Radon: The Leading Environmental Cause of Cancer Mortality in the U.S

Transcription

1 Radon: The Leading Environmental Cause of Cancer Mortality in the U.S R. William Field, PhD, MS College of Public Health Department of Occupational and Environmental Health Department of Epidemiology University of Iowa

2 What Is Radon 222 (radon)? Radon is a gas It is naturally occurring 3.8 days Radon Radium 1,600 years 4.5 billion years Uranium You can not see or smell it It enters buildings primarily from the soil

3 Reading Prong

4 U.S. Radon Potential Based on geology and surveys Expected closed building radon (pci/l): Zone 1: 4.0 and above Zone 2: between 2.0 & 4.0 Zone 3: 2.0 and lower

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8 RISK PERCEPTION: Why is the evidence often ignored or not accepted? Invisible, odorless, colorless Naturally occurring outdoors Can not link an individual death to radon exposure Long latency period Not a dread hazard Cancers occur one at a time Lung cancer does not occur in children Voluntary risk Lack of press no sensational story No sensory reminders to repetitively stimulate us to think about it

9 Stanley Watras at the Limerick Nuclear Power Plant, Christmas 1984 "I just thank God that if it was going to be anybody living in that house, it would be me, somebody who could, through their work activities, discover the situation, Philadelphia Inquirer March 20, 1985

10 Radon Decay Products Po-218 and Po-214 deliver the majority of radiation dose to the lung. Radon-222 a,g Polonium-218 a,g Lead-214 b,g Bismuth-214 b,g Polonium-214 a,g Lead-210 b,g Bismuth-210 b,g Polonium-210 a,g Lead day 3 min 27 min 20 min 0.2 ms 22 yrs 5 day 138 day Stable

11 Why are radon decay products a health concern? Radon Decay Products Radon These particles are easily inhaled and deposited in the lungs where they can damage sensitive lung tissue. Radon

12 Alpha Decay He nucleus ejected from 222 Rn nucleus Radon He Po

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14 What Happens When Radon Decay Products Are Inhaled? Double Strand Breaks Highly radioactive particles adhere to lung tissue, where they can irradiate sensitive cells. Radiation can alter the cells, increasing the potential for cancer.

15 Ionizing radiation can directly and indirectly damage DNA Alpha Particle Defects in tumor suppressor genes p53 At risk individuals GSTM 1 (glutathione S-transferase M1)

16 Annual Effective Dose Equivalent to Member of the U.S. Population NCRP 93 (1987) Consumer Products Nuclear Other 3% Medicine < 1% 4% Medical X-rays 11% Other Includes: Artificial 18% Occupational 0.3% Natural (mrem) Fallout < 0.3% Radon 200 Nuclear Pow er 0.1% Miscellaneous 0.1% Cosmic 27 Terrestrial: -external 28 -internal 39 Radon 55% Artificial (mrem) -Diag. X-rays 39 -Nuc. Med. 14 Natural 82% -Consumer Pro. 10 -Other ~1 TOTAL ~360 Cosmic (Outer Space) 8% Terrrestrial (Rocks & Soil) 8% Internal (Inside Human Body) 11%

17 From NCRP Report No. 160, Ionizing Radiation Exposure of the Population of the United States (2009)

18 "Statistics are people with the tears wiped away." Irving Selikoff

19 Studies of Underground Miners

20 Cohort Studies (15) of Radon-Exposed Miners Port Radium Ontario Beaverlodge Cornwall Newfoundland E. Germany Sweden France Czech Republic (2) China Colorado New Mexico Brazil Radium Hill

21 National Academy of Sciences BEIR VI (1999): Pooled Analysis of 11 Miner Studies Study Lung ca P-yrs China ,342 Czech Republic ,924 Colorado ,821 Ontario ,719 Newfoundland ,742 Sweden 79 33,293 New Mexico 69 55,964 Beaverlodge ,385 Port Radium 57 52,677 Radium Hill 54 51,624 France 45 43,962 Total 2,787 1,155,453 Mean: WLM = 164, Duration=5.7 y Lubin et al * With smoking info

22 Number of lung cancer cases Radon Exposure of Lung Cancer Cases in Miners 600 Reside <20 pci/l <10 pci/l <5 pci/l < Working Level Months

23 Relative risk 3 China 8 Czechoslovakia Dose- Response in Miner Studies (I) Colorado (<3.2K WLM) Ontario Cumulative WLM Lubin et al NRC BEIR VI, 1999

24 Relative risk Dose- Response in Miner Studies (II) Newfoundland Sweden New Mexico Beaverlodge Cumulative WLM

25 Relative risk Dose- Response in Miner Studies (III) Port Radium Radium Hill France Cumulative WLM

26 National Academy of Sciences BEIR VI 1999 Risk estimates based primarily on radonexposed miners Estimated 18,600 lung cancer deaths each year in the U.S. from residential radon exposure

27 In 2003, the EPA updated the BEIR VI risk estimates to 21,000 radon-related lung cancer deaths each year in the United States.

