Residential Radon and Lung Cancer

Transcription

1 Residential Radon and Lung Cancer

2 Residential Radon and Lung Cancer radon decay particles are inhaled into the lungs energy released from radon decay products damages DNA

3 Radon-222 α,γ Polonium-218 α,γ Lead-214 β,γ Bismuth-214 β,γ Polonium-214 α,γ Lead-210 β,γ Bismuth-210 β,γ Polonium-210 α,γ Lead day 3 min 27 min 20 min 0.2 ms 22 yrs 5 day 138 day Stable 218 Po and 214 Po deliver radiologically significant dose to the respiratory epithelium. Long residency in glass Decay easy to measure

4 Winnipeg Radon Case-control Study 1980: Cross-Canada radon survey of 18,000 homes (average of 150 Bq/m3 in Winnipeg) 1982: First planning meeting for Winnipeg case-control study (large scale, complete dosimetry) 1984: Case recruitment initiated 1992: Field work completed (750 case-control pairs, 35,000+ dosimeters) 1993: Data analysis completed, manuscript written 1994: Publication in American Journal of Epidemiology (Letourneau, Krewski, Zielinski et al., 140, pp ) Overall odds ratio = 0.97 (0.81, 1.15) at 5,0000 Bq/m3-years

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6 BEIR VI: Health Risks of Radon 1994: Committee convened 1999: Report released Radon responsible for % of all lung cancer deaths in the United States

7 North American Case-control Studies Study Case Available Control New Jersey (NY) Winnipeg (Winn) Missouri-I (MO-I) 618 1,402 Missouri-II (MO-II) Iowa (IA) Connecticut (CT) Utah-South Idaho (UT) Subtotal 4,420 5,707 Total 10,127

8 Distribution of Radon Levels Percentage New Jersey Iowa Winnipeg Connecticut Missouri-I Utah-Idaho Radon Concentration (Bq/m 3 ) Missouri-II Combined

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10 Odds Ratio (95% CI) for Lung Cancers: Restricted Data Study NJ Winn MO-I MO-II IA CT UT-ID Total Radon Concentration (Bq/m 3 ) < ß (0.5,1.5) (0.3,3.5) (0.1,7.9) (0.1,1.8) (-0.41,1.34) (0.3,3.3) (0.6,5.3) (03,2.1) (0.5,6.6) (0.4,3.2) (-0.04,0.69) (0.6,17) (0.6,1.7) (0.5,1.9) (0.7,2.5) (- -,0.66) (0.5,1.5) (0.5,1.8) (0.4,2.3) (0.4,2.2) (-0.34,1.56) (1.1,4.1) (08,3.4) (1.0,3.9) (1.2,4.9) (1.0,3.7) (-0.01,1.37) (0.7,1.8) (0.7,2.4) (0.3,1.9) (0.5,1.7) (-0.21,0.51) (0.5,1.8) (0.8,3.2) (0.7,3.7) (0.7,3.1) (-0.08,2.68) (0.8,1.3) (1.0,1.7) (0.9,1.7) (0.9,1.8) (0.9,2.1) (0.9,2.1) (0.02,0.43)

11 Odds Ratio Odds Ratio for Restricted Data OR (x) = x Radon Concentration (Bq/m 3 ) NJ Winn MO-I MO-II IA CT UT-ID Pooled

12 Radon Handbook for Canada Institute of Population Health R. Samuel McLaughlin Centre for Population Health Risk Assessment PAHO/WHO Collaborating Centre in Population Health Risk Assessment

13 Table of Contents Radon Gas Radon Gas Health Effects Measurement of Radon Gas in the Home Radon and Water Measurement Techniques for Radon Gas in the Home A) Pathways for Radon Entry into Homes B) Reducing Radon Levels in Existing Homes C) Precautionary Measures for New Homes New Canadian Residential Radon Guideline Frequently Asked questions about Radon Gas Further Information on Radon

