Case-control studies on residential radon and lung cancer: A concise review

Abstract

The risk estimates for the general population extrapolated from the risk obtained from the miner studies leaded many national and international health organizations to estimate that residential exposure to radon and its decay products can be considered one of the main lung cancer risks after the tobacco smoking, which is responsible of a very large fraction of the total number of lung (and other) cancers. Due to this health relevance and to uncertainties in the extrapolation from studies on miners, many residential case-controls studies have been conducted in Europe, North America and China, are shortly reviewed in this paper. Most of these studies estimated an increased risk, proportional to the radon expo- sure, although a statistical significance of the estimated risk was reached only in few studies or restricted analyses, due to the low statistical power related to the relatively small study size and the presence of not negligible uncertainties in the evaluated radon exposure. The effects of these uncertainties were analyzed in some studies, and it was estimated to reduce the risk by 50% to 100%. Moreover, some restricted analyses showed that selecting subjects with a presumably better evaluation of radon exposure, for example with radon measurement covering all the exposure period of interest, the estimated risk increases by a factor of about two. The use of retrospective dosimetry compared with contemporary radon concentration measurements produce higher risks, too. In most of the studies a multiplicative interaction between tobacco smoking and radon is suggested, which implies that the lung cancer risk due to radon exposure is much higher for a smoker, compared with the risk for a never-smoker. More precise and definitive results are expected from pooled analysis. The just published pooled analyses of two Chinese studies and seven North American estimate a (slightly) significant excess odds ratio of 14% and 11% respectively. A more precise and comprehensive assessment is expected from the forthcoming results of the European pooling of 13 studies and the following pooling of all the studies. Other studies will be probably needed to answer some question on the risk for never-smokers and the interaction with passive smoking.