Radon in homes and risk of lung cancer: collaborative analysis of individual data from 13 European case-control studies

Lung cancer mortality attributable to residential radon: a systematic scoping review

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.

Parametrization identification and characterization of the radon priority areas for indoor radon risk management

The aim of work is to contribute to the development of methodologies concerning the selection and characterisation of radon priority areas. The selection of areas was based on risk from indoor radon exposure, expressed in terms of number of expected deaths per year. Radon data come from a survey carried out in the Lazio Region (Italy) and consist of 5297 indoor concentration measurements. Population data were also used. Data showed that dwellings with concentrations above 300 Bq/m³, taken as reference level (RL), are not confined to specific areas, but rather spread out over the territory. An absolute risk model has been chosen to predict annual deaths on a regular grid of cells 2kmx2km sized. The analysis showed that 21.7% of the territory is completely uninhabited and that another 13.9% presents a marginal risk, quantifiable in total as less than one expected death per year. The remaining territory is of interest to identify the areas where dwellings with a concentration higher than the RL would be located. It was found that: such dwellings occur with different percentage in all the cells; exposed people varies from a few to almost 2000 per cell; indoor radon risk from exposure above RL is dominated by the number of exposed people and amounts to 106 deaths per year; the number of cells where a such risk is low is far greater than where the risk is high. These findings led to restrict RPA to the smallest set of cells that retained 85% of risk, i.e. 90 expected deaths per year. This percentage has been subjectively set because the technical and economic information required for its optimal calculation was not available. Based on this assumption, the RPA were identified by applying a threshold of 43 to the number of exposed people in each cell, in order to reach 85% of risk. The other main characteristics, also expressed as percentages of the corresponding totals within the area of interest, were found to be: extension 31.5% and exposed people 84%.

Experimental Setups for In Vitro Studies on Radon Exposure in Mammalian Cells-A Critical Overview

Naturally occurring radon and its short lived progeny are the second leading cause of lung cancer after smoking, and the main risk factor for non-smokers. The radon progeny, mainly Polonium-218 (²¹⁸Po) and Polonium-214 (²¹⁴Po), are responsible for the highest dose deposition in the bronchial epithelium via alpha-decay. These alpha-particles release a large amount of energy over a short penetration range, which results in severe and complex DNA damage. In order to unravel the underlying biological mechanisms which are triggered by this complex DNA damage and eventually give rise to carcinogenesis, in vitro radiobiology experiments on mammalian cells have been performed using radon exposure setups, or radon analogues, which mimic alpha-particle exposure. This review provides an overview of the different experimental setups, which have been developed and used over the past decades for in vitro radon experiments. In order to guarantee reliable results, the design and dosimetry of these setups require careful consideration, which will be emphasized in this work. Results of these in vitro experiments, particularly on bronchial epithelial cells, can provide valuable information on biomarkers, which can assist to identify exposures, as well as to study the effects of localized high dose depositions and the heterogeneous dose distribution of radon.

Quantifying indoor radon levels and determinants in schools: A case study in the radon-prone area Galicia-Norte de Portugal Euroregion

Radon is a carcinogenic compound, and is particularly concerning in the education sector, where children and teachers may be exposed even longer than at home. Thus, this study intended to characterise radon in the indoor air of scholar environments in different provinces/districts of the Euroregion Galicia-Norte de Portugal. With a pioneering approach, this study evaluated the influence of specific factors/characteristics (location, type of management, construction material, season and floor within the building) and quantified their relative contribution to indoor radon levels. Radon was continuously monitored in 416 classrooms from school buildings located in urban and rural sites from different provinces/districts both in the regions of Galicia (A Coruña and Lugo provinces) and Portugal (Porto and Bragança districts), considering rooms for different age groups (from nursery schools to universities). Single and multivariate linear regression models were built considering the radon concentrations as the outcome variable and different room/building characteristics as predictor variables. Mean and median radon concentrations were 332 Bq·m^-3 and 181 Bq·m^-3, respectively. The radon concentrations observed are a public health concern, as almost 1/3 of the places monitored exceeded the reference limit value of the European legislation (300 Bq·m^-3). Moreover, around 50 % of the indoor levels measured could be attributed to room/building characteristics: the building's location and the main construction material, as well as the occupants' age group, the floor within the building and the school's type of management (public/private). This study concluded that radon testing is needed in all school buildings and classrooms without exceptions. Thus, public administrations are urged to dedicate funds for testing, mitigation and public dissemination initiatives in schools. A special protocol for radon sampling in school buildings should also be developed.

Consequences of changing Canadian activity patterns since the COVID-19 pandemic include increased residential radon gas exposure for younger people

The COVID-19 pandemic has produced widespread behaviour changes that shifted how people split their time between different environments, altering health risks. Here, we report an update of North American activity patterns before and after pandemic onset, and implications to radioactive radon gas exposure, a leading cause of lung cancer. We surveyed 4009 Canadian households home to people of varied age, gender, employment, community, and income. Whilst overall time spent indoors remained unchanged, time in primary residence increased from 66.4 to 77% of life (+ 1062 h/y) after pandemic onset, increasing annual radiation doses from residential radon by 19.2% (0.97 mSv/y). Disproportionately greater changes were experienced by younger people in newer urban or suburban properties with more occupants, and/or those employed in managerial, administrative, or professional roles excluding medicine. Microinfluencer-based public health messaging stimulated health-seeking behaviour amongst highly impacted, younger groups by > 50%. This work supports re-evaluating environmental health risks modified by still-changing activity patterns.

Regulation of Autophagy via Carbohydrate and Lipid Metabolism in Cancer

Metabolic changes are an important component of tumor cell progression. Tumor cells adapt to environmental stresses via changes to carbohydrate and lipid metabolism. Autophagy, a physiological process in mammalian cells that digests damaged organelles and misfolded proteins via lysosomal degradation, is closely associated with metabolism in mammalian cells, acting as a meter of cellular ATP levels. In this review, we discuss the changes in glycolytic and lipid biosynthetic pathways in mammalian cells and their impact on carcinogenesis via the autophagy pathway. In addition, we discuss the impact of these metabolic pathways on autophagy in lung cancer.

Lung cancer incidence attributable to residential radon exposure in Finland

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.

Effects of radon exposure on gut microbiota and its metabolites short-chain fatty acids in mice

Radon (²²²Rn) is a naturally occurring radioactive gas. Forty percent of the natural radiation to which the human body is exposed comes from radon gas. Long-term exposure to high concentrations of radon induces systemic damage. However, the effect of such exposure on gut microbiota still remains unclear. We explored the effects of radon exposure on gut microbiota and its metabolites short-chain fatty acids (SCFAs) in BALB/c mice by cumulative inhalation of radon at 30, 60, and 120 working level months (WLM). The radon-exposed mice showed slow body weight gain, decreased serum triglycerides and low-density lipoproteins, decreased diversity, lower community structure, and altered abundance of the gut microbiota. Lachnospiraceae, Amaricoccus, and Enterococcus could differentiate the IR30, 60, and 120 WLM groups, respectively. Meanwhile, radon exposure affected the metabolic functions of the gut microbiota, mainly carbohydrate, amino acid, and lipid metabolic pathways. The altered abundance of microbiota and resulting reduced levels of SCFAs may aggravate the damage caused by radon exposure.

