Residential radon exposure and lung cancer: risk in nonsmokers

Smoking Modifies the Association Between Radon Exposure and Incident Ischemic Stroke: The REGARDS Study

BACKGROUND

Exposure to radon has been linked to lung cancer and other lung diseases. Although biologically plausible, research of residential radon exposure in relation to stroke risk is scarce.

METHODS

Study participants were from the REGARDS (Reasons for Geographic and Racial Differences in Stroke) cohort (n=30 239), which consisted of male and female non-Hispanic Black and White adults aged 45 and older. After excluding participants with baseline stroke and transient ischemic attack, and missing information on exposure and outcome of interest, the final sample size was 26 950. The primary outcome was time to the first ischemic stroke through September 30, 2020. County-level radon measures from Lawrence Berkeley National Laboratory were linked to each participant based on their geocoded residential history. We used Cox proportional hazards regression models with a time-dependent exposure to estimate hazard ratios and 95% CIs for the association.

RESULTS

After controlling for potential confounding factors including demographic, lifestyle, clinical variables, and PM2.5, radon exposure was significantly associated with incident ischemic stroke among never-smokers (hazard ratio, 1.39 [95% CI, 1.01-1.90]) but not ever-smokers. The results were generally consistent in the sensitivity analysis when using radon measures from state/Environmental Protection Agency residential radon survey.

CONCLUSIONS

Findings from this study suggest that the association between residential radon exposure and incidence of ischemic stroke varies by smoking status and may be prominent in never-smokers. Further studies incorporating indoor-radon measures are needed to confirm these findings.

Effect of 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol and benzo[a]pyrene exposure on the development of metabolic syndrome in mice

AIM

The prevalence of metabolic syndrome (MetS), a cluster of serious medical conditions that raise the risk of lung cancer, has increased worldwide. Tobacco smoking (TS) potentially increases the risk of developing MetS. Despite the potential association of MetS with lung cancer, preclinical models that mimic human diseases, including TS-induced MetS, are limited. Here we evaluated the impact of exposure to tobacco smoke condensate (TSC) and two representative tobacco carcinogens, 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNK) and benzo[a]pyrene (BaP), on MetS development in mice.

MATERIALS AND METHODS

FVB/N or C57BL/6 mice were exposed to vehicle, TSC, or NNK and BaP (NB) twice weekly for 5 months. The serum levels of total cholesterol (TCHO), triglycerides, high-density lipoprotein (HDL), blood glucose, and metabolites, along with glucose tolerance and body weight, were measured.

KEY FINDINGS

Compared with those of vehicle-treated mice, mice with TSC or NB exposure displayed major phenotypes associated with MetS, including increased serum levels of TCHO, triglycerides, and fasting and basal blood glucose and decreased glucose tolerance, and serum levels of HDL. These MetS-associated changes were found in both FVB/N and C57BL/6 mice that were susceptible or resistant to carcinogen-induced tumorigenesis, respectively, indicating that tumor formation is not involved in the TSC- or NB-mediated MetS. Moreover, oleic acid and palmitoleic acid, which are known to be associated with MetS, were significantly upregulated in the serum of TSC- or NB-treated mice compared with those in vehicle-treated mice.

SIGNIFICANCE

Both TSC and NB caused detrimental health problems, leading to the development of MetS in experimental mice.

Tracing Lung Cancer Risk Factors Through Mutational Signatures in Never-Smokers

Epidemiologic studies often rely on questionnaire data, exposure measurement tools, and/or biomarkers to identify risk factors and the underlying carcinogenic processes. An emerging and promising complementary approach to investigate cancer etiology is the study of somatic "mutational signatures" that endogenous and exogenous processes imprint on the cellular genome. These signatures can be identified from a complex web of somatic mutations thanks to advances in DNA sequencing technology and analytical algorithms. This approach is at the core of the Sherlock-Lung study (2018-ongoing), a retrospective case-only study of over 2,000 lung cancers in never-smokers (LCINS), using different patterns of mutations observed within LCINS tumors to trace back possible exposures or endogenous processes. Whole genome and transcriptome sequencing, genome-wide methylation, microbiome, and other analyses are integrated with data from histological and radiological imaging, lifestyle, demographic characteristics, environmental and occupational exposures, and medical records to classify LCINS into subtypes that could reveal distinct risk factors. To date, we have received samples and data from 1,370 LCINS cases from 17 study sites worldwide and whole-genome sequencing has been completed on 1,257 samples. Here, we present the Sherlock-Lung study design and analytical strategy, also illustrating some empirical challenges and the potential for this approach in future epidemiologic studies.

