OncologyLive® is the flagship publication of OncLive®. Each issue delivers expert insights and clinical oncology news and updates, which impact the day-to-day clinical practice of oncology professionals who work tirelessly to help improve patient outcomes.

	Radon is an invisible, odorless, and tasteless radioactive gas that is released into the air or dissolves into groundwater as uranium in rocks or soil decays. It was classified as a human carcinogen in 1988 by the International Agency for

on Cancer, but the ill health effects of this invisible killer had been observed for centuries in Europe. Today, radon is known to be the second leading cause of lung cancer overall and the leading cause of lung cancer in nonsmokers in the United States. The risk of lung cancer is greatest in smokers exposed to radon, with the majority of the estimated 15,000 to 22,000 

 deaths occurring in these individuals annually.

 have examined whether a link may also exist between leukemia and indoor radon exposure, especially in pediatric patients, but most have failed to establish such a correlation; however, a recently published epidemiological

of childhood leukemia in Denmark that included 2400 patients and 6697 controls between 1968 and 1994 found a weak but statistically significant correlation between residential radon exposure and acute childhood lymphoblastic leukemia. Studies examining possible links between radon exposure and stomach cancer, cardiovascular diseases, multiple sclerosis, and a host of other maladies have also been undertaken, yielding mixed results.

	To increase the public’s awareness of radon’s health risks, promote radon testing and mitigation, and advance the use of radon-resistant new construction practices, the US Environmental Protection Agency (EPA) has designated January as National Radon Action Month. The 

 estimates that one in every 15 homes nationwide has a radon level at or above the recommended action level of 4 picocuries per liter (pCi/L) of air, which according to 

articles from 2008 is a level that has “about the same risk for cancer as smoking a half a pack of cigarettes per day” and delivers the same amount of radiation per year as receiving more than 200 chest 

. Unless you are buying or selling a home, when radon testing may be mandatory, you may not know if the radon levels in your home are in the danger zone. Many kits are readily available to help you to determine your home’s radon levels, and if they are found to be elevated, there are various mitigation strategies that can be explored, some for nominal cost. We explore radon testing, how to locate a radon mitigation professional, and describe some of the online resources that can help you safeguard your home from this insidious carcinogen.

	You can see if you live in a zone with potentially high radon concentrations by consulting the 

 radon concentrations have been observed in Iowa and southeastern Pennsylvania, but according to a report published by the World Health Organization (

) in 2009, “the majority of radon-induced lung cancers are caused by low and moderate radon concentrations rather than by high radon concentrations, because in general less people are exposed to high indoor radon concentrations”. If you discover that you live in an area with potentially high concentrations of radon, it is especially important to test your home for radon, but even if you live in an area predicted to have low levels (<2 pCi/L), you cannot guarantee that the levels in your home are in that range unless you test.

	Although you can have your home professionally tested for radon, using a do-it-yourself kit is easy and economical. Radon test kits can be found at many home improvement stores, through online 

 such as the Kansas State University National Radon Program Services at, and sometimes for free from local or county health departments or state radon programs.

	Several types of radon test kits are on the market, including short-term and long-term tests, radon water tests, and electronic radon detectors. With so many choices, it may be difficult to determine what you need. Short-term tests, which remain in your home from 2 to 90 days, are the most commonly used. These tests cost approximately $15 each, which includes laboratory analysis. The EPA recommends using two or more of these kits throughout the year to ensure accuracy of the readings because the absorptive material of these tests can react to temperature and humidity changes, especially during transit, which may affect their precision. Radon levels also vary daily, so using multiple tests throughout the year gives a more accurate assessment of your year-round mean radon level. If you would rather avoid the hassle of dealing with multiple short-term tests, you may opt to use a long-term radon test instead. Long-term tests cost between $25 and $45 and remain in your home for more than 90 days, with some remaining in your home for up to a year.

	While the risk of lung cancer from inhaling radon is far greater than the risk of gastric or other cancers from ingesting water containing radon, radon can be released into the air when using water for daily living activities such as showering, contributing to lung cancer risk. The risk of radon entering your home through water is generally low, unless your water is from a ground water source, such as a private well, or a public supply that uses ground water. If your water comes from a public supply, you should receive a Water Quality Consumer

	Confidence Report (CCR) every year from your city or township, which will include radon levels. To learn more about these reports and how to decipher them, you can visit 

 International. If you have a private well or want to confirm the radon results of your CCR, you can buy a radon water test kit. These tests generally cost between $25 and $40, which includes laboratory assessment. If you have any questions about radon in drinking water, you can contact the Safe Drinking Water Hotline at (800) 426-4791.

