Radon gas exposure is the leading cause of lung cancer in non-smokers, accounting for approximately 3,000 cases annually in Canada. A “Five things to know about…” paper in CMAJ entitled “Radon and lung cancer risk" encourages physicians to ask patients to test their home and workplace for the invisible gas.
Dr. Silvina Mema and Greg Baytalan are co-authors of the article, and on this episode, they detail the significant public health risk radon poses, the relative ease of testing, and the cost of successful mitigation. They argue that family doctors and specialists play a critical role in creating awareness about radon gas and reducing its impact on patient health and the public healthcare system.
Next, Dr. Aaron Goodarzi advocates for changes to cancer screening guidelines to include individuals with elevated lifetime radon exposure. Dr. Goodarzi is the Scientific Director of the Evict Radon national study. He points out that 40% of people who experience lung cancer will never be eligible for current screening programs because they don't use enough tobacco.
Dr. Goodarzi goes on to describe the many ways public policy can be used to reduce the risk of radon exposure, from updated building codes to mandatory testing of public spaces like daycares, and financial assistance for radon gas mitigation.
Join us as we explore medical solutions that address the urgent need to change healthcare. Reach out to us about this or any episode you hear. Or tell us about something you'd like to hear on the leading Canadian medical podcast.
You can find Blair and Mojola on X @BlairBigham and @Drmojolaomole
X (in English): @CMAJ
X (en français): @JAMC
Facebook
Instagram: @CMAJ.ca
The CMAJ Podcast is produced by PodCraft Productions
Radon gas exposure is the leading cause of lung cancer in non-smokers, accounting for approximately 3,000 cases annually in Canada. A “Five things to know about…” paper in CMAJ entitled “Radon and lung cancer risk" encourages physicians to ask patients to test their home and workplace for the invisible gas.
Dr. Silvina Mema and Greg Baytalan are co-authors of the article, and on this episode, they detail the significant public health risk radon poses, the relative ease of testing, and the cost of successful mitigation. They argue that family doctors and specialists play a critical role in creating awareness about radon gas and reducing its impact on patient health and the public healthcare system.
Next, Dr. Aaron Goodarzi advocates for changes to cancer screening guidelines to include individuals with elevated lifetime radon exposure. Dr. Goodarzi is the Scientific Director of the Evict Radon national study. He points out that 40% of people who experience lung cancer will never be eligible for current screening programs because they don't use enough tobacco.
Dr. Goodarzi goes on to describe the many ways public policy can be used to reduce the risk of radon exposure, from updated building codes to mandatory testing of public spaces like daycares, and financial assistance for radon gas mitigation.
Join us as we explore medical solutions that address the urgent need to change healthcare. Reach out to us about this or any episode you hear. Or tell us about something you'd like to hear on the leading Canadian medical podcast.
You can find Blair and Mojola on X @BlairBigham and @Drmojolaomole
X (in English): @CMAJ
X (en français): @JAMC
Facebook
Instagram: @CMAJ.ca
The CMAJ Podcast is produced by PodCraft Productions
Dr. Mojola Omole:
Hi, I'm Mojola Omole.
Dr. Blair Bigham:
I'm Blair Bigham. This is the CMAJ Podcast.
Dr. Mojola Omole:
So today, Blair, we are talking about radon and it's link to lung cancer.
Dr. Blair Bigham:
Radioactive gas. This is going to be a cool episode.
Dr. Mojola Omole:
So yeah, so this was a practice paper, which is “Five things to know about radon and lung cancer risk”, and it really outlines what family physicians can do to help mitigate the risk of radon in causing lung cancer.
Dr. Blair Bigham:
So I got really excited about this episode when one of our senior editors messaged us and said, "Hey, here's a podcast topic for you." As soon as we got this paper submitted, a bunch of us ran out and bought radon detectors. I was like, "Wow, that's impact."
Dr. Mojola Omole:
So we're going to speak to the authors of the practice paper, and after that we're going to explore possible changes to lung cancer screening guidelines that are aimed at reducing the risk of radon exposure.
