Radon exposure: a major cause of lung cancer

Effect of hygroscopicity of typical powder solid wastes on their radon exhalation characteristics

The characteristics of radon exhalation in the hygroscopic properties of powder solid wastes are immensely significant for environmental safety and their transportation, storage, and landfill. This study detected the radon concentration of superfine cement and five kinds of powder solid waste: fly ash, silica fume, coal gangue, S95 mineral powder, and molybdenum tailing powder, at different hygroscopic times for 1-5 d under 95 % relative humidity. Additionally, the influence of particle size and porosity of solid waste on radon exhalation characteristics was analyzed using a laser particle size analyzer and nitrogen adsorption technology. The results show that the radon exhalation rate of the solid waste was at a low level in dry conditions. Although the presence of water due to the increased moisture absorption rate inhibited the radon exhalation to a certain extent, it was higher than that in dry conditions. The reciprocal of the moisture absorption rate had a strong linear relationship with the ratio between the radon exhalation rate after hygroscopy and radon exhalation rate from dry materials. The pore structure has a significant effect on the exhalation rate of radon, and the macropores inhibits the exhalation rate of radon. The results of this study have guiding significance for the reuse of solid waste and the prevention of radiation risk of radon exhalation during transportation.

Radon Exhalation Rate: A Metrological Approach for Radiation Protection

Radon, a radioactive inert gas that comes from the decay of naturally occurring radioactive species, poses a substantial health risk due to its involvement in lung cancer carcinogenesis. This work proposes a metrological approach for determining radon exhalation rates from diverse building materials. This methodology employs an electrostatic collection chamber for alpha spectrometry of radon isotopic decay products. Experimental evaluations were conducted particularly focusing on volcanic gray tuff from Sant'Agata de' Goti (Campania region, Italy), a material commonly utilized in construction, to assess radon exhalation rates. The study aligns with Legislative Decree 101/2020, a transposition of European Directive 59/2013/Euratom, highlighting the need to identify materials with a high risk of radon exhalation. Moreover, this work supports the goals of the Italian National Radon Action Plan related to the aforementioned decree, aiming to develop methodologies for estimating radon exhalation rates from building materials and improving radioprotection practices.

Radon and lung cancer: Current status and future prospects

Beyond tobacco smoking, radon takes its place as the second most significant contributor to lung cancer, excluding hereditary and other biologically related factors. Radon and its byproducts play a pivotal role in exposing humans to elevated levels of natural radiation. Approximately 10-20 % of lung cancer cases worldwide can be attributed to radon exposure, leading to between 3 % and 20 % of all lung cancer-related deaths. Nevertheless, a knowledge gap persists regarding the association between radon and lung cancer, impeding radon risk reduction initiatives globally. This review presents a comprehensive overview of the current state of research in epidemiology, cell biology, dosimetry, and risk modeling concerning radon exposure and its relevance to lung cancer. It also delves into methods for measuring radon concentrations, monitoring radon risk zones, and identifying priorities for future research.

Radon Exposure Assessment in Occupational and Environmental Settings: An Overview of Instruments and Methods

Radon is a naturally occurring noble radioactive gas that poses significant health risks, particularly lung cancer, due to its colorless, odorless, and tasteless nature, which makes detection challenging without formal testing. It is found in soil, rock, and water, and it infiltrates indoor environments, necessitating regulatory standards and guidelines from organizations such as the Environmental Protection Agency, the World Health Organization, and the Occupational Health and Safety Agency to mitigate exposure. In this paper, we present various methods and instruments for radon assessment in occupational and environmental settings. Discussion on long- and short-term monitoring, including grab sampling, radon dosimetry, and continuous real-time monitoring, is provided. The comparative analysis of detection techniques-active versus passive-is highlighted from real-time data and long-term exposure assessment, including advances in sensor technology, data processing, and public awareness, to improve radon exposure evaluation techniques.

Epidemiological trend of lung cancer burden caused by residential radon exposure in China from 1990 to 2019

OBJECTIVE

This study employed time series data to assess long-term changes in the burden of lung cancer (LC) caused by residential radon exposure, an important environmental risk factor, so as to develop evidence-based strategies for future public health management.

METHODS

Based on the open data from the Global Burden of Disease (GBD 2019) database, we conducted an analysis of the residential radon exposure-caused LC mortality, disability-adjusted life years (DALYs), and corresponding crude rates and age-standardized rates (ASRs) for various age groups. We employed the employed age-period-cohort (APC) model to investigate the age, period, and cohort effects of the data, allowing us to discern the trends in LC disease burden attributable to radon exposure in residential settings over time.

RESULTS

From 1990 to 2019, age-standardized mortality rates (ASMR) and age-standardized DALYs rates of LC caused by residential radon exposure in China demonstrated an overall increasing trend, with males higher than females. The CMR and crude DALYs rate for males were higher than those for females across all age groups. The APC analysis revealed that the local drift of LC death and DALYs rates in males and females showed a decreasing trend before 60 and an increasing trend after 60.

CONCLUSION

The persistent presence of residential radon exposure as a crucial risk factor for LC underscores the need for public health authorities and policymakers to take more proactive measures to reduce radon exposure. Particularly, attention should be paid on the elderly population and male patients.

