01/30/15
Illinois Department of
1
Health Effects OfHealth Effects Of
RadonRadon
And Its Decay ProductsAnd Its Decay Produc...
01/30/15
Illinois Department of
2
Radon Is a Class A
Known
Human Carcinogen
Alpha particles from the radon decay products
...
01/30/15
Illinois Department of
3
History
An “unknown” lung disease in miners in the
1400’s.
Identified in 1879 in autopsi...
01/30/15
Illinois Department of
4
Mechanism of Lung Cancer Induction
Radon and RDPs breathed in.
Radon exhaled.
RDPs remai...
01/30/15
Illinois Department of
5
How RDPs Impact Lung Tissue
RDPs stick to lung.RDPs stick to lung.
Alpha energyAlpha ene...
01/30/15
Illinois Department of
6
Physical and Chemical Damage to
DNA from Radiation
Physical damagePhysical damage
occurs...
01/30/15
Illinois Department of
7
Scientific Basis for Radon
Risk Estimates
Studies on miners.
Committee on the biological...
01/30/15
Illinois Department of
8
EPA Risk Assessment (1992)
Radon-Related Lung Cancer Risk:
– Lifetime Risk at 4 pCi/L Ac...
01/30/15
Illinois Department of
9
Residential Risk Affirmed by:
The National Academy of Sciences (NAS)
The International C...
01/30/15
Illinois Department of
10
IDNS STATE POLICYIDNS STATE POLICY
RECOMMENDS THATRECOMMENDS THAT
PEOPLE NOT HAVE LONG-...
01/30/15
Illinois Department of
11
IDNS RADON POLICY
The Illinois General Assembly declared effective
July 30, 1997, that ...
01/30/15 12
Miner Studies
01/30/15
Illinois Department of
13
Working Level Month
The actual potential for contracting lung cancer
increases with the...
01/30/15
Illinois Department of
14
Miner Studies
Demonstrating Risk at Low Levels
Miner Cohort Aver. Cum. Exp. Risk Eviden...
01/30/15
Illinois Department of
15
Miners Studies
Demonstrating Non-Smoker Risk
Miner Cohort Aver. Cum. Exp. Risk Observed...
01/30/15
Illinois Department of
16
NCI-Led Joint Analysis
of Miner Data ('94)
Conclusions:
Authors' estimates for U.S.:
– ...
01/30/15
Illinois Department of
17
National Cancer Institute
January 1997
Original miner-based estimates are on target for...
01/30/15
Illinois Department of
18
Potential Confounders
Other Mine Exposures
Close correlation of risk estimates despite ...
01/30/15
Illinois Department of
19
Translation of Miner Risk to Homes
Risk Estimates
Dose per unit exposure in homes is 70...
01/30/15
Illinois Department of
20
Excess Lung Cancer Risk
LinearLinear
No thresholdNo threshold
Indicates no safeIndicate...
01/30/15
Illinois Department of
21
Who Has a Higher Risk Potential for
Radon Induced Lung Cancer?
Case A:
Person A: 5 year...
01/30/15
Illinois Department of
22
Lifetime Lung Cancer Risk Per 1,000
People (Refer to page 12 Citizens Guide)
20 pCi/L20...
01/30/15
Illinois Department of
23
“X” Years in Home at “Y” Radon to Equal
50 WLM Cumulative Exposure
0
5
10
15
20
25
30
3...
01/30/15 24
Residential Risk Studies
Determining actual risk in homes
01/30/15
Illinois Department of
25
Residential Study Designs
Cohort
– Identify population based on exposure
– Follow for d...
01/30/15
Illinois Department of
26
Swedish Residential
Case Control Study
1360 cases, 2847 controls (male & female).
Avera...
01/30/15
Illinois Department of
27
Canadian Case Control Study
750 cases, 750 controls (male & female).
Average radon conc...
01/30/15
Illinois Department of
28
NCI Missouri
Case Control Study
538 Cases, 1183 Controls (all women).
All Never Smokers...
01/30/15
Illinois Department of
29
Samet Editorial
Re: NCI Missouri Study
Cautioned that residential studies "that showed ...
01/30/15
Illinois Department of
30
Finnish Nested Case - Control Study
1055 cases, 1544 controls (93% male).