Dr. Blair Bigham:
Let's get into it.
Dr. Mojola Omole:
Dr. Silvina Mema and Greg Baytalan are the authors of the practice paper and CMAJ entitled “Five things to know about radon and lung cancer risks”. Silvina and Greg, thank you for joining us from Kelowna.
Dr. Silvina Mema:
Thank you for having us.
Greg Baytalan:
Thank you.
Dr. Blair Bigham:
Silvina, there's a lot of potential targets for public health measures I feel like, especially in the pandemic. Everyone loves their public health docs and they have so much to do and we've covered a lot of those on this podcast. But why radon exposure of all the things public health needs to worry about. Tell us why radon exposure deserves attention.
Dr. Silvina Mema:
Well, radon is a radioactive gas and it is the leading cause of lung cancer for people who don't smoke tobacco. And that is a big deal because every year in Canada there are approximately 30,000 cases of lung cancer diagnosed and 21,000 deaths due to lung cancer. And while tobacco is responsible for the vast majority of cases of lung cancer, radon is also a significant risk and is responsible for about 3000 cases of cancer.
So when you think about the impact, 3000 cases of lung cancer that could be prevented with radon mitigation measures, that is significant. And I feel that physicians don't really know a lot about radon and if they know, they feel that the risk is so small that it's not worth it, and I don't agree with that. I think that it is a public health issue and that the public should be made aware of what they can do to protect themselves against radiation.
Dr. Blair Bigham:
So where would I go to find radon? Is it in my backyard? Is it where I work? How do people know? And if there's a little bit of radon or a lot of radon. Greg, where would we find it in Canada?
Greg Baytalan:
It's everywhere. You're breathing it right now. It's just you don't know what the level is. And the only way to know the level is to test. Now certainly it's more apt to be in a basement or a ground floor because it's heavier than air, and it comes from the ground. But depending on what kind of HVAC system you have, heating system and the sort and where it's drawn its air from, it can be blowing all through the building. And especially in winter time when buildings stack like hot air rises and the air has to be replaced from somewhere and it's drawn from the ground.
That's why Health Canada recommends that buildings be tested during the winter season, the season that we have the windows and doors generally closed and we're heating. We're in heating mode because when we heat, hot air rises and the house acts like a chimney and we can have more radon inside. And there are no areas free of radon in Canada. Well, it's global.
Dr. Blair Bigham:
Are there hotspots in Canada? Are there hotspots?
Greg Baytalan:
Absolutely. And the area that Dr. Mema and I cover is a hotspot. The Health Canada Cross Country Survey report in 2011 reflected that the national average is roughly 7% of homes tested above the Canadian guideline, but the two highest provinces in order were New Brunswick and Manitoba, which was I believe 29 and 28 point something percent above the guideline. But the interior of BC that Dr. Mema and I cover is higher. There's spots higher than both of those two hottest provinces.
Dr. Blair Bigham:
And so I want to find out what Health Canada is advising, but first take us back and just tell me where is radon coming from? It's emitted from the ground?
Greg Baytalan:
Yes, it's the breakdown of uranium and specifically it's radium. And if you Google radon DK chart, you'll get a very interesting half-life chart and there's two plenums in there, and those have a big energy kick in it. And these are the ones that are suspected to be causing a lot of the DNA damage. So people will say, "Well, oh, we don't live near a uranium mine or there's, we're not on the Canadian shield." It doesn't matter. Manitoba is a clay belt, and it's high in radon. People will say, "Well, radon is natural." Well, yes, so I say so are rattlesnakes and poisonous mushrooms, and I wouldn't want them in my house. What isn't natural is how we build.
Dr. Blair Bigham:
Got it.
Greg Baytalan:
And we're building tighter and tighter all the time. And radon is getting trapped inside of these houses.
Dr. Blair Bigham:
What does Canada recommend people do about this? What is the guideline?
