Skip to main content

Main menu

  • Home
  • Current issue
  • Past issues
  • Authors/reviewers
    • Instructions for authors
    • Submit a manuscript
    • COVID-19 submission information
    • Institutional open access agreements
    • Peer reviewer login
  • Alerts
  • Subscriptions
  • ERS Publications
    • European Respiratory Journal
    • ERJ Open Research
    • European Respiratory Review
    • Breathe
    • ERS Books
    • ERS publications home

User menu

  • Log in
  • Subscribe
  • Contact Us
  • My Cart

Search

  • Advanced search
  • ERS Publications
    • European Respiratory Journal
    • ERJ Open Research
    • European Respiratory Review
    • Breathe
    • ERS Books
    • ERS publications home

Login

European Respiratory Society

Advanced Search

  • Home
  • Current issue
  • Past issues
  • Authors/reviewers
    • Instructions for authors
    • Submit a manuscript
    • COVID-19 submission information
    • Institutional open access agreements
    • Peer reviewer login
  • Alerts
  • Subscriptions

Systematic review and meta-analysis of residential radon and lung cancer in never-smokers

Elvin S. Cheng, Sam Egger, Suzanne Hughes, Marianne Weber, Julia Steinberg, Bayzidur Rahman, Heather Worth, Alberto Ruano-Ravina, Patrick Rawstorne, Xue Qin Yu
European Respiratory Review 2021 30: 200230; DOI: 10.1183/16000617.0230-2020
Elvin S. Cheng
1Cancer Research Division, Cancer Council NSW, Sydney, Australia
2School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • ORCID record for Elvin S. Cheng
  • For correspondence: elvin.cheng@nswcc.org.au
Sam Egger
1Cancer Research Division, Cancer Council NSW, Sydney, Australia
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Suzanne Hughes
1Cancer Research Division, Cancer Council NSW, Sydney, Australia
2School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Marianne Weber
1Cancer Research Division, Cancer Council NSW, Sydney, Australia
2School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Julia Steinberg
1Cancer Research Division, Cancer Council NSW, Sydney, Australia
2School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • ORCID record for Julia Steinberg
Bayzidur Rahman
3School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Heather Worth
3School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Alberto Ruano-Ravina
4Dept of Preventive Medicine and Public Health, University of Santiago de Compostela, Santiago de Compostela, Spain
5Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP, Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública), Madrid, Spain
6Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • ORCID record for Alberto Ruano-Ravina
Patrick Rawstorne
3School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
7Equal contribution as last author
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Xue Qin Yu
1Cancer Research Division, Cancer Council NSW, Sydney, Australia
2School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
7Equal contribution as last author
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Figures & Data
  • Info & Metrics
  • PDF
Loading

Figures

  • Tables
  • Supplementary Materials
  • FIGURE 1
    • Download figure
    • Open in new tab
    • Download powerpoint
    FIGURE 1

    Flowchart of the search process and results for studies looking at radon and lung cancer in never-smokers. #: these 24 studies are unique individual studies included in the four pooled data analyses. Accordingly, Barros-Dios et al. [33], which appears in two of the four pooled data analyses, is only counted once.

  • FIGURE 2
    • Download figure
    • Open in new tab
    • Download powerpoint
    FIGURE 2

    Adjusted excess relative risk (aERR) and 95% CI per 100 Bq·m−3 (radon exposure) for diagnosis of lung cancer. #: Barros-Dios et al. [66] in this pooled study contributed to the “ever-smoker” meta-analysis. p=0.32 for test of difference between aERRs for never-smokers and ever-smokers.

  • FIGURE 3
    • Download figure
    • Open in new tab
    • Download powerpoint
    FIGURE 3

    Adjusted excess relative risk (aERR) and 95% CI per100 Bq·m−3 (radon exposure) for diagnosis of lung cancer in never-smokers stratified by sex. p=0.027 for difference between male and female aERRs.

Tables

  • Figures
  • Supplementary Materials
  • TABLE 1

    Inclusion and exclusion criteria for screening articles

    DomainInclusion criteriaExclusion criteria
    Study type/designPooled data analysis of cohort or case–control studiesEcological study case series
    Meta-analysis of cohort or case–control studies
    Systematic review of cohort or case–control studies
    Cohort study
    Case–control study
    Study populationNever-smokers (<100 cigarettes in lifetime)
    ExposureIndoor or residential radon exposureMining radon exposure
    ComparatorNo or lower radon exposure
    OutcomeLung cancer diagnosis or death
    Time of publicationPublished from 1 January 1990 to 5 March 2020Published before 1990
    Publication typeFull-text published articleEditorials, conference proceedings, abstracts, posters, narrative reviews, commentaries, grey literature
    LanguageEnglishLanguage other than English
  • TABLE 2

