© UMn 2008 1

A Lung Cancer Victim SpeaksDennie Edwards, Elyria, OH, www.CanSAR.orgwww.CanSAR.org

““In 2004, I had a very bad cold, so my doctor performed a chest x-ray to check for pneumonia. I've never smoked, so you can imagine how shocked I was that he found a 4.5 centimeter mass in my left lung.“Even though I've been a real estate agent for 31 years, I had never bothered to test my house for radon. I always informed my clients that radon testing prior to purchase was an option (to protect my liability), but truthfully, I really didn't care if they tested or not. “Now I had to wonder whether my lung cancer had been caused by radon exposure. While the doctor scheduled my surgery, I scheduled a radon test. The result was 10 pCi/l, (2 ½ times the EPA's Action Level). I had lived in the home for 12 years. Needless to say, I called a contractor to have a mitigation system installed.“Two days later I had surgery. I thought I was surely going to die. When I woke up choking with tubes in my throat, panic set in. They had removed my entire left lung. I'm getting better. I can walk up to a mile. But, I can no longer dance, lift things, or exert myself.

““My clients now get a very personal testimonial My clients now get a very personal testimonial about the importance of testing for radonabout the importance of testing for radon."."

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Introduction

Good AfternoonGood AfternoonWilliam J. AngellWilliam J. Angell

President, American Association of Radon Scientists and Technologists

• www.aarst.org or email director@aarst.org

Chair, Prevention and Mitigation Working GroupWorld Health Organization’s International Radon Project • www.who.int/ionizing_radiation/env/radon/en/

Professor, University of MinnesotaDirector, Midwest Universities Radon Consortium• U.S. EPA founded; serves 10 states• www.cce.umn.edu/radon

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IntroductionPurposePurpose

To offer a basic perspective of:To offer a basic perspective of:Radon health effects and risksRadon health effects and risksHow radon enters homes and other buildingsHow radon enters homes and other buildingsHow we remediation existing homes and control radon in How we remediation existing homes and control radon in new homesnew homes

To offer an assessment of current radon policy and To offer an assessment of current radon policy and optionsoptions

To suggest sources for further informationTo suggest sources for further information•• Cancer Survivors Against Radon Cancer Survivors Against Radon www.CanSAR.orgwww.CanSAR.org•• Lead State Radon Contracts Lead State Radon Contracts www.epa.gov/iaq/whereyoulive.htmlwww.epa.gov/iaq/whereyoulive.html•• Radon Professionals Radon Professionals www.aarst.orgwww.aarst.org

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1. Physics ... Introduction - Radon

Radon CharacteristicsRadioactive Gas1. Causes Lung Cancer2. Outdoors, Naturally Occurring, Naturally Occurring

But But indoors, human influenced~ The we design, build and use our buildings

– Primary exposure in the home2. No Static Electrical Charge 3. Noble Gas - Inert (does not chemically react)4. Colorless, Odorless, and Tasteless

Not Detected by Human Senses

New Ionizing RadiationWarning Symbol from theInternational Radiation Protection Association

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1. Physics ... Introduction - Radioactive Decay and Radon Entry

Radon Entry

Radium

Radon

Uranium

100s - 100,000s pCi/L –

1.3 pCi/L* U.S. annual average indoors in homes (living areas)

0.4 pCi/L *U.S. annual average outdoors

pCi/L is a unit of radon radioactivity (or ‘activity’) concentration

1 PCi/L = 2.2 radioactive disintegrations per minute per liter

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Health Effects of Radonand its Decay Products

Image from Switzerland’s Federal Office of Public Health

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Health Effects

Cancer Deaths in the U.S.About 560,000 Americans died of cancer in 2007About 560,000 Americans died of cancer in 2007

Lung cancer is the leading cause of U.S. cancer deaths

About 213,400 lung cancer cases in 2007• 160,400 will die

Most important carcinogens• Tobacco smoke followed by

– Radon ~ 21,000 lung cancer deaths per year– Secondhand smoke ~ 3,000 lung cancer deaths

per year–– AsbestosAsbestos

The dominate forms of cancer deaths are:The dominate forms of cancer deaths are:For men: 1) lung, 2) prostate, 3) colon, and 4) rectum.For men: 1) lung, 2) prostate, 3) colon, and 4) rectum.For women: 1) lung, 2) breast, and 3) colon.For women: 1) lung, 2) breast, and 3) colon.

