The Hidden Dangers of Radon – What You Need to Know

Jesse recently teamed up with Dr. Abbie Begnaud, a pulmonologist, to break down the truth about the hidden dangers of radon and lung cancer. Is radon really as dangerous as people say? Can it affect pets? And how can you protect yourself and your family?

Join Jesse Green from American Radon Mitigation as we dive into these questions and more, covering everything from radon exposure to lung cancer, testing, and treatment options. The written transcript has been edited for clarity. 

Jesse Green (JG): Hello, I’m Jesse with American Radon Mitigation. I’m here with Dr Abbie Begnaud. She is a pulmonologist, and we’re here to answer some of the common myths and misconceptions about radon.

Dr. Abbie Begnaud (Dr. AB): Great, I’m so glad to be here. My name is Abbie Begnaud. I am an associate professor of medicine here at the University of Minnesota, and I’m an Interventional Pulmonologist.  That means I’m a lung specialist who really focuses primarily on lung cancer. I see people with lung abnormalities and do procedures to diagnose them, so I give a lot of people diagnosis of lung cancer and take care of a lot of people with lung cancer. I care a lot about radon and I’m so happy to talk with you today and to tell everybody the word about radon.

What is Radon?

JG: Can you explain what radon is and how it affects our health?

Dr. AB: Sure, radon is a gas. It’s colorless, odorless, it’s tasteless. It is radioactive, which is a very important part of understanding radon, and it comes from the ground. It comes from uranium, which is part of the soil and the rocks underneath the ground. So it comes up through the ground, and you can’t see it, you can’t taste it, and you can’t smell it. The only way that you would know if you are being exposed to it is by testing.

Health Affects of Radon

JG: And what impact does that have on our health?

Dr. AB: So radon is thought to be the second leading cause of lung cancer behind cigarette smoking.

Are You Skeptical About Radon?

JG: Some people are skeptical about radon. What would you say to them?

Dr. AB: Well, I know what you mean. I think a lot of people have never even heard of radon, or it’s not even on their radar. And I can understand why you might be skeptical about radon. I mean, you can’t see it, you can’t taste it, you can’t smell it, how would you know it’s there? It’s very easy to have a hard time believing that it’s real.

You know there are other things in the world that are harmful to us, but most of those things you can see, you can feel, you can taste, you can smell, so I absolutely understand why someone would be skeptical about radon. Even things like viruses we can’t see or feel, but they make you sick right away, so you can kind of put two and two together and connect those dots.

With radon, it’s very hard. The health effects of radon take many, many years, decades even to be apparent. So I totally get why people would be skeptical about radon. As a scientist and a physician, I see not only the real health effects on people’s lives of radon, but I understand the science, and I understand the studies that have been done to show radon is an important health risk, a health threat, and so that’s why I’m not skeptical, but I absolutely understand why most people would be skeptical.

Dangers of Radon

JG: Why do you think the dangers of radon aren’t as widely understood as mold or smoking?

Dr. AB: You know that’s a tough one, again, because it’s so hard to put your finger on radon. I mean, they call radon the silent killer, and that’s absolutely true. You can’t observe radon with any of your senses. It’s even hard, it’s really impossible, for medical professionals to attribute a health problem to radon. We don’t have a test that can say, aha, this was caused by radon, and so it really is just the silent killer.

Radon and Lung Cancer

JG: Can you tell us exactly how radon causes lung cancer?

Dr. AB: The gas is radioactive, so I think most people recognize radioactivity is not good. That’s bad for your health, right? When you inhale the gas into your lungs, those radioactive particles stay in your lungs, and the radioactive particles can cause damage.

Our bodies are incredible, and they are exposed to all kinds of damage all day long and all throughout our lives. They do a great job of repairing most damage that we experience, but over time, repeated exposure to radon and radiation leads to damage that can cause mutations in your cells. Those mutations can become cancer, which can grow uncontrolled and become a tumor.

How Radon Affects Lung Cells

JG: So, when the radon gives off its alpha particle, my understanding is it’s a little burst of energy and it’s that energy that damages the cells that line your lungs.