A case study on seasonal and annual average indoor radon, thoron, and their progeny level in Kohima district, Nagaland, India

Indoor radon and thoron survey has been carried out in 50 dwellings under Kohima district, Nagaland, India, using the latest measurement technology. The survey has been carried out for a one-year period in 3 different seasons, and the dwellings were selected according to the building materials used for construction. Indoor radon and thoron concentrations, as well as their progeny, followed a predictable pattern with greater levels in the winter and lower levels in the summer. Concrete housing had greater radon and thoron concentrations than bamboo and semi-wood/bamboo homes. The equilibrium factor (E.F.) and inhalation dose due to radon, thoron, and their corresponding progeny were also studied in the present study.

Evolution of traceable radon emanation sources from MBq to few Bq

In the framework of the EMPIR project traceRadon, stable atmospheres with low-level radon activity concentrations have to be produced for calibrating radon detectors designed to measure outdoor air activity concentrations. The traceable calibration of these detectors at very low activity concentrations is of special interest to the radiation protection, climate observation, and atmospheric research communities. Radiation protection networks (such as the EUropean Radiological Data Exchange Platform (EURDEP)) and atmospheric monitoring networks (such as the Integrated Carbon Observation System (ICOS)) need reliable and accurate radon activity concentration measurements for a variety of reasons, including: the identification of Radon Priority Areas (RPA); improving the sensitivity and reliability of radiological emergency early warning systems (Melintescu et al., 2018); for more reliable application of the Radon Tracer Method (RTM) to estimate greenhouse gas (GHG) emissions; for improved global "baseline" monitoring of changing GHG concentrations and quantification of regional pollution transport (Chambers et al., 2016), (Chambers et al., 2018); and for evaluating mixing and transport parameterisations in regional or global chemical transport models (CTMs) (Zhang et al., 2021), (Chambers et al., 2019). To achieve this goal, low activity sources of radium with a variety of characteristics were produced using different methods. Sources ranging from MBq ²²⁶Ra down to several Bq ²²⁶Ra were developed and characterised during the evolution of production methods, and uncertainties below 2 % (k= 1) were achieved through dedicated detection techniques, even for the lowest activity sources. The uncertainty of the lowest activity sources was improved using a new online measurement technique for which the source and detector were combined in the same device. This Integrated Radon Source Detector device, henceforth an IRSD, reaches a counting efficiency approaching 50 % through detection under quasi 2π sr solid-angle. At the time of this study the IRSD was already produced with ²²⁶Ra activities between 2 Bq and 440 Bq. To compare the working performance of the developed sources (i.e., to establish a reference atmosphere), study the stability of the sources, and to establish traceability to national standards, an intercomparison exercise was carried out at the PTB facility. Here we present the various source production techniques, the determination of their radium activity, and determination of their radon emanation (including assigned uncertainties). This includes details of the implementation of the intercomparison set-up, and a discussion of the results of the source characterisations.

Indoor radon survey in Whitehorse, Canada, and dose assessment

Radon-222 (²²²Rn) and its decay products are the primary sources of a population's exposure to background ionizing radiation. Radon decay products are the leading cause of lung cancer for non-smokers and the second leading cause of lung cancer after smoking for smokers. A community-driven long-term radon survey was completed in 232 residential homes in different subdivisions of Whitehorse, the capital of the Yukon, during the heating season from November to April in 2016-2017 and in 2017-2018. Radon concentrations were measured in living rooms and bedrooms on ground floors. The arithmetic and geometric means of indoor radon activity concentrations in different subdivisions of Whitehorse ranged from 52 ± 0.6 Bq m^-3and 37 ± 2.3 Bq m^-3in the Downtown area of Whitehorse to 993.0 ± 55.0 Bq m^-3and 726.2 ± 2.4 Bq m^-3in Wolf Creek. Underlying geology and glacial surfaces may partly explain these variations of indoor radon concentrations in subdivisions of Whitehorse. A total of 78 homes (34.0%) had radon concentrations higher than 100 Bq m^-3, 47 homes (20.5%) had concentrations higher than 200 Bq m^-3and 33 homes (14.4%) had concentrations higher than 300 Bq m^-3. The indoor radon contribution to the annual effective inhalation dose to residents ranged from 3.0 mSv in the Downtown area to 51.0 mSv in Wolf Creek. The estimated annual average dose to adults in Whitehorse, Yukon, is higher than the world's average annual effective dose of 1.3 mSv due to the inhalation of indoor radon. The annual radon inhalation effective dose was assessed using radon measurements taken during winter; hence the assessed dose may be overestimated. Cost-efficient mitigation methods are available to reduce radon in existing buildings and to prevent radon entry into new buildings.

Exposure to radon and heavy particulate pollution and incidence of brain tumors

BACKGROUND

Global incidence for brain tumors varies substantially without explanation. Studies correlating radon exposure and incidence are inconclusive. Particulate pollution has been linked to increased tumor incidence. Particulates may disrupt the blood-brain barrier allowing intracranial exposure to oncogenic radon. We investigated the relationship between exposure to residential radon, particulate pollution, and brain tumor incidence in the United States (US).

METHODS

County-level median radon testing results and annual air quality index values were obtained and divided into tertiles. Counties without both values were excluded. Four groups of counties were generated: high particulate/high radon (high/high), high/low, low/high, and low/low. Using incidence data from the Central Brain Tumor Registry of the US (provided by CDC's National Program of Cancer Registries and NCI's SEER), annual age-adjusted incidence rates (AAAIRs) by group were generated by behavior. Incidence rate ratios were calculated to examine for significant differences (α = .05). Poisson regression accounting for possible confounders was conducted.

RESULTS

Counties with available data included 83% of the US population. High/high exposure was significantly associated with increased AAAIR of all non-malignant tumors (up to 26% higher, including most meningiomas) even after accounting for potential confounders. An increased AAAIR was noted for all malignant tumors (up to 10% higher), including glioblastoma, but was negated after accounting for demographic/socioeconomic differences.

CONCLUSIONS

We present the first report suggesting increased non-malignant brain tumor incidence in regions with high particulate and radon exposure. These findings provide insight into unexplained variation in tumor incidence. Future studies are needed to validate these findings in other populations.

