Impact of Indoor Radon Exposure on Lung Cancer Incidence in Slovenia.

Indoor radon is an important risk factor for lung cancer, as 3-14% of lung cancer cases can be attributed to radon. The aim of our study was to estimate the impact of indoor radon exposure on lung cancer incidence over the last 40 years in Slovenia. We analyzed the distribution of lung cancer incidence across 212 municipalities and 6032 settlements in Slovenia. The standardized incidence ratios were smoothed with the Besag-York-Mollie model and fitted with the integrated nested Laplace approximation. A categorical explanatory variable, the risk of indoor radon exposure with low, moderate and high risk values, was added to the models. We also calculated the population attributable fraction. Between 2.8% and 6.5% of the lung cancer cases in Slovenia were attributable to indoor radon exposure, with values varying by time period. The relative risk of developing lung cancer was significantly higher among the residents of areas with a moderate and high risk of radon exposure. Indoor radon exposure is an important risk factor for lung cancer in Slovenia in areas with high natural radon radiation (especially in the southern and south-eastern parts of the country).

Radon exposure risks among residents proximal to gold mine tailings in Gauteng Province, South Africa: a cross-sectional preliminary study protocol.

Gold mine tailings, a legacy of the mining industry, harbors significant amount of radon gas, a classified human carcinogen. Radon exposure, especially near tailings, is a significant public health threat, potentially leading to increased risk of lung cancer, leukemia, and chronic obstructive pulmonary disease (COPD). These health problems are often associated with lower survival rates and significant financial burdens. This ongoing research aim to evaluating the relationship between indoor radon exposure and lung cancer, leukemia, and COPD risks among residents proximal to gold mine tailings in Gauteng Province, South Africa. This cross-sectional preliminary study focus on two distinct groups: Riverlea (exposed group, <2 km to Gold mine tailings) and Orlando East (unexposed group, >2 km to Gold mine tailings). Indoor radon levels is measured using AlphaE monitors, while health risks (lung cancer, leukemia, and COPD) linked to exposure are evaluated through interview-administered questionnaire and secondary data from Gauteng Health Department. Of the 476 residents randomly selected for this study, 300 have already participated, with balanced representation from both the exposed and unexposed groups. The study will compare indoor radon levels and health outcomes between the two groups. This study's results could aid in creating targeted interventions and policies to mitigate indoor radon exposure risks and safeguard vulnerable communities from this significant public health hazard.

Experimental Setups for In Vitro Studies on Radon Exposure in Mammalian Cells-A Critical Overview.

Naturally occurring radon and its short lived progeny are the second leading cause of lung cancer after smoking, and the main risk factor for non-smokers. The radon progeny, mainly Polonium-218 (218Po) and Polonium-214 (214Po), are responsible for the highest dose deposition in the bronchial epithelium via alpha-decay. These alpha-particles release a large amount of energy over a short penetration range, which results in severe and complex DNA damage. In order to unravel the underlying biological mechanisms which are triggered by this complex DNA damage and eventually give rise to carcinogenesis, in vitro radiobiology experiments on mammalian cells have been performed using radon exposure setups, or radon analogues, which mimic alpha-particle exposure. This review provides an overview of the different experimental setups, which have been developed and used over the past decades for in vitro radon experiments. In order to guarantee reliable results, the design and dosimetry of these setups require careful consideration, which will be emphasized in this work. Results of these in vitro experiments, particularly on bronchial epithelial cells, can provide valuable information on biomarkers, which can assist to identify exposures, as well as to study the effects of localized high dose depositions and the heterogeneous dose distribution of radon.

Radiation Protection of Polydatin Against Radon Exposure Injury of Epithelial Cells and Mice.