Dr. AB: That’s right. Yeah, it causes DNA damage. DNA is the material for all of the cells in our body, and we are replicating and overturning cells. Old cells die, and new cells are being created. So anytime you have any of that change and growth, if you have a mutation to your DNA from the radiation particles, then you can suddenly have a copy that’s made wrong. If you were hand-copying something on paper, you would make a mistake sometimes, right? So every time you hand copy, every mistake that gets made has the potential to grow exponentially and become a cancer.

Symptoms of Lung Cancer

JG: What are the symptoms of lung cancer?

Dr. AB: Often, lung cancer has no symptoms, especially early on. By the time someone has lung cancer and develops symptoms, sometimes it could be very advanced. When it does cause symptoms, typically a cough or difficulty breathing, people might experience pain in their chest, pain in their back, pain in the shoulders, sometimes hoarseness, or a change in voice, fatigue, and weight loss are all some potential symptoms. All of those things are really non-specific, which means they could be caused by a lot of things, so just because you have some back pain doesn’t mean you have lung cancer.

One important finding that can happen with lung cancer is something called clubbing, which is a change in the shape of the fingernails. So, the fingernails become a little bit more bulbous, a little bit like an ET finger; they don’t light up, but they do get round at the tip of the finger. That is certainly a concerning finding that should be evaluated. If someone is experiencing any of these things, a cough or difficulty breathing that lasts more than a few months or a few weeks, they should definitely get checked out.

Testing for Lung Cancer

JG: How do you test for lung cancer when someone comes in, and what does that process look like?

Dr. AB: Well, it depends a little bit on if the person has symptoms or how they come to medical attention.

Imaging

Like I said, sometimes someone has, let’s say, a shoulder X-ray, and then they notice a spot on the lung because you see part of the lung on a shoulder X-ray. Usually, chest imaging is part of it, so whether you come in with a cough or trouble breathing or maybe again, you had another x-ray of some kind, and something showed up. We’ll do a dedicated chest imaging, so probably a CT scan. A CT scan is a pretty simple test to do and it gives us a look at all of the lungs.

Biopsy

Then, if we see something on the lungs that looks concerning, like it could be a cancer, then we’ll typically consider doing a biopsy of the lungs. Now, many people have lung nodules or spots on their lungs that are not cancer, so I don’t want people to panic. Lung nodules are very common. If you have lung nodules, you work with a doctor to figure out if those nodules are suspicious or concerning. Most nodules are not cancer, but if there’s a concern for lung cancer and someone has a spot on their lungs, they can undergo a biopsy.

There are different ways we can biopsy the lungs. We can do it endoscopically, which means we go in through the windpipe with a small flexible camera and a device to take samples. We can also do it percutaneously, so that means we go from the outside in between the ribs and stick a needle into the lung. Or you can have surgery, but thankfully, our minimally invasive techniques have advanced such that most people don’t have to have a surgery and be cut open just to get a diagnosis. You do a scan, and if you see something concerning, then you possibly get a biopsy, and the biopsy is what’s needed to confirm lung cancer.

CT Scans for Lung Cancer

JG: When you do that CT scan and you’re looking at the results, is it like, oh yeah, I’m concerned about this, or what does it look like after that?

Dr. AB: Well, we look at a lot of features of lung nodules to determine if they’re suspicious. So one thing that we look at is characteristics of the nodule itself the size of the nodule, the shape of the nodule, and the edges of it. Is it smooth or is it spiky, and the location of the nodule as well. Lung nodules are more likely to be cancer if they’re in the upper lobes of the lung because when you inhale gases, more of a gas goes in. So, something like smoke or radon goes to the top part of the lungs first.

Then, we also look at the characteristics of the person. If someone has a heavy history of smoking or a heavy family history of lung cancer, we’re going to be a little bit more worried about a nodule in that type of person than in someone who has no identifiable risk factors for lung cancer. Notice I said identifiable risk factors for lung cancer, right? When I interview people who come to me with lung nodules, which is a main part of the work that I do, I always ask people if they know anything about radon levels in the homes that they’ve lived in. And I am constantly shocked at how few people know much about it at all.

