Radon and Healthy Housing: What’s

Happening Now, What’s in Store for the Future

Bill LongUS EPA

Acknowledgements

• Antonio Neri MD, MPH• Medical Epidemiologist• CDC Comprehensive Cancer Control Branch

• R. William Field, PhD, MS• Professor, Department of Occupational and

Environmental Health• Department of Epidemiology, College of Public Health,

University of Iowa

• Phil Jalbert• US EPA radon program

Radon Decay

Products

Lead-210Lead-210

Polonium-214Polonium-214

Bismuth-214Bismuth-214

Lead-214Lead-214

Polonium-218Polonium-218

Radon-222Radon-222

Lead-206Lead-206

Polonium-210Polonium-210

Bismuth-210Bismuth-210

22 yrs22 yrs

4 day

3 min

27 min

20 min

0.2 ms

5 day

138 day

Stable

Po-218 and Po-214deliver the majority of radiation dose to

the lung.

Ionizing radiation can directly and indirectly damage DNA

Alpha Alpha ParticleParticle

Defects in tumor suppressor genes – p53

At risk individuals–GSTM1

(glutathione S-transferase M1)

Dou

ble

–stra

nd

Dou

ble

–stra

nd

DN

A br

eaks

DN

A br

eaks

Free

radi

cal

Free

radi

cal

form

atio

n

form

atio

n

Reading Reading ProngProng

From NCRP Report No. 160, “Ionizing Radiation Exposure of the Population of the

United States” (2009)

U.S. Radon PotentialU.S. Radon Potential

Based on geology and Based on geology and

surveyssurveys

Expected closed Expected closed

building radon (pCi/L):building radon (pCi/L):

Zone 1: 4.0 and aboveZone 1: 4.0 and above

Zone 2: between 2.0 & Zone 2: between 2.0 &

4.0 4.0

Zone 3: 2.0 and lowerZone 3: 2.0 and lowerEPA Radon Action Level 4 pCi/L

National Academy of SciencesNational Academy of SciencesBEIR VI 1999BEIR VI 1999

• Risk estimates based primarily on radon-exposed miners

• Estimated 18,600 lung cancer deaths each year in the U.S. from residential radon exposure

BEIR VI Conclusions Serious public health problem

Second-leading cause of lung cancer

No evidence of a threshold

Effects of Radon & Smoking more powerful in combination

Radon contributed to 15K or 21K US lung cancer deaths in 1995 [2,100 or 2,900 in never smokers].

Reduction of residential radon levels above 4 pCi/L could prevent approx. 1/3 of the annual deaths

Residential Radon Case-Control Residential Radon Case-Control Around the World Around the World

European StudiesEuropean Studies

13 Studies from 9 Countries• Austria• Czech Republic• Finland [nationwide]• Finland [south]• France• Germany [eastern]• Germany [western]• Italy• Spain• Sweden [nationwide]• Sweden [never smokers]• Sweden [Stockholm]• United Kingdom

• Total 7,148 cases and 14,208 controls

North American StudiesNorth American Studies

• 7 Studies from 2 countries:• New Jersey• Winnipeg• Missouri I [non-smoking

women]• Missouri II [women]• IowaIowa• Connecticut• Utah-South Idaho

• Total 3,622 cases and 4,966 controls

In 2003, the EPA updated the BEIR VI risk

estimates to 21,000 radon-related lung

cancer deaths each year in the United States.

http://www.epa.gov/radon/risk_assessment.html

EPA Radon Assessment Results

Modified & extended the NAS BEIR VI report [consultation with SAB and NAS panel members]

Best estimate of US population risk in homes is about 21,000 lung cancer deaths per year. [At US average indoor radon conc.]

Current Risks at Action Level Smokers 6/100 Never Smokers 7/1000

Cancer Statistics 2014CA: A Cancer Journal for CliniciansVolume 64, Issue 1, pages 9-29, 7 JAN 2014 DOI: 10.3322/caac.21208http://onlinelibrary.wiley.com/doi/10.3322/caac.21208/full#caac21208-fig-0001

CANCER MORTALITY – 2014

CANCER TYPE ESTIMATED U.S. DEATHS in 2014

1. Lung and Bronchus 159,260

2. Colon and Rectum 50,310

3. Breast Cancer 40,430

4. Pancreas 39,590

5. Prostate 29,480

6. Leukemia 24,090

7. Liver and Bile Duct 23,0008. Lymphoma 20,1709. Urinary Bladder 15,580

10. Esophagus 15,450

11. Ovary 14,270

12. Kidney and Renal Pelvis 13,860

13. Myeloma 11,090

14. Stomach 10,990

15. Melanoma - skin 9,710

CANCER MORTALITY – 2014

CANCER TYPE ESTIMATED U.S. DEATHS in 2014

1. Lung and Bronchus 159,2602. Colon and Rectum 50,3103. Breast Cancer 40,4304. Pancreas 39,5905. Prostate 29,4806. Leukemia 24,0907. Liver and Bile Duct 23,000 Radon- Induced Lung Cancer 21,0008. Lymphoma 20,1709. Urinary Bladder 15,58010. Esophagus 15,45011. Ovary 14,27012. Kidney and Renal Pelvis 13,86013. Myeloma 11,09014. Stomach 10,99015. Melanoma - skin 9,710

Toxic Substances Control Act (TSCA)Title III (1988)

Indoor Radon Abatement Act (IRAA)