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.

Metabolic Syndrome and Risk of Lung Cancer: An Analysis of Korean National Health Insurance Corporation Database

INTRODUCTION

Metabolic syndrome is known to increase the risk of several cancers. However, the association between lung cancer and metabolic syndrome remains unclear. Thus, we investigated the impact of metabolic syndrome on the incidence of lung cancer.

METHODS

This study enrolled participants in a health screening program provided by the Korean National Health Insurance Service between January 2009 and December 2012. The incidence of lung cancer was observed until December 2016. We analyzed the risk of lung cancer according to the presence of metabolic syndrome, metabolic syndrome components, and number of metabolic syndrome components.

RESULTS

During the study, 45 635 new cases of lung cancer were recorded among 9 586 753 participants. The presence of metabolic syndrome and all its components was positively associated with the risk of lung cancer in men after multivariate adjustment (hazard ratio [HR] of metabolic syndrome 1.15; 95% confidence interval [CI], 1.12-1.18). The risk of lung cancer increased with the number of components present. The effect of metabolic syndrome on the increasing risk of lung cancer is may be higher in underweight male ever-smokers than in other participants.

CONCLUSION

Metabolic syndrome was associated with an increased risk of lung cancer in men. Moreover, the higher the number of metabolic syndrome components, the higher the risk of lung cancer.

Estimation of Seasonal Correction Factors for Indoor Radon Concentrations in Korea

Long-term exposure to high radon concentration exerts pathological effects and elicits changes in respiratory function, increasing an individual’s risk of developing lung cancer. In health risk assessment of indoor radon, consideration of long-term exposure thereto is necessary to identify a relationship between indoor radon exposure and lung cancer. However, measuring long-term indoor radon concentration can be difficult, and a statistical model for predicting mean annual indoor radon concentrations may be readily applicable. We investigated the predictability of mean annual radon concentrations using national data on indoor radon concentrations throughout the spring, summer, fall, and winter seasons in Korea. Indoor radon concentrations in Korea were highest in the winter and lowest in the summer. We derived seasonal correction and seasonal adjustment factors for each season based on the method proposed by previous study. However, these factors may not be readily applicable unless measured in a specific season. In this paper, we separate seasonal correction factors for each month of the year (new correction factors) based on correlations between indoor radon and meteorological factors according to housing type. To evaluate the correction factors, we assessed differences between estimated and measured mean annual radon concentrations. Roughly 97% of the estimated values were within ±40 Bq/m³ of actual measured values in detached houses, and roughly 85–87% of the estimated values were within ±40 Bq/m³ of the measured values in other residences. In most cases, the seasonal correction factors and the new correction factors had slightly better agreement than the seasonal adjustment factor. For predicting mean annual radon concentrations, the seasonal correction factors or seasonal adjustment factors can be of use when actual measurements of indoor radon concentrations for a specific season are available. Otherwise, the new correction factors may be more readily applicable.

Meta-Analysis and Systematic Review in Environmental Tobacco Smoke Risk of Female Lung Cancer by Research Type

More than 50% of women worldwide are exposed to Environmental Tobacco Smoke (ETS). The impact of ETS on lung cancer remains unclear. Cohort studies since the late 1990s have provided new evidence of female lung cancer risk due to ETS. The objective of this meta-analysis and systematic review was to analyze the association of ETS with female lung cancer risk from 1997 to 2017, organised based on research design. According to our applied inclusion and exclusion criteria, 41 published studies were included. The relative risk (RR) from the cohort studies or odds ratio (OR) from case-control studies were extracted to calculate the pooled risks based on the type of study. The summary risks of ETS were further explored with the modulators of ETS exposure sources and doses. The pooled risks of lung cancer in non-smoking women exposed to ETS were 1.35 (95% CI: 1.17⁻1.56), 1.17 (95% CI: 0.94⁻1.44), and 1.33 (95% CI: 1.17⁻1.51) for case-control studies, cohort studies, and both types of studies, respectively. The summary RR estimate of the cohort studies was not statistically significant, but the RR increased with increasing doses of ETS exposure (p trend < 0.05). Based on the results of this study, ETS might be an important risk factor of female lung cancer in non-smokers.