Dr. Silvina Mema:
So in Canada, the guideline is that homes be tested for at least three months with a long-term alpha track detector. And that the levels should be below 200 becquerel per cubic meter. That's the Canadian guideline, 200 becquerel per cubic meter. The World Health Organization has a lower threshold of 100 becquerel per cubic meter because that's where the additive effect of radon begins. Because radon causes cancer in and of itself, but it also has a synergistic effect with other risk factors. So if you are a smoker or if you live in a place with air pollution or have other risk factors, it will increase the risk. So the Canadian guideline is double really than the World Health Organization's.
Dr. Blair Bigham:
So should family doctors be recommending that everybody goes out and just what do you do? Do you buy a radon detector? Do you hire a company to come in? Practically speaking, what do we do with this guideline?
Dr. Silvina Mema:
Yeah, absolutely. I think that family doctors and specialist doctors as well have a role to play in creating awareness about radon. As we discussed, the effect of radon is not insignificant. About 3000 cases of lung cancer are attributed to radon per year in Canada and each case of lung cancer, the cost of it is about between 70 and a hundred thousand dollars per case. So we are talking about significant cost to our publicly funded healthcare system. And in addition to that, is the loss in terms of personal loss for individuals diagnosed with lung cancer.
Dr. Mojola Omole:
I just wanted to ask, how about people in apartment buildings in condos, is that also a factor for them to be testing or is this mainly in houses?
Dr. Silvina Mema:
No, absolutely. And actually buildings like the newer buildings, the condo buildings are built in a way that is so efficient in terms of heating and ventilation that those concentrate actually the radon. And there was a study recently published that was very interesting, that showed that the number of homes in Canada that contain radon is increasing and up to 50% of homes in Canada are above the hundred becquerel per cubic meter recommended by the WHO. So any home can contain radon and it's recommended that every home be tested for radon. And Greg, do you want to speak about how to test and what is the mitigation that is recommended by the CNRP?
Greg Baytalan:
Yeah, sure. Essentially, everybody should test, and it's a simple test. BC lung for example, out here and other lung associations and different groups across Canada will have detectors. If you go online, you can Google take action on radon. That's a Health Canada sponsored group that has detectors or information on how to get one for $30.
Dr. Blair Bigham:
That's it?
Greg Baytalan:
$30. 29.99 in British Columbia. That includes laboratory analysis, and it's a decent quality, really good quality alpha track detector, which is essentially a sheet of plastic that's sensitive to alpha radiation. And then the lab counts the number of pits in the plastic per unit time exposed. It's like a dosimeter that a worker would wear in a mine or something like that.
Dr. Blair Bigham:
Oh, so it's not like a carbon monoxide detector that you plug in?
Greg Baytalan:
Yes, they are available, but to do a proper test, you should do a three-month test because the problem with a short term test is you could get a false negative. Like today here in Kelowna, it's a high pressure day because it's clear and sunny, so the ground is absorbing air. Now of course, there's a whole bunch of factors. Is it windy? Yes. No. Is it heating season? Yes, no. Or is the house stacking?
Dr. Blair Bigham:
Gotcha.
Greg Baytalan:
But the best way to get your annual average in your house is to leave a detector in there for a whole year.
Dr. Blair Bigham:
And then do you hand it back to the lab?
Greg Baytalan:
Yes.
Dr. Blair Bigham:
Got it. Okay.
Greg Baytalan:
But what Health Canada wants people to do is test during the most likely worst case scenario, which is winter time.
Dr. Blair Bigham:
What do you do if you get this radon result back that says you're at 600 or 700, what adjustments or modifications do you need to make to a house to clear it of radon or reduce the risk of lung cancer?
Greg Baytalan:
Well, what Health Canada suggests is if you're between 200 and 600, you should fix the place within two years if you're above 600 within one year. But of course, the message that we're trying to say and what Health Canada says is, look it, if you can get on it today, get on it. We tested daycares in the interior and some of them were in the thousands.