Average Radon...
01/30/15
Illinois Department of
31
Other National Action Levels (pCi/L)
CountryCountry Existing HomesExisting Homes New Ho...
01/30/15
Illinois Department of
32
Problems with Residential
Radon Studies
Lack of Statistical Power
– Increase statistica...
01/30/15
Illinois Department of
33
Problems with Residential
Radon Studies
Limited access to previously occupied homes.
– ...
01/30/15 34
Residential Radon Studies
U.S. Public Health Service radon experts have estimated
at least 10,000-30,000 lung ...
01/30/15
Illinois Department of
35
Summary
The current risk estimate is based on most complete and
extensive information c...
01/30/15
Illinois Department of
36
Sources of Radiation Exposure
to the US Population
Assumes averageAssumes average
indoo...
01/30/15 37
Animal Studies
Confirm carcinogenicity of radon.
Evidence of respiratory tract tumors observed in
rats with cu...
01/30/15
Illinois Department of
38
Carcinogenicity of Five Groups
Group A:
Group B:
Group C:
Group D:
Group E:
Demonstrate...
01/30/15
Illinois Department of
39
Regulatory Comparison of Radon to
Other Group A Carcinogens
Always regulated.
Standard ...
01/30/15
Illinois Department of
40
Environmental Risk Comparisons
Pesticide ApplicationsPesticide Applications
Hazardous W...
01/30/15
Illinois Department of
41
Lung Cancer and Smoking
Assuming a population of 250,000,000 there are
158,000 lung can...
01/30/15
Illinois Department of
42
Comparison of Radon to Other
Causes of Death
25,00025,000
20,00020,000
15,00015,000
10,...
01/30/15
Illinois Department of
43
“Radon is a Serious
National Health Problem
American Lung Association
American Medical ...
01/30/15
Illinois Department of
44
National Radon Health Advisory
“Indoor radon gas is a national health problem.
Radon ca...
01/30/15
Illinois Department of
45
Recent Analysis of Multiple Studies
Confirm Risk-January 2, 1997
National
Cancer
Instit...
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Health Effects of Radon and Its Decay Products

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  • A study completed in 1996 and published in the January 1, 1997 issue of the Journal of the National Cancer Institute combined and examined eight major case-control studies of lung cancer and radon gas.
    The eight completed studies each had 200 lung cancer cases and used long-term indoor radon measurements. In total the study examined 4,263 lung cancer patients and 6,612 control subjects.
    The study estimated that lung cancer risks increased 14% for every 4 pCi/L increase in long-term exposure. Furthermore a statistically significant trend of increased risk with increased exposure was seen.
    For the general public this study provides the following risk analysis for long-term exposures:
    at 4 pCi/L your risk of dying of lung cancer is 14% higher than if you were exposed at outdoor radon concentrations.
    at 8 pCi/L your risk of dying of lung cancer is 28% higher than if you were exposed at outdoor radon concentrations.
    at 12 pCi/L your risk of dying of lung cancer is 42% higher than if you were exposed at outdoor radon concentrations.
  • Health Effects of Radon and Its Decay Products

    1. 1. 01/30/15 Illinois Department of 1 Health Effects OfHealth Effects Of RadonRadon And Its Decay ProductsAnd Its Decay Products
    2. 2. 01/30/15 Illinois Department of 2 Radon Is a Class A Known Human Carcinogen Alpha particles from the radon decay products can damage lung tissue. Lung cancer is the main health effect.
    3. 3. 01/30/15 Illinois Department of 3 History An “unknown” lung disease in miners in the 1400’s. Identified in 1879 in autopsies of European miners as lung cancer (Lymphosarcoma). Excess lung cancer deaths observed in uranium miners in U.S., Czechoslovakia, France and Canada. Excess lung cancer deaths in other underground miners in Newfoundland, Sweden, Britain, France, Australia, China, and U.S.
    4. 4. 01/30/15 Illinois Department of 4 Mechanism of Lung Cancer Induction Radon and RDPs breathed in. Radon exhaled. RDPs remain stuck to lung tissue. Po-218 and Po-214 emit alpha particles. Alpha particles strike lung cells causing physical and/or chemical damage to DNA.