Measurements and computational fluid dynamics investigation of the indoor radon distribution in a typical naturally ventilated room

Based on the European Union Basic Safety Standards to protect people against exposure to ionizing radiation, establishing and addressing the reference levels for indoor radon concentrations is necessary. Therefore, the indoor radon concentration should be monitored and control in dwelling and workplaces. However, proper ventilation and sustainability are the major factors that influence how healthy the environment in a building is for its occupants. In this paper, the indoor radon distribution in a typical naturally ventilated room under two scenarios (when the door is closed and open) using the computational fluid dynamics (CFD) technique was studied. The CFD code ANSYS Fluent 2020 R1 based on the finite volume method was employed before the simulation results were compared with analytical calculations as well as passive and active measurements. The average radon concentration from the CFD simulation was found to be between 70.21 and 66.25 Bq m^-3 under closed and open-door conditions, respectively, at the desired ventilation rate of 1 ACH (Air Changes per Hour). Moreover, the highest concentrations of radon were measured close to the floor and the lowest values were recorded near to the inlet, resulting in the airflow velocity profile. The simulation results were in good agreement with the maxima of 19% and 7% compared to analytical calculations at different indoor air velocities in the open- and closed-door scenarios, respectively. The measured radon concentrations obtained by the active measurements also fitted well with the CFD results, for example, with a relative standard deviation of around 7% and 2% when measured by AlphaGUARD and RAD7 monitors at a height of 1.0 m above the ground in the open-door scenario. From the simulation results, the effective dose received by an individual from the indoor air of the workplace was also calculated.

Indoor radon survey in Greenland and dose assessment

Indoor radon and its decay products are the primary sources of the population's exposure to background ionizing radiation. Radon decay products are one of the leading causes of lung cancer, with a higher lung cancer risk for smokers due to the synergistic effects of radon decay products and cigarette smoking. A total of 459 year-long radon measurements in 257 detached and semi-detached residential homes in southwest and south Greenland were carried out, and a dose assessment for adults was performed. The annual arithmetic and geometric means of indoor radon concentrations was 10.5 ± 0.2 Bq m^-3 and 8.0 ± 2.3 Bq m^-3 in Nuuk, 139.0 ± 1.0 Bq m^-3 and 97.3 ± 2.1 Bq m^-3 in Narsaq, and 42.1 ± 0.7 Bq m^-3 and 22.0 ± 3.1 Bq m^-3 in Qaqortoq. Arithmetic and geometric mean radon concentration of 79.0 Bq m^-3 and 50.3 Bq m^-3 were estimated for adult, person-weighted living in south Greenland. The total number of detached and semi-detached residential homes where indoor radon is exceeding 100 Bq m^-3, 200 Bq m^-3, and 300 Bq m^-3 is 37 homes (15.0%), 13 homes (5.2%), and 8 homes (3.2%), respectively. A positive correlation between indoor air radon concentrations and underlying geology was observed. The indoor radon contribution to the annual inhalation effective dose to an average adult was 0.5 mSv in Nuuk, 6.5 mSv in Narsaq, 2.0 mSv in Qaqortoq, and 4.0 mSv for south Greenland adult person weighted. The estimated annual average effective dose to adults in Narsaq is higher than the world's average annual effective dose of 1.3 mSv due to inhalation of indoor radon. Cost-efficient mitigation methods exist to reduce radon in existing buildings, and to prevent radon entry into new buildings.

Radon Solubility in Different Tissues after Short Term Exposure

Radon, a naturally occurring radioactive noble gas, contributes significantly to lung cancer when incorporated from our natural environment. However, despite having unknown underlying mechanisms, radon is also used for therapeutic purposes to treat inflammatory diseases such as rheumatoid arthritis. Data on the distribution and accumulation of radon in different tissues represent an important factor in dose determination for risk estimation, the explanation of potential therapeutic effects and the calculation of doses to different tissues using biokinetic dosimetry models. In this paper, radon's solubility in bones, muscle tissue, adipose tissue, bone marrow, blood, a dissolved gelatin and oleic acid were determined. In analogy to current radon use in therapies, samples were exposed to radon gas for 1 h using two exposure protocols combined with established γ-spectroscopic measurements. Solubility data varied over two orders of magnitude, with the lowest values from the dissolved gelatin and muscle tissue; radon's solubility in flat bones, blood and adipose tissue was one order of magnitude higher. The highest values for radon solubility were measured in bone marrow and oleic acid. The data for long bones as well as bone marrow varied significantly. The radon solubility in the blood suggested a radon distribution within the body that occurred via blood flow, reaching organs and tissues that were not in direct contact with radon gas during therapy. Tissues with similar compositions were expected to reveal similar radon solubilities; however, yellow bone marrow and adipose tissue showed differences in solubility even though their chemical composition is nearly the same-indicating that interactions on the microscopic scale between radon and the solvent might be important. We found high solubility in bone marrow-where sensitive hematopoietic cells are located-and in adipose tissue, where the biological impact needs to be further elucidated.

Machine Learning-Enabled Framework for High-Throughput Screening of MOFs: Application in Radon/Indoor Air Separation

Radon and its progeny may cause severe health hazards, especially for people working in underground spaces. Therefore, in this study, a hybrid artificial intelligence machine learning-enabled framework is proposed for high-throughput screening of metal-organic frameworks (MOFs) as adsorbents for radon separation from indoor air. MOFs from a specific database were initially screened using a pore-limiting diameter filter. Subsequently, random forest classification and grand canonical Monte Carlo simulations were implemented to identify MOFs with a high adsorbent performance score (APS) and high regenerability (R %). Interpretability and trustworthiness were determined by variable importance analysis , and adsorption mechanisms were elucidated by calculating the adsorption sites using Materials Studio. Notably, two MOF candidates were discovered with higher APS values in both the radon/N₂ and radon/O₂ systems compared with that of ZrSQU which is the best-performing MOF thus far, with R % values exceeding 85%. Furthermore, the proposed framework can be flexibly applied to multiple data sets due to good performance in model transfer. Therefore, the proposed framework has the potential to provide guidelines for the strategic design of MOFs for radon separation.

Average uranium bedrock concentration in Swedish municipalities predicts male lung cancer incidence rate when adjusted for smoking prevalence: Indication of a cumulative radon induced detriment

Bedrock U has been used as a proxy for local indoor radon exposure. A preliminary assessment of cancer incidence rate in a cohort of 809,939 adult males living in 9 different Swedish counties in 1986 has been used to correlate the cumulative lung cancer and total cancer (excluding lung) incidence rates between 1986 and 2020, respectively with the municipality average value of bedrock U concentration obtained from Swedish geological Survey (SGU). To control for regional difference in tobacco smoking, data on county average smoking prevalence, obtained from a survey conducted by the Public Health Agency of Sweden from 2001 to 2004, was used. Regression analysis shows that there is a significant positive correlation between smoking prevalence adjusted lung cancer incidence rate in males and the municipality bedrock U concentration (R² = 0.273 with a slope 5.0 ± 0.87·10^-3 ppm^-1). The correlation is even more significant (R² = 0.759 with a slope = 4.8 ± 0.25·10^-3 ppm^-1) when assessed on population weighted cancer incidence data binned in nine intervals of municipality average bedrock U concentration (ranging from 0.97 to 4.9 ppm). When assessing the corresponding correlations for total cancer incidence rate (excluding cancer of the lung) with adjustment for smoking prevalence, there appears to be no or little correlation with bedrock U concentration (R² = 0.031). We conclude that an expanded future study needs age-standardized cancer incidence data to obtain a more consistent exposure-response model. Such model could be used to predict future lung cancer cases based on geological survey maps of bedrock U as an alternative to laborious indoor radon measurements, and to discern what future lung cancer rates can be expected for a population nearing zero smoking prevalence, with and without radon prevention.

