.), School of Medicine, University of North Carolina, Chapel Hill; Program in Public Health (J.R.M.), Stony Brook University, Stony Brook, NY; Division of Oncological Sciences (Z.Z.), Knight Cancer Institute, Oregon Health & Science University, Portland; Department of Cardiology (A.B.), Medstar Washington Hospital Center, Washington, DC; Department of Medicine (A.B.), Georgetown University, Washington, DC; Division of Hematology and Oncology (P.D.), Weill Cornell Medicine, New York; Department of Social Sciences and Health Policy (K.M.H.), Wake Forest University School of Medicine, Winston-Salem, NC; Cardiology Division (M.C.H.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics (M.C.H., P.N.), Broad Institute of Harvard and MIT, Cambridge, MA; Department of Pathology (S.J.), Stanford University School of Medicine, CA; Cardiovascular Research Center and Center for Genomic Medicine (P.N.), Massachusetts General Hospital, Boston; Department of Medicine (P.N.), Harvard Medical School, Boston; Division of Genetic Medicine (A.G.B.), Department of Medicine, Vanderbilt University Medical Center, Nashville, TN; Division of Public Health Sciences (C.K., A.P.R.), Fred Hutchinson Cancer Center, Seattle, WA; Department of Medicine (J.E.M.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Epidemiology (A.P.R.), University of Washington, Seattle; and Department of Medicine (E.A.W.), School of Medicine, University of North Carolina, Chapel Hill
| | - Shelly-Ann M Love
- From the Department of Epidemiology (K.M.A., J.M.C., S.-A.M.L., J.D.S., R.G., E.A.W.), Gillings School of Global Public Health, University of North Carolina, Chapel Hill; Brown University (S.F.B.), Providence, RI; Department of Population Health (G.G.S.), University of North Dakota School of Medicine & Health Sciences, Grand Forks; Department of Neurology (D.Y.H.), School of Medicine, University of North Carolina, Chapel Hill; Program in Public Health (J.R.M.), Stony Brook University, Stony Brook, NY; Division of Oncological Sciences (Z.Z.), Knight Cancer Institute, Oregon Health & Science University, Portland; Department of Cardiology (A.B.), Medstar Washington Hospital Center, Washington, DC; Department of Medicine (A.B.), Georgetown University, Washington, DC; Division of Hematology and Oncology (P.D.), Weill Cornell Medicine, New York; Department of Social Sciences and Health Policy (K.M.H.), Wake Forest University School of Medicine, Winston-Salem, NC; Cardiology Division (M.C.H.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics (M.C.H., P.N.), Broad Institute of Harvard and MIT, Cambridge, MA; Department of Pathology (S.J.), Stanford University School of Medicine, CA; Cardiovascular Research Center and Center for Genomic Medicine (P.N.), Massachusetts General Hospital, Boston; Department of Medicine (P.N.), Harvard Medical School, Boston; Division of Genetic Medicine (A.G.B.), Department of Medicine, Vanderbilt University Medical Center, Nashville, TN; Division of Public Health Sciences (C.K., A.P.R.), Fred Hutchinson Cancer Center, Seattle, WA; Department of Medicine (J.E.M.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Epidemiology (A.P.R.), University of Washington, Seattle; and Department of Medicine (E.A.W.), School of Medicine, University of North Carolina, Chapel Hill
| | - James D Stewart
- From the Department of Epidemiology (K.M.A., J.M.C., S.-A.M.L., J.D.S., R.G., E.A.W.), Gillings School of Global Public Health, University of North Carolina, Chapel Hill; Brown University (S.F.B.), Providence, RI; Department of Population Health (G.G.S.), University of North Dakota School of Medicine & Health Sciences, Grand Forks; Department of Neurology (D.Y.H.), School of Medicine, University of North Carolina, Chapel Hill; Program in Public Health (J.R.M.), Stony Brook University, Stony Brook, NY; Division of Oncological Sciences (Z.Z.), Knight Cancer Institute, Oregon Health & Science University, Portland; Department of Cardiology (A.B.), Medstar Washington Hospital Center, Washington, DC; Department of Medicine (A.B.), Georgetown University, Washington, DC; Division of Hematology and Oncology (P.D.), Weill Cornell Medicine, New York; Department of Social Sciences and Health Policy (K.M.H.), Wake Forest University School of Medicine, Winston-Salem, NC; Cardiology Division (M.C.H.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics (M.C.H., P.N.), Broad Institute of Harvard and MIT, Cambridge, MA; Department of Pathology (S.J.), Stanford University School of Medicine, CA; Cardiovascular Research Center and Center for Genomic Medicine (P.N.), Massachusetts General Hospital, Boston; Department of Medicine (P.N.), Harvard Medical School, Boston; Division of Genetic Medicine (A.G.B.), Department of Medicine, Vanderbilt University Medical Center, Nashville, TN; Division of Public Health Sciences (C.K., A.P.R.), Fred Hutchinson Cancer Center, Seattle, WA; Department of Medicine (J.E.M.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Epidemiology (A.P.R.), University of Washington, Seattle; and Department of Medicine (E.A.W.), School of Medicine, University of North Carolina, Chapel Hill
| | - Sophie F Buchheit
- From the Department of Epidemiology (K.M.A., J.M.C., S.-A.M.L., J.D.S., R.G., E.A.W.), Gillings School of Global Public Health, University of North Carolina, Chapel Hill; Brown University (S.F.B.), Providence, RI; Department of Population Health (G.G.S.), University of North Dakota School of Medicine & Health Sciences, Grand Forks; Department of Neurology (D.Y.H.), School of Medicine, University of North Carolina, Chapel Hill; Program in Public Health (J.R.M.), Stony Brook University, Stony Brook, NY; Division of Oncological Sciences (Z.Z.), Knight Cancer Institute, Oregon Health & Science University, Portland; Department of Cardiology (A.B.), Medstar Washington Hospital Center, Washington, DC; Department of Medicine (A.B.), Georgetown University, Washington, DC; Division of Hematology and Oncology (P.D.), Weill Cornell Medicine, New York; Department of Social Sciences and Health Policy (K.M.H.), Wake Forest University School of Medicine, Winston-Salem, NC; Cardiology Division (M.C.H.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics (M.C.H., P.N.), Broad Institute of Harvard and MIT, Cambridge, MA; Department of Pathology (S.J.), Stanford University School of Medicine, CA; Cardiovascular Research Center and Center for Genomic Medicine (P.N.), Massachusetts General Hospital, Boston; Department of Medicine (P.N.), Harvard Medical School, Boston; Division of Genetic Medicine (A.G.B.), Department of Medicine, Vanderbilt University Medical Center, Nashville, TN; Division of Public Health Sciences (C.K., A.P.R.), Fred Hutchinson Cancer Center, Seattle, WA; Department of Medicine (J.E.M.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Epidemiology (A.P.R.), University of Washington, Seattle; and Department of Medicine (E.A.W.), School of Medicine, University of North Carolina, Chapel Hill
| | - Rahul Gondalia
- From the Department of Epidemiology (K.M.A., J.M.C., S.-A.M.L., J.D.S., R.G., E.A.W.), Gillings School of Global Public Health, University of North Carolina, Chapel Hill; Brown University (S.F.B.), Providence, RI; Department of Population Health (G.G.S.), University of North Dakota School of Medicine & Health Sciences, Grand Forks; Department of Neurology (D.Y.H.), School of Medicine, University of North Carolina, Chapel Hill; Program in Public Health (J.R.M.), Stony Brook University, Stony Brook, NY; Division of Oncological Sciences (Z.Z.), Knight Cancer Institute, Oregon Health & Science University, Portland; Department of Cardiology (A.B.), Medstar Washington Hospital Center, Washington, DC; Department of Medicine (A.B.), Georgetown University, Washington, DC; Division of Hematology and Oncology (P.D.), Weill Cornell Medicine, New York; Department of Social Sciences and Health Policy (K.M.H.), Wake Forest University School of Medicine, Winston-Salem, NC; Cardiology Division (M.C.H.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics (M.C.H., P.N.), Broad Institute of Harvard and MIT, Cambridge, MA; Department of Pathology (S.J.), Stanford University School of Medicine, CA; Cardiovascular Research Center and Center for Genomic Medicine (P.N.), Massachusetts General Hospital, Boston; Department of Medicine (P.N.), Harvard Medical School, Boston; Division of Genetic Medicine (A.G.B.), Department of Medicine, Vanderbilt University Medical Center, Nashville, TN; Division of Public Health Sciences (C.K., A.P.R.), Fred Hutchinson Cancer Center, Seattle, WA; Department of Medicine (J.E.M.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Epidemiology (A.P.R.), University of Washington, Seattle; and Department of Medicine (E.A.W.), School of Medicine, University of North Carolina, Chapel Hill
| | - Gary G Schwartz
- From the Department of Epidemiology (K.M.A., J.M.C., S.-A.M.L., J.D.S., R.G., E.A.W.), Gillings School of Global Public Health, University of North Carolina, Chapel Hill; Brown University (S.F.B.), Providence, RI; Department of Population Health (G.G.S.), University of North Dakota School of Medicine & Health Sciences, Grand Forks; Department of Neurology (D.Y.H.), School of Medicine, University of North Carolina, Chapel Hill; Program in Public Health (J.R.M.), Stony Brook University, Stony Brook, NY; Division of Oncological Sciences (Z.Z.), Knight Cancer Institute, Oregon Health & Science University, Portland; Department of Cardiology (A.B.), Medstar Washington Hospital Center, Washington, DC; Department of Medicine (A.B.), Georgetown University, Washington, DC; Division of Hematology and Oncology (P.D.), Weill Cornell Medicine, New York; Department of Social Sciences and Health Policy (K.M.H.), Wake Forest University School of Medicine, Winston-Salem, NC; Cardiology Division (M.C.H.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics (M.C.H., P.N.), Broad Institute of Harvard and MIT, Cambridge, MA; Department of Pathology (S.J.), Stanford University School of Medicine, CA; Cardiovascular Research Center and Center for Genomic Medicine (P.N.), Massachusetts General Hospital, Boston; Department of Medicine (P.N.), Harvard Medical School, Boston; Division of Genetic Medicine (A.G.B.), Department of Medicine, Vanderbilt University Medical Center, Nashville, TN; Division of Public Health Sciences (C.K., A.P.R.), Fred Hutchinson Cancer Center, Seattle, WA; Department of Medicine (J.E.M.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Epidemiology (A.P.R.), University of Washington, Seattle; and Department of Medicine (E.A.W.), School of Medicine, University of North Carolina, Chapel Hill
| | - David Y Huang
- From the Department of Epidemiology (K.M.A., J.M.C., S.-A.M.L., J.D.S., R.G., E.A.W.), Gillings School of Global Public Health, University of North Carolina, Chapel Hill; Brown University (S.F.B.), Providence, RI; Department of Population Health (G.G.S.), University of North Dakota School of Medicine & Health Sciences, Grand Forks; Department of Neurology (D.Y.H.), School of Medicine, University of North Carolina, Chapel Hill; Program in Public Health (J.R.M.), Stony Brook University, Stony Brook, NY; Division of Oncological Sciences (Z.Z.), Knight Cancer Institute, Oregon Health & Science University, Portland; Department of Cardiology (A.B.), Medstar Washington Hospital Center, Washington, DC; Department of Medicine (A.B.), Georgetown University, Washington, DC; Division of Hematology and Oncology (P.D.), Weill Cornell Medicine, New York; Department of Social Sciences and Health Policy (K.M.H.), Wake Forest University School of Medicine, Winston-Salem, NC; Cardiology Division (M.C.H.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics (M.C.H., P.N.), Broad Institute of Harvard and MIT, Cambridge, MA; Department of Pathology (S.J.), Stanford University School of Medicine, CA; Cardiovascular Research Center and Center for Genomic Medicine (P.N.), Massachusetts General Hospital, Boston; Department of Medicine (P.N.), Harvard Medical School, Boston; Division of Genetic Medicine (A.G.B.), Department of Medicine, Vanderbilt University Medical Center, Nashville, TN; Division of Public Health Sciences (C.K., A.P.R.), Fred Hutchinson Cancer Center, Seattle, WA; Department of Medicine (J.E.M.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Epidemiology (A.P.R.), University of Washington, Seattle; and Department of Medicine (E.A.W.), School of Medicine, University of North Carolina, Chapel Hill
| | - Jaymie R Meliker
- From the Department of Epidemiology (K.M.A., J.M.C., S.-A.M.L., J.D.S., R.G., E.A.W.), Gillings School of Global Public Health, University of North Carolina, Chapel Hill; Brown University (S.F.B.), Providence, RI; Department of Population Health (G.G.S.), University of North Dakota School of Medicine & Health Sciences, Grand Forks; Department of Neurology (D.Y.H.), School of Medicine, University of North Carolina, Chapel Hill; Program in Public Health (J.R.M.), Stony Brook University, Stony Brook, NY; Division of Oncological Sciences (Z.Z.), Knight Cancer Institute, Oregon Health & Science University, Portland; Department of Cardiology (A.B.), Medstar Washington Hospital Center, Washington, DC; Department of Medicine (A.B.), Georgetown University, Washington, DC; Division of Hematology and Oncology (P.D.), Weill Cornell Medicine, New York; Department of Social Sciences and Health Policy (K.M.H.), Wake Forest University School of Medicine, Winston-Salem, NC; Cardiology Division (M.C.H.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics (M.C.H., P.N.), Broad Institute of Harvard and MIT, Cambridge, MA; Department of Pathology (S.J.), Stanford University School of Medicine, CA; Cardiovascular Research Center and Center for Genomic Medicine (P.N.), Massachusetts General Hospital, Boston; Department of Medicine (P.N.), Harvard Medical School, Boston; Division of Genetic Medicine (A.G.B.), Department of Medicine, Vanderbilt University Medical Center, Nashville, TN; Division of Public Health Sciences (C.K., A.P.R.), Fred Hutchinson Cancer Center, Seattle, WA; Department of Medicine (J.E.M.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Epidemiology (A.P.R.), University of Washington, Seattle; and Department of Medicine (E.A.W.), School of Medicine, University of North Carolina, Chapel Hill
| | - Zhenzhen Zhang
- From the Department of Epidemiology (K.M.A., J.M.C., S.-A.M.L., J.D.S., R.G., E.A.W.), Gillings School of Global Public Health, University of North Carolina, Chapel Hill; Brown University (S.F.B.), Providence, RI; Department of Population Health (G.G.S.), University of North Dakota School of Medicine & Health Sciences, Grand Forks; Department of Neurology (D.Y.H.), School of Medicine, University of North Carolina, Chapel Hill; Program in Public Health (J.R.M.), Stony Brook University, Stony Brook, NY; Division of Oncological Sciences (Z.Z.), Knight Cancer Institute, Oregon Health & Science University, Portland; Department of Cardiology (A.B.), Medstar Washington Hospital Center, Washington, DC; Department of Medicine (A.B.), Georgetown University, Washington, DC; Division of Hematology and Oncology (P.D.), Weill Cornell Medicine, New York; Department of Social Sciences and Health Policy (K.M.H.), Wake Forest University School of Medicine, Winston-Salem, NC; Cardiology Division (M.C.H.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics (M.C.H., P.N.), Broad Institute of Harvard and MIT, Cambridge, MA; Department of Pathology (S.J.), Stanford University School of Medicine, CA; Cardiovascular Research Center and Center for Genomic Medicine (P.N.), Massachusetts General Hospital, Boston; Department of Medicine (P.N.), Harvard Medical School, Boston; Division of Genetic Medicine (A.G.B.), Department of Medicine, Vanderbilt University Medical Center, Nashville, TN; Division of Public Health Sciences (C.K., A.P.R.), Fred Hutchinson Cancer Center, Seattle, WA; Department of Medicine (J.E.M.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Epidemiology (A.P.R.), University of Washington, Seattle; and Department of Medicine (E.A.W.), School of Medicine, University of North Carolina, Chapel Hill
| | - Ana Barac
