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Lung cancer mortality attributable to residential radon: a systematic scoping review

Journal of Exposure Science & Environmental Epidemiology volume 33, pages 368–376 (2023)Cite this article

Abstract

After smoking, residential radon is the second risk factor of lung cancer in general population and the first in never-smokers. Previous studies have analyzed radon attributable lung cancer mortality for some countries. We aim to identify, summarize, and critically analyze the available data regarding the mortality burden of lung cancer due to radon, performing a quality assessment of the papers included, and comparing the results from different countries. We performed a systematic scoping review using the main biomedical databases. We included original studies with attributable mortality data related to radon exposure. We selected studies according to specific inclusion and exclusion criteria. PRISMA 2020 methodology and PRISMA Extension for Scoping Reviews requirements were followed. Data were abstracted using a standardized data sheet and a tailored scale was used to assess quality. We selected 24 studies describing radon attributable mortality derived from 14 different countries. Overall, 13 studies used risk models based on cohorts of miners, 8 used risks from residential radon case-control studies and 3 used both risk model options. Radon geometric mean concentration ranged from 11 to 83 Becquerels per cubic meter (Bq/m3) and the population attributable fraction (PAF) ranged from 0.2 to 26%. Studies performed in radon prone areas obtained the highest attributable mortality. High-quality publications reported PAF ranging from 3 to 12% for residential risk sources and from 7 to 25% for miner risk sources. Radon PAF for lung cancer mortality varies widely between studies. A large part of the variation is due to differences in the risk source used and the conceptual description of radon exposure assumed. A common methodology should be described and used from now on to improve the communication of these results.

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Fig. 1: Flowchart of the included studies estimation attributable mortality to radon exposure worldwide.
Fig. 2: Relation between population attributable fraction (PAF) and radon geometric mean (GM).
Fig. 3: Population attributable fraction (PAF) and radon geometric mean (GM) results sorted by smoking status and sex.

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Funding

This research was funded by Instituto de Salud Carlos III grants ISCIIII/PI21/01081 and ISCIII/PI19/01081 co-funded by the European Union.

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Authors and Affiliations

  1. Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Santiago de Compostela, Spain

    Lucia Martin-Gisbert, Alberto Ruano-Ravina, Leonor Varela-Lema, Marina Penabad, Alexandra Giraldo-Osorio, Cristina Candal-Pedreira, Julia Rey-Brandariz, Nerea Mourino & Mónica Pérez-Ríos

  2. Health Research Institute of Santiago de Compostela (Instituto de Investigación Sanitaria de Santiago de Compostela - IDIS), Santiago de Compostela, Spain

    Lucia Martin-Gisbert, Alberto Ruano-Ravina, Leonor Varela-Lema, Cristina Candal-Pedreira & Mónica Pérez-Ríos

  3. Cross-disciplinary Research in Environmental Technologies (CRETUS), University of Santiago de Compostela, Santiago de Compostela, Spain

    Lucia Martin-Gisbert & Alberto Ruano-Ravina

  4. Consortium for Biomedical Research in Epidemiology and Public Health (CIBER en Epidemiología y Salud Pública/CIBERESP), Santiago de Compostela, Spain

    Alberto Ruano-Ravina, Leonor Varela-Lema & Mónica Pérez-Ríos

  5. Grupo de Investigación Promoción de la Salud y Prevención de la Enfermedad (GIPSPE), Departamento de Salud Pública, Universidad de Caldas, Manizales, 170002, Colombia

    Alexandra Giraldo-Osorio

  6. Scholarship Holder of Fundación Carolina (C.2021), 28071, Madrid, Spain

    Alexandra Giraldo-Osorio

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  1. Lucia Martin-Gisbert
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Contributions

LM-G has participated in the formal analysis, investigation, methodology, writing of the individual draft and visualization. AR-R has participated in the conceptualization, methodology, supervision, writing-review & editing and visualization. LV-L performed formal analysis, investigation, methodology, supervision, project administration and writing-review & editing. MP has participated in the conception, investigation, methodology, writing-review & editing. AG-O has participated in the conception, investigation, methodology, writing-review & editing. CC-P has participated in the conception, investigation, and writing-review & editing. JR-B has participated in the conception, investigation, and writing-review & editing. NM has participated in the conception, investigation, and writing-review & editing. MP-R has participated in the conceptualization, formal analysis, investigation, methodology, supervision, project administration, writing-review & editing and visualization.

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Correspondence to Leonor Varela-Lema.

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Martin-Gisbert, L., Ruano-Ravina, A., Varela-Lema, L. et al. Lung cancer mortality attributable to residential radon: a systematic scoping review. J Expo Sci Environ Epidemiol 33, 368–376 (2023). https://doi.org/10.1038/s41370-022-00506-w

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