Public Health Perspective on Radon Control in Ireland Dr. Ina Kelly Specialist Registrar in Public Health Medicine Health Service Executive Department of Public Health Tullamore

Radon Control in Ireland Prevention – Building Regulation 1997 (Technical Guidance Document C) –All new homes fitted with standby radon sump –Homes located in High Radon Areas -install radon barrier as well as a standby radon sump Mitigation –Homes - RPII has identified and focuses on high radon areas, raising awareness of radon and the benefits of testing –Workplaces - Safety, Health and Welfare at Work Act employers to identify all hazards in their workplace, including radon

New Evidence & International Guidance 1.Gray et al 2009 Health economic study showed installation of radon barrier in all new builds is cost effective 2. WHO Radon Handbook As no threshold for radon risk, recommends reducing overall burden of radon for population 3.Independent Advisory Group on Ionising Radiation (AGIR) Recommend criteria for health screening should be applied to radon screening

Why apply criteria for health screening to Control of Radon in Ireland? Radon control strategies differ from country to country –Threshold values and action levels, definition of high radon area –Approach to prevention –Testing and mitigation interventions –Awareness in population –Resource issues Radon exposure is different from country to country –Geology and rock formations –Building practice –Smoking rates (co-factor with radon)

About the screening criteria of the National Cancer Forum, Ireland Disease screening - WHO criteria 1968 (Wilson and Jungner) Criteria to also consider: –Harmful effects of screening –Quality of evidence of effectiveness of screening –Opportunity costs of implementing screening programme

National Cancer Forum Criteria The condition The test The treatment The screening programme Note – screening may be population based or instead, targeted at higher risk groups

Cancer screening criteria The condition Important health problem Epidemiology and natural history understood Cost-effective primary prevention interventions implemented The test Simple, safe, precise and validated Distribution of test values known and cut-off level defined and agreed Should be acceptable to population Agreed policy on further diagnostic investigation of individuals with a positive test and on choices available

Cancer screening criteria The treatment Effective treatment or intervention for those identified through early detection, with evidence of better outcomes for early rather than late treatment Agreed evidence-based policies covering which individuals should be offered treatment and the appropriate treatment to be offered Management of the condition and patient outcomes should be maximised prior to starting programme

The screening programme Screening programme reducing mortality or morbidity Complete screening programme acceptability to health professionals and to the public Benefit should outweigh the adverse effects Opportunity cost Plan for evaluating programme with agreed QA standards Adequate resources in place prior to commencement All other options for managing the condition should have been considered (e.g. improving treatment, providing other services) Cancer screening criteria

Public Health priorities Overall aim: To reduce the number of cases of lung cancer due to radon exposure Effective radon control strategy Primary prevention first Screening programme (secondary prevention) - effectiveness and opportunity cost Evaluation of outcomes of programme implementation

Public Health recommendations Time to review current policy on radon control including: –Building regulations –Smoking cessation –Standardisation of prevention, testing and mitigation interventions –On-going monitoring and evaluation of programme effectiveness

References 1.Gray A, Read S, McGale P, Darby S. Lung cancer deaths from indoor radon and the cost effectiveness and potential of policies to reduce them. BMJ 2009; 338:a3310. doi: /bmj.a3110 HPA (2009) 2.WHO. WHO Handbook on Indoor Radon. A public health perspective (2009) 3.Independent Advisory Group on Ionising Radiation (AGIR) “Radon and Public Health” Available at: