The 1St Meeting of National Experts for WHO's International Radon Project 17-18 January 2005
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World Health Organization =============================================================== The 1st Meeting of National Experts for WHO's International Radon Project 1 -18 January 2005 Meeting report prepared by J. M. Zielinski and Z. Carr Geneva, Switzerland 2005 Table of Contents articipants.......................................................................................................................... 1 Background......................................................................................................................... 2 Session 1: Justification for the ()O Radon pro,ect and need for global action on radon 4 Session 2: Current science in support of developing sound radon policy ........................ 10 Section .: ()O methodology for burden of disease assessment .................................... 1. Session 4: Current regulatory environment for radon across the world ........................... 10 Session 5: Mitigation measures and national snapshots ................................................... 11 Session 2: Shaping the ()O Radon pro,ect .................................................................... 22 Appendi4 A. 5iscussion leading to consensus statements ............................................... .2 Appendi4 B. Management of the ro,ect: (orking Groups, Timelines........................... .0 Participants Suminory Akiba, Japan )annu Arvela, 7inland Anssi Auvinen, 7inland 8evin Brand, Canada Zhanat Carr, ()O 5oug Chambers, Canada Margaret Chan, ()O Ian Chell, :8 Sarah 5arby, :8 Eckhard Ettenhuber, Germany 5avid 7enton, Ireland R. (illiam 7ield, :SA Alastair Gray, :8 5ave )ill, :8 Jerzy Jankowski, oland Barnes Johnson, :SA Gerald 8endall, :8 Virginia 8oukouliou, Greece Lothar 8reienbrock, Germany Michaela 8reuzer, Germany 5aniel 8rewski, Canada )ans Landfermann, Germany James McLaughlin, Ireland )erwig aretzke, Germany Maria avia, Italy Georges iller, Switzerland Luis S. Quindos, Spain Michael Repacholi, ()O Bing Shang, China Ter,e Strand, Norway Ann-Louis SAderman, Sweden 5an Steck, :SA Quanfu Sun, China Margot Tirmarche, 7rance Jochen Tschiersch, Germany Lene S. Veiga, Brazil (alker, )ilary, :8 Bu,i Bamada, Japan Shunichi Bamashita, ()O )idenori Bonehara, Japan Mikhail Zhukovsky, Russia Jan M. Zielinski, Canada 1st Meeting of the WHO International Radon Project Jan 17-1 2005 Geneva Background Radon occurs in significant amounts in the ground. 5ocumentary evidence from as far back as the 12th century indicates that elevated radon e4posure was probably responsible for e4cess lung cancer mortality of miners in some Central European mines, such as the silver mines in Germany and Bohemia. Initially scientists thought natural radiation was of little health significance for the general population in most countries. )owever, that view began to change in the mid 20th centuryCthe change became dramatic in the 1100s and DE0s as it was discovered that some houses in a number of countries had indoor radon levels at significant concentrations. Then, in 11E4, the issue surged to :S national attention when a construction worker set off a radiation monitor on entering the Limerick Nuclear Generating Station in ennsylvania. The plant was not yet generating fission products, which suggested that his home was the source of contamination. It is now understood that in areas where the natural radon level is high, the lower air pressure in houses results in an inward flow of radon-rich air through cracks in the bottom slab and cellar walls. In response to the need for information on risks from indoor e4posure, epidemiologic studies were directed at the general population in the 1100s and 11E0s. The first studies were largely ecological in design and provided mi4ed findings. Case-control studies of lung cancer were also implemented in the :S, Europe, and elsewhere. Some of these first studies did not actually measure indoor radon, relying on surrogate measures such as the type of housing construction, so the resulting data could not provide Fuantitative estimates of risk By the mid- to late-11E0s, more sophisticated studies with larger sample sizes were undertaken. Some of these studies have suggested an association between elevated levels of radon in homesG others, including the study conducted by )ealth Canada in (innipeg, have not. Overall, these results have failed to provide conclusive evidence of elevated lung cancer risk. As studies were implemented and planned, the challenge of providing the certainty sought by policymakers became apparent. To produce results that can set policy direction reFuires a more demanding study design than to simply show that indoor radon probably causes lung cancer. In the late 