utah radon logo

Dr. Akerley on radon

Dr. Wallace Akerley - Huntsman Cancer Institute medical oncologist explains what radon is

Dr. Akerley's interview on radon

Read video transcript

Hi, my name is Dr. Wallace Akerley, I'm a medical oncologist at the University of Utah's Huntsman Cancer Institute. I take care of lung cancer specifically. And and that includes both smoking and non smoking lung cancer. I'm a professor of medicine and have been at the huntsman for over 20 years.

So within the area of lung cancer, it's overwhelmingly dominated by tobacco. And one of my great interests at the University of Utah has been to look at never smokers lung cancer, specifically, because the state of Utah has the lowest smoking rates in the country. And it's important to look at what's going on in your population. So my interest has been dominated by never smokers lung cancer. And then, and that comes into two forms. One is Radon is the number two cause of lung cancer. So clearly a reason that I would have an interest. But all of the molecular breakthroughs, all of the gene therapies that are occurring, are very much related and occur in patients who don't smoke. So So while we used to call lung cancer, just one disease, they, they did break it into non small cell lung cancer, but it was everything that wasn't small cell. And so it was one disease, but it was that single disease was the number one cause of cancer death in the United States. But as we've understood what makes the cancer, the cancer, we've been able to identify specific genes that are broken, that are not caused by tobacco. And fortunately, we've been able to make often pill forms of medications for up to nine of these pathways. So where lung cancer used to just be one disease, it's now nine pathways worth of disease. And within that nine pathways, there are those that are able to be stimulated by immune therapy, and others that are more likely to be refractory to immune therapy. So you might argue that lung cancer is nine diseases, plus being immuno sensitive or not, which gets it up to one cancer is probably more like 18 that we can identify. And I think in two or three more years, it'll be 30 or 40.

So Radon is a radioactive gas, it gets off alpha, beta and gamma decay. And so it's radioactivity, that's the piece that people have to understand Radon is a radioactive material. And anything that's radioactive can damage our DNA. And we are made of DNA we are we are our genes and our genes produce proteins and that is who we are. And so we are let's see, that's kind of a weird Yeah. What was our question again, wherever your goodness ya know, working on might start this off a little bit differently. Talk about radon and lung cancer.

So the Radon is radioactivity, period. But radioactivity is dangerous. I mean, we know about this from nuclear atomic bombs and the like. The I think one of the most telling stories for me is just just to say radioactivity is real, is if you look at the the atomic bombs in Japan, it's clearly people died of the thermal blast of the heat blast. But if you draw concentric rings around where the bomb was dropped, there was different degrees of radiation looks like a topographical map. And as you went further out with these rings, you could pick an area where people would develop cancer. And we were based in and we know when that event was what the exposure was. And you can actually go and say that radiation causes leukemia, probably seven years later. And radiation causes cancer of the solid Oregon's breast, lung, colon, etc. But anywhere between 12 and 30 years later. So beyond the shadow of a doubt, radiation is bad for us. But that's the kind of radiation that you see with Three Mile Island or other things that radiation is passing right through you. Much of radon is about short, alpha radiation, so radiation that only travels a small distance. And so Radon is a radioactive gas, we breathe it in, we breathe it out, it's got a relatively long half life. But as it decays, it can, at the moment kind of musical chairs give off a particle of radiation. And that particle of radiation, if it's in your lungs, gives you radiation, and where does it get exposed to the surface of your lung epithelium, the the interface between breathing and the outside and, and radon, why we call it a gas as it decays to polonium, and other products that actually become solid. So now all of a sudden, I got a gas that I breathed in, it gave off an alpha particle, it turns solid, it can sit right on my lung tissue, and it can give off another alpha particle and another and give off some local radiation. But this radiation only travels a few millimeters. So we've argued that radon can deliver radiation to anywhere in our body, including our skin and other places. But we've evolved in a world of solar radiation and other types of radiation, our skin is largely adapted to dealing with it, we still get skin cancers, but we've adapted there, we've gone the other way with radon we typically didn't live in, in tight, well heated, well insulated poorly, then we had extremely well ventilated homes that we didn't really want to have. But as we become more energy efficient, the gas can collect in a space. And our lungs have never been meant to be exposed to that kind of local radiation concentration. And by by that DNA damage that we know causes cancer. For many examples, atomic bombs, we treat patients with breast cancer or other types of cancers, lymphoma, and we may cure the cancer but potentially 10 years later, you may actually find a lung cancer or some other type along the way. So as good as this focus Medical Radiation is we can't control it completely radiation is a cancer cause.

