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concerted anti-smoking campaigns have substantially contributed to improved public health. Though messaging on radon has been but a fraction of that devoted to smoking, awareness of the need for testing our homes for radon has grown. What are largely the incumbent testing methods (plastic track detector chips and activated carbon packets-- both of which are exposed for a period of time and sent away to a laboratory for analysis) have made important contributions to prevention. In the search for what more can be done to reduce the societal costs of lung cancer, it is logical to examine the status of screening techniques.
Since diagnoses of lung cancer are most often made at later stages, to reduce overall costs, low cost non- (or minimally) invasive screening techniques are needed for use prior to the appearance of symptoms. For now, annual low-dose CT (computed tomography) scans remain the only approved method for screening of non-symptomatic individuals. Such screening involves the risky exposure to x-ray radiation at a level (1.4 mSv) equivalent to 14 chest x-rays and the false positive rate is significant (356 false positives if 1,000 individuals are screened each year for three years). [Ref. 6] Due to its costs and its risks, the Centers for Disease Control (CDC) guidelines are that low-dose CT scans are justified only for past or present heavy smokers in the 55 to 80 age bracket. Private insurance and Medicare pay (more or less) accordingly. Confirmation via visual bronchoscopy and biopsy remains necessary.
There is some promise worth noting toward screening tests employing breath analysis and “liquid biopsy” techniques. OneBreath, Inc. and Owlstone Medical, Inc. are start-up companies that focus on breath analysis. Cancers in lung tissue produce certain small molecule volatile organic chemical (VOC) markers, e.g.: 1-butanol and 3-hydroxy-2-butanone. [Ref. 7] In OneBreath’s version of such new technology, the patient exhales into an absorber cartridge at the point of care, which is later desorbed at a laboratory for analysis by gas chromatography. [Ref. 8] In Owlstone’s version, breath is absorbed over several minutes and desorbed into a gas stream flowing though what is known as a Field Assisted Ion Mobility Spectroscopy chip for artificial intelligence pattern recognition. [Ref. 9] In a completely different approach, there is much research on “liquid biopsy” techniques based on drawing blood samples and analyzing for ct-DNA (circulating tumor DNA) arising from apoptosis and necrosis of dying cells. [Refs. 10, 11] Despite continuing clinical studies, none of the above approaches will be in widespread use in the near term. False positives and false negatives remain a concern.
Thus, early diagnosis remains a remains difficult proposition, and for now it is reasonable that society must double-down on prevention.
As a part of taking prevention to new levels, the rationale for the expanded use of continuous electronic
monitors is persuasive. The RadonEye from Ecosense is a particularly precise and accurate example, which is remarkably user friendly. A principle reason to choose continuous monitoring is that radon levels in homes can vary dramatically from season to season, making long term testing crucial. [Ref. 12] The RadonEye reports via Bluetooth BLE to either an Android or iOS smartphone app that allows visualization of data over days, weeks, and months. A short-term measurement is insufficient to capture the full annual range (largely driven by internal/external temperature and air pressure differential. Having said that, the RadonEye offers an unprecedented data rate (updating measurements every 10 minutes) owing to its 30 CPH/pCi/L (counts per hour per pico-Curie per liter) sensitivity. The data rate allows the attentive user to draw correlations to their ventilation behavior.
What Else Can We Do?
Given the costs borne directly or indirectly by all of us, one might rightly ask how mush more can be done in promoting residential radon testing and mitigation activities?
The most cost-effective measures undoubtedly focus on education and communication. For instance, as part of patient intake, electronic heath records initiatives, Medicare annual physicals, and the like, we are generally asked about our smoking history. What if whether one’s home has been tested also commonly becomes part of such questionnaires? General practitioners need to be at the forefront of education on radon. Can more with done with pamphlets in waiting rooms-- possibly bearing discount coupons for detectors? How many people know that radon mitigation projects can be tax deductible if their doctor so advises?
One might think it in the interest of private health care insurance companies to reduce costs by incentivizing their insureds to reduce radon risks. However, given the nature of lung cancer, investments made by health insurers today (say in terms of rebates or reduced premiums upon evidence one’s home is tested) may have a decades long time lag prior to paying off in reducing their costs.
Lobbying for additional government regulation may be a logical way forward. Testing upon the transfer of title to homes is already practiced in 29 states. [Ref. 13] Requiring testing of schools, public buildings, and workplaces may make sense if bounded by some logical criteria. There are numerous resources for identifying legislation and the responsible agencies within individual states. [Ref. 14]
Non-profits and foundations may be interested in setting up library programs to lend electronic radon detectors and equip schools with detectors for science projects. As of 2020, Health Canada successfully operates such programs in 52 library locations, nearly all of which experience long wait lists. [Ref. 15] Lending periods are short (3-6 weeks), which runs counter to the modern understanding of the need for long term testing; however, the educational opportunity presented can be used to counteract any possible false sense of security arising from short-term tests.
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