Encouraging a Deeper Doctor-Patient Dialog on the Risks of Lung Cancer
Ecosense published the article in CR3 News Magazine
2020 VOL 3: MAY Medical
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Encouraging a Deeper Doctor-Patient Dialog on the Risks of Lung Cancer
Most of us are lucky enough to have a trusted primary care physician who gives us a thorough check-up once a year. Amidst the application of pokes and prods, and diagnostics new and old, we have conversations. Time is taken to discuss existing conditions, review lab work, adjust medications, and talk about those many supplements we all take thinking they will reduce our of risk or this that.
Some risks are inherent in our genetics; other risks take the form of what substances we are exposed to in our daily lives. Often, the doctor and patent delve into questions concerning lifestyle choices (such as smoking and drinking) and environmental exposures at home and at work (allergens, pollution, cleaning products, industrial chemicals, etc.).
We suggest a deeper discussion of lung cancer risk should be a more common part of this dialog since outcomes here so directly tie to avoidable exposures.
The dangers of radon
After smoking, radon exposure is acknowledged to be the second leading cause of lung cancer. [Ref. 1] The patient is almost always asked about smoking, but what about radon? When this naturally occurring radioactive gas is inhaled, due to the short (3.8 day) half-life of Rn222, some fraction of it will decompose within the lungs resulting in the emission of high energy alpha particles which are damaging to DNA. Daughter products of the radioactive decay (polonium 214 and 218) are no longer gaseous, may be retained within the lungs, and so result in further emissions of high-energy alpha and beta particles.
In the U.S., 222,500 new cases of lung cancer are diagnosed per year [Ref. 2], many at Stage IV since there is often very little sign of the onset. Of these new cases, the fraction that may be attributed to radon may be calculated by taking a ratio of the U.S. EPA’s generally accepted number of annual lung cancer deaths due to radon (21,000) [Ref. 3] and the total number of annual lung cancer deaths (155,870 in 2017) [Ref. 2], thus 13.5% of all lung cancer cases. Given the $282,000 average lifetime costs of each lung cancer case [Ref. 4], aside from the horrific human costs, using the above figures, the economic cost of lung cancer attributable to radon can be estimated to be $8.5 Billion/year in the U.S alone. (This is a large number. One might rightly ask why the public health, medical, and insurance establishments are not involved to a greater extent in promoting residential radon assessments and remediations.)
Exposure to radon is not elective, as is smoking, but it is controllable-- and therefore some portion of this ongoing tragedy is preventable. We believe most general practitioners will agree that most homes should be investigated for hazardous levels of radon.
The factors influencing radon exposure
The greatest determinant of whether your home may have a radon issue is where it is situated. The underlying geology is the single most critical factor. Radon enters homes from the soil upon which they are built. It is a naturally occurring gas resulting from the decay of uranium and other radioactive elements naturally present in rocky and alluvial soils present in many regions of North America. The EPA has published maps of the U.S. showing the location of the soil types from which radon is emitted. [Ref. 5] Outdoors, such emissions are of no concern due to the immediate dilution of radon into the vast volume of the atmosphere. Indoors, however, the air within your home turns over slowly and radon has a tendency to concentrate.
Entry points are cracks in slabs and foundations, unsealed penetrations for plumbing and sumps, the seams between slabs and walls, and, to lesser degrees, from the use of well water, concrete from certain sources, and natural gas heating. The seasonal variation of water table height is also a factor. Modern homes are built with more efficient and better-sealed moisture barrier membranes and a higher degree of insulation than in the past. Despite achieving the desired improvement in energy efficiency, this has led to a lesser degree of passive ventilation. Depending upon the season, indoor warmer air being at a lower pressure than its surroundings, a home may exhibit a “chimney effect,” actively drawing in radon. Stanley, et al. [Ref. 6] point out that higher footprint homes provide more opportunity for radon intrusion, and low-rise construction promotes greater accumulation in living spaces, as does increased ceiling height. This is especially true in the case of homes with larger basement square footage and taller basement ceilings.
Stanley et al. also point out lifestyle effects: we now spend an estimated 87% of our time indoors and the use of air conditioning is increasingly prevalent. Frequent opening of windows is consequently now a less common behavior. Necessary to an acceptable energy efficiency, air conditioning recirculates residential air, thus increasing the opportunity for the accumulation of radon in summer months.
As important as radon assessments are, there has been confusion over the appropriate roles for short and longer-term measurements. Stanley, et al. show that while there is a R2 = 0.805 correlation between 5-day testing and 90+ (average 108) day testing in central Canada, there is essentially zero (R2 = 0.011) correlation between 5-day winter and 5-day summer testing. Longer term testing across several seasons is thus needed for accurate radon assessments.
The EPA has recommended mitigation actions definitely be taken when radon, as measured by its radioactive decay, exceeds 4 pico-Curies per hour per liter of air (4 pCi/hr/L). [Ref. 5] Consideration of mitigation actions is recommended at 2 pCi/hr/L. Some 34 states have also put in place various regulations. [Ref 7] These mainly relate to testing upon the pending sale of real estate (and bear civil and criminal penalties for non-disclosure) and mandatory testing in schools and certain civic buildings.
