Editorials

Radon and Lung Cancer



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Am Fam Physician. 2000 Sep 1;62(5):950-951.

Family physicians often must counsel patients about preventive measures that may help prevent disease or prolong life. Lung cancer continues to be the leading cause of cancer deaths. While we know that cigarette smoking causes lung cancer, many physicians are not aware of the hidden threat posed by naturally occurring radon gas.

Results of several large epidemiologic studies of uranium miners exposed to radon,1 along with experimental data,2 have led the U.S. Surgeon General to warn that radon is the second leading cause of lung cancer.3 The World Health Organization and the National Academy of Sciences agree that radon is a known human carcinogen.3

Radon gas is a byproduct of naturally occurring uranium decay. Odorless, tasteless and invisible, it seeps into homes through cracks in foundations, pores in walls, floor drains or any areas exposed to the ground. Differences in pressure create a vacuum effect between buildings and the ground that draws radon into homes, where it can accumulate undiluted by outdoor air. The amount of radon in the soil beneath the house and the design of the house itself contribute to the variation of indoor radon levels. Knowing the radon level in a home is not possible without testing. Levels can vary widely, even between houses directly adjacent to each other.

Radon may cause cancer in smokers and nonsmokers, but the risk to smokers is much greater. The risk of developing lung cancer is proportionate to the amount of exposure (Table 1), with higher levels posing a higher risk. It is estimated that radon causes up to 30,000 deaths per year in the United States.3

Prevalence of Lung Cancer for Smokers and Nonsmokers by Radon Exposure

Radon level Smokers* Never-smokers†

2 pCi per L

15

1

4 pCi per L

29

2

8 pCi per L

57

3

10 pCi per L

71

4

20 pCi per L

135

8


pCi = picocuries.

*—Number of lung cancers expected if 1,000 persons who smoked were exposed to this level over a lifetime.

†—Number of lung cancers expected if 1,000 persons who had never smoked were exposed to this level over a lifetime.

Information from reference 3.

Prevalence of Lung Cancer for Smokers and Nonsmokers by Radon Exposure

View Table

Prevalence of Lung Cancer for Smokers and Nonsmokers by Radon Exposure

Radon level Smokers* Never-smokers†

2 pCi per L

15

1

4 pCi per L

29

2

8 pCi per L

57

3

10 pCi per L

71

4

20 pCi per L

135

8


pCi = picocuries.

*—Number of lung cancers expected if 1,000 persons who smoked were exposed to this level over a lifetime.

†—Number of lung cancers expected if 1,000 persons who had never smoked were exposed to this level over a lifetime.

Information from reference 3.

Since 1986, the U.S. Environmental Protection Agency (EPA) and the Surgeon General have recommended that all homes be tested for radon. The American Medical Association supports this recommendation. The average indoor level of radon in United States homes is 1.25 picocuries per L (pCi per L). Millions of homes in the United States are estimated to have a high radon level. If the measured level of radon in a home is greater than 4 pCi per L, it is recommended that a radon mitigation system be installed. A mitigation system vents radon from beneath the house to the outside of the home. Installation typically costs from $500 to $2,500.

Radon is a known carcinogen and may pose a serious health threat. Physicians may be the only science professionals that patients contact. It may not be cost effective to install a mitigation system in every home, but patients should be educated about the potential dangers of radon so that they are able to make informed decisions. Smokers should be made aware that they are at particularly high risk.

Of course, smoking cessation remains the most effective way to reduce the incidence of lung cancer. More information about radon can be found at the EPA Web site (www.epa.gov/iaq/radon). In addition, the EPA will supply a free booklet codeveloped by the American Medical Association entitled, “Radon: The Health Threat with a Simple Solution: A Physician's Guide.”3

Anthony J. Viera, LT, MC, USNR, is a staff family physician at Naval Hospital Guam.

Address correspondence to Anthony J. Viera, LT MC USNR, Naval Hospital Guam, PSC 490 Box NCT, AMS, FPO AP 96538.

The opinions and assertions contained herein are the private views of the author and are not to be construed as official or as reflecting the views of the Navy Medical Department or the Naval Service at large.

REFERENCES

1. Lubin JH, Boice JD, Edling C, Hornung RW, Howe G, Kunz E, et al. Radon and lung cancer risk: a joint analysis of 11 underground miners studies. Bethesda, Md.: National Institutes of Health, 1994.

2. Cross FT. Invited commentary: residential radon risks from the perspective of experimental animal studies Am J Epidemiol. 1994;140:333–9.

3. Radon: the health threat with a simple solution: a physician's guide. Washington, D.C.: U.S. Environmental Protection Agency, 1993.



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