title: Home energy efficiency and radon related risk of lung cancer: modelling study.
abstract: OBJECTIVE
  To investigate the effect of reducing home ventilation as part of household energy efficiency measures on deaths from radon related lung cancer.
  
  
  METHODS
  Modelling study.
  
  
  METHODS
  England.
  
  
  METHODS
  Home energy efficiency interventions, motivated in part by targets for reducing greenhouse gases, which entail reduction in uncontrolled ventilation in keeping with good practice guidance.
  
  
  METHODS
  Modelled current and future distributions of indoor radon levels for the English housing stock and associated changes in life years due to lung cancer mortality, estimated using life tables.
  
  
  RESULTS
  Increasing the air tightness of dwellings (without compensatory purpose-provided ventilation) increased mean indoor radon concentrations by an estimated 56.6%, from 21.2 becquerels per cubic metre (Bq/m(3)) to 33.2 Bq/m(3). After the lag in lung cancer onset, this would result in an additional annual burden of 4700 life years lost and (at peak) 278 deaths. The increases in radon levels for the millions of homes that would contribute most of the additional burden are below the threshold at which radon remediation measures are cost effective. Fitting extraction fans and trickle ventilators to restore ventilation will help offset the additional burden but only if the ventilation related energy efficiency gains are lost. Mechanical ventilation systems with heat recovery may lower radon levels and the risk of cancer while maintaining the advantage of energy efficiency for the most airtight dwellings but there is potential for a major adverse impact on health if such systems fail.
  
  
  CONCLUSIONS
  Unless specific remediation is used, reducing the ventilation of dwellings will improve energy efficiency only at the expense of population wide adverse impact on indoor exposure to radon and risk of lung cancer. The implications of this and other consequences of changes to ventilation need to be carefully evaluated to ensure that the desirable health and environmental benefits of home energy efficiency are not compromised by avoidable negative impacts on indoor air quality.
authors.affiliation: Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK.
authors.forename: James
authors.initials: J
authors.lastname: Milner
authors.forename: Clive
authors.initials: C
authors.lastname: Shrubsole
authors.forename: Payel
authors.initials: P
authors.lastname: Das
authors.forename: Benjamin
authors.initials: B
authors.lastname: Jones
authors.forename: Ian
authors.initials: I
authors.lastname: Ridley
authors.forename: Zaid
authors.initials: Z
authors.lastname: Chalabi
authors.forename: Ian
authors.initials: I
authors.lastname: Hamilton
authors.forename: Ben
authors.initials: B
authors.lastname: Armstrong
authors.forename: Michael
authors.initials: M
authors.lastname: Davies
authors.forename: Paul
authors.initials: P
authors.lastname: Wilkinson
mesh_terms: D000396:Air Pollutants, Radioactive / Q000633:toxicity*; D016902:Air Pollution, Indoor / Q000009:adverse effects*; D002274:Carcinogens, Environmental / Q000633:toxicity*; D004739:England / Q000453:epidemiology; D006078:Government Programs; D006798:Housing / Q000592:standards*; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality*; D008962:Models, Theoretical; D009381:Neoplasms, Radiation-Induced / Q000401:mortality*; D011886:Radon / Q000633:toxicity*; D014691:Ventilation / Q000592:standards
chemical_list: D000396:Air Pollutants, Radioactive; D002274:Carcinogens, Environmental; D011886:Radon