And so when parents put their children in school under good faith or a daycare under good faith that the building is safe, we want the managers and the operators of these facilities to be able to say, the parents, look, we are now aware of this and we've taken measures immediately by increasing the ventilation, increasing the pressure or whatever, and we're looking forward ahead to long-term mitigation, which you essentially pour a hole in the concrete floor and hollow out a small sump area, put a pipe in there and catch the gas by a low wattage radon fan and exhaust it out and it works. Some mitigators say they're getting 90% plus levels lowered.
Dr. Blair Bigham:
This doesn't sound cheap though. Are we talking about 40, 40 million Canadians investing in major modifications to get rid of radon? Until I read your paper, I had never ever thought of radon in my entire life, and now I'm like on Amazon trying to order a radon detector.
Greg Baytalan:
Well, the cheapness is a good point. The house I'm sitting in, I fixed it for about $350 with a lot of grunt work. It's not rocket science, but yes, certainly a lot of the building stock out there that's old would require somebody going into, let's say the laundry room or an unfinished area of the house in the basement and coring a hole through it. But yes, you're looking at roughly between 2,500 and $3500 to mitigate a house. If you just pick up the phone and say, look it, I want this done.
Dr. Silvina Mema:
And I would add from a public health perspective, our role is to inform the public of what risks they are facing or may be facing and awareness of the risk, and not only among the public, but also among physicians who at the office, they screen for risk factors for things all the time. What's your diet like? What do you do for exercise, occupation, et cetera. So they really create awareness so that individuals are informed, and they can make their own decisions. At the end of the day, a person may choose to smoke tobacco or to live in a place or not mitigate an area with radon or not to test, but they need to know. And from a public health perspective, what is important to highlight is the equity impact, so impact on people who are low socioeconomic status, low education, and those individuals tend to smoke tobacco at higher rates than individuals who are in a higher socioeconomic status.
So for that reason, they have higher risk. So we need to target obviously tobacco reduction interventions towards those. But those individuals also tend to live in basements in places that have not been tested for radon. And landlords aren't necessarily going to test because they are not going to invest in mitigating. And we know that individuals in the lower socioeconomic status are impacted disproportionately really for most things, but also lung cancer.
So there is also a case to be made about the disproportionate impact on individuals that are low socioeconomic status and cannot make those decisions because it's out of their control if they rent in a place and you've seen what the cost of housing has been raising. So that's I think for me, the public health implications of radon.
Dr. Blair Bigham:
Silvina, Greg, thank you so much for bringing this our attention. Really, really fascinating and worrisome. Thank you so much for your time.
Dr. Silvina Mema:
Thank you Blair and Jola.
Greg Baytalan:
Thank you.
Dr. Mojola Omole:
Thank you so much.
Dr. Blair Bigham:
Dr. Silvina Mema is a Deputy Chief Medical Officer of health, and Greg Baytalan is an air quality specialist. Both of them are at the Interior Health Authority in British Columbia.
Dr. Mojola Omole:
So talking to patients about radon is one piece of the puzzle, but to really lower the risk of radon exposure, we need to do more. We need to use tools from public policy and also as our next guest suggests, change how we screen for lung cancer. Dr. Aaron Goodarzi is the Scientific Chair of the Evict Radon National Study. He's also an Associate Professor of the University of Calgary. Thanks for joining us today.
Aaron Goodarzi:
Thank you for having me.
Dr. Mojola Omole:
So we've talked about how radon is associated with lung cancer. What do you think some of the screening guidelines can be to help mitigate the risk of radon exposure?
Aaron Goodarzi:
So lung cancer screening programs in Canada are emerging at this time, but 40% of people who will experience lung cancer will never be eligible for those programs because they don't use tobacco enough or never have in fact ever used tobacco. And a very important question is how can we assess risk on non-tobacco sources of lung cancer? As radon is the second leading cause of lung cancer, it behooves us to figure out a way to assess everyone's lifetime radon exposure history. Now that's a big challenge. It's a challenge because very few of us, I would argue hardly anybody, myself included, has a radon test result that's valid. That goes back to every single home school workplace I've ever been in since I was born. And so the question becomes how do we do that?