- From the Department of Epidemiology (K.M.A., J.M.C., S.-A.M.L., J.D.S., R.G., E.A.W.), Gillings School of Global Public Health, University of North Carolina, Chapel Hill; Brown University (S.F.B.), Providence, RI; Department of Population Health (G.G.S.), University of North Dakota School of Medicine & Health Sciences, Grand Forks; Department of Neurology (D.Y.H.), School of Medicine, University of North Carolina, Chapel Hill; Program in Public Health (J.R.M.), Stony Brook University, Stony Brook, NY; Division of Oncological Sciences (Z.Z.), Knight Cancer Institute, Oregon Health & Science University, Portland; Department of Cardiology (A.B.), Medstar Washington Hospital Center, Washington, DC; Department of Medicine (A.B.), Georgetown University, Washington, DC; Division of Hematology and Oncology (P.D.), Weill Cornell Medicine, New York; Department of Social Sciences and Health Policy (K.M.H.), Wake Forest University School of Medicine, Winston-Salem, NC; Cardiology Division (M.C.H.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics (M.C.H., P.N.), Broad Institute of Harvard and MIT, Cambridge, MA; Department of Pathology (S.J.), Stanford University School of Medicine, CA; Cardiovascular Research Center and Center for Genomic Medicine (P.N.), Massachusetts General Hospital, Boston; Department of Medicine (P.N.), Harvard Medical School, Boston; Division of Genetic Medicine (A.G.B.), Department of Medicine, Vanderbilt University Medical Center, Nashville, TN; Division of Public Health Sciences (C.K., A.P.R.), Fred Hutchinson Cancer Center, Seattle, WA; Department of Medicine (J.E.M.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Epidemiology (A.P.R.), University of Washington, Seattle; and Department of Medicine (E.A.W.), School of Medicine, University of North Carolina, Chapel Hill
| | - Pinkal Desai
- From the Department of Epidemiology (K.M.A., J.M.C., S.-A.M.L., J.D.S., R.G., E.A.W.), Gillings School of Global Public Health, University of North Carolina, Chapel Hill; Brown University (S.F.B.), Providence, RI; Department of Population Health (G.G.S.), University of North Dakota School of Medicine & Health Sciences, Grand Forks; Department of Neurology (D.Y.H.), School of Medicine, University of North Carolina, Chapel Hill; Program in Public Health (J.R.M.), Stony Brook University, Stony Brook, NY; Division of Oncological Sciences (Z.Z.), Knight Cancer Institute, Oregon Health & Science University, Portland; Department of Cardiology (A.B.), Medstar Washington Hospital Center, Washington, DC; Department of Medicine (A.B.), Georgetown University, Washington, DC; Division of Hematology and Oncology (P.D.), Weill Cornell Medicine, New York; Department of Social Sciences and Health Policy (K.M.H.), Wake Forest University School of Medicine, Winston-Salem, NC; Cardiology Division (M.C.H.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics (M.C.H., P.N.), Broad Institute of Harvard and MIT, Cambridge, MA; Department of Pathology (S.J.), Stanford University School of Medicine, CA; Cardiovascular Research Center and Center for Genomic Medicine (P.N.), Massachusetts General Hospital, Boston; Department of Medicine (P.N.), Harvard Medical School, Boston; Division of Genetic Medicine (A.G.B.), Department of Medicine, Vanderbilt University Medical Center, Nashville, TN; Division of Public Health Sciences (C.K., A.P.R.), Fred Hutchinson Cancer Center, Seattle, WA; Department of Medicine (J.E.M.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Epidemiology (A.P.R.), University of Washington, Seattle; and Department of Medicine (E.A.W.), School of Medicine, University of North Carolina, Chapel Hill
| | - Kathleen M Hayden
- From the Department of Epidemiology (K.M.A., J.M.C., S.-A.M.L., J.D.S., R.G., E.A.W.), Gillings School of Global Public Health, University of North Carolina, Chapel Hill; Brown University (S.F.B.), Providence, RI; Department of Population Health (G.G.S.), University of North Dakota School of Medicine & Health Sciences, Grand Forks; Department of Neurology (D.Y.H.), School of Medicine, University of North Carolina, Chapel Hill; Program in Public Health (J.R.M.), Stony Brook University, Stony Brook, NY; Division of Oncological Sciences (Z.Z.), Knight Cancer Institute, Oregon Health & Science University, Portland; Department of Cardiology (A.B.), Medstar Washington Hospital Center, Washington, DC; Department of Medicine (A.B.), Georgetown University, Washington, DC; Division of Hematology and Oncology (P.D.), Weill Cornell Medicine, New York; Department of Social Sciences and Health Policy (K.M.H.), Wake Forest University School of Medicine, Winston-Salem, NC; Cardiology Division (M.C.H.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics (M.C.H., P.N.), Broad Institute of Harvard and MIT, Cambridge, MA; Department of Pathology (S.J.), Stanford University School of Medicine, CA; Cardiovascular Research Center and Center for Genomic Medicine (P.N.), Massachusetts General Hospital, Boston; Department of Medicine (P.N.), Harvard Medical School, Boston; Division of Genetic Medicine (A.G.B.), Department of Medicine, Vanderbilt University Medical Center, Nashville, TN; Division of Public Health Sciences (C.K., A.P.R.), Fred Hutchinson Cancer Center, Seattle, WA; Department of Medicine (J.E.M.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Epidemiology (A.P.R.), University of Washington, Seattle; and Department of Medicine (E.A.W.), School of Medicine, University of North Carolina, Chapel Hill
| | - Michael C Honigberg
- From the Department of Epidemiology (K.M.A., J.M.C., S.-A.M.L., J.D.S., R.G., E.A.W.), Gillings School of Global Public Health, University of North Carolina, Chapel Hill; Brown University (S.F.B.), Providence, RI; Department of Population Health (G.G.S.), University of North Dakota School of Medicine & Health Sciences, Grand Forks; Department of Neurology (D.Y.H.), School of Medicine, University of North Carolina, Chapel Hill; Program in Public Health (J.R.M.), Stony Brook University, Stony Brook, NY; Division of Oncological Sciences (Z.Z.), Knight Cancer Institute, Oregon Health & Science University, Portland; Department of Cardiology (A.B.), Medstar Washington Hospital Center, Washington, DC; Department of Medicine (A.B.), Georgetown University, Washington, DC; Division of Hematology and Oncology (P.D.), Weill Cornell Medicine, New York; Department of Social Sciences and Health Policy (K.M.H.), Wake Forest University School of Medicine, Winston-Salem, NC; Cardiology Division (M.C.H.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics (M.C.H., P.N.), Broad Institute of Harvard and MIT, Cambridge, MA; Department of Pathology (S.J.), Stanford University School of Medicine, CA; Cardiovascular Research Center and Center for Genomic Medicine (P.N.), Massachusetts General Hospital, Boston; Department of Medicine (P.N.), Harvard Medical School, Boston; Division of Genetic Medicine (A.G.B.), Department of Medicine, Vanderbilt University Medical Center, Nashville, TN; Division of Public Health Sciences (C.K., A.P.R.), Fred Hutchinson Cancer Center, Seattle, WA; Department of Medicine (J.E.M.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Epidemiology (A.P.R.), University of Washington, Seattle; and Department of Medicine (E.A.W.), School of Medicine, University of North Carolina, Chapel Hill
| | - Siddhartha Jaiswal
- From the Department of Epidemiology (K.M.A., J.M.C., S.-A.M.L., J.D.S., R.G., E.A.W.), Gillings School of Global Public Health, University of North Carolina, Chapel Hill; Brown University (S.F.B.), Providence, RI; Department of Population Health (G.G.S.), University of North Dakota School of Medicine & Health Sciences, Grand Forks; Department of Neurology (D.Y.H.), School of Medicine, University of North Carolina, Chapel Hill; Program in Public Health (J.R.M.), Stony Brook University, Stony Brook, NY; Division of Oncological Sciences (Z.Z.), Knight Cancer Institute, Oregon Health & Science University, Portland; Department of Cardiology (A.B.), Medstar Washington Hospital Center, Washington, DC; Department of Medicine (A.B.), Georgetown University, Washington, DC; Division of Hematology and Oncology (P.D.), Weill Cornell Medicine, New York; Department of Social Sciences and Health Policy (K.M.H.), Wake Forest University School of Medicine, Winston-Salem, NC; Cardiology Division (M.C.H.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics (M.C.H., P.N.), Broad Institute of Harvard and MIT, Cambridge, MA; Department of Pathology (S.J.), Stanford University School of Medicine, CA; Cardiovascular Research Center and Center for Genomic Medicine (P.N.), Massachusetts General Hospital, Boston; Department of Medicine (P.N.), Harvard Medical School, Boston; Division of Genetic Medicine (A.G.B.), Department of Medicine, Vanderbilt University Medical Center, Nashville, TN; Division of Public Health Sciences (C.K., A.P.R.), Fred Hutchinson Cancer Center, Seattle, WA; Department of Medicine (J.E.M.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Epidemiology (A.P.R.), University of Washington, Seattle; and Department of Medicine (E.A.W.), School of Medicine, University of North Carolina, Chapel Hill
| | - Pradeep Natarajan
- From the Department of Epidemiology (K.M.A., J.M.C., S.-A.M.L., J.D.S., R.G., E.A.W.), Gillings School of Global Public Health, University of North Carolina, Chapel Hill; Brown University (S.F.B.), Providence, RI; Department of Population Health (G.G.S.), University of North Dakota School of Medicine & Health Sciences, Grand Forks; Department of Neurology (D.Y.H.), School of Medicine, University of North Carolina, Chapel Hill; Program in Public Health (J.R.M.), Stony Brook University, Stony Brook, NY; Division of Oncological Sciences (Z.Z.), Knight Cancer Institute, Oregon Health & Science University, Portland; Department of Cardiology (A.B.), Medstar Washington Hospital Center, Washington, DC; Department of Medicine (A.B.), Georgetown University, Washington, DC; Division of Hematology and Oncology (P.D.), Weill Cornell Medicine, New York; Department of Social Sciences and Health Policy (K.M.H.), Wake Forest University School of Medicine, Winston-Salem, NC; Cardiology Division (M.C.H.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics (M.C.H., P.N.), Broad Institute of Harvard and MIT, Cambridge, MA; Department of Pathology (S.J.), Stanford University School of Medicine, CA; Cardiovascular Research Center and Center for Genomic Medicine (P.N.), Massachusetts General Hospital, Boston; Department of Medicine (P.N.), Harvard Medical School, Boston; Division of Genetic Medicine (A.G.B.), Department of Medicine, Vanderbilt University Medical Center, Nashville, TN; Division of Public Health Sciences (C.K., A.P.R.), Fred Hutchinson Cancer Center, Seattle, WA; Department of Medicine (J.E.M.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Epidemiology (A.P.R.), University of Washington, Seattle; and Department of Medicine (E.A.W.), School of Medicine, University of North Carolina, Chapel Hill
| | - Alexander G Bick
- From the Department of Epidemiology (K.M.A., J.M.C., S.-A.M.L., J.D.S., R.G., E.A.W.), Gillings School of Global Public Health, University of North Carolina, Chapel Hill; Brown University (S.F.B.), Providence, RI; Department of Population Health (G.G.S.), University of North Dakota School of Medicine & Health Sciences, Grand Forks; Department of Neurology (D.Y.H.), School of Medicine, University of North Carolina, Chapel Hill; Program in Public Health (J.R.M.), Stony Brook University, Stony Brook, NY; Division of Oncological Sciences (Z.Z.), Knight Cancer Institute, Oregon Health & Science University, Portland; Department of Cardiology (A.B.), Medstar Washington Hospital Center, Washington, DC; Department of Medicine (A.B.), Georgetown University, Washington, DC; Division of Hematology and Oncology (P.D.), Weill Cornell Medicine, New York; Department of Social Sciences and Health Policy (K.M.H.), Wake Forest University School of Medicine, Winston-Salem, NC; Cardiology Division (M.C.H.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics (M.C.H., P.N.), Broad Institute of Harvard and MIT, Cambridge, MA; Department of Pathology (S.J.), Stanford University School of Medicine, CA; Cardiovascular Research Center and Center for Genomic Medicine (P.N.), Massachusetts General Hospital, Boston; Department of Medicine (P.N.), Harvard Medical School, Boston; Division of Genetic Medicine (A.G.B.), Department of Medicine, Vanderbilt University Medical Center, Nashville, TN; Division of Public Health Sciences (C.K., A.P.R.), Fred Hutchinson Cancer Center, Seattle, WA; Department of Medicine (J.E.M.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Epidemiology (A.P.R.), University of Washington, Seattle; and Department of Medicine (E.A.W.), School of Medicine, University of North Carolina, Chapel Hill
| | - Charles Kooperberg
- From the Department of Epidemiology (K.M.A., J.M.C., S.-A.M.L., J.D.S., R.G., E.A.W.), Gillings School of Global Public Health, University of North Carolina, Chapel Hill; Brown University (S.F.B.), Providence, RI; Department of Population Health (G.G.S.), University of North Dakota School of Medicine & Health Sciences, Grand Forks; Department of Neurology (D.Y.H.), School of Medicine, University of North Carolina, Chapel Hill; Program in Public Health (J.R.M.), Stony Brook University, Stony Brook, NY; Division of Oncological Sciences (Z.Z.), Knight Cancer Institute, Oregon Health & Science University, Portland; Department of Cardiology (A.B.), Medstar Washington Hospital Center, Washington, DC; Department of Medicine (A.B.), Georgetown University, Washington, DC; Division of Hematology and Oncology (P.D.), Weill Cornell Medicine, New York; Department of Social Sciences and Health Policy (K.M.H.), Wake Forest University School of Medicine, Winston-Salem, NC; Cardiology Division (M.C.H.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics (M.C.H., P.N.), Broad Institute of Harvard and MIT, Cambridge, MA; Department of Pathology (S.J.), Stanford University School of Medicine, CA; Cardiovascular Research Center and Center for Genomic Medicine (P.N.), Massachusetts General Hospital, Boston; Department of Medicine (P.N.), Harvard Medical School, Boston; Division of Genetic Medicine (A.G.B.), Department of Medicine, Vanderbilt University Medical Center, Nashville, TN; Division of Public Health Sciences (C.K., A.P.R.), Fred Hutchinson Cancer Center, Seattle, WA; Department of Medicine (J.E.M.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Epidemiology (A.P.R.), University of Washington, Seattle; and Department of Medicine (E.A.W.), School of Medicine, University of North Carolina, Chapel Hill
| | - JoAnn E Manson
- From the Department of Epidemiology (K.M.A., J.M.C., S.-A.M.L., J.D.S., R.G., E.A.W.), Gillings School of Global Public Health, University of North Carolina, Chapel Hill; Brown University (S.F.B.), Providence, RI; Department of Population Health (G.G.S.), University of North Dakota School of Medicine & Health Sciences, Grand Forks; Department of Neurology (D.Y.H.), School of Medicine, University of North Carolina, Chapel Hill; Program in Public Health (J.R.M.), Stony Brook University, Stony Brook, NY; Division of Oncological Sciences (Z.Z.), Knight Cancer Institute, Oregon Health & Science University, Portland; Department of Cardiology (A.B.), Medstar Washington Hospital Center, Washington, DC; Department of Medicine (A.B.), Georgetown University, Washington, DC; Division of Hematology and Oncology (P.D.), Weill Cornell Medicine, New York; Department of Social Sciences and Health Policy (K.M.H.), Wake Forest University School of Medicine, Winston-Salem, NC; Cardiology Division (M.C.H.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics (M.C.H., P.N.), Broad Institute of Harvard and MIT, Cambridge, MA; Department of Pathology (S.J.), Stanford University School of Medicine, CA; Cardiovascular Research Center and Center for Genomic Medicine (P.N.), Massachusetts General Hospital, Boston; Department of Medicine (P.N.), Harvard Medical School, Boston; Division of Genetic Medicine (A.G.B.), Department of Medicine, Vanderbilt University Medical Center, Nashville, TN; Division of Public Health Sciences (C.K., A.P.R.), Fred Hutchinson Cancer Center, Seattle, WA; Department of Medicine (J.E.M.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Epidemiology (A.P.R.), University of Washington, Seattle; and Department of Medicine (E.A.W.), School of Medicine, University of North Carolina, Chapel Hill
| | - Alexander P Reiner
