Radon Gas Levels and Cancer Rates in Jersey.

STATES OF JERSEY

RADON GAS LEVELS AND CANCER RATES IN JERSEY

Lodged au Greffe on 19th August 2011 by Deputy P.V.F. Le Claire of St. Helier

STATES GREFFE

2011   Price code: B  P.144

PROPOSITION

THE STATES are asked to decide whether they are of opinion

to request the Minister for Health and Social Services –

1. to conduct an updated study on radon gas levels in Jersey;
2. to undertake a campaign to increase public awareness of the dangers posed by radon gas (including where in Jersey the risks are greatest) and to set out what precautions can be taken, including the use of detectors;
3. to commission and publish an independent expert's report into why Jersey has the cancer rates that it does and, in particular, why those rates are higher for certain cancers than in the South West of England, with  this  study  to  include  an  epidemiological  study  of  cancer incidence in Jersey, based on an audit over a defined period and an exploration of individuals' documented exposure to recognised risk factors.

DEPUTY P.V.F. LE CLAIRE OF ST. HELIER

REPORT

Background

When I was on the Health and Social Services Committee I vigorously pursued the argument that something had to be done to tackle the number of deaths and the overall harm that tobacco had upon our community. I am therefore proud of my part in the eventual approval by the States of the current Tobacco Strategy. The Tobacco Strategy has been hailed as the greatest single benefit to island health by the former Medical Officer of Health. However, it is instructive to recall that that strategy took a great deal of  perseverance.  It  was  not  universally  supported.  Yet  it  has  now  had  such  a significant impact upon the lives of islanders.

This has been one of the clearest examples of investing in Jersey and shows the immediate benefits we can produce as legislators in achieving a better society in terms of health and life experience if we try to see beyond the brow of the hill.

Radon

There are many causes of cancer and our understanding in this area is evolving. Amongst one of the least publicly understood causes of death by cancer is that caused by radon gas that is released from certain geology. Radon is the second largest cause of lung cancer in the UK resulting in about 5% of all fatal lung cancers. It has been classified by the International Agency for Research on Cancer (part of the World Health  Organisation),  as  a  Group  1  Carcinogen.  This  means  that  there  is  direct evidence from studies of a link between exposure to radon and lung cancer. Radon is therefore in the same group of carcinogens as asbestos and tobacco smoke as a cause of lung cancer.

As radon decays it creates particles that can damage the cells lining the airways of the lung. This damage can lead to cancer and, as the lungs of smokers may have many cells that are already somewhat damaged, the extra risk from radon is much greater for them than it is for non-smokers.

The  UK's  National  Radiological  Protection  Board  (NRPB)  has  estimated  around 100,000 properties in Britain are significantly affected by radon. In 2004 the NRPB reported concentrations of radon up to 85 times higher than recognised safety limits in 2 homes in Cornwall; an area that has a similar geology to Jersey. The geology map of Jersey is attached at the Appendix and is further explained below.

The risk from radon for people living in dwellings at the action level of 200 bq/m3 is roughly 1 in 100. For smokers the risk from radon increases dramatically to 1 in 10. This means that if your home has a radon level of 200 Bq/m3 or higher, then you should seriously consider taking remedial action to reduce the household radon levels. It is worth noting that the action level in the USA is 150 Bq/m3 and it is anticipated that the EU recommended action level will be reduced to 100 Bq/m3 for homes and 300Bq/m3 for workplaces during the course of 2011.

A research conducted by Northampton University and published in July 2011 has reinforced fears as to the effects of radon and suggested that no more than 4 hours per month should be spent in potentially high level areas such as mines. This is the type of research that we in Jersey should actively be considering. There are many people in Jersey who may potentially be exposed to longer periods of radon than this, for

instance,  in  our  War  Tunnels  (which  further  sometimes  hosts  events  involving rehearsals and the performance itself) although I am unaware of any health and safety testing for radon having been conducted and published.

There have been studies on a small scale only conducted in Jersey but even these have shown some worrying features. The following is an extract from the States' website –

"There have been 4 surveys in Jersey. Phase 1 survey

In the initial 1987 / 88 survey, 3 houses out of the 30 tested (10%) were above 200 Bq m3. The average reading from the 30 houses tested in the initial survey was 86 Bq m3. The objective of the phase 2 survey was to undertake further measurement in the 3 houses and to extend the survey to include nearby premises, or premises in similar geological areas, to determine if there was a problem, and if so, its extent.

Phase 2 survey

The radon concentrations were determined at 22 houses and 2 underground work  places.  In  each  of  the  dwellings  selected,  the  average  radon concentration was measured in a living area and the main bedroom for a period of just over 9 months. The detectors were supplied and subsequently analysed by the NRPB (National Radiological Protection Board; now part of the Health Protection Agency).The results from the phase 2 survey indicated that 8 of the 22 dwellings tested (36%) were above the current precautionary level. The average annual radon concentration of the 22 selected buildings was 140 Bq m3.