Radon exposure is significantly associated with lung cancer. Radon concentration is currently reduced mainly by physical methods, but there is a lack of protective drugs or biochemical reagents for radon damage. This study aimed to explore the protective effect of polydatin (PD) on the radon-exposed injury. The results showed that PD can significantly reduce ROS level, raise SOD activity, weaken the migration ability, increase E-cad, and decrease mesenchymal cell surface markers (FN1, Vimentin, N-cad, α-SMA, and Snail) in radon-exposed epithelial cells. In vivo, PD increased the mice weight, promoted SOD activity, and decreased MDA content, the number of bullae, pulmonary septum thickness, lung collagenous fibers, and mesenchymal cell surface markers. Furthermore, PD inhibited p-PI3K, p-AKT, and p-mTOR expression. Compared with directly adding PD on radon-exposed cells, adding PD before and after radon exposure could more obviously improve the adhesion of radon-exposed cells, significantly alleviate the migration ability, and more significantly reduce mesenchyme markers and p-AKT and p-mTOR. These results indicate that PD can reduce oxidative stress, weaken epithelial-mesenchymal transition (EMT) and lung fibrosis in radon-exposed cells/mice, and have good radiation protection against radon injury. The mechanism is related to the inhibition of the PI3K/AKT/mTOR pathway.

Radon - occurrence and impact on the health.

Radon is noble, monatomic, radioactive, heavier than the air gas. It is colorless, odorless, tasteless. It exists in natural environment as a result of the decay of radium, and emits mainly alpha radiation and less beta radiation. Residential radon concentrations vary widely by geographic area. The higher concentration of radon is expected globally in the grounds where uranium, radium and thoron are present. Radon may gather in caves, tunnels, mines as well as in other lowestlying spaces, such as basements, and cellars. In accordance with Atomic Law (2000), the reference level for the average annual concentration of radioactive radon in rooms intended for human habitation is 300 Bq/m3. The most dangerous damages caused by ionizing radiation i.e. radon and its derivatives are changes to DNA, which may disturb the functions of cells and in the consequence lead to induction of cancer of respiratory tract, mainly of lungs and also leukaemia. So, the main consequence of exposure to high amount of radon are cancers of respiratory system. Radon enters the human organism mainly through inhaled atmospheric air. Moreover, radon significantly increased a risk of induction cancer in smokers and vice versa, smoking promotes the development of lung cancer after the exposure to radon and its derivatives. Radon may also have beneficial effect on the human body. Therefore it is used in medicine; mainly in radonbalneotherapy i.e. bath treatments, rinsing the mouth and inhalation. Beneficial effects of radon confirms the validity of the theory of radiation hormesis, which assumes that low doses of radiation may stimulate the repair of DNA damage by activation of protective mechanisms, which neutralize free radicals.

Indoor Radon Concentration Levels in Healthcare Settings: The Results of an Environmental Monitoring in a Large Italian University Hospital.

The aim of the study is to determine the radon concentrations in the University Hospital of Bari, Apulia Region, Southern Italy. The monitoring took place from 2017 to 2018 for a total of 402 days and included 3492 premises. Radon environmental sampling was performed with passive dosimeters of the CR-39 type. The highest mean concentration was found in basement rooms (118.9 Bq/m3), followed by ground-floor rooms (88.2 Bq/m3), first-floor rooms (78.1 Bq/m3), second-floor rooms (66.7 Bq/m3), and third-floor rooms (68.9 Bq/m3). An average radon concentration lower than the WHO recommended level of 100 Bq/m3 was detected in 73.5% of monitored environments, while only 0.9% exceeded the reference level of 300 Bq/m3 set by the national law (Legislative Decree 101/2020). The frequency of environments in which radon concentrations exceed 300 Bq/m3 is significantly higher in the basement (p-value < 0.001). As for a previous preliminary investigation in the same hospital conducted on a much smaller number of premises (n = 401), most of the monitored environments had radon concentrations lower than the reference levels set by the new national law, and the risk to the healthcare workers' health derived from occupational exposure to radon could be considered acceptable.

Assessment of indoor radon exposure in South Korea.

The objective of this study is to update the national and regional indoor radon concentrations in South Korea and assess indoor radon exposure. Based on the previously published survey results and the collected measurement data of surveys conducted since 2011, a total of 9271 indoor radon measurement data covering 17 administrative divisions are finally used for analysis. The annual effective dose from the indoor radon exposure is calculated using dose coefficients recommended by the International Commission on Radiological Protection. The population-weighted average indoor radon concentration was estimated to be a geometric mean of 46 Bq m-3(GSD = 1.2) with 3.9% of all samples showing values exceeding 300 Bq m-3. The regional average indoor radon concentration ranged from 34 to 73 Bq m-3. The radon concentrations in detached houses were relatively higher than those in public buildings and multi-family houses. The annual effective doses to the Korean population due to indoor radon exposure were estimated to be 2.18 mSv. The updated values in this study might better represent the national indoor radon exposure level in South Korea because they contain more samples and cover a wider range of geographical areas than previous studies.