- From the Department of Epidemiology (K.M.A., J.M.C., S.-A.M.L., J.D.S., R.G., E.A.W.), Gillings School of Global Public Health, University of North Carolina, Chapel Hill; Brown University (S.F.B.), Providence, RI; Department of Population Health (G.G.S.), University of North Dakota School of Medicine & Health Sciences, Grand Forks; Department of Neurology (D.Y.H.), School of Medicine, University of North Carolina, Chapel Hill; Program in Public Health (J.R.M.), Stony Brook University, Stony Brook, NY; Division of Oncological Sciences (Z.Z.), Knight Cancer Institute, Oregon Health & Science University, Portland; Department of Cardiology (A.B.), Medstar Washington Hospital Center, Washington, DC; Department of Medicine (A.B.), Georgetown University, Washington, DC; Division of Hematology and Oncology (P.D.), Weill Cornell Medicine, New York; Department of Social Sciences and Health Policy (K.M.H.), Wake Forest University School of Medicine, Winston-Salem, NC; Cardiology Division (M.C.H.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics (M.C.H., P.N.), Broad Institute of Harvard and MIT, Cambridge, MA; Department of Pathology (S.J.), Stanford University School of Medicine, CA; Cardiovascular Research Center and Center for Genomic Medicine (P.N.), Massachusetts General Hospital, Boston; Department of Medicine (P.N.), Harvard Medical School, Boston; Division of Genetic Medicine (A.G.B.), Department of Medicine, Vanderbilt University Medical Center, Nashville, TN; Division of Public Health Sciences (C.K., A.P.R.), Fred Hutchinson Cancer Center, Seattle, WA; Department of Medicine (J.E.M.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Epidemiology (A.P.R.), University of Washington, Seattle; and Department of Medicine (E.A.W.), School of Medicine, University of North Carolina, Chapel Hill
| | - Eric A Whitsel
- From the Department of Epidemiology (K.M.A., J.M.C., S.-A.M.L., J.D.S., R.G., E.A.W.), Gillings School of Global Public Health, University of North Carolina, Chapel Hill; Brown University (S.F.B.), Providence, RI; Department of Population Health (G.G.S.), University of North Dakota School of Medicine & Health Sciences, Grand Forks; Department of Neurology (D.Y.H.), School of Medicine, University of North Carolina, Chapel Hill; Program in Public Health (J.R.M.), Stony Brook University, Stony Brook, NY; Division of Oncological Sciences (Z.Z.), Knight Cancer Institute, Oregon Health & Science University, Portland; Department of Cardiology (A.B.), Medstar Washington Hospital Center, Washington, DC; Department of Medicine (A.B.), Georgetown University, Washington, DC; Division of Hematology and Oncology (P.D.), Weill Cornell Medicine, New York; Department of Social Sciences and Health Policy (K.M.H.), Wake Forest University School of Medicine, Winston-Salem, NC; Cardiology Division (M.C.H.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics (M.C.H., P.N.), Broad Institute of Harvard and MIT, Cambridge, MA; Department of Pathology (S.J.), Stanford University School of Medicine, CA; Cardiovascular Research Center and Center for Genomic Medicine (P.N.), Massachusetts General Hospital, Boston; Department of Medicine (P.N.), Harvard Medical School, Boston; Division of Genetic Medicine (A.G.B.), Department of Medicine, Vanderbilt University Medical Center, Nashville, TN; Division of Public Health Sciences (C.K., A.P.R.), Fred Hutchinson Cancer Center, Seattle, WA; Department of Medicine (J.E.M.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Epidemiology (A.P.R.), University of Washington, Seattle; and Department of Medicine (E.A.W.), School of Medicine, University of North Carolina, Chapel Hill
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Urrutia-Pereira M, Chatkin JM, Chong-Neto HJ, Solé D. Radon exposure: a major cause of lung cancer in nonsmokers. J Bras Pneumol 2023; 49:e20230210. [PMID: 38055388 PMCID: PMC10760439 DOI: 10.36416/1806-3756/e20230210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 09/06/2023] [Indexed: 12/08/2023] Open
Abstract
Exposure to radon can impact human health. This is a nonsystematic review of articles written in English, Spanish, French, or Portuguese published in the last decade (2013-2023), using databases such as PubMed, Google Scholar, EMBASE, and SciELO. Search terms selected were radon, human health, respiratory diseases, children, and adults. After analyzing the titles and abstracts, the researchers initially identified 47 studies, which were subsequently reduced to 40 after excluding reviews, dissertations, theses, and case-control studies. The studies have shown that enclosed environments such as residences and workplaces have higher levels of radon than those outdoors. Moreover, radon is one of the leading causes of lung cancer, especially in nonsmokers. An association between exposure to radon and development of other lung diseases, such as asthma and COPD, was also observed. It is crucial to increase public awareness and implement governmental control measures to reduce radon exposure. It is essential to quantify radon levels in all types of buildings and train professionals to conduct such measurements according to proven efficacy standards. Health care professionals should also be informed about this threat and receive adequate training to deal with the effects of radon on human health.
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Affiliation(s)
- Marilyn Urrutia-Pereira
- . Departamento de Medicina, Universidade Federal do Pampa - UNIPAMPA - Uruguaiana (RS) Brasil
| | - José Miguel Chatkin
- . Disciplina de Medicina Interna e Pneumologia, Escola de Medicina, Pontifícia Universidade Católica do Rio Grande do Sul - PUCRS - Porto Alegre (RS) Brasil
| | | | - Dirceu Solé
- . Disciplina de Pediatria, Escola Paulista de Medicina - EPM - Universidade Federal de São Paulo - UNIFESP - São Paulo (SP) Brasil
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13
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Ruano-Ravina A, Martin-Gisbert L, Kelsey K, Pérez-Ríos M, Candal-Pedreira C, Rey-Brandariz J, Varela-Lema L. An overview on the relationship between residential radon and lung cancer: what we know and future research. Clin Transl Oncol 2023; 25:3357-3368. [PMID: 37610496 PMCID: PMC10603006 DOI: 10.1007/s12094-023-03308-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 08/09/2023] [Indexed: 08/24/2023]
Abstract
We aim to provide an overview of the research available on indoor radon and lung cancer, with a special focus on Spanish investigations. Early studies on underground miners established the link between radon and lung cancer, which was later confirmed for the general population by residential case-control studies. Spain contributed with extensive evidence, including 5 multicentric, hospital-based, case-control studies in the last 30 years, exploring diverse aspects, such as radon's effect on never-smokers, molecular pathways linking radon exposure to lung cancer risk, survival rates, mortality burden, and occupational exposure. There is a well-established causal association between radon with lung cancer. Despite pioneering research performed in our country by the Galician Radon Laboratory, particularly on driver genes, the evidence on the potential molecular pathways which makes radon a carcinogen is sparse. Also, relevant questions on the potential association of radon exposure with the induction of other diseases are still pending.
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Affiliation(s)
- Alberto Ruano-Ravina
- Department of Preventive Medicine and Public Health, Facultade de Medicina, University of Santiago de Compostela, Rua San Francisco S/N, 15782, Santiago de Compostela, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBER en Epidemiología y Salud Pública/CIBERESP), Madrid, Spain
- Health Research Institute of Santiago de Compostela (Instituto de Investigación Sanitaria de Santiago de Compostela-IDIS), Santiago de Compostela, Spain
- Cross-Disciplinary Research in Environmental Technologies (CRETUS), University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Lucia Martin-Gisbert
- Department of Preventive Medicine and Public Health, Facultade de Medicina, University of Santiago de Compostela, Rua San Francisco S/N, 15782, Santiago de Compostela, Spain.
- Cross-Disciplinary Research in Environmental Technologies (CRETUS), University of Santiago de Compostela, Santiago de Compostela, Spain.
| | - Karl Kelsey
- Department of Epidemiology, Brown School of Public Health, Brown University, Providence, RI, USA
| | - Mónica Pérez-Ríos
- Department of Preventive Medicine and Public Health, Facultade de Medicina, University of Santiago de Compostela, Rua San Francisco S/N, 15782, Santiago de Compostela, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBER en Epidemiología y Salud Pública/CIBERESP), Madrid, Spain
- Health Research Institute of Santiago de Compostela (Instituto de Investigación Sanitaria de Santiago de Compostela-IDIS), Santiago de Compostela, Spain
| | - Cristina Candal-Pedreira
- Department of Preventive Medicine and Public Health, Facultade de Medicina, University of Santiago de Compostela, Rua San Francisco S/N, 15782, Santiago de Compostela, Spain
- Health Research Institute of Santiago de Compostela (Instituto de Investigación Sanitaria de Santiago de Compostela-IDIS), Santiago de Compostela, Spain
- Cross-Disciplinary Research in Environmental Technologies (CRETUS), University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Julia Rey-Brandariz
- Department of Preventive Medicine and Public Health, Facultade de Medicina, University of Santiago de Compostela, Rua San Francisco S/N, 15782, Santiago de Compostela, Spain
- Cross-Disciplinary Research in Environmental Technologies (CRETUS), University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Leonor Varela-Lema
- Department of Preventive Medicine and Public Health, Facultade de Medicina, University of Santiago de Compostela, Rua San Francisco S/N, 15782, Santiago de Compostela, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBER en Epidemiología y Salud Pública/CIBERESP), Madrid, Spain
- Health Research Institute of Santiago de Compostela (Instituto de Investigación Sanitaria de Santiago de Compostela-IDIS), Santiago de Compostela, Spain
- Cross-Disciplinary Research in Environmental Technologies (CRETUS), University of Santiago de Compostela, Santiago de Compostela, Spain
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14
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Timmons S, Lunn PD. Behaviourally-informed household communications increase uptake of radon tests in a randomised controlled trial. Sci Rep 2023; 13:20401. [PMID: 37990108 PMCID: PMC10663451 DOI: 10.1038/s41598-023-47832-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 11/19/2023] [Indexed: 11/23/2023] Open
Abstract
Exposure to radon gas is a leading cause of lung cancer. Testing homes for the gas is straightforward, yet most people do not undertake tests even when offered freely. We report a pre-registered randomised controlled trial of communications to encourage test uptake. Households (N = 3500) in areas at high risk of radon exposure were randomly assigned to receive (i) a the control letter from the national Environmental Protection Agency; (ii) a behaviourally-informed version of the control letter that incorporated multiple nudges, including reciprocity messages and numeric frequencies of risk; (iii) this same behaviourally-informed letter in a re-designed envelope; (iv) the behaviourally-informed letter in the re-designed enveloped with a radon risk map of the household's county. The behaviourally-informed letter led to a large increase in test uptake, from 22% in the control condition to 33% (a 50% increase). There was no additional benefit of the re-designed envelope, which generated uptake of 30%. Including the map led some households to respond faster, but the overall uptake (26%) was weaker. The results have implications for public health communications with households and show the potential for techniques from behavioural science to help mitigate environmental risks.
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Affiliation(s)
- Shane Timmons
- Economic and Social Research Institute, Whitaker Square, Sir John Rogerson's Quay, Dublin, Ireland.
- School of Psychology, Trinity College Dublin, Dublin, Ireland.
| | - Peter D Lunn
- Economic and Social Research Institute, Whitaker Square, Sir John Rogerson's Quay, Dublin, Ireland
- Department of Economics, Trinity College Dublin, Dublin, Ireland
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Zhukovsky M, Onishchenko A. Paracelsian 'Bergsucht' - lung cancer or radiation-induced fibrosis? Int J Radiat Biol 2023; 100:399-410. [PMID: 37930055 DOI: 10.1080/09553002.2023.2276916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 09/28/2023] [Indexed: 11/07/2023]
Abstract
PURPOSE Assessment of absorbed doses on organs and tissues of miners during radon exposure in the Schneeberg mines in the sixteenth century and calculation of the probability of occurrence of radiation-induced lung cancer and lung fibrosis, considering the life expectancy characteristic and the absence of smoking. MATERIALS AND METHODS The expected radon concentration at the Schneeberg mines has been estimated using published data. Modeling of the accumulation of radon in the working tunnels of mine workings was carried out using the RESRAD-Build 4.0, based on the radium concentration in soil and geometric parameters of the mining tunnel from the engravings in Agricola's book. The dynamics of radionuclides in the human body were performed using the WinAct software in accordance with data from ICRP Publications 130 and 137. The values of absorbed doses on the tissues of the respiratory tract were obtained using the IDAC 2.1 program. Several models based on the epidemiology of uranium miners have been used to calculate radiation risks from radon exposure. The probability of male survival at birth and the age-specific frequency of spontaneous lung cancer not associated with radiation for miners of the sixteenth century (nonsmoking men aged 20-40 years) were estimated to properly calculate the radiation risks. RESULTS The expected radon concentration in the Schneeberg mines was assessed in the range of 75-100 kBq m-3. The average value of the equilibrium factor was estimated as 0.49 ± 0.03. The annual exposure of miners to radon decay products was assessed as 125-165 WLM year-1. The annual values of absorbed doses to different sections of the respiratory tract were calculated, the maximum absorbed doses of α-radiation are formed on the bronchial and bronchiolar regions of the lungs (2.23 Gy year-1). The deterministic effects as radiation fibrosis of the lungs with 10 years of experience in the mines of Schneeberg have a probability of occurrence from 60 to 100%. All the models used for radiation risk assessments showed that the lifetime risk of developing lung cancer for nonsmoking Schneeberg miners is many times lower than the risk of developing deterministic radiation effects. In contrast, for the smoking cohort of miners in the nineteenth century lung cancer become the dominant cause of death. CONCLUSIONS The deterministic radiation effects of Schneeberg miners in sixteenth century, exposed to extremely high levels of radon, such as radiation pneumosclerosis or pulmonary fibrosis, are more likely than the development of radiation-induced lung cancer.
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Zhang Y, Yan Q, Angley M, Lu L, Miller EC, Judd S, Field RW, Kahe K. Smoking Modifies the Association Between Radon Exposure and Incident Ischemic Stroke: The REGARDS Study. Stroke 2023; 54:2737-2744. [PMID: 37846562 PMCID: PMC10615728 DOI: 10.1161/strokeaha.123.043648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 08/23/2023] [Indexed: 10/18/2023]
Abstract
BACKGROUND Exposure to radon has been linked to lung cancer and other lung diseases. Although biologically plausible, research of residential radon exposure in relation to stroke risk is scarce. METHODS Study participants were from the REGARDS (Reasons for Geographic and Racial Differences in Stroke) cohort (n=30 239), which consisted of male and female non-Hispanic Black and White adults aged 45 and older. After excluding participants with baseline stroke and transient ischemic attack, and missing information on exposure and outcome of interest, the final sample size was 26 950. The primary outcome was time to the first ischemic stroke through September 30, 2020. County-level radon measures from Lawrence Berkeley National Laboratory were linked to each participant based on their geocoded residential history. We used Cox proportional hazards regression models with a time-dependent exposure to estimate hazard ratios and 95% CIs for the association. RESULTS After controlling for potential confounding factors including demographic, lifestyle, clinical variables, and PM2.5, radon exposure was significantly associated with incident ischemic stroke among never-smokers (hazard ratio, 1.39 [95% CI, 1.01-1.90]) but not ever-smokers. The results were generally consistent in the sensitivity analysis when using radon measures from state/Environmental Protection Agency residential radon survey. CONCLUSIONS Findings from this study suggest that the association between residential radon exposure and incidence of ischemic stroke varies by smoking status and may be prominent in never-smokers. Further studies incorporating indoor-radon measures are needed to confirm these findings.