Multiple signal amplification strategy induced by biomarkers of lung cancer: A self-powered biosensing platform adapted for smartphones

Lung cancer is a major malignant cancer with low survival rates, and early diagnosis is crucial for effective treatment. Herein, a biosensing platform that is self-powered derived from a capacitor-coupled EBFC has been developed for ultra-sensitive real-time identification of microRNA-21 (miRNA-21) with the assistance of a mobile phone. The flexible substrate of the platform is prepared on a carbon paper modified with graphdiyne and gold nanoparticles. The biosensor employs DNAzyme-mediated dual strand displacement amplification, which enhances the signal output intensity of the EBFC and improves selectivity. The coupling of the capacitor with the EBFC significantly amplifies the sensing signal, causing a 10.6-fold surge in current respond and further improving the sensitivity of the sensing platform. The established detection approach demonstrates a linear relationship varied from 0.0001 to 10,000 pM, with a sensitivity down to 32.3 aM as the minimum detectable limit, which has been effectively utilized for detecting miRNA-21 in practical samples. This sensing system provides strong support for the construction of portable detection devices, and the strategy of the platform construction provides an effective method for ultra-sensitive and accurate detection of miRNA, holding great potential in clinical diagnosis, prognosis evaluation, and drug screening for cancer.

Causal relationships between mitochondrial proteins and different pathological types of lung cancer: a bidirectional mendelian randomization study

An increasing number of studies point to an association between mitochondrial proteins (MPs) and lung cancer (LC). However, the causal relationship between MPs and LC remains unclear. Consequently, our study employed a bidirectional Mendelian randomization (MR) analysis to explore the causal association between MPs and different pathological types of LC. A two-sample MR study was performed using the genome-wide association study (GWAS) data publicly available. We applied the primary inverse variance weighted (IVW) method along with additional MR methods to validate the causality between MPs and different pathological types of LC. To ensure the robustness of our findings, sensitivity analyses were employed. Moreover, we performed a bi-directional MR analysis to determine the direction of the causal association. We identified a total of seven MPs had significant causal relationships on overall LC, lung squamous cell carcinoma (LUSC), and small cell lung carcinoma (SCLC). We found two MPs had significant associations with overall LC, four MPs had significant associations with LUSC, and four MPs had significant associations with SCLC. Additionally, an MP was found to have a nominal relationship with LUSC. Moreover, no causality was found between MPs and lung adenocarcinoma (LUAD). Bidirectional MR showed no reverse effect between identified MPs and different pathological types of LC. In general, our findings of this MR study suggest causal associations of specific MPs with overall LC, LUSC, and SCLC. However, no such causality was found in LUAD.

Study on the influence of water content on radon emission from loess

Radon, an environmental pollutant gas, occurs naturally in soil. Although loess, an essential building material in northwest China, is commonly used, research on radon emissions from loess remains limited. This study aims to address this gap by conducting both field and laboratory experiments to examine the impact of water content on radon emission from loess. The findings reveal that the radon emission rate from loess follows a non-linear pattern with respect to water content, initially increasing and then decreasing. The highest cumulative radon concentration occurs at 14% moisture content, with an emission rate of 0.44 Bq·m-3/g·h. Moreover, high water content significantly inhibits radon emission from loess. These results have practical implications for ensuring "radon safety" in loess buildings.

Unveiling the potential of proteomic and genetic signatures for precision therapeutics in lung cancer management

Lung cancer's enduring global significance necessitates ongoing advancements in diagnostics and therapeutics. Recent spotlight on proteomic and genetic biomarker research offers a promising avenue for understanding lung cancer biology and guiding treatments. This review elucidates genetic and proteomic lung cancer biomarker progress and their treatment implications. Technological strides in mass spectrometry-based proteomics and next-generation sequencing enable pinpointing of genetic abnormalities and abnormal protein expressions, furnishing vital data for precise diagnosis, patient classification, and customized treatments. Biomarker-driven personalized medicine yields substantial treatment improvements, elevating survival rates and minimizing adverse effects. Integrating omics data (genomics, proteomics, etc.) enhances understanding of lung cancer's intricate biological milieu, identifying novel treatment targets and biomarkers, fostering precision medicine. Liquid biopsies, non-invasive tools for real-time treatment monitoring and early resistance detection, gain popularity, promising enhanced management and personalized therapy. Despite advancements, biomarker repeatability and validation challenges persist, necessitating interdisciplinary efforts and large-scale clinical trials. Integrating artificial intelligence and machine learning aids analyzing vast omics datasets and predicting treatment responses. Single-cell omics reveal cellular connections and intratumoral heterogeneity, valuable for combination treatments. Biomarkers enable accurate diagnosis, tailored medicines, and treatment response tracking, significantly impacting personalized lung cancer care. This approach spurs patient-centered trials, empowering active patient engagement. Lung cancer proteomic and genetic biomarkers illuminate disease biology and treatment prospects. Progressing towards individualized efficient therapies is imminent, alleviating lung cancer's burden through ongoing research, omics integration, and technological strides.

Radon exposure: a major cause of lung cancer in nonsmokers

Exposure to radon can impact human health. This is a nonsystematic review of articles written in English, Spanish, French, or Portuguese published in the last decade (2013-2023), using databases such as PubMed, Google Scholar, EMBASE, and SciELO. Search terms selected were radon, human health, respiratory diseases, children, and adults. After analyzing the titles and abstracts, the researchers initially identified 47 studies, which were subsequently reduced to 40 after excluding reviews, dissertations, theses, and case-control studies. The studies have shown that enclosed environments such as residences and workplaces have higher levels of radon than those outdoors. Moreover, radon is one of the leading causes of lung cancer, especially in nonsmokers. An association between exposure to radon and development of other lung diseases, such as asthma and COPD, was also observed. It is crucial to increase public awareness and implement governmental control measures to reduce radon exposure. It is essential to quantify radon levels in all types of buildings and train professionals to conduct such measurements according to proven efficacy standards. Health care professionals should also be informed about this threat and receive adequate training to deal with the effects of radon on human health.