14 International Radon Project Scope: Establish a global project, with all key international and d national partners participating, to identify and promote programs that reduce the health impact of exposure to residential radon Objectives: Estimate the global health impact of exposure to residential radon Create a global database of residential radon exposure Identify effective measures to reduce radon's health impact Promote sound policy options and mitigation programs to Member StatesS Raise public and political awareness about the consequences of exposure e to radon Monitor and periodically review mitigation measures to ensure effectiveness fectiveness Provide annual reports WHO Radiation and Environmental Health Programme Overview

15 U.S. National Academy of Sciences Research Priorities for Airborne Particulate Matter ( ) $ Millions Year McLaughlin Centre for Population Health Risk Assessment

16 # # # # Modeled (Kriged) Sulfate (SO 4 ) Surface N X San Francisco N =151 Seattle Los Angeles SO 4 [ugm -3 ] Salt Lake City Phoenix Billings Denver Oklahoma City Dallas Minneapolis Kansas City Houston Gary Memphis Steubenville Detr oit Nashville New Orleans Atlanta Johnstown Tampa Kilometers Miles New York Boston Washington Char leston Sulfate Cohort Loc'ns (151) Sulfate ( SO 4 ) [ ugm -3 ] < > 23.00

17 # Modeled (Kriged) Fine Particulate Surface Portland Seattle Spokane Boise City Minneapolis Buffalo Hartford N Reno San Francisco Fresno Los Angeles N =50 X Fine Particulate [ugm -3 ] Salt Lake City Phoenix Albuquerque El Paso Denver Wichita Omaha Topeka Oklahoma City Dallas Houston Little Rock Chicago Gary Jackson Indianapolis Nashville Mobile Cleveland Youngstown Steubenville Dayton Birmingham Atlanta Charleston Huntington Charlotte Tampa Kil ometers Miles Raleigh Philadelphia Washington Norfolk Fine Particula te Cohort Fine Particulate [ ugm -3 ] < > 33.00

18 Sulfate (SO 4 ) Air Pollution Levels and Mortality Rates (All Cause) # # # # San Francisco Seattle Los Angeles Sulfate Cohort Loc'ns (151) High Sulfate Air Pollution High Mortality Medium Mortality Medium Sulfate Air Pollution High Mortality Medium Mortality Low Mortality Low Sulfate Air Pollution High Mortality Medium Mortality Low Mortality Salt Lake City Phoenix Billings Denver Note: Low Mortality rate is not present in areas with High Sulfate Air Pollution Oklahoma City Dallas Minneapolis Kansas City Houston Johnstown Detroit New York Gary Charleston Memphis Nashville New Orleans Atlanta Tampa Boston Washington Steubenville Kilometers Miles

19 Particulate Matter and Mortality in U.S. Cities Cause of Death RR PM2.5 RR SO4 All-cause 1.17 (1.09, 1.26) 1.15 (1.09, 1.22) Cardiopulmonary 1.31 (1.17, 1.46) 1.26 (1.16, 1.37) Lung cancer 1.03 (0.80, 1.33) 1.36 (1.17, 1.66) McLaughlin Centre for Population Health Risk Assessment

20 Utilization of recent advances in statistical modeling, including the incorporation of random effects and non-parametric spatial smoothing components to the Cox Proportional Hazard model. lo(longitude, latitude, span = 0.2) latitude longitude a) Spatial representation of prevalence of heart disease adjusted for individual-level risk factors lo(longitude, latitude, span = 0.2) latitude longitude b) Spatial representation of particulate sulfate levels See: Burnett, Ma, Jerrett, Goldberg Cakmak, Pope, and Krewski. The Spatial Association Between Community Air Pollution and Mortality: A New Method of Analyzing Correlated Geographic Cohort Data. Environ Health Prespect 109(suppl): (2001). McLaughlin Centre for Population Health Risk Assessment

21 Mortality Risk Ratios (and 95% CIs) [for each 10 µg/m 3 increase in fine particles] PM 2.5 (ave) Cause of Death (10 µg/m 3 ) All Cause ( ) Cardiopulmonary ( ) Lung Cancer ( ) Other ( ) Source: A. Pope, R. T. Burnett, M. J. Thun, E. E. Calle, D. Krewski, K. Ito, and G. D. Thurston. Lung cancer, cardiopulmonary mortality and long-term exposure to fine particulate air pollution. Journal of the American Medical Association 287: , 2002.