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Affiliation(s)
- Yijia Zhang
- Department of Obstetrics and Gynecology, Vagelos College of Physician and Surgeons, Columbia University Irving Medical Center, New York, NY
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
| | - Qi Yan
- Department of Obstetrics and Gynecology, Vagelos College of Physician and Surgeons, Columbia University Irving Medical Center, New York, NY
| | - Meghan Angley
- Department of Obstetrics and Gynecology, Vagelos College of Physician and Surgeons, Columbia University Irving Medical Center, New York, NY
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
| | - Liping Lu
- Department of Obstetrics and Gynecology, Vagelos College of Physician and Surgeons, Columbia University Irving Medical Center, New York, NY
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
| | - Eliza C Miller
- Department of Neurology, Division of Stroke and Cerebrovascular Disease, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, New York
| | - Suzanne Judd
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL
| | - R. William Field
- Department of Obstetrics and Gynecology, Vagelos College of Physician and Surgeons, Columbia University Irving Medical Center, New York, NY
- Department of Occupational and Environmental Health and Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA
| | - Ka Kahe
- Department of Obstetrics and Gynecology, Vagelos College of Physician and Surgeons, Columbia University Irving Medical Center, New York, NY
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
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Ramadhani D, Purnami S, Suvifan VA, Wanandi SI, Wibowo H, Syaifudin M. Preliminary study of chromosome aberrations using Giemsa, two-colour fish, and micronucleus assays in lymphocytes of individuals living in elevated radon concentration areas. Radiat Prot Dosimetry 2023; 199:1508-1515. [PMID: 37721082 DOI: 10.1093/rpd/ncac165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 06/24/2022] [Accepted: 07/05/2022] [Indexed: 09/19/2023]
Abstract
The frequencies of unstable and stable chromosome aberrations and micronuclei were examined in peripheral blood samples from 10 individuals living in elevated radon concentration areas (Takandeang Village, Mamuju, Indonesia). Blood samples from 10 people living in Topoyo Village were used as a control group. For unstable chromosome aberration analysis, a dicentric chromosome assay was conducted using conventional Giemsa staining. Chromosomal painting of chromosomes 1 and 4 using the fluorescence in situ hybridisation technique was also applied to four subjects to assess the stable chromosome aberration. Our study showed no significant increases across all groups in dicentric and other unstable chromosome aberrations, such as rings and acentric fragments. Translocations were found in one person from Takandeang Village and two Topoyo Village inhabitants. The translocations found in the subjects from Takandeang Village were due more to aging factors than to radon exposure. The number of micronuclei per 1000 binucleus cells in Takandeang Village inhabitants was not significantly different than that in the control group (p = 0.943). A more comprehensive analysis should be conducted in a subsequent study by increasing the number of study donors and the number of metaphases to be analysed in both dicentric chromosome assay and fluorescence in situ hybridisation assays. Such research could provide valid information on the cytogenetic effects of elevated indoor radon exposure.
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Affiliation(s)
- Dwi Ramadhani
- Doctoral Program for Biomedical Sciences, Faculty of Medicine, Universitas Indonesia, Jl. Salemba Raya No. 6, DKI Jakarta, 10430, Indonesia
- Research Center for Radioisotope, Radiopharmaceutical and Biodosimetry Technology, Research Organization for Nuclear Energy, National Research and Innovation Agency, Jl. Kw. Puspitek Blok NN No. 11, Muncul, Setu, Tangerang, 15314, Indonesia
| | - Sofiati Purnami
- Research Center for Safety, Metrology and Nuclear Quality Technology, Research Organization for Nuclear Energy, National Research and Innovation Agency, Jl. Lebak Bulus Raya No. 49, DKI Jakarta, 12440, Indonesia
| | - Viria Agesti Suvifan
- Research Center for Safety, Metrology and Nuclear Quality Technology, Research Organization for Nuclear Energy, National Research and Innovation Agency, Jl. Lebak Bulus Raya No. 49, DKI Jakarta, 12440, Indonesia
| | - Septelia Inawati Wanandi
- Department of Biochemistry & Molecular Biology, Faculty of Medicine, Universitas Indonesia, Jl. Salemba Raya No. 6, DKI Jakarta, 10430, Indonesia
| | - Heri Wibowo
- Department of Parasitology, Faculty of Medicine, Universitas Indonesia, Jl. Salemba Raya No. 6, DKI Jakarta, 10430, Indonesia
| | - Mukh Syaifudin
- Research Center for Radioisotope, Radiopharmaceutical and Biodosimetry Technology, Research Organization for Nuclear Energy, National Research and Innovation Agency, Jl. Kw. Puspitek Blok NN No. 11, Muncul, Setu, Tangerang, 15314, Indonesia
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18
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Yelizarov M, Yelizarov O, Berezovska I, Rataj M. Influence of the natural radon radiation on the spread of the COVID 19 pandemic. Sci Rep 2023; 13:12752. [PMID: 37550495 PMCID: PMC10406895 DOI: 10.1038/s41598-023-39705-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 07/29/2023] [Indexed: 08/09/2023] Open
Abstract
The statistics of COVID-19 accumulated in Ukraine show areas with a significantly lower incidence of diseases. The purpose of the study was to identify factors that could influence the pattern of the pandemic in a particular area. Within the study it was assumed that the level of health care is approximately the same throughout the country. Population density was considered the main factor influencing the dynamics of the spread of infection. To reduce the impact of changes in population density across regions, it was normalized by the average population density in the country. The normalization of statistics for the country resulted in a model in the form of a linear relationship between the normalized values of the number of COVID-19 cases in the region and the size of the region. Subsequent analysis of the graphical data made it possible to identify four regions with the lowest incidence of COVID-19. The geographical proximity of these regions Dnipro, Kherson, Vinnytsia and Kirovograd, indicates the presence of a common factor for them, not typical for the rest of Ukraine. Such a factor may be the location of 83% of Ukraine's uranium deposits in the territories around Kirovohrad. Radon is one of the decay products of uranium, so the population of these areas may experience increased exposure to radon. This noble gas has more than a century of medical use, in particular for pulmonary diseases, although there is still no consensus about its effectiveness and side effects. Considering that COVID-19 was often complicated by pulmonary diseases, it can be assumed that the geological specificity of these four regions of Ukraine had an impact on the course of the COVID-19 pandemic in their territories. The study findings are important in terms of further COVID-19 research and prevention strategies.
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Affiliation(s)
- Mykhaylo Yelizarov
- Natural Sciences Department, Kremenchuk Mykhailo Ostrohradskyi National University, Kremenchuk, Ukraine
| | - Olexandr Yelizarov
- Natural Sciences Department, Kremenchuk Mykhailo Ostrohradskyi National University, Kremenchuk, Ukraine
| | - Iryna Berezovska
- Department of Artificial Intelligence, University of Information Technology and Management in Rzeszow, Rzeszow, Poland
| | - Malgorzata Rataj
- Department of Cognitive Science and Mathematical Modeling, University of Information Technology and Management in Rzeszow, Rzeszow, Poland.
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Grzywa-Celińska A, Krusiński A, Kozak K, Mazur J, Grządziel D, Dos Santos Szewczyk K, Chmielewska I, Milanowski J. Indoor radon exposure and living conditions in patients with advanced lung cancer in Lublin region, Poland. Eur Rev Med Pharmacol Sci 2023; 27:7352-7361. [PMID: 37606144 DOI: 10.26355/eurrev_202308_33307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 08/23/2023]
Abstract
OBJECTIVE Radon (Rn-222) is a noble gas formed in the uranium path (U-238) as a decay product of radium (Ra-226). It is estimated to cause between 3% to 14% of all lung cancers, depending on the national average radon level and smoking prevalence. Radon molecules emit alpha radiation, which is characterized by low permeability through tissues, but due to its remarkably high energy, it has a high potential for DNA damage. The aim of our research was to assess the radon concentration inside the houses of patients with advanced lung cancer and to analyze their socio-economics status. PATIENTS AND METHODS The measurements of radon concentration were performed in 102 patients with stage 3B or higher lung cancer in the region of Lublin, Poland. One month of radon exposure measurement was performed with alpha-track detectors. In addition, patients filled in a detailed survey about factors that might influence the concentration of radon inside their houses. RESULTS The average concentration of radon during the exposure of the detector in the residential premises of the respondents was at the level of 69.0 Bq/m3 [37.0-117.0]. A few significant correlations were discovered, e.g., higher levels of radon in countryside houses or in houses equipped with air conditioning. CONCLUSIONS As radon exposure is a modifiable risk factor for lung cancer, it is extremely important to find factors that may reduce its concentration in dwelling places. Since our research was performed in houses of people with lung cancer, taking corrective actions based on our findings could prevent new lung cancer incidence in patients' flatmates.
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Affiliation(s)
- A Grzywa-Celińska
- Department of Pneumonology, Oncology and Allergology, Medical University of Lublin, Lublin, Poland.
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Kelly-Reif K, Bertke SJ, Rage E, Demers PA, Fenske N, Deffner V, Kreuzer M, Samet J, Schubauer-Berigan MK, Tomasek L, Zablotska LB, Wiggins C, Laurier D, Richardson DB. Radon and lung cancer in the pooled uranium miners analysis (PUMA): highly exposed early miners and all miners. Occup Environ Med 2023; 80:385-391. [PMID: 37164624 PMCID: PMC10369304 DOI: 10.1136/oemed-2022-108532] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 04/20/2023] [Indexed: 05/12/2023]
Abstract
OBJECTIVES Radon is a ubiquitous occupational and environmental lung carcinogen. We aim to quantify the association between radon progeny and lung cancer mortality in the largest and most up-to-date pooled study of uranium miners. METHODS The pooled uranium miners analysis combines 7 cohorts of male uranium miners with 7754 lung cancer deaths and 4.3 million person-years of follow-up. Vital status and lung cancer deaths were ascertained between 1946 and 2014. The association between cumulative radon exposure in working level months (WLM) and lung cancer was modelled as the excess relative rate (ERR) per 100 WLM using Poisson regression; variation in the association by temporal and exposure factors was examined. We also examined analyses restricted to miners first hired before 1960 and with <100 WLM cumulative exposure. RESULTS In a model that allows for variation by attained age, time since exposure and annual exposure rate, the ERR/100 WLM was 4.68 (95% CI 2.88 to 6.96) among miners who were less than 55 years of age and were exposed in the prior 5 to <15 years at annual exposure rates of <0.5 WL. This association decreased with older attained age, longer time since exposure and higher annual exposure rate. In analyses restricted to men first hired before 1960, we observed similar patterns of association but a slightly lower estimate of the ERR/100 WLM. CONCLUSIONS This new large, pooled study confirms and supports a linear exposure-response relationship between cumulative radon exposure and lung cancer mortality which is jointly modified by temporal and exposure factors.
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Affiliation(s)
- Kaitlin Kelly-Reif
- Division of Field Studies and Engineering, National Institute for Occupational Safety and Health, Cincinnati, Ohio, USA
| | - Stephen J Bertke
- Division of Field Studies and Engineering, National Institute for Occupational Safety and Health, Cincinnati, Ohio, USA
| | - Estelle Rage
- Institute for Radiological Protection and Nuclear Safety, Fontenay-aux-Roses, France
| | - Paul A Demers
- Occupational Cancer Research Centre, Ontario Health, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Nora Fenske
- Federal Office for Radiation Protection (BfS), Munich (Neuherberg), Germany
| | - Veronika Deffner
- Federal Office for Radiation Protection (BfS), Munich (Neuherberg), Germany
| | - Michaela Kreuzer
- Federal Office for Radiation Protection (BfS), Munich (Neuherberg), Germany
| | | | - Mary K Schubauer-Berigan
- Evidence Synthesis and Classification Branch, International Agency for Research on Cancer, Lyon, France
| | | | - Lydia B Zablotska
- Epidemiology and Biostatistics, University of California, San Francisco, California, USA
| | - Charles Wiggins
- University of New Mexico, Albuquerque, New Mexico, USA
- New Mexico Tumor Registry, Albuquerque, Mexico, USA
| | - Dominique Laurier
- Institute for Radiological Protection and Nuclear Safety, Fontenay-aux-Roses, France
| | - David B Richardson
- Department of Environmental and Occupational Health, University of California, Irvine, Program in Public Health, Irvine, California, USA
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Banzon TM, Greco KF, Li L, Mukharesh L, Vieira CLZ, Steiner MK, Hauptman M, Ratchataswan T, Koutrakis P, Phipatanakul W, Gaffin JM. Effect of radon exposure on asthma morbidity in the School Inner-City Asthma study. Pediatr Pulmonol 2023; 58:2042-2049. [PMID: 37083192 PMCID: PMC10330665 DOI: 10.1002/ppul.26429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 03/06/2023] [Accepted: 03/31/2023] [Indexed: 04/22/2023]
Abstract
BACKGROUND Radon may have a role in obstructive lung disease outside its known carcinogenicity. Little is known about radon's effects on asthma morbidity. OBJECTIVE To determine the effect of radon on fractional exhaled nitric oxide (FE NO), asthma symptom-days, and lung function in inner-city asthmatic school children. METHODS Two hundred ninety-nine school-aged asthmatic children enrolled in the School Inner-City Asthma Study (SICAS-1) were followed. One and two-month averaged radon was assessed using a spatiotemporal model predicting zip code-specific monthly exposures. FE NO and spirometry were measured twice during the academic year. Asthma symptoms were assessed four times during the academic year. The interaction between indoor radon exposure (Bq/m3 ) and seasonality predicting log-transformed FE NO, forced expiratory volume in 1 s (FEV1 ) % predicted, forced vital capacity (FVC) % predicted, FEV1 /FVC, and asthma symptom-days was evaluated. RESULTS Participants with high radon exposure had greater change in FE NO from warm to cold periods compared to low radon exposure (interaction p = 0.0013). Participants with >50th percentile radon exposure experience significant FE NO increase from warm to cold weather (β $\beta $ = 0.29 [95% confidence interval [CI]: 0.04-0.54], p = 0.0240). We report a positive association between radon 1-month moving average (incidence rate ratio [IRR] = 1.01, p = 0.0273) and 2-month moving average (IRR = 1.01, p = 0.0286) with maximum asthma symptom-days (n = 299, obs = 1167). CONCLUSIONS In asthmatic children, radon may be associated with increased asthma morbidity, suggesting radon may be a modifiable environmental risk factor for airway inflammation.
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Affiliation(s)
- Tina M. Banzon
- Division of Allergy and Immunology, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Kimberly F. Greco
- Institutional Centers for Clinical and Translational Research, Boston Children’s Hospital, Boston, MA, USA
| | - Longxiang Li
- Department of Environmental Health, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Lana Mukharesh
- Division of Pulmonary Medicine, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
| | | | - M. Kathryn Steiner
- Department of Allergy and Immunology, Boston Children’s Hospital, Boston, MA, USA
| | - Marissa Hauptman
- Pediatric Environmental Health Center, Division of General Pediatrics, Boston Children’s Hospital
| | | | - Petros Koutrakis
- Department of Environmental Health, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Wanda Phipatanakul
- Division of Allergy and Immunology, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Jonathan M. Gaffin
- Division of Pulmonary Medicine, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
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Martin-Gisbert L, Ruano-Ravina A, Varela-Lema L, Penabad M, Giraldo-Osorio A, Candal-Pedreira C, Rey-Brandariz J, Mourino N, Pérez-Ríos M. Lung cancer mortality attributable to residential radon: a systematic scoping review. J Expo Sci Environ Epidemiol 2023; 33:368-376. [PMID: 36577801 DOI: 10.1038/s41370-022-00506-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 11/24/2022] [Accepted: 11/24/2022] [Indexed: 06/03/2023]
Abstract
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.
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Affiliation(s)
- Lucia Martin-Gisbert
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Santiago de Compostela, Spain
- Health Research Institute of Santiago de Compostela (Instituto de Investigación Sanitaria de Santiago de Compostela - IDIS), Santiago de Compostela, Spain
- Cross-disciplinary Research in Environmental Technologies (CRETUS), University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Alberto Ruano-Ravina
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Santiago de Compostela, Spain
- Health Research Institute of Santiago de Compostela (Instituto de Investigación Sanitaria de Santiago de Compostela - IDIS), Santiago de Compostela, Spain
- Cross-disciplinary Research in Environmental Technologies (CRETUS), University of Santiago de Compostela, Santiago de Compostela, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBER en Epidemiología y Salud Pública/CIBERESP), Santiago de Compostela, Spain
| | - Leonor Varela-Lema
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Santiago de Compostela, Spain.
- Health Research Institute of Santiago de Compostela (Instituto de Investigación Sanitaria de Santiago de Compostela - IDIS), Santiago de Compostela, Spain.