Lung Cancer Risk Prediction Nomogram in Nonsmoking Chinese Women: Retrospective Cross-sectional Cohort Study

BACKGROUND

It is believed that smoking is not the cause of approximately 53% of lung cancers diagnosed in women globally.

OBJECTIVE

The study aimed to develop and validate a simple and noninvasive model that could assess and stratify lung cancer risk in nonsmoking Chinese women.

METHODS

Based on the population-based Cancer Screening Program in Urban China, this retrospective, cross-sectional cohort study was carried out with a vast population base and an immense number of participants. The training set and the validation set were both constructed using a random distribution of the data. Following the identification of associated risk factors by multivariable Cox regression analysis, a predictive nomogram was developed. Discrimination (area under the curve) and calibration were further performed to assess the validation of risk prediction nomogram in the training set, which was then validated in the validation set.

RESULTS

In sum, 151,834 individuals signed up to take part in the survey. Both the training set (n=75,917) and the validation set (n=75,917) were comprised of randomly selected participants. Potential predictors for lung cancer included age, history of chronic respiratory disease, first-degree family history of lung cancer, menopause, and history of benign breast disease. We displayed 1-year, 3-year, and 5-year lung cancer risk-predicting nomograms using these 5 factors. In the training set, the 1-year, 3-year, and 5-year lung cancer risk areas under the curve were 0.762, 0.718, and 0.703, respectively. In the validation set, the model showed a moderate predictive discrimination.

CONCLUSIONS

We designed and validated a simple and noninvasive lung cancer risk model for nonsmoking women. This model can be applied to identify and triage people at high risk for developing lung cancers among nonsmoking women.

Survival in Lung Cancer in the Nordic Countries Through A Half Century

Objective

Lung cancer is often diagnosed at an advanced stage and survival has been poor, although long-term studies have been rare. We analyzed data on survival in lung cancer from Denmark, Finland, Norway, and Sweden over a 50-year period (1971-2020).

Methods

Relative 1- and 5-year survival data were obtained from the NORDCAN database for 1971-2020. We used generalized additive models to estimate survival trends over time and uncertainty of these estimates. We additionally calculated conditional survival from the 1st to 5th year (5/1-year), estimated annual changes in survival rates, and determined significant breaking points.

Results

In 2016-2020, 5-year survival rate for lung cancer was best for Norwegian men (26.6%) and women (33.2%). The sex difference was significant and it was found for each country. Survival improved modestly until the year 2000, after which time survival curves increased steeply and kept the linear shape to the end of follow-up, indicating consistent improvement in survival. Survival curves for 1- and 5/1-year survival were almost superimposable, indicating that deaths in the first year were approximately as many as in the subsequent 4 years, thus marking sustained long-term survival.

Conclusion

We could document a positive development in lung cancer survival with steep upward trends after the year 2000. Intensions for curative treatment have been increasing and the outcomes have been improving with the help of novel imaging methods. Pathways for facile patient access to treatment have been instituted. Close to 90% of the patients are ever smokers. National anti-smoking acts and alerting people who smoke about early symptoms may be beneficial, as metastatic lung cancer remains difficult to cure.

Chronic Home Radon Exposure Is Associated with Higher Inflammatory Biomarker Concentrations in Children and Adolescents

Children are particularly vulnerable to the deleterious impacts of toxic environmental exposures, though the effects of some rather ubiquitous toxins have yet to be characterized in youths. One such toxin, radon gas, is known to accumulate to hazardous levels in homes, and has been linked with the incidence of lung cancer in aging adults. However, the degree to which chronic home radon exposure may impact risk for health problems earlier in life is unknown. Herein, we explored the degree to which chronic home radon exposure relates to biomarkers of low-grade inflammation in 68 youths ages 6- to 14 years old residing in an area of the United States prone to high home radon concentrations. Parents completed a home radon test kit, and youths provided a saliva sample to assess concentrations of five biomarkers. Using a multiple regression approach, we found that greater radon exposure was specifically associated with higher levels of C-reactive protein (β = 0.31, p = 0.007) and interleukin-1β (β = 0.33, p = 0.016). The data suggested specificity in associations between chronic home radon exposure and different biomarkers of inflammatory activity and highlight a pathway which may confer risk for future mental and physical health maladies.

Human Health Impacts of Residential Radon Exposure: Updated Systematic Review and Meta-Analysis of Case-Control Studies

This study investigated the impact of residential radon exposure on human cancers (i.e., lung cancer and childhood leukemia) through a systematic review and meta-analysis of case−control studies. A total of 9724 articles obtained from electronic databases were assessed; however, only 55 case−control studies were eligible after manually screening and eliminating unnecessary studies. The causal associations were addressed by determining the meta-analysis’s estimated size effects (i.e., ORs/RRs) of the meta-analysis. Residential radon was revealed to significantly increase the incidence of lung cancer and childhood leukemia with pooled ORs of 1.38 [1.19; 1.60] (I2 = 90%; p < 0.00001) and 1.43 [1.19; 1.72] (I2 = 0% and p = 0.51), respectively. In addition, subgroup analyses were performed to reduce the heterogeneity of the initial meta-analyses. The results provided strong evidence that inhaling radon in the indoor environments is closely associated with the development of lung cancer and childhood leukemia in patients living in Europe and areas with high radon levels (≥100 Bq/m3).

Radon transport in permeable geological environments

This article presents the results of a long-term soil radon and meteorological parameter monitoring study in the fault zone at Mt. Beshtau, North Caucasus, which for more than 3 years. Strong seasonal variations in the radon levels with maxima during summer and minima during winter were recorded. The values of radon exhalation and soil radon concentration have a range of 0.025-25 Bq m ² s ^-1 and 1-170 kBq m ^-3, respectively. In addition, measurements of the air radon concentration, and direction of air movement at the adits mouths of the former uranium mine on the same mountain were carried out. Seasonal radon variations, similar to those observed in fault zones, were recorded at the mouths of adits. It was established that radon anomalies are associated with the periodic release of mine air from the fractures and tunnels into the atmosphere. Above an altitude of 900 m a. s. l., an abnormal release of radon occurs in winter, when the mine air is warmer than the surrounding atmosphere. At the altitudes below 900 m the cold radon rich air blows from the adit mouths in summer. During mine air discharge, radon concentrations in the open atmosphere locally around the adit mouth reach 600,000 Bq m^-3, averaging 50,000-250,000 Bq m^-3. The temporal pattern of radon fluctuations in fault zones and at the adit mouths is similar. A very close correlation between radon levels and atmospheric air temperature was observed both in the fault zone and at the adits mouths. It indicates that radon release in both cases are caused by a single mechanism. This mechanism probably is the atmospheric air circulation in shallow permeable zones due to the temperature difference between the inside mountain and ambient atmosphere.