    5. 5. 01/30/15 Illinois Department of 5 How RDPs Impact Lung Tissue RDPs stick to lung.RDPs stick to lung. Alpha energyAlpha energy delivered directly todelivered directly to cells.cells. LungLung Bronchial TubesBronchial Tubes Particle with Attached Radon Decay ProductsParticle with Attached Radon Decay Products RespiratoryRespiratory TractTract AlveoliAlveoli BronchiolesBronchioles Mucous LayerMucous Layer CiliaCilia Alpha ParticleAlpha Particle Energy DepositedEnergy Deposited in Live Cells inin Live Cells in the Bronchialthe Bronchial EpitheliumEpithelium Connective TissueConnective Tissue BronchialBronchial EpitheliumEpithelium Air SpaceAir Space (Bronchial Tube)(Bronchial Tube)
    6. 6. 01/30/15 Illinois Department of 6 Physical and Chemical Damage to DNA from Radiation Physical damagePhysical damage occurs when DNAoccurs when DNA struck directly.struck directly. Chemical attack canChemical attack can occur from ions andoccur from ions and free radicals createdfree radicals created when radiation impactswhen radiation impacts fluid surroundingfluid surrounding DNA.DNA. OHOH -- HH ++ HH22OO
    7. 7. 01/30/15 Illinois Department of 7 Scientific Basis for Radon Risk Estimates Studies on miners. Committee on the biological effects of ionizing radiation (BEIR). – National Academy of Sciences, and NRC Studies on residential occupants. Laboratory animal studies.
    8. 8. 01/30/15 Illinois Department of 8 EPA Risk Assessment (1992) Radon-Related Lung Cancer Risk: – Lifetime Risk at 4 pCi/L Action Level: 1:100 (10-2 ) for Smokers 1:1000 (10-3 ) for Non-Smokers – Central risk estimate: 14,000 lung cancer deaths/year Uncertainty Range: 7,000 to 30,000 deaths/year
    9. 9. 01/30/15 Illinois Department of 9 Residential Risk Affirmed by: The National Academy of Sciences (NAS) The International Commission on Radiological Protection Committee (ICRP50) The National Council on Radiation Protection and Measurement The World Health Organization's International Agency for Research on Cancer (IARC) and Working Group on Indoor Air Quality: A Risk-Based Approach to Health Criteria for Radon Indoors The NCI-led International Reassessment of Radon Miner Data
    10. 10. 01/30/15 Illinois Department of 10 IDNS STATE POLICYIDNS STATE POLICY RECOMMENDS THATRECOMMENDS THAT PEOPLE NOT HAVE LONG-PEOPLE NOT HAVE LONG- TERM EXPOSURES ABOVETERM EXPOSURES ABOVE 4.0 pCi/L4.0 pCi/L
    11. 11. 01/30/15 Illinois Department of 11 IDNS RADON POLICY The Illinois General Assembly declared effective July 30, 1997, that it is in the interest of the people of Illinois to establish a comprehensive program for determining the extent to which radon and radon progeny are present in dwellings and in other buildings in Illinois, at levels that pose a potential risk to the occupants and for determining measures that can be take to reduce and prevent such a risk.
    12. 12. 01/30/15 12 Miner Studies
    13. 13. 01/30/15 Illinois Department of 13 Working Level Month The actual potential for contracting lung cancer increases with the dose received and the duration of exposure to a given dose. A time and dose measure is used to quantify lung cancer potential. This is the Working Level Month (WLM). Equivalent to 170 hours of exposure at 1 Working Level (WL)
    14. 14. 01/30/15 Illinois Department of 14 Miner Studies Demonstrating Risk at Low Levels Miner Cohort Aver. Cum. Exp. Risk Evident At Czech Uranium Miners 3-300 WLM 50-99 WLM Ontario Uranium Miners 40 & 90 WLM 40-70 WLM New Mexico Uranium Miners 110 WLM 100+ WLM Swedish Iron Miners 80 WLM 80+ WLM Australian Uranium Miners 7 WLM 40+ WLM Home Exposure at 4 pCi/L for 70 years = Cumulative Exposure of 54 WLM
    15. 15. 01/30/15 Illinois Department of 15 Miners Studies Demonstrating Non-Smoker Risk Miner Cohort Aver. Cum. Exp. Risk Observed Colorado Plateau Uranium Miners 720 WLM 9-12 fold increase Statistically Sig. Swedish Iron Miners 80 WLM 10 fold increase Statistically Sig. Czech Clay Shale Miners 32 WLM 10 fold increase Not Statistically Sig. NM Navajo Uranium Miners* 1207 WLM 12 fold increase Statistically Sig. *Includes some smokers aver 3 cig/day - RR adjusted
    16. 16. 01/30/15 Illinois Department of 16 NCI-Led Joint Analysis of Miner Data ('94) Conclusions: Authors' estimates for U.S.: – 15,000 lung cancer deaths/year 10,000 in smokers 5,000 in never-smokers – Uncertainty Range = 6,000-36,000/yr. Linear dose-response. Little credible evidence for a threshold effect. Increased risk for nonsmokers confirmed. Higher risk associated with exposure received at low rates.