And so radon it's not their thing, it's an entity and it's continuous, meaning that there can be levels of outdoors where there's a lot of dilution levels can be typically on average Each point for BioCurious per liter. and higher levels, higher levels, higher levels is more radiation and gives you a greater risk. The country has picked the number of four piko curIs per liter as a reasonable number to say we should do something about. But if one actually goes backwards and says how does the dose of radon correlate with the ability to develop lung cancer, it's not necessarily a linear relationship. It's more of a bit of a hockey stick, meaning that low doses we do pretty well with and but the inflection point where it really starts to take off is probably around 2.7 piko calories per liter. And then more is obviously worse. But it's not an exposure just one time. It's an exposure long lived over long periods of time. And how prevalent is it? So we pick a magic number four, which is, I think, a very reasonable conservative well thought out number. But studies in our own state of Utah, we found perhaps that a third of houses have numbers that are greater than four. And I think there's a lot of variations there. No one, we say that changes include atmospheric pressure and weather and whether your doors are open or whether your doors are closed. Tie time will change things. If there has been blasting in your region, then perhaps you will change the cracks underground as this comes from the granite from down below. And so my own personal experiences, my house didn't have radon. I was one of those who was very aware of this quite early and actually checked my house quite regularly. And at least checked rent annually. It didn't dawn on me, but I had skipped a year or two. And we had had an earthquake sometime in the middle and thought I thought maybe it would be a good idea to go ahead and check again. And to my surprise, even though I had checked several times before, over the course of several years, we actually ended up with elevated radon levels in my house. So So I too have now while I have had it in my house twice in two different houses over the years, I've had it mitigated twice at this point. But anyway prevalent, but maybe a third of the houses in Utah, but most of the things we deal with in medicine, we're always talking about a small chance of making a difference. If you got a one in three chance of having a problem in your house today at this moment. It's something that you should do something about. And it's something I want you to think about more than once over the course of the lifetime of living in a house.

And that goes back to an earlier statement we talked about, is there a safe level, while radiation is not really good for us, no matter how we do it. And so there isn't a safe level. But there are practical issues. I mean, if if in fact, the outdoor air has levels of point four, we can't really get lower than that. And I think that we have lived in that from an evolutionary standpoint forever. So I think we have accommodated to some degree to be able to deal with these low levels. And the higher level, the worse it is. I know that radon conferences there are conference that there are there are discussions as to what the right level should be the original decision making it for piko curIs per liter took into account that at the time measurements weren't perfectly accurate. You know that there's day to day variation. And while one may think that the level is a single number at one moment, there is great variation around that number. And so it seems from the evidence that maybe 2.7 might be the area where one might don't want to argue. And if you wanted to go ahead and do a correction, you'd like to get below that level. So I think the accepted standards of doing something about for, and trying to make sure it's less than to kind of make reasonable sense considering what we know. Now, other countries have different levels that they've chosen. But it, there's cost associated with it, right? If you have an extremely low level and try for perfection, you're spending a lot of money and not necessarily helping people. And you're helping people but you get less bang for your buck as you try to achieve perfection. Perfection is really hard. Yeah,