	A few years ago, the risk of radon leaking from granite countertops made mainstream news. Although most experts agree that the risk of radon being emitted from most granite countertops is extremely low, slabs emitting more than 4 pCi/L have been identified. In an interview with CBS in 2008, Stanley Liebert, quality assurance director at 

 Laboratories in Clifton, New York, noted that certain colors seem to pose a higher risk than others, with reds, pinks, and purples appearing to emit the highest levels. Other 

 have indicated that the exotic and striated granite varieties from Brazil and Namibia are the most suspect. Because uranium levels in granite are not measured or controlled, the only way to guarantee your granite countertop is not a radon hot zone is by testing it. A pack of seven tests can be purchased for $79.95 at 

, where you can also watch a video on how to use these tests.

	If you wish to continuously monitor your home for radon, as you may already be doing for carbon monoxide, you can opt to purchase an electronic radon detector instead. Currently, the Safety Siren Pro Series3 HS71512 Electronic Radon Gas Detector is the only radon gas detector designed specifically for use by homeowners. It is available through 

 for approximately $125. The Safety Siren Pro features a numeric LED display to show the level of radon gas in the air, and offers both a short-term reading that displays the average radon level over the past 7 days and a long-term reading that displays the average radon level since being powered-up or since the last reset within the past 5 years. If the long- term measurement reaches 4 pCi/L or greater, or if the short-term measures stays above 4 pCi/L for 30 consecutive days, an alarm will sound.

	If radon testing reveals a level of 4 pCi/L or more, it is important to fix your home to mitigate risk, but even levels between 2 pCi/L and 4 Ci/L pose some risk and may warrant a repair. Costs of radon mitigation generally average between $800 and $2500. A comprehensive

 of mitigation techniques is available. If you are handy, you may be able to tackle some of these repairs yourself, but because mitigation generally requires sealing basement foundations, concrete slab floors, or areas under crawl spaces, and installing ventilation or radon collection systems, these tasks may be best left to the professionals.

	To find a radon service professional in your area, you can visit 

and then select your state, which will pull up contact information for state radon programs and other organizations that can help you identify contractors in your area. You can also opt to contact one of the following privately-run National Radon Proficiency Programs, which provide accreditation and certification in radon testing and mitigation. Both organizations maintain a database of certified radon professionals on their Website:

National Environmental Health Association - National Radon Proficiency Program 

	If you prefer to tackle the radon problem yourself, you may consider purchasing 

Protecting Your Home from Radon: A Step by Step Manual for Radon Reduction

 by Douglas L. Kladder and colleagues before you get started. The book has a 5-star rating on Amazon based on two reviews. One reviewer commented, “[The book allows] a reasonably competent DIYer to design and install their own radon mitigation system. In addition, it covers the necessary safety precautions to take in the process.” The book can be purchased through Air-Chek for $29.95 by calling (800) AIR-CHEK. To view the book’s table of contents, visit 

www.radon.com/radon/radon_mitigation-book.html.

	January is a time for making resolutions to improve health, and while eating better and exercising are important, environmental health risks should not be overlooked. Radon exposure is a known risk factor for lung cancer, and more studies are showing that it may contribute to the development of other health issues as well, such as leukemia. Radon testing is inexpensive and easily performed, and mitigation costs are no greater than most other home improvements, but can have a considerable impact on health. As you know from treating patients with cancer, health is our most precious commodity, so don’t let radon rob you, your loved ones, or your patients and their families of it. Take action by testing your home and encouraging your patients to do the same.

Articles

Radon is an invisible, odorless, and tasteless radioactive gas that is released into the air or dissolves into groundwater as uranium in rocks or soil decays.

The Invisible Killer in Your Home: Understanding Radon, Testing, and Mitigation

	For faster manipulation of patient records and imaging, try Magic Mouse, Apple’s new multi-touch wireless mouse, which retails for approximately $65. Its content interaction technology matches the iPhone and iPod, with simple finger gestures controlling onscreen features. One- and two-finger motions allow scrolling, zooming, and swiping through Webpages or images. An internal chip differentiates between the various finger commands. Magic Mouse’s entire surface is a button, so users can click or double-click anywhere on the top shell. Its powerful laser tracking eliminates the need for a mousepad. With no mousepad and no cord, Magic Mouse frees your workspace from restrictive clutter. If you are interested in obtaining more information about the Magic Mouse, visit 

	With VoiceFactor voice-recognition technology, your computer recognizes the sound of your voice and instantly creates reports,e-mails, patient evaluations, prescriptions, spreadsheets, and more. The speech-to-text technology composes documents without typos at the speed of your voice. VoiceFactor consultants tailor packages to meet an individual practice’s needs. Continual support is offered through training videos, online and in-house training sessions, and a helpline. VoiceFactor packages also include Text Aloud Speech Technology, in which a voice reads text aloud from your monitor. Another feature, Voice Shortcuts, performs Web searches in response to your voice commands. Use the technology on the go with Bluetooth and other wireless devices. To check out these and other VoiceFactor products and applications, visit 

