Residential randon exposure and lung cancer risk in Misasa, Japan: a case-control study

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).

Residential Radon and Histological Types of Lung Cancer: A Meta-Analysis of Case‒Control Studies

Epidemiological studies on residential radon exposure and the risk of histological types of lung cancer have yielded inconsistent results. We conducted a meta-analysis on this topic and updated previous related meta-analyses. We searched the databases of Cochrane Library, Embase, PubMed, Web of Science and Chinese National Knowledge Infrastructure for papers published up to 13 November 2018. The pooled odds ratio (OR) and 95% confidence interval (CI) were calculated using fixed and random effects models. Subgroup and dose‒response analyses were also conducted. This study was registered with PROSPERO (No. CRD42019127761). A total of 28 studies, which included 13,748 lung cancer cases and 23,112 controls, were used for this meta-analysis. The pooled OR indicated that the highest residential radon exposure was significantly associated with an increased risk of lung cancer (OR = 1.48, 95% CI = 1.26–1.73). All histological types of lung cancer were associated with residential radon. Strongest association with small-cell lung carcinoma (OR = 2.03, 95% CI = 1.52–2.71) was found, followed by adenocarcinoma (OR = 1.58, 95% CI = 1.31–1.91), other histological types (OR = 1.54, 95% CI = 1.11–2.15) and squamous cell carcinoma (OR = 1.43, 95% CI = 1.18–1.74). With increasing residential radon levels per 100 Bq/m³, the risk of lung cancer, small-cell lung carcinoma and adenocarcinoma increased by 11%, 19% and 13%, respectively. This meta-analysis provides new evidence for a potential relationship between residential radon and all histological types of lung cancer.

Meta-analysis of case-control studies on the relationship between lung cancer and indoor radon exposure

Indoor exposure to natural radon is a factor that influences lung cancer risk worldwide. The present study includes a meta-analysis of epidemiological data on the relationship between lung cancer and indoor radon. Altogether, 31 case-control studies with 20,703 cases, 34,518 controls and 140 individual odds ratio (OR) estimates are included in the meta-analysis. Weighted median OR was calculated for five radon intervals. The following parameters were used for the weighting: standard error of OR, duration of radon concentration measurement, and relative number of controls in reference intervals. The dependence of the weighted median OR on the radon concentration was estimated applying linear non-threshold and threshold models. The results obtained suggest a significant linear no-threshold exposure-effect relationship for radon concentrations above 100 Bq/m³, with a slope of 0.14 (95% confidence interval 0.08-0.21) per 100 Bq/m³.

Meta-analysis of thirty-two case-control and two ecological radon studies of lung cancer

A re-analysis has been carried out of thirty-two case-control and two ecological studies concerning the influence of radon, a radioactive gas, on the risk of lung cancer. Three mathematically simplest dose-response relationships (models) were tested: constant (zero health effect), linear, and parabolic (linear-quadratic). Health effect end-points reported in the analysed studies are odds ratios or relative risk ratios, related either to morbidity or mortality. In our preliminary analysis, we show that the results of dose-response fitting are qualitatively (within uncertainties, given as error bars) the same, whichever of these health effect end-points are applied. Therefore, we deemed it reasonable to aggregate all response data into the so-called Relative Health Factor and jointly analysed such mixed data, to obtain better statistical power. In the second part of our analysis, robust Bayesian and classical methods of analysis were applied to this combined dataset. In this part of our analysis, we selected different subranges of radon concentrations. In view of substantial differences between the methodology used by the authors of case-control and ecological studies, the mathematical relationships (models) were applied mainly to the thirty-two case-control studies. The degree to which the two ecological studies, analysed separately, affect the overall results when combined with the thirty-two case-control studies, has also been evaluated. In all, as a result of our meta-analysis of the combined cohort, we conclude that the analysed data concerning radon concentrations below ~1000 Bq/m3 (~20 mSv/year of effective dose to the whole body) do not support the thesis that radon may be a cause of any statistically significant increase in lung cancer incidence.

Radioprotective Effects of Sulfur-containing Mineral Water of Ramsar Hot Spring with High Natural Background Radiation on Mouse Bone Marrow Cells

BACKGROUND

We intend to study the inhibitory effect of sulfur compound in Ramsar hot spring mineral on tumor-genesis ability of high natural background radiation.

OBJECTIVE

The radioprotective effect of sulfur compounds was previously shown on radiation-induced chromosomal aberration, micronuclei in mouse bone marrow cells and human peripheral lymphocyte. Ramsar is known for having the highest level of natural background radiation on Earth. This study was performed to show the radioprotective effect of sulfur-containing Ramsar mineral water on mouse bone marrow cells.

METHOD

Mice were fed three types of water (drinking water, Ramsar radioactive water containing sulfur and Ramsar radioactive water whose sulfur was removed). Ten days after feeding, mice were irradiated by gamma rays (0, 2 and 4 Gy). 48 and 72 hours after irradiating, mice were killed and femurs were removed. Frequency of micronuclei was determined in bone marrow erythrocytes.