© UMn 2008 8*Excludes basal and squamous cell skin cancers and in situ carcinomas except urinary bladder.Source: American Cancer Society, 2007.

Men 667,860 Women 678,060

26%26% BreastBreast

15% Lung & bronchus11%11% Colon & rectumColon & rectum6%6%Uterine corpus Uterine corpus 4%4% NonNon--HodgkinHodgkin

lymphoma lymphoma 4%4%Melanoma of skinMelanoma of skin4% Thyroid4% Thyroid3%3% OvaryOvary3%3% KidneyKidney

3%3%LeukemiaLeukemia21%21% All Other SitesAll Other Sites

Prostate 29%

Lung & bronchus15%Colon & rectum 10%Urinary bladder 7%Non-Hodgkin 4% lymphomaMelanoma of skin 4%Kidney 4%Leukemia 3%Oral cavity 3%Pancreas 2%All Other Sites 19%

Health Effects

New U.S. Cancer Cases, 2007www.cancer.org/downloads/stt/CAFF06EsCsMcLd.pdf

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Health Effects

U.S. Cancer Deaths, 2007 www.cancer.org/downloads/stt/CAFF06EsCsMcLd.pdf

ONS=Other nervous system. Source: American Cancer Society, 2007.

Men 289,550 Women 270,10026% Lung & bronchus15%15% BreastBreast10%10% Colon & rectumColon & rectum6%6% PancreasPancreas6%6% OvaryOvary4%4% LeukemiaLeukemia3%3% NonNon--HodgkinHodgkin

lymphomalymphoma3%3% Uterine corpusUterine corpus2%2% Brain/ONSBrain/ONS2%2% Liver & Liver & intrahepaticintrahepatic

bile ductbile duct23% All other sites23% All other sites

Lung & bronchus 31%Prostate 9%Colon & rectum 9%Pancreas 6%Leukemia 4%Liver & 4%

bile ductEsophagus 4%Urinary bladder 3% Non-Hodgkin 3%

lymphoma Kidney 3%All other sites 24%

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Health Effects

Lung Cancer Incidence Rates High Among Female Never Smokers

Lung cancer incidence Lung cancer incidence rates per 100,000 personrates per 100,000 person--years among never years among never smokers aged 40 to 79 smokers aged 40 to 79 were:were:

14.4 to 20.8 for females

4.8 to 13.7 for males

Calculated from six large cohort Calculated from six large cohort populations populations

Several factors have been Several factors have been proposed for the development proposed for the development of LCINSof LCINS, including, including

secondhand smoke;occupational exposures such as asbestos, chromium, or arsenic;environmental exposures such asdomestic radon; indoor pollutants; previous lung disease; dietary factors; family history; and genetic factors

However, the relative significance of However, the relative significance of these individual factors among these individual factors among different ethnic populations in the different ethnic populations in the development of LCINS has not been development of LCINS has not been wellwell--characterized. characterized.

(Wakelee, H.A. et al. 2007 Lung Cancer in Never Smokers: A Review, Journal of Clinical Oncology, 25, 5 (February 10): 472-478

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Health Effects

Summary of Lung Cancer Facts (Lung Cancer Alliance, www.lungcanceralliance.org/pdf_docs/lungcancer_factsheet.pdf)

Lung cancer is Lung cancer is the leading causethe leading cause of U.S. of U.S. cancer deathscancer deaths

Causes 1/3 of cancer deathsCauses 1/3 of cancer deathsKills more than breast, prostate, colon, liver, kidney, & Kills more than breast, prostate, colon, liver, kidney, & melanoma cancer melanoma cancer combined!combined!•• Kills 3 times as many men compared to prostate cancerKills 3 times as many men compared to prostate cancer•• Kills nearly twice as many women Kills nearly twice as many women compared tocompared to breast cancerbreast cancer

60% of those diagnosed are never or former 60% of those diagnosed are never or former smokerssmokers

Radon is the leading cause of lung cancer among never Radon is the leading cause of lung cancer among never smokers (U.S. EPA) smokers (U.S. EPA) Radon multiples the lung cancer risk for former and Radon multiples the lung cancer risk for former and current smokers (National Academy of Science, BEIR VI) current smokers (National Academy of Science, BEIR VI)

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Health Effects: Opportunity for Exposure

Sources of Annual Radiation Exposure to the General U.S. Population

Assumes average Assumes average indoor living area indoor living area radon concentration of radon concentration of 1.3 pCi/L.1.3 pCi/L.Radon is by far the Radon is by far the greatest single source greatest single source of radiation to the of radiation to the general public.general public.