Early Lung Cancer Detection

JG: Is there a screening or early detection test for people who were exposed to high levels of radon?

Dr. AB: Typically, no. So there are ways that we can detect lung cancer early, and we do screen for lung cancer in people who have the biggest known contributor to lung cancer, which is cigarette smoking. So, people over the age of 50 who’ve smoked cigarettes for a long time should be screened for lung cancer with a CT scan of the chest.

For people who are known to have been exposed to high levels of radon in their homes, we don’t do any additional testing at this time because it’s thankfully still rare that somebody would get lung cancer. But the early detection test usually requires knowing that someone has a risk factor, right?

There are tests that are being developed now that are easier and cheaper to do than a CT scan that, one day, we might be able to screen everybody. But right now, the CT scan gives you radiation, right? So, of course, we have to balance the risk and the benefit of doing a test that gives more radiation to somebody when we’re concerned that they’ve already been exposed to radiation potentially. So, the short answer is no. If the only known risk factor is exposure to radon, we do not typically do any kind of screening or early detection tests for lung cancer.

Lung Cancer Advocacy

JG: I was talking to Rachel Malmberg, a lung cancer advocate, and she said that sometimes you have to fight for yourself. Like my aunt thought, oh, I’ve lived in this house for a long time, and the radon was high. We found out when she was going to sell it. But she asked her doctor for a low-dose CT scan, and the doctor shut her down. I told Rachel that, and she’s like, ah, I hate it when they do that. So, is it simply an exposure issue, or is it a cost issue?

Dr. AB: It’s a little bit of all of those things. So, I do a lot of work in the lung cancer advocacy space. I’ve met countless people with lung cancer who have similar stories. You know, most of those people, it took a long time for them to get a scan, to get a diagnosis because no one thought they could have lung cancer, right? I mean, like Rachel, a young and athletic person who never smoked cigarettes. So, lots of people who have again no identifiable or obvious risk factors for lung cancer can definitely develop lung cancer. So it’s a little bit of a balance, right? I mean, we can’t do a CT scan on everybody. It’s not a good idea to do that. 

Lung Nodules

Again, like I said, lung nodules are really common. Probably one in three people in Minnesota have a lung nodule that’s mostly not cancer. So, if you start scanning people, you’ll start finding stuff that often is nothing to worry about. It’s just going to cause them more anxiety potentially, unnecessary testing like additional biopsies and additional tests, so it is a really difficult balance, I think.

Occupational Risk

There are certainly situations where people who have occupational exposure to radon and other carcinogens and hazards do get screening programs as part of their Occupational Health. But for people who lived in homes with high levels of radon, that in and of itself probably would not be a good reason to get scanned.

Symptoms

Now, certainly, if somebody like that had symptoms, they say, oh yeah, I’ve had this cough for 6 months or a year, something that I’ve never been able to figure out, and I took allergy medicine, and it didn’t go away, that kind of thing, that would definitely make sense.

Lung Cancer Stages

JG: What is the earliest stage you can detect damage to the lungs?

Dr. AB: So if we’re talking about radon or other things that potentially cause lung cancer, usually the earliest time you can see something is when something shows up on a CT scan. On a CT scan, we can see kind of a shadow. What we sometimes call a ground glass area, a fuzzy little area, that might be an indication of a pre-cancer. Some cells that are starting to grow out of control but maybe haven’t even become aggressive cancers yet. At the cellular level, there’s no widely available testing for evidence of radon damage to the lungs.

Lung Cancer Treatment

JG: What are the treatment options for lung cancer?

Dr. AB: Well, the good news is we have a lot of treatment options for lung cancer. Lung cancer treatment has dramatically improved in the last decade. So we have more and more people who are surviving lung cancer, thankfully through early detection from screening, as well as better treatment options. In general, the broad groups of treatment options are surgery, radiation therapy, medications, or systemic therapy.