Characterizing occupational radon exposure greater than 100 Bq/m3 in a highly exposed country

Radon is an established lung carcinogen concentrating in indoor environments with importance for many workers worldwide. However, a systematic assessment of radon levels faced by all workers, not just those with direct uranium or radon exposure, has not previously been completed. The objective of this study was to estimate the prevalence of workers exposed to radon, and the level of exposure (> 100-200 Bq/m3, 200-400 Bq/m3, 400-800 Bq/m3, and > 800 Bq/m3) in a highly exposed country (Canada). Exposures among underground workers were assessed using the CAREX Canada approach. Radon concentrations in indoor workplaces, obtained from two Canadian surveys, were modelled using lognormal distributions. Distributions were then applied to the susceptible indoor worker population to yield the number of exposed workers, by occupation, industry, province, and sex. In total, an estimated 603,000 out of Canada's 18,268,120 workers are exposed to radon in Canada. An estimated52% of exposed workers are women, even though they comprise only 48% of the labour force. The majority (68%) are exposed at a level of > 100-200 Bq/m3. Workers are primarily exposed in educational services, professional, scientific and technical services, and health care and social assistance, but workers in mining, quarrying, and oil and gas extraction have the largest number of exposed workers at high levels (> 800 Bq/m3). Overall, a significant number of workers are exposed to radon, many of whom are not adequately protected by existing guidelines. Radon surveys across multiple industries and occupations are needed to better characterize occupational exposure. These results can be used to identify exposed workers, and to support lung cancer prevention programs within these groups.

Etiology of lung cancer: Evidence from epidemiologic studies

Lung cancer is one of the leading causes of cancer incidence and mortality worldwide. While smoking, radon, air pollution, as well as occupational exposure to asbestos, diesel fumes, arsenic, beryllium, cadmium, chromium, nickel, and silica are well-established risk factors, many lung cancer cases cannot be explained by these known risk factors. Over the last two decades the incidence of adenocarcinoma has risen, and it now surpasses squamous cell carcinoma as the most common histologic subtype. This increase warrants new efforts to identify additional risk factors for specific lung cancer subtypes as well as a comprehensive review of current evidence from epidemiologic studies to inform future studies. Given the myriad exposures individuals experience in real-world settings, it is essential to investigate mixture effects from complex exposures and gene-environment interactions in relation to lung cancer and its subtypes.

Factors influencing radon transport in the soils of Moscow

This article delves into the factors that may influence radon flux, such as soil properties and weather conditions, on the example of two experimental locations with different soil compositions, composed primarily of clay and sand, respectively. The experimental location with sandy soil was previously observed to have anomalously high radon flux levels. Radon monitoring was performed routinely, approximately at the same time of day and in parallel on both of these locations to exclude the influence of diurnal variations. The results show that radon transport in these locations differs in mechanism: Location with clay soil has diffusive radon transport, with an average radon flux density of 37.4 ± 24.9 mBq m^-2 s^-1 and a range of 0.3-167.8 mBq m^-2 s^-1, while the location with sandy soil has convective radon transport with an average radon flux density of 93.6 ± 51.2 mBq m^-2 s^-1 and a range of 9.8-302.2 mBq m^-2 s^-1. This corresponds to about 8.3% of RFD measurements on site with clay soils exceeding the national reference level of 80 mBq m^-2 s^-1 and 45.6% exceeding them on the site with sandy soils. Average radon flux density values were then compared to meteorological variables using Pearson correlation analysis with Student's t-test. It was observed that radon flux density correlates the most with ambient air temperature both for diffusive and convective radon transport mechanisms, while a weaker inverse correlation is observed with atmospheric precipitation and wind speed for the diffusive mode of radon transport, but not for the convective. Radon activity concentration in soil air correlates with the radon flux density and air temperature in the case of convective radon transport, but does not correlate in the case of diffusive transport.

Lung cancer as adverse health effect by indoor radon exposure in China from 2000 to 2020: A systematic review and meta-analysis

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.

Effects of spatial variation in dose delivery: what can we learn from radon-related lung cancer studies?

Exposure to radon progeny results in heterogeneous dose distributions in many different spatial scales. The aim of this review is to provide an overview on the state of the art in epidemiology, clinical observations, cell biology, dosimetry, and modelling related to radon exposure and its association with lung cancer, along with priorities for future research. Particular attention is paid on the effects of spatial variation in dose delivery within the organs, a factor not considered in radiation protection. It is concluded that a multidisciplinary approach is required to improve risk assessment and mechanistic understanding of carcinogenesis related to radon exposure. To achieve these goals, important steps would be to clarify whether radon can cause other diseases than lung cancer, and to investigate radon-related health risks in children or persons at young ages. Also, a better understanding of the combined effects of radon and smoking is needed, which can be achieved by integrating epidemiological, clinical, pathological, and molecular oncology data to obtain a radon-associated signature. While in vitro models derived from primary human bronchial epithelial cells can help to identify new and corroborate existing biomarkers, they also allow to study the effects of heterogeneous dose distributions including the effects of locally high doses. These novel approaches can provide valuable input and validation data for mathematical models for risk assessment. These models can be applied to quantitatively translate the knowledge obtained from radon exposure to other exposures resulting in heterogeneous dose distributions within an organ to support radiation protection in general.

A prospective cohort analysis of residential radon and UV exposures and malignant melanoma mortality in the Swiss population

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.

Molecular Characteristics of Radon Associated Lung Cancer Highlights MET Alterations

Simple Summary

Lung cancer (LC) is the leading cause of cancer death worldwide. After smoking, one of the most prominent risk factors for LC development is radon (Rn) exposure. In our study we analysed and compared the genetic landscape of LC patients from a Rn exposed village with local matched non-exposed patients. Within the concordant genetic landscape, an increase in genetic MET proto-oncogene, receptor tyrosine kinase (MET) alteration in the Rn-exposed cohort was monitored, underlining the importance of routine MET testing and potential to enable a more effective treatment for this specific subgroup.

Abstract

Effective targeted treatment strategies resulted from molecular profiling of lung cancer with distinct prevalent mutation profiles in smokers and non-smokers. Although Rn is the second most important risk factor, data for Rn-dependent driver events are limited. Therefore, a Rn-exposed cohort of lung cancer patients was screened for oncogenic drivers and their survival and genetic profiles were compared with data of the average regional population. Genetic alterations were analysed in 20 Rn-exposed and 22 histologically matched non-Rn exposed LC patients using targeted Next generation sequencing (NGS) and Fluorescence In Situ Hybridization (FISH). Sufficient material and sample quality could be obtained in 14/27 non-exposed versus 17/22 Rn-exposed LC samples. Survival was analysed in comparison to a histologically and stage-matched regional non-exposed lung cancer cohort (n = 51) for hypothesis generating. Median overall survivals were 83.02 months in the Rn-exposed and 38.7 months in the non-exposed lung cancer cohort (p = 0.22). Genetic alterations of both patient cohorts were in high concordance, except for an increase in MET alterations and a decrease in TP53 mutations in the Rn-exposed patients in this small hypothesis generating study.

Risk Factors for the Diagnosis of Lung Cancer in Poland: A Large-Scale, Population-Based Case-Control Study

OBJECTIVE

Lung cancer is one of the most common and deadly malignant neoplasms. Currently, it is one of the main causes of cancer deaths worldwide. The study aimed to identify and evaluate patient characteristics, demographic and lifestyle factors that are associated with lung cancer at diagnosis.

