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Epidemiology:
doi: 10.1097/EDE.0b013e31818ef498
Letters: Letters to the Editor

Residential Radon and Lung Cancer

Ruano-Ravina, Alberto; Rodríguez, Miguel Conde; Cerdeira-Caramés, Sara; Barros-Dios, Juan M.

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Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Santiago de Compostela, Galicia, Spain (Ruano-Ravina)

CIBER de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain (Ruano-Ravina)

Galician Agency for Health Technology Assessment, Department of Health Santiago de Compostela, Galicia, Spain (Ruano-Ravina)

Ferrol Health Department Galician Health Service Ferrol, Galicia, Spain (Rodríguez)

Service of Epidemiology Galician Directorate of Public Health Santiago de Compostela, Galicia, Spain (Cerdeira-Caramés)

Department of Preventive Medicine and Public Health, University of Santiago de Compostela Santiago de Compostela, Galicia, Spain (Barros-Dios)

CIBER de Epidemiología y Salud Pública (CIBERESP) Barcelona, Spain (Barros-Dios)

Service of Preventive Medicine, University Hospital of Santiago de Compostela, Galician Health Service Santiago de Compostela, Galicia, Spain (Barros-Dios)

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To the Editor:

Residential radon exposure causes lung cancer. The International Agency for Research on Cancer declared radon as a human carcinogen in 1988.1 Evidence for this statement is based mainly on studies in miners2 and residential case-control studies.3,4 There are no published cohort studies assessing the relationship between residential radon exposure and the development of lung cancer.

Between 1992 and 1994, we enrolled 241 randomly selected controls in a population-based case-control study on residential radon and lung cancer by using 1991 census data for the Santiago de Compostela Health District.5 Initially, 500 persons from the general population were selected through sex-stratified random sampling. Of these, 391 met the eligibility criteria and 241 were finally included (32% refused and 5% were not located after 3 attempts).

Participants younger than 35 years of age, those with previous cancers, and those who had lived fewer than 5 years in the same dwelling were excluded. All participants were personally interviewed on lung cancer risk factors, and radon concentration was measured in the main bedroom under standard conditions.

Cohort follow-up ended on 31 May 2007. For each cohort member, the vital status was assessed through 2 databases: hospital records at the Clinic University Hospital of Santiago de Compostela and the Galician Mortality Registry, which covers the whole Galician population. The survival outcomes were (a) alive, (b) death from a cause other than cancer, (c) incidence or death from cancer other than lung cancer, and (d) incidence or death from lung cancer. Radon exposure at baseline was compared among persons without cancer, those with cancer other than lung cancer, and those with lung cancer at the end of the follow-up.

We could find determine outcome status of 211 persons (88%); median follow-up was 12 years. During the follow-up, 11% (25 subjects) had developed some type of cancer, 5 additional patients had lung cancer. Tobacco consumption was similar among groups at the baseline (Table 1). The median radon concentration was 226 Bq/m3 among future lung cancer cases and 52 Bq/m3 among all others. All lung cancer cases lived in the same dwelling until the end of the follow-up. The crude relative risk for lung cancer among those exposed to radon concentrations higher than 148 Bq/m3 compared with nonexposed was 6.6 (95% confidence interval = 1.2–38), whereas the relative risk for any cancer type was 0.68 (0.2–2.2).

Table 1
Table 1
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To our knowledge these are the first cohort data on residential radon exposure and lung cancer, and the results confirm an association. Residential radon concentration in those who developed lung cancer was 4.5-fold higher than the radon concentration in the other groups, the median concentration being far above the action level considered by EPA or European Union (148 and 200 Bq/m3, respectively).

This study has a small sample size, which does not allow a detailed analysis. Nevertheless, these are the first data of their kind and add evidence that radon concentration predicts the risk of lung cancer years before its onset. An advantage in this investigation is that the proportion of smokers was similar among the study groups, and therefore, we believe that the higher lung cancer incidence in those exposed to higher radon concentrations is not due to higher tobacco consumption.

Other researchers who have conducted residential case-control studies may be able to add to these results using larger samples.

Alberto Ruano-Ravina

Department of Preventive Medicine and Public Health

University of Santiago de Compostela

Santiago de Compostela, Galicia, Spain

CIBER de Epidemiología y Salud Pública (CIBERESP)

Barcelona, Spain

Galician Agency for Health Technology Assessment

Department of Health

Santiago de Compostela, Galicia, Spain

Miguel Conde Rodríguez

Ferrol Health Department

Galician Health Service

Ferrol, Galicia, Spain

Sara Cerdeira-Caramés

Service of Epidemiology

Galician Directorate of Public Health

Santiago de Compostela, Galicia, Spain

Juan M. Barros-Dios

Department of Preventive Medicine and Public Health

University of Santiago de Compostela

Santiago de Compostela, Galicia, Spain

CIBER de Epidemiología y Salud Pública (CIBERESP)

Barcelona, Spain

Service of Preventive Medicine

University Hospital of Santiago de Compostela

Galician Health Service

Santiago de Compostela, Galicia, Spain

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REFERENCES

1. IARC. Man-made mineral fibres and radon. IARC monographs on the evaluation of carcinogenic risks to humans. Lyon, France: IARC; 1988;43:39.

2. Darby SC, Whitley E, Howe GR, et al. Radon and cancers other than lung cancer in underground miners: a collaborative analysis of 11 studies. J Natl Cancer Inst. 1995;87:378–384.

3. Darby S, Hill D, Auvinen A, et al. Radon in homes and risk of lung cancer: collaborative analysis of individual data from 13 European case-control studies. BMJ. 2005;330:223–227.

4. Krewski D, Lubin JH, Zielinski JM, et al. Residential radon and risk of lung cancer: a combined analysis of 7 North American case-control studies. Epidemiology. 2005;16:137–145.

5. Barros-Dios JM, Barreiro MA, Ruano-Ravina A, et al. Exposure to residential radon and lung cancer in Spain: a population-based case-control study. Am J Epidemiol. 2002;156:548–555.

Cited By:

This article has been cited 1 time(s).

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© 2009 Lippincott Williams & Wilkins, Inc.

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