Abstract
Lung cancer risk estimation in relation to residential radon exposure remains uncertain, partly as a result of imprecision in air-based retrospective radon-exposure assessment in epidemiological studies. A recently developed methodology provides estimates for past radon concentrations and involves measurement of the surface activity of a glass object that has been in a subject's dwellings through the period for exposure assessment. Such glass measurements were performed for 110 lung cancer subjects, diagnosed 1985 to 1995, and for 231 control subjects, recruited in a case–control study of residential radon and lung cancer among never-smokers in Sweden. The relative risks (with 95% confidence intervals) of lung cancer in relation to categories of surface-based average domestic radon concentration during three decades, delimited by cutpoints at 50, 80, and 140 Bq m−3, were 1.60 (0.8 to 3.4), 1.96 (0.9 to 4.2), and 2.20 (0.9 to 5.6), respectively, with average radon concentrations below 50 Bq m−3 used as reference category, and with adjustment for other risk factors. These relative risks, and the excess relative risk (ERR) of 75% (−4% to 430%) per 100 Bq m−3 obtained when using a continuous variable for surface-based average radon concentration estimates, were about twice the size of the corresponding relative risks obtained among these subjects when using air-based average radon concentration estimates. This suggests that surface-based estimates may provide a more relevant exposure proxy than air-based estimates for relating past radon exposure to lung cancer risk.
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Acknowledgements
This study was supported by grants from the Swedish Cancer Society and the European Commission. We thank the staff of the municipal public health boards for assistance with the performance of radon measurements, and Hillevi and Giertz and Östergren for the preparation and readings of air and surface detectors, respectively.
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Appendices
Appendix A
Formula for estimating the average radon concentration (Bq m−3) to which the glass object has been exposed between acquisition until the end of the relevant observation period for radon exposure (i.e., with adjustment for build-up and decay past that date and until measurement of the current 210Po activity in the glass surface), denoted C below
where S=measured surface activity (Bq m−2) for the object exposed during m years; m=age of the object, in years; a=radon concentration in current dwelling (Bq m−3); and n=number of years past the end of the relevant observation period for radon exposure during which the object has been placed in the current dwelling.
Comments
1. The constant 42 is a calibration factor indicating that an object exposed during 20 years in an environment where the radon concentration is 42 Bq m−3 of radon is expected to show a 210Po surface activity of 1 Bq m−2. This value may be modified to account for factors affecting the plate-out rate of radon daughters on the surface of the glass.
2. The constant 0.05136 is the surface activity at equilibrium for a constant radon concentration of 1 Bq m−3.
3. The structure of the formula above is as follows:
where
(i) the component s represents the current surface activity from exposure during the non relevant time period (which is subtracted from the currently measured activity S);
(ii) the ratio is thus the surface activity that would have been observed at the end of the relevant time period (the denominator adjusting for decay since the date);
(iii) norm20 is a component included to transform the estimated activity into the activity that would have been measured if the object had been building-up activity on its surface during 20 years rather than for the number of years assessed (normalization is necessary because objects have been building up activity for different time lengths, but the choice of a length of 20 years for normalization is inconsequential and may be changed, granted that the present calibration constant of 42 is also modified).
Appendix B
Formula for estimating the radon concentration in Bq m−3 to which a subject has been exposed on average during the observation period for radon exposure, with imputation for the unknown average radon concentration during the time period not covered by the glass object, denoted E below
where C, m are as defined in A.1 above; L=duration in years of the relevant observation period for radon exposure; p=the duration in years of the time period between the end of the relevant observation period for radon exposure and measurement of the 210Po activity in the glass surface; μ=study-specific mean of the values for C among control subjects, or more generally any appropriate value for imputation that is not expected to bias risk estimation.
Appendix C
Formula for the modified form of E where years imputed are weighted in order to account for decay, as occurred naturally for measured years
For the radon concentration corresponding to each year of the relevant observation period, indexed by i to indicate single years of exposure ending i years prior to the end of the observation period, we attribute the weights Wi defined as:
where L is defined as in A.2.
The modified form of E is then computed as:
where C, p and μ are defined as in A.2.
Appendix D
Formula for the modified form of the air-based average radon concentration estimate where individual years are weighted in order to account for decay, as occur naturally for glass monitors
where L is defined as in A.2, and Wi as in A.3; Ai=radon concentration (Bq m−3) for year ending i years prior to the end of the observation period, based on measured concentrations in dwellings occupied the corresponding years, or if not measured, imputed using the study-specific average of the measured dwellings among control subjects.
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LAGARDE, F., FALK, R., ALMRÉN, K. et al. Glass-based radon-exposure assessment and lung cancer risk. J Expo Sci Environ Epidemiol 12, 344–354 (2002). https://doi.org/10.1038/sj.jea.7500236
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DOI: https://doi.org/10.1038/sj.jea.7500236
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