Surgical

So if you find a cancer that is very small and can be removed surgically and a person is healthy enough to undergo surgery, that’s usually considered the gold standard. That’s what most people would want. That gives you the highest chance of cure. Surgery is only an option for people who are in kind of specific categories, stages if you will, of lung cancer. So, the person needs to be healthy enough to have part of their lung removed, and they also need to have a tumor that’s small enough and in an area that can safely be removed.

Radiation

Radiation therapy also can be part of treatment for lung cancer from all stages. Stage one, which is an early local lung cancer, to even stage four, depending on the scenario.

Systemic Therapies

And then systemic therapies or medications have just exploded not even in just the last few years but in the last decade. We now understand so much more about lung cancer. There are so many different types of lung cancer. There are many different mutations and molecular signatures of lung cancer that we can identify. And we now have targeted therapies that just go right to that little thing that’s causing lung cancer, that little molecular alteration, and so those are better tolerated and more effective. So, we have a lot of different options for lung cancer treatment, thankfully.

Life Expectancy

JG: What is the life expectancy of someone diagnosed with lung cancer?

Dr. AB: That depends a lot on the stage. When we talk about any type of cancer, the stage of the cancer is really important. Stage is a standardized way of describing the extent of the cancer. So stage one, again, is a local focally involved cancer, stage two is a little bit more, stage three is a little bit more, and stage four is kind of distant spread to other parts of the body. So that definitely makes a difference.

In cancer, we typically talk about 5-year survival. So, what percent of people are still alive at 5 years? For stage one lung cancer, you’re looking at around 90% of people surviving 5 years. For stage four lung cancer, the numbers are much smaller. You know, probably something like 15% of people might survive four years. But things are looking up because of treatment and early detection. The 5-year survival for lung cancer is close to 24%, so that means about 1 in 4 people diagnosed with lung cancer will be alive in 5 years, but that includes all groups, that includes stage one and stage four. It depends a lot on how advanced the lung cancer is when it starts getting treated.

Lung Cancer Diagnosis

JG: What would you say to someone who’s never smoked and gets diagnosed with lung cancer?

Dr. AB: The first thing I would say is I’m really sorry, you know, it’s a terrible disease. And anybody with lungs can get lung cancer. Increasingly, we are seeing people who never smoked cigarettes get lung cancer. Most people think you have to have smoked cigarettes to get lung cancer, and that’s simply not true. Probably about 15% of people who get lung cancer never smoked. And then a lot more people used to smoke but have quit.

So, an important thing is to really think about family history. Ask people in your family: “Is there anybody else who has lung cancer?” Because if a person has a family history of lung cancer, especially if that person never smoked, that means that they are at risk of lung cancer themselves. So when you find out that somebody in your family has lung cancer if they never smoked, that means you need to be on the lookout.

Asthma and COPD

JG: Can prolonged radon exposure worsen other conditions like asthma or COPD?

Dr. AB: You know, the short answer is maybe. Probably. It’s not quite clear. We don’t nearly have the depth and wealth of data that we have about lung cancer that we do about other respiratory conditions. Asthma and COPD are both related conditions. COPD stands for chronic obstructive pulmonary disease, and both of those are conditions that narrow the bronchial tubes, which limit airflow, cause trouble with breathing, and might cause coughing or wheezing. But there are some studies that suggest people who have chronic respiratory diseases like asthma and COPD maybe are more likely to be living in homes with more radon or people with more radon are likely to have more problems with their lung disease. The connection there is not quite as clear.

Risks of Radon + Cigarette Smoking 

JG: How does radon exposure compare to other risk factors like smoking?

Dr. AB: So, for lung cancer, cigarette smoking is still, by far and away, the most important risk factor. If you’re listening to this and you smoke cigarettes, I would strongly encourage you to quit or cut back. That being said, radon and cigarette smoking can have a multiplicative effect or a synergistic effect in terms of developing lung cancer. They’re both causing different kinds of damage to the lining of the airway. If your airway is receiving different types of insults, it’s much harder for your body to manage that damage and prevent the development of lung cancer. But cigarette smoking is a much stronger risk factor for lung cancer than radon only.