Average uranium bedrock concentration in Swedish municipalities predicts male lung cancer incidence rate when adjusted for smoking prevalence: Indication of a cumulative radon induced detriment.

Bedrock U has been used as a proxy for local indoor radon exposure. A preliminary assessment of cancer incidence rate in a cohort of 809,939 adult males living in 9 different Swedish counties in 1986 has been used to correlate the cumulative lung cancer and total cancer (excluding lung) incidence rates between 1986 and 2020, respectively with the municipality average value of bedrock U concentration obtained from Swedish geological Survey (SGU). To control for regional difference in tobacco smoking, data on county average smoking prevalence, obtained from a survey conducted by the Public Health Agency of Sweden from 2001 to 2004, was used. Regression analysis shows that there is a significant positive correlation between smoking prevalence adjusted lung cancer incidence rate in males and the municipality bedrock U concentration (R2 = 0.273 with a slope 5.0 ±â€¯0.87·10-3 ppm-1). The correlation is even more significant (R2 = 0.759 with a slope = 4.8 ±â€¯0.25·10-3 ppm-1) when assessed on population weighted cancer incidence data binned in nine intervals of municipality average bedrock U concentration (ranging from 0.97 to 4.9 ppm). When assessing the corresponding correlations for total cancer incidence rate (excluding cancer of the lung) with adjustment for smoking prevalence, there appears to be no or little correlation with bedrock U concentration (R2 = 0.031). We conclude that an expanded future study needs age-standardized cancer incidence data to obtain a more consistent exposure-response model. Such model could be used to predict future lung cancer cases based on geological survey maps of bedrock U as an alternative to laborious indoor radon measurements, and to discern what future lung cancer rates can be expected for a population nearing zero smoking prevalence, with and without radon prevention.

Lung cancer incidence attributable to residential radon exposure in Finland.

This study aimed to estimate (1) the number of avoidable lung cancer cases attributable to residential radon in Finland in 2017, separately by age, sex, dwelling type and smoking status, (2) the impact of residential radon alone and the joint effect of residential radon and smoking on the number of lung cancers and (3) the potential decrease in the number of radon-attributable lung cancers if radon concentrations exceeding specified action levels (100, 200 and 300 Bq m-3) would have been mitigated to those levels. Population-based surveys of radon concentrations and smoking patterns were used. Observed radon levels were contrasted with 25 Bq m-3 representing a realistic minimum level of exposure. Lung cancer risk estimates for radon and smoking were derived from literature. Lastly, the uncertainty due to the estimation of exposure and risk was quantified using a computationally derived uncertainty interval. At least 3% and at most 8% of all lung cancers were estimated as being attributable to residential radon. For small cell carcinoma, the proportion of cases attributable to radon was 8-13%. Among smokers, the majority of the radon-related cases were attributable to the joint effect of radon and smoking. Reduction of radon exposure to 100 Bq m-3 action level would eliminate approximately 30% of radon-attributable cases. Estimates were low compared with the literature, given the (relatively high) radon levels in Finland. This was mainly due to the lower radon levels and higher smoking prevalence in flats than in houses and a more realistic point of comparison, factors which have been ignored in previous studies. The results can guide actions in radon protection and in prevention of lung cancers.

Radon Exposure in the Underground Tourist Route-Historic Silver Mine in Tarnowskie Góry, Poland.

An assessment of the exposure of workers and tourists to radon in the underground tourist route of the Historic Silver Mine in Tarnowskie Góry was carried out. The study was conducted over a one-year period to capture seasonal variations in radon concentrations. CR-39 track detectors were used to measure radon concentrations, which were exposed in the mine during the following periods: 9 February 2021-19 May 2021, 19 May 2021-26 August 2021, 26 August 2021-25 November 2021 and 25 November 2021-3 March 2022. The annual average radon concentration along the tourist route was 1021 Bq m-3. The highest measured concentration was 2280 Bq m-3 and the lowest concentration was 80 Bq m-3. Based on the measured concentrations, effective doses were calculated, assuming that employees spend 1350 h a year in underground areas and that the time of visiting the mine by tourists is ca. 1 h. The average annual effective dose a worker would receive is approximately 2.5 mSv, and a tourist below 2 µSv. The dose limit expressed as the annual effective dose is 1 mSv for members of the general public and 20 mSv for occupational exposure.