Role of EGCG in Containing the Progression of Lung Tumorigenesis - A Multistage Targeting Approach

Lung cancer is a prominent form among various types of cancers, irrespective of the sex worldwide. Treatment of lung cancer involves the intensive phase of chemotherapy/radiotherapy which is associated with high rate of adverse events. There is a need of safe and reliable treatment/adjunctive therapy to apprehend the cancer by reducing the undesirable outcome of primary therapy. Epigallocatechin-3-gallate (EGCG), which is a potent antioxidant and anticancer compound extracted from the plant camellia sinensis has proved to be a novel agent to control or reduce lung tumorigenesis by affecting the signaling molecules of cell cycle regulation and apoptotic pathways. In vitro studies have revealed that EGCG can contain carcinogenesis by altering the molecules involved in multiple signal transduction pathways like ERK, VEGF, COX2, NEAT, Ras-GTPase, and kinases. The animal studies have also demonstrated effectiveness of EGCG by inhibiting various molecular pathways which include AKT, NFkB, MAPK, Bcl/Bax, DNMT1, and HIF-1α. Various attempts have been made to see the adjunctive role of EGCG in human lung cancer. Phase I/II clinical studies have recommended that EGCG is quite safe and effective in providing protection against cancer. In this review, we will discuss the role of EGCG and its molecular mechanisms in lung carcinogenesis.

A preliminary study for conducting a rational assessment of radon exposure levels

The aim of this study was to determine the factors that go into a highly reliable estimate of radon exposure levels for use in setting up the case-control study. To this end, the present study conducted a multi-faceted investigation of the distribution of radon concentrations in the bedrooms and living rooms of 400 households in the target areas during the winter months from December 2014 to February 2015. We determined that taking the mean value of the radon concentration levels detected in the bedroom and living room as the representative value of residential concentration is appropriate, given the usability of previous research data and the difference in the concentration levels between the two. In terms of detector placement, we found that detectors should not inconvenience residents or be affected by an air current. Further, we found that housing type should distinguish between regular housing (single-detached, row, and multiplex housing) and apartments but that the building type was not a key factor in the assessment of radon exposure levels. Houses should be classified into those constructed with soil (red clay) and those with constructed with general building materials for the assessment of radon exposure levels.

Distribution of radon concentrations in child-care facilities in South Korea

This study was conducted to provide fundamental data on the distribution of radon concentrations in child day-care facilities in South Korea and to help establish radon mitigation strategies. For this study, 230 child-care centers were randomly chosen from all child-care centers nationwide, and alpha track detectors were used to examine cumulative radon exposure concentrations from January to May 2015. The mean radon concentration measured in Korean child-care centers is approximately 52 Bq m^-3, about one-third of the upper limit of 148 Bq m^-3, which is recommended by South Korea's Indoor Air Quality Control in Public Use Facilities, etc. Act and the U.S. Environmental Protection Agency (EPA). Furthermore, this concentration is about 50% lower than 102 Bq m^-3, which is the measured concentration of radon in houses nationwide from December 2013 to February 2014. Our results indicate that the amount of ventilation, as a major determining factor for indoor radon concentrations, is strongly correlated with the fluctuation of indoor radon concentrations in Korean child-care centers.

Carcinogenic and inflammatory effects of plutonium-nitrate retention in an exposed nuclear worker and beagle dogs

PURPOSE

Plutonium-nitrate has a moderately rapid translocation rate from the lung to blood stream. Previous studies have shown an unexpected retention of soluble plutonium in the beagles and human case studied here. The inflammatory responses that may be associated with long-term exposure to ionizing radiation were characterized. These pathways include tissue injury, apoptosis, and gene expression modifications. Other protein modifications related to carcinogenesis and inflammation and the various factors that may play a role in orchestrating complex interactions which influence tissue integrity following irradiation were investigated.

MATERIALS AND METHODS

We have examined numerous lung samples from a plutonium-exposed worker, a human control, and a variety of plutonium-exposed beagle dogs using immunohistochemistry and quantitative Reverse Transcriptase-Polymerase Chain Reaction (RT-PCR).

RESULTS

The exposed human showed interstitial fibrosis in peripheral regions of the lung, but no pulmonary tumors. Beagles with similar doses were diagnosed with tumors in bronchiolo-alveolar, peripheral and sub-pleural alveolar regions of the lung. The terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) assay showed an elevation of apoptosis in tracheal mucosa, tumor cells, and nuclear debris in the alveoli and lymph nodes of the beagles but not in the human case. In both the beagles and human there were statistically significant modifications in the expression of Fas ligand (FASLG), B-cell lymphoma 2 (BCL2), and Caspase 3 (CASP3).