Dr. Blair Bigham:
So does that mean that present day, if you don't smoke cigarettes, you're basically never screened for lung cancer?
Aaron Goodarzi:
Correct. The current guidelines to my understanding, although it varies a little bit between provinces, are that you need to be approximately between the age of 50 to 75, and you need about 20 to 30 pack year equivalences. So that for example, would be what would be considered a pretty heavy tobacco smoking history. And if you don't meet that criteria, which confers upon you a 1.5% risk of lung cancer over the next six years, you're not considered at sufficiently high enough risk to warrant a low dose CT scan.
Now remember, low dose CT scan is also radiation, so it does carry some risk in itself. Most screening does, think of a colonoscopy, carries some risk. So you have to gate keep it not only from a health economic perspective, but also from an exposure perspective. So how we do that for non-tobacco sources, that's the great challenge right.
Dr. Mojola Omole:.
Do we know if the timeline from radon exposure to causing lung cancer, is it similar to tobacco or is it vastly different?
Aaron Goodarzi:
It's in fact quite similar to tobacco and also asbestos, right? So if you look at asbestos, it's about a one to three decade exposure difference between first exposure to when you're diagnosed with lung cancer. And we know that from historical data on asbestos, but we also know that from historical data on radon exposure in people going back to the 1950s, where large numbers of Canadian uranium miners were unintentionally exposed to radon in uranium mines and by the seventies were being diagnosed in droves with lung cancer. There's in fact large population studies in Canada and also the former East Germany where the same thing was going on that demonstrate that one to three decade latency period from exposure to diagnosis.
Dr. Mojola Omole:
And so what can be done to make landlords more responsible for the radon mitigation in their property?
Aaron Goodarzi:
Landlords in many Canadian provinces actually have a legal obligation that if the rental has been deemed unacceptably high for radon and in Canada, the action thresholds of 200 becquerels per cubic meter, that means 200 radioactive emanations from radon per second per cubic meter of air twice where you'd start to see a cancer risk evident. They're obliged to reduce that. Now that's not uniform across the country, that's only in some provinces, but most provinces have something in there that the landlord’s obligated to ensure an indoor healthy environment for the tenants.
Dr. Blair Bigham:
So I think I'm missing a piece of the puzzle here. I get that radon is a naturally occurring radioactive gas. It's heavy, so it's lower down and then we breathe it in. It damages our lungs and DNA like the way cigarette smoke does. But can you tell me more about the features of a house and a house foundation that permit radon to accumulate to these dangerous levels versus a house where radon's not an issue?
Aaron Goodarzi:
I'll illustrate this with a tale of two countries, Sweden and Canada. Both cold climate countries, very comparable populations, very comparable built environments. In fact, at the end of World War II, a Canadian house in a Swedish house looked pretty similar. And through most of the middle of the 20th century, that was also the case. Now at the end of World War II, Swedish houses actually were built with higher average radon than Canadian houses. By the 1980s, they were the same. New Canadian house, new Swedish house, same radon.
Today, a new Canadian house has 467% greater radon. Now the ground between Sweden, Canada has not changed, but the building codes have, and certainly the way we're heating our houses have. Radon can enter a property through many different sneaky ways. It can come in through certainly the gaps between your foundation and where it meets the wall under the furnace, if there's a gap there through cracks that you might often might not even be able to see, radon will be sometimes even sucked into a property simply by the aerodynamics of your home.
So really the property matters a great deal. You can have one street with 10 houses. Two, were very high for radon. Two, were very low for radon and everything else is in the middle. This illustrates the fact that radon, while naturally occurring and has indeed been coming out of the ground in the front lawn and in a field for all of human history, has only become an exposure problem in the 20th and 21st century as we have built buildings, homes, schools, workplaces that have captured, contained and concentrated to levels that we have never from an evolutionary perspective seen before. And that's a big problem because we are-
Dr. Blair Bigham:
So it's the way we're building that's causing this risk. It's not necessarily, it's not the environment. The radon hasn't changed, our lungs haven't changed, the way we're building is at fault.