Ion channels in lung cancer: biological and clinical relevance

Despite improvements in treatment, lung cancer is still a major health problem worldwide. Among lung cancer subtypes, the most frequent is represented by adenocarcinoma (belonging to the Non-Small Cell Lung Cancer class) although the most challenging and harder to treat is represented by Small Cell Lung Cancer, that occurs at lower frequency but has the worst prognosis. For these reasons, the standard of care for these patients is represented by a combination of surgery, radiation therapy and chemotherapy. In this view, searching for novel biomarkers that might help both in diagnosis and therapy is mandatory. In the last 30 years it was demonstrated that different families of ion channels are overexpressed in both lung cancer cell lines and primary tumours. The altered ion channel profile may be advantageous for diagnostic and therapeutic purposes since most of them are localised on the plasma membrane thus their detection is quite easy, as well as their block with specific drugs and antibodies. This review focuses on ion channels (Potassium, Sodium, Calcium, Chloride, Anion and Nicotinic Acetylcholine receptors) in lung cancer (both Non-Small Cell Lung Cancer and Small Cell Lung Cancer) and recapitulate the up-to-date knowledge about their role and clinical relevance for a potential use in the clinical setting, for lung cancer diagnosis and therapy.

Evolutionary game analysis of indoor radon mitigation with local government involvement

Radon is the second leading risk factor for lung cancer after smoking. As a public policy, radon mitigation not only involves radon control technology or its cost-benefit analysis, but also includes the decision-making process of local governments. In this study, the evolutionary game theory was used to analyse the interaction between local governments and residents based on the subsidy of the central government. Considering the practical data in China, factors influencing the behaviour of local governments and residents were discussed using numerical simulations. The results indicated that radon mitigation is a fully government-promoted action; thus, its implementation largely depends on the subsidy of the central government and the share of radon control costs borne by the local government. The financial burden for both local governments and residents is a more important determinant than long-term health effects. The relatively poor local economic situation could limit the implementation of radon control. There would be a public policy paradox wherein cities or regions with higher radon risk would have lower willingness for radon control, mainly due to the significantly higher costs of radon control. This work provides reference data for decision-making to implement radon control and is expected to offer some suggestions for local governments.

Integrative analysis of GWAS and transcriptomics data reveal key genes for non-small lung cancer

Lung cancer is one of the world's most common and deadly cancers. The two main types of lung cancer are non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC). More than 85% of lung cancers are NSCLC. Genetic factors play a significant role in the risk of NSCLC. Growing studies focus on studying risk factors at the molecular level. The aim of the study is to build a pipeline to integrate Genome-wide association analysis (GWAS) and transcriptomics data with machine learning to effectively identify genetic risk factors of NSCLC. GWAS datasets and GWAS summary data were downloaded from GWAS catalog, which include lung carcinoma genetic variants among the European population. Then, with the GWAS summary, data functional analysis of significant SNPs was performed using a webserver called FUMAGWAS. The transcriptomics data of NSCLC and non-NSCLC people were used to build a machine learning model to identify the key genes that help predict the NSCLC. The top up-regulation and down-regulation genes were identified by the BART cancer webserver, and the mechanistic roles of the genes were validated by literature review. By performing integrative analysis of GWAS and transcriptomics analysis using machine learning, we identified multiple SNPs and genes that related to NSCLC. The computational pipeline may facilitate the biomarker discovery for NSCLC and other diseases.

Fabrication of Ni−MOF−74@PA−PEI for Radon Removal under Ambient Conditions

Radon is one of the 19 carcinogenic substances identified by the World Health Organization, posing a significant threat to human health and the environment. Properly removing radon under ambient conditions remains challenging. Compared with traditional radon−adsorbent materials such as activated carbon and zeolite, metal–organic framework (MOF) materials provide a high specific surface area, rich structure, and designability. However, MOF material powders demonstrate complications regarding practical use, such as easy accumulation, deactivation, and difficult recovery. Ni−MOF−74 was in situ grown on a porous polyacrylic acid (PA) spherical substrate via stepwise negative pressure impregnation. Ni−MOF−74 was structured as one−dimensional rod−shaped crystals (200–300 nm) in large−pore PA microspheres, whose porous structure increased the diffusion of radon gas. The radon adsorption coefficient of a Ni−MOF−74@PA−polyethyleneimine composite material was 0.49 L/g (293 K, relative humidity of 20%, air carrier). In comparison with pristine Ni−MOF−74 powder, our composite material exhibited enhanced adsorption and longer penetration time. The radon adsorption coefficient of the composite material was found to be from one to two orders of magnitude higher than that of zeolite and silica gel. The proposed material can be used for radon adsorption while overcoming the formation problem of MOF powders. Our preparation approach can provide a reference for the composite process of MOFs and polymers.

