About 1100 people each year die in the UK from lung cancer correlation to indoor radon, but current government protection policies focus mainly on the small number of homes with high radon levels and neglect the 95% of radon related deaths caused by lower levels of radon, as per a research studypublished on bmj.com today.
The authors argue that installing basic and cheap measures to prevent radon in all new homes would be more cost-effective and have greater potential for reducing lung cancer deaths caused by radon, and UK Building Regulations should be amended to enforce this.
Radon in the home is a natural air pollutant produced by the decay of uranium in the ground. Radon gas seeps into buildings through cracks and holes in the foundations and when it decays it produces particles that can enter the lungs and expose them to damaging radiation.
At present, government policies in the UK concentrate on searching for homes with high levels of radon and encouraging homeowners to take remedial action at their own expense.
Professor Alastair Gray, Professor Sarah Darby and other colleagues from the University of Oxford, assessed the contribution of indoor radon to lung cancer deaths in the UK, and examined the cost- effectiveness of policies to control radon exposure. They used recent evidence on the risk of lung cancer from indoor radon, based on data from 7,000 people with lung cancer and more than 21,000 people without lung cancer across Europe. They then calculated the lifetime risk of lung cancer death before and after various interventions to control radon, and the costs involved.
The authors estimate that 1100 deaths a year in the UK are correlation to radon, about 3.3% of all deaths from lung cancer, but less than 5% of radon related deaths occur from exposure above the current action level. In addition, they report that a number of homeowners refuse to have their home tested or to spend money reducing radon levels. As a result these policies are costly and have a minimal impact on radon related deaths.
In contrast, the authors observed that installing simple preventive measures in new homes is highly cost-effective, but at present is only being done in selected areas of the country. This should be rolled out across the whole UK, say the authors, and should be backed up by changes to the Building Regulations. A gas-resistant membrane in the foundations would reduce radon by about 50% and would cost only about 100.
Importantly, the study also observed that six out of seven radon related lung cancers occur in people who smoke or who have smoked in the past. The best way for current smokers to reduce risk is to stop smoking. Current and former smokers can also reduce their risk by taking radon control measures seriously, say the authors.
The authors suggest that their findings are relevant to a number of other countries, most of which have higher concentrations of radon than the UK. The average radon concentration in UK homes is 21 bequerels per cubic metre, but in the European Union the average is 55, suggesting that about 8% of deaths from lung cancer, or 18,000 deaths each year, are caused by radon across the EU.
This is the most extensive and detailed evaluation to date of the policies to counter radon-induced and deaths from lung cancer, say Professor Anssi Auvinen from the University of Tampere in Finland and Professor Gran Pershagen from the Institute of Environmental Medicine in Sweden, in an accompanying editorial.
The findings suggest that:”Radon policies need to be scrutinised [and especially in populations with low average levels], the priority should be to apply basic measures universally rather than to take action only when high radon levels have been identified by measurement.”
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Coal from China’s Xuan Wei County, widely used for cooking and heating, may contribute to unusually high rates of lung cancer among women in the region.
Credit: US Department of Energy
David Large and his colleagues note that parts of China’s Xuan Wei County in Yunnan Province have the world’s highest occurence rate of lung cancer in nonsmoking women 20 times higher than the rest of China. Women in the region heat their homes and cook on open coal-burning stoves that are not vented to the outside. Researchers think that indoor emissions from burning coal cause cancer, but are unclear why the lung cancer rates in this region are so much higher than other areas. Earlier studies show a strong link between certain volatile substances, called PAHs, in coal smoke and lung cancer in the region.
The researchers observed that coal used in parts of Xuan Wei County had about 10 times more silica, a suspected carcinogen, than U.S. coal. Silica may work in conjunction with PAHs to make the coal more carcinogenic, they indicate. The researchers also observed that this high-silica coal was formed 250 million years ago, at a time when massive volcanic eruptions worked to deposit silica in the peat that formed Xuan Wei’s coal.
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A study featured in the recent issue of the Journal of Thoracic Oncology confirms the success of a simple questionnaire designed to identify patients at high risk of lung cancer. Initiated in 2001, the current study confirmed 18 cases of cancer of the original 430 patients who qualified as high risk after completing a five-minute questionnaire.
