Running Head: THE HEALTH EFFECTS OF RADON ON LUNG CANCER
The Health Effects of Radon on Lung Cancer
From Radon in the Home
Esther Yoon
Concordia University – Nebraska
MPH 500
Dr. Madeline Angela Meyer
June 23, 2013
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Running Head: THE HEALTH EFFECTS OF RADON ON LUNG CANCER
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The Health Effects of Radon on Lung Cancer from Radon in the Home
Naturally a part of our environment, radon is the natural radioactive decay of radium that
is in the rocks, soil, water, and air around us all (Turner, 2012). What makes it so dangerous is its
lack of color, smell, and taste while being so small and able to attach to most surfaces because of
its charge (U.S. Department, 2010). This allows radon to travel freely and surround us daily,
especially in our homes. It can enter through cracks in solid floors, construction joints, gaps
around service pipes, and even through gas appliances (U.S. Department, 2010). Just some of the
common surfaces are walls, floors, ventilation, clothing, and soil that can get into buildings (U.S.
Department, 2010). With proper ventilation, radon levels can be reduced to a concentration
below 4.0 pCi/L, the EPA’s recommendation (U.S. Department, 2010).
People may think that because radon is naturally a part of our environment, it must not
have negative effects on people. However, radon can be deadly if people are exposed for long
periods of time at elevated levels. It has been identified that radon gas is the second leading
cause of lung cancer after cigarette smoking (U.S. Department, 2010). There have also been
cases of kidney and cardiovascular cancer (Turner, 2012). For this paper, lung cancer will be the
main affect focus. As a preventable disease, the U.S. Congress mandated each state to organize
an office in charge of radon assistance that often provides free radon test kits (U.S. Department,
2010). Because it is believed that everyone is at risk of radon exposure, this issue is placed in
public health department’s responsibility. With an estimated 6 million homes in the United States
having radon concentration levels above what the EPA recommends, the government, public
health officials, and even the public have begun educating others to raise awareness and increase
testing of homes (U.S. Department, 2010).
Biomedical Basis
Running Head: THE HEALTH EFFECTS OF RADON ON LUNG CANCER
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Discovered in 1900 by German physicist Friedrich Ernst Dorn, radon is a radioactive
natural gas that is a major part of our environment (U.S. Department, 2010). For how harmful the
substance can be to us, it is unfortunately in the soil, water, and the air naturally (World Health
Organization, 2013). The specific radon isotope is radon-220 (thoron), an odorless and colorless
radioactive noble gas. Even though there are many different isotopes of radon, the ones that raise
concern are radon-222 and radon-220 because they are the only ones with the possibility of
causing health effects on humans. There are decay series from uranium-238 and thorium-234,
respectively, for both radon-222 and radon-220 in Yamada article on page 418 (2003). The risk
of lung cancer is linearly proportional to the exposure, so most public health work is focused on
removing the threat as much as possible. With a stable half-life of 3.8 days, radon can enter a
human’s environment and because of its small size (50 to 300nm), it can easily attach to aerosol
particles and enter the lungs (Yamada, 2003). We all are surrounded by radon all the type, no
matter how hard we try to get away from it.
The first time a link was made between radon and lung cancer was when underground
miners showed a spike in lung cancer (U.S. Department, 2010). Even though studies have shown
the health risks of radon, it is still questioned if lung cancer could be because of radon exposure.
Yamada’s Radon Research Group at the National Institute of Radiological Sciences has studied
radon exposure to trachea epithelial cells to look for genetic biomarkers (2003). They found that
the penetrating power of α-particles emitted from radon is weak so only a thin layer is actually
targeted, but that thin layer can be damaged by α radiation. The decay products are deposited in
the respiratory tract and directly deliver the α-energy to respiratory cells. In 2003, groups were
still trying to find proof that it was radon-220 that was the second leading cause of lung cancer,
Running Head: THE HEALTH EFFECTS OF RADON ON LUNG CANCER
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but now, the Environmental Protection Agency and National Institute of Health consider it true
(U.S. Department, 2010).
Epidemiology
Radon does not discriminate. Everyone is exposed to some level of radon. Some may
have a higher risk of exposure than others and some may have more serious health effects due to
the exposure. However, there are areas of the country, and the world, unavoidably at a greater
risk. The EPA has several color-coded maps of the United States that show areas with the
greatest risks, which allows them to better identify at-risk populations (Environmental Protection
Agency). The maps show a pattern of the more mountainous areas with colder climates having
higher levels of radon, because rocks can hold radon well in colder temperatures (Environmental
Protection Agency).