So, studies of uranium miners, a lot of the data, and the initial understanding about radon and lung cancer came from studies of miners who worked in uranium mines. So these people were exposed to very high levels of radon underground for a long time, for years, right? In these studies, miners who never smoked did get lung cancer, but miners who smoked cigarettes were seven times more likely to get lung cancer. So lung cancer plus radon exposure is very bad. Radon has always been estimated to be the second leading cause of lung cancer, behind cigarette smoking.

Radon and Kids

JG: Does radon affect kids more than adults since their lungs are smaller?

Dr. AB: I think there is some evidence that radon may affect children more. Of course, the effects of radon with regard to lung cancer take decades to develop, right? So you don’t know. We’re not seeing a lot of lung cancer in kids. However, it is thought that radon may affect children more because their bodies are smaller and they’re breathing more air, cycling more air, through their lungs relative to their body size than adults.

Radon and Pets

JG: Does Radon affect our pets?

Dr. AB: There is evidence that, yes, it can. You know, domestic animals like cats and dogs are mammals like we are. There are studies which show that there are dogs with lung cancer. It’s not a very common condition for dogs, but lung cancer and dogs are more common in places where radon levels are higher, counties where there are higher radon levels. So yes, they can.

Is There a Safe Level of Radon?

JG: Wow, that’s interesting. Is there a safe level of radon exposure, or is any exposure over time considered dangerous?

Dr. AB: There’s not really a safe level. As, of course, you probably know the EPA, the Environmental Protection Agency, recommends mitigation if the level is above four picocuries per liter and recommends considering it if it’s between two and four, right? Ambient air outside probably has a level of 0.4, so 10 times less than the highest level recommended for mitigation. So, how much radiation is safe? How much radiation do you want to be exposed to?

For me personally, I bought a home about a year ago, and we did radon testing, of course, as part of our inspection process. Our levels were 11 pCi/L. So you know, and I know, I was like, oh my goodness. My husband didn’t know, didn’t understand that I was like that is a serious problem; we need to get that taken care of. We’re not moving in until we get a mitigation system installed. I would say probably a level less than one is something I would be comfortable with. If our level had been three, I probably still would have gotten a mitigation system installed in my home.

Risk Tolerance

JG: And that risk factor is probably different for other people’s tolerance to risk, I would imagine.

Dr. AB: As somebody who takes care of people with lung cancer and who can see the potential ravages of lung cancer, my tolerance for lung cancer risk is not very high.

Radon and Other Cancers

JG: Other than lung cancer, can radon cause any other types of cancer?

Dr. AB: I think the evidence around that is a lot less clear. Lung cancer is definitely thought to be the most significant health risk from radon. There are some studies that suggest leukemia or melanoma, aerodigestive tract (head and neck and mouth), and stomach. It’s really not clear. Lung cancer is definitely the one where we have the most convincing evidence.

If You Have Lungs, You Can Get Lung Cancer

JG: What’s one thing about lung cancer that you wish everyone knew?

Dr. AB: If you have lungs, you can get lung cancer. That’s the most important thing to know. I take care of so many people who, because they never smoked, don’t think that they could get lung cancer. And that means that their doctors don’t think that they could have lung cancer either, so they have a delay in the diagnosis. So, I think for everyone, including medical professionals, the most important thing to remember is if you have lungs, you can get lung cancer. That’s not to scare people but that’s just to say that it’s always a possibility. Not everybody who gets lung cancer has smoked cigarettes.

Biggest Takeaway

JG: What would you say is the single most important takeaway for someone watching this video?

Dr. AB: Well, I think if you’re watching this video, that means you’re thinking about radon. And if you haven’t tested your home for Radon, do it today. It’s easy, it’s cheap. Testing it will give you peace of mind if your levels are below the safe level, and if not, then you have an action item.

Do a Radon Test Today

JG: And if you’d like to learn more about radon testing, check out some of our favorite radon testing options.

Dr. AB: Well, Jesse, thank you for the opportunity today. Thank you for joining us. I think radon really is a silent killer, and I wish more people knew about it, so I really appreciate the opportunity to dispel some myths.

JG: Thank you very much.