So the typical reaction is for everybody. Right, the typical denial acceptance strategies. And so pretty much everyone denies but then they have a chance to go ahead and stop and think and say, Well, geez, I've actually not been a smoker. Isn't tobacco the number one cause? And it is? And so some, so it takes a little bit of time to get used to it? Very different, right? Every other cancer if one gets colon cancer, breast cancer, why did I get it? I get it, because I exist and cancer, unfortunately, common pathway for, for living, you just, we make gene breaks all the time. And we fixed gene breaks all the time. And and so it's the absence of fixing that leads to this cancer. And it seems that the prevalence of this cancer showing up is related to a couple of things, probably the rate of cancer developments the same in every state for never smokers. But if one looks at the other kind of smoking initiated lung cancer, that's proportional to the number of people that smoke in the state. And so, yeah, so people are very surprised and shocked. The first question, the first statement we do in addition to talking about cancer, and how we're going to treat it, and the new breakthroughs and therapies that occur, we also say, Hey, man, you gotta go and get a radon test, or make sure that your house is safe. Just because you've gotten it doesn't mean that there aren't other people who might develop a cancer at some time in the future. So it's important that we do testing. And everything in the real world is a bit of nature, nurture. And so if I've got the same genes as my family members, I don't believe it's all the radon it's caused, it's going to be my genes that, let me get it. We all hear the story of probably not so much anymore. But there was a famous George Burns years ago, who used to stand on stage and always have a cigar in his hand. And earlier years when I was younger, I remember seeing many of those movie stars with a glass of alcohol in their hands. And many of them did end up with a lung cancer, unfortunately, but George Burns never did. And so, the point there is there are some people who are more predisposed, and others less predisposed, but if someone in the house did develop lung cancer, it argues there may be some predisposition that we can't measure yet. And and if there's radon there, the last thing you want to do is have a predisposition and have an inciting event. We leave a two second break there. And I could just fill in a little bit more. Yeah. So so so the University of Utah is unique and that it has this thing called the Utah population database. So there's there's two of these databases that show family relationships in the world. Iceland has won, and Utah has won. So we're able to go and figure out who's related to whom. And you think, pretty well that you might know who your relatives are. But But things get out of hand pretty quickly. I know for my own example, I was recently trying to find my grandmother's maiden name. And gee, my mom couldn't quite remember it. And so what does that mean? Well, one generation away is my mom, two generations away, I can't even figure it out a maiden name. So when you start to get on to 10th, and 14th cousins, you probably don't know those people. So the unique part about this Utah population database is we've been able to go ahead and look to understand what is heredity, and what is the so the nature and then the environmental, the nurture side of the coin. And we find that smoking related lung cancer, as you might guess, is almost universally related to an environmental toxin, the tobacco. But the question is, well, gee, if you look at the never smokers, is it likely to be toxin related, like secondhand smoke? And while we can't say that it is, or is it hereditary, and we've been able, because we have this database, we've been able to look at the never smoking lung cancer, and we find a strong heredity relationship, we're not advanced enough to figure out what Gene it is, it could be a tumor suppressor gene or something. And it's got to be a tumor suppressor gene. So as I said earlier, the majority of cancers that form form probably because we broke one of our DNA or gene fix it mechanisms. And so I suspect that the, there will be a gene that fixes some of the mutations we see in lung cancer is probably the original deficiency, and that may well be hereditary. But the point of this Utah population database, again, without doing any gene research, we're able to show that statistically, never smokers, lung cancer has a hereditary component to it, not something that's talked about. And it's probably not strong enough penetrance not strong enough in every family member, that it would be worthwhile getting CT scan screening to go ahead and look for it, the radiation from the CT screening might actually cause more cancers, and it prevents, but I do believe if you've done this research, as we have, it says that there's probably going to be a gene that's responsible for it. And if you can actually then go find the gene and see in whom it might be damaged, then I think it's a very easy screening process. And I think in the future, we will be screening people based on their genetics to look for this never smokers lung cancer.

It's still a ways away, but, but it's now in people's everyday consciousness to think about this and say, Wow, we can, all we have to do is come up with the tools to go ahead and do it. But it's very reasonable. 

So, surprisingly, the internet is more when maybe not. That's not fair. The internet is actually made an awareness of radon greater than it has been in the past. So I would say the majority of people have heard that there is such a thing, but they very frequently think that they've already tested for it and they sometimes get their carbon monoxide monitor mixed up with a radon monitor. So we did a study here Well, years ago, we found that maybe when it was like 12% of patients actually 12% of people. This was college educated people, because we held it at a university site. And we did a survey at at the Salt Lake City Public Library. So people that were reading, so in theory, we were talking to a relatively educated population of patients. And at that time, 12% of patients had even heard of radon. The numbers got better over time as we've worked on awareness campaigns. But it felt like we slacked off for a couple of years. And I get the sense that the numbers have dropped off again, since. And I think you have to keep re educating because there's a whole brand new crop of people getting old enough to go and buy a house, and they've got to be educated all over again, has to be part of our everyday education for every generation. Absolutely.

So every Utah resident should know that radon exists. It's it is radioactivity, it's a cause of cancer. And see, it's you can't smell it, you can't feel it. But it's there in every house to some degree. And if and there are levels that are more dangerous than others, and if you don't test, you don't know whether you have a dangerous house or not. And in the biggest, biggest picture in terms of cancer, right, we all talk about this. Most of the cancers we see in the Cancer Center are cancers you couldn't have done a whole lot about. But this is one that you really can do something about. And the chance to go ahead and take care of something that you could have fixed is just a chance that one should never miss.

Copyright - 2024 - All rights reserved. utahradon.org