Public Health Perspective
on
Radon Control in Ireland
Dr. Ina Kelly
Specialist Registrar in Public Health Medicine
Health Service Executive
Department of Public Health Tullamore
Radon Control in Ireland
• Prevention – Building Regulation 1997 (Technical
Guidance Document C)
– All new homes fitted with standby radon sump
– Homes located in High Radon Areas -install radon barrier
as well as a standby radon sump
• Mitigation
– Homes - RPII has identified and focuses on high radon
areas, raising awareness of radon and the benefits of
testing
– Workplaces - Safety, Health and Welfare at Work Act
2005 - employers to identify all hazards in their
workplace, including radon
New Evidence
& International Guidance
1. Gray et al 2009
•
2.
Health economic study showed installation of radon
barrier in all new builds is cost effective
WHO Radon Handbook
•
As no threshold for radon risk, recommends reducing
overall burden of radon for population
3. Independent Advisory Group on Ionising
Radiation (AGIR)
•
Recommend criteria for health screening should be
applied to radon screening
Why apply criteria for health screening
to Control of Radon in Ireland?
Radon control strategies differ from country to country
– Threshold values and action levels, definition of high radon
area
– Approach to prevention
– Testing and mitigation interventions
– Awareness in population
– Resource issues
Radon exposure is different from country to country
– Geology and rock formations
– Building practice
– Smoking rates (co-factor with radon)
About the screening criteria of the
National Cancer Forum, Ireland
Disease screening
- WHO criteria 1968 (Wilson and
Jungner)
Criteria to also consider:
– Harmful effects of screening
– Quality of evidence of
effectiveness of screening
– Opportunity costs of
implementing screening
programme
National Cancer Forum Criteria
•
•
•
•
The condition
The test
The treatment
The screening programme
Note – screening may be population based
or instead, targeted at higher risk groups
Cancer screening criteria
The condition
• Important health problem
• Epidemiology and natural history understood
• Cost-effective primary prevention interventions implemented
The test
• Simple, safe, precise and validated
• Distribution of test values known and cut-off level defined
and agreed
• Should be acceptable to population
• Agreed policy on further diagnostic investigation of
individuals with a positive test and on choices available
Cancer screening criteria
The treatment
• Effective treatment or intervention for those identified
through early detection, with evidence of better
outcomes for early rather than late treatment
• Agreed evidence-based policies covering which
individuals should be offered treatment and the
appropriate treatment to be offered
• Management of the condition and patient outcomes
should be maximised prior to starting programme
Cancer screening criteria
The screening programme
• Screening programme reducing mortality or morbidity
• Complete screening programme acceptability to health
professionals and to the public
• Benefit should outweigh the adverse effects
• Opportunity cost
• Plan for evaluating programme with agreed QA
standards
• Adequate resources in place prior to commencement
• All other options for managing the condition should
have been considered (e.g. improving treatment,
providing other services)
Public Health priorities
Overall aim: To reduce the number of cases of lung
cancer due to radon exposure
• Effective radon control strategy
• Primary prevention first
• Screening programme (secondary prevention) effectiveness and opportunity cost
• Evaluation of outcomes of programme
implementation
Public Health recommendations
• Time to review current policy on radon
control including:
– Building regulations
– Smoking cessation
– Standardisation of prevention, testing and
mitigation interventions
– On-going monitoring and evaluation of
programme effectiveness
References
1.
2.
3.
Gray A, Read S, McGale P, Darby S. Lung cancer
deaths from indoor radon and the cost effectiveness and
potential of policies to reduce them. BMJ 2009;
338:a3310. doi:10.1136/bmj.a3110 HPA (2009)
WHO. WHO Handbook on Indoor Radon. A public
health perspective (2009)
Independent Advisory Group on Ionising Radiation
(AGIR) “Radon and Public Health” Available at:
http://www.hpa.org.uk/web/HPAwebFile/HPAweb_C/1
243838496865