ResidentialRadon55%

Medical XMedical X--RaysRays11%11%

Other IndustrialOther IndustrialSources 1%Sources 1%

InternalInternal(potassium(potassium--40)40)

11%11%Nuclear MedicineNuclear Medicine

4%4%Consumer ProductsConsumer Products

3%3%TerrestrialTerrestrial

(earth’s crust)(earth’s crust)8%8%

CosmicCosmic8%8% Source: NCRP 93 (1987)

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Health Effects: 2.A. Human Epidemiological Studies: Cohort - Miners

National Academy of Sciences Radon/Health Effects Findings

Committee on the Committee on the BBiological iological EEffects of ffects of IIonizing onizing RRadiation Report (adiation Report (BEIR VI)BEIR VI) “The Health Effects “The Health Effects of Exposure to Indoor Radon” (1999)of Exposure to Indoor Radon” (1999)

A definitive review of scientific dataA definitive review of scientific dataUsed updated data from 11 NCI miner studies Used updated data from 11 NCI miner studies since residential data was too sparse for valid since residential data was too sparse for valid risk estimaterisk estimate

•• Central estimate of radon attributed lung cancer Central estimate of radon attributed lung cancer in U.S. homes: up to 21,800in U.S. homes: up to 21,800

–– 18,900 ever18,900 ever--smokers 2,900 neversmokers 2,900 never--smokers smokers –– with an uncertain range of 3,000 to 33,000 with an uncertain range of 3,000 to 33,000

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Health Effects: Risk Assessment

EPA Radon Risk Assessment (2004)

Lifetime risk in homes at 4 pCi/L Action Lifetime risk in homes at 4 pCi/L Action Level:Level:

7 of 1000 for Never7 of 1000 for Never--SmokersSmokersIncrease more than three times from 0.2% in 1992

62 of 1000 for Smokers (62 of 1000 for Smokers (7 X that of never7 X that of never--smokerssmokers))Increase more than double from 2.9% in 1992

Central risk estimate for all home radon Central risk estimate for all home radon concentrationsconcentrations

AboutAbout 21,000 lung cancer deaths/year21,000 lung cancer deaths/year•• Uncertainty range of Uncertainty range of 8,000 to 45,000 deaths/year8,000 to 45,000 deaths/year

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Health Effects: Risk Assessment

North American Studies Combined Analysis (Krewski, D. et al. 2005 “Residential Radon and Risk of Lung Cancer: A Combined Analysis of 7 North American Case-Control Studies,” Epidemiology16(2):137-145, March)

3665 cases and 4966 controls from 7 studies of 3665 cases and 4966 controls from 7 studies of residential exposure using longresidential exposure using long--term detectorsterm detectors

Results: OR 1.11 for lung cancer at 2.7 pCi/LResults: OR 1.11 for lung cancer at 2.7 pCi/L over over 5 to 30 years 5 to 30 years

which are comparable to previous predications from which are comparable to previous predications from miner studies miner studies

Conclusion: results provide direct evidence of Conclusion: results provide direct evidence of association of residential radon and lung cancer association of residential radon and lung cancer riskrisk

© UMn 2008 16

Health Effects: Risk Assessment

European Radon Risk Assessment (Darby, S et al., 2004, Radon in homes and risk of lung cancer: Collaborative analysis of individual data from 13 European case-control studies, BMJ.com, doi: 10.1136/bmj.38308.477650.63)

This study found that This study found that the risk of lung cancer the risk of lung cancer increased 16% for each 2.7 pCi/L increaseincreased 16% for each 2.7 pCi/L increase

7,148 lung cancer cases, 14,208 controls in 9 European 7,148 lung cancer cases, 14,208 controls in 9 European countriescountriesMean concentration: 104 Bq/mMean concentration: 104 Bq/m33 (2.8 pC/l)(2.8 pC/l)

Conclusion: Conclusion: radon in homes is responsible for 15% radon in homes is responsible for 15% of all lung cancer deaths in Europe (similar to of all lung cancer deaths in Europe (similar to EPA’s 12% in U.S)EPA’s 12% in U.S)