CONCLUSIONS

The data suggests that FASLG, BCL2, CASP3 and apoptosis play a role in the inflammatory responses following prolonged plutonium exposure. Utilizing these unique tissues revealed which pathways are triggered following the internal deposition and long-term retention of plutonium-nitrate in a human and a large animal model.

Analyzing spatial and temporal (222)Rn trends in Maine

Prolonged radon exposure has been linked to lung cancer. Cancer registry data indicates excess risk for age-adjusted lung cancer in Maine. Maine's mean residential radon activity exceeds the EPA maximum contaminant level (MCL). This paper describes the application of spatial autocorrelation methods to retrospective data as a means of analyzing radon activity in Maine. Retrospective air and well water radon activity data, sampled throughout Maine between 1993 and 2008, are standardized and geocoded for analysis. Three spatial autocorrelation algorithms-local Getis-Ord, local Moran, and spatial scan statistic-are used to identify spatial, temporal, and spatiotemporal radon activity clusters and/or outliers. Spatial clusters of high air- and well water-Rn activity are associated with Maine's Lucerne and Sebago granitic formations. Spatial clusters of low air- and well water-Rn activity are associated with Biddeford Granite and the metamorphic bedrock formation Silurian Ordovician Vassalboro. Space-time analysis indicates that most spatial clusters persist over the period of sampling. No significant temporal clusters are identified. Persistent spatial variations in radon may help to better understand and predict radon-related health risks associated with Maine residences.

Preliminary lung cancer risk assessment of exposure to radon progeny for Transylvania, Romania

The objective of the present study was to assess the lung cancer risk induced by exposures to radon progeny of people living in some areas of Transylvania, Romania. Indoor radon concentrations were measured in 667 dwellings of Stei area, Cluj, Bistrita-Nasaud, Sibiu, and Alba counties. Measurements were performed using CR-39 track detectors, exposed for a minimum of 3 mo. Average annual radon concentrations were 232, 114, 71, 62, and 161 Bq m for Stei area, Cluj, Bistrita-Nasaud, Sibiu, and Alba, respectively. The linear risk model of Darby was used to simulate the dose-effect relationship and relative lung cancer risk at low doses of alpha particles specific to residential radon exposures. Predicted relative risks at the measured exposure levels, together with information on the total number of reported lung cancer deaths and the number of people living in these regions, enabled us to estimate the fraction of lung cancer cases in each area that is attributable to radon. These percentages are 16.67% for Stei area, 9.09% for Cluj, 5.66% for Bistrita-Nasaud, 4.76% for Sibiu, and 12.28% for Alba county among lifetime non-smokers. Assuming that the smoking rates are similar for the investigated regions (10.72% smokers among men and 5.95% among women), around 64 to 69% of the total number of annual lung cancer deaths, stratified by sex, would be attributed to radon and occur among smoking male population, and around 35 to 44% would be attributed to radon and occur among smoking female population.

Smoking and hormesis as confounding factors in radiation pulmonary carcinogenesis

Confounding factors in radiation pulmonary carcinogenesis are passive and active cigarette smoke exposures and radiation hormesis. Significantly increased lung cancer risk from ionizing radiation at lung doses < 1 Gy is not observed in never smokers exposed to ionizing radiations. Residential radon is not a cause of lung cancer in never smokers and may protect against lung cancer in smokers. The risk of lung cancer found in many epidemiological studies was less than the expected risk (hormetic effect) for nuclear weapons and power plant workers, shipyard workers, fluoroscopy patients, and inhabitants of high-dose background radiation. The protective effect was noted for low- and mixed high- and low-linear energy transfer (LET) radiations in both genders. Many studies showed a protection factor (PROFAC) > 0.40 (40% avoided) against the occurrence of lung cancer. The ubiquitous nature of the radiation hormesis response in cellular, animal, and epidemio-logical studies negates the healthy worker effect as an explanation for radiation hormesis. Low-dose radiation may stimulate DNA repair/apoptosis and immunity to suppress and eliminate cigarette-smoke-induced transformed cells in the lung, reducing lung cancer occurrence in smokers.

