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
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 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
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
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
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