Lung cancer as adverse health effect by indoor radon exposure in China from 2000 to 2020: A systematic review and meta-analysis.

Indoor radon exposure is thought to be associated with adverse health effect as lung cancer. Lung cancer incidences in China have been the highest worldwide during the past two decades. It is important to quantitively address indoor radon exposure and its health effect, especially in countries like China. In this paper, we have conducted a meta-analysis based on indoor radon and its health effect studies from a systematic review between 2000 and 2020. A total of 8 studies were included for lung cancer. We found that the relative risk (RR) was 1.01 (95% CI: 1.01-1.02) per 10 Bq/m3 increase of indoor radon for lung cancer in China. The subgroup analysis found no significant difference between the conclusions from the studies from China and other regions. The health effect of indoor radon exposure is relatively consistent for the low-exposure and high-exposure groups in the subgroup analysis. With a better understanding of exposure level of indoor radon, the outcomes and conclusions of this study will provide supports for next phase of researches on estimation of environmental burden of disease by indoor radon exposures in countries like China.

Molecular Characteristics of Radon Associated Lung Cancer Highlights MET Alterations.

Effective targeted treatment strategies resulted from molecular profiling of lung cancer with distinct prevalent mutation profiles in smokers and non-smokers. Although Rn is the second most important risk factor, data for Rn-dependent driver events are limited. Therefore, a Rn-exposed cohort of lung cancer patients was screened for oncogenic drivers and their survival and genetic profiles were compared with data of the average regional population. Genetic alterations were analysed in 20 Rn-exposed and 22 histologically matched non-Rn exposed LC patients using targeted Next generation sequencing (NGS) and Fluorescence In Situ Hybridization (FISH). Sufficient material and sample quality could be obtained in 14/27 non-exposed versus 17/22 Rn-exposed LC samples. Survival was analysed in comparison to a histologically and stage-matched regional non-exposed lung cancer cohort (n = 51) for hypothesis generating. Median overall survivals were 83.02 months in the Rn-exposed and 38.7 months in the non-exposed lung cancer cohort (p = 0.22). Genetic alterations of both patient cohorts were in high concordance, except for an increase in MET alterations and a decrease in TP53 mutations in the Rn-exposed patients in this small hypothesis generating study.

Effects of spatial variation in dose delivery: what can we learn from radon-related lung cancer studies?

Exposure to radon progeny results in heterogeneous dose distributions in many different spatial scales. The aim of this review is to provide an overview on the state of the art in epidemiology, clinical observations, cell biology, dosimetry, and modelling related to radon exposure and its association with lung cancer, along with priorities for future research. Particular attention is paid on the effects of spatial variation in dose delivery within the organs, a factor not considered in radiation protection. It is concluded that a multidisciplinary approach is required to improve risk assessment and mechanistic understanding of carcinogenesis related to radon exposure. To achieve these goals, important steps would be to clarify whether radon can cause other diseases than lung cancer, and to investigate radon-related health risks in children or persons at young ages. Also, a better understanding of the combined effects of radon and smoking is needed, which can be achieved by integrating epidemiological, clinical, pathological, and molecular oncology data to obtain a radon-associated signature. While in vitro models derived from primary human bronchial epithelial cells can help to identify new and corroborate existing biomarkers, they also allow to study the effects of heterogeneous dose distributions including the effects of locally high doses. These novel approaches can provide valuable input and validation data for mathematical models for risk assessment. These models can be applied to quantitatively translate the knowledge obtained from radon exposure to other exposures resulting in heterogeneous dose distributions within an organ to support radiation protection in general.

Risk assessment and prediction for lung cancer among Hong Kong Chinese men.