28 CANCER MORTALITY CANCER TYPE ESTIMATED U.S. DEATHS/YR 1. Lung and Bronchus 160, Colon and Rectum 51, Breast Cancer 39, Pancreas 37, Prostate 28, Leukemia 23,540 >>> Radon Induced Lung Cancer 21, Liver and Bile Duct 20, Non-Hodgkin Lymphoma 18, Ovary 15, Esophagus 15, Urinary Bladder 14, Kidney and Renal Pelvis 13, Myeloma 10, Stomach 10,540 CA: A Cancer Journal for Clinicians Volume 62, Issue 1, pages 10-29, 4 JAN 2012 DOI: /caac Published Online: 27 May Copyright 2009 American Cancer Society #fig4

29 Epidemiologic Residential Radon Studies

30 Adverse Health Effects Dose Response Model Linear Non-Threshold Theory Observed Effects Radon-Exposed Miners Dose

31 Residential Radon Case-Control European Studies 13 Studies from 9 Countries Austria Czech Republic Finland [nationwide] Finland [south] France Germany [eastern] Germany [western] Italy Spain Sweden [nationwide] Sweden [never smokers] Sweden [Stockholm] United Kingdom Total 7,148 cases and 14,208 controls Around the World North American Studies 7 Studies from 2 countries: New Jersey Winnipeg Missouri I [non-smoking women] Missouri II [women] Iowa Connecticut Utah-South Idaho Total 3,622 cases and 4,966 controls

32 Residential Radon Studies Odds Ratios at 4.0 pci/l (150 Bq/m 3 ) China: Lubin 2004 Eur: Darby et al. 2004, 2006 NA: Krewski et al. 2005, 2006 Study Utah/South Idaho Connecticut Iowa Missouri-II Missouri-I Winnipeg New Jersey Shenyang Gansu United Kingdom Stockholm Sweden (never-smkrs) Sweden Spain Italy Germany (western) Germany (eastern) France Finland (south) Finland Czech Republic Austria Cases/Cntls 511/ / / / / / / / / / / / / / / / / / / / / /188 North America 4155/5341 China 1053/1997 Europe7148/ OR at 4.0 pci/l OR at 148 Bq/m 3

33 Pooled Analyses Agreement at 3 pci/l?? New Jersey, Missouri I, Canada, Iowa, Missouri II, a combined study from Connecticut, Utah and S. Idaho Shenyang, China, Stockholm, Sweden, Swedish nationwide, Winnipeg, Canada, S. Finland, Finnish nationwide, SW England, W. Germany, Sweden, Czech Republic, Italy- Trento, Spain, Austria, France, China - Gansu Province, E. Germany

34 Continuing support was provided by the National Cancer Institute and U.S. EPA

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36 Odds ratio Odds ratio Results of All Radon Studies of Lung Cancer EPA NA pooled RRs Gansu Shenyang China pooled RRs Pooled European RRs IA CT Pooled miners MO-1 UT MO-2 Winn NJ Radon concentration (x), pci/l

37 Occupational Radon Exposure also a health risk

38 Occupational Exposure to Radon Very Common Mine workers, including uranium, hard rock, and vanadium School Employees Workers remediating radioactive contaminated sites, including uranium mill sites and mill tailings Workers at underground nuclear waste repositories Radon mitigation contractors and testers Phosphate fertilizer plant workers Oil refinery workers Utility tunnel workers

39 Subway tunnel workers Construction excavators Power plant workers, including geothermal power and coal Employees of radon health mines Employees of radon balneotherapy spas (waterborne radon source) Water plant operators (waterborne radon source) Fish hatchery attendants (waterborne radon source) Employees who come in contact with technologically enhanced sources of naturally occurring radioactive materials Incidental exposure in almost any occupation from local geologic radon sources Farming related activities

40 Other types of cancer may be associated with protracted radon exposure

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42 Summary Radon is a global public health concern. The residential radon studies have provided direct evidence that prolonged residential radon is one of our leading public health risks and major cause of cancer mortality. Radon is our leading environmental cause of cancer mortality in the United States and seventh leading cause of cancer mortality overall.

