Transcript Science Update - CHEEC Home

Current National and International Scientific RadonRelated Activities and Educational Initiatives
Keynote Address
R. William Field, Ph.D., M.S.
Associate Professor
Department of Occupational
and Environmental Health
Department of Epidemiology
College of Public Health
104 IREH
University of Iowa
Iowa City, IA 52242
[email protected]
Fifteenth National Radon Meeting
Shelter Pointe Hotel and Marina
San Diego, California
September 25–28, 2005
Current National and International Scientific
Radon-Related Activities and Educational
Initiatives
• Residential Radon Epidemiology
–
–
–
–
European Residential Radon Pooling
North American Residential Radon Pooling
Global Residential Radon Pooling
Iowa and Missouri Glass-based Residential
Pooling (Laboratory and Field Studies - Steck)
– Genetic polymorphims
– Other diseases related to radon exposure?
• Educational Initiatives
– Coordination of stakeholders within regions and states
– World Health Organization Initiative
Radon Epidemiology
1556
1879
1921
1950s
1970s
1990s
1994
1999
2005
Agricola - Miners in Europe
Harting & Hesse - Lung Cancer in Miners
Uhlig - Radium Emanations & Lung Cancer
Peller - First Review of Mining Related Cancers
Studies of Underground Miners (ongoing)
Residential Radon Studies
NCI Pooled Analyses of Miners
NAS BEIR VI Report
North American and European Pooled
Residential Radon Studies
2007 Global Pooling of Residential Radon Studies
2007 Pooling of Glass-based Residential Radon
Studies
European Residential Radon Pooling
Radon in homes and risk of lung cancer:
European case-control studies collaborative
analysis of individual data from 13 European
Case-control studies.
S Darby, D Hill, A Auvinen, J M Barros-Dios, H Baysson, F Bochicchio,
H Deo, R Falk, F Forastiere, M Hakama, I Heid, L Kreienbrock, M
Kreuzer, F Lagarde, I Mäkeläinen, C Muirhead, W Oberaigner, G
Pershagen, A Ruano-Ravina, E Ruosteenoja, A Schaffrath Rosario, M
Tirmarche, L Tomácek, E Whitley, H-E Wichmann, and R Doll
7,148 Cases, 14,208 controls
British Medical Journal 330: 223, Jan 2005
Study
Cases
Controls
% increase of
risk at 100
Bq/m3
Austria
183
188
46
Czech Republic
171
713
19
Finland (nationwide)
881
1435
3
Finland (south)
160
328
6
France
571
1209
11
Germany (eastern)
945
1516
18
Germany (western)
1323
2146
-2
Italy
384
405
10
Spain
156
235
-11
Sweden (nationwide)
960
2045
11
Sweden (never smokers)
258
487
24
Sweden (Stockholm)
196
375
12
United Kingdom
960
3126
4
European Pooling Summary
• The risk of lung cancer increased by 8.4%
(95% confidence interval 3.0% to 15.8%)
per 100 Bq/m3
• After correction for the dilution caused by
random uncertainties in measuring radon
concentrations, an increase of 16% (5% to
31%) per 100 Bq/m3 was noted
• Small cell histologic type most associated
with radon exposure
2.2
ODDS RATIO
2.0
1.8
1.6
1.4
1.2
1.0
0.8
25-49
50-99
100-199 200-399 400-799
>800
North American Residential Radon
Pooled Analyses
Residential Radon and Risk of Lung
Cancer: a Combined Analysis of 7 North
American Case-control Studies
Krewski D, Lubin JH, Zielinski JM, Alavanja M, Catalan
VS,Field RW,Klotz JB, Letourneau EG, Lynch CF, Lyon
JI,Sandler DP, Schoenberg JB, Steck DJ, Stolwijk JA,
Weinberg C, Wilcox HB
3,662 cases, 4,966 controls
Epidemiology 16(2):137-45. Mar 2005
Basement and Living Area Radon Concentrations
for U.S. Residential Radon Studies.
Study
Location
New Jersey
Missouri-I
Missouri-II
Iowa
Connecticut,
Utah Southern
Idaho2
1Summary
Geometric Mean in pCi/L
Basement
2.4
2.4
4.6
1.5
1.8
Level 1
0.5
1.2
Level 2
0.7
1.2
1.2
2.5
1.2
2.0
0.5
1.2
0.4
1.0
data represent those homes that were measured with no imputed
(values added to replace missing values) values.