METHODS

The study included 400 patients diagnosed with lung cancer and 400 within the control group. The research was based on a clinical, direct, individual, structured, in-depth and focused interview. Assessment of activity and BMI was used according to WHO recommendations, as well as the expert system.

RESULTS

The mean age of the patients was 74.53 ± 7.86 years, while in the control group 59.5 (7.93). There was a strong positive relationship between the incidence of tuberculosis and chronic obstructive pulmonary disease and the risk of lung cancer (p <0.001). The risk of lung cancer was significant in the case of smoking 20 or more than 20 cigarettes a day and smoking for more than 20 years (p = 0.01).

CONCLUSIONS

Active and passive smoking, are a leading risk factor for lung cancer, which shows that understanding of the long-term and fatal effects of smoking is still very low in society.  No significant correlation has been found between lifestyle and risk of lung cancer. However, there was a strong positive correlation between tuberculosis and chronic obstructive pulmonary disease and the risk of lung cancer. Occupation is a predisposing factor for lung cancer occurrence.

A global burden assessment of lung cancer attributed to residential radon exposure during 1990-2019

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.

Mapping the Way to Good Health: The Interdisciplinary Challenges of Geographers in Medical Research

Geography has an important role to play in shaping the direction of medical research. In particular, its tools and theory provide essential understanding to the impacts of place on health behaviors and outcomes. Understanding some of its evolution-particularly into the subfield of medical geography-is therefore useful both for geographers and medical researchers. In this paper, we present some of the debates that geographers have grappled with, the growth of GIS (particularly in the context of medical research), some important methodological considerations that geographers help center, and some recommendations for future work at this nexus. Throughout, we speak from the perspective of geographers who have worked nearly exclusively in the health sciences since obtaining our PhDs.

Challenges and Suggestions in Management of Lung and Liver Cancer in Uzbekistan: The Second Report of the Uzbekistan-Korea Oncology Consortium

The health burden of cancer increases in Uzbekistan as the country develops and the life expectancy increases. Management of such a burden requires efficient screening, treatment optimization, and investigation of the causes of cancer. The Ministry of Health of Uzbekistan formed an advisory consortium, including clinical oncology and healthcare management experts from Uzbekistan and South Korea, to design a strategy for cancer management. Our consortium has analyzed six cancer types with high morbidity and mortality in Uzbekistan by classifying them into three categories (breast, cervical (gynecologic cancers), lung, liver (cancer common in men), stomach, and colorectal cancers (gastrointestinal cancers)). Lung and liver cancers are common causes of death in men after middle age-they can yield a serious health burden on the country and ruin the livelihood of families. In this review, we will analyze the oncologic literature and suggest practical recommendations for the treatment and prevention of lung and liver cancer in Uzbekistan. Data from South Korea, which has conducted nationwide screening for two decades and made progress in improving prognosis, will be discussed as a comparative control.

Association between Air Pollution and Squamous Cell Lung Cancer in South-Eastern Poland

Air pollution is closely associated with the development of respiratory illness. The aim of the present study was to assess the relationship between long-term exposure to PM2.5, PM10, NO₂, and SO₂ pollution and the incidence of lung cancer in the squamous subtype in south-eastern Poland from the years 2004 to 2014. We collected data of 4237 patients with squamous cell lung cancer and the level of selected pollutants. To investigate the relationship between the level of concentrations of pollutants and the place of residence of patients with lung cancer in the squamous subtype, proprietary pollution maps were applied to the places of residence of patients. To analyze the data, the risk ratio was used as well as a number of statistical methods, i.e., the pollution model, inverse distance weighted interpolation, PCA, and ordered response model. Cancer in women and in men seems to depend in particular on the simultaneous inhalation of NO₂ and PM10 (variable NO₂PM10) and of NO₂ and SO₂ (variable NO₂ SO₂), respectively. Nitrogen dioxide exercises a synergistic leading effect, which once composed with the other elements it becomes more persistent in explaining higher odds in the appearance of cancers and could constitute the main cause of squamous cancer.

Groundwater radon exposure and risk of lung cancer: A population-based study in Finland

Naturally occurring radioactive elements can be found in groundwater and exposure to such elements is associated with an increased risk of lung cancer. In this study, we aimed to observe the association between exposure to these radioactive elements in groundwater and the risk of lung cancer in selected regions in Finland. This is a population-based study from 1955 to 2019 in Finland. The exposed municipalities with their corresponding hospital districts were selected based on radon measurements at groundwater treatment plants. Lung cancer cases were obtained from the Finnish cancer registry. The 5-year incidence rates for lung cancer were calculated and a comparison was made between each of the hospital districts with radon exposure. More than 93,000 cases of lung cancer were reported in the radon-exposed regions over the examined period of 64 years. The highest number of cases was recorded in the Helsinki University hospital district and the least in the Southern Savo hospital district. Similarly, the lung cancer incidence rate was highest in Lapland and lowest in the Southern Savo hospital district. The number of daily smokers in the working-age population appears to have decreased in all the hospital districts from 2013 to 2018. A statistically significant increased risk of lung cancer was observed in the high radon-exposed hospital districts compared to those with lower exposure. Groundwater radon exposure is observed to be associated with an increased risk of lung cancer.

Social factors and behavioural reactions to radon test outcomes underlie differences in radiation exposure dose, independent of household radon level

Radioactive radon gas inhalation causes lung cancer, and public health strategies have responded by promoting testing and exposure reduction by individuals. However, a better understanding of how radon exposure disparities are driven by psychological and social variables is required. Here, we explored how behavioural factors modified residential radon-related radiation doses incurred by 2390 people who performed a radon test. The average time from first awareness to receiving a radon test outcome was 6.8–25.5 months, depending on behaviour and attitudes. 20.5% displayed radon test urgency that reduced irradiation between awareness and outcome to 1.8 mSv from a typical 3.5 mSv, while 14.8% (more likely to be men) displayed delaying behaviours that increased exposure to 8.0 mSv. Of those with low radon, 45.9% indicated no future testing intention, underscoring the importance of original tests to reliably establish risk. Among people finding high radon, 38% mitigated quickly, 29% reported economic impediments, and 33% displayed delaying behaviours. Economic barriers and delaying behaviours resulted in 8.4 mSv/year or 10.3 mSv/year long term excess exposure, respectively, increasing lifetime risk of lung cancer by ~ 30–40%. Excess radiation doses incurred from behaviour were independent of household radon level, highlighting the strong influence of psychological and socioeconomic factors on radon exposure and lung cancer risks.

Neighborhood disadvantage and lung cancer risk in a national cohort of never smoking Black women

BACKGROUND

Compared to women of other races who have never smoked, Black women have a higher risk of lung cancer. Whether neighborhood disadvantage, which Black women experience at higher rates than other women, is linked to never-smoking lung cancer risk remains unclear. This study investigates the association of neighborhood disadvantage and lung cancer risk in Black never-smoking women.