• Section 306. Grant Assistance to States for Radon Programs• Governor Designates the Recipient• Recipient can be a Department, Agency or State Institution,

e.g., University• EPA Responsibilities Delegated to Regional

Administrators & Assistant Administrator for OAR

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21,000 Radon-related U.S. Lung Cancer Deaths Annually21,000 Radon-related U.S. Lung Cancer Deaths AnnuallyLeading Environmental Cause of Cancer MortalityLeading Environmental Cause of Cancer Mortality

Long-term Exposure to 1.25 pCi/LLong-term Exposure to 1.25 pCi/LAverage Indoor Radon Level in U.S. HomesAverage Indoor Radon Level in U.S. Homes

7,083,0007,083,000Homes ≥4pCi/L Homes ≥4pCi/L

2 ways to reduce risk: mitigate high homes; build homes 2 ways to reduce risk: mitigate high homes; build homes radon-resistantradon-resistant

EPA Radon ProgramEPA Radon Program

Radon

• Interventions• ≤ $20 / test, $300 – $2,000 remediate

• < $250 – $750 to build radon resistant homes

• EPA $8 million to state radon programs/yr• education, testing, remediation, policy-related radon activities

• Intervention = ↓ exposure• Vent air from under house

• Seal basement cracks

• Laws• 28 states + DC have laws specific to radon

• Req. testing, Req. Disclosure, Voluntary Testing

• Radon-Resistant New Construction o Int’l Building Code adoption

Website: http://sktelokkalong.co.cc/buy-radon-test-kit

States with Radon-specific Cancer Activities 2005 – 2011

Tribes and Territories with Radon-specific Cancer Plan Activities include: Alaska Native Tribal Healthcare Corporation, Fon du Lac Tribe,Northern Plains Native American Tribal CCC Program, Tohono O'odham Tribe, and Guam.

Note that Alaska, Hawaii, and DC do not have radon-specific cancer plan activities

States with Radon-specific Laws in 2014 *

* Washington, DC has one radon-specific law. The ELI database does not review or track radon laws for tribes

Annual Radon-related Lung Cancer Deaths

State16-20 Draft

Annual Radon-related Lung Cancer Deaths

State17-20 Draft

Progress on Risk Progress on Risk ReductionReduction

7.1M Homes ≥4pCi/L7.1M Homes ≥4pCi/LMitigate existing homes (2 – 4 pCi/L)

•1,244,000 mitigation systems installed since 1986•9,100 lives saved (lung cancer deaths avoided)•1,542 mitigated homes saves 1 life•Multi-pronged demand/supply strategy (partnerships [ELI, CRCPD, NCSL, NEHA, KSU], PSAs, real estate, home inspection, stakeholder trainings)

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State Indoor Radon Grant State Indoor Radon Grant (SIRG) Program(SIRG) Program

• 45 states participating

• 5 Not Participating (NH, MD, LA, AR, HI)

• Tribes: FY2013 10 Awards = Tribes: FY2013 10 Awards = $304,000$304,000

Philip Jalbert343.9431,

Jalbert.Philip@epa.govhttp://www.epa.gov/radon/

sirgprogram.html

Federal Radon Action Plan• Federal leadership required to accelerate action on

radon risk reduction – a key Healthy Homes concern

• An example of Inter-Agency Collaboration (USDA, DOD, DOE, EPA, GSA, HHS, HUD, DOI, VA)

• A special focus on families and low income communities

Framework for Federal Action: Our Areas of Focus

• Demonstrate Importance of radon risk reduction

• Provide Incentives to encourage testing and mitigation

• Build Demand for testing and mitigation

Key Milestones Tracking Our ProgressNov 2010: Held Federal Radon Summit where agencies agreed to develop the Federal Radon Action Plan

Jun 2011: Launched the Action Plan at the Healthy Homes Conference

Jan 2012: Released the Action Plan Scorecard

Aug 2012: Celebrated one-year anniversary at CDC’s National Cancer Conference in Washington DC

Feb 2013: Released the Accomplishments Report in conjunction with the unveiling of the Advancing Healthy Housing – A Strategy for Action. 

Agency Green – Completed Yellow – On Track Red – No Progress

USDA 6

DoD 1 1 1

DOE 2 2

EPA 1 1

GSA 1 1

HHS 2 1

HUD 3 1

DOI 2 1

VA 1 1

Multi 1 3

TOTAL 19 12 2

33 Total CommitmentsTo access Scorecard visit www.epa.gov/radon/action_plan.html

Status of Commitments

www.epa.gov/radon

Build Demand for Testing & Mitigation

• The Department of Housing and Urban Development (HUD) wrote new radon testing and mitigation requirements for their multifamily housing mortgage insurance programs, estimated to reach 105,000 housing units in 2013.

• The Environmental Protection Agency (EPA) is investing in 4 new standards of practice. New provisional standard for radon mitigation in multifamily housing released this year.

Provide Incentives to Encourage Testing and Mitigation

• The Department of Agriculture (USDA) issued new secretary-level guidance to all of its field office housing, community, loan (~301K this year), and public information programs to promote radon mitigation and new construction.

Demonstrate the importance of radon testing & mitigation

•The Department of Health and Human Services reported that 27 CDC sponsored state five-year cancer plans now include radon, representing 41% of existing cancer plans.

– Of that total, two cancer programs have included radon activities for the first time and two have expanded radon activities within their plans.

Moving Forward: Leadership, Leverage and Visibility

Priorities for the Near-term Future

•Federal Radon Action Plan (FRAP)•Allied Leaders•Partnerships with NGOs•Standards of Practice•Code adoption•Labelling programs

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