Evolution of pore structure and radon exhalation characterization of porous media grouting

Cracks and pores are considered as major sources of radon. Cement is widely used as a grouting material in mines, tunnels, and other projects for reinforcement, seepage prevention, and water plugging. This paper mainly experimentally studied the correlation between the radon exhalation rate of the porous medium after grouting and the sand grain diameter, grouting pressure, and slurry water-cement ratio. The pore characteristics of the samples before and after grouting were also studied based on the low field nuclear magnetic resonance (LF-NMR). The findings of the study show that the porosity of samples increases after the superfine cement solidification with an increase in the water-cement ratio, and the radon exhalation rate is proportional to porosity, the radon exhalation rate increases by 0.0005 Bq·m-2/s at W/C = 1.5, and by 0.0017 Bq·m^-2/s at W/C = 2 increases, in comparison to the W/C = 1.The radon exhalation rate of porous media gradually increased after grouting in response to an increase in grouting pressure and the water-cement ratio. The radon exhalation rate of the porous media with larger pores was relatively higher and exhibited a positive correlation with the volume of micropores in porous media，the correlations of coarse, medium and fine media are 0.815, 0.826, and 0.859. The change in pore structure has an influence on radon exhalation. Although grouting changes the pore structure and reduces the connectivity between internal pores, the micropores generated after cement slurry solidification improves the radon exhalation rate by providing new channels, When the water-cement ratio is 1.5 and the grouting pressure is 1.5 MPa, the radon exhalation rate of porous media is 0.00273 Bq·m^-2/s. The research results serve as a reference basis for the evaluation of the impact of rock masses on grouting reinforcement and pore sealing.

Indoor Radon Concentration Levels in Healthcare Settings: The Results of an Environmental Monitoring in a Large Italian University Hospital

The aim of the study is to determine the radon concentrations in the University Hospital of Bari, Apulia Region, Southern Italy. The monitoring took place from 2017 to 2018 for a total of 402 days and included 3492 premises. Radon environmental sampling was performed with passive dosimeters of the CR-39 type. The highest mean concentration was found in basement rooms (118.9 Bq/m³), followed by ground-floor rooms (88.2 Bq/m³), first-floor rooms (78.1 Bq/m³), second-floor rooms (66.7 Bq/m³), and third-floor rooms (68.9 Bq/m³). An average radon concentration lower than the WHO recommended level of 100 Bq/m³ was detected in 73.5% of monitored environments, while only 0.9% exceeded the reference level of 300 Bq/m³ set by the national law (Legislative Decree 101/2020). The frequency of environments in which radon concentrations exceed 300 Bq/m³ is significantly higher in the basement (p-value < 0.001). As for a previous preliminary investigation in the same hospital conducted on a much smaller number of premises (n = 401), most of the monitored environments had radon concentrations lower than the reference levels set by the new national law, and the risk to the healthcare workers' health derived from occupational exposure to radon could be considered acceptable.

Risk-Reducing Measures for Cancer Prevention

Cancer, or malignancy, continues to be one of the most serious health problems in the world, leading to death and disability. Unlike in previous years, where new cases of cancer were predominant in developed nations, the number of cases of cancer and the resultant deaths are increasing in low- and middle-income countries. This is partially attributable to the current trend of adopting a Western lifestyle, substantial urbanization, and the rise in infections, such as the human papillomavirus (HPV) and hepatitis B virus (HBV), which together account for over 30% of cancer cases in underdeveloped and developing nations. The deleterious impact of cancer, as cases multiply worldwide, is multi-dimensional. Cancer exerts serious physical, psychological, and monetary burdens, not only on cancer patients but also on their family members, close friends, health care systems, and society at large. Importantly, over half of all cancer types can be prevented globally by mitigating the risk and causative factors as well as prompt adherence to scientifically recommended prevention measures. This review provides various scientifically based and people-centered strategies that every individual could adopt to reduce their risk of developing cancer in the future. It is recommended that, for these cancer prevention strategies to be effective, there should be a strong political will from the governments of individual countries to enact specific laws and implement policies that will significantly reduce sedentary lifestyles and unhealthy eating among the general public. Likewise, HPV and HBV vaccines, as well as cancer screenings, should be made available, affordable, and accessible on a timely basis for those who are eligible to take them. Finally, intensified campaigns and numerous informative and educational programs that promote cancer prevention should be initiated globally.

Can Low-Level Ionizing Radiation Do Us Any Harm?

The current system of radiological protection relies on the linear no-threshold (LNT) hypothesis of cancer risk due to humans being exposed to ionizing radiation (IR). Under this tenet, effects of low doses (i.e. of those not exceeding 100 mGy or 0.1 mGy/min. of X- or γ-rays for acute and chronic exposures, respectively) are evaluated by downward linear extrapolation from regions of higher doses and dose rates where harmful effects are actually observed. However, evidence accumulated over many years clearly indicates that exposure of humans to low doses of radiation does not cause any harm and often promotes health. In this review, we discuss results of some epidemiological analyses, clinical trials and controlled experimental animal studies. Epidemiological data indicate the presence of a threshold and departure from linearity at the lowest dose ranges. Experimental studies clearly demonstrate the qualitative difference between biological mechanisms and effects at low and at higher doses of IR. We also discuss the genesis and the likely reasons for the persistence of the LNT tenet, despite its scientific implausibility and deleterious social consequences. It is high time to replace the LNT paradigm by a scientifically based dose-effect relationship where realistic quantitative hormetic or threshold models are exploited.