    17. 17. 01/30/15 Illinois Department of 17 National Cancer Institute January 1997 Original miner-based estimates are on target for predicting indoor radon related lung cancer risks. Long-term exposure to radon in U.S. homes may account for 6,000 to 36,000 lung cancer deaths per year. “estimates of exposure response from homes are virtually the same as the extrapolations you get from miner studies….” (Lubin, Boice)
    18. 18. 01/30/15 Illinois Department of 18 Potential Confounders Other Mine Exposures Close correlation of risk estimates despite presence of different environmental pollutants. Increased lung cancer risk from radon: – Regardless of silica dust levels, – Regardless of arsenic levels, – In absence of arsenic, chromium, nickel, asbestos, – In mines without diesel engines, – In mines without radioactive ore.
    19. 19. 01/30/15 Illinois Department of 19 Translation of Miner Risk to Homes Risk Estimates Dose per unit exposure in homes is 70% of that in mines, due to lower respiratory rates. 14,000 deaths per year in US projected based upon an average indoor radon concentration of 1.3 pCi/L.
    20. 20. 01/30/15 Illinois Department of 20 Excess Lung Cancer Risk LinearLinear No thresholdNo threshold Indicates no safeIndicates no safe levellevel Many homes canMany homes can provide similarprovide similar accumulativeaccumulative exposures.exposures. 0 0.2 0.4 0.6 0.8 1 1.2 1.4 1.6 1.8 0 2000 4000 6000 Cumulative Exposure (WLM) %excesslungcancerdeaths House at 200 pCi/LHouse at 200 pCi/L House at 20 pCi/LHouse at 20 pCi/L
    21. 21. 01/30/15 Illinois Department of 21 Who Has a Higher Risk Potential for Radon Induced Lung Cancer? Case A: Person A: 5 years at an average of 10 pCi/L. Person B: 15 years at an average of 4.0 pCi/L Case B: Person A: 10 years at 4.0 pCi/L. Person B: 4 years at 10 pCi/L. Note if dose was given in WL one would simply convert to radon, using the equilibrium equation.
    22. 22. 01/30/15 Illinois Department of 22 Lifetime Lung Cancer Risk Per 1,000 People (Refer to page 12 Citizens Guide) 20 pCi/L20 pCi/L 8 pCi/L8 pCi/L 4 pCi/L4 pCi/L 2 pCi/L2 pCi/L 1.3 pCi/L1.3 pCi/L 88 33 22 11 <1<1 135135 5757 2929 1515 99 Non-Smoker SmokerNon-Smoker Smoker
    23. 23. 01/30/15 Illinois Department of 23 “X” Years in Home at “Y” Radon to Equal 50 WLM Cumulative Exposure 0 5 10 15 20 25 30 35 40 45 0 10 20 30 40 50 60 70 80 90 Years in home AverageRninhme(pCi/L) 50 WLM is where excess lung cancer deaths observed in Ontario study. Assumptions – 75% occupancy – 50% equilibrium 4 pCi/L4 pCi/L
    24. 24. 01/30/15 24 Residential Risk Studies Determining actual risk in homes
    25. 25. 01/30/15 Illinois Department of 25 Residential Study Designs Cohort – Identify population based on exposure – Follow for disease occurrence Ecological – Compares level of disease and exposure in groups – Cannot correlate exposure to sick individual Case-Control – Identify individuals with disease and individuals without disease – Look at and compare exposures
    26. 26. 01/30/15 Illinois Department of 26 Swedish Residential Case Control Study 1360 cases, 2847 controls (male & female). Average Radon Concentration = 2.9 pCi/L. Compared to individuals whose home exposure averaged below 1.4 pCi/L. Found 30% increased risk with average home radon concentrations of 3.8-10.8 pCi/L. Found 80% increased risk with average home radon concentrations above 10.8 pCi/L. 2 separate control groups increases confidence in validity.