Analysis of the individual health benefits accruing from a domestic radon remediation programme

Although radon can be present within buildings at sufficient levels to pose a health risk, levels can be reduced relatively easily. Recent studies on a group of radon-remediated homes, based on assessment of collective population-average risk coefficients, have estimated the benefits and cost effectiveness accruing from remediation and have confirmed that domestic remediation in UK radon Affected Areas would result in significantly reduced cancer risks to the population in those areas. Although the population-average approach used hitherto has applied occupancy and lung-cancer risk factors, these are potentially misleading in assessing discrete populations. The study reported here uses the recently developed European Community Radon Software (ECRS) to quantify individual risks in a sample of householders who remediated their homes following indications that radon levels exceeded the action level. The study proceeds from population-averaged to 'individual risk' evaluation, successfully comparing individual and collective risk assessments, and demonstrates that those who remediate are not representative of the general population. Health benefits accruing from remediation are three times lower than expected, largely because remediators are older, live in smaller households, and smoke less than the population average, leading to the conclusion that the current strategy employed in the UK is failing to target those most at risk.

Radon-induced lung cancer in French and Czech miner cohorts described with a two-mutation cancer model

A two-mutation carcinogenesis model with clonal expansion of pre-malignant cells is used to describe lung cancer mortality data from studies on French and Czech miners with relatively low exposures to radon. The aim was to derive radon-induced lung cancer risk estimates applicable to different populations using a model description consistent with both cellular dose-response relationships, and previous model analyses of animal and human epidemiological data. The significantly different baseline lung cancer risks for the two cohorts that include the effects from the unknown smoking habits, are described with different background model parameters. A uniform description of the effect of radon for both miner cohorts is achieved by applying the same multiplicative effect for radon on the background mutation rates in the model. Incorporating the effects of decreased cellular proliferation at very advanced age improves the description of the baseline lung cancer risk, but does not lead to significant changes in the estimated radiation parameters. Here, a multi-stage model demonstrates the possibility of transferring radon-induced lung cancer risks across populations. The inherent age-time dose-rate relationships in the model allow for extrapolation to lifelong exposures to residential radon concentrations. The resulting cumulated (lifetime) risks from continuous exposure to low-level radon concentrations were found to agree with the results of the BEIR VI models.

Exposition domestique au radon et risque de cancer du poumon : bilan des études cas-témoins

BACKGROUND

Radon is a radioactive gas that tends to accumulate in indoor environment. A causal relationship between lung cancer and radon exposure has been demonstrated in epidemiologic studies of miners. The objective of this paper is to present the results of case-control studies of lung cancer risk associated with indoor radon exposure.

METHODS

Case-control studies published since 1990 are included in this review. This type of protocol is particularly well suited for studying the relationship between indoor radon exposure and lung cancer risk, taking into account possible confounding factors such as tobacco smoking. The characteristics and results of these studies are summarized. The limitations associated with each of these studies are also discussed.

RESULTS

The results of available studies are relatively concordant and suggest a positive association between lung cancer risk and indoor radon exposure with an estimated excess relative risk of about 6 to 9% per 100Bq/m3 increase in the observed time-weighted average radon concentration. The order of magnitude of this estimation agrees with extrapolations from miners but some studies may suffer from inadequate statistical power.

CONCLUSION

At present, efforts are underway to pool together the data from the existing studies of indoor radon. This pooling analysis with thousands of cases and controls will provide a more precise estimate of the lung cancer risk from indoor radon exposure and explore the effect of modifying factors, such as smoking.

Hormesis, an update of the present position

The ongoing debate over the possible beneficial effects of ionising radiation on health, hormesis, is reviewed from different perspectives. Radiation hormesis has not been strictly defined in the scientific literature. It can be understood as a decrease in the risk of cancer due to low-dose irradiation, but other positive health effects may also be encompassed by the concept. The overwhelming majority of the currently available epidemiological data on populations exposed to ionising radiation support the assumption that there is a linear non-threshold dose-response relationship. However, epidemiological data fail to demonstrate detrimental effects of ionising radiation at absorbed doses smaller than 100-200 mSv. Risk estimates for these levels are therefore based on extrapolations from higher doses. Arguments for hormesis are derived only from a number of epidemiological studies, but also from studies in radiation biology. Radiobiological evidence for hormesis is based on radio-adaptive response; this has been convincingly demonstrated in vitro, but some questions remain as to how it affects humans. Furthermore, there is an ecologically based argument for hormesis in that, given the evolutionary prerequisite of best fitness, it follows that humans are best adapted to background levels of ionising radiation and other carcinogenic agents in our environment. A few animal studies have also addressed the hormesis theory, some of which have supported it while others have not. To complete the picture, the results of new radiobiological research indicate the need for a paradigm shift concerning the mechanisms of cancer induction. Such research is a step towards a better understanding of how ionising radiation affects the living cell and the organism, and thus towards a more reliable judgement on how to interpret the present radiobiological evidence for hormesis.