Looking more closely to the population, it has been found that children are more at-risk
to radon exposure of their lung shape, size differences, and more rapid breathing rates than adults
(U.S. Department, 2010). Even though children and adults have the same route and amount of
exposure, children do have a greater body surface area and do not metabolize toxins as fully as
adults do (Hill, et al., 2006). In addition, children’s developmental behaviors more often include
spending time on the floor and placing objects into their mouths (Hill, et al., 2006). The risk of
lung cancer for children exposed to the same amount of radon as adults doubles because of these
different behaviors and their growing bodies (U.S. Department, 2010). This increase risk of lung
cancer increases to at least 20 times more if children are exposed to both radon and tobacco
smoke (U.S. Department, 2010). Radon is a part everyone’s lives, including children, and it can
have a dangerous effect on health.
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Another at-risk demographic is rural, low-income families. A study done in Montana, a
high radon concentration state, showed that most families rarely tested their homes and most of
them never had heard of the health effects of radon (Larsson, Hill, Odom-Maryon, & Yu, 2009).
When 49 of Montana’s 56 counties have residential radon levels above the EPA recommended
4.0 pCi/L, this is an issue that should be address by public health because the effects are
preventable (Larsson, et al., 2009). Being in a rural community, members often find it difficult to
find, or know that there are, resources they need so the risk of not knowing has ill effect.
Environmental Factors
Radon is present in most of the air, but with good air ventilation, radon concentrations
will be drastically decreased and at safe levels. Even being outside will lessen the health risks
(National Cancer Institute). Because of the small size of radon, it can enter the home through the
smallest spaces and sit in the environment. Americans spend 90% of their time inside, so home
with poor ventilation can lead to harmful effects on the body (Larsson, 2009).
There is an environmental precautionary principle that promises, “to protect humans’
health from environmental threats even when scientific cause and effect relationships are not
fully established” (Luo & Hendryx, 2011). Even though the US has the Environmental
Protection Agency, we do not do as good of a job keeping this promise compared to European
countries (Luo & Hendryx, 2011).
There has been some progress in reducing environmental carcinogens, but the exposure is
still present (Luo & Hendryx, 2011). The work of community organizations and officials will
hopefully lead to better knowledge of this dangerous substance. Since we cannot reasonably
remove the harmful radon, public health organizations are working on educating people so that
they can learn how to protect themselves.
Running Head: THE HEALTH EFFECTS OF RADON ON LUNG CANCER
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Biostatistics
To evaluate the progress of education programs and figure out where to go next,
biostatistics are used in researching the public’s awareness of residential radon. The Iowa Radon
Lung Cancer Study was a population-based case-control study of Iowa women (Field, et al).
Working level months (WLM) were used to measure the exposure to radon and radon dosimetry
calculated the dose (Field, et al.). There was a positive categorical trend for all the lung cancer
patients in this study with their excess odds of 0.24 and 0.50 per 11 WLM. Higher excess odds
between 0.49 and 0.83 were also recorded. This also compared the results to previous casecontrolled studies done in Canada, China, Finland, Germany, Sweden, the United Kingdom, and
the US, which showed similar results. The results suggested the cumulative radon exposure is a
significant risk factor for lung cancer in women.
When looking at the rural parents’ perceptions of risks from radon, Hill, Butterfield, &
Larsson examined the awareness, behaviors, and accuracy of risk perceptions. They used the
National Health Interview Survey to measure the results because the questions asked about the
amount of knowledge participants had prior to the education and measured the radon
concentrations of their homes. In a four year period, home testing increased from 9.7% to 15.5%
overall (Larsson, 2009). Healthy People 2010 recognized the increased testing and saw that it
was due to the public knowing about radon (Larsson, 2009). The goal of Healthy People 2010
was to reach 20% of homes being tested (Larsson, 2009). Housing types and householder status
can be another indicator for environmental risk level for radon (Larsson, et al., 2009). The data
was proof of how education can make a difference in changing behavior to reduce preventative
illness.
Running Head: THE HEALTH EFFECTS OF RADON ON LUNG CANCER
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Overall, the methods of retrieving biostatistics for assessing the risks of residential radon
are commonly surveys that participants must agree to take part in and reports by different levels
of environmental health offices of the number of radon kits sold. When looking at the
householder status and residence type, the census could be used as well. Also, the census could
be used when looking at the number of children in rural areas and homes.