22 Spatial Analysis of Air Pollution and Mortality in Los Angeles

23 Modeled PM2.5 Concentration Levels throughout the Los Angeles Region

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25 Standard Errors in Original Units

26 Results Pollution effects significant and large RR ~ 1.17 over 10 ug/m 3 contrast for all cause mortality (3 times as large as the inter-urban effect reported by Pope et al. 2002) Lung cancer and heart disease RR range from

27 NERAM Colloquia on Health and Air Quality: Interpreting Science for Decision Makers Social Issues Economic Issues Scientific Data Interpretation Science Policy Technological Issues Political Issues Network for Environmental Risk Assessment & Management

28 NERAM Air Quality Risk Management: Colloquium Schedule 2001 University of Ottawa Ottawa, Canada 2002 Johns Hopkins University Baltimore, USA 2003 Santo Spirito Hospital Rome, Italy 2005 National Institute for Public Health Cuernavaca, Mexico 2006 Simon Fraser University Vancouver, Canada McLaughlin Centre for Population Health Risk Assessment

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30 Current State of Science 1. A diverse and growing range of scientific evidence demonstrates significant effects of air pollution on human health and the environment, thereby justifying continued local and global efforts to reduce exposures. McLaughlin Centre for Population Health Risk Assessment

31 Communication of Science of Policy Decisions 3. A clearer articulation of the physical and policy linkages between air quality and climate change is needed to inform public opinion and influence policymakers. Care must be taken not to compromise air quality through actions to mitigate climate change. Similarly, air quality solutions must be reviewed in terms of impacts on climate. McLaughlin Centre for Population Health Risk Assessment

32 Policy Approaches for Air Quality Management 4. Improving air quality is best approached at a systems level with multiple points of intervention. Policy solutions at the local, regional and international scale through cross-sectoral policies in energy, environment, climate, transport, agriculture and health will be more effective than individual single-sector policies. McLaughlin Centre for Population Health Risk Assessment

33 Science and Policy Assessment Needs 13.The effectiveness of local, regional and global policy measures must be scientifically evaluated to confirm that the expected benefits of interventions on air quality, human health and the environment are achieved and if not, that alternate measures are implemented quickly. McLaughlin Centre for Population Health Risk Assessment

34 For more information Visit us at: McLaughlin Centre for Population Health Risk Assessment

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36 Persistent Organic Pollutants (POPs) USA Arctic Circle Russia Ocean currents Air trajectories Riverine inputs Canada Greenland Norway 55 N

37 What are POPs? Long-lived (persistent) organic chemicals (not metals) Fat soluble substances that bioaccumulate and bioconcentrate Semi-volatile substances that can travel long distances Toxic substances that have a variety of significant health effects Old pesticides (DDT, Aldrin, Mirex, Chlordane, Toxaphene) Commercial chemicals (HCB, PCBs) ndustrial by-products (dioxins, furans, PAHs)

38 Arctic Science: 15 years of research Air/Soil/Ice Scientists: identified several POPs and metals in Arctic air and ice/sediment cores Wildlife Researchers: quantified presence of multiple contaminants in birds, fish and sea mammals Epidemiologists: confirmed and characterized more than 15 POPs and metals in Arctic residents, some at very high concentrations

39 THE GRASSHOPPER EFFECT... POPs move thousands of kilometers in the upper atmosphere CACAR, 1997

40 CACAR, 1997

41 POPs and organo-metals biomagnify in the long Arctic food chain because they are persistent and lipophilic. In the Arctic ecosystem biomagnification from water to seals, polar bears, and Inuit mothers is > 10,000,000 Phytoplankton (algae) Zooplankton Small fish Predatory fish Less methylmercury More methylmercury

42 Regional mercury survey in 8 Arctic countries Maternal blood values in ppb (AMAP, 2003)