The Wyoming Department of Health6101 Yellowstone

Cheyenne, WY307-777-6015

Radon-Induced Lung Cancer…Radon-Induced Lung Cancer…An Environmental Hazard andAn Environmental Hazard andA Community Health ConcernA Community Health Concern

OBJECTIVES

• 1. Increase Physician and allied healthcare provider knowledge on Radon and the related health effects.

• 2. Enlist the assistance of the Wyoming physicians in promoting Home Radon Testing to their patients.

• 3. Supply the physicians with Radon Test Kit Coupons and all necessary material in support of Home Radon testing to their patients.

Radon is part of the Earth’s crust and radiates on a continual basis

Rn86222

Periodic Table of the Elements

Rn86222

• Radon behaves like an inert gas

– Does not combine chemically with other atoms to form molecules.

– Allows it to move freely through soil

• Its nuclear configuration is unstable

– Will easily lose two protons, causing it to change its characteristics to that of another element (polonium)

Pico CuriepCi/L

Pico = Trillionth

Curie = Radium Measurement

1 Curie = 1 Gram of Radium Per Liter of Air

“L” Number of Liters of Air per Room

U.S. Radon Potential U.S. Radon Potential

Many parts of the country

have elevated radon

concentrations

Map developed as basis for

radon control techniques in

new construction.

Why Is Radon A Concern?Why Is Radon A Concern?

• Radon decays into radioactive particles

known as radon decay products.

• These particles are easily inhaled and

deposited in the lungs where they can damage

sensitive lung tissue.

Radon Decay Products

Radon

RadonRadon

Because….Radon Causes Lung Cancer

&LUNG CANCER KILLS!

• Why is Radon a Concern?

Statistically Speaking,ONLY 21,000 + People Die Each Year Because of Radon

That’s not TOO Many…Unless you happen to be One of those 21,000!

RadonRadium

Uranium

Radon is a gas.It is naturally occurring.

It cannot be seen or smelled.It enters buildings from the soil beneath them

What Happens When Radon-222 Enters a House?

• Radon enters home.• Radon radioactively

decays into RDPs in the air.

• Some RDPs remain in the air.

• Some RDPs plate out on surfaces.

Radon

Radon

RDPsRDPsRDPsRDPs

Radon Progeny

218Po and 214Po deliver the

radiologically significant dose to

the respiratory epithelium.

Lead-210Lead-210

Polonium-214Polonium-214

Bismuth-214Bismuth-214

Lead-214Lead-214

Polonium-218Polonium-218

Radon-222Radon-222

Lead-206Lead-206

Polonium-210Polonium-210

Bismuth-210Bismuth-210

22 yrs22 yrs

4 day

3 min

27 min

20 min

0.2 ms

5 day

138 day

Stable

How Radon Gas / RDP How Radon Gas / RDP Cause Cause

Lung CancerLung Cancer

Inhalation of Inhalation of Radon Decay Radon Decay ProductsProducts

AlphaAlphaParticlesParticles

Irradiate LungsIrradiate Lungs

Radiation DamageRadiation Damageto DNA / P53 Geneto DNA / P53 Gene

> Lung Cancer> Lung Cancer

Ionizing radiation can directly and indirectly damage DNA

Alpha Alpha ParticleParticle

Defects in tumor Defects in tumor suppressor genes – p53suppressor genes – p53

At risk individuals–GSTMAt risk individuals–GSTM11

(glutathione S-transferase M1)(glutathione S-transferase M1)

Dou

ble

–stra

nd

Dou

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–stra

nd

DN

A br

eaks

DN

A br

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Free

radi

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Free

radi

cal

form

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form

atio

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What Happens When Radon Decay Products Are Inhaled?

Highly radioactive Highly radioactive particles adhere to particles adhere to lung tissue, where lung tissue, where they can irradiate they can irradiate sensitive cells.sensitive cells.

Radiation can alter Radiation can alter the cells, increasing the cells, increasing the potential for the potential for cancer.cancer.Double Strand BreaksDouble Strand Breaks

Alpha Alpha Decay Decay

44He Nucleus Ejected He Nucleus Ejected from from 222222Rn NucleusRn Nucleus

+2+2

4He + He + 218PoPo

+

+

+

+

+

+

+

+

+

Radon - 222Radon - 222

Alpha Particles Are Strong Enough To Pit Plastic

Alpha Particles Are Strong Enough To Pit Plastic

• Plastic chip from

passive radon test

(alpha track)

• Magnified only 100

times

• 3 months at EPA

Action Level of 4

pCi/L

Scientific Basis For Radon Risk Estimates

Scientific Basis For Radon Risk Estimates

• Studies on miners

– Uranium miners in U.S. and other countries

• Studies on residential occupants

– On-going and as a group confirm application of miner data to residential exposures

• Studies on laboratory animals

National Research CouncilBEIR VI: February 19, 1998National Research CouncilBEIR VI: February 19, 1998

0

5000

10000

15000

20000

25000

U.S

. Lun

g C

ance

r D

eath

s/yr

Never Smokers Smokers

• Lung cancer due to radon exposure

– Higher risk among smokers– High non-smoker risk

• “Radon is one of the most extensively investigated human carcinogens.”