OBJECTIVE: Most of the previous risk prediction models for lung cancer were developed from smokers, with discriminatory power ranging from 0.57 to 0.72. We constructed an individual risk prediction model for lung cancer among the male general population of Hong Kong. METHODS: Epidemiological data of 1,069 histology confirmed male lung cancer cases and 1,208 community controls were included in this analysis. Residential radon exposure was retrospectively reconstructed based on individual lifetime residential information. Multivariable logistic regression with repeated cross-validation method was used to select optimal risk predictors for each prediction model for different smoking strata. Individual absolute risk for lung cancer was estimated by Gail model. Receiver-operator characteristic curves, area under the curve (AUC) and confusion matrix were evaluated to demonstrate the model performance and ability to differentiate cases from non-cases. RESULTS: Smoking and smoking cessation, education, lung disease history, family history of cancer, residential radon exposure, dietary habits, carcinogens exposure, mask use and dust control in workplace were selected as the risk predictors for lung cancer. The AUC of estimated absolute risk for all lung cancers was 0.735 (95% CI: 0.714-0.756). Using 2.83% as the cutoff point of absolute risk, the predictive accuracy, positive predictive value and negative predictive value were 0.715, 0.818 and 0.674, respectively. CONCLUSION: We developed a risk prediction model with moderate discrimination for lung cancer among Hong Kong males. External validation in other populations is warranted for this model in future studies.

Risk estimation for lung cancer caused by indoor radon exposure in China based on EPA/BEIR-VI model / 中华放射医学与防护杂志

Objective:To estimate the attribution share of residents′lung cancer caused by indoor Radon.Methods:Based on the 2015 lung cancer mortality, all-cause mortality from China together with nationally representative smoking rate and the average indoor radon concentration of 30 Bq/m 3, the relatively authoritative and applicable EPA/BEIR-VI risk model was used to predict the lung cancer mortality caused by indoor radon exposure. Results:The excess relative risk (ERR) of indoor radon-related lung cancer mortality among the male non-smokers is higher than that of smokers. For the age-group above 50, the male smokers and male non-smokers have the highest ERR values, which were 0.511 and 0.230, respectively. Assuming the exposure incurred starting at age 0 with the same radon concentration, the lifetime risk of men and women non-smokers is higher than that of the smokers of the same gender. The higher the radon concentration, the higher the lifetime risk of lung cancer. Assuming that the radon concentration level in China is 30 Bq/m 3, the number of deaths from indoor radon-related lung cancer in 2015 is about 55 512. According to this, about 6.62% of lung cancers are caused by indoor radon exposure. If we assume that radon concentration levels are 40 Bq/m 3and 70 Bq/m 3 in China, approximately 8.82% and 15.38% of lung cancer deaths can be attributed to indoor radon exposure. Conclusions:Indoor radon exposure is an important environmental factor that causes Chinese residential lung cancer. Effective measures should be taken to prevent and control the increasing indoor radon levels. In order to accurately assess risk of lung cancer morality caused by indoor radon, more detailed data such as the indoor radon level in China are needed.

Status of radon exposure in Bangladeshi locations and dwellings.

Potentially higher cancer risk due to exposure from natural background radiation was indicated for the Bangladeshi population by estimations based on the countrywide study. Several regions with elevated natural background exhibited higher soil radium and thorium contents than the world average. Being the decay products of these radioactive elements, natural radon isotopes could constitute environmental risk factors for internal radiation exposure to the lungs of people living in these areas. Although lung cancer is one of the most prevalent types of cancer in Bangladesh, its status and features are still unclear. To clarify the present status of one of the potential risk factors for lung cancer in the country, this review intends to ascertain the countrywide radon exposure, and its pathways by types of local dwelling and by regions, which would provide an indication of the internal exposures in areas of elevated natural background radiation and radionuclides of soil as well as an understanding of the preliminary contribution of environmental radon on the country's lung cancer prevalence. In this review, countrywide monitored air radon exposures for Bangladeshi dwellings and workplaces are organized from peer-reviewed published papers. Radon has been identified as one of influential sources of radiation dose in Bangladesh with its higher radon exhalation and emanation rate from soil. A novel nationwide depiction of the overall assessed indoor and soil radon levels for Bangladesh has been made through radiation maps. This would be helpful for designing future systematic radon/radiological monitoring and research on the country's lung cancer prevalence.

