For Your Health
For Your Health

News from the University of North Dakota School of Medicine & Health Sciences

Your gonna hear me R.O.A.R.

SMHS researchers partner with the UND Department of Communication and Grand Forks Public on radon testing

Evangelist is too strong a word. Although activist doesn’t quite capture it either.

Whatever the designation, Dr. Gary Schwartz, chair of the Department of Population Health at the UND School of Medicine & Health Sciences, acknowledges the zeal with which he tackles the problem of radon in North Dakota.

Indeed, zeal may be just what North Dakota, which ranks among the most radon-dense states in the nation, needs.

“I think radon, in a way, is a huge opportunity for UND because North Dakota has so much of it,” says Schwartz with something of a grimace. “And what we’re learning is that it’s probably related to diseases other than lung cancer.”

Radon – number 86 on the periodic table of the elements – is a colorless, odorless, naturally-occurring radioactive gas. It emerges from the breakdown of the uranium and thorium embedded in our state’s topsoil. North Dakota has higher levels of ground-based radon, relative to many other states, due to its geological history, wherein bulldozing glaciers brought these elements closer to the Earth’s surface millennia ago. After the glaciers melted and humans began building increasingly well-sealed homes on such a terrain, radon gas levels tended to collect in prairie basements, especially if the homes’ foundations had even small fissures in them.

And as rafts of studies suggest, average levels of 4 picocuries per liter (pCi/L) and higher are known to increase the risk of at least lung cancer, and likely stroke, says Schwartz, adding that nearly every North Dakota county has an average radon level that exceeds 4 pCi/L and one out of every 15 homes nationwide has high radon levels.

Steeped in such studies on the effects chronic radon exposure has on cells, tissues, and organ systems, Schwartz means that while the radon-lung cancer connection is well-established, it is very likely that radon contributes to a host of other conditions, from chronic obstructive pulmonary disease (COPD) to stroke to some forms of leukemia.

“If radon contributed even modestly to stroke or COPD, that’s incredibly important to know, so there are a lot of reasons why we’re studying radon – not just for lung cancer,” he says. “And the fact that we have such massive exposure to it here in North Dakota means we have an opportunity to become an expert in something big. And it’s a good thing to be an expert on the stuff in your own backyard, because no one else is going to do it for you.”


You’re gonna hear me ROAR

To that end, Schwartz helped establish the Radon Outreach and Research (ROAR) project at UND. The goal of ROAR, he says, is to improve community health not only through directed radon research, but by informing the public of the risks of radon and, subsequently, providing access to radon detection and mitigation resources.

ROAR initiatives already underway include partnering with Grand Forks Public – the city’s public library – on free radon test kit lending; a project with chair of the SMHS Department of Family & Community Medicine, Dr. David Schmitz, wherein callers to the ND Quits Tobacco Quitline are offered free radon counseling and free radon test kits; and the development of an experimental radon test chamber, to be used in animal studies.

This last task has been embraced by newly-minted Ph.D. Mark Williamson, a research assistant professor in the Department of Population Health. Calling such test chambers rare in institutions of higher education, particularly in the Midwest, Williamson says that his association with the UND-based Dakota Community Collaborative on Translational Activity (DaCCoTA) provided him and Schwartz with an equipment grant to help purchase materials for a radon test chamber, soon to be housed at UND.

“There are a couple of these [chambers] worldwide, but there really isn’t a lot of infrastructure for that type of research – at least at a reasonable price,” Williamson explains. “We hope to build that infrastructure here to be able to have mechanistic radon-based studies.”

By “mechanistic,” Williamson means research studies that go beyond mere observational studies of the most superficial effects of radon on animals to produce papers that focus on biological processes and the pathophysiology of a disease – research that’s cell-based and data-driven.

“There’s a lot you could do with a chamber here,” Williamson continues. “We’ve purchased the parts and have most of the approvals. Now we’re really just working hard to find a location that can be approved and renovated. That’s a still ongoing process, but we’re doing our best to make that a reality.”

Williamson, who hopes to have the chamber up and running by the middle of 2024 at the latest, adds that the scholarship such a project could produce would both launch a variety of interdisciplinary radon studies in the region and serve to enhance UND’s reputation nationally. Describing the type of animal studies his team could design, he says, tongue-in-cheek, that the sky’s the limit with radon.

“There’ll actually be four different chambers. You could have a control group – who have no radon exposure – and increase the levels of radon in the other chambers and see if there’s higher incidences of cancer, or if exposure makes existing conditions worse.”


A cancer test for your house

And that’s just the beginning. For his part, Schwartz, who specializes in cancers of unknown etiology, says that the local data implicating radon in a variety of conditions is already compelling – and that a public university-based test chamber could do a world of good in building on existing literature.

Pointing to North Dakota’s statistically outsized incidence – first out of 50 American states – of chronic lymphocytic leukemia (CLL), a cancer that occurs primarily among the elderly, the researcher says that it’s quite possible that radon is involved.

“About 70% of CLL is diagnosed accidentally, in the course of other medical care,” says Schwartz. “I saw these data and thought ‘gosh, what’s that about?’ I didn’t know. Nobody does – we don’t know what causes chronic lymphocytic leukemia. But most leukemias are caused by exposure to radiation. So I asked myself, naively, ‘do we have any radiation in North Dakota?’ Well, it turns out that the most common source of ionizing radiation, the kind that causes cancer, is radon at home.”

This is where the test chamber might help determine the cause and/or contributing factors of something like CLL.

Even so, Schwartz understands the general lack of awareness about radon in the region: getting the public’s attention about the dangers of a colorless, odorless gas that might produce a health problem years from now can be a hard sell. This is why good data and good communication are keys to helping change community behavior. And part of the way to do that, he says, is to adapt the literature on cancer screening and human behavior to radon testing.

To that end, Schwartz has been working with UND Department of Communication chair and associate professor Soojung Kim on communicating the risks of radon. Kim met Schwartz when she was earning her Master of Public Health degree at the SMHS. The pair bonded over changing behavior through communication and recognized that getting people to test their homes for radon involved solving communication issues more than anything.

“Our recent clinical trial data on the results of distributing short-term charcoal radon test kits show that despite the receipt of free radon test kits, they are rarely returned to the laboratory,” Kim says, adding that simplifying the testing and remediation process – and communicating the ease of such home tests – has been enormously productive. “These findings strongly suggested that an alternate means to promote radon testing was needed.”

Nodding at his colleague’s comments, Schwartz says that he’s happy to be at the forefront of both the on-the-ground research into radon and the campaign to communicate the results of that research.

“The beauty of free, electronic tests is that they remove that particular barrier. You don’t have to put a test in an envelope or mail it. You don’t have to do any of those things, because the answer is right there,” Schwartz concludes of the Grand Forks Public’s digital take-home radon tests. “It’s much more like a COVID test that you can get for free. And those work because people take them and 10 minutes later you get a positive result or you don’t. If you think about testing your house for radon, it’s a cancer test for your house. And I think if you look at it with that much wider lens, you get a better sense of how to fix the problem.”

By Brian James Schill
Patrick Miller contributed to this story