Aaron Goodarzi:
Yes. And if you look at Sweden, the way they're building today in the 2020s versus how they built in 1980s is very different. And they have, although unbeknownst to them at the time, successfully engineered out their radon problem almost completely where Canada had the unfortunate, although we didn't know it at the time, radon was only discovered in the mid 1980s. But even before that, we were accidentally engineering up our radon levels.
Dr. Mojola Omole:
So how do we build differently? What should builders be doing differently and why is that not policy? Living in Toronto, there's a new building every two hours, so what can we do? Why is that not policy of building in a different way?
Aaron Goodarzi:
So I'll start out by saying it's not yet entirely clear what the Swedish did or that what we did that made our radon go up and theirs go down. One of the key differences between the two countries is less how the property is built, but more how the property is heated and cooled. The Swedish successfully starting in the 1970s and eighties, changed their build codes to move towards district heating.
That's a type of heating where you would probably have for a quadrant of a given Canadian city. Say there's a quarter million people there. You'd have one or two plants that would direct superheated water or steam into in-floor heating throughout the whole process. They basically got rid of what most of Canada has, oil fired or natural gas, forced air ventilation. And if you're not using natural gas and oil fired forced air ventilation, the air dynamics of that building is entirely different.
Dr. Blair Bigham:
So it's essentially a ventilation solution?
Aaron Goodarzi:
So it's an air dynamic problem versus-
Dr. Blair Bigham:
Oh, I feel as if I'm not smart enough to know the difference between air dynamics and ventilation, but it has to do with using-
Dr. Mojola Omole:
He has a PhD in radiation biology.
Dr. Blair Bigham:
It has to do with how the radon blows around the house and eventually gets out?
Aaron Goodarzi:
Yeah. So think of your house.
Dr. Mojola Omole:
He's like, no, you're dumb.
Aaron Goodarzi:
No, no, no, no. You're absolutely right. Think of your house like a person. Your house breathes. It brings in fresh air, it heats it up and it exhales the stale air. And that's happening all the time through the fresher intakes. Heat it up by your furnace or whatever you have that heats the air. And then it usually is exhaled through the roof. Now, very often houses can't bring in enough fresh air to balance the amount of stale air they're breathing out. And if that happens, it creates a negative pressure in the house and it makes up the difference by sucking on the ground. And so this is where-
Dr. Mojola Omole:
Now you're talking about... Okay.
Aaron Goodarzi:
This is where the aerodynamics really comes into play. Now they do not come much more energy efficient than a new Swedish house. So I'm going to underline the point that the Canadian radon problem, although at this time correlates with energy efficiency. It is not because of energy efficiency. It is because of a few flaws that we have in practice. For example, heat recovery ventilation, standard practice in the Canadian build code since 2010, often installed, but then it's never subsequently checked to see if that system is balanced. If the amount of air being brought in is balanced with the amount of air being exhaled. And if it's not, which typically aren't in Canada, unfortunately the house will make up the difference by sucking on the ground, creating a worse radon problem.
Dr. Blair Bigham:
So it actually pulls radon into the house? In a way.
Aaron Goodarzi:
Absolutely. And many other examples of that happening where radon is being drawn into the house simply due to the effect of negative pressure. Now hot air rises as well. So the hot air balloon effect. Well, when you're heating air in a Canadian house, the hot air's going to rise and exhale itself through the roof. And that will create a chimney draft across the whole height of the property, which can also bring it in. And of course the greater the temperature differential outside.
Super cold outside, warm inside, that's going to happen much more. And so then you can get higher levels in the winter. Now not necessarily does that always happen. In fact, we find today a quarter of Canadian houses actually have higher radon in summer, and that's because of air conditioning. So again, it all comes back to those air dynamics.
Dr. Blair Bigham:
Got it.
Aaron Goodarzi:
We're now closing up all the windows and doors because there's so much forest fire smoke or it's so hot outside that we're keeping our summer houses as closed up as we used to do for our winter heating season.