Cases
Controls
% Excess Risk at
100 Bq/m3
480
738
442
738
56
2
Missouri I
NCI
538
1183
1
Missouri II (Gas Phase)
NCI
512
553
27
Iowa (Gas Phase)
NIEHS, NCI, EPA
413
614
44
Connecticut
NIEHS
963
949
2
Utah-South Idaho
NIEHS
511
862
3
Study
New Jersey
Winnipeg
Health Canada
North American Pooling Summary
• The 11% estimated risk at 100 Bq/m3 is
consistent with the predicted excess risk of
12% per 100 Bq/m3 based on a linear model
developed by the National Research Council
• When the analyses were restricted to
individuals living in one or two homes for at
least 20 years, the risk estimates increased
to 18% at 100 Bq/m3
2.2
ODDS RATIO
2.0
1.8
1.6
1.4
1.2
1.0
25-49
50-74
75-99 100-149150-199 >200
Bq/m3
Pooled Analyses Agreement ??
New Jersey, Missouri I, Canada, Iowa,
Missouri II, a combined study from
Connecticut, Utah and S. Idaho
Shenyang, China, Stockholm, Sweden,
Swedish nationwide, Winnipeg, Canada,
S. Finland, Finnish nationwide, SW
England, W. Germany, Sweden, Czech
Republic, Italy-Trento, Spain, Austria,
France, China - Gansu Province, E.
Germany
We have “demonstrated that empiric
models with improved retrospective
radon exposure estimates were more
likely to detect an association between
prolonged residential radon exposure and
lung cancer.”
Therefore, estimated pooled risk
estimates are likely low.
Journal of Exposure Analysis and Environmental Epidemiology 12(3):197-203, 2002.
Risk Estimates for Alternative Models
(live cases and controls)
2.2
Complete
exposure
Odds Ratio
2.0
1.8
Other location
radon
concentrations
only
WLM20
1.6
1.4
1st Story
BR
BR/LR
LR
Basement
1.2
1.0
0.8
20-39%
40-59%
60-79%
JEAEE 12(3): 197-203, 2002
80+%
Special Residential Radon Publication
February 2006 issue
Samet, J. Residential Radon Epidemiology
Zielinski, J, Field, R.W., Residential Radon and Lung Cancer - Preface
Krewski et al. A Combined Analysis of North American Case-Control
Studies of Residential Radon and Lung Cancer.
Field et al. An Overview of the North American Case-Control Studies
of Residential Radon and Lung Cancer.
Sandler et al. Connecticut, Utah/S. Idaho Residential Radon Studies
Steck, D., Field, R.W. Dosimetric Challenges for Residential Radon
Epidemiology.
GLOBAL RESIDENTIAL RADON POOLING
Led by Sarah Darby at Oxford, U.K.
Next meeting of investigators – Geneva, March 2006
Anticipated completion 2007
10,810 cases; 19,174 controls
New Jersey, Missouri I, Canada, Iowa, Missouri II,
Connecticut, Utah and S. Idaho, Shenyang, China,
Stockholm, Sweden, Swedish nationwide, Winnipeg,
Canada, S. Finland, Finnish nationwide, SW England, W.
Germany, Sweden, Czech Republic, Italy-Trento, Spain,
Austria, France, China - Gansu Province, E. Germany
Current Activities
Current collaboration between the University
of Iowa and the National Cancer Institute
involve pooling of the glass-based
retrospective radon detectors used in the two
studies. We believe the glass-based detectors
provide both improved retrospective radon and
radon progeny dosimetry.
“Glass-Based” Residential Radon
Studies
Glass-based detectors
measure embedded
radon progeny in glass
surfaces and can be
used to reconstruct the
average radon
concentration for
periods as long as
several decades.
Radon-222
4 day
a,g
Polonium-218
3 min
Retrospective Radon
Detectors
a,g
Lead-214
27 min
b,g
Bismuth-214
20 min
b,g
Polonium-214
• Progeny adhere to solid objects
• Can become embedded in glass
surfaces
0.2 ms
a,g
Lead-210
22 yrs
b,g
Bismuth-210
b,g
Polonium-210
a,g
Lead-206
(Stable)
5 day
138 day
• Alphas can be detected from Po 210
decay.
• Can provide a long-term indication of
radon decay deposition on objects in
home.
• A means to look back in time at radon
levels.
