Lung cancer and radon - letters in the British Medical Journal

reproduced from British Medical Journal vol 304 13 June 1992 and vol 305 18 July 1992

Lung cancer and radon

EDITOR, - Minerva has drawn attention to the 10% of lung cancers not attributed directly to smoking.' Much may be known about this already, as radon gas is cited as the second leading cause, especially in combination with smoking. Fiona Godlee in her article on environmental radiation discusses radon but omits to mention that the prospects for cost effective intervention may be limited, especially when smoking has been phased out.

The number of preventable premature deaths from radon induced lung cancer among non-smokers in the United States is perhaps 700 a year (out of 5000) but in the United Kingdom less than 20 (out of 500). This is because only the buildings with a high level of radon may be thought worth treating to exclude radon so as to limit lifetime risks to 1% or less for non-smokers. This compares with an underlying total risk of cancer of around 20%, some of which may be addressed through diet and lifestyle.

However, up to 250 (out of 500) premature deaths in non-smokers might be avoided each year in the United Kingdom if £10 billion (£10 000 million) were spent on lowering radon levels in 10-20 million buildings. Such a sum might prove adequate to re-equip the NHS. More realistically, and assuming radon systems lifetimes of 50 years within 80,000 of the worst affected houses, the cost per year of life extension may average at £70,000 for non-smokers. Action in the 2000 highest level houses would be better value at around £12,000 per life year, and might prevent two or three cases of lung cancer in non-smokers annually.

Recent articles have highlighted the debate on priorities within health budgets. However, vast sums that might be better spent on health continue to be allocated to "environment" via a public health heading. Already billions of dollars have been spent on asbestos in the United States, apparently with little consideration of marginal cost effectiveness. Billion dollar bandwagons seem not to be fitted with brakes, and even the steering seems haphazard.

The central point is this: in the rush to environmental kudos funding is being devoted not only to genuine environmental issues but to minor health concerns, such as incidental exposure to benzene vapour from petrol. But some of the benefits may be so small that we need to pause to consider whether mainstream medical care could better utilise the resources. In short, it is time for some common sense to be applied as an antidote to shroud waving. Those with a good case need fear neither a dose of health economics nor rational environmental assessment. I would welcome correspondence on costs per unit benefit over a wide field for a review of spending on health compared with spending on the environment.

STEPHEN J WOZNIAK

References:
1 Minerva. BMJ 1992;304:516. (22 February)
2 Godlee F. Environmental radiation: a cause for concern? BMJ 1992;304:299-304. (1 February.)
3 Normand C. Economics, health and the economics of health. BMJ 1991;303: 1572-7
4 Smith R. Rationing: the search for sunlight BMJ 1991;303:1561-2
5 Common sense in the environment Nature 1991;353:779-80.


Lung Cancer and Radon

EDITOR, - Stephen J Wozniak doubts the economic benefit of lowering radon levels in buildings on a mass scale to reduce the incidence of lung cancer. He is right to say this, particularly as there is as yet no proof that radon in dwellings causes lung cancer.

Cornwall has been designated a high risk area by the National Radiological Protection Board, and many people are having their properties tested. When a high level is found (over 200Bq/m3) householders are tempted to install ventilation systems to reduce the level. The standardised mortality ratio for lung cancer in the county for 1986-90, however , is 79, which scarcely suggests that radon is having a major effect.

An important study by the Imperial Cancer Fund is underway in Cornwall to test the hypothesis linking radon with lung cancer. Until this has reported, my advice to any inquirers is to delay a decision on remedial action in any domestic property.

D P B MILES
Cornwall and Isles of Scilly Health Authority, TruroTRl 1NR

References
1 Wozniak SJ. Lung Cancer and radon. BMJ 1992;304:1571.(13June)
2 Bowie C, Bowie SHU. Radon and health. Lancet 1991;337:409-13
3 Abelson PH. Mineral dusts and radon in uranium mines. Science 1991;254:777.
4 Darby SC, Doll R, Sayers K, Silcocks P, Thakrar B. S Study of indoor air pollution and health: progress report October1991. London: Imperial Cancer Research Fund Cancer Epidemiology Unit, 1991.


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