• Radon is a “...public-health problem and makes indoor radon the second leading cause of lung cancer after cigarette smoking.”

International Pooling of Residential Radon Case-Control Studies

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

Medical Radon StudiesStudy

LocationPublication

DateCases Controls

Shenyang, China 1990 308 356

Stockholm, Sweden 1992 201 378

Swedish nationwide 1994 1,281 2,576

Winnipeg, Canada 1994 738 514

S. Finland 1996 164 331

Finnish nationwide 1996 517 517

SW England 1998 982 3,185

W. Germany 1998 1,449 2,297

Sweden 2001 258 487

Czech Republic 2001 210 11,794

Italy-Trento 2001 138 210

Spain 2002 163 241

Austria 2002 194 198

France 2002 486 984

China –Gansu Province 2002 768 1,659

E. Germany 2003 1,053 1,667

Residential Radon Epidemiology

Bill Field, MS, Ph.Dbill-field@uiowa.edu

319-335-4413

Iowa Radon Lung Cancer Study National Institutes of Health

http://www.cheec.uiowa.edu/misc/radon.html

Radon Professionals Listservhttp://list.uiowa.edu/archives/radonprofessionals.html

College of Public HealthDepartment of Occupational and Environmental HealthDepartment of EpidemiologyUniversity of Iowa

IRLCS sites

-96 -95 -94 -93 -92 -91

41

42

43

Histopathologic Review

• Blinded review by two surgical pathologists

• Consensus diagnosis based on World Health Organization 1981 (WHO) histologic type

• 72% agreement between Iowa Cancer Registry and consensus histologic type

The relative odds of misclassification for samples collected using The relative odds of misclassification for samples collected using

cytology and biopsy as compared to resection was 2.4 (CI; 1.1- 5.2) and cytology and biopsy as compared to resection was 2.4 (CI; 1.1- 5.2) and 2.2 (CI; 1.1 - 4.2), respectively. JNCI 2004, in press2.2 (CI; 1.1 - 4.2), respectively. JNCI 2004, in press

STUDY DEMOGRAPHICS

Cases Controls

Total 413 614Age in yrs. (median) 68 67Residency in yrs. (median) 33 31Alive at interview 69% 100%Ever-smokers 86% 33% Previous lung disease 44% 27%At least H.S. Education 90% 92%

Morphologic Distribution of413 Lung Cancers

Morphology Number %

Adenocarcinoma 175 42.4

Squamous Cell 82 19.9

Small Cell 74 17.9

Large Cell 32 7.7

Carcinoma, NOS 50 12.1

OVERVIEW

. Lung Cancer Trends

• Iowa Radon Lung Cancer Study• Residential Radon Studies• Have Residential Radon Studies

Underestimated Risk?• Glass-Based Retrospective Radon

Measurements• Future Directions

SUMMARY

• The Iowa Radon Lung Cancer Study found a statistically significant association between residential Radon exposure and lung cancer.

• The findings suggest that prolonged exposure to Radon, even at 4 pCi/L, increases lung cancer risk.

• These findings suggest that Radon is a major environmental carcinogen.

“Radon Is A Serious National Health Problem”

“Radon Is A Serious National Health Problem”

• American Lung Association

• American Medical Association

• Environmental Protection Agency

• National Academy of Sciences

• National Council on Radiation Protection and Measurement

• U.S. Surgeon General

• World Health Organization

EPA & Surgeon General RecommendEPA & Surgeon General RecommendThat People Not Have ExposuresThat People Not Have Exposures

Above 4 pCi/L On A Long-Term BasisAbove 4 pCi/L On A Long-Term Basis One is advised to take action if a home is at or above 4.0 pCi/LOne is advised to take action if a home is at or above 4.0 pCi/L

Average indoor: 1.3 pCi/LAverage indoor: 1.3 pCi/L

Average outdoor: 0.4 pCi/LAverage outdoor: 0.4 pCi/L

RecommendationsRecommendations

How Does Radon Rank As A Cancer Causing Agent?