    Summary of the studies included in systematic review and meta-analysis

    First author [ref.]Country/regionStudy periodStudy designRadon detection techniqueSexPopulation sourceOutcome: LC diagnosis/deathNever-smokersEver-smokers
    CasesControlsCasesControls
    Darby[48]#¶
    Darby[51]#¶
    Europe1960–99Pooled studyM/FGeneral+hospitalDiagnosis884541860408252
    Oberaigner[25]Austria1970–92C-CM/FGeneralDiagnosis2241159127
    Tomasek[26]Czechia1960–99CohortKodak LR115M/FGeneralDeath28295143417
    Auvinen [27]Finland1986–92C-CAlpha trackM/FGeneralDiagnosis44229772752
    Ruosteenoja[28]Finland1979–85C-CRadon dosimeterMGeneralDiagnosis333155291
    Baysson[29]France1990–99C-CKodalpha LR115M/FHospitalDiagnosis44344521797
    Kreuzer[30]Germany: eastern1991–97C-CAlpha trackM/FGeneralDiagnosis96544850994
    Kreienbrock[31]Germany: western1990–95C-CSolid-state nuclear trackM/FGeneralDiagnosis8965312251433
    Bochicchio[32]Italy1993–96C-CRadon dosimeterM/FHospitalDiagnosis28102355291
    Barros-Dios [33]Spain1992–94C-CAlpha trackM/FGeneralDiagnosis1294144133
    Pershagen[34]Sweden1980–84C-CSolid-state alpha trackM/FGeneralDiagnosis1751156682761
    Lagarde[35]Sweden1978–95C-CRadon dosimeterM/FGeneralDiagnosis258487
    Pershagen[44]Sweden: Stockholm1983–87C-CAlpha trackFGeneral+hospitalDiagnosis36181160194
    Darby[36]England1988–95C-CSmall passive radonM/FGeneral+hospitalDiagnosis268968742062
    Krewski[49]#¶
    Krewski[50]#¶
    North America1982–97Pooled studyM/FGeneralDiagnosis659218529302681
    Schoenberg[37]USA: New Jersey1982–84C-CAlpha trackFGeneralDiagnosis61213372189
    Letourneau[38]Canada: Winnipeg1983–90C-CCR-39 alpha trackM/FGeneralDiagnosis24224509498
    Alavanja[39]USA: Missouri1986–92C-CAlpha trackFGeneralDiagnosis377983161200
    Alavanja[45]USA: Missouri1993–94C-CCR-39 alpha-particleFGeneralDiagnosis3162471480
    Field[40]USA: Iowa1993–97C-CAlpha trackFGeneralDiagnosis56414357200
    Sandler[65]USA: Connecticut1989–92C-CAlpha track etchM/FGeneralDiagnosis5478718735
    Sandler[65]USA: Utah1989–92C-CAlpha track etchM/FGeneralDiagnosis56211342379
    Lubin[46]#¶
    Lubin[47]#¶
    China1985–98Pooled studyM/FGeneralDiagnosis322+708+7061266
    Blot[42]China: Shenyang1985–87C-CRadon dosimeterFGeneralDiagnosis113213162120
    Wang[43]China: Gansu1994–98C-CAlpha trackM/FGeneralDiagnosis2094955441146
    Lorenzo-Gonzalez [52]#§Spain: northwest2003–13Pooled studyAlpha trackM/FHospitalDiagnosis476+656+261f264f
    Barros-Dios [66]¶Spain: Galicia2004–08C-CAlpha trackM/FHospitalDiagnosis47220261264
    Torres-Duran [64]##Spain: Galicia2011–13C-CAlpha trackM/FHospitalDiagnosis192329
    Wilcox[68]¶¶USA: New Jersey1989–92C-CAlpha trackM/FGeneralDiagnosis40116521513
    Turner[67]¶¶USA1982–88CohortMean county-level of radonM/FGeneralDeath271375 0872733355 286

    Data are presented as n. LC: lung cancer; C-C: case–control study; M: male; F: female. #: these studies are included in the meta-analysis for never-smokers; ¶: these studies are included in the meta-analysis for ever-smokers; +: unpublished data provided by original investigators; §: this study has been revised by its lead investigator to exclude the results of Barros-Dios [33] which was included in the Darby [48] pooled study; ƒ: data for ever-smokers extracted from Barros-Dios [66] which was not analysed in the pooled study; ##: this study has been updated from July 2013 by its lead investigator to include more cases and controls in the Lorenzo-Gonzalez [52] pooling study; ¶¶: these studies are not included in the meta-analysis due to different measures of effect (cohort study) or standard errors or confidence intervals (case–control study) not reported for their risk estimates.