METHODS AND MATERIALS

This research utilized data from the Black Women's Health Study, a prospective cohort of 59,000 Black women recruited from across the US in 1995 and followed by biennial questionnaires. Associations of lung cancer incidence with neighborhood-level factors (including two composite variables derived from Census Bureau data: neighborhood socioeconomic status and neighborhood concentrated disadvantage), secondhand smoke exposure, and PM_2.5 were estimated using Fine-Gray subdistribution hazard models.

RESULTS

Among 37,650 never-smokers, 77 were diagnosed with lung cancer during follow-up from 1995 to 2018. The adjusted subdistribution hazard ratio (sHR) of lung cancer incidence with ten unit increase in neighborhood concentrated disadvantage index was 1.30 (95 % CI: 1.04, 1.63, p = 0.023). Exposure to secondhand smoke at work was associated with increased risk (sHR = 1.93, 95 % CI: 1.21, 3.10, p = 0.006), but exposure to secondhand smoke at home and PM_2.5 was not.

CONCLUSION

Worse neighborhood concentrated disadvantage was associated with increased lung cancer risk in Black women who never smoked. These findings suggest that non-tobacco-related factors in disadvantaged neighborhoods may be linked to lung cancer risk in Black women and that these factors must be understood and targeted to achieve health equity.

An Innovative Tool to Control Occupational Radon Exposure

After smoking, indoor radon is the main contributor to lung cancer in many countries. The European Union (EU) Directive 2013/59/Euratom establishes a maximum reference level of 300 Bq/m³ of radon concentration in the workplace, and an effective dose limit of 20 mSv per year for workers. If the radon concentration in a workplace exceeds the reference level, constructive mitigation applies. When constructive mitigation is not feasible, we propose to keep workers' effective dose below 6 mSv per year (category B of exposed workers) by controlling occupancy time. Setting the maximum annual dose at 6 mSv protects workers' health and eases the regulatory requirements for employers. If multisite workers are present, each worker has to be monitored individually by tracking the time spent and the radon concentration at each worksite. This paper shows a software tool for employers to perform this complex tracking in an accurate, conservative, and transparent manner, and in compliance with the EU by-laws.

Measurement of Radon Concentration in Water within Ojo Axis of Lagos State, Nigeria

Background: The problem of radon (Radon-222) in water is one of the daily health hazards faced by those in Ojo Axis, Nigeria. Therefore, continuous monitoring of radon contamination in different types of water is essential. In the present work, sixteen groundwater and surface-water samples (wells, boreholes, and sachets) were collected from six different locations within the Ojo Local Government area in Nigeria. The water samples collected were stored in 75 cl bottles that were already sterilized with distilled water to avoid contamination. Water samples were then taken to the laboratory for the analysis of radon levels using a RAD7, an active electronic device produced by the Durridge Company in the USA. The radon level in the water is higher than the safe limits of 11.1 Bq/L, as per EPA regulations, except for two sample points from the studied areas. The total annual effective doses from ingestion and inhalation for drinking and groundwater were higher than the safe limit of 0.1 mSv y−1 that is recommended by the World Health Organization and the European Union Commission. Conclusions: The obtained results underline the importance of the development and/or updating of databases regarding radon levels in drinking and groundwater in the Ojo Local Government area in Nigeria.

Development of an Evidence-Based Risk Assessment Framework

Assessment of potential human health risks associated with environmental and other agents requires careful evaluation of all available and relevant evidence for the agent of interest, including both data-rich and data-poor agents. With the advent of new approach methodologies in toxicological risk assessment, guidance on integrating evidence from mul-tiple evidence streams is needed to ensure that all available data is given due consideration in both qualitative and quantitative risk assessment. The present report summarizes the discussions among academic, government, and private sector participants from North America and Europe in an international workshop convened to explore the development of an evidence-based risk assessment framework, taking into account all available evidence in an appropriate manner in order to arrive at the best possible characterization of potential human health risks and associated uncertainty. Although consensus among workshop participants was not a specific goal, there was general agreement on the key consider-ations involved in evidence-based risk assessment incorporating 21st century science into human health risk assessment. These considerations have been embodied into an overarching prototype framework for evidence integration that will be explored in more depth in a follow-up meeting.

Assessment of Natural Radiation Exposure Due to 222Rn and External Radiation Sources: Case of the Far North, Cameroon

ABSTRACT

This paper assesses public exposure to natural radioactivity from radon and external radiation sources in the Far North region, Cameroon, and studies the correlation between radon data obtained using several techniques. The RADTRAK, RadonEye, and Markus 10 detectors were used to measure radon concentrations in dwellings and soil, respectively. To understand radon variations in the study area, a correlation coefficient between radon in soil and in dwellings was determined. The ambient equivalent dose rate was measured using a RadEye PRD-ER, and the effective doses from internal and external radiation were determined. In soil, 20% of the measuring points had a concentration above 50 kBq m-3, the action value for radon exposure from soil according to Swedish Radiation Protection Institute regulations. After 90 d of measurement using RADTRAK, half of the concentrations in the dwellings were greater than or equal to 160 Bq m-3, which is above the WHO reference level of 100 Bq m-3. The ambient equivalent dose rate and the external and internal radiation effective dose were 0.08 μSv h-1, 0.6 mSv y-1, and 2.86 mSv y-1, respectively. These results reveal a strong correlation between the radioactivity level of a locality and its geological and mineralogical structure. Although these different results in general do not present a very high risk of radiological exposure for the public, it is nevertheless necessary that the rules of radiation protection are respected in order to reduce it.

Multi-level continuous monitoring of indoor radon activity

We present the results of an experiment taking place inside the geophysical museum of Rocca di Papa (Rome, Italy), where the high radon levels detected might pose a risk to the health of workers and of the public audience. As a first step towards the mitigation of potential exposure risk, four active sensors were installed at different floors of the building, in order to continuously monitor not only radon exhalation from the soil but also its transport from the ground up to elevated floors. Collecting more than three years of data of radon concentration enables us to identify fluctuations over both short and seasonal scales and to elucidate the relation between radon variations and changes of internal temperature and relative humidity. The analysis of such dataset reveals how the healthiness of indoor environments in terms of radon concentration is controlled by a number of factors, including the environmental conditions and the use of heating and ventilation systems. Finally, the continuous radon monitoring at different levels of the building provides a unique chance to trace the vertical radon diffusion, allowing to make a first-order estimate of upward radon velocity.

A COMPREHENSIVE STUDY ON INDOOR RADON, THORON AND THEIR PROGENY LEVEL IN DIMAPUR DISTRICT OF NAGALAND, INDIA

Indoor radon (222Rn), thoron (220Rn) and their progeny concentrations were detected in several homes in Dimapur district, Nagaland, utilizing Direct Radon and Thoron progeny sensors based on solid-state Nuclear Track Detectors (Type-2 film) and pinhole type radon-thoron discriminating dosemeters. For three separate seasons, the annual inhalation dose has been determined in 80 residences in the research regions. The residences were chosen to have various types of housing, such as concrete, semi-wood/bamboo and bamboo, with varying levels of ventilation that contribute to indoor 222Rn, 220Rn and their progeny. The inhalation dose in the survey area lies between 0.33 and 3.04 mSvy-1 and is within the reference value as suggested by ICRP, 2018.