Dr. Mojola Omole:
So when we're talking about buildings, I'm assuming that exposure starts from a young age, so you're in schools and you're in daycares. How do we mitigate in those environments and what can be done? Are there examples of what's being done?
Dr. Blair Bigham:
Because those buildings are already there and they're going to be there for another 50 years. Instead of focusing on new builds, what do we do about all those buildings that exist now?
Aaron Goodarzi:
Yeah, the existing built environments. So schools is an interesting one. I'll start with that one. So several years ago, CAREX Canada, that's Carcinogen Exposure Canada, federally funded project that looks at various cancer causing exposure in workplaces, surveyed the entirety of the Canadian school system. Of course it differs by province. Some Canadian provinces, and I'll cite the examples of Yukon and Saskatchewan, a hundred percent of schools have been tested. And if high, mitigated.
Other Canadian provinces, it's a fraction of 10%, like less than single digit percent. And so there's a very unlevel playing field in terms of school systems, who's tested, who hasn't, who's fixed, who hasn't. But it certainly can be done because it has been done in many jurisdictions. Daycares are important one. I'll give you the great example of the BC interior. The BC interior have done a tremendous job led by public health officers there in reaching out to local daycares, asking them and getting them to radon test and enforcing radon reduction if those tests proved to be unacceptably high.
I'm unaware of that being systemically carried out elsewhere in Canada, except it's supposed to be done here in Alberta. In 2017, the Alberta Radon Awareness and Testing Act was passed unanimously, received Royal Ascent the following year, unfortunately had never been implemented. But if it was, that would require all Albertan daycares one year they'd have to radon tests. And then if it was high, another year after that, to mitigate unacceptably high levels. To me, it's no-brainer not to have radioactive daycares.
Dr. Blair Bigham:
That sounds like a sales pitch.
Aaron Goodarzi:
Right. Because we know early life exposure to radon, and this is work done by Health Canada and others, demonstrates it is the worst possible scenario because you have that much more life left within which to be diagnosed. And childhood exposure, given that, again, 10 to 30 year latency period means a diagnosis with lung cancer. And I have met too many people who are in their thirties with their own children who are combating stage four lung cancer, never having picked up a tobacco cigarette in their life, by knowing that their childhood house was high for radon.
Dr. Mojola Omole:
Let's say you test a daycare and it's high, why can't that be a responsibility of the Ontario government to help subsidize mitigation efforts?
Aaron Goodarzi:
Well, there's no reason it couldn't be.
Dr. Mojola Omole:
They're serving the public.
Aaron Goodarzi:
Except if it's for money. There's all sorts of tricks you can do from a policy perspective. You could go to The Brick tomorrow and buy a couch and spend two years paying it off in installments. That makes it a little bit more digestible to folks who can't afford upfront costs. Depending on what the building that the daycare's housed in looks like. Those costs could be relatively minor, particularly if you implemented some sort of subsidy or an installment plan or what have you. And I think it would be a great policy move for governments to enable that. But of course it all comes down to money.
Dr. Mojola Omole:
And so what is the single public policy change that we can make or action that would have the greatest impact in terms of reducing the lethality of radon in lung cancer?
Aaron Goodarzi:
Single greatest policy change, which is more of a guideline change from medical perspective to reduce lethality will be to figure out how to include non-tobacco sources of lung cancer in the risk assessment for screening. Screening is by far and away the best thing that we can do to reduce lethality because it means moving the needle from people being diagnosed at stage four, where unfortunately the five-year survival is in single digits to stage, ideally one or earlier, where lung cancer can actually be cured or at least seriously treated to the point where you're not dying of it, you're dying with it.
Dr. Blair Bigham:
So upstream we can build differently and downstream we just try to catch it early enough where we can resect it. Is that sort of the two prongs?
