Dr Silvina Mema
Leading advocate for radon testing and mitigation
Originally from Argentina where she received her medical degree from the University of Buenos Aires Dr. Mema specialized in ophthalmology. After coming to Canada Dr. Mema switched gears and specialized in Public Health and Preventive Medicine. Dr. Mema is currently the Deputy Chief Medical Officer Interior Health Authority in British Columbia Canada.
Practicing medicine in Canada and specifically in British Columbia is one of the most rewarding experiences of my career. Our Universal, publicly funded healthcare system does not differentiate among people based on their ability to pay. For this reason, we need to focus on prevention activities that can spare healthcare from incurring costs for preventable diseases like lung cancer.
Public Health is a fascinating specialty and covers all aspects of health care not directly related to healthcare system. Dr Mema views the population as her patient. With the
majority of factors that influence health care
are outside the system,case in point, the physical environment in which we live can
make us sick. An important example is exposure to radon which can significantly increase the risk of lung cancer and become a public health concern.
We work closely with the healthcare system, advocacy groups and community leaders who can influence and champion initiatives towards creating awareness about radon.
A cancer diagnosis can have a devastating impact on individuals and families, testing
for radon is a relatively low effort, low-cost initiative that empowers individuals to prevent their risk of cancer.
Lung cancer is the most common type of cancer in Canada, and 86% of cases are attributable to a modifiable risk factor with approximately 16% of all lung cancer deaths attributable to radon exposure Health Canada recommends homeowners test for radon and if levels are above 200Bq/m3 they should take remedial action to lower the radon levels as low as possible. Smoking and radon form a nasty mix per increased exposure to each, with smoking imparting a greater than 8x risk of lung cancer at the 200 Bq/m³ Guideline, 2% lifetime risk for people who don’t smoke, and 17% lifetime risk for people who smoke, respectively.
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As tobacco prevention activities and cessation programs expand, we have seen rates of lung cancer decline as well, particularly among males. This is why it is important to focus on other risk factors, such as physical inactivity, residential radon, and air pollution, which contribute to 11, 7 and 6 per cent of lung cancer cases respectively.
There is no safe level of radon, and I look to credible agencies like the World Health Organization Reference Level of 100 Bq/m³, and the USA EPA Action Level of 4 pCi/L (148 Bq/m³), each bestowing less exposure than the 200 Bq/m³ Canadian Guideline, each recommending getting radon to as low as reasonably achievable below their guidance. These guidance levels were established prior to the 2017 Publication 137 by the International Commission on Radiological Protection revised Effective Dose Coefficient that realizes a doubling to quadruple (depending upon physical breathing activity) negative impact to lung tissue from alpha radiation exposure.
The British Columbia Centre for Disease Control, our surveillance hub for public health, estimates 30% of homes in the Southern Interior have radon levels that exceed guidelines with levels above recommended levels which can lead to lung cancer for those living within.
At Interior Health we understand that efforts towards creating awareness and mitigating the impact of radon are important. Our licensing program requires childcare facilities to test for radon as a condition of licence. This is because many childcare centres are located in basements, where radon tends to accumulate, but importantly children can be more susceptible to the impacts of radon as their lungs are developing and they breathe faster, leading to an increased exposure relative to adults.
In 2022, we launched an initiative to reach out to schools across our region, the Southern
Interior of BC. We distributed approximately 4,000 radon test kits and are currently collecting,
and analyzing the results. This initiative was well received, most school districts participated and
we are now working toward reaching the remaining schools that did notparticipate last year.
Test results from the alpha track puck tests is relayed from the laboratory to school management and Interior Health. The data is shared with the British Columbia Centre for Disease Control for entry into the central provincial database that contributes to a provincial mapping process underway. Although maps should not be used on a micro level (2 houses side-by-side can test far different), mapping can help educate local government officials about radon hot spots and assist decision-making around building code rough-in amendments.
The impact will be that all schools in our region will have radon levels below the Canadian guideline.Students and staff working in school buildings will be better protected from radon exposure. As long-term inhalation of alpha particle radiation increases the lifetime relative risk of lung cancer, the goal is to bring radon into the overall portfolio of school indoor air quality maintenance under the As Low as Reasonably Achievable principle (below the Canadian Guideline).
A secondary but very important impact is that our initiative is increasing awareness about radon. Staff and students from schools will now know about radon and may decide to test their homes, or other workplaces. We are planning a Student Radon Skill Testing Contest associated with the school initiative to further incentivize knowledge spread.
The last word:
It is important that individuals be aware of the risks of radon and be motivated to test their homes, workplaces and indoor leisure spaces. Public health efforts should make it easier for individuals to access information and obtain test kits so people can have the tools they need to be healthy.
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