Phase 3, St Helier Town survey

This 3-month survey of St Helier houses and schools took place in 1992. The results indicate that all of the 24 houses were below the current precautionary Action Level of 200 Bq m3, and the average level was 61 Bq m3. Two of the dwellings were close to the Action Level and the occupiers of these were offered another free test in order to confirm the results. The 5 schools tested would  be  judged  in  the  UK  as  occupational  premises  with  regard  to  the Ionising Radiation Regulations which give a level of 400 Bq m3 at which detailed investigations would be required. The average level in the schools was 47 Bq m3, indicating no further measurements were required.

Phase 4 survey

In 1998 another radon survey for householders was completed. On the results so  far,  12%  of  Jersey  properties  tested  have  been  at  or  above  the recommended action level of 200 Bq/m². The areas in Jersey of concern are those on the granite boundaries / borders, especially where the boundary is with diorite (ie the boundaries of the orange areas on Jersey's geology map, which you can download below). Areas of possible higher levels are:

1. around the granite north-west shoulder of the Island

2. around the diorite boundary with granite throughout the south-east of the Island
3. possibly  on  the  edge  of  the  granite  south  west  shoulder  around Corbiere.".

The studies that have been conducted in Jersey, therefore, were some time ago now and were on a small scale. We need to know more about the current risks of radon, the extent to which there remain problems in Jersey and the public made more aware of the dangers of radon. In this respect, I believe that only a small proportion of the general public have even heard of the word "radon" and even then the vast majority are ignorant of its significance and what they can do to test for this harmful gas or lessen its risks.

Modern building regulations mean that new buildings are less likely to suffer from radon  but  the  vast  majority  of  Jersey's  housing  stock  was  not  built  to  modern standards and remain a potential risk. Even then it is important to note that radon may also be present in water and drinking water quality is another area that in my view needs consideration in relation to this issue.

The States of Jersey has a page dedicated to radon at the following URL http://www.gov.je/Health/Environment/Pages/Radon.aspx

Radon can also feature in water and together with nitrates and the need to ensure safe drinking water the States has a duty to ensure the public is informed and protected. I have been particularly concerned recently about radon and nitrates in drinking water and their effects and where and how this is being monitored and how the public is being protected from any potential harm. I have discussed the mater with the Minister for Planning and Environment and he has informed me that this is being looked at now especially in terms of nitrates. The details of this I hope can be drawn out by this debate and study also but in my view, they should be there now for all to see front and centre, not dragged out by propositions brought by back bench members, efforts. I hope that there can be a maturing of the States Environmental and Health Protection governance in the future and as per our pledge in relation to the Strategic Plan that we can be more open and transparent, where perhaps in the past there was a desire to do things  quietly  and  I  would  hope  that  this  area  in  particular  can  be  drawn  out immediately if there is a problem or a concern.

Cancer incidence in Jersey Generally

I set out below a recent answer to a question I posed about cancer in Jersey. I believe that the following illustrates the worrying levels of certain cancers in Jersey and the need for a proper investigation into the issues. I do not believe that (and it is very dangerous to assume) that high levels of cancer simply mean that we are good at detecting cancer. Lung cancer in particular is often symptomless until it is too late for the victim to be cured; death usually then occurring within a matter of a few years.

_____________________________________________________________________

"WRITTEN QUESTION TO THE MINISTER FOR HEALTH AND SOCIAL SERVICES BY DEPUTY P.V.F. LE CLAIRE OF ST. HELIER

ANSWER TO BE TABLED ON TUESDAY 5th JULY 2011

Question

Could the Minister for Health and Social Services give the most current figures for each type of cancer in Jersey and also indicate the age brackets for each type of cancer? Does the Department maintain data on how the figures and age brackets compare with the UK and the neighbouring region of Normandy?

Answer

Cancer Information

Locally statistics on cancer incidence (the annual number of new cancers diagnosed) and cancer mortality (annual deaths) are maintained by the Health Intelligence Unit within HSSD. This data is collated and analysed to look at trends and compare with other areas where possible. Because of the small numbers for some cancers annual rates do vary from year to year so it can be difficult to get an accurate picture of what is happening.

Cancer Incidence

The statistics for incidence of new cancers in Jersey are contained within the regular reports produced for us by the UK South West Cancer Intelligence Service. The latest Channel Islands Cancer Registration Report 2010 covers the three year period 2005 - 2007 and is available on from:

http://www.gov.je/Government/Pages/StatesReports.aspx?ReportID=538give link

This report showed that the main cancers diagnosed in Jersey in 2005-07 were non malignant skin cancer, lung cancer, breast cancer, prostate cancer, colorectal cancer, malignant melanoma and blood cancers (see p7 of report).

Table 1 summarises the information from this report for the 5 main malignant cancer types diagnosed in Jersey.

Table 1: Summary of the main malignant cancer types diagnosed in Jersey

Data shows that 1% of all new cancers occurred in the under 20's, 40% in those aged 20-64 years and 59% in the over 65's. This is a similar pattern to Guernsey & the South West.