A study on the differences in radon exhalation of different lithologies at various depths and the factors influencing its distribution in northern Shaanxi, China

The inhalation of a high concentration of radon gas increases the risk of cancer. Therefore, it is of utmost necessity to pay due attention to the problem of environmental radon pollution. The high radioactivity above the coal slab causes serious radon radiation contamination on the mining grounds in coal mining areas such as the northern part of China and the western part of the United States. At present, there is a lack of research on radon exhalation in different lithologies. In this study, the differences in the radon exhalation of different lithologies at various depths and their controlling factors were studied by NMR and radon measurement. The results highlighted that the radon exhalation rates in different rocks varied from 0.3 to 0.6 Bq/m²·s. The average radon exhalation rate of the soil was 0.7 Bq/m²·s, and the radon exhalation rates of different lithologies followed the pattern red clay > loess > sandstone > mudstone > coal. The radon exhalation rate increased initially, followed by a decrease, and the radon exhalation rate was the highest at the boundary between the soil and rock layers. The radon exhalation rates of different lithologies have a strong correlation with the small pores (<0.1 μm), which govern the changes in the porous structure with depth. The results of this study are important from the perspective evaluation of environmental radon pollution.

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.

Radon and Lung Cancer: Current Trends and Future Perspectives

Simple Summary

Radon represents the main risk factor of lung cancer in non-smokers and the second one in smoking patients. In Europe, there are several radon-prone areas, but regulatory policies may vary between countries. Radon causes DNA damage and high genomic tumor instability, but its exact carcinogenesis mechanism in lung cancer remains unknown. Molecular drivers in NSCLC are more often described in non-smoker patients and a potential association between radon exposure and oncogenic-driven NSCLC has been postulated. This is an updated review on indoor radon exposure and its role in lung cancer carcinogenesis, especially focusing on its potential relation with NSCLC with driver genomic alterations. We want to contribute to rising knowledge and awareness on this still silent but preventable lung cancer risk factor.

Abstract

Lung cancer is a public health problem and the first cause of cancer death worldwide. Radon is a radioactive gas that tends to accumulate inside homes, and it is the second lung cancer risk factor after smoking, and the first one in non-smokers. In Europe, there are several radon-prone areas, and although the 2013/59 EURATOM directive is aimed to regulate indoor radon exposition, regulating measures can vary between countries. Radon emits alpha-ionizing radiation that has been linked to a wide variety of cytotoxic and genotoxic effects; however, the link between lung cancer and radon from the genomic point of view remains poorly described. Driver molecular alterations have been recently identified in non-small lung cancer (NSCLC), such as somatic mutations (EGFR, BRAF, HER2, MET) or chromosomal rearrangements (ALK, ROS1, RET, NTRK), mainly in the non-smoking population, where no risk factor has been identified yet. An association between radon exposure and oncogenic NSCLC in non-smokers has been hypothesised. This paper provides a practical, concise and updated review on the implications of indoor radon in lung cancer carcinogenesis, and especially of its potential relation with NSCLC with driver genomic alterations.

Risk assessment and prediction for lung cancer among Hong Kong Chinese men

Objective

Most of the previous risk prediction models for lung cancer were developed from smokers, with discriminatory power ranging from 0.57 to 0.72. We constructed an individual risk prediction model for lung cancer among the male general population of Hong Kong.

Methods

Epidemiological data of 1,069 histology confirmed male lung cancer cases and 1,208 community controls were included in this analysis. Residential radon exposure was retrospectively reconstructed based on individual lifetime residential information. Multivariable logistic regression with repeated cross-validation method was used to select optimal risk predictors for each prediction model for different smoking strata. Individual absolute risk for lung cancer was estimated by Gail model. Receiver-operator characteristic curves, area under the curve (AUC) and confusion matrix were evaluated to demonstrate the model performance and ability to differentiate cases from non-cases.

Results

Smoking and smoking cessation, education, lung disease history, family history of cancer, residential radon exposure, dietary habits, carcinogens exposure, mask use and dust control in workplace were selected as the risk predictors for lung cancer. The AUC of estimated absolute risk for all lung cancers was 0.735 (95% CI: 0.714–0.756). Using 2.83% as the cutoff point of absolute risk, the predictive accuracy, positive predictive value and negative predictive value were 0.715, 0.818 and 0.674, respectively.

Conclusion

We developed a risk prediction model with moderate discrimination for lung cancer among Hong Kong males. External validation in other populations is warranted for this model in future studies.

The level of free-circulating mtDNA in patients with radon-induced lung cancer

OBJECTIVE

According to the World Health Organization, radon is the second leading cause of lung cancer after smoking. Cell free circulating mitochondrial DNA (cf mtDNA) have been used not only as a biomarker of carcinogenesis but also as a biomarker of exposure to radiation, but nothing is known about changes in the level of cf mtDNA following radon exposure. Therefore, the purpose of this study was to estimate the cf mtDNA copy number as a biomarker of the response to radon exposure in lung cancer pathogenesis.

METHODS

207 subjects were examined including 41 radon-exposed lung cancer patients, 40 lung cancer patients without radon exposure and 126 healthy controls exposed/not exposed to high level of radon. Total cell free circulating DNA from blood samples was extracted and used to detect cell free circulating mitochondrial DNA copy number by quantitative real-time polymerase chain reaction (qRT-PCR).

RESULTS

Our data indicate that the level of cf mtDNA in the radon-induced lung cancer patients was significantly higher than that of the other study participants. There was a significant difference in the level of cf mtDNA in the blood plasma of healthy volunteers exposed and not exposed to high doses of radon. Moreover, in healthy volunteers living in areas with high radon levels, the mtDNA copy number was higher than that in patients with lung cancer who were not exposed to high doses of radon.

CONCLUSION

Our study provides evidence for a possible role of cf mtDNA as a promising biomarker of lung cancer induced by exposure to high dose of radon.