• Radon is ranked as a Group A carcinogen– Highest ranking for cancer potential– Known to cause cancer in humans– Tobacco smoke and tobacco products in same

category

• Provides basis for regulatory and liability concerns!

It is the 2nd Leading Cause of

Lung Cancer

Only 21,000+ Die / Year

Wyoming Cancer Deaths2004Wyoming Cancer Deaths

2004

212

8770

56 55 5238 34 29 23

0

50

100

150

200

250

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LUNG CANCER DIAGNOSIS By AGE

1997 - 2001

Incidence By Age

Wyoming Lung Cancer Incidence by Age (Per 100,000)

2000 - 2004

0 0 0 0 0 2 1 4

20 33

74

114

175

243

245 203 130 58

0

50

100150

200

250

300

Is Wyoming The Only State Where Radon Concerns Exist?

Is Wyoming The Only State Where Radon Concerns Exist?

Radon is a National and World-Wide problem

NO!NO!

Radon Potential By County In Wyoming

Radon Potential By County In Wyoming

Based on geology and Based on geology and surveyssurveys

Expected closed Expected closed building radon (pCi/L):building radon (pCi/L): Zone 1: 4.0 and aboveZone 1: 4.0 and above

Zone 2: between 2.0 Zone 2: between 2.0 & 4.0& 4.0

Zone 3: 2.0 and lowerZone 3: 2.0 and lower

Distribution Of RadonIn Housing Units In Wyoming Counties*

Distribution Of RadonIn Housing Units In Wyoming Counties*

80%

42%

64%

38%

67%68%

51%

72%67% 74%

78%

38%

66%

20%

58%

36%

62%

33%32%28%

49%

33%26% 22%

62%

34%

0%10%20%30%40%50%60%70%80%90%

<4 pCi/L >4 pCi/L

* Source: Homeowner test devices obtained through Wyoming Radon Project

Indoor Radon Average, National and Wyoming1/3rd @ or above 4.0 pCi/L / 2/3rds @ or below 4.0 pCi/l

Estimated Radon-Induced Lung Cancer Deaths(National and Wyoming)

1/3rd of Cases @ or above 4.0 pCi/L2/3rds @ or below 4.0 pCi/l

0%

10%

20%

30%

40%

50%

60%

70%

4.0+ pCi/L <4.0 pCi/L

U.S. Annual Radon Source Death Rates Comparison

02000400060008000

100001200014000160001800020000

Ann

ual U

.S. C

ance

r C

ases

Soil Gas

Inhalation of Radonfrom Outdoor air

Ingestion of radonin water

Inhalation of radonand RDPs releasedfrom water

Comprehensive multi-media health risk reduction program includes Comprehensive multi-media health risk reduction program includes radon reduction from both soil and waterradon reduction from both soil and water

18,20018,200 720720 1818 149.6149.6

Outdoor Outdoor 222222Rn Rn ConcentrationsConcentrations

How Is Radon Drawn Into A Building?

How Is Radon Drawn Into A Building?

• Vacuum– Exhaust systems– Thermal stack effects

0

20

40

60

80

1 2 3 4

Days

Radon pCi/L

Vacuum (pa.)

How Radon Gets into a Home:

Radon Distribution

• Radon enters from beneath foundation and

travels upward. – Diluted with outdoor air

infiltrating building

• If radon is less than 4 pCi/L in lower level, one can say with reasonable confidence that upper

floors are also less than 4 pCi/L.

10

1

4-5

45

Average Contributions From Radon Sources In U.S. Homes

The movement of The movement of soil gas into a home soil gas into a home is the predominant is the predominant

entry route.entry route.

These are averages - These are averages - a particular home a particular home can be different!can be different!

Water< 1%

Soil Gas85 - 90%

Diffusion1 - 4%

Emanation2 - 5%

Radium Containing SoilRadium Containing Soil

Some Radon Can Also Enter Building From Water SupplySome Radon Can Also Enter Building From Water Supply

• Radon enters water in ground and outgasses in

building.

• Concern primarily isolated to private wells.

• Typically adds minor amount to air compared

to that from soil gas.Ra

Rn

Rn Rn

w

Various Various Perceptions of Perceptions of

RadonRadon

AlphaAlphaParticle?Particle?

Radiation DamageRadiation Damageto DNA?to DNA?

Lung Lung Cancer?Cancer?

??Radon ?Radon ?

Lung Cancer ?Lung Cancer ?Myth !Myth !

Why is the Evidence Ignored or

Not Accepted ?