Analysis carried out by the South West Public Health Observatory over the years has shown that Jersey has rates of cancer roughly comparable with the mainland and Guernsey for colorectal cancer, gynaecological cancer, leukaemia and upper gastro- intestinal cancer and, more recently, slightly lower for breast cancer incidence.

Incidence  rates  were  significantly  higher  in  Jersey  than  the  South  West  for  lung cancer,  head  &  neck  cancer,  malignant  skin  melanoma,  stomach  cancer,  prostate cancer  and  testicular  cancer  in  2005-07  (see  p13  of  the  report  for  full  details). However, the numbers for some of these cancers are low so the data must be treated with some caution.

Higher incidence rates are not always a bad thing. If an area has better systems in place to detect a certain cancer and/or specialists skilled in diagnosing that cancer then more  people  will  be  picked  up  with  it.  High  incidence  rates  can  indicate  better detection of a cancer. Early detection of cancer can led to better outcomes & cure.

The Health Intelligence Unit is working on finding reliable European data (including French  regions)  for  further  comparison.  Such  data  is  not  always  suitable  for comparative purposes due to differences in the way it is collected, coded or analysed. For example French cancer incidence data is patchy across the various regions and does not cover all cases (unlike the UK & Jersey where almost 100% of cases are picked up by a robust cancer registration process).

Cancer Mortality

Mortality data is collated and analysed annually by the HSSD's Health Intelligence Unit.

Jersey data shows that lung, upper gastrointestinal (oesophagus, stomach & pancreas) and colorectal cancers contribute to almost half of all cancer deaths in Jersey. This reflects world wide and European trends where lung cancer the single main cause of all cancer deaths.

Cancer of digestive organs (including upper gastrointestinal and colorectal cancers) accounts for a quarter of all Jersey deaths due to cancer. The second most common cause of cancer death is cancers of respiratory organs (mostly lung cancer) at 24%, followed by female breast cancers at 9% and male genital cancer (mostly prostate) at 7% (See Figure 1).

Figure 1: Jersey cancer deaths by site (2005-09)

Respiratory 24%

Digestive Breast 25% 9%

Male genital 7%

Lymphoid, haematopoi

etic tissue All other  7%

sites

In  terms  of  the  age  groups  affected  HSSD's  Health  Intelligence  Unit  maintains detailed spreadsheets for the main cancer sites by age group with data going back to 1996. This allows in depth analysis of individual cancers as required. From this we can show that nearly 60% of all cancer deaths in Jersey occur in those aged 70 or over and we have very few cancer deaths under aged 40 (Table 2).

Table 2: Jersey cancer deaths by age (2005-09)

Figure 2: Cancer deaths by age group 2005 – 2009

Average number of annual cancer deaths by age group (2005-09)

100 90 80 70 60 50 40

30 20

10 0

9 74 +

 year 1-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-6 70- 75 <1

Using Incidence & Mortality data

Ideally cancer incidence and cancer mortality should be looked at together.

A high incidence rate and an equally high mortality rate would indicate that that cancer was a particular problem, for example lung cancer.

But a high incidence rate can also be due to better diagnosis and detection of a cancer, and, if linked with lower mortality rates, indicate better treatment of those cancers, for example breast cancer.". ____________________________________________________________________

Financial and manpower implications

Health and Social Services have been working very closely in line with these issues and I am grateful for an explanation from the Medical Officer of Health and the Chief Executive  Officer  as  to  the  implications.  I  am  also  grateful  to  the  States Communications Unit and media team who have provided me with the costings. The overall costs of the study, expert's report together with a public awareness campaign will be in the region of £50,000. This funding will need to be found from within current Health budgets although I believe this would be a very cost effective use of funds when compared to the cost of treatment for a cancer patient as referred to below. It may be possible for such costs to be reduced, for instance by working with UK agencies and in particular Cancer Research and the UK agencies dealing with radon research.

I witnessed a documentary on revolutionary robotic cancer treatment this month. In the programme it identified that if a robot is used the likelihood of missing any cancer is almost eliminated. The programme said this investment although expensive pales in comparison when the returning costs of one cancer patient for additional surgery, treatment and care is on average £100,000 to the NHS.

£50,000.00 therefore will be money well spent in my view in addition to the work that Health and Social Services are doing and plan at this time in helping us fight this disease.

A national study in the UK is soon to be repeated and Jersey can take part in that with the additional benefits of a local study. We have an opportunity if we act now, to capture important statistical and clinical data that can help us reduce the number of cancer sufferers in Jersey in the near to long term.

With  a  public  awareness  campaign  we  can  help  islanders  take  steps  to  help themselves. This is an opportunity that will not present itself again for some time and I urge members to commit to supporting this important proposition with their votes and an extra commitment to Health and Social Services of this small amount of money to tackle a disease that touches so many lives in such terrible ways and leaves so many people utterly shaken and alone.

I ask members to stand with me and do something within their term of office, that once again can be recognised by our heath professionals as a visionary step towards a healthier, more productive and caring society.

APPENDIX