Air Pollution Effects to the Subtype and Severity of Lung Cancers

The correlation between lung cancer incidence and air pollution has been established in previous research, but the other detail impact of air pollution to lung cancer is still under investigation. This study aimed to explore if air pollution affected the subtype and staging of lung cancer. At the same time, we investigated the effect of individual pollutant to subtypes and staging. Single center data were extracted from January 1, 2020 to June 30, 2020 using the search engine in the radiology reporting system of Shuang-Ho Hospital, New Taipei City, Taiwan. There were 169 patients finally included for analysis. The nationwide statistics data of lung cancer were extracted from the Taiwan Cancer Registry. The air quality data were extracted from the Taiwan air quality monitoring network. Comparison of the single center lung cancer characteristics with nationwide data was made using the chi-square test. Comparison of the air quality of the living space of the included cases with the average quality in Taiwan in 2020 was made using the Z-test. The result shows there was significant difference of cancer subtype and staging between the regional data and the nationwide data. The regional data demonstrated a tendency of higher incidence of adenocarcinoma and advanced stage disease. As for air quality, there was no significant difference. The regional PM10 level presented generally lower levels in regional data as compared to Taiwan in 2020 with near statistically significant P-value (0.052); the regional NO₂ level presented generally higher levels in regional data as compared to Taiwan in 2020 with near statistically significant P-value (0.060). The results indicate that air pollution might be related to increase in adenocarcinoma ratio and advanced stage of lung cancer at initial presentation. The NO₂ was probably the leading pollutant causing this trend.

Polymorphisms in DNA Repair and Xenobiotic Biotransformation Enzyme Genes and Lung Cancer Risk in Coal Mine Workers

Background: Currently coal mining employs over 7 million miners globally. This occupational setting is associated with exposure to dust particles, heavy metals, polycyclic aromatic hydrocarbons and radioactive radon, significantly increasing the risk of lung cancer (LC). The susceptibility for LC is modified by genetic variations in xenobiotic detoxification and DNA repair capacity. The aim of this study was to investigate the association between GSTM1 (deletion), APEX1 (rs1130409), XPD (rs13181) and NBS1 (rs1805794) gene polymorphisms and LC risk in patients who worked in coal mines. Methods: The study included 639 residents of the coal region of Western Siberia (Kemerovo region, Russia): 395 underground miners and 244 healthy men who do not work in industrial enterprises. Genotyping was performed using real-time and allele-specific PCR. Results: The results show that polymorphisms of APEX1 (recessive model: OR_adj = 1.87; CI 95%: 1.01–3.48) and XPD (log additive model: OR_adj = 2.25; CI 95%: 1.59–3.19) genes were associated with increased LC risk. GSTM1 large deletion l was linked with decreased risk of LC formation (OR_adj = 0.59, CI 95%: 0.36–0.98). The multifactor dimensionality reduction method for 3-loci model of gene–gene interactions showed that the GSTM1 (large deletion)—APEX1 (rs1130409)—XPD (rs13181) model was related with a risk of LC development. Conclusions: The results of this study highlight an association between gene polymorphism combinations and LC risks in coal mine workers.

COVID-19 and the Additional Radiological Risk during the Lockdown Period in the Province of Naples City (South Italy)

The lockdown restrictions, as a first solution to contain the spread of the COVID-19 pandemic, have affected everyone's life and habits, including the time spent at home. The latter factor has drawn attention to indoor air quality and the impact on human health, particularly for chemical pollutants. This study investigated how the increasing time indoor influenced exposure to natural radioactive substances, such as radon gas. To calculate the radiological risk, we considered the most consolidated indices used for radiation protection: annual effective dose, excess lifetime cancer risk, and the lung cancer case. Furthermore, two different exposure times were considered: pre-lockdown and post-lockdown. The lockdown increased the indoor exposure time by 4% and, consequently, the radiological risk factors by 9%. Furthermore, the reference value of 300 Bq/m3, considered acceptable for human radiation protection, may need to be lowered further in the case of conditions similar to those of the lockdown period.

Updated fraction of cancer attributable to lifestyle and environmental factors in Denmark in 2018

Environmental exposures and avoidable risk factors account for a large proportion of cancer burden. Exposures and lifestyle vary over time and between populations, which calls for updated and population-specific quantification of how various avoidable risk factors influence cancer risk to plan and design rational and targeted prevention initiatives. The study considered 12 risk-factor groups categorized as class I carcinogens by IARC/WCRF. Exposure data was derived from national studies and surveys and were linked to cancer incidence in 2018 based on the nationwide Danish Cancer Registry. In 2018, 23,078 men and 21,196 women were diagnosed with cancer excluding non-melanoma skin cancer, in Denmark. Of these, 14,235 (32.2%) were estimated to be attributable to avoidable class I carcinogens. Tobacco smoking accounted for 14.6% of total cancers, followed by UV-radiation that accounted for 5.8%. Based on exposure data from 2008, one-third of the cancers in Denmark in 2018 are estimated to be caused by class I carcinogens with tobacco use being the main contributor followed by UV-radiation. Our results should be integrated with public health policies to effectively increase awareness and promote strategies to decrease risk factor exposures at population level.

Health-Related and Behavioral Factors Associated With Lung Cancer Stage at Diagnosis: Observations From Alberta's Tomorrow Project

Background

Lung cancer is the leading cause of cancer death in Canada, with stage at diagnosis among the top predictors of lung cancer survival. Identifying factors associated with stage at diagnosis can help reduce lung cancer morbidity and mortality. This study used data from a prospective cohort study of adults living in Alberta, Canada to examine factors associated with lung cancer stage at diagnosis.