Recent results for retrospective radonrelated dose reconstruction from radon
progeny implanted in glass
Dose per unit radon
Exposure room studies
Simplified Models
Comparison with exposure room results
Dose Conversion Factor
• Concept
– Improve dose rate estimate using a dose delivery
efficiency factor to interpret the radon or radon
progeny concentration
• Basis
– Small radon progeny (nanoparticles) are much more
effective at delivering dose to sensitive lung tissues
than either radon or progeny attached to aerosols
– Different home atmospheres have different mixtures
of small and large progeny
Radon Dose Conversion Factors
Dose rate per unit radon concentration
measured in a radon exposure room
160
140
120
80
60
40
20
n
Fa
in
g
M
ix
HE
PA
Ai
rM
HE
is
t
PA
&IO
N
Oi
l
de
le
s
Gl
a
Ca
nd
ET
S
0
No
rm
al
DCF
100
Deposition – Results
Normalized activities of select runs
100
surface act. normed to Rn
((Bq/m2)/(kBq/m3)=mm)
90
80
Hepa filter
70
60
candle
50
Smoke
40
med R.H.
30
20
10
0
Po218
Pb214
Bi-Po214
Introduction and Background
• Each of these
processes must be
modeled for all
the progeny
Model correlations
• Look for strong
correlations
between
measurable
activities and dose
• Non-linear or
linear functions
• single or multiple
variables
Test dose predictions against
exposure room data
What’s the situation in homes?
• Long-term, integrated measurements
of airborne radon progeny, radon, and
deposited radon progeny in a variety
of homes to test the model
• Fieldwork started in Iowa and
Minnesota with a goal of at least 20
houses, depending on funding, in each
state split between smoking and nonsmoking.
Residential Radon Epidemiology: Do the
risk estimates indicate that everyone has
the same risk of developing radon
induced lung cancer?
• First degree relatives of a lung cancer victim have a 2 to
3 fold increased risk of developing lung cancer.
• Genetic polymorphisms play a role in susceptibility.
Genetic polymorphisms are defined as variations in
DNA that are observed in 1% or more of the population.
Ionizing radiation can directly and
indirectly damage DNA
Alpha
Particle
Defects in tumor
suppressor genes – p53
At risk individuals–GSTM1
(glutathione S-transferase M1)
Bonner MR, Bennett WP, Lan Q,Wright ME, Lubin JH, Field RW,
Brownson RC, Alavanja MCR,Radon, Environmental Tobacco Smoke,
Glutathione-s-transferase M1 and Lung Cancer in US Women.
• Recent work with collaborators at the NCI and City of
Hope (Los Angeles) have explored gene-environment
interactions between residential radon, environmental
tobacco smoke (ETS), and the GSTM1 null genotype.
• The sample series included lung cancer cases pooled
from three previously completed case-control studies.
• Recent results show a statistically significant 3-fold
increase in the interaction OR for GSTM1 null cases
compared with GSTM1 present cases.
• These findings have just been submitted for publication.
Educational Initiatives
Why is it so hard to get people to
take action on radon ??
 Invisible, odorless, colorless
 Naturally occurring (no villains)
 Can not link deaths to radon exposure
 Long latency period
 Not a disease affecting children
 Not a dread hazard
 Cancers occur one at a time
 Voluntary risk
 Lack of press – no sensational story
 No sensory reminders to repetitively stimulate
us to think about it
“Motivation is the art of getting people to
do what you want them to do because they
want to do it.”
Dwight D. Eisenhower
“Motivation is a fire from within. If
someone else tries to light that fire under
you, chances are it will burn very briefly.”
Stephen R. Covey
Education is the starting point
• Lead by example – Develop a “Top 10”
reasons I am concerned about radon
presentation. Describe why you have a fire
inside to take action on radon.
• Provide sample health-based presentations
to local civics groups etc.
• Team up with local health organizations
Comparing Radon Related
Cancer to Other Cancer Types
Annual U.S. Cancer Deaths
Lung Cancer (radon)
20000
18000
16000
14000
12000
10000
8000
6000
4000
2000
0
Liver Cancer
Brain Cancer
Stomach Cancer
Melanoma
Oral Cancer
Gallbladder Cancer
Bone Cancer
Radon Induced Lung Cancer
Non-Hodgkin Lymphoma
Ovary
Liver
Esophagus
Bladder
Brain
Kidney
Stomach
Multiple Myeloma
Acute Myeloid Leukemia
Melanoma
Oral Cavity and Pharynx
Uterine Corpus
Chronic Lymphocytic Leukemia
Larynx
Uterine Cervix
Soft tissue
Gall Bladder
Thyroid
Acute Lymphocytic Leukemia
Hodgkin Disease
Bone and Joint
Small Intestine
Chronic Myeloid Leukemia
Ureter
Testis
Eye
CA Cancer J Clin 2005 55: 10-30.