RESULTS

A significant reduction was shown in the rate of micronuclei polychromatic erythrocyte in sulfur-containing hot spring water compared to sulfur-free water in hot spring mineral water. Gamma irradiation induced significant increases in micronuclei polychromatic erythrocyte (MNPCE) and decreases in polychromatic erythrocyte/polychromatic erythrocyte + normochromatic erythrocyte ratio (PCEs/PCEs+NCEs) (P < 0.001) in sulfur-containing hot spring water compared to sulfur-free hot spring mineral water. Also, apparently there was a significant difference between drinking water and sulfur-containing hot spring water in micronuclei polychromatic erythrocyte and polychromatic erythrocyte/polychromatic erythrocyte+ normochromatic erythrocyte ratio.

CONCLUSION

The results indicate that sulfur-containing mineral water could result in a significant reduction in radiation-induced micronuclei representing the radioprotective effect of sulfur compounds.

Residential radon and lung cancer risk: an updated meta- analysis of case-control studies

BACKGROUND

Numbers of epidemiological studies assessing residential radon exposure and risk of lung cancer have yielded inconsistent results.

METHODS

We therefore performed a meta-analysis of relevant published case- control studies searched in the PubMed database through July 2011 to examine the association. The combined odds ratio (OR) were calculated using fixed- or random-effects models. Subgroup and dose-response analyses were also performed.

RESULTS

We identified 22 case-control studies of residential radon and lung cancer risk involving 13,380 cases and 21,102 controls. The combined OR of lung cancer for the highest with the lowest exposure was 1.29 (95% CI 1.10-1.51). Dose-response analysis showed that every 100 Bq/m3 increment in residential radon exposure was associated with a significant 7% increase in lung cancer risk. Subgroup analysis displayed a more pronounced association in the studies conducted in Europe. Studies restricted to female or non-smokers demonstrated weakened associations between exposure and lung cancer.

CONCLUSIONS

This meta- analysis provides new evidence supporting the conclusion that residential exposure to radon can significantly increase the risk of lung cancer in a dose-response manner.

Pooled Bayesian analysis of twenty-eight studies on radon induced lung cancers

The influence of ionizing radiation of (222)Rn and its progeny on lung cancer risks that were published in 28 papers was re-analyzed using seven alternative dose-response models. The risks of incidence and mortality were studied in two ranges of low annual radiation dose: 0-70 mSv per year (391 Bq m(-3)) and 0-150 mSv per year (838 Bq m(-3)). Assumption-free Bayesian statistical methods were used. The analytical results demonstrate that the published incidence and mortality data do not show that radiation dose is associated with increased risk in this range of doses. This conclusion is based on the observation that the model assuming no dependence of the lung cancer induction on the radiation doses is at least ∼90 times more likely to be true than the other models tested, including the linear no-threshold (LNT) model.

Does scientific evidence support a change from the LNT model for low-dose radiation risk extrapolation?

The linear no-threshold (LNT) model has been widely used to establish international rules and standards in radiation protection. It is based on the notion that the physical energy deposition of ionizing radiation (IR) increases carcinogenic risk linearly with increasing dose (i.e., the carcinogenic effectiveness remains constant irrespective of dose) and, within a factor of two, also with dose-rate. However, recent findings have strongly put into question the LNT concept and its scientific validity, especially for very low doses and dose-rates. Low-dose effects are more difficult to ascertain than high-dose effects. Epidemiological studies usually lack sufficient statistical power to determine health risks from very low-dose exposures. In this situation, studies of the fundamental mechanisms involved help to understand and assess short- and long-term effects of low-dose IR and to evaluate low-dose radiation risks. Several lines of evidence demonstrate that low-dose and low dose-rate effects are generally lower than expected from high-dose exposures. DNA damage signaling, cell cycle checkpoint activation, DNA repair, gene and protein expression, apoptosis, and cell transformation differ qualitatively and quantitatively at high- and low-dose IR exposures, and most animal and epidemiological data support this conclusion. Thus, LNT appears to be scientifically invalid in the low-dose range.

A simulation study of radon and thoron discrimination problem in case-control studies

In most countries, radon is the dominant contributor among natural radiation sources to the radiation exposure dose of the general population. Numerous case-control studies of residential radon and lung cancer have been conducted using passive radon (Rn-222) detectors. These studies showed that radon may increase lung cancer risk, but most of them did not show a significant risk. Recently it was shown that the readings of passive radon detectors that do not employ thoron (Rn-220) discrimination techniques are affected by thoron. Therefore, we conducted a simulation study to evaluate the possible effect of thoron interference on the estimation of radon-related lung cancer risk. Various assumptions were made based on the number of cases, matching ratio, baseline risk, true radon-related risk, distribution of radon and thoron concentrations, correlation between radon and thoron, and radon detectors. The results suggested that in certain circumstances thoron interference in radon measurements resulted in an approximately 90% downward bias. In addition, the magnitude of the bias increased as the geometric mean and geometric standard error of radon concentration decreased and those of thoron increased. In order to resolve this problem, it is necessary to use passive radon detectors with thoron discrimination techniques in epidemiological studies.