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBER en Epidemiología y Salud Pública/CIBERESP), Santiago de Compostela, Spain.
| | - Marina Penabad
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Alexandra Giraldo-Osorio
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Santiago de Compostela, Spain
- Grupo de Investigación Promoción de la Salud y Prevención de la Enfermedad (GIPSPE), Departamento de Salud Pública, Universidad de Caldas, Manizales, 170002, Colombia
- Scholarship Holder of Fundación Carolina (C.2021), 28071, Madrid, Spain
| | - Cristina Candal-Pedreira
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Santiago de Compostela, Spain
- Health Research Institute of Santiago de Compostela (Instituto de Investigación Sanitaria de Santiago de Compostela - IDIS), Santiago de Compostela, Spain
| | - Julia Rey-Brandariz
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Nerea Mourino
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Mónica Pérez-Ríos
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Santiago de Compostela, Spain
- Health Research Institute of Santiago de Compostela (Instituto de Investigación Sanitaria de Santiago de Compostela - IDIS), Santiago de Compostela, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBER en Epidemiología y Salud Pública/CIBERESP), Santiago de Compostela, Spain
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Kurkela O, Nevalainen J, Pätsi SM, Kojo K, Holmgren O, Auvinen A. Lung cancer incidence attributable to residential radon exposure in Finland. Radiat Environ Biophys 2023; 62:35-49. [PMID: 36344858 PMCID: PMC9950193 DOI: 10.1007/s00411-022-01004-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 10/23/2022] [Indexed: 06/16/2023]
Abstract
This study aimed to estimate (1) the number of avoidable lung cancer cases attributable to residential radon in Finland in 2017, separately by age, sex, dwelling type and smoking status, (2) the impact of residential radon alone and the joint effect of residential radon and smoking on the number of lung cancers and (3) the potential decrease in the number of radon-attributable lung cancers if radon concentrations exceeding specified action levels (100, 200 and 300 Bq m-3) would have been mitigated to those levels. Population-based surveys of radon concentrations and smoking patterns were used. Observed radon levels were contrasted with 25 Bq m-3 representing a realistic minimum level of exposure. Lung cancer risk estimates for radon and smoking were derived from literature. Lastly, the uncertainty due to the estimation of exposure and risk was quantified using a computationally derived uncertainty interval. At least 3% and at most 8% of all lung cancers were estimated as being attributable to residential radon. For small cell carcinoma, the proportion of cases attributable to radon was 8-13%. Among smokers, the majority of the radon-related cases were attributable to the joint effect of radon and smoking. Reduction of radon exposure to 100 Bq m-3 action level would eliminate approximately 30% of radon-attributable cases. Estimates were low compared with the literature, given the (relatively high) radon levels in Finland. This was mainly due to the lower radon levels and higher smoking prevalence in flats than in houses and a more realistic point of comparison, factors which have been ignored in previous studies. The results can guide actions in radon protection and in prevention of lung cancers.
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Affiliation(s)
- Olli Kurkela
- STUK-Radiation and Nuclear Safety Authority, Environmental Surveillance, Helsinki, Finland.
- Faculty of Social Sciences, Tampere University, Unit of Health Sciences, P.O. Box 100, 33014, Tampere, Finland.
- Laurea University of Applied Sciences, Ratatie 22, 01300, Vantaa, Finland.
| | - Jaakko Nevalainen
- Faculty of Social Sciences, Tampere University, Unit of Health Sciences, P.O. Box 100, 33014, Tampere, Finland
| | - Salla-Maaria Pätsi
- STUK-Radiation and Nuclear Safety Authority, Environmental Surveillance, Helsinki, Finland
- Faculty of Social Sciences, Tampere University, Unit of Health Sciences, P.O. Box 100, 33014, Tampere, Finland
| | - Katja Kojo
- STUK-Radiation and Nuclear Safety Authority, Environmental Surveillance, Helsinki, Finland
| | - Olli Holmgren
- STUK-Radiation and Nuclear Safety Authority, Environmental Surveillance, Helsinki, Finland
| | - Anssi Auvinen
- STUK-Radiation and Nuclear Safety Authority, Environmental Surveillance, Helsinki, Finland
- Faculty of Social Sciences, Tampere University, Unit of Health Sciences, P.O. Box 100, 33014, Tampere, Finland
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Su C, Pan M, Liu N, Zhang Y, Kan H, Zhao Z, Deng F, Zhao B, Qian H, Zeng X, Sun Y, Liu W, Mo J, Guo J, Zheng X, Sun C, Zou Z, Li H, Huang C. Lung cancer as adverse health effect by indoor radon exposure in China from 2000 to 2020: A systematic review and meta-analysis. Indoor Air 2022; 32:e13154. [PMID: 36437653 DOI: 10.1111/ina.13154] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 10/08/2022] [Accepted: 10/14/2022] [Indexed: 06/16/2023]
Abstract
Indoor radon exposure is thought to be associated with adverse health effect as lung cancer. Lung cancer incidences in China have been the highest worldwide during the past two decades. It is important to quantitively address indoor radon exposure and its health effect, especially in countries like China. In this paper, we have conducted a meta-analysis based on indoor radon and its health effect studies from a systematic review between 2000 and 2020. A total of 8 studies were included for lung cancer. We found that the relative risk (RR) was 1.01 (95% CI: 1.01-1.02) per 10 Bq/m3 increase of indoor radon for lung cancer in China. The subgroup analysis found no significant difference between the conclusions from the studies from China and other regions. The health effect of indoor radon exposure is relatively consistent for the low-exposure and high-exposure groups in the subgroup analysis. With a better understanding of exposure level of indoor radon, the outcomes and conclusions of this study will provide supports for next phase of researches on estimation of environmental burden of disease by indoor radon exposures in countries like China.
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Affiliation(s)
- Chunxiao Su
- School of Environment and Architecture, University of Shanghai for Science and Technology, Shanghai, China
| | - Minyi Pan
- School of Environment and Architecture, University of Shanghai for Science and Technology, Shanghai, China
| | - Ningrui Liu
- Department of Building Science, Tsinghua University, Beijing, China
| | - Yinping Zhang
- Department of Building Science, Tsinghua University, Beijing, China
| | - Haidong Kan
- School of Public Health, Fudan University, Shanghai, China
| | - Zhuohui Zhao
- School of Public Health, Fudan University, Shanghai, China
| | - Furong Deng
- School of Public Health, Peking University, Beijing, China
| | - Bin Zhao
- Department of Building Science, Tsinghua University, Beijing, China
| | - Hua Qian
- School of Energy and Environment, Southeast University, Nanjing, China
- Engineering Research Center of BEEE, Ministry of Education, Xicheng, China
| | - Xiangang Zeng
- School of Environment and Natural Resources, Renmin University of China, Beijing, China
| | - Yuexia Sun
- School of Environmental Science and Engineering, Tianjin University, Tianjin, China
| | - Wei Liu
- Institute for Health and Environment, Chongqing University of Science and Technology, Chongqing, China
| | - Jinhan Mo
- Department of Building Science, Tsinghua University, Beijing, China
| | - Jianguo Guo
- Institute of Laboratory Animal Science, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Xiaohong Zheng
- School of Energy and Environment, Southeast University, Nanjing, China
- Engineering Research Center of BEEE, Ministry of Education, Xicheng, China
| | - Chanjuan Sun
- School of Environment and Architecture, University of Shanghai for Science and Technology, Shanghai, China
| | - Zhijun Zou
- School of Environment and Architecture, University of Shanghai for Science and Technology, Shanghai, China
| | - Hao Li
- School of Environment and Architecture, University of Shanghai for Science and Technology, Shanghai, China
| | - Chen Huang
- School of Environment and Architecture, University of Shanghai for Science and Technology, Shanghai, China
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25
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Boz S, Berlin C, Kwiatkowski M, Bochud M, Bulliard JL, Zwahlen M, Röösli M, Vienneau D. A prospective cohort analysis of residential radon and UV exposures and malignant melanoma mortality in the Swiss population. Environ Int 2022; 169:107437. [PMID: 36152363 DOI: 10.1016/j.envint.2022.107437] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 05/31/2022] [Accepted: 07/25/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Radon is a radioactive noble gas naturally found in the earth crust that can accumulate in buildings. In addition to lung cancer, alpha particles emitted by radon may contribute to the risk of skin cancer. We evaluated the association between residential radon exposure and skin cancer mortality, over a fifteen year period, taking residential ultra-violet (UV) exposure into account. METHODS We included 4.9 million adults from the Swiss National Cohort. Hazard ratios for melanoma mortality were estimated using Cox proportional hazard models (20+ years old; follow-up 2001-2015). Long-term modelled residential radon and ambient UV exposures were assigned at baseline, and included together in the Cox models. With age as a time scale, models were adjusted for calendar time, sex, marital status, education, mother tongue, socioeconomic position, and occupational environment with potential for UV exposure. Age specific hazard ratios were derived. Effect modification, sensitivity analyses and the shape of the exposure response, as well as secondary analysis using other outcome definitions, were investigated. RESULTS During follow-up (average of 13.6 years), 3,979 melanoma deaths were observed. Associations declined with age, with an adjusted hazard ratio per 100 Bq/m3 radon at age 60 of 1.10 (95% CI: 0.99, 1.23). The dose-response showed an approximate linear trend between the minimum and mean radon exposure of 75 Bq/m3. Having outdoor occupation significantly increased the risk of melanoma mortality associated with UV exposure compared to indoor jobs. Analysis restricted to the last five years of follow-up showed similar results compared to the main analysis. Similar associations were found for mortality from melanoma and non-melanoma skin cancer combined. CONCLUSION With double the follow-up time, this study confirmed the previously observed association between residential radon exposure and melanoma and non-melanoma skin cancer mortality in Switzerland. Accumulation of radon indoors is preventable and of public health importance.
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Affiliation(s)
- Seçkin Boz
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Allschwil, Switzerland; University of Basel, Basel, Switzerland
| | - Claudia Berlin
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Marek Kwiatkowski
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Allschwil, Switzerland; University of Basel, Basel, Switzerland
| | - Murielle Bochud
- Centre for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Jean-Luc Bulliard
- Centre for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Marcel Zwahlen
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Martin Röösli
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Allschwil, Switzerland; University of Basel, Basel, Switzerland
| | - Danielle Vienneau
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Allschwil, Switzerland; University of Basel, Basel, Switzerland.
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Kelly-Reif K, Bertke S, Daniels RD, Richardson DB, Schubauer-Berigan MK. Nonmalignant respiratory disease mortality in male Colorado Plateau uranium miners, 1960-2016. Am J Ind Med 2022; 65:773-782. [PMID: 35941829 PMCID: PMC10031748 DOI: 10.1002/ajim.23419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 07/17/2022] [Accepted: 07/20/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND To evaluate trends of nonmalignant respiratory disease (NMRD) mortality among US underground uranium miners on the Colorado Plateau, and to estimate the exposure-response association between cumulative radon progeny exposure and NMRD subtype mortality. METHODS Standardized mortality ratios (SMRs) and excess relative rates per 100 working level months (excess relative rate [ERR]/100 WLM) were estimated in a cohort of 4021 male underground uranium miners who were followed from 1960 through 2016. RESULTS We observed elevated SMRs for all NMRD subtypes. Silicosis had the largest SMR (n = 52, SMR = 41.4; 95% confidence interval [CI]: 30.9, 54.3), followed by other pneumoconiosis (n = 49, SMR = 39.6; 95% CI: 29.6, 52.3) and idiopathic pulmonary fibrosis (IPF) (n = 64, SMR = 4.77; 95% CI 3.67, 6.09). SMRs for silicosis increased with duration of employment; SMRs for IPF increased with duration of employment and calendar period. There was a positive association between cumulative radon exposure and silicosis with evidence of modification by smoking (ERR/100 WLM≥10 pack-years = 0.78; 95% CI: 0.05, 24.6 and ERR/100 WLM<10 pack-years = 0.01; 95% CI: -0.03, 0.52), as well as a small positive association between radon and IPF (ERR/100 WLM = 0.06, 95% CI: 0.00, 0.24); these associations were driven by workers with prior employment in hard rock mining. CONCLUSIONS Uranium mining workers had excess NMRD mortality compared with the general population; this excess persisted throughout follow-up. Exposure-response analyses indicated a positive association between radon exposure and IPF and silicosis, but these analyses have limitations due to outcome misclassification and missing information on occupational co-exposures such as silica dust.
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Affiliation(s)
- Kaitlin Kelly-Reif
- National Institute for Occupational Safety and Health, Cincinnati, OH, USA
| | - Stephen Bertke
- National Institute for Occupational Safety and Health, Cincinnati, OH, USA
| | - Robert D Daniels
- National Institute for Occupational Safety and Health, Cincinnati, OH, USA
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Shan X, Tian X, Wang B, He L, Zhang L, Xue B, Liu C, Zheng L, Yu Y, Luo B. A global burden assessment of lung cancer attributed to residential radon exposure during 1990-2019. Indoor Air 2022; 32:e13120. [PMID: 36305076 DOI: 10.1111/ina.13120] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 08/30/2022] [Accepted: 09/12/2022] [Indexed: 06/16/2023]
Abstract
This study aimed to explore the spatial and temporal trends of lung cancer burden attributable to residential radon exposure at the global, regional, and national levels. Based on the Global Burden of Disease Study (GBD) 2019, we collected the age-standardized mortality rate (ASMR) and age-standardized disability-adjusted life rate (ASDR) of lung cancer attributable to residential radon exposure from 1990 to 2019. The Joinpoint model was used to calculate the annual average percentage change (AAPC) to evaluate the trend of ASMR and ASDR from 1990 to 2019. The locally weighted regression (LOESS) was used to estimate the relationship of the socio-demographic index (SDI) with ASMR and ASDR. In 2019, the global ASMR and ASDR for lung cancer attributable to residential radon exposure were 1.03 (95% CI: 0.20, 2.00) and 22.66 (95% CI: 4.49, 43.94) per 100 000 population, which were 15.6% and 23.0% lower than in 1990, respectively. According to the estimation, we found the lung cancer burden attributable to residential radon exposure declined significantly in high and high-middle SDI regions, but substantially increased in middle and low-middle SDI regions from 1990 to 2019. Across age and sex, the highest burden of lung cancer attributable to residential radon exposure was found in males and elderly groups. In conclusion, the global burden of lung cancer attributable to residential radon exposure showed a declining trend from 1990 to 2019, but a relatively large increase was found in the middle SDI regions. In 2019, the burden of lung cancer attributable to residential radon exposure remained high, particularly in males, the elderly, and high-middle SDI regions compared with other groups.
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Affiliation(s)
- Xiaobing Shan
- Institute of Occupational Health and Environmental Health, School of Public Health, Lanzhou University, Lanzhou, Gansu, China
| | - Xiaoyu Tian
- Institute of Occupational Health and Environmental Health, School of Public Health, Lanzhou University, Lanzhou, Gansu, China
| | - Bo Wang
- Institute of Occupational Health and Environmental Health, School of Public Health, Lanzhou University, Lanzhou, Gansu, China
| | - Li He
- Institute of Occupational Health and Environmental Health, School of Public Health, Lanzhou University, Lanzhou, Gansu, China
| | - Ling Zhang
- Institute of Occupational Health and Environmental Health, School of Public Health, Lanzhou University, Lanzhou, Gansu, China
| | - Baode Xue
- Institute of Occupational Health and Environmental Health, School of Public Health, Lanzhou University, Lanzhou, Gansu, China
| | - Ce Liu
- Institute of Occupational Health and Environmental Health, School of Public Health, Lanzhou University, Lanzhou, Gansu, China
| | - Ling Zheng
- Institute of Occupational Health and Environmental Health, School of Public Health, Lanzhou University, Lanzhou, Gansu, China
| | - Yunhui Yu
- Institute of Occupational Health and Environmental Health, School of Public Health, Lanzhou University, Lanzhou, Gansu, China
| | - Bin Luo
- Institute of Occupational Health and Environmental Health, School of Public Health, Lanzhou University, Lanzhou, Gansu, China
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Böhm R, Bulko M, Holý K. INFLUENCE OF AIRWAY GEOMETRY ON RADON RISK ASSESSMENT IN ADULTS AND CHILDREN (MICRODOSIMETRIC APPROACH). Radiat Prot Dosimetry 2022; 198:802-808. [PMID: 36005983 DOI: 10.1093/rpd/ncac136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The aim of this work was to use the microdosimetric threshold energy model to study the effects of alpha-emitting 222Rn progeny on the probability of developing lung cancer. The results suggest that the radiation risk may increase by several times as the thickness of the surface layer decreases. The thicker the protective mucus layer and the deeper the sensitive target cells are located in the tissue, the less radiation damage the same dose produces. These findings have been applied to children of various ages. As children grow older, their lungs enlarge, the mucus layer thickens and the cells sensitive to radiation damage move deeper into the lung tissue, resulting in a reduction of radiation risk. The fraction of affected target cells is not only a function of dose but also of lung tissue depth. The results indicate that children can be several times more vulnerable to radiation than adults.