Methods

This cohort study used data from adults aged 35–69 years enrolled in Alberta’s Tomorrow Project. Partial Proportional Odds models were used to examine associations between sociodemographic characteristics and health-related factors and subsequent lung cancer stage at diagnosis.

Results

A total of 221 participants (88 males and 133 females) developed lung cancer over the study period. Nearly half (48.0%) of lung cancers were diagnosed at a late stage (stage IV), whereas 30.8 % and 21.3% were diagnosed at stage I/II and III, respectively. History of sunburn in the past year was protective against late-stage lung cancer diagnosis (odds ratio (OR) .40, P=.005). In males, a higher number of lifetime prostate specific antigen tests was associated with reduced odds of late-stage lung cancer diagnosis (odds ratio .66, P=.02). Total recreational physical activity was associated with increased odds of late-stage lung cancer diagnosis (OR 1.08, P=.01).

Discussion

Lung cancer stage at diagnosis remains a crucial determinant of prognosis. This study identified important factors associated with lung cancer stage at diagnosis. Study findings can inform targeted cancer prevention initiatives towards improving early detection of lung cancer and lung cancer survival.

Burden of lung cancer attributable to household air pollution in the Chinese female population: trend analysis from 1990 to 2019 and future predictions

This study analyzes the long-term trend of the burden of lung cancer attributable to household air pollution in the Chinese female population, from 1990 to 2019, and make predictions for the next decade. Based the data from the 2019 Global Burden of Diseases (GBD 2019), the joinpoint regression model was used to reflect the temporal trend of the burden of lung cancer attributable to household air pollution, and an autoregressive integrated moving average (ARIMA) model was used to predict the burden of disease over the next decade. From 1990 to 2019, the age-standardized mortality and disability-adjusted life years (DALYs) rates of the Chinese female population were higher than the global rates, and the gap due to residential radon increased over time. The burden of lung cancer attributable to solid fuels has shown a significant downward trend while that due to residential radon has increased slightly overall, but remains lower than the former. The burden of lung cancer increased with age, and the peak age of DALYs rates changed from 70 < 75 years in 1990 to 75 < 80 years in 2019. The model predicted that the burden of lung cancer attributable to solid fuels will gradually decrease over the next decade, whereas the burden of lung cancer due to residential radon will gradually increase and surpass the burden due to solid fuels in 2023. Residential radon will become a more important factor of household air pollution than solid fuels in the next decade for the Chinese female population. Future interventions targeted at household air pollution are needed to reduce the burden of lung cancer.

Easy Breathing: A Review of the Impact of Air Quality on Pediatric Health Outcomes

Preventable environmental factors such as exposure to poor air quality are predicted to affect 23% of all global deaths. Although there have been efforts to reduce air pollution through federal guidelines for vehicle and industrial emissions, the air in the United States remains far from clean. Children and pregnant women have been identified as high-risk populations who are particularly susceptible to the negative effects of poor air quality. This paper provides an overview of health concerns related to poor air quality, pediatric considerations from pregnancy through childhood, the importance of increased awareness of air quality assessment and prevention in patient encounters, and current advocacy efforts and legislation.

WINDCATCHER VENTILATION COMPUTATION AND INDOOR 222RN CONCENTRATION IN TRADITIONAL ADOBE HOUSES

Radon-based radiation is a significant issue that can affect resident health as a contributory source of natural radiation from soil construction materials. This study investigates the effect of windcatchers on radon activity concentrations and radon exhalation rate from the soil surface in traditional adobe houses of Yazd, Iran. Radon concentrations were measured by passive detectors in 16 adobe houses. Computational fluid dynamics simulations were performed for different wind speed to calculate ventilation rate. The concentrations of 222Rn were in the ranges of 22 ± 1-117 ± 8 Bq m-3 with an average value of 50 ± 3 Bq m-3. The radon exhalation rates values were in the range of 8.3 ± 0.1 to 47.2 ± 0.5 Bq m-2 h-1. Radon concentration results in only one dwelling site were higher than the level recommended by the World Health Organization. The annual radon inhalation dose was found in seven sites higher than the worldwide average.

Incidence trends and risk factors of lung cancer in never smokers: Pooled analyses of seven cohorts

The trends in incidence of lung cancer in never smokers are unclear as well as the significance of risk factors. We studied time trends in the incidence and risk factors of lung cancer in never smokers in Finland in a large, pooled cohort. We pooled data from seven Finnish health cohorts from the period between 1972 and 2015 with 106 193 never smokers. The harmonised risk factors included education, alcohol consumption, physical activity, height and BMI. We retrieved incident lung cancers from the nation-wide Finnish Cancer Registry. We estimated average annual percent change (AAPC) and the effects of risk factors on cause-specific hazard ratios (HRs) of lung cancer using Poisson regression. We detected 47 lung cancers in never smoking men (n = 31 859) and 155 in never smoking women (n = 74 334). The AAPC of lung cancer incidence was -3.30% (95% confidence interval [CI]: -5.68% to -0.88%, P = .009) in never smoking men and 0.00% (95% CI: -1.57% to 1.60%, P = .996) in never smoking women. Of the five studied risk factors only greater height in women had a statistically significant increased risk of lung cancer (multivariate HR = 1.84, 95%CI: 1.08 to 3.12). It is plausible that tobacco control measures focused on working places have reduced passive smoking among men more than among women, which could explain the declining trend in lung cancer incidence in never smoker men but not in never smoker women. As tobacco control measures have not been targeted to domestic environments, it is likely that women's exposure to passive smoking has continued longer.