The study was conducted in primary care doctor offices among patients seeking care for general health issues. The evaluating doctor incorporated a simple questionnaire focused in three areas: risks, environments and genetics. Specific questions included smoking habit, occupational environments (mining, construction or railroad),subsequent exposure to chemicals and family history.
Colorado’s Primary Care Partners surveyed more than 1,000 patients to evaluate their corresponding risk of lung cancer. Almost half of those surveyed qualified as high risk, and 126 of these identified underwent spinometry, a non-invasive breath measurement procedure. Of the patients with airflow obstruction, 88 underwent a full lung cancer screening. After five years, the study confirmed lung cancer in eight patients with obstructed airflow and 10 in of the patients without.
The study opened the door to mitigate late diagnosis through embedding these simple questions into the patient-doctor dialogue. “Simple by design, our initiative received widespread community support from physicians, patients and hospitals,” said lead investigator Thomas Petty, MD. By providing the guidelines for pointed questions when patients are face-to-face with physicians, we can begin to identify those at risk”.
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New lung cancer staging system
15/10/11
The new TNM 7 lung cancer staging system seems to be a better predictor of local or regional recurrence of lung cancer following surgery, as per a research studyreported in the recent issue of the Journal of Thoracic Oncology
Being able to better define which patients might experience a cancer recurrence is important, particularly given the controversies surrounding the use of adjuvant therapies, especially postoperative radiation treatment (RT), for patients with non-small cell lung cancer (NSCLC).
In 2009, the International Association for the Study of Lung Cancer (IASLC) published its 7th edition of the tumor, node, metastasis (TNM) classification, which was developed in collaboration with the American Joint Committee on Cancer and the Union Internationale Contre le Cancer. The changes were based on an analysis of a large international database.
Scientists at Duke University School of Medicine in Durham, N.C., analyzed 709 patients who had undergone surgery for non-small cell lung cancer between 1995 and 2005. Stage was assigned based on both TNM 6 and TNM 7. The 5-year actuarial risk of local/regional recurrence (LRR) for all patients was 23%. None of the patients received any adjuvant chemotherapy or radiation treatment.
When patients were converted from TNM 6 to TNM 7, about 13% were placed in a higher stage and 8% in a lower stage. For most malignancies, increasing stage is generally linked to a higher risk of disease recurrence.
Five-year rates of local/regional recurrence for stages IA, IB, IIA, IIB and IIIA disease using TNM 6 were 16%, 26%, 43%, 35% and 40%, respectively. Using TNM 7, the corresponding rates were 16%, 23%, 37%, 39% and 30%.
“The TNM 7 system seems to be a better predictor for LRR after surgery for NSCLC than TNM 6,” scientists wrote in the study. “This information may prove to be valuable when designing future studies of postoperative RT”.
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Black patients suffering from lung cancer are less likely to receive recommended chemotherapy and surgery than white patients with lung cancer, a disparity that shows no signs of lessening. That is the conclusion of a newly released study reported in the May 15, 2009 issue of CANCER, a peer-evaluated journal of the American Cancer Society. The study’s findings indicate that efforts are needed to provide appropriate therapys for black patients and to educate them about the value of those therapys.
Scientists led by Dale Hardy, Ph.D., of the University of Texas School of Public Health analyzed data from 83,101 patients 65 years old or older who were diagnosed with non-small cell lung cancer, the most common type of lung cancer, between 1991 and 2002. They looked for racial differences in therapy, the first attempt to address the changes in receipt of therapy over time for this disease.
The scientists observed that for patients with early lung cancer, blacks were 37 percent less likely than whites to receive recommended surgery and 42 percent less likely to receive recommended chemotherapy. For patients with later stage of the disease, blacks were 57 percent less likely to receive recommended chemotherapy than whites. Older patients, women, and those with lower socioeconomic status also experienced greater disparities in receiving therapy.
The study indicates that lung cancer therapy disparities were just as large in 2002 as they were in the early part of 1990s, despite efforts to address inequalities in medical therapy. This study adds to a large and growing body of research indicating that significant steps are needed to ensure equal cancer-related care for all races. “Efforts should focus on the appropriate quality therapy and educating blacks on the value of having these therapys to reduce these disparities in receipt of therapy for non-small cell lung cancer,” the authors write. Only then will black patients with lung cancer experience similar survival rates and quality of life as white patients.
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