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Affiliation(s)
- Radoslav Böhm
- Department of Nuclear Physics and Biophysics, Faculty of Mathematics and Physics Comenius University, Mlynská dolina F1, 842 48 Bratislava, Slovak Republic
| | - Martin Bulko
- Department of Nuclear Physics and Biophysics, Faculty of Mathematics and Physics Comenius University, Mlynská dolina F1, 842 48 Bratislava, Slovak Republic
| | - Karol Holý
- Department of Nuclear Physics and Biophysics, Faculty of Mathematics and Physics Comenius University, Mlynská dolina F1, 842 48 Bratislava, Slovak Republic
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Abstract
Home radon testing is a primary lung cancer prevention strategy, yet the majority of Americans have not tested their home. This descriptive, ecological study uses 54,683 observed radon values collected in Kentucky homes from 1996 to 2016 to examine the association of county-level social determinants of health and environmental exposures on home radon testing rates. Multivariate linear regression analysis indicates that as median home value, rurality, and radon risk potential increased, counties experienced an increase in annual home radon testing rates. As adult smoking prevalence increased, counties experienced a decrease in annual rates of residential radon testing. These findings indicate that counties with low median home values, high adult smoking prevalence, and high incidence of lung cancer may benefit most from prevention interventions aimed at promoting home radon testing, adopting radon- and smoke-free home policies, and integrating radon risk reduction messaging into tobacco cessation and lung cancer screening programs.
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Affiliation(s)
| | - Mary Kay Rayens
- College of Nursing, University of Kentucky, Lexington, KY, USA
| | - Amanda Wiggins
- College of Nursing, University of Kentucky, Lexington, KY, USA
| | - Ellen J. Hahn
- College of Nursing, University of Kentucky, Lexington, KY, USA
- College of Public Health, University of Kentucky, Lexington, KY, USA
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Wang C, Wang J, Norbäck D. A Systematic Review of Associations between Energy Use, Fuel Poverty, Energy Efficiency Improvements and Health. Int J Environ Res Public Health 2022; 19:ijerph19127393. [PMID: 35742650 PMCID: PMC9223700 DOI: 10.3390/ijerph19127393] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 06/13/2022] [Accepted: 06/15/2022] [Indexed: 11/16/2022]
Abstract
Energy use in buildings can influence the indoor environment. Studies on green buildings, energy saving measures, energy use, fuel poverty, and ventilation have been reviewed, following the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The database PubMed was searched for articles published up to 1 October 2020. In total, 68 relevant peer-reviewed epidemiological or exposure studies on radon, biological agents, and chemicals were included. The main aim was to assess current knowledge on how energy saving measures and energy use can influence health. The included studies concluded that buildings classified as green buildings can improve health. More efficient heating and increased thermal insulation can improve health in homes experiencing fuel poverty. However, energy-saving measures in airtight buildings and thermal insulation without installation of mechanical ventilation can impair health. Energy efficiency retrofits can increase indoor radon which can cause lung cancer. Installation of a mechanical ventilation systems can solve many of the negative effects linked to airtight buildings and energy efficiency retrofits. However, higher ventilation flow can increase the indoor exposure to outdoor air pollutants in areas with high levels of outdoor air pollution. Finally, future research needs concerning energy aspects of buildings and health were identified.
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Geysmans R, Perko T, Keser M, Pölzl-Viol C, Fojtíková I, Mihók P. Cure or Carcinogen? A Framing Analysis of European Radon Spa Websites. Int J Public Health 2022; 67:1604559. [PMID: 35529478 PMCID: PMC9073685 DOI: 10.3389/ijph.2022.1604559] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 03/31/2022] [Indexed: 11/13/2022] Open
Abstract
Objectives: Radon, a radioactive gas, is among the leading causes of lung-cancer worldwide. While public health authorities emphasize radon’s health risks, there are spas across Europe which claim health benefits of radon. This study investigates how websites of European radon spas frame radon gas, in order to understand the potential controversy between “radon as carcinogen” and “radon as cure,” and its potential impact on public health interventions. Methods: A two-phased frame analysis of websites of radon spas (n = 26) situated in the European Union. Results: Five frames are identified, which present radon as a 1) source of health, 2) natural gas, 3) (non) risk, 4) luxury and 5) fountain of youth. These five partly overlapping frames are at times in clear contrast with the ways in which radon is presented in a public health context. Conclusion: Being aware of the existence and contents of radon frames, which potentially challenge or contradict public health interventions, helps responsible authorities in designing more effective campaigns and interventions.
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Affiliation(s)
- Robbe Geysmans
- Belgian Nuclear Research Centre, Mol, Belgium
- *Correspondence: Robbe Geysmans,
| | - Tanja Perko
- Belgian Nuclear Research Centre, Mol, Belgium
| | - Mirjana Keser
- Austrian Agency for Health and Food Safety (AGES), Vienna, Austria
| | | | | | - Peter Mihók
- Research and Innovation Centre, Faculty of Economics, Matej Bel University, Banská Bystrica, Slovakia
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Enjo-Barreiro JR, Ruano-Ravina A, Pérez-Ríos M, Kelsey K, Varela-Lema L, Torres-Durán M, Parente-Lamelas I, Provencio-Pulla M, Vidal-García I, Piñeiro-Lamas M, Fernández-Villar JA, Barros-Dios JM. Radon, Tobacco Exposure and Non-Small Cell Lung Cancer Risk Related to BER and NER Genetic Polymorphisms. Arch Bronconeumol 2022; 58:311-322. [PMID: 35312585 DOI: 10.1016/j.arbres.2021.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 07/06/2021] [Accepted: 07/14/2021] [Indexed: 11/02/2022]
Abstract
INTRODUCTION Tobacco consumption and radon exposure are considered the first and second most common causes of lung cancer, respectively. The aim of this study was to analyze both whether selected genetic polymorphisms in loci that are in DNA repair pathways, are related to non-small-cell lung cancer (NSCLC) and whether they may modulate the association between residential radon exposure and lung cancer in both smokers and never smokers. METHODS A multicentre, hospital-based, case-control study with 826 cases and 1201 controls was designed in a radon-prone area. Genotyping was determined in whole blood and residential radon exposure was measured in participants' dwellings. RESULTS Attending to tobacco exposure, the variant in the gene NBN (rs1805794) was associated with lung cancer in never smokers (OR 2.72; 95%1.44-5.2) and heavy smokers (OR 3.04; 95%CI 1.21-7.69). The polymorphism with the highest lung cancer association was OGG1 (rs125701), showing an OR of 8.04 (95%CI 1.64-58.29) for its homozygous variant genotype in heavy smokers. Attending to indoor radon exposure (>200Bq/m3), rs1452584, for its homozygous variant genotype, showed the highest association (OR 3.04 (95%CI 1.15-8.48). CONCLUSION The genes analyzed seem to have no association with the fully adjusted model, but they might modulate lung cancer association when different categories of tobacco consumption are considered (i.e. heavy smokers). This association may similarly be elevated for those individuals having high indoor radon exposures, though at a minor extent.
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Affiliation(s)
- José Ramón Enjo-Barreiro
- Service of Preventive Medicine, University Complex of Santiago de Compostela, Spain; Department of Preventive Medicine, Santiago de Compostela University Teaching Hospital Complex, Santiago de Compostela, Spain; Consortium for Biomedical Research in Epidemiology and Public Health (CIBER en Epidemiología y Salud Pública, CIBERESP), Spain
| | - Alberto Ruano-Ravina
- Department of Preventive Medicine, Santiago de Compostela University Teaching Hospital Complex, Santiago de Compostela, Spain; Consortium for Biomedical Research in Epidemiology and Public Health (CIBER en Epidemiología y Salud Pública, CIBERESP), Spain; Health Research Institute of Santiago de Compostela (Instituto de Investigación Sanitaria de Santiago de Compostela-IDIS), Santiago de Compostela, Spain.
| | - Mónica Pérez-Ríos
- Department of Preventive Medicine, Santiago de Compostela University Teaching Hospital Complex, Santiago de Compostela, Spain; Consortium for Biomedical Research in Epidemiology and Public Health (CIBER en Epidemiología y Salud Pública, CIBERESP), Spain; Health Research Institute of Santiago de Compostela (Instituto de Investigación Sanitaria de Santiago de Compostela-IDIS), Santiago de Compostela, Spain
| | - Karl Kelsey
- Department of Epidemiology, Brown School of Public Health, Brown University, Providence, Rhode Island, USA
| | - Leonor Varela-Lema
- Department of Preventive Medicine, Santiago de Compostela University Teaching Hospital Complex, Santiago de Compostela, Spain
| | | | | | | | - Iria Vidal-García
- Service of Neumology, University Hospital Complex of A Coruña, Spain
| | - María Piñeiro-Lamas
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBER en Epidemiología y Salud Pública, CIBERESP), Spain
| | | | - Juan M Barros-Dios
- Service of Preventive Medicine, University Complex of Santiago de Compostela, Spain; Department of Preventive Medicine, Santiago de Compostela University Teaching Hospital Complex, Santiago de Compostela, Spain; Consortium for Biomedical Research in Epidemiology and Public Health (CIBER en Epidemiología y Salud Pública, CIBERESP), Spain
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Nunes LJR, Curado A, da Graça LCC, Soares S, Lopes SI. Impacts of Indoor Radon on Health: A Comprehensive Review on Causes, Assessment and Remediation Strategies. Int J Environ Res Public Health 2022; 19:ijerph19073929. [PMID: 35409610 PMCID: PMC8997394 DOI: 10.3390/ijerph19073929] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 03/23/2022] [Accepted: 03/23/2022] [Indexed: 02/01/2023]
Abstract
Indoor radon exposure is raising concerns due to its impact on health, namely its known relationship with lung cancer. Consequently, there is an urgent need to understand the risk factors associated with radon exposure, and how this can be harmful to the health of exposed populations. This article presents a comprehensive review of studies indicating a correlation between indoor radon exposure and the higher probability of occurrence of health problems in exposed populations. The analyzed studies statistically justify this correlation between exposure to indoor radon and the incidence of lung diseases in regions where concentrations are particularly high. However, some studies also showed that even in situations where indoor radon concentrations are lower, can be found a tendency, albeit smaller, for the occurrence of negative impacts on lung cancer incidence. Lastly, regarding risk remediation, an analysis has been conducted and presented in two core perspectives: (i) focusing on the identification and application of corrective measures in pre-existing buildings, and (ii) focusing on the implementation of preventive measures during the project design and before construction, both focusing on mitigating negative impacts of indoor radon exposure on the health of populations.
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Affiliation(s)
- Leonel J. R. Nunes
- PROMETHEUS, Unidade de Investigação em Materiais, Energia e Ambiente para a Sustentabilidade, Instituto Politécnico de Viana do Castelo, 4900-347 Viana do Castelo, Portugal;
- Escola Superior Agrária, Instituto Politécnico de Viana do Castelo, 4990-706 Ponte de Lima, Portugal
- Correspondence:
| | - António Curado
- PROMETHEUS, Unidade de Investigação em Materiais, Energia e Ambiente para a Sustentabilidade, Instituto Politécnico de Viana do Castelo, 4900-347 Viana do Castelo, Portugal;
- Escola Superior de Tecnologia e Gestão, Instituto Politécnico de Viana do Castelo, 4900-348 Viana do Castelo, Portugal;
| | - Luís C. C. da Graça
- UICISA:E, Unidade de Investigação em Ciências da Saúde: Enfermagem, Escola Superior de Saúde, Instituto Politécnico de Viana do Castelo, 4900-347 Viana do Castelo, Portugal; (L.C.C.d.G.); (S.S.)
| | - Salete Soares
- UICISA:E, Unidade de Investigação em Ciências da Saúde: Enfermagem, Escola Superior de Saúde, Instituto Politécnico de Viana do Castelo, 4900-347 Viana do Castelo, Portugal; (L.C.C.d.G.); (S.S.)
| | - Sérgio Ivan Lopes
- Escola Superior de Tecnologia e Gestão, Instituto Politécnico de Viana do Castelo, 4900-348 Viana do Castelo, Portugal;
- ADiT-Lab, Instituto Politécnico de Viana do Castelo, 4900-347 Viana do Castelo, Portugal
- Instituto de Telecomunicações (I), Campus Universitário de Santiago, 3810-193 Aveiro, Portugal
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Kelly-Reif K, Sandler DP, Shore D, Schubauer-Berigan M, Troester M, Nylander-French L, Richardson DB. Lung and extrathoracic cancer incidence among underground uranium miners exposed to radon progeny in the Příbram region of the Czech Republic: a case-cohort study. Occup Environ Med 2022; 79:102-108. [PMID: 34417337 PMCID: PMC8760136 DOI: 10.1136/oemed-2021-107392] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 06/14/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Radon is carcinogenic, but more studies are needed to understand relationships with lung cancer and extrathoracic cancers at low exposures. There are few studies evaluating associations with cancer incidence or assessing the modifying effects of smoking. METHODS We conducted a case-cohort study with 16 434 underground uranium miners in the Czech Republic with cancer incidence follow-up 1977-1996. Associations between radon exposure and lung cancer, and extrathoracic cancer, were estimated with linear excess relative rate (ERR) models. We examined potential modifying effects of smoking, time since exposure and exposure rate. RESULTS Under a simple ERR model, assuming a 5-year exposure lag, the estimated ERR of lung cancer per 100 working level months (WLM) was 0.54 (95% CI 0.33 to 0.83) and the estimated ERR of extrathoracic cancer per 100 WLM was 0.07 (95% CI -0.17 to 0.72). Most lung cancer cases were observed among smokers (82%), and the estimated ERR of lung cancer per 100 WLM was larger among smokers (ERR/100 WLM=1.35; 95% CI 0.84 to 2.15) than among never smokers (ERR/100 WLM=0.12; 95% CI -0.05 to 0.49). Among smokers, the estimated ERR of lung cancer per 100 WLM decreased with time since exposure from 3.07 (95% CI -0.04 to 10.32) in the period 5-14 years after exposure to 1.05 (95% CI 0.49 to 1.87) in the period 25+ years after exposure. CONCLUSIONS We observed positive associations between cumulative radon exposure and lung cancer, consistent with prior studies. We observed a positive association between cumulative radon exposure and extrathoracic cancers, although the estimates were small. There was evidence that the association between radon and lung cancer was modified by smoking in a multiplicative or super-multiplicative fashion.
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Affiliation(s)
- Kaitlin Kelly-Reif
- Epidemiology, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Dale P Sandler
- Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina, USA
| | - David Shore
- Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina, USA
- Westat Inc, Rockville, Maryland, USA
| | - Mary Schubauer-Berigan
- Evidence Synthesis and Classification Section, International Agency for Research on Cancer, Lyon, France
| | - Melissa Troester
- Epidemiology, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Leena Nylander-French
- Environmental Sciences and Engineering, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - David B Richardson
- Epidemiology, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
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Abstract
PURPOSE This study compared differences in sociodemographic characteristics, personal risk perception of lung cancer, lung cancer worry, and synergistic risk perception among rural Appalachia residents who completed home radon testing with those who did not, after receiving a free long-term test kit at a rural primary care clinic. The study also examined the association between the Teachable Moment Model constructs and home radon testing. METHODS The study was an exploratory correlational design with a convenience sample of (N = 58) adult participants recruited from 2 rural primary care clinics in Appalachia Kentucky. Participants completed a brief survey and were given a free long-term home radon test kit. Multiple logistic regression was used to determine characteristics associated with home radon testing. FINDINGS Twenty-eight participants (48%) completed home radon testing. There were no differences in personal risk perception of lung cancer, lung cancer worry, or synergistic risk perception between those who completed home radon testing and those who did not. Age was the only significant factor associated with completion of radon testing (B = 0.077, P = .005). For every 5-year increase in age, participants were 47% more likely to test their home for radon. CONCLUSION Providing free home radon test kits in the primary care setting shows promise in prompting radon testing in rural Appalachia. As radon-induced lung cancer risk increases with exposure over time, health care providers in rural Appalachia need to encourage patients of all ages to test their home for radon, especially those who smoke or report smoking in the home.