5000
10000
15000
20000
Cancer Mortality per Year - United State
Networking
Maximize Educational Efforts
•
•
•
•
•
•
•
•
National Institute of Environmental Health
Sciences, Environmental Health Sciences
Research Center, University of Iowa
U.S. EPA Region VII
Iowa Department of Public Health
American Lung Association
Iowa Consortium for Comprehensive Cancer
Control
Holden Comprehensive Cancer Center
Iowa Air Coalition
American Cancer Society
International Radon Initiative
January 2005
Develop guidelines for member countries to
reduce radon exposure and develop radon
measurement and mitigation guidelines.
http://www.who.int/ionizing_radiation/env/radon/en/index.html
What are the benefits of an international
action agenda on radon?
• Provide scientific consensus on radon health risks
• Promote public awareness of health risks associated
with residential radon
• Promote action at national level
• Increase homeowner compliance with
voluntary/advisory radon guidelines
• Set minimum criteria for radon risk management (e.g.
measurement and mitigation) that allow for country
specific needs)
WHO Jan 17-18 Geneva
Consensus Statements
• For many people, radon represents the
largest source of exposure to ionizing
radiation in humans.
• Radon is known to cause lung cancer in
humans.
• Radon is an important contributor to the
human lung cancer burden, after tobacco
smoking.
• Radon is considered responsible for some 10 percent of
the human lung cancer burden in developed
countries/worldwide (will differ between developed and
undeveloped countries).
• The BEIR VI Report estimated there are approximately
22,000 deaths annually from radon in the United States
alone (European results will be added).
• Radon related lung cancer risk is affected by tobacco
smoking with most radon-related lung cancers occurring
in smokers; however, radon is one of the leading causes
of cancer in nonsmokers.
• Radon should be a priority public health issue for
national environmental and radiation safety programs.
• There is a need to carefully evaluate the costs and
benefits of national and international radon mitigation
programs.
• Based on existing knowledge of geological conditions
and building types, and consideration of the total lung
cancer burden, countries should consider developing
cost-effective national or regional policies on testing
and mitigation.
• Where appropriate, countries should build capacity
within the public and or/private sectors to provide
testing, mitigation and radon resistant new
construction.
• Where appropriate, countries should issue and widely
disseminate statements that address the importance of
radon risk reduction and the steps that can be taken to
reduce such risks.
• Countries should explore ways to address radon
health risks in a cost-effective manner,
considering both the installation of preventive
measures in new buildings and remediation of
existing buildings.
• National governments should team with other
stakeholders to ensure radon risk communication
messages are delivered from multiple sources
• Governments should strive to include radon health
messages and action steps with other national
efforts on green buildings, housing policy and the
built environment.
Radon Working Groups
• Risk Assessment – “World burden of disease”
• Exposure Guidelines
• Measurement and Mitigation
• Cost Effectiveness
• Risk Communication
• Program Evaluation
Measurement and Mitigation
Working Group
•
•
•
•
•
•
•
•
•
Radon Entry and Fate
Measurement Methods and Devices
Measurement Practices, Protocols, and Standards
Quality Management, Assurance, and Control
Mitigation Methods
Mitigation Practices and Standards
Prevention Strategies and Codes
Recommended Content for Training Programs for
Radon Testers and Mitigators
Gaps of Knowledge and Research Recommendations
Measurement Methods and Devices
• Recommended detector needs to be
able to perform well under a variety
of field conditions (good accuracy and
precision in the field setting)
• Factors that affect validity of the
measurement need to be examined
(e.g. humidity, gamma radiation,
thoron, etc.)
Summary
• Residential radon epidemiology has made major
advances the past few years.
• We no longer need to rely solely on
extrapolations from miners to predict risk for
people exposed to residential radon.
• We now have direct evidence that prolonged
residential radon is one of our leading public
health risks and major cause of cancer.
• The challenge now is to use this information so
that a fire can be lit within people to test and
mitigate as well as to promote radon resistant
new construction.