    • TABLE 3

      Important findings and impact on public health

      Important findingsImpact on public health
      • This is the first systematic review and meta-analysis which provides quantified risk estimates for lung cancer from residential radon exposure, with aERRs of 0.15 and 0.09 per 100 Bq·m−3 among never-smokers and ever-smokers respectively

      These findings quantify the excess relative risks for never-smokers and ever-smokers at the WHO “action level of radon” of 100 Bq·m−3
      • There was evidence to support a synergistic interaction between radon and tobacco smoking

      Ever-smokers living in radon-prone areas should be considered as a high-risk group and smoking cessation should be among their top health priorities
      • Among never-smokers, aERR of lung cancer per 100 Bq·m−3 of radon exposure was higher for men than women

      Among never-smokers in radon-prone areas, men may need to take greater caution than women to avoid or reduce their exposure to radon

      aERR: adjusted excess relative risk; WHO: World Health Organization.

      Supplementary Materials

      • Figures
      • Tables
      • Supplementary Material

        Please note: supplementary material is not edited by the Editorial Office, and is uploaded as it has been supplied by the author.

        Supplementary_material ERR-0230-2020_Supplementary_material

      PreviousNext
      Back to top
      View this article with LENS
      Vol 30 Issue 159 Table of Contents
      European Respiratory Review: 30 (159)
      • Table of Contents
      • Index by author
      Email

      Thank you for your interest in spreading the word on European Respiratory Society .

      NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

      Enter multiple addresses on separate lines or separate them with commas.
      Systematic review and meta-analysis of residential radon and lung cancer in never-smokers
      (Your Name) has sent you a message from European Respiratory Society
      (Your Name) thought you would like to see the European Respiratory Society web site.
      CAPTCHA
      This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
      Print
      Citation Tools
      Systematic review and meta-analysis of residential radon and lung cancer in never-smokers
      Elvin S. Cheng, Sam Egger, Suzanne Hughes, Marianne Weber, Julia Steinberg, Bayzidur Rahman, Heather Worth, Alberto Ruano-Ravina, Patrick Rawstorne, Xue Qin Yu
      European Respiratory Review Mar 2021, 30 (159) 200230; DOI: 10.1183/16000617.0230-2020

      Citation Manager Formats

      • BibTeX
      • Bookends
      • EasyBib
      • EndNote (tagged)
      • EndNote 8 (xml)
      • Medlars
      • Mendeley
      • Papers
      • RefWorks Tagged
      • Ref Manager
      • RIS
      • Zotero

      Share
      Systematic review and meta-analysis of residential radon and lung cancer in never-smokers
      Elvin S. Cheng, Sam Egger, Suzanne Hughes, Marianne Weber, Julia Steinberg, Bayzidur Rahman, Heather Worth, Alberto Ruano-Ravina, Patrick Rawstorne, Xue Qin Yu
      European Respiratory Review Mar 2021, 30 (159) 200230; DOI: 10.1183/16000617.0230-2020
      del.icio.us logo Digg logo Reddit logo Technorati logo Twitter logo CiteULike logo Connotea logo Facebook logo Google logo Mendeley logo
      Full Text (PDF)

      Jump To

      • Article
        • Abstract
        • Abstract
        • Introduction
        • Methods
        • Results
        • Discussion
        • Supplementary material
        • Footnotes
        • References
      • Figures & Data
      • Info & Metrics
      • PDF

      Subjects

      • Lung cancer
      • Tweet Widget
      • Facebook Like
      • Google Plus One

      More in this TOC Section

      • Mucolytics for acute exacerbations of COPD: a meta-analysis
      • Targeting IL-33 and TSLP pathways for novel pulmonary therapeutics
      • Physical activity promotion interventions in chronic airways disease
      Show more Reviews

      Related Articles

      Navigate

      • Home
      • Current issue
      • Archive

      About the ERR

      • Journal information
      • Editorial board
      • Reviewers
      • Press
      • Permissions and reprints
      • Advertising
      • Sponsorship

      The European Respiratory Society

      • Society home
      • myERS
      • Privacy policy
      • Accessibility

      ERS publications

      • European Respiratory Journal
      • ERJ Open Research
      • European Respiratory Review
      • Breathe
      • ERS books online
      • ERS Bookshop

      Help

      • Feedback

      For authors

      • Instructions for authors
      • Publication ethics and malpractice
      • Submit a manuscript

      For readers

      • Alerts
      • Subjects
      • RSS

      Subscriptions

      • Accessing the ERS publications

      Contact us

      European Respiratory Society
      442 Glossop Road
      Sheffield S10 2PX
      United Kingdom
      Tel: +44 114 2672860
      Email: journals@ersnet.org

      ISSN

      Print ISSN: 0905-9180
      Online ISSN: 1600-0617

      Copyright © 2023 by the European Respiratory Society