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.