Investigation of Radon Sources, Health Hazard and Risks assessment for children using analytical and geospatial techniques in District Bannu (Pakistan)

PURPOSE

Radon (Rn) is a radioactive, odorless, and colorless gas which has a half-life of 3.83 days. One of the main sources of Rn which is directly consumed by the population is Groundwater (Tube well, Bore well, Hand pump). Rn gas is found naturally in rock, soil and water and can be considered as main health risk factor in terms of lung cancer, stomach diseases, leukemia and childhood cancer. The objective of this study was to determine the concentration of Rn in the drinking water sources, appraisal of health risk for children in District Bannu, Pakistan.

MATERIAL AND METHOD

Total of 98 drinking water samples were analyzed by using RAD-7 detector. The experimental data was statistically analyzed by using Pearson's test. The experimental and epidemiological data of the study area are shown on map using ArcGIS version 10.5.

RESULTS

The analytical results show that Rn in drinking water was found varying from 10.1 Bq/l to 53.1 Bq/l with the average highest and lowest depth of 60 ft to 550 ft respectively. Pearson's test was used to show the concentration of Rn verses the depth of the water sources so +1 positive linear correlation was observed among the depth of water sources and the concentration of Rn. Out of 98 drinking water samples 40 sample were above the maximum contaminant level of 11.1 Bq/l (MCL) set by WHO, 2002. The effective doses (AED and DE_ing) for children ranges from 0.00001 to 3.792 mSv/y which exceeds the Permissible Exposure Limit (PEL) of Rn (0.1mSv/y) in 30 drinking water samples . On the basis of analytical results Rn high concentration areas are shown on the map using IDW model of interpolation and health risks were shown in areas where Rn content was above the maximum contaminant level. High correlations of diseases related to Rn were observed amongst the residence of the study area. Gastrointestinal diseases, brain tumor, lung cancer and kidney diseases were observed among the children of the study area.

CONCLUSION

From the overall analysis it was observed that high Rn concentration in drinking water may cause substantial health damage in children after long term exposure.

Survey of Radon Concentrations in the University of Granada in Southern Spain

The objective of this pilot study was to gather and analyze data on radon concentrations in workplaces in three buildings of Granada University (Southern Spain) constructed in different centuries. All measurements were made at basement or ground floor level under normal use conditions except for one space (mineral store), in which measurements were compared between the door closed and open. Measurements were conducted during different time periods between October 2013 and March 2019 with a Radon-Scout PLUS portable Radonmonitor. The duration of continuous recordings at different sites ranged between 42 and 1104 h. Mean accumulated radon concentrations ranged between 12 and 95 Bq/m³, below the maximal level of 300 Bq/m³ set by the World Health Organization (WHO). Relatively high values were recorded in the oldest building (15th century), which was also poorly ventilated. Ventilation appeared to be an important factor in reducing radon levels, especially in areas less exposed to radon, such as Southern Spain.

The P2X7 purinergic receptor: a potential therapeutic target for lung cancer

PURPOSE

Purinergic P2X7 receptor (P2X7R) is a gated ion channel for which adenosine triphosphate (ATP) is a ligand. Activated P2X7R is widely expressed in a variety of immune cells and tissues and is involved in a variety of physiological and pathological processes. Studies have confirmed that P2X7R is involved in the regulation of tumor cell growth, stimulating cell proliferation or inducing apoptosis. Recent studies have found that P2X7R is abnormally expressed in lung cancer and is closely related to the carcinogenesis and development of lung cancer. In this paper, we comprehensively describe the structure, function, and genetic polymorphisms of P2X7R. In particular, the role and therapeutic potential of P2X7R in lung cancer are discussed to provide new targets and new strategies for the treatment and prognosis of clinical lung cancer.

METHODS

The relevant literature on P2X7R and lung cancer from PubMed databases is reviewed in this article.

RESULTS

P2X7R regulates the function of lung cancer cells by activating multiple intracellular signaling pathways (such as the JNK, Rho, HMGB1 and EMT pathways), thereby affecting cell survival, growth, invasion, and metastasis and patient prognosis. Targeting P2X7R with inhibitors effectively suppresses the growth and metastasis of lung cancer cells.

CONCLUSION

In summary, P2X7R is expected to become a potential target for the treatment of lung cancer, and more clinical research is needed in the future to explore the effectiveness of P2X7R antagonists as treatments.

Ionizing Radiation as a Source of Oxidative Stress-The Protective Role of Melatonin and Vitamin D

Ionizing radiation (IR) has found widespread application in modern medicine, including medical imaging and radiotherapy. As a result, both patients and healthcare professionals are exposed to various IR doses. To minimize the negative side effects of radiation associated with oxidative imbalance, antioxidant therapy has been considered. In this review, studies on the effects of melatonin and vitamin D on radiation-induced oxidative stress are discussed. According to the research data, both substances meet the conditions for use as agents that protect humans against IR-induced tissue damage. Numerous studies have confirmed that melatonin, a hydro- and lipophilic hormone with strong antioxidant properties, can potentially be used as a radioprotectant in humans. Less is known about the radioprotective effects of vitamin D, but the results to date have been promising. Deficiencies in melatonin and vitamin D are common in modern societies and may contribute to the severity of adverse side effects of medical IR exposure. Hence, supporting supplementation with both substances seems to be of first importance. Interestingly, both melatonin and vitamin D have been found to selectively radiosensitise cancer cells, which makes them promising adjuvants in radiotherapy. More research is needed in this area, especially in humans.