    27. 27. 01/30/15 Illinois Department of 27 Canadian Case Control Study 750 cases, 750 controls (male & female). Average radon concentration = 3.2pCi/L. Found no significant increase in risk of lung cancer related to radon exposure. Lacks statistical power - limited by: – highly mobile population – missing data (lack 40% of measurements initially targeted) – large smoking confounder
    28. 28. 01/30/15 Illinois Department of 28 NCI Missouri Case Control Study 538 Cases, 1183 Controls (all women). All Never Smokers or Long-Term Ex-Smokers. Average Radon Concentration= 1.6 pCi/L. (6.7% >4pCi/L). Over 63% cases deceased, next-of-kin interviews. Power of study: 80% chance of detecting a 40-55% increase. No radon/lung cancer association seen in total data. Statistically significant positive associations seen for cases with "in person" interviews and adenocarcinoma.
    29. 29. 01/30/15 Illinois Department of 29 Samet Editorial Re: NCI Missouri Study Cautioned that residential studies "that showed no statistical significance for associations between radon and lung cancer cannot be interpreted as suggesting no risk of exposure to indoor radon." Described residential studies as individually having "little prospect for characterizing the risk of exposure to indoor radon." Warned: "Neither policy makers nor the public should look solely to the epidemiological studies of indoor radon and lung cancer in determining the imperative for risk management."
    30. 30. 01/30/15 Illinois Department of 30 Finnish Nested Case - Control Study 1055 cases, 1544 controls (93% male). Average Radon Concentration = 1.8 pCi/L. Found no statistically significant risk of lung cancer from indoor radon exposure. Authors acknowledged uncertainty over power of a single study to detect effect expected based on miner studies. Differences in % deceased and % smokers between cases and controls.
    31. 31. 01/30/15 Illinois Department of 31 Other National Action Levels (pCi/L) CountryCountry Existing HomesExisting Homes New HomesNew Homes United KingdomUnited Kingdom 5.45.4 5.45.4 SwitzerlandSwitzerland 5.45.4 5.45.4 SwedenSweden 5.45.4 1.91.9 GermanyGermany 6.756.75 LuxembourgLuxembourg 6.756.75 CanadaCanada 2222
    32. 32. 01/30/15 Illinois Department of 32 Problems with Residential Radon Studies Lack of Statistical Power – Increase statistical power by increasing # of cases. Confounders – Other causes can obscure radon/lung cancer relationship. Smoking, heredity, diet, occupation, other air pollutants.
    33. 33. 01/30/15 Illinois Department of 33 Problems with Residential Radon Studies Limited access to previously occupied homes. – Impedes accurate estimates of past exposures. Estimation of past exposures from current measurements. – Physical parameters of house, home use, etc. may have changed.
    34. 34. 01/30/15 34 Residential Radon Studies U.S. Public Health Service radon experts have estimated at least 10,000-30,000 lung cancer cases plus twice as many control individuals required to address the issue. Eight residential studies completed involving a total of 4,941 cases. CONCLUSION: Residential Studies Are Currently Not Helpful for Radon Risk Assessment.
    35. 35. 01/30/15 Illinois Department of 35 Summary The current risk estimate is based on most complete and extensive information currently available. Less uncertainty than for most other pollutants since: – Based on human data. – Good understanding of general population's exposure. Indoor radon poses a substantial risk. Testing, mitigation, and the use of radon-resistant construction techniques are prudent approaches.