Aaron Goodarzi:
Basically? Yes, it's resected, it's a stage one. It's heavily localized, it's resected out. And then of course, you're right. The systemic solution is a build code intervention. Now both things, I'm pleased to say are being actively explored, looked at and are funded to be done right now. How it happens though, that remains to be seen. So Codes Canada, for example, they're preparing the 2025 build code draft at this time. Proactive radon control measures are being actively explored by experts in those areas right now and theoretically and could be implemented by the 2025 code.
Similarly, the Canadian Cancer Society has funded a large team, I know because I'm part of said team, with more than a $5 million clinical trial grant in order to explore non-tobacco sources of lung cancer, including radon as well as air pollution and arsenic, which is a big problem in Atlantic, Canada as criteria to include people for screening if they need it.
Dr. Blair Bigham:
This is fascinating.
Dr. Mojola Omole:
I know. I'm like, oh, that's a lot. Thank you so much for joining us.
Aaron Goodarzi:
My pleasure. Thank you for having me.
Dr. Mojola Omole:
Dr. Aaron Goodarzi is a Scientific Chair of the Evict Radon National Study. He joined us today from Calgary.
Dr. Blair Bigham:
So Jola, remind me how old your kid is.
Dr. Mojola Omole:
He is three.
Dr. Blair Bigham:
And he goes to daycare?
Dr. Mojola Omole:
He does, which I'm going to call after this conversation and text her and be like, "Hey, have you thought of a radon exposure? Here's a really good podcast you should listen to and maybe we should order a test and see."
Dr. Blair Bigham:
I feel like we should be buying radon detectors in bulk. I'm just going to hand them out to everybody.
Dr. Mojola Omole:
Well, I do think that part of this is that my personal, I'm going to say beef, with a lot of public policy is that we make everything to be individualized and not systemic changes. It's like you're reason turtles are dying in the ocean. You're the reason why our world is literally on fire and melting, where really it's not. A lot of this is systemic changes and corporate changes.
And I do think that there is a role here for governments, local governments to step up to help with this mitigation. Schools and daycares should not be your first exposure to lung cancer. It shouldn't be that you going to daycare is the same as you smoking a pack of cigarettes.
Dr. Blair Bigham:
And all these things that Aaron had mentioned are very future forward. New buildings might. Because I'm always skeptical when people say, "Oh yeah, a couple years from now Canada will have this fixed." Sure, maybe future buildings will be built more like the Swedes so that we're not having these problems. But what about all those buildings that are going to sit around for the next 50 or a hundred years where people congregate and spend their entire day Monday to Friday working or going to school or daycare?
Dr. Mojola Omole:
I do definitely see that there's a role in terms of we spend a lot of time in our homes and that there should be part of that. But we have to think about our patients who are from lower resource settings who don't necessarily have the ability to do the mitigation. Exactly. Or they live in a high rise complex that they don't have control over that. We really need to put the pressure in prevention by this being a systemic issue. We pay taxes for a reason. Our healthcare dollar should not just be to treat lung cancer when you're about to die and getting chemo for stage four cancer, but to actually prevent it. So you're not getting radon exposure as a toddler.
Dr. Blair Bigham:
And screening for lung cancer. It's like we've missed the boat. If you've got lung cancer from radon, this is so far downstream now that you're going to need a vats. Why didn't we just figure this out upstream before you got your lung cancer?
Dr. Mojola Omole:
And it's interesting because I've ran into people who are like, "Oh, my cousin or this person had lung cancer and they were only 30 something, 40 something and they never smoked." And I'm like, "Oh, that's so unfortunate," thinking that it's just errant crappy luck, but it's not. It's probably due to radon exposure. So that to me makes it much more of a public policy and a public health emergency because this is the environment and there's so much that family doctors already do that this is actually something that our government can step in to do something about.
Dr. Blair Bigham:
And in the meantime, I'm getting a radon test.
Dr. Mojola Omole:
Exactly.
Dr. Blair Bigham:
That's it for this episode of the CMAJ Podcast. Please remember to or share this podcast wherever it is you download. I'm Blair Bigham.
Dr. Mojola Omole:
I'm Mojola Omole. Until next time, be well.