43 Global Perspective on Radon WHO s International Agency for Research on Cancer - Monographs on the Evaluation of Carcinogenic Risks to Humans. Volume 43. Man-made Mineral Fibres and Radon. Summary of Data Reported and Evaluation (1988)

44 WHO-IRP National Partners Albania Argentina Austria Belgium Brasil Bulgaria Canada China Czech Republic Finland France Georgia Germany Greece Hungary India Ireland Italy Japan Lithuania Luxembourg Norway Poland Romania Russian Federation Serbia Slovenia South Korea Spain Sweden Switzerland Turkey USA Ukraine United Kingdom

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46 WHO Handbook on Indoor Radon THE WHO INITIATIVE TO REDUCE LUNG CANCER RISK AROUND THE WORLD

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48 Availability of WHO Handbook WHO Handbook on Indoor Radon: A Public Health Perspective: WHO Radon Webpage: l

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54 Radon in Schools A nationwide survey of radon levels in schools estimates that nearly one in five has at least one schoolroom with a short-term radon level above the action level of 4 pci/l (picocuries per liter) - the level at which EPA recommends that schools take action to reduce the level. EPA estimates that more than seventy thousand (70,000) schoolrooms in use today have high short-term radon levels.

55 EPA's national survey of schools produced some alarming results about concentrations in our children's classrooms. Public awareness must be raised about the hazards of radon to hasten efforts to reduce the danger. All schools must be tested to determine if there is a problem, and schools must inform parents of the results. We cannot ignore this problem." Kathryn Whitfill, National PTA President.

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60 Radon Testing and Mitigation

61 Closed House Conditions For All Short-Term Tests All exterior doors and windows closed, except for normal entry and exit Internal-external air exchange systems off Total internal recycle is allowed Combustion or make-up air must not be closed Permanent radon mitigation systems remain on

62 Test Location Depends on Purpose Lowest lived in Suitable for Occupancy Non-Real Estate Real Estate Lowest lived in Bedroom YES Bedroom YES Bedroom YES Kitchen NO Closet NO Bathroom Living Room YES NO Garage NO Choose occupied room Keep away from drafts and moisture

63 Test Placement Within A Room 12 inches min. 20 inches min. 3 feet min. 3 feet from windows or exterior doors At least 20 inches above floor 4 inches from other objects Where it won t be disturbed

64 A Common Real Estate Testing Method 2 Simultaneous Tests Two Simultaneous tests Mitigation Recommended YES Average of Both Tests > 4.0 pci/l NO No Mitigation Recommended

65 Homes With High Radon Concentrations Can Be Remediated Active soil depressurization is a means of creating a vacuum beneath a slab or plastic sheet and collecting the radon before it enters a building.

66 Can t We Just Seal The Cracks? Radon can enter through very small openings. Without affecting house pressures, sealing is not a stand-alone technique.

67 Suction Point For Slabs And Basements Hole cut through slab Pit dug out PVC pipe connected to hole Pipe routed to fan May require more than one suction point

68 System Depressurization Fan Installed in attic, garage, or outside Quiet watt fan runs continuously 11 year expected life

69 System Discharges Away From Building Openings Discharge should be high to avoid radon entering building Minimum of 10 feet above grade 10 feet from openings, 2 feet below discharge Above eave Rain cap not recommended 1/4 inch bird screen US EPA Mitigation Standards

70 New Homes Can Be Built With Radon Control Systems RADON VENT RADON VENT

71 Radon: The Leading Environmental Cause of Cancer Mortality in Iowa and the Midwest R. William Field, PhD, MS College of Public Health Department of Occupational and Environmental Health Department of Epidemiology University of Iowa

72 CANCER MORTALITY CANCER TYPE ESTIMATED U.S. DEATHS/YR 1. Lung and Bronchus 160, Colon and Rectum 51, Breast Cancer 39, Pancreas 37, Prostate 28, Leukemia 23, Liver and Bile Duct 20, Non-Hodgkin Lymphoma 18, Ovary 15, Esophagus 15, Urinary Bladder 14, Kidney and Renal Pelvis 13, Myeloma 10, Stomach 10, Melanoma 9,180 CA: A Cancer Journal for Clinicians Volume 62, Issue 1, pages 10-29, 4 JAN 2012 DOI: /caac Published Online: 27 May Copyright 2009 American Cancer Society #fig4

73 Outreach activities related to Radon

74 Iowa Cancer Consortium (ICC)

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78 Clin Chest Med 33 (2012)

79 Video on radon geared to health care professionals Please watch:

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83 Your help is needed!

84 Radon: The Leading Environmental Cause of Cancer Mortality in Iowa and the Midwest R. William Field, PhD, MS College of Public Health Department of Occupational and Environmental Health Department of Epidemiology University of Iowa