    36. 36. 01/30/15 Illinois Department of 36 Sources of Radiation Exposure to the US Population Assumes averageAssumes average indoor radonindoor radon concentration of 1.3concentration of 1.3 pCi/L.pCi/L. Radon is by far theRadon is by far the greatest single sourcegreatest single source of radiation to theof radiation to the general public.general public. RadonRadon 55%55% Medical X-RaysMedical X-Rays 11%11% OtherOther 1%1% InternalInternal 11%11% Nuclear MedicineNuclear Medicine 4%4% Consumer ProductsConsumer Products 3%3%TerrestrialTerrestrial 8%8% CosmicCosmic 8%8%
    37. 37. 01/30/15 37 Animal Studies Confirm carcinogenicity of radon. Evidence of respiratory tract tumors observed in rats with cumulative exposures as low as 20 WLM. Exposure to ore dusts and diesel fumes, simultaneously with radon, did not increase incidence of lung cancer above that produced by radon progeny exposures alone. (DOE/OER 1988).
    38. 38. 01/30/15 Illinois Department of 38 Carcinogenicity of Five Groups Group A: Group B: Group C: Group D: Group E: DemonstratedDemonstrated human carcinogenhuman carcinogen mustard gas, tobacco smoke, asbestos, benzene,mustard gas, tobacco smoke, asbestos, benzene, vinyl chloride, RADONvinyl chloride, RADON Cause cancer in animals,Cause cancer in animals, probableprobable human carcinogenhuman carcinogen PCB’s, DDT, alar, chewing tobacco, cholesterolPCB’s, DDT, alar, chewing tobacco, cholesterol Limited animal evidence,Limited animal evidence, possiblepossible human carcinogenhuman carcinogen Inadequate evidence to classify (Saccharin)Inadequate evidence to classify (Saccharin) Evidence of non-carcinogenicityEvidence of non-carcinogenicity
    39. 39. 01/30/15 Illinois Department of 39 Regulatory Comparison of Radon to Other Group A Carcinogens Always regulated. Standard of exposure set at 1 death per 1,000,000 people/year. Not regulated in home.Not regulated in home. Has been regulated inHas been regulated in mines since 1950’s.mines since 1950’s. Present guideline of 4.0Present guideline of 4.0 pCi/L estimates 28 deathspCi/L estimates 28 deaths per 1,000,000per 1,000,000 people/year.people/year. Manmade Group A’sManmade Group A’s RadonRadon
    40. 40. 01/30/15 Illinois Department of 40 Environmental Risk Comparisons Pesticide ApplicationsPesticide Applications Hazardous Waste SitesHazardous Waste Sites Toxic Outdoor PollutantsToxic Outdoor Pollutants Pesticide Residues on FoodPesticide Residues on Food RADONRADON 100100 1,1001,100 2,0002,000 6,0006,000 14,00014,000 AnnualAnnual Cancer DeathsCancer Deaths
    41. 41. 01/30/15 Illinois Department of 41 Lung Cancer and Smoking Assuming a population of 250,000,000 there are 158,000 lung cancer deaths per year in the U.S. 14,000 lung cancer deaths per year from radon. 81% to 95% of lung cancer deaths are primarily from smoking alone.
    42. 42. 01/30/15 Illinois Department of 42 Comparison of Radon to Other Causes of Death 25,00025,000 20,00020,000 15,00015,000 10,00010,000 5,0005,000 00 DrunkDrunk DrivingDriving RadonRadon DrowningDrowning FiresFires AirlineAirline CrashesCrashes US EPA, NSCUS EPA, NSC AnnualU.S.DeathRateAnnualU.S.DeathRate
    43. 43. 01/30/15 Illinois Department of 43 “Radon is a Serious National Health Problem American Lung Association American Medical Association Environmental Protection Agency National Academy of Sciences National Council on Radiation Protection and Measurement U.S. Surgeon General World Health Organization
    44. 44. 01/30/15 Illinois Department of 44 National Radon Health Advisory “Indoor radon gas is a national health problem. Radon causes thousands of deaths each year. Millions of homes have elevated radon levels. Most homes should be tested for radon. When elevated levels are confirmed, the problem should be corrected.” U.S. Public Health Service
    45. 45. 01/30/15 Illinois Department of 45 Recent Analysis of Multiple Studies Confirm Risk-January 2, 1997 National Cancer Institute overall analysis of several studies. Rocky Mountain News, January 2, 1997Rocky Mountain News, January 2, 1997

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