11E0s, members of the Biological Effects of Ionizing Radiation (BEIRI IV Committee and the Committee on the Biological Effects of Ionizing Radiation reviewed the published and planned case-control studies. The potential limitations of sample size and the plausible levels of measurement error were immediately evident. They proposed pooling individual studies, and easily convinced founders C :S 5epartment of Energy and the Commission for European CommunitiesCto support planning for eventual pooling of the world case-control studies of indoor radon and lung cancer. The investigators in Fuestion participated eagerly and established continuing North American 2 1st Meeting of the WHO International Radon Project Jan 17-1 2005 Geneva and European collaborations, which will eventually be pooled. The uncertainties around radon and lung cancer that first prompted case-control studies have been reduced by the many scientific advances. It is now accepted that tens of thousands of lung cancer deaths each year are linked to radon e4posure. The consistency of the data and the analysis points to a need for action. To reduce radon risk, national authorities must have methods and tools based on solid scientific evidence and sound public health policy. ()O has had the foresight to have been working towards development of guidelines. In 111. it published a report containing several conclusions and recommendations covering the scientific understanding of radon risk and the need for countries to take action in the areas of risk management and risk communication. The Radiation and Environmental )ealth rogramme within ()ODs Sustainable 5evelopment and )ealthy Environments Cluster evaluates health risks and public health issues related to environmental and occupational radiation e4posure. The programme promotes research and provides recommendation for emergency medical and public health responses to radiation accidents and terrorist acts and provides advice to national authorities. The ()O Residential Radon Risk pro,ect will develop a programme on the public health aspects of e4posure and identify resources for its implementation. The programme will include: a world-wide database on national residential radon levels, radon action levels, regulations, research institutions, and authoritiesG public health guidance for awareness-raising and mitigationG estimation of the global burden of disease (G5BI associated with residential radon e4posure. G5B is a tool for national public health authorities to Fuantify the burden of disability and mortality for ma,or diseases or disease groups associated with specific risk factor. ()O has been assessing G5B for some 20 ma,or risk factors, but never for ionizing radiation risk factors. ()O is encouraging its member states to create programmes towards such ob,ectives as issuing advisory levels, issuing guidelines for identifying radon risk areas, checking for radon risks prior to new construction, establishing mitigation programmes, and increasing public awareness. ()O has formed a network of key partner agencies around the world working on radon in homes and is proceeding with the International Radon ro,ect (IR I, with completion e4pected in late 2000. At this point in time, the development of a global policy for radon and the process to establish a G5B for radon centre around the following Fuestions: . 1st Meeting of the WHO International Radon Project Jan 17-1 2005 Geneva (hat are the benefits of an international action agenda for radonJ (hat actions could ()O take to move an action agenda forwardJ (hat are some key opportunities to raise visibility for the action recommendationsJ (hat are the first steps for development and implementation of a step-by-step processJ The 1st meeting of the ()O IR was held in Geneva, Switzerland, January 10-1E 2005. This meeting report was prepared by the rapporteur J.M. Zielinski ()ealth CanadaI and Z. Carr ( ro,ect Manager, ()OI. The report contains the collective views of an international group of e4perts, and does not necessarily represent the decisions or the stated policy of the (orld )ealth Organization. Session 1: Justification for the WHO Radon project and need for global action on radon Co chairs: M. Repacholi, H. Walker Welcome Address Margaret Chan, Director, Protection of the Human Environment, WHO Margaret Chan welcomed participants to the 7irst Meeting of the E4pert Group for the ()O Radon ro,ect, on behalf of ()O 5irector General, J.(. Lee. She observed that e4posure to radon, either at home or in the workplace, is one of the greatest risks of ionizing radiation, and causes tens of thousands of deaths from lung cancer each year. )ow can ()O work with international e4perts to help member states formulate good public health policies in this area based on the best available scienceJ This meeting is well-timed, said Chan. 7indings