Health Effects of High Radon Environments in Central Europe: Another Test for the LNT Hypothesis?

Among the various "natural laboratories" of high natural or technical enhanced natural radiation environments in the world such as Kerala (India), Brazil, Ramsar (Iran), etc., the areas in and around the Central European Ore Mountains (Erzgebirge) in the southern parts of former East Germany, but also including parts of Thuringia, northern Bohemia (now Czech Republic), and northeastern Bavaria, are still relatively little known internationally.Although this area played a central role in the history of radioactivity and radiation effects on humans over centuries, most of the valuable earlier results have not been published in English or quotable according to the current rules in the scientific literature and therefore are not generally known internationally. During the years 1945 to 1989, this area was one of the world's most important uranium mining areas, providing the former Soviet Union with 300,000 tons of uranium for its military programs. Most data related to health effects of radon and other carcinogenic agents on miners and residents became available only during the years after German reunification. Many of the studies are still unpublished, or more or less internal reports.By now, substantial studies have been performed on the previously unavailable data about the miners and the population, providing valuable insights that are, to a large degree, in disagreement with the opinion of various international bodies assuming an increase of lung cancer risk in the order of 10% for each 100 Bq/m(3) (or doubling for 1000 Bq/m(3)), even for small residential radon concentrations. At the same time, other studies focusing on never-smokers show little or no effects of residential radon exposures. Experiments in medical clinics using radon on a large scale as a therapeutic against various rheumatic and arthritic disease demonstrated in randomized double-blind studies the effectiveness of such treatments.The main purpose of this review is to critically examine, including some historical references, recent results primarily in three areas, namely the possible effects of the inhalation of very high radon concentrations on miners; the effect of increased residential radon concentrations on the population; and the therapeutic use of radon. With many of the results still evolving and/or under intense discussion among the experts, more evidence is emerging that radon, which has been inhaled at extremely high concentrations in the multimillion Bq/m(3) range by many of older miners (however, with substantial confounders, and large uncertainties in retrospective dosimetry), was perhaps an important but not the dominating factor for an increase in lung cancer rates. Other factors such as smoking, inhalation of quartz and mineral dust, arsenic, nitrous gases, etc. are likely to be more serious contributors to increased miner lung cancer rates. An extrapolation of miner data to indoor radon situations is not feasible.Concerning indoor radon studies, the by far dominating effect of smoking on the lung cancer incidence makes the results of some studies, apparently showing a positive dose-response relationship, questionable. According to recent studies in several countries, there are no, or beneficial, residential radon effects below about 600 to 1000 Bq/m(3) (the extensive studies in the U.S., in particular by B. Cohen, and the discussions about these data, will not be part of this review, because they have already been discussed in detail in the U.S. literature). As a cause of lung cancer, radon seems to rank - behind active and passive smoking, and probably also air pollution in densely populated and/or industrial areas (diesel exhaust soot, etc.) - as a minor contributor in cases of extremely high residential radon levels, combined with heavy smoking of the residents.As demonstrated in an increasing number of randomized double-blind clinical studies for various painful inflammatory joint diseases such as rheumatism, arthritic problems, and Morbus Bechterew, radon treatments are beneficial, with the positive effect lasting until at least 6 months after the normally 3-week treatment by inhalation or bathes. Studies on the mechanism of these effects are progressing. In other cases of extensive use of radon treatment for a wide spectrum of various diseases, for example, in the former Soviet Union, the positive results are not so well established. However, according to a century of radon treatment experience (after millenniums of unknown radon therapy), in particular in Germany and Austria, the positive medical effects for some diseases far exceed any potential detrimental health effects.The total amount of available data in this field is too large to be covered in a brief review. Therefore, less known - in particular recent - work from Central Europe has been analyzed in an attempt to summarize new developments and trends. This includes cost/benefit aspects of radon reduction programs. As a test case for the LNT (linear non-threshold) hypothesis and possible biopositive effects of low radiation exposures, the data support a nonlinear human response to low and medium-level radon exposures.