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Affiliation(s)
- Stacy R. Stanifer
- College of Nursing, University of Kentucky, Lexington, Kentucky
- University of Kentucky Center for Appalachian Research in Environmental Sciences (UK-CARES), Lexington, KY
| | - Mary Kay Rayens
- College of Nursing, University of Kentucky, Lexington, Kentucky
- College of Public Health, University of Kentucky, Lexington, Kentucky
| | - Amanda Wiggins
- College of Nursing, University of Kentucky, Lexington, Kentucky
| | - David Gross
- Northeast Kentucky Area Health Education Center, St. Claire Healthcare, Morehead, Kentucky
| | - Ellen J. Hahn
- College of Nursing, University of Kentucky, Lexington, Kentucky
- University of Kentucky Center for Appalachian Research in Environmental Sciences (UK-CARES), Lexington, KY
- College of Public Health, University of Kentucky, Lexington, Kentucky
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Ruano-Ravina A, Cameselle-Lago C, Torres-Durán M, Pando-Sandoval A, Dacal-Quintas R, Valdés-Cuadrado L, Hernández-Hernández J, Consuegra-Vanegas A, Tenes-Mayén JA, Varela-Lema L, Fernández-Villar A, Barros-Dios JM, Pérez-Ríos M. Indoor Radon Exposure and COPD, Synergic Association? A Multicentric, Hospital-Based Case-Control Study in a Radon-Prone Area. Arch Bronconeumol 2021; 57:630-636. [PMID: 35699045 DOI: 10.1016/j.arbr.2020.11.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 11/23/2020] [Indexed: 06/15/2023]
Abstract
BACKGROUND COPD is a multifactorial disease which causes considerable mortality and morbidity worldwide. Previous studies assessing the possible relationship between indoor radon exposure and COPD have shown inconclusive results. METHODS A multicentric, hospital-based, case-control study was conducted in a Spanish radon-prone area. COPD cases were confirmed by spirometry and controls were selected due to trivial surgery or procedures not related to tobacco consumption. All participants had to have lived for at least 15 years in the same dwelling. Radon measurements were conducted individually in dwellings using alpha-track detectors. Results were obtained using multivariate logistic regression. RESULTS 189 cases and 747 controls took part. There was no significant association between residential radon concentrations and COPD onset with a OR of 1.12 (95%CI 0.41-3.06) for individuals exposed to more than 200Bq/m3 compared to those exposed to less than 50Bq/m3. Heavy smokers seem to increase their COPD risk if exposed to higher radon concentrations vs those exposed to lower concentrations. There was a statistically significant synergy index between radon exposure and tobacco consumption, S-index 11.60 (95%CI 3.71-36.26). Indoor radon concentration was higher in never/light smokers with COPD compared to controls. CONCLUSIONS No association between indoor radon and COPD has been observed. However, there might be some effect modification on the COPD risk in heavy smokers when high radon exposure is present. This is supported by the additive synergy observed. Also, a possible association between indoor radon and COPD onset in never and light smokers needs to be further studied.
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Affiliation(s)
- Alberto Ruano-Ravina
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Spain; Consortium for Biomedical Research in Epidemiology and Public Health (CIBER en Epidemiología y Salud Pública - CIBERESP), Spain; Health Research Institute of Santiago de Compostela (Instituto de Investigación Sanitaria de Santiago de Compostela - IDIS), Santiago de Compostela, Spain.
| | - Candela Cameselle-Lago
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Spain
| | | | | | | | - Luis Valdés-Cuadrado
- Service of Neumology, Clinic University Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | | | | | | | - Leonor Varela-Lema
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Spain; Consortium for Biomedical Research in Epidemiology and Public Health (CIBER en Epidemiología y Salud Pública - CIBERESP), Spain
| | | | - Juan Miguel Barros-Dios
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Spain; Consortium for Biomedical Research in Epidemiology and Public Health (CIBER en Epidemiología y Salud Pública - CIBERESP), Spain; Health Research Institute of Santiago de Compostela (Instituto de Investigación Sanitaria de Santiago de Compostela - IDIS), Santiago de Compostela, Spain
| | - Mónica Pérez-Ríos
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Spain; Consortium for Biomedical Research in Epidemiology and Public Health (CIBER en Epidemiología y Salud Pública - CIBERESP), Spain; Health Research Institute of Santiago de Compostela (Instituto de Investigación Sanitaria de Santiago de Compostela - IDIS), Santiago de Compostela, Spain
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Abstract
BACKGROUND Radon is a predominant indoor air pollutant and second leading cause of lung cancer in radon-prone areas. Despite the gravity of the health risk, residents in Canada have inadequate perception and taken minimal protective actions. Better perception of a risk motivates people to take preventive measures. Scholarship about radon health risk perception is lacking in Canada. We applied a mixed methods population health approach to explore the determinants shaping perception and actions of a resident population in Canada. METHODS We conducted mixed surveys (n = 557) and qualitative bilingual interviews (n = 35) with both homeowners and tenants of Ottawa-Gatineau areas. The study explored residents' risk perception and adaptations factors. Descriptive, correlational and regression analyses described and established associations between quantitative variables. Thematic, inductive analyses identified themes in the qualitative data. A mixed methods analysis triangulated both results to draw a holistic perception of the health risk. RESULTS Residents' quantitative perceptions of radon health risk, smoking at home, synergistic risk perception, social influence and care for family were associated significantly with their intention to test for radon levels in their home, actual testing and mitigation. These results were explained further with the qualitative findings. Residents who had dual cognitive and emotional awareness of the risk were motivated enough to take preventive actions. Caring for family, knowing others who contracted lung cancer and financial capability were enablers, whereas lack of awareness and homeownership, cost of mitigation and stigma were obstacles to preventive actions. We also explored the dual subjective and objective aspects of risk perception that are influenced by micro- and macro-level determinants. CONCLUSIONS Inducing protective action to reduce risk requires comprehensive population-level interventions considering dual perceptions of the risk that can modify the risk determinants. Future research can explore the dual aspects of risk perception and unequal distribution of the risk factors.
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Affiliation(s)
- S. M. Khan
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - J. Gomes
- Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - S. Chreim
- Telfer School of Management, University of Ottawa, Ottawa, ON, Canada
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Papatheodorou S, Yao W, Vieira CLZ, Li L, Wylie BJ, Schwartz J, Koutrakis P. Residential radon exposure and hypertensive disorders of pregnancy in Massachusetts, USA: A cohort study. Environ Int 2021; 146:106285. [PMID: 33395935 DOI: 10.1016/j.envint.2020.106285] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 10/30/2020] [Accepted: 11/15/2020] [Indexed: 05/13/2023]
Abstract
BACKGROUND Exposure to ionizing radiation has been associated with hypertension, but the relationship between residential radon exposure and hypertensive disorders of pregnancy (HDP) has not been examined. METHODS We used the Massachusetts Birth Registry of Vital Records from 2001 to 2015 including women with a singleton pregnancy without prior hypertension. The binary outcome (HDP) included gestational hypertension and pre-eclampsia cases and was assessed using birth certificate data. We obtained 141,665 basement radon measurements from Spruce Environmental Technologies, Inc. and modeled the monthly zip code basement radon level. We used a logistic regression model adjusted for sociodemographic covariates, maternal comorbidities, PM2.5, season, temperature, and relative humidity. We examined effect modification by maternal age, race, and maternal education as an indicator of socio-economic status. RESULTS Of 975,528 women, 3.7% (36,530) of them developed HDP. Zip code level radon ranged from 22 to 333 mBq/m3. An interquartile range (IQR) increase in zip code radon level throughout pregnancy was associated with a 15% increase in the odds of HDP (95% CI 13% to 18%). In women less than 20 years old, an IQR increase in zip code level radon was associated with 38% increase in the odds of HDP (95% CI 24% to 50%), while the effect was smaller in older women. There was no effect modification by maternal race or education. CONCLUSIONS In this cohort, higher levels of residential radon are associated with increased odds of HDP. After stratifying by age, this effect was stronger in participants younger than 20 years old. Since the burden of hypertensive disorders of pregnancy is increasing and affects women's future cardiovascular health, identification of modifiable risk factors is of great importance.
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Affiliation(s)
| | - Weiyu Yao
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Carolina L Z Vieira
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Longxiang Li
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Blair J Wylie
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Harvard Medical School, Boston, MA, USA; Division of Maternal-Fetal Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Joel Schwartz
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Petros Koutrakis
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Maier A, Wiedemann J, Rapp F, Papenfuß F, Rödel F, Hehlgans S, Gaipl US, Kraft G, Fournier C, Frey B. Radon Exposure-Therapeutic Effect and Cancer Risk. Int J Mol Sci 2020; 22:ijms22010316. [PMID: 33396815 PMCID: PMC7796069 DOI: 10.3390/ijms22010316] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 12/22/2020] [Accepted: 12/24/2020] [Indexed: 01/18/2023] Open
Abstract
Largely unnoticed, all life on earth is constantly exposed to low levels of ionizing radiation. Radon, an imperceptible natural occurring radioactive noble gas, contributes as the largest single fraction to radiation exposure from natural sources. For that reason, radon represents a major issue for radiation protection. Nevertheless, radon is also applied for the therapy of inflammatory and degenerative diseases in galleries and spas to many thousand patients a year. In either case, chronic environmental exposure or therapy, the effect of radon on the organism exposed is still under investigation at all levels of interaction. This includes the physical stage of diffusion and energy deposition by radioactive decay of radon and its progeny and the biological stage of initiating and propagating a physiologic response or inducing cancer after chronic exposure. The purpose of this manuscript is to comprehensively review the current knowledge of radon and its progeny on physical background, associated cancer risk and potential therapeutic effects.
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Affiliation(s)
- Andreas Maier
- Biophysics Department, GSI Helmholtzzentrum für Schwerionenforschung GmbH, 64291 Darmstadt, Germany; (A.M.); (J.W.); (F.R.); (F.P.); (G.K.); (C.F.)
| | - Julia Wiedemann
- Biophysics Department, GSI Helmholtzzentrum für Schwerionenforschung GmbH, 64291 Darmstadt, Germany; (A.M.); (J.W.); (F.R.); (F.P.); (G.K.); (C.F.)
| | - Felicitas Rapp
- Biophysics Department, GSI Helmholtzzentrum für Schwerionenforschung GmbH, 64291 Darmstadt, Germany; (A.M.); (J.W.); (F.R.); (F.P.); (G.K.); (C.F.)
| | - Franziska Papenfuß
- Biophysics Department, GSI Helmholtzzentrum für Schwerionenforschung GmbH, 64291 Darmstadt, Germany; (A.M.); (J.W.); (F.R.); (F.P.); (G.K.); (C.F.)
| | - Franz Rödel
- Department of Radiotherapy and Oncology, University Hospital Frankfurt, Goethe-Universität Frankfurt am Main, 60590 Frankfurt am Main, Germany; (F.R.); (S.H.)
| | - Stephanie Hehlgans
- Department of Radiotherapy and Oncology, University Hospital Frankfurt, Goethe-Universität Frankfurt am Main, 60590 Frankfurt am Main, Germany; (F.R.); (S.H.)
| | - Udo S. Gaipl
- Translational Radiation Biology, Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054 Erlangen, Germany;
| | - Gerhard Kraft
- Biophysics Department, GSI Helmholtzzentrum für Schwerionenforschung GmbH, 64291 Darmstadt, Germany; (A.M.); (J.W.); (F.R.); (F.P.); (G.K.); (C.F.)
| | - Claudia Fournier
- Biophysics Department, GSI Helmholtzzentrum für Schwerionenforschung GmbH, 64291 Darmstadt, Germany; (A.M.); (J.W.); (F.R.); (F.P.); (G.K.); (C.F.)
| | - Benjamin Frey
- Translational Radiation Biology, Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054 Erlangen, Germany;
- Correspondence:
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Noh J, Jang H, Cho J, Kang DR, Kim TH, Shin DC, Kim C. Estimating the disease burden of lung cancer attributable to residential radon exposure in Korea during 2006-2015: A socio-economic approach. Sci Total Environ 2020; 749:141573. [PMID: 32841859 DOI: 10.1016/j.scitotenv.2020.141573] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 08/05/2020] [Accepted: 08/07/2020] [Indexed: 06/11/2023]
Abstract
Estimating the lung cancer disease burden can provide evidence for public health practitioners, researchers, and policymakers. This study uses claim data from lung cancer patients for 2006-2015 from the Korean National Health Insurance Service to estimate the lung cancer burdens attributable to residential radon in Korea using disability-adjusted life years (DALY) and patients' annual economic burden with societal perspectives using the cost-of-illness (COI) method. The number of patients increased during our study period (from 35,866 to 59,168). The disease burden and that attributable to residential radon, respectively, increased from 517.57 to 695.74 and 64.62 (95%; CIs 61.33-67.69) to 86.99 (95%; CIs 82.7-91.1) DALYs per 100,000 patients. The percentage of years lost due to disability among the DALY doubled from 8% to 17%. The cost for all the patients was US$2.33 billion, with US$292 (95%; CIs 278-306) million attributable to residential radon. During the last decade, the lung cancer disease burden increased by 1.34 times, with a doubled percentage of non-fatal burden and average annual growth rate of 9.5% of the total cost. Hence, the burden and cost of lung cancer in Korean provinces have been steadily increasing. The findings could be used as input data for future cost-effectiveness analysis of policies regarding radon reduction.
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Affiliation(s)
- Juhwan Noh
- Department of Preventive Medicine, Yonsei University, College of Medicine, Seoul, Republic of Korea; Institute of Human Complexity and Systems Science, Yonsei University, Seoul, Republic of Korea.
| | - Heeseon Jang
- Department of Preventive Medicine, Yonsei University, College of Medicine, Seoul, Republic of Korea; Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea.
| | - Jaelim Cho
- Institute of Human Complexity and Systems Science, Yonsei University, Seoul, Republic of Korea; School of Medicine, University of Auckland, Auckland, New Zealand; Institute for Environmental Research, Yonsei University, College of Medicine, Seoul, Republic of Korea.
| | - Dae Ryong Kang
- Center of Biomedical Data Science, Yonsei University, Wonju College of Medicine, Wonju, Republic of Korea.
| | - Tae Hyun Kim
- Graduate School of Public Health, Yonsei University, Seoul, Republic of Korea.
| | - Dong Chun Shin
- Department of Preventive Medicine, Yonsei University, College of Medicine, Seoul, Republic of Korea; Institute for Environmental Research, Yonsei University, College of Medicine, Seoul, Republic of Korea.
| | - Changsoo Kim
- Department of Preventive Medicine, Yonsei University, College of Medicine, Seoul, Republic of Korea; Institute of Human Complexity and Systems Science, Yonsei University, Seoul, Republic of Korea; Institute for Environmental Research, Yonsei University, College of Medicine, Seoul, Republic of Korea.
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Abstract
Fundamental estimates of radon-associated health risk have been provided by epidemiological studies of miners. In total, approximately 15 studies have been conducted worldwide since the 1960s. These results have contributed directly to radiological protection against radon. The present article summarises the main results, with a focus on analyses of miners exposed more recently, estimates of radon lifetime attributable risk, and interaction between radon and smoking. The potential for the upcoming Pooled Uranium Miner Analysis project to further improve our knowledge is discussed.
