Radon,Smoking, and Lung Cancer: The Need to Refocus Radon Control Policy

Exposure to radon is the second leading cause of lung cancer, and the risk is significantly higher for smokers than for nonsmokers. More than 85% of radon-induced lung cancer deaths are among smokers. The most powerful approach for reducing the public health burden of radon is shaped by 2 overarching principles: public communication efforts that promote residential radon testing and remediation will be the most cost effective if they are primarily directed at current and former smokers; and focusing on smoking prevention and cessation is the optimal strategy for reducing radon-induced lung cancer in terms of both public health gains and economic efficiency. Tobacco control policy is the most promising route to the public health goals of radon control policy.It is estimated that 222 520 new cases of lung cancer were diagnosed and approximately 157 300 people died from this disease in the United States in 2010.1 Exposure to radon—an odorless radioactive gas that can be trapped in homes and other structures—is considered the second leading cause of lung cancer after smoking.2–5 The Environmental Protection Agency (EPA) estimates that residential radon causes approximately 21 000 lung cancer deaths in the United States each year.6,7 In response, the EPA and numerous organizations, including the National Radon Safety Board, promote wide-scale radon screening and remediation in domestic residences.8The strong synergism between radon exposure and smoking as risk factors is a critical aspect of the relationship between radon and lung cancer.2,4,9 That is, the absolute magnitude of the lung cancer risk associated with radon exposure is significantly higher for ever-smokers than for never-smokers. It is estimated that 86% of radon-related lung cancer deaths are in current and former smokers.7,10Angell recently claimed that radon research and remediation programs have “stalled” in the face of severe funding cuts over the past decade and that there has been little progress in testing and remediation in the US housing stock.11 With the recent economic downturn and the resource constraints most governmental health departments face, Angell’s concerns unfortunately will remain salient in the near term. Thus, we have argued that a concentrated policy focus on smoking prevention and cessation and on smokers as targets of both smoking cessation efforts and of radon testing and remediation programs currently provides the most powerful and cost-effective opportunity for reducing the public health burden of radon.Although some researchers have made this argument in the past, there is very little evidence in the United States of any significant radon control activities targeting smokers or of any coordinated efforts between tobacco control and radon control programs or initiatives.4,12 We have elucidated the evidence-based position that residential radon control policy will be most effective and efficient if it combines forces with tobacco prevention and control efforts. We have also offered strategic guidance about what a synergistic radon and tobacco control approach entails.