Bryan Stierman, MD, MPHClinical Fellow in Environmental Health

Region 1 Pediatric Environmental Health Specialty UnitBoston Children’s Hospital

Radon: Information for Clinicians

Presented during the May 10, 2018 AAP Environmental Health ECHO

This material was supported by the American Academy of Pediatrics (AAP) and funded (in part) by the cooperative agreement FAIN: 5 NU61TS000237-04 from the Agency for Toxic Substances and Disease Registry (ATSDR).

Acknowledgement: The U.S. Environmental Protection Agency (EPA) supports the PEHSU by providing partial funding to ATSDR under Inter-Agency Agreement number DW-75-95877701-4. Neither EPA nor ATSDR endorse the purchase of any commercial products or services mentioned in PEHSU publications

• Understand what radon is and how people are exposed

• List the health effects associated with radon exposure

• Identify methods for radon detection and mitigation

Objectives

What is radon?

Radon (and radon progeny)

Sources:https://pubs.usgs.gov/gip/7000018/report.pdfhttps://www.epa.gov/radiation/radionuclide-basics-radon#sourceshttps://www.epa.gov/radiation/radioactive-decay

Type Particle Charge? Penetrating AbilityAlpha Particle 2 protons & 2 neutrons Yes Very limitedBeta Particle Electron Yes MoreGamma & X Rays Electromagnetic Wave No Even MoreNeutrons Neutron No Greatest

Types of Ionizing Radiation

Source: https://www.nrc.gov/about-nrc/radiation/health-effects/radiation-basics.html

Environmental measurements are given in concentration of radon (radioactive decays per time per volume)

USA: picocuries per liter (pCi/L) Elsewhere: becquerels per cubic meter

(Bq/m3) 1 pCi/L = 37 Bq/m3

Units

Radon in Buildings

Source: https://www.epa.gov/radiation/radionuclide-basics-radon

Radon in the Body

Source: http://www.epa.ie/radon/builders/

Radon Across the USA

Average outdoor radon in US: 0.4 pCi/L

Average indoor radon in US: 1.3 pCi/L

Source: https://www.epa.gov/radon/epa-map-radon-zones

No federal regulations, only recommendations (states may regulate)

EPA recommends mitigation for ≥4 pCi/L EPA suggests consider mitigation for 2-4

pCi/L EPA recommends all schools test for and

mitigate areas with elevated concentrations No regulations for drinking water but EPA

provides guidance on private wells (and public supply using ground water)

Regulations

Health Effects of Radon

Good evidence supporting radon causes increased risk of lung cancer• Evidence from animal studies, occupational

mining studies, residential case-control studies

Health Effects

1 in 15 homes (5.8 million homes) in US above action level of 4 pCi/L

Estimated 21,000 lung cancer deaths annually in US secondary to radon

Number 2 cause of lung cancer and lung cancer deaths in US

Epidemiology

Tobacco exposure and radon exposure have synergistic effect on lung cancer

Tobacco and Radon

Source: http://www.radonleaders.org/sites/default/files/HP_Radon_Guide_2018_FINAL_CRCPD%20E-18-2_FinalDraft.May_2018.pdf

Children have higher exposure compared to adults in the same environment given their physiology:• Smaller lungs• Higher minute ventilation• Longer lifespan ahead

No specific research evidence of increased susceptibility to radon in children or fetuses

A few studies show possible decrease in ratio of male to female births in male miners – overall evidence is limited

Children and Reproductive Effects

Other health effects/other cancer?• Some associations with other respiratory disease and

other cancers (such as leukemia) found but mixed evidence, confounding make it inconclusive

• Insufficient evidence to draw any conclusions with certainty

Health effects of radon from ingestion in food or drinking water? • Association with lung cancer in some studies, but may

be due to inhalation radon gas coming from water• Insufficient evidence to draw any conclusions with

certainty Is linear no-threshold model correct?

Unanswered Questions

Reducing Radon Exposure

Passive vs. Active devices• Passive: Alpha track detectors, charcoal

canisters, charcoal liquid scintillation detectors, electret ion chamber detectors

• Active: Continuous monitors Short-Term vs. Long-Term

• Short-term: Often use charcoal canisters• Long-Term: Often use alpha track or electret ion

chambers Testing conditions matter!

Radon Testing

EPA provides guidance on when to mitigate, when to retest

Select a State Certified or Qualified Radon Mitigation Contractor

For water, can use point-of-use or point-of-entry filtration

Radon Mitigation

Active soil depressurization

Ventilation House/basement pressurization Sealing Other methods

Radon Mitigation, Continued

Source: http://sosradon.org/reducing-radon-in-your-home

Ask if have had home tested for radon• Recommend testing periodically if they have not had their home

tested ever or recently• Ex: If <4 pCi/L, retest with major home renovations, heating or cooling system

changes, or every 5 years• Ex: If previously >4pCi/L, retest after mitigation and then every 2 years

• Recommend mitigation or retesting, if necessary, based on level in home (EPA provides guidance)

• Know resources to connect families to help with testing and mitigation

Being able to explain why it is important (some risk of lung cancer)

No acute symptoms expected in children – this is a long-term risk factor for lung cancer

Counsel against smoking! Obtaining biomarkers or x-rays not recommended for radon

exposure

Role of Primary Care Provider

Resources

EPA Radon:• https://www.epa.gov/radon

ATSDR ToxFAQ and ToxProfile:• https://www.atsdr.cdc.gov/toxfaqs/TF.asp?id=406&tid=71

National Radon Program Services (Kansas State U)• http://sosradon.org/• National Radon Hotline: 1-800-767-7236• National Radon Helpline: 1-800-557-2366• National Radon Fix-It-Line: 1-800-644-6999

Radon Leaders• http://www.radonleaders.org/

State Radon Department• https://www.epa.gov/radon/find-information-about-local-radon-

zones-and-state-contact-information#radonmap Your Friendly Regional PEHSU!

• https://www.pehsu.net/

Resources Continued

Questions???