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Affiliation(s)
- D Laurier
- Institute for Radiological Protection and Nuclear Safety, 92262 Fontenay aux Roses Cedex, France; e-mail:
| | | | - E Rage
- Institute for Radiological Protection and Nuclear Safety, 92262 Fontenay aux Roses Cedex, France; e-mail:
| | - L Tomasek
- National Radiation Protection Institute, Czech Republic
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Tomasek L. LUNG CANCER LIFETIME RISKS IN COHORT STUDIES OF URANIUM MINERS. Radiat Prot Dosimetry 2020; 191:171-175. [PMID: 33130900 DOI: 10.1093/rpd/ncaa143] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 09/24/2020] [Accepted: 10/01/2020] [Indexed: 06/11/2023]
Abstract
The article summarizes the most recent results from the cohorts of uranium miners, particularly the risks at low exposures and the risk models with modifying effects of exposure rate, age and time since exposure, which are used for the calculation of lifetime risks (LRs). The excess relative risks per unit exposure (ERR/WLM) arising from low exposures were found up to 10 times higher than the crude risk coefficients. For studies that reported models with modifying effect of age, time since exposure and exposure rate, LRs were calculated using the BEIR VI projection. These LRs were also calculated for a model with effect modification on the annual exposure rate. The results were prepared for the UNSCEAR report on 'Lung cancer from exposure to radon.'(1).
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Affiliation(s)
- Ladislav Tomasek
- Dept of Research & Development, National Radiation Protection Institute, Prague CZ14000, Czech Republic
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Gómez-Anca S, Barros-Dios JM. Radon Exposure and Neurodegenerative Disease. Int J Environ Res Public Health 2020; 17:ijerph17207439. [PMID: 33066046 PMCID: PMC7600778 DOI: 10.3390/ijerph17207439] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 10/05/2020] [Accepted: 10/10/2020] [Indexed: 12/28/2022]
Abstract
Background: To carry out a systematic review of scientific literature about the association between radon exposure and neurodegenerative diseases. Methods: We performed a bibliographic search in the following databases: Pub med (Medline), Cochrane, BioMed Central and Web of Science. We collected the data by following a predetermined search strategy in which several terms werecombined. After an initial search, 77 articles were obtained.10 of which fulfilled the inclusion criteria. Five of these 10 studies were related to multiple sclerosis (MS), 2 were about motor neuron diseases (MND), in particular amyotrophic lateral sclerosis (ALS) and 3 were related to both Alzheimer's disease (AD) and Parkinson's disease (PD). Results: The majority of the included articles, suggested a possible association between radon exposure and a subsequent development of neurodegenerative diseases. Some of the studies that obtained statistically significant resultsrevealed a possible association between radon exposure and an increase in MS prevalence. Furthermore, it was also suggested that radon exposure increases MND and AD mortality. Regarding AD and PD, it was observed that certainde cay products of radon-222 (222Rn), specifically polonium-210 (210Po) and bismuth-210 (210Bi), present a characteristic distributionpattern within the brain anatomy. However, the study with the highest scientific evidence included in this review, which investigated a possible association between the concentration of residential radon gas and the MS incidence, revealed no significant results. Conclusions: It cannot be concluded, although it is observed, that there is a possible causal association between radon exposure and neurodegenerative diseases. Most of the available studies are ecological so, studies of higher statistical evidence are needed to establish a causal relationship. Further research is needed on this topic.
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Affiliation(s)
- Silvia Gómez-Anca
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, 15782 Santiago, Spain;
| | - Juan Miguel Barros-Dios
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, 15782 Santiago, Spain;
- Department of Preventive Medicine, Santiago de Compostela University Teaching Hospital Complex, Santiago de Compostela, 15706 Santiago, Spain
- Center for Biomedical Research on the Network of Epidemiology and Public Health (Centro DE Investigacion Biomédica en Red DE Epidemiología Y Salud Pública), 15706 Santiago de Compostela, Spain
- Correspondence:
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44
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Chen J, Harley NH. A Review of Radon Equilibrium Factors in Underground Mines, Caves, and Thermal Spas. Health Phys 2020; 119:342-350. [PMID: 31934931 DOI: 10.1097/hp.0000000000001214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Radon equilibrium factor Feq is an important factor in radon progeny dose assessment. A review of published measurements of Feq shows a range of values from 0.1 to 1.0 reported in studies from more than 26 countries measured in 173 underground mines, and 136 show caves, tourist mines, and thermal spas. The average values of Feq are 0.38 in underground mines and 0.39 for show caves, tourist mines, and thermal spas. The wide range of Feq in those special workplaces suggests that location-, environment-, and operation-specific values are more appropriate than a recommended average value in the calculation of lung bronchial dose. This is especially important in mines or other typically high radon exposure locations because Feq can be used for recording an individual's occupational radon exposure or dose.
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Affiliation(s)
- Jing Chen
- Radiation Protection Bureau, Health Canada, 775 Brookfield Road, Ottawa K1A 1C1, Canada
| | - Naomi H Harley
- New York University School of Medicine, 1 Marine View Plaza, Hoboken, NJ
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Abstract
In Australia, worker exposure to radon in underground uranium mines has been a focus of policy makers and regulators, and has been well controlled in the industry sector. That cannot be said for public exposure to radon. Radon exposure studies in the late 1980s and early 1990s demonstrated that the levels of radon in Australian homes were some of the lowest in the world. The International Basic Safety Standards, published by the International Atomic Energy Agency, requires the government to establish and implement an action plan for controlling public exposure due to radon indoors. When considering different policy options, it is important to develop radon prevention and mitigation programmes reflecting elements that are unique to the region or country. The Australian Radon Action Plan is being considered at a national level, and presents a long-range strategy designed to reduce radon-induced lung cancer in Australia, as well as the individual risk for people living with high concentrations of radon. In Australia, workers who are not currently designated as occupationally exposed are also considered as members of the public. In the Australian context, there are only a limited set of scenarios that might give rise to sufficiently high radon concentrations that warrant mitigation. These include highly energy efficient buildings in areas of high radon potential, underground workplaces, workplaces with elevated radon concentrations (e.g. spas using natural spring waters), and enclosed workspaces with limited ventilation. The key elements for a successful plan will rely on collaboration between government sectors and other health promotion programmes, cooperative efforts involving technical and communication experts, and partnering with building professionals and other stakeholders involved in the implementation of radon prevention and mitigation.
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Affiliation(s)
- S A Long
- Australian Radiation Protection and Nuclear Safety Agency, 619 Lower Plenty Road, Yallambie 3085, Australia
| | - R A Tinker
- Australian Radiation Protection and Nuclear Safety Agency, 619 Lower Plenty Road, Yallambie 3085, Australia
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46
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Dubin S, Griffin D. Lung Cancer in Non-Smokers. Mo Med 2020; 117:375-379. [PMID: 32848276 PMCID: PMC7431055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Lung cancer is the leading cause of cancer death worldwide and the third most common cancer following breast and prostate.1 As expected, the primary factor leading to lung cancer is tobacco smoke, and as smoking rates have declined, we have also seen an overall decline in lung cancer rates.2 Despite the general reduction in lung cancer rates, the rate of lung cancer in non-smokers has been noted to be increasing.3-8.
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Affiliation(s)
- Sarah Dubin
- Practice Pulmonary and Critical Care medicine in the Truman Medical Center Health Sciences District, Kansas City, Missouri
| | - Daniel Griffin
- Practice Pulmonary and Critical Care medicine in the Truman Medical Center Health Sciences District, Kansas City, Missouri
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Chiavacci SJ, Shapiro CD, Pindilli EJ, Casey CF, Rayens MK, Wiggins AT, Andrews WM, Hahn EJ. Economic valuation of health benefits from using geologic data to communicate radon risk potential. Environ Health 2020; 19:36. [PMID: 32197610 PMCID: PMC7083012 DOI: 10.1186/s12940-020-00589-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 03/05/2020] [Indexed: 05/21/2023]
Abstract
BACKGROUND Radon exposure is the second leading cause of lung cancer worldwide and represents a major health concern within and outside the United States. Mitigating exposure to radon is especially critical in places with high rates of tobacco smoking (e.g., Kentucky, USA), as radon-induced lung cancer is markedly greater among people exposed to tobacco smoke. Despite homes being a common source of radon exposure, convincing homeowners to test and mitigate for radon remains a challenge. A new communication strategy to increase radon testing among Kentucky homeowners utilizes fine-scale geologic map data to create detailed radon risk potential maps. We assessed the health benefits of this strategy via avoided lung cancer and associated premature mortality and quantified the economic value of these benefits to indicate the potential utility of using geologic map data in radon communication strategies. METHODS We estimated the change in radon testing among all 120 counties in Kentucky following a new communication strategy reliant on geologic maps. We approximated the resultant potential change in radon mitigation rates and subsequent expected lung cancer cases and mortality avoided among smokers and non-smokers exposed to 4 pCi/L of radon in the home. We then applied the value of a statistical life to derive the economic value of the expected avoided mortality. RESULTS The new communication strategy is estimated to help 75 Kentucky residents in 1 year avoid exposure to harmful radon levels via increased testing and mitigation rates. This equated to the potential avoidance of approximately one premature death due to lung cancer, with a net present value of $3.4 to $8.5 million (2016 USD). CONCLUSIONS Our analysis illustrates the potential economic value of health benefits associated with geologic map data used as part of a communication strategy conveying radon risk to the public. Geologic map data are freely available in varying resolutions throughout the United States, suggesting Kentucky's radon communication strategy using geologic maps can be employed in other states to educate the public about radon. As this is only a single application, in a single state, the economic and health benefits of geologic map data in educating the public about radon are likely to exceed our estimates.
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Affiliation(s)
- Scott J. Chiavacci
- Science and Decisions Center, United States Geological Survey, 12201 Sunrise Valley Dr, Reston, VA 20191 USA
| | - Carl D. Shapiro
- Science and Decisions Center, United States Geological Survey, 12201 Sunrise Valley Dr, Reston, VA 20191 USA
| | - Emily J. Pindilli
- Science and Decisions Center, United States Geological Survey, 12201 Sunrise Valley Dr, Reston, VA 20191 USA
| | - Clyde F. Casey
- Science and Decisions Center, United States Geological Survey, 12201 Sunrise Valley Dr, Reston, VA 20191 USA
| | - Mary Kay Rayens
- University of Kentucky College of Nursing, BREATHE, Lexington, KY 40536 USA
| | - Amanda T. Wiggins
- University of Kentucky College of Nursing, BREATHE, Lexington, KY 40536 USA
| | - William M. Andrews
- Kentucky Geological Survey, University of Kentucky, Lexington, KY 40506 USA
| | - Ellen J. Hahn
- University of Kentucky College of Nursing, BREATHE, Lexington, KY 40536 USA
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Rage E, Richardson DB, Demers PA, Do M, Fenske N, Kreuzer M, Samet J, Wiggins C, Schubauer-Berigan MK, Kelly-Reif K, Tomasek L, Zablotska LB, Laurier D. PUMA - pooled uranium miners analysis: cohort profile. Occup Environ Med 2020; 77:194-200. [PMID: 32005674 PMCID: PMC8663280 DOI: 10.1136/oemed-2019-105981] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 12/02/2019] [Accepted: 12/21/2019] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Epidemiological studies of underground miners have provided clear evidence that inhalation of radon decay products causes lung cancer. Moreover, these studies have served as a quantitative basis for estimation of radon-associated excess lung cancer risk. However, questions remain regarding the effects of exposure to the low levels of radon decay products typically encountered in contemporary occupational and environmental settings on the risk of lung cancer and other diseases, and on the modifiers of these associations. These issues are of central importance for estimation of risks associated with residential and occupational radon exposures. METHODS The Pooled Uranium Miner Analysis (PUMA) assembles information on cohorts of uranium miners in North America and Europe. Data available include individual annual estimates of exposure to radon decay products, demographic and employment history information on each worker and information on vital status, date of death and cause of death. Some, but not all, cohorts also have individual information on cigarette smoking, external gamma radiation exposure and non-radiological occupational exposures. RESULTS The PUMA study represents the largest study of uranium miners conducted to date, encompassing 124 507 miners, 4.51 million person-years at risk and 54 462 deaths, including 7825 deaths due to lung cancer. Planned research topics include analyses of associations between radon exposure and mortality due to lung cancer, cancers other than lung, non-malignant disease, modifiers of these associations and characterisation of overall relative mortality excesses and lifetime risks. CONCLUSION PUMA provides opportunities to evaluate new research questions and to conduct analyses to assess potential health risks associated with uranium mining that have greater statistical power than can be achieved with any single cohort.
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Affiliation(s)
- Estelle Rage
- Institute for Radiological Protection and Nuclear Safety (IRSN), PSE-SANTE, SESANE, Fontenay-aux-Roses, France
| | | | | | - Minh Do
- Cancer Care Ontario, Toronto, Ontario, Canada
| | - Nora Fenske
- Federal Office for Radiation Protection, Department of Radiation Protection and Health, Neuherberg, Germany
| | - Michaela Kreuzer
- Federal Office for Radiation Protection, Department of Radiation Protection and Health, Neuherberg, Germany
| | | | - Charles Wiggins
- University of New Mexico, Albuquerque, New Mexico, USA
- New Mexico Tumor Registry, Albuquerque, New Mexico, USA
| | - Mary K Schubauer-Berigan
- International Agency for Research on Cancer, Lyon, France
- National Institute for Occupational Safety and Health, Cincinnati, Ohio, USA
| | - Kaitlin Kelly-Reif
- National Institute for Occupational Safety and Health, Cincinnati, Ohio, USA
| | | | - Lydia B Zablotska
- University of California, San Francisco, San Francisco, California, USA
| | - Dominique Laurier
- Institute for Radiological Protection and Nuclear Safety (IRSN), PSE-SANTE, SESANE, Fontenay-aux-Roses, France
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Böhm R, Sedlák A, Bulko M, Holý K. Radon as a Tracer of Lung Changes Induced by Smoking. Risk Anal 2020; 40:370-384. [PMID: 31404471 DOI: 10.1111/risa.13385] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 07/03/2019] [Accepted: 07/05/2019] [Indexed: 06/10/2023]
Abstract
After smoking, exposure to radon and its progeny is the second leading cause of lung cancer. The probability of inducing lung carcinomas by inhaled radon progeny depends on the deposited radiation dose, and is significantly affected by physiological and morphometric changes induced by smoking. Due to irritation of the airways, the inhalation of cigarette smoke leads to the hyperproduction of mucus. Two concurrent processes occur: on one hand, increased production of mucus protects the target cells against radiation damage; on the other hand, in the case of long-term smokers, a chronic lung obstruction develops, causing an increase in the radiation dose to the lungs. Depending on the duration and intensity of smoking, these processes contribute to the final radiation dose with different weights. The primary objective of this study was to investigate to what extent these smoke-induced changes can modify the resulting absorbed dose of inhaled radon progeny relative to healthy nonsmokers. Since the bronchial dose depends on the degree of lung tissue damage, we have used this dose as a tool for detecting the effects of smoking on the lung epithelium. In other words, the biological effect of radon served as a tracer of changes induced by smoking.
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Affiliation(s)
- Radoslav Böhm
- Faculty of Mathematics and Physics, Comenius University, Bratislava, Slovak Republic
| | - Antonín Sedlák
- National Radiation Protection Institute, Prague, Czech Republic
| | - Martin Bulko
- Faculty of Mathematics and Physics, Comenius University, Bratislava, Slovak Republic
| | - Karol Holý
- Faculty of Mathematics and Physics, Comenius University, Bratislava, Slovak Republic
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Sedlák A. MEAN VALUE OF LET FOR ONCOGENIC EFFECTS OF RADON AND ITS PROGENY. Radiat Prot Dosimetry 2019; 186:159-162. [PMID: 31803906 DOI: 10.1093/rpd/ncz194] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 08/14/2019] [Indexed: 06/10/2023]
Abstract
The topic of the article is to define the average value of linear energy transfer (LET) for carcinogenic effects of radon progeny. The microdosimetric model of boundary specific energy is used. It follows that the effect at high LET should decrease approximately with the third power of LET. This is verified by the analysis of the relationship between radiation effects ratio and LET in published experiments with oncogenic transformation of mammalian cells irradiated with the monoenergetic alpha particles. If these cells are exposed with the radon irradiator, our analysis leads us to conclude that the oncogenic effect of radon progeny is comparable to that of alpha particles with a LET of 75 keV/μm. It is about a quarter lower than the LET value, where the effect of the monoenergetic alpha particles reaches its maximum level. Some implications for lung cancer due to radon inhalation may also be carefully examined.
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Affiliation(s)
- A Sedlák
- National Radiation Protection Institute, Bartoškova 28, 140 00 Prague, Czech Republic
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