Simultaneous measurements of radon and thoron exhalation rates and comparison with values calculated by UNSCEAR equation

We simultaneously measured radon and thoron exhalation rates in areas of weathered acid rocks in Japan to investigate the relationship between them and between measured and calculated radon exhalation rates. To calculate the radon exhalation rate, we used an equation proposed by UNSCEAR. Our analysis showed that both the radon and thoron exhalation rates measured at one location in a natural environment fluctuated widely, even within one day. We found a strong correlation between the radon and thoron exhalation rates. The measured radon exhalation rates tended to be lower than the calculated values: the mean ratio of the measured exhalation rate to the calculated rate was 0.65. We concluded that the UNSCEAR equation is applicable under a controlled environment (temperature, humidity, etc.), but not where there are artificial underground structures that may influence the transportation of radon in soil.

Elevation of antioxidant enzymes in the clinical effects of radon and thermal therapy for bronchial asthma

An increased systemic production of oxygen-free radicals by activated inflammatory cells is thought to be involved in the pathophysiology of asthma. The aim of this study is to evaluate the clinical effects of radon and thermal therapy on asthma in relation to antioxidant enzymes and lipid peroxide. Radon and thermal therapy were performed once a week. All subjects went to a hot bathroom with a high concentration of radon, and nasal inhalation of vapor from a hot spring was performed for 40 min once a day under conditions of high humidity. The room temperature was 48 degrees C; the room radon concentration was 2,080 Bq/m3. Blood samples were collected at 2 h, 14, and 28 days after the first therapy. A blood sample also was collected before the first therapy (at body temperature and background radon level) to be used as the control. The forced expiratory volume in one second (%FEV1) was significantly increased 28 days after the first therapy. On day 28, the catalase (CAT) activity was significantly increased in comparison with the control. The superoxide dismutase (SOD) activity was significantly increased compared to the control after first inhalation. On days 14 and 28, the lipid peroxide level was significantly decreased in comparison with the control. In conclusion, the present pilot study has shown that radon and thermal therapy improved the pulmonary function of asthmatics by increasing the reduced activities of antioxidant enzymes.

Residential radon exposure and lung cancer: risk in nonsmokers

Lung cancer is a disease that is almost entirely caused by smoking; hence, it is almost totally preventable. Yet there are a small percentage of cases, perhaps as many as 5 to 15%, where there are other causes. Risk factors identified for this other group include passive smoking, occupational exposure to certain chemicals and ionizing radiation, diet, and family history of cancer. In the United States cigarette smoking is on the decline among adults, occupational exposures are being reduced, and people are being made more aware of appropriate diets. These changes are gradually resulting in a reduced risk for this disease. Lung cancer in the U.S. may, therefore, eventually become largely a disease of the past. It remains important, however, to continue to study the cause(s) of lung cancer in non-smokers, particularly never smokers. Because of our interest in the effects of residential radon exposure on the development of lung cancer in non-smokers, we conducted a critical review of the scientific literature to evaluate this issue in detail. Strict criteria were utilized in selecting studies, which included being published in a peer reviewed journal, including non-smokers in the studied populations, having at least 100 cases, and being of case-control design. A total of 12 individual studies were found that met the criteria, with 10 providing some information on non-smokers. Most of these studies did not find any significant association between radon and lung cancer in non-smokers. Furthermore, data were not presented in sufficient detail for non-smokers in a number of studies. Based on the most recent findings, there is some evidence that radon may contribute to lung cancer risk in current smokers in high residential radon environments. The situation regarding the risk of lung cancer from radon in non-smokers (ex and never) is unclear, possibly because of both the relatively limited sample size of non-smokers and methodological limitations in most of the individual studies. A summary of these studies is provided concerning the state of knowledge of the lung cancer risk from radon, methodological problems with the residential studies, the need for the provision of additional data on non-smokers from researchers, and recommendations for future research in non-smokers.

Pre-irradiation at a low dose-rate blunted p53 response

We investigated whether chronic irradiation at a low dose-rate interferes with the p53-centered signal transduction pathway induced by radiation in human cultured cells and C57BL/6N mice. In in vitro experiments, we found that a challenge with X-ray irradiation immediately after chronic irradiation resulted in lower levels of p53 than those observed after the challenge alone in glioblastoma cells (A-172). In addition, the levels of p53-centered apoptosis and its related proteins after the challenge were strongly correlated with the above-mentioned phenomena in squamous cell carcinoma cells (SAS/neo). In in vivo experiments, the accumulation of p53 and Bax, and the induction of apoptosis were observed dose-dependently in mouse spleen at 12 h after a challenge with X-rays (3.0 Gy). However, we found significant suppression of p53 and Bax accumulation and the induction of apoptosis 12 h after challenge irradiation at 3.0 Gy with a high dose-rate following chronic pre-irradiation (1.5 Gy, 0.001 Gy/min). These findings suggest that chronic pre-irradiation suppressed the p53 function through radiation-induced signaling and/or p53 stability.