A Lung Cancer Victim Speaks

Transcription

1 A Lung Cancer Victim Speaks Dennie Edwards, Elyria, OH, In 2004, I had a very bad cold, so my doctor performed a chest x-ray to check for pneumonia. I've never smoked, so you can imagine how shocked I was that he found a 4.5 centimeter mass in my left lung. Even though I've been a real estate agent for 31 years, I had never bothered to test my house for radon. I always informed my clients that radon testing prior to purchase was an option (to protect my liability), but truthfully, I really didn't care if they tested or not. Now I had to wonder whether my lung cancer had been caused by radon exposure. While the doctor scheduled my surgery, I scheduled a radon test. The result was 10 pci/l, (2 ½ times the EPA's Action Level). I had lived in the home for 12 years. Needless to say, I called a contractor to have a mitigation system installed. Two days later I had surgery. I thought I was surely going to die. When I woke up choking with tubes in my throat, panic set in. They had removed my entire left lung. I'm getting better. I can walk up to a mile. But, I can no longer dance, lift things, or exert myself. My clients now get a very personal testimonial about the importance of testing for radon." UMn

2 Introduction Good Afternoon William J. Angell President, American Association of Radon Scientists and Technologists or Chair, Prevention and Mitigation Working Group World Health Organization s International Radon Project Professor, University of Minnesota Director, Midwest Universities Radon Consortium U.S. EPA founded; serves 10 states UMn

3 Introduction Purpose To offer a basic perspective of: Radon health effects and risks How radon enters homes and other buildings How we remediation existing homes and control radon in new homes To offer an assessment of current radon policy and options To suggest sources for further information Cancer Survivors Against Radon Lead State Radon Contracts Radon Professionals UMn

4 1. Physics... Introduction - Radon Radon Characteristics Radioactive Gas 1. Causes Lung Cancer 2. Outdoors,, Naturally Occurring But indoors, human influenced New Ionizing Radiation Warning Symbol from the International Radiation Protection Association ~ The we design, build and use our buildings Primary exposure in the home 2. No Static Electrical Charge 3. Noble Gas - Inert (does not chemically react) 4. Colorless, Odorless, and Tasteless Not Detected by Human Senses UMn

5 1. Physics... Introduction - Radioactive Decay and Radon Entry Radon Entry 0.4 pci/l *U.S. annual average outdoors 1.3 pci/l* U.S. annual average indoors in homes (living areas) pci/l is a unit of radon radioactivity (or activity ) concentration 1 PCi/L = 2.2 radioactive disintegrations per minute per liter Radon 100s - 100,000s pci/l Radium Uranium UMn

6 Health Effects of Radon and its Decay Products Image from Switzerland s Federal Office of Public Health UMn

7 Health Effects Cancer Deaths in the U.S. About 560,000 Americans died of cancer in 2007 Lung cancer is the leading cause of U.S. cancer deaths About 213,400 lung cancer cases in ,400 will die Most important carcinogens Tobacco smoke followed by Radon ~ 21,000 lung cancer deaths per year Secondhand smoke ~ 3,000 lung cancer deaths per year Asbestos The dominate forms of cancer deaths are: For For men: 1) lung, 2) prostate, 3) colon, and 4) rectum. For For women: 1) lung, 2) breast, and 3) colon. UMn

8 Health Effects New U.S. Cancer Cases, Men 667,860 Women 678,060 Prostate 29% Lung & bronchus15% Colon & rectum 10% Urinary bladder 7% Non-Hodgkin 4% lymphoma Melanoma of skin 4% Kidney 4% Leukemia 3% Oral cavity 3% Pancreas 2% All Other Sites 19% 26% Breast 15% Lung & bronchus 11% Colon & rectum 6%Uterine corpus 4% Non-Hodgkin lymphoma 4%Melanoma of skin 4% Thyroid 3% Ovary 3% Kidney 3%Leukemia 21% All Other Sites *Excludes basal and squamous cell skin cancers and in situ carcinomas except urinary bladder. Source: American Cancer Society, UMn

9 Health Effects U.S. Cancer Deaths, Men 289,550 Women 270,100 Lung & bronchus 31% Prostate 9% Colon & rectum 9% Pancreas 6% Leukemia 4% Liver & 4% bile duct Esophagus 4% Urinary bladder 3% Non-Hodgkin 3% lymphoma Kidney 3% All other sites 24% ONS=Other nervous system. Source: American Cancer Society, % Lung & bronchus 15% Breast 10% Colon & rectum 6% Pancreas 6% Ovary 4% Leukemia 3% Non-Hodgkin lymphoma 3% Uterine corpus 2% Brain/ONS 2% Liver & intrahepatic bile duct 23% All other sites UMn