Social and Behavior Factors
Seeing radon as a major health issue, the U.S. Environmental Protection Agency
designated January as National Radon Action Month to increase awareness, promote testing and
mitigation, and advance radon-resistant construction practices (U.S. Environmental Protection
Agency [EPA]. January is national, 2012). To make it a successful month in educating the public,
especially home-owners and future home-owners, the EPA depends on individuals and
organizations nationally and locally. To help communities educate their populations, the EPA
created an “event planning kit” with suggestions of possible advertisements and outreach
programs (EPA. January is national, 2012). Knowing how difficult it is to change behavior, the
EPA made this kit so the steps are clear and directs you to applicable activities for the
community (EPA. Where can I, 2012). With its publication in March of 2012, the EPA hopes to
see some behavioral change in the awareness and testing in Americans’ homes in the coming
years with the help of local encouragement.
Several health organizations have started reaching out to the public to encourage testing
of newer and older homes. The Public Health Office in Minnesota’s Isanti County has free radon
home testing kits available (Kafer, 2013). They are also encouraging builders to spend an extra
couple hundred dollars to include vents so radon does not accumulate in the house (Kafer, 2013).
With three reasonable ways to protect families in their homes, the first step is to get a test kit and
Running Head: THE HEALTH EFFECTS OF RADON ON LUNG CANCER
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follow the directions. If levels are above the EPA’s recommended, county health departments
have several different price ranges to work with for the individual home (Kafer, 2013).
In Montana, Montana State University received $350,000 from the Robert Wood Johnson
Foundation to use ChannelCare healthcare digital signage for promoting radon testing (Reuters,
2011). This program was launched in August 2011 with custom designed videos playing in
Women, Infant, and Children (WIC) waiting rooms. These messages encouraged the purchase of
subsidized radon test kits at the Environmental Services office down the hall along with other
health education messages (Reuters, 2011). Studies have shown that digital signage is more
effective than print material because it grabs attention and is more “senses-engaging” (Reuters,
2011). Organizations are becoming more aware of the better ways to encourage change and
different methods are being used by different communities. This is the basis in the ecological
model’s third and fourth levels (Schneider, 2010).
In the Health Belief Model, the health behavior change is focused on promoting better
health behaviors and being able to predict those behaviors (Schneider, 2010). If people feel
personally threatened, they are more likely to change those behaviors. Therefore, if the dangers
of radon are better known, more people should be testing their homes and eventually reducing
the rates of lung cancer by radon, which are preventable. The Federal Radon Action Plan, led by
the EPA with many other government departments, presented strategies for the radon risk
reduction campaign that will increase the publics’ understanding of the risk; advance national,
state and local radon policy; promote testing, mitigation, and radon-resistant construction, realestate and construction industries; and deliver financing and other incentives for mitigation (EPA:
Protecting people, 2011). This action plan began in January 2011 and is scheduled until January
2015, saving over 6,500 lives in 10 million homes (EPA: Protecting people, 2011). Hopefully
Running Head: THE HEALTH EFFECTS OF RADON ON LUNG CANCER
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this action plan will better encourage communities to be a part of this preventable, public health
movement.
Theoretically, interventions should be successful once all five levels of the ecological
model are attained (Schneider, 2010). For level one, information needs to be better presented to
the public so that they become personally knowledgeable and skilled in necessary actions. With
the increased advertisement and action plan by the EPA, this is currently underway nation-wide.
Once more people are made aware of the dangers, they can help the government and other radon
organizations by telling their family, friends, and coworkers, which is level two. To achieve level
three, organizations should take advantage of currently used programs and ideas to build
community specific programs so the fourth level can be addressed. Lastly, the EPA has been
working closely with the U.S. Department of Health and Human Services, Agriculture, Defense,
Energy, Housing and Urban Development, and several others to protect the people from a public
policy stand-point. Bettering the knowledge of the public will influence the behavior of the
community and eventually change how radon affects lives of people.
Government Policies and Prevention
When purchasing a home, it is still not required that sellers test the home for radon in all
states. The EPA and Surgeon General just highly recommend it, especially if the home has never
been tested before. It was not until recently that radon was considered a danger in homes, new
and old, all over the United States. To identify populations, the EPA’s colored maps visualize the
high-risk areas for the public. It is estimated that one out of every 15 homes has elevated radon
levels (Environmental Protection Agency).
Thanks to the media and vocal anti-smoking organizations, the public knows that
smoking is the leading cause of lung cancer, the leading cause of cancer-related deaths. The
Running Head: THE HEALTH EFFECTS OF RADON ON LUNG CANCER
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second leading cause in the United States has a much smaller risk, but acts silently. The
radioactive gas of radon, naturally found in soil, rock, and water gets into the air and is estimated
to cause 15,000 to 22,000 lung cancer deaths each year (National Cancer Institute). Those who
live in a home with elevated levels of radon and smoke are at a much greater risk for lung cancer
(Environmental Protection Agency). With more information readily available to the public, the
hope is to increase awareness for residential radon so that the second cause of lung cancer can
soon cease to exist.