However, Jerome Puskin of EPA’s Center for Risk However, Jerome Puskin of EPA’s Center for Risk Assessment notes that the European estimate may be biased Assessment notes that the European estimate may be biased low low (www.bmj.com/cgi/content/full/330/7500/1151(www.bmj.com/cgi/content/full/330/7500/1151--a)a)

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Health Effects: Cumulative Exposure

Lifetime Lung Cancer Death Risk Per Person (out of 1,000; 2004 Updated)

202010108842 2 1.31.3

36 36 1818151574422

2602601501501201206232322020

Never Smokers

CurrentSmokers

GeneralPopulation

1101105656454523121277

pCi/LpCi/L

‘Remember, each of these numbers represent a real person with a loving family,’ Bill Field, UIa

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Health Effects: Risks

Radon Compared to Other Risks (A Citizen’s Guide to Radon, 2003, EPA; Health Risk, 2007, EPA and National Electronic Injury Surveillance System Consumer Product Safety Commission, 2003)

Health Effects: Risks

Radon Compared to Other Risks (A Citizen’s Guide to Radon, 2003, EPA; Health Risk, 2007, EPA and National Electronic Injury Surveillance System Consumer Product Safety Commission, 2003)

0

5000

10000

15000

20000

25000 Radon in HomesDrunk DrivingFalls in HomesDrowningsETS Lung CancerHome FiresCO in Homes

Perspective: ten years ago, radon ~14,000; drunk driving ~22,000

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Health Effects: Risks

How Do Radon and Mold Compare?

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Factors Affecting Radon Entry and Concentrations

Note: Image from Switzerland’s Federal Office of Public Health

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Indoor Radon Concentrations: Introduction

Radon Entry Dynamics OverviewCan be influenced by the complex interaction of:Can be influenced by the complex interaction of:

Building characteristics Building characteristics Heating system (e.g., type, use)Heating system (e.g., type, use)Pressure differences

House ~ soilIntraIntra--zonal zonal

Dynamic ventilation rateDynamic ventilation rateWater source (e.g., radon Water source (e.g., radon concentration in well water)concentration in well water)Building materials (emanation)Building materials (emanation)

DiffusionDiffusionOccupant activitiesOccupant activities

Window opening (e.g., location)Window opening (e.g., location)Fireplace and wood stove useFireplace and wood stove useExhaust fan useExhaust fan use

Local geologyLocal geology (including karst)(including karst)Soil

Radium contentMoisture contentMoisture contentTemperature differencesTemperature differencesPermeability Permeability Water table (e.g., fluctuation) Water table (e.g., fluctuation)

Metrological factorsMetrological factorsBarometric pressure changes Barometric pressure changes Wind speed and directionWind speed and directionPrecipitation (e.g., rate, amount)Precipitation (e.g., rate, amount)Season (e.g., indoor Season (e.g., indoor –– outdoor outdoor temperature difference ~ stack temperature difference ~ stack effect)effect)Temperature inversionsTemperature inversionsSnow cover or soil saturationSnow cover or soil saturation

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Indoor Radon Concentrations: Introduction - Mapping

U.S. Radon Zone MapMap based on Map based on

Geologic factorsGeologic factorsAerial surveys Aerial surveys Results of home surveysResults of home surveys

Primarily shortPrimarily short--term term tests in lowest lived tests in lowest lived in level in level

Home foundation typeHome foundation typeSoil surveys Soil surveys

Expected average short term Radon (pCi/L):

Red = Zone 1 > 4.0High probability

Orange = Zone 2 > 2 < 4Yellow = Zone 3 < 2

Low probabilityShould use map with EPA manual explaining methodology. High and low radon may be found in any zone.

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Indoor Radon Concentrations: Introduction Indoor Radon Concentrations: Introduction Rock, Soil, IndoorsRock, Soil, Indoors

Indoor Radon in a Community Indoor Radon in a Community --FYIFYI

Source: Mike Mudrey, 2005, UW-

Test Results< 4 pCi/L

4 - 1010 - 1212 - 1616 – 2020 – 30>30

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2. Transport, B. Driving Forces, 1) Air Pressure Differences

The Predominant Driving Force is Building Induced Soil Suction

Buildings create Buildings create vacuums that vacuums that draw in soil gas.draw in soil gas.These vacuums These vacuums may be very small may be very small and are referred to and are referred to as air pressure as air pressure differentials.differentials.