10 Health Effects Lung Cancer Incidence Rates High Among Female Never Smokers (Wakelee, H.A. et al Lung Cancer in Never Smokers: A Review, Journal of Clinical Oncology, 25, 5 (February 10): Lung cancer incidence rates per 100,000 person- years among never smokers aged 40 to 79 were: 14.4 to 20.8 for females 4.8 to 13.7 for males Calculated from six large cohort populations Several factors have been proposed for the development of LCINS,, including secondhand smoke; occupational exposures such as asbestos, chromium, or arsenic; environmental exposures such as domestic radon; indoor pollutants; previous lung disease; dietary factors; family history; and genetic factors However, the relative significance of these individual factors among different ethnic populations in the development of LCINS has not been well-characterized. UMn

11 Health Effects Summary of Lung Cancer Facts (Lung Cancer Alliance, Lung cancer is the leading cause of U.S. cancer deaths Causes 1/3 of cancer deaths Kills more than breast, prostate, colon, liver, kidney, & melanoma cancer combined! Kills 3 times as many men compared to prostate cancer Kills nearly twice as many women compared to breast cancer 60% of those diagnosed are never or former smokers Radon is the leading cause of lung cancer among never smokers (U.S. EPA) Radon multiples the lung cancer risk for former and current smokers (National Academy of Science, BEIR VI) UMn

12 Health Effects: Opportunity for Exposure Sources of Annual Radiation Exposure to the General U.S. Population Residential Radon 55% Cosmic 8% Medical X-RaysX 11% Other Industrial Sources 1% Internal (potassium-40) 11% Nuclear Medicine 4% Consumer Products 3% Terrestrial (earth s crust) 8% Assumes average indoor living area radon concentration of 1.3 pci/l. Radon is by far the greatest single source of radiation to the general public. Source: NCRP 93 (1987) UMn

13 Health Effects: 2.A. Human Epidemiological Studies: Cohort - Miners National Academy of Sciences Radon/Health Effects Findings Committee on the Biological Effects of Ionizing Radiation Report (BEIR( VI) The Health Effects of Exposure to Indoor Radon (1999) A definitive review of scientific data Used Used updated data from 11 NCI miner studies since residential data was too sparse for valid risk estimate Central estimate of radon attributed lung cancer in U.S. homes: up to 21,800 18,900 ever-smokers 2,900 never-smokers with an uncertain range of 3,000 to 33,000 UMn

14 Health Effects: Risk Assessment EPA Radon Risk Assessment (2004) Lifetime risk in homes at 4 pci/l Action Level: 7 of 1000 for Never-Smokers Increase more than three times from 0.2% in of 1000 for Smokers (7( 7 X that of never-smokers smokers) Increase more than double from 2.9% in 1992 Central risk estimate for all home radon concentrations About 21,000 lung cancer deaths/year Uncertainty range of 8,000 to 45,000 deaths/year UMn

15 Health Effects: Risk Assessment North American Studies Combined Analysis (Krewski, D. et al Residential Radon and Risk of Lung Cancer: A Combined Analysis of 7 North American Case-Control Studies, Epidemiology 16(2): , March) 3665 cases and 4966 controls from 7 studies of residential exposure using long-term detectors Results: OR 1.11 for lung cancer at 2.7 pci/l over 5 to 30 years which are comparable to previous predications from miner studies Conclusion: results provide direct evidence of association of residential radon and lung cancer risk UMn

16 Health Effects: Risk Assessment European Radon Risk Assessment (Darby, S et al., 2004, Radon in homes and risk of lung cancer: Collaborative analysis of individual data from 13 European case-control studies, BMJ.com, doi: /bmj ) This study found that the risk of lung cancer increased 16% for each 2.7 pci/l increase 7,148 lung cancer cases, 14,208 controls in 9 European countries Mean concentration: 104 Bq/m 3 (2.8 pc/l) Conclusion: radon in homes is responsible for 15% of all lung cancer deaths in Europe (similar to EPA s 12% in U.S) However, Jerome Puskin of EPA s Center for Risk Assessment notes that the European estimate may be biased low ( UMn

17 Health Effects: Cumulative Exposure Lifetime Lung Cancer Death Risk Per Person (out of 1,000; 2004 Updated) pci/l Never Smokers Current Smokers General Population Remember, each of these numbers represent a real person with a loving family, Bill Field, UIa 7 UMn

18 Health Effects: Risks Radon Compared to Other Risks (A Citizen s Guide to Radon, 2003, EPA; Health Risk, 2007, EPA and National Electronic Injury Surveillance System Consumer Product Safety Commission, 2003) Radon in Homes Drunk Driving Falls in Homes Drownings ETS Lung Cancer Home Fires CO in Homes Perspective: ten years ago, radon ~14,000; drunk driving ~22,000 UMn