Assessment of Seasonal Radon Concentration in Dwellings and Soils in Selected Areas in Ga East, Greater Accra Region of Ghana

Seasonal radon levels have been studied in dwellings and soils in selected areas in Ga East, Greater Accra Region of Ghana using LR-115-type II (SSNTDs). This study was conducted to determine the seasonal correlation between soil and dwelling radon concentrations. Detectors were exposed from January to March and April to June, for dry and wet seasons, respectively. Overall, indoor radon was 133.4 ± 6.7 Bqm-3 and 72.1 ± 3.6 Bqm -3 for wet and dry seasons. The estimated annual effective dose to the lung received by the occupants at Paraku Estate, Dome, and Kwabenya was 6.9 ± 0.4, 7.2 ± 0.5, and 9.8 ± 0.8 mSvy-1 for the wet season and 3.8 ± 0.2, 4.3 ± 0.2, and 4.6 ± 0.3 mSvy-1 for the dry season. On average, the soil radon concentration was found to be 0.96 ± 0.07 kBqm-3 and 2.24 ± 0.01 kBqm-3 for wet and dry seasons. To determine the correlation between soil and dwelling radon, a positive Pearson correlation coefficient value R = (0.74) and R = (0.66) was obtained representing the dry and wet seasons. To test the statistical significance between soil and dwelling radon, P < 0.05 was obtained, indicating a statically significant relationship between the two.

Residents' perception and worldview about radon control policy in Canada: A pro-equity social justice lens

Radon is a potent indoor air pollutant, especially in radon prone areas and in countries with long winters. As the second top lung carcinogen, radon is disproportionately affecting certain population subgroups. While many provinces have taken sporadic actions, the equity issue has remained unaddressed across all policy measures. Attempts to enforce radon guidelines and enact building regulations without considering residents' views have proved ineffective. Research linking residents' radon risk perception and worldviews regarding radon control policy is lacking in Canada. We applied mixed (quantitative and qualitative) methods in a pro-equity social justice lens to examine the variations in residents' risk perception, access to risk communication messages, and worldviews about risk management across the sociodemographic strata. Triangulation of the quantitative and qualitative findings strengthened the evidence base to identify challenges and potential solutions in addressing the health risk through upstream policy actions. Enacting radon control policy requires actions from all levels of governments and relevant stakeholders to ensure equal opportunities for all residents to take the preventive and adaptive measures. Small sample size limited the scope of findings for generalization. Future studies can examine the differential impacts of radon health risk as are determined by various sociodemographic variables in a representative national cohort.

Chromosome aberrations, micronucleus frequency, and catalase concentration in a population chronically exposed to high levels of radon

PURPOSE

To deepen our knowledge on the effects of high levels of indoor radon exposure, we assessed the frequencies of unstable and stable chromosome aberrations and micronucleus (MN), as well as the concentration of an endogenous antioxidant (catalase, CAT), in blood samples of individuals chronically exposed to high indoor radon concentrations in Indonesia (Tande-Tande sub-village, Mamuju, West Sulawesi). Moreover, we also investigated the occurrence of a radio-adaptive response (RAR) in Tande-Tande sub-village inhabitants using the G2 MN assay.

MATERIALS AND METHODS

The frequencies of dicentric (DC), acentric (AF), ring (R), and translocation (Tr) chromosomes in Tande-Tande inhabitants were compared to those in people living in a reference area with low levels of indoor radon levels (Topoyo village, Indonesia). The number of MN per 1000 binucleated cells (BNC) and CAT concentration per total protein was quantified and compared between groups. Lastly, we irradiated (2 Gy) phytohemagglutinin-stimulated samples in vitro and measured the frequency of MN to verify the occurrence of a RAR in Tande-Tande sub-village inhabitants.

RESULTS AND CONCLUSION

The frequencies of DC, AF, and Tr did not differ between Tande-Tande inhabitants and control subjects (p = 0.350, 0.521, 0.597). The frequency of MN in Tande-Tande inhabitants was significantly lower than that in the control group (p = 0.006). Similarly, CAT concentration in Tande-Tande inhabitants was also significantly lower than that in the control population (p < 0.001). Significant negative correlations were identified for MN number and CAT concentration versus indoor radon concentration, annual effective dose, or cumulative dose both within groups and when all data were analyzed together. Our findings indicate that, despite the high indoor radon levels, Tande-Tande inhabitants are not under oxidative stress, since this group had lower CAT concentration and MN frequency than those in the control group. The negative correlation between MN frequency and indoor radon concentration, annual effective dose, and cumulative dose suggests the occurrence of an RAR phenomenon in Tande-Tande sub-village inhabitants. This interpretation is also supported by the results of the G2 MN assay, which revealed lower MN frequencies after in vitro irradiation of samples from Tande-Tande sub-village inhabitants than those in samples from the control group (p = 0.0069, for cumulative MN frequency; p = 0.0146, for radiation-induced MN only).

Adverse Outcome Pathways and Linkages to Transcriptomic Effects Relevant to Ionizing Radiation Injury

BACKGROUND

In the past three decades, a large body of data on the effects of exposure to ionizing radiation and the ensuing changes in gene expression has been generated. These data have allowed for an understanding of molecular-level events and shown a level of consistency in response despite the vast formats and experimental procedures being used across institutions. However, clarity on how this information may inform strategies for health risk assessment needs to be explored. An approach to bridge this gap is the adverse outcome pathway (AOP) framework. AOPs represent an illustrative framework characterizing a stressor associated with a sequential set of causally linked key events (KEs) at different levels of biological organization, beginning with a molecular initiating event (MIE) and culminating in an adverse outcome (AO). Here, we demonstrate the interpretation of transcriptomic datasets in the context of the AOP framework within the field of ionizing radiation by using a lung cancer AOP (AOP 272: https://www.aopwiki.org/aops/272) as a case example.

METHODS

Through the mining of the literature, radiation exposure-related transcriptomic studies in line with AOP 272 related to lung cancer, DNA damage response, and repair were identified. The differentially expressed genes within relevant studies were collated and subjected to the pathway and network analysis using Reactome and GeneMANIA platforms. Identified pathways were filtered (p < 0.001, ≥ 3 genes) and categorized based on relevance to KEs in the AOP. Gene connectivities were identified and further grouped by gene expression-informed associated events (AEs). Relevant quantitative dose-response data were used to inform the directionality in the expression of the genes in the network across AEs.

RESULTS

Reactome analyses identified 7 high-level biological processes with multiple pathways and associated genes that mapped to potential KEs in AOP 272. The gene connectivities were further represented as a network of AEs with associated expression profiles that highlighted patterns of gene expression levels.

CONCLUSIONS

This study demonstrates the application of transcriptomics data in AOP development and provides information on potential data gaps. Although the approach is new and anticipated to evolve, it shows promise for improving the understanding of underlying mechanisms of disease progression with a long-term vision to be predictive of adverse outcomes.