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Radon Mitigationand Prevention Strategies

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Mitigation of Existing Dwellings

Remediation in Existing Homes: Active Soil Depressurization

Mitigation of Existing Dwellings

Remediation in Existing Homes: Active Soil Depressurization

Active Active = FanFanReverses air Reverses air pressure pressure difference difference between indoors between indoors and soiland soilReduces radon Reduces radon concentrations in concentrations in soil adjacent to soil adjacent to the foundationthe foundation

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Radon Control Options in New Homes

Radon Control in New HomesPassive or Active Soil Depressurization

Minimum 3” passive stack routed Minimum 3” passive stack routed through conditioned space through conditioned space

Connects to subslab tee, interior Connects to subslab tee, interior drain tile or sumpdrain tile or sumpInsulate outside conditioned spaceInsulate outside conditioned spaceMinimize horizontal pipeMinimize horizontal pipePitch to drain condensation Pitch to drain condensation

Electrical roughElectrical rough--in provided in in provided in accessibleaccessible attic near vent stack attic near vent stack

Sealing and caulking of possible Sealing and caulking of possible radon entry pointsradon entry points

Gas permeable material beneath Gas permeable material beneath slabslab

Minimize building depressurizationMinimize building depressurizationLabel system Label system

Avoid unsealed ducts and air Avoid unsealed ducts and air handlers outside conditioned spacehandlers outside conditioned space

Stack terminates 12” above roofStack terminates 12” above roof

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State Radon Policy Considerations

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Policy Considerations

Radon Policy in Other Countries

Norway has required test of all new homesNorway has required test of all new homesMust be less that reference levelMust be less that reference level

Goal for all new homes ¼ of reference levelGoal for all new homes ¼ of reference levelSweden is most advancedSweden is most advanced

Local health authorities have the power to orderLocal health authorities have the power to orderRadon testingRadon testing•• Used for rental housingUsed for rental housing

Radon mitigationRadon mitigation•• 50% grant up to 1500 Euros for owner50% grant up to 1500 Euros for owner--occupiedoccupied

–– Switzerland offers a tax creditSwitzerland offers a tax credit

Switzerland has established goals, e.g.,Switzerland has established goals, e.g.,All elevated homes and schools must be mitigated by 2014 All elevated homes and schools must be mitigated by 2014

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Policy Considerations

Status of U.S. Radon Policy

Today in the U.S. and probably every state, we have more homes that need to be mitigated than anytime in our history

The reason for this situation is that we have built The reason for this situation is that we have built more new homes with elevated radon than we have more new homes with elevated radon than we have mitigationmitigation

EPA has recognized this problem and initiated a EPA has recognized this problem and initiated a major emphasis on radon control systems in new major emphasis on radon control systems in new homeshomesSeveral State Legislature have passed a bills that Several State Legislature have passed a bills that call for building code adoption of radon control call for building code adoption of radon control requirements requirements

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Policy Considerations

Radon Policy Options

1. For all ground contact units:A. Statewide building code requirements

1) Low-rise residential buildings2) Schools and child care facilities

B. Mandatory radon testing prior to: 1) Leasing an apartment or other dwelling unit

• Especially important ~ environmental justice2) Home sale

2. Radon testing of all:A. State owned or leased buildings B. Schools and child care facilities every 5 years

3. Certification or licensing of radon professionals

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Radon Policy Considerations

Countries with Radon Control Building Code Requirements

Czech RepublicCzech RepublicDenmarkDenmarkFinlandFinlandIrelandIrelandLatviaLatviaNorwayNorwaySlovak RepublicSlovak RepublicSwedenSwedenUnited KingdomUnited Kingdom

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Summary

Indoor radon is a very serious environmental health Indoor radon is a very serious environmental health riskriskIt is easy and inexpensive to It is easy and inexpensive to

Test for indoor radonTest for indoor radonRemediation high concentrations in existing buildingsRemediation high concentrations in existing buildingsPrevention in new constructionPrevention in new construction

Public policy is needed ~Public policy is needed ~Building codesBuilding codesTestingTesting

Rental housingRental housingHomes for saleHomes for salePublic buildings including schools and day care facilitiesPublic buildings including schools and day care facilities

Strong certification or licensing programs Strong certification or licensing programs