A Novel Strategy for the Assessment of Radon Risk Based on Indicators.

Among the physical pollutants affecting indoor air, the radioactive gas radon may turn out to be the most hazardous. Health effects related to radon exposure have been investigated for several decades, providing major scientific evidence to conclude that chronic exposures can cause lung cancer. Additionally, an association with other diseases, such as leukemia and cancers of the extra-thoracic airways, has been advanced. The implementation of a strategy to reduce the exposure of the population and minimize the health risk, according to the European Directive 59/2013/Euratom on ionizing radiations, is a new challenge in public health management. Starting from an understanding of the general state-of-the-art, a critical analysis of existing approaches has been conducted, identifying strengths and weaknesses. Then, a strategy for assessing the radon exposure of the general population, in a new comprehensive way, is proposed. It identifies three main areas of intervention and provides a list of hazard indicators and operative solutions to control human exposure. The strategy has been conceived to provide a supporting tool to authorities in the introduction of effective measures to assess population health risks due to radon exposure.

Survey of Radon Concentrations in the University of Granada in Southern Spain.

The objective of this pilot study was to gather and analyze data on radon concentrations in workplaces in three buildings of Granada University (Southern Spain) constructed in different centuries. All measurements were made at basement or ground floor level under normal use conditions except for one space (mineral store), in which measurements were compared between the door closed and open. Measurements were conducted during different time periods between October 2013 and March 2019 with a Radon-Scout PLUS portable Radonmonitor. The duration of continuous recordings at different sites ranged between 42 and 1104 h. Mean accumulated radon concentrations ranged between 12 and 95 Bq/m3, below the maximal level of 300 Bq/m3 set by the World Health Organization (WHO). Relatively high values were recorded in the oldest building (15th century), which was also poorly ventilated. Ventilation appeared to be an important factor in reducing radon levels, especially in areas less exposed to radon, such as Southern Spain.

The National Dose Registry-Canadian occupational exposure to ionising radiation, 1998-2018.

The National Dose Registry (NDR) is owned and operated independently by Health Canada. This paper provides an overview of how the registry operates within the Canadian regulatory structure, followed by an analysis of annual effective dose trends in nine job classes with relatively higher mean annual effective doses, i.e. greater than 1 mSv as reported in 2017. The analysis showed that, with a few exceptions, mean annual effective doses have generally decreased or remained practically unchanged in the past two decades at relatively low exposure levels. This review of occupational dose trends is evidence of the effectiveness of radiation protection programmes in Canada. The NDR has played an important role in the identification of relatively higher dose records and allowed the regulatory bodies to act immediately to ensure appropriate actions were taken.

Indoor radon exposure and excess of lung cancer mortality: the case of Mexico-an ecological study.

Radon is a radioactive gas that can migrate from soils and rocks and accumulate in indoor areas such as dwellings and buildings. Many studies have shown a strong association between the exposure to radon, and its decay products, and lung cancer (LC), particularly in miners. In Mexico, according to published surveys, there is evidence of radon exposure in large groups of the population, nevertheless, only few attention has been paid to its association as a risk factor for LC. The aim of this ecological study is to evaluate the excess risk of lung cancer mortality in Mexico due to indoor radon exposure. Mean radon levels per state of the Country were obtained from different publications and lung cancer mortality was obtained from the National Institute of Statistics, Geography and Informatics for the period 2001-2013. A model proposed by the International Commission on Radiological Protection to estimate the annual excess risk of LC mortality (per 105 inhabitants) per dose unit of radon was used. The average indoor radon concentrations found rank from 51 to 1863 Bq m-3, the higher average dose exposure found was 3.13 mSv year-1 in the north of the country (Chihuahua) and the mortality excess of LC cases found in the country was 10 ± 1.5 (range 1-235 deaths) per 105 inhabitants. The highest values were found mainly in the Northern part of the country, where numerous uranium deposits are found, followed by Mexico City, the most crowded and most air polluted area in the country. A positive correlation (r = 0.98 p < 0.0001) was found between the excess of LC cases and the dose of radon exposure. Although the excess risk of LC mortality associated with indoor radon found in this study was relatively low, further studies are needed in order to accurately establish its magnitude in the country.