Naturally occurring (no villains) Invisible, odorless, colorless No sensory reminders to repetitively stimulate

us to think about it Lack of press – no sensational story Long latency period Cancers occur one at a time Lung cancer does not occur in children Can not directly link deaths to radon exposure Voluntary risk Not a “Dread Hazard”

Environmental Risk Comparison

0

5,000

10,000

15,000

20,000

Estimated Annual Cancer Deaths

Pesticide Pesticide ApplicationsApplications

Hazardous Hazardous Waste SitesWaste Sites

Toxic Toxic Outdoor Outdoor

Air Air PollutantsPollutants

Pesticide Pesticide Residue Residue on Foodon Food

RADONRADON

Ranking of Environmental Hazards

Public Ranking Scientific Ranking1. Active Hazardous Waste Sites 1. Radon2. Abandoned HZ Waste Sites 2. Worker Exposure to Chemicals3. Ozone Layer 3. Pesticides on Food4. Accidental oil spills 4. Consumer exposure to chemicals5. Water Pollution (Industry) 7. Indoor Air pollutants6. Worker Chemical Exposure 8. Ozone depletion7. (18) Pesticides on Food 13. Abandoned HZ Waste Sites8. (26) Indoor Air Pollution 23. Point source discharge to water9. (29) Radon 26. Accidental oil spills

Radon Radon MinesMines

How can Physicians help, regarding Radon-induced lung cancer, given that the risk

pales in comparison to the risk posed by smoking?

??Dr.’s Cory and Renee Stirling of CasperDr.’s Cory and Renee Stirling of Casper

Patients Trust, Respect and Look To You Patients Trust, Respect and Look To You For Guidance Regarding Their HealthFor Guidance Regarding Their Health

Talk to them about testing their homes for RadonTalk to them about testing their homes for Radon

Easy

Accurate

Inexpensive

Easy

Accurate

Inexpensive

Testing is:

Testing is the only way to Testing is the only way to know if you and your know if you and your

family are at riskfamily are at risk

Residential Construction Team

Radon Test Kits

Short-Term Testing Determines Radon Exposure POTENTIALLong-Term Testing Determines Radon Exposure ACTUALITY

Both Help Determine the Need for Radon Mitigation

New Homes Can Be Built With Radon Control Systems

RADON VENT

RADONVENT

Typical Cost of Radon Mitigation

• Retro-Fitting an Existing Home– Lowest Cost = $500.00– Highest Cost = $3,000.00 +– Average Cost = $1,700.00

• New Construction– Approximately $500 - $1,000 (Method Dependant)

Advantages of Radon Mitigation Systems

• Reduces Radon in the Home• Reduces Excess Moisture in the Soil• Helps to Control Mold• Helps to Control Mildew• Helps to Control Indoor Air Pollutants• Helps to Control Asthma Triggers• Increases Property Value of your Home• Adds a Value-Added Feature to your Home

WDH maintains a listing of WDH maintains a listing of Radon ProfessionalsRadon Professionals

777-6015777-6015

Average Cost of a Radon Mitigation System is:$1,700.00

Cost Range = $500 to $2,500

Cost of Radon-Induced Lung Cancer

• Doctor’s Office Visits: $100.00’s +/ -• Tests/CT Scans: $5,000.00 + / -• Chemotherapy: $25,000.00 + / -• Radiation Therapy: $25,000.00 + / -• Follow-up Exams / Tests: $10,000.00 + / -• Quality of Life Deterioration / Death?

National Environmental Health Association's National Radon Proficiency Program

• Measurement and mitigation contractors trained and certified by NEHA carry ID cards.

Lists of certified individuals, labs and other helpful informationLists of certified individuals, labs and other helpful information can be found at:can be found at: http://www.radongas.org

Testing is the Testing is the onlyonly way to know if you way to know if you and your family are at riskand your family are at risk

RADON TEST KIT COUPON

Name ____________________________________________________________Address __________________________________________________________City, State, Zip _____________________________________________________Phone ___________________________________________________________

Mail Coupon, & Make Check Payable to: Please Indicate Type of Kit & Amount*Wyoming Radon Program □ Short-Term Kit $5.00 *6101 Yellowstone Road □ Long-Term Kit $15.00*Qwest Building; Room # 510 □ Water Test Kit $20.00*Cheyenne, WY 82002

http://wdh.state.wy.us/radon/index.asp

RadonDoes NOT

Have To Be A Problem …..UNLESS….. You IGNORE It.

RadonDoes NOT

Have To Be A Problem …..UNLESS….. You IGNORE It.

For More Information Contact:For More Information Contact:

Wyoming Department Of HealthWyoming Department Of Health(307) 777-6015(307) 777-6015

smelia@state.wy.ussmelia@state.wy.us