Modeling the Impact and Costs of Radon Policy for Lung Cancer Control

描述（由申请人提供）：肺癌发病率和死亡率的趋势遵循烟草使用的趋势，因为据估计，吸烟导致约90%的男性肺癌死亡和80%的女性肺癌死亡。然而，暴露于氡——一种可以被困在家里的无味放射性气体——被认为是肺癌的第二大原因。氡与肺癌之间关系的一个非常重要的方面是氡暴露与吸烟在肺癌风险中的强相互作用。美国环境保护署估计，与氡有关的肺癌死亡中，有86%发生在长期吸烟者身上。因此，氡造成的绝大多数公共卫生负担是在吸烟者和前吸烟者之间。我们提出的研究的总体目标是阐明一套选定的公共政策的潜在影响和成本，这些政策旨在减少美国氡诱发肺癌的负担，考虑到氡暴露与吸烟之间的强烈相互作用，以及我们目前处于一个减少吸烟的时代。我们的具体目标如下：1)通过纳入美国国家科学院电离辐射生物效应VI模型的修订结构和参数，修改现有的基于人群的预测烟草使用、氡暴露和肺癌死亡率的动态模型；2)在考虑成人吸烟率下降的情况下，利用修正后的模型估算1980-2005年期间氡对肺癌死亡率的影响；3)利用修订后的氡模型，就氡测试/修复及控烟进行各种政策模拟演习（包括针对吸烟者进行氡教育/测试/修复）；4)对选定的一系列降低肺癌死亡率的政策方法进行成本效益分析，比较以戒烟为重点的政策策略和以减少氡暴露为重点的政策策略。我们的工作旨在进一步澄清一些问题，这些问题对有关氡的健全公共政策至关重要，但尚未得到阐明。我们提出的研究的中心是需要进行政策研究和论述，以更好地解释氡暴露和吸烟之间的相互作用对肺癌的影响。总之，我们的工作将有助于阐明21世纪住宅氡修复策略与减少吸烟对氡相关肺癌的相对影响和成本效益。

DESCRIPTION (provided by applicant): Trends in lung cancer incidence and mortality have followed trends in tobacco use, as cigarette smoking is estimated to cause approximately 90 percent of lung cancer deaths in men and 80 percent in women. However, exposure to radon-an odorless radioactive gas that can become trapped in homes-is considered the second leading cause of lung cancer. A very important aspect of the relationship between radon and lung cancer is the strong interaction between radon exposure and smoking in lung cancer risk. The EPA estimates that 86 percent of radon-related lung cancer deaths are in ever-smokers. As such, the vast majority of the public health burden of radon is among smokers and former smokers. The overall goal of our proposed research is to elucidate the potential impact and costs of a selected set of public policies aimed at reducing the burden of radon-induced lung cancer in the U.S., taking into account the strong interaction between radon exposure and smoking, and the fact that we are currently in an era of decreased smoking. Our specific aims are as follows: 1) to modify an existing population-based dynamic model that predicts tobacco use, radon exposure, and lung cancer mortality by incorporating revised structure and parameters from the National Academy of Sciences' Biological Effects of Ionizing Radiation VI model; 2) to use the modified model to estimate the impact that radon had on lung cancer mortality during the time period of 1980-2005, taking into account decreases in smoking among adults over this time; 3) to use the modified radon model to conduct a variety of policy simulation exercises regarding both radon testing/remediation and tobacco control (including the targeting of radon education/testing/remediation at smokers); and 4) to conduct cost-effectiveness analyses of a selected set of policy approaches to reducing lung cancer mortality, comparing policy strategies focused on smoking cessation and those focused on reducing exposure to radon. Our work seeks to add clarity to a number of questions that are central to sound public policy regarding radon but have yet to be elucidated. At the center of our proposed research is the need for policy research and discourse to better explicate the implications of the interaction between radon exposure and smoking for lung cancer. In sum, our work will help to elucidate the relative impact and cost-effectiveness of residential radon remediation strategies versus smoking reductions on radon-related lung cancer in the 21st century.