Radon Gas in the City of Alicante. High Risk of Low Indoor Air Quality in Poorly Ventilated Buildings

Biomarkers of lung cancer for screening and in never-smokers-a narrative review

Background and Objective

Lung cancer is the leading cause of cancer-related mortality worldwide, partially attributed to late-stage diagnoses. In order to mitigate this, lung cancer screening (LCS) of high-risk patients is performed using low dose computed tomography (CT) scans, however this method is burdened by high false-positive rates and radiation exposure for patients. Further, screening programs focus on individuals with heavy smoking histories, and as such, never-smokers who may otherwise be at risk of lung cancer are often overlooked. To resolve these limitations, biomarkers have been posited as potential supplements or replacements to low-dose CT, and as such, a large body of research in this area has been produced. However, comparatively little information exists on their clinical efficacy and how this compares to current LCS strategies.

Methods

Here we conduct a search and narrative review of current literature surrounding biomarkers of lung cancer to supplement LCS, and biomarkers of lung cancer in never-smokers (LCINS).

Key Content and Findings

Many potential biomarkers of lung cancer have been identified with varying levels of sensitivity, specificity, clinical efficacy, and supporting evidence. Of the markers identified, multi-target panels of circulating microRNAs, lipids, and metabolites are likely the most clinically efficacious markers to aid current screening programs, as these provide the highest sensitivity and specificity for lung cancer detection. However, circulating lipid and metabolite levels are known to vary in numerous systemic pathologies, highlighting the need for further validation in large cohort randomised studies.

Conclusions

Lung cancer biomarkers is a fast-expanding area of research and numerous biomarkers with potential clinical applications have been identified. However, in all cases the level of evidence supporting clinical efficacy is not yet at a level at which it can be translated to clinical practice. The priority now should be to validate existing candidate markers in appropriate clinical contexts and work to integrating these into clinical practice.

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.

Comparison of Indoor Radon Reduction Effects Based on Apartment Housing Ventilation Methods

A lack of ventilation in multi-unit dwellings can affect human health adversely owing to accumulated radon gases; therefore, developing immediate and effective methods to reduce radon gas in indoor living environments is urgently needed. Therefore, this study conducted a basic research study to develop ventilation guidelines for radon through assessments of various ventilation strategies on indoor radon concentration in multiple-unit dwellings, a typical residential type in Korea. Radon measurement was conducted in November 2020 using RAD 7 Radon Detector (Durridge Co., Billerica, MA, USA) for living rooms and rooms of an apartment located in Uijeongbu, Gyeonggi-do, Korea. The radon reduction effect according to the ventilation conditions per hour was compared and evaluated by performing seven natural ventilation scenarios through opening and closing windows leading to the outside and three types of mechanical ventilation with high, middle, and low operating intensity. The concentration ratio (Cr) was estimated to present the indoor radon increase/decrease ratio. Among the natural ventilation scenarios, Case 3 had the highest radon reduction rate in the living room and Case 1 in the room, and Case 2 using natural ventilation equipment showed the lowest reduction rate in both the room and the living room. When ventilated by mechanical ventilation conditions, the radon reduction rate (Pr) was 70% or less under all conditions. Under the natural ventilation measurement condition, when every doors and windows was opened, it showed an effective ventilation in a short time. With high mechanical ventilation, the radon reduction effect in a relatively large space was better. Additionally, with middle and low mechanical ventilation, the reduction effect seems to be good in a relatively narrow space.