19 Health Effects: Risks How Do Radon and Mold Compare? UMn

20 Factors Affecting Radon Entry and Concentrations Note: Image from Switzerland s Federal Office of Public Health UMn

21 Indoor Radon Concentrations: Introduction Radon Entry Dynamics Overview Can be influenced by the complex interaction of: Local geology (including karst) Soil Radium content Moisture content Temperature differences Permeability Water table (e.g., fluctuation) Metrological factors Barometric pressure changes Wind speed and direction Precipitation (e.g., rate, amount) Season (e.g., indoor outdoor temperature difference ~ stack effect) Temperature inversions Snow cover or soil saturation Building characteristics Heating system (e.g., type, use) Pressure differences House ~ soil Intra-zonal Dynamic ventilation rate Water source (e.g., radon concentration in well water) Building materials (emanation) Diffusion Occupant activities Window opening (e.g., location) Fireplace and wood stove use Exhaust fan use UMn

22 Indoor Radon Concentrations: Introduction - Mapping U.S. Radon Zone Map Should use map with EPA manual explaining methodology. High and low radon may be found in any zone. Map based on Geologic factors Aerial surveys Results of home surveys Primarily short-term term tests in lowest lived in level Home foundation type Soil surveys Expected average short term Radon (pci/l): Red = Zone 1 > 4.0 High probability Orange = Zone 2 > 2 < 4 Yellow = Zone 3 < 2 Low probability UMn

23 Indoor Radon Concentrations: Introduction Rock, Soil, Indoors Indoor Radon in a Community - FYI Test Results < 4 pci/l >30 Source: Mike Mudrey, 2005, UW- UMn

24 2. Transport, B. Driving Forces, 1) Air Pressure Differences The Predominant Driving Force is Building Induced Soil Suction Buildings create vacuums that draw in soil gas. These vacuums may be very small and are referred to as air pressure differentials. UMn

25 Radon Mitigation and Prevention Strategies UMn

26 Mitigation of Existing Dwellings Remediation in Existing Homes: Active Soil Depressurization Active = Fan Reverses air pressure difference between indoors and soil Reduces radon concentrations in soil adjacent to the foundation UMn

27 Radon Control Options in New Homes Radon Control in New Homes Stack terminates 12 above roof Passive or Active Soil Depressurization Minimum 3 passive stack routed through conditioned space Connects to subslab tee, interior drain tile or sump Insulate outside conditioned space Minimize horizontal pipe Pitch to drain condensation Electrical rough-in provided in accessible attic near vent stack Avoid unsealed ducts and air handlers outside conditioned space Sealing and caulking of possible radon entry points Gas permeable material beneath slab Minimize building depressurization Label system UMn

28 State Radon Policy Considerations UMn

29 Policy Considerations Radon Policy in Other Countries Norway has required test of all new homes Must be less that reference level Goal for all new homes ¼ of reference level Sweden is most advanced Local health authorities have the power to order Radon testing Used for rental housing Radon mitigation 50% grant up to 1500 Euros for owner-occupied occupied Switzerland offers a tax credit Switzerland has established goals, e.g., All elevated homes and schools must be mitigated by 2014 UMn

30 Policy Considerations Status of U.S. Radon Policy Today in the U.S. and probably every state, we have more homes that need to be mitigated than anytime in our history The reason for this situation is that we have built more new homes with elevated radon than we have mitigation EPA has recognized this problem and initiated a major emphasis on radon control systems in new homes Several State Legislature have passed a bills that call for building code adoption of radon control requirements UMn

31 Policy Considerations Radon Policy Options 1. For all ground contact units: A. Statewide building code requirements 1) Low-rise residential buildings 2) Schools and child care facilities B. Mandatory radon testing prior to: 1) Leasing an apartment or other dwelling unit Especially important ~ environmental justice 2) Home sale 2. Radon testing of all: A. State owned or leased buildings B. Schools and child care facilities every 5 years 3. Certification or licensing of radon professionals UMn

32 Radon Policy Considerations Countries with Radon Control Building Code Requirements Czech Czech Republic DenmarkDenmark FinlandFinland IrelandIreland LatviaLatvia NorwayNorway Slovak Slovak Republic SwedenSweden United United Kingdom UMn

33 Summary Indoor radon is a very serious environmental health risk It is easy and inexpensive to Test for indoor radon Remediation high concentrations in existing buildings Prevention in new construction Public policy is needed ~ Building codes Testing Rental housing Homes for sale Public buildings including schools and day care facilities Strong certification or licensing programs UMn