If your readings are high
There are several actions that may be taken if radon in your home is found to be high. If actionable levels of radon are found, then well known and effective mitigation steps may be taken, some of which are not even very costly. First, it would be wise to see how readings trend over time by moving about an electronic consumer radon detector between different locations of your home. Opening windows more often on hot days may prove helpful. If readings are consistently high, you may wish to explore means of sealing cracks in your slab or foundation should they be accessible. Similarly, are through-holes for sumps or piping well sealed? In the case of consistently elevated readings, it may be wise to bring in a radon mitigation professional, who may recommend installing a 24-hour fan to duct basement or crawl space air above your roofline. Such work may run $2,000 or so. The installation of an HRV (Heat Recovery Ventilator) may be even lower cost. (However, if you elect not to remediate, do quit smoking, since together the outcomes of both exposures are worse than individually.)
The beauty of having a consumer electronic radon measurement device is that a sequence of steps may be explored in determining whether progressive levels of expenditure are necessary. Whatever the expenditure may be, avoiding the chances of serious health issues may be well worth the peace of mind.
Ecosense, Inc.: Solely Dedicated to Radon Measurement Technology
Ecosense, Inc. (San Jose, CA) [Ref. 8] stands by to assist with our “RadonEye”, a near real time and accurate consumer product for the continuous measurement of radon. It has been well received throughout in North America and South Korea (another of the world’s “hot spots”) with nearly 50,000 of these devices sold. Just as found in our professional model for home inspectors and remediators, the RadonEye uses the same radon detection technology, a pulsed ion chamber read by super-sensitive U.S.-patented analog measurement electronics capable of an industry leading 30 counts per hour per pico-Curie per liter count rate. The approach used is very fast, updating readings every 10 minutes and achieving +/- 10% of the final average value within one hour of set-up. The technology is very accurate and in academic studies has compared favorably to the RAD7 by Durridge, Inc. and the AlphaGuard by Saphymo, Inc., both benchmark professional monitors priced at several thousand dollars. [Ref. 9] Ecosense has introduced the RadonEye consumer product at $179. It is available via our website and on Amazon.
The RadonEye is easily set up using Bluetooth communications to your smartphone. Either an Android or iOS smartphone is fine. The appropriate RadonEye app may be downloaded from Google Play or the Apple App Store. Because the device is so fast, the unit may be moved around a home every 30 to 40 minutes to determine the areas with the highest radon levels. The built-in OLED display shows the last measurement taken and continuously scrolls through averages determined over longer periods of time. The data may also be accessed through the RadonEye app, which synchs the RadonEye’s locally stored data to your phone and constructs graphic displays of radon levels over time. Once the most meaningful area of your home is identified, the device can be left to continuously monitor and construct a graphic seasonal profile.
Have the conversation!
If the physician does not ask about whether the patient’s home has been tested, we suggest the patient initiates the conversation. How does your doctor view the importance of testing? There are many resources a doctor can “prescribe” to help with a patient’s decisions on the testing of their home: for instance, the EPA has compiled a convenient guide to state-by-state resources on radon. [Ref. 5] The general practitioner is also critical to the tax-efficient financing of any needed corrective actions. Perhaps not very well known, but with a doctor’s support, before-tax health savings accounts can be tapped to perform potentially lifesaving radon remediations.
In conclusion, if you are a general practitioner, ask the question. If you are a patient, get an opinion from someone you trust. Let’s work together to manage a manageable situation!
- Field, R.W., American Family Physician, 2018 Sep 1; 98(5): 280-282
- New lung cancer cases diagnosed annually: Sheehan, D.F., et al., Cancer Med. 2019 Jan; 8(1): 94–103. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6346221/
- Lung cancer deaths due to radon: https://www.epa.gov/radon/health-risk-radon
- Lifetime costs of lung cancer: https://healthpayerintelligence.com/news/cost-of-cancer-care-reaches-nearly-150b-nationally
- Radon map of the U.S.: https://www.epa.gov/radon/find-information-about-local-radon-zones-and-state-contact-information#radonmap
- Stanley, F.K.T., Irvine, J.L., Jacques, W.R. et al.,“Radon exposure is rising steadily within the modern North American residential environment and is increasingly uniform across seasons,” Sci Rep9, 18472 (2019). https://doi.org/10.1038/s41598-019-54891-8
- State regulations: https://www.ncsl.org/research/environment-and-natural-resources/radon.aspx#2
- Ecosense, Inc. website: https://ecosense.io
- “Intercomparison of Commercially Available Active Radon Measurement Devices in a “Discovered” Radon Chamber,” Marco Carmona, et al., Radiological Health Engineering Laboratory Department of Nuclear Engineering and Radiological Sciences, University of Michigan, Ann Arbor, Consortium for Verification Technology under the Department of Energy National Nuclear Security Administration, award number DE-NA0002534.