From 1990 till 2007, the Surveillance, Epidemiology, and End Results (SEER) cancer
registries website created a program that adjusts the ages of lung cancer mortalities. The software
used population proportions to make sure it all was accurate. The Toxics Release Inventory (TRI)
database had information for 3,141 counties and was used to assess the mortality rates through
those years. This article does consider other factors, such as smoking and other environmental
carcinogens, but does provide conclusions that focus on lung cancer by toxins like radon (Luo
and Hendryx, 2011).
The World Health Organization has a program, WHO’s Ionizing Radiation Programme
that acts under the Sustainable Development and Healthy Environments Cluster (2013). Its role
is to evaluate health risks and public health issues due to radiation. Through education and the
promotion of research, this program makes recommendations to public health response groups.
Some big aims are dealing with radiation exposure efficiently, facilitating research, and offering
accurate advice(World Health Organization, 2013).
Conclusion
Public health organizations have much work to do in raising awareness for radon. In the
home, tests can easily be done in either days or months. These test kits are sometimes free at the
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county health departments or are available in local hardware stores for less than $20. Even if
homeowners are not thinking about selling their home, if the home has not been tested before,
they really should look into it. Mitigation can be as cheap or as expensive as the homeowners
want to make it. For those on a budget, it can be as easy as placing a new filter for the ventilation
system or covering fans that will make a difference and bring radon levels down considerably.
(Environmental Protection Agency). With more education and public awareness, people will
learn how dangerous this natural gas is and the government will develop better policies to reduce
the affect radon has on lung cancer.
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Reference
Environmental Protection Agency: Radon (Rn). (2009, January). Home Buyer’s and Seller’s
Guide to Radon. Retrieved from http://www.epa.gov/radon/pdfs/hmbuygud.pdf.
Field, R.W., Steck, D.J., Smith, B.J., Brus, C.P., Fisher, E.L., Neuberger, J.S., . . . Lynch, C.F.
(2000). Residential radon gas exposure and lung cancer: The Iowa radon lung cancer study.
American Journal of Epidemiology,151(11), 1091-1102.
Hill, W.G., Butterfield, P., & Larsson, L.S. (2006). Rural parents’ perceptions of risks associated
with their children’s exposure to radon. Public Health Nursing, 23 (5), 392-399, doi:
10.1111/j.1525-1446.2006.00578.x
Kafer, T. (2013, May 16). Health officials encourage radon testing. Isanti-Chisago County Star.
Retrieved from http://www.presspubs.com/isanti/news/article_1d82001e-be3b-11e2-946b001a4bcf887a.html
Larsson, L.S., Hill, W.G., Odom-Maryon, T., & Yu, P. (2009). Householder status and residence
type as correlates of radon awareness and testing behaviors. Public Health Nursing, 26 (5),
387-395. doi: 10.1111/j.1525-1446.2009.00796.x
Luo, J., & Hendryx, M. (2011). Environmental Carcinogen Releases and Lung Cancer Mortality
in Rural-Urban Areas of the United States. The Journal of Rural Health, 27, 342 – 349, doi:
10.1111/j.1748-0361.2010.00357.x.
National Cancer Institute at the National Institute of Health, National Cancer Institute Fact Sheet.
(2011, December 6). Radon and Cancer. Retrieved from http://www.cancer.gov/cancer
topics/factsheet/Risk/radon.
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Reuters. (2011, November 15). Montana state university educates about harmful radon gas with
Vericom’s ChannelCare Digital Signage. [Press release]. Retrieved from
http://www.reuters.com/article/2011/11/15/idUS212839+15-Nov-2011+GNW20111115
Schneider, M. (2010). Introduction to Public Health. Sudbury, MA: Jones & Bartlett Publishers.
U.S. Department of Health and Human Services, National Institute of Health, Agency for Toxic
Substances and Disease Registry. (2010). Radon Toxicity: Case studies in environmental
medicine. Retrieved from http://www.atsdr.cdc.gov/csem/csem.asp?csem=8&po=0.
World Health Organization, Programmes and Projects. (2013). Ionizing Radiation. Retrieved
from http://www.who.int/ionizing_radiation/about/en/.
Yamada, Y. (2003). Radon exposure and its health effects. Journal of Health Sciences, 49(6),
417-422).