	In 2010, technology bling is coming to a store near you with the ORB

 is a ring that twists open into a Bluetooth headset. Designers Hybra Advance Technology, Inc and AbsolutelyNew are even releasing limited-edition models with decorative gemstones. The comfortable, noninvasive ORB rests outside the ear, using bone-conducting technology to deliver high- quality sound. All models come in multiple ring sizes and have class 2 Bluetooth range (approximately 30 ft). The deluxe edition offers voice-to-text technology and a display screen featuring caller ID and texts. ORB was named the Consumer Electronics Show (CES) 2010 Best of Innovation winner in the wireless handsets accessories category. Look for basic editions in January for $129.00 and deluxe models in April for $175.00. For more information, visit 

Oncology Gadget Watch: May 14, 2010

	While family history and lifestyle factors affect cancer risk, environmental factors also play a considerable role. You will no doubt recall the movie 

, which recounted the story of a law firm file clerk uncovering the dumping of hexavalent chromium, also called chromium 6, into the groundwater supply of Hinkley, a small town in southern California, by Pacific Gas & Electric. This finding and subsequent lawsuit led to one of the largest toxic tort injury settlements in US history, with $333 million in settlements awarded to approximately 600 Hinkley residents suffering from ailments such as breast cancer, Hodgkin lymphoma, lung cancer, brain-stem cancer, gastrointestinal cancer, kidney and ovarian tumors, and a host of other maladies as a result of being exposed to chromium 6. While similar cases have surfaced throughout the United States, and stories of chemicals being leached into drinking water by corporate entities may receive considerable attention by the media, there are naturally occurring environmental risk factors for cancer, such as radon, that receive comparably little attention but affect far more households.

	The ill health effects of radon have long been observed in miners, but it was not known to be a health risk in the general population until the 1980s. Radon is now known to be the second leading cause of lung cancer, and it may contribute to the development of other cancers as well, yet the only time this environmental risk factor may be brought to anyone’s attention is during a real estate transaction. January is National Radon Action Month, as designated by the US Environmental Protection Agency, and our cover story, “The Invisible Killer in Your Home: Understanding Radon, Testing, and Mitigation”, provides an overview of radon, testing methods, and locating a mitigation professional, while outlining some online resources that can help keep you, your family, and your patients informed and safeguarded from this environmental health hazard. 

	Our second feature story, “Mapping the Cancer Genome”, reviews some of the findings that cancer genome sequencing has yielded, including how environmental and lifestyle factors can increase cancer risk. Recently, researchers from the Wellcome Trust Sanger Institute in Cambridge reported the results of their study published in Nature, which compared the genetic sequence of small cell lung cancer cells and melanoma cells with normal cells taken from the same individuals. Through this analysis, the researchers were able to identify thousands of mutations in the cancer cells, with almost all mutations in the small cell lung cancer and melanoma cells being traced back to smoking and ultraviolet exposure, respectively. The researchers estimate that a typical smoker may acquire one mutation for every pack of cigarettes smoked, and one may surmise that exposure to other environmental toxins, such as radon, could lead to additional mutations, as research has shown that lung cancer risk from radon is especially high in smokers. As more cancer cells are sequenced, which is being made possible by the dramatic drop in gene mapping costs, the effects of various carcinogens and the role of genetic factors will be better understood, which will also lead to more effective, personalized treatments.

	In our From the Editor column, Dr Markman discusses electronic cigarettes, which have become increasingly popular, with some individuals using them as an alternative to traditional cigarettes because they are perceived to be healthier. As Dr Markman points out, however, assessment of these cigarettes has shown that they may contain other known carcinogens, as this industry is largely unregulated. Further, because electronic cigarettes are relatively new, their ill health effects are not yet known; thus, patients expressing interest in using electronic cigarettes should be warned of their potential dangers.

 and would love to know what you think of it, or if you have any topics you would like to see covered in an upcoming issue. You can send an e-mail to the editor, Christina Loguidice, at 

While family history and lifestyle factors affect cancer risk, environmental factors also play a considerable role. You will no doubt recall the movie Erin Brockovich, which recounted the story of a law firm file clerk uncovering the dumping of hexavalent chromium, also called chromium 6, into the groundwater supply of Hinkley, a small town in southern California, by Pacific Gas & Electric.

January 2010 | Oncology Live®

The Invisible Killer in Your Home: Understanding Radon, Testing, and Mitigation

Oncology Gadget Watch: May 14, 2010

Cancer Risk: Role of Environmental and Lifestyle Factors