Lung cancer in Mayak workers: interaction of smoking and plutonium exposure

The Russian Radiobiological Human Tissue Repository: characteristics of biological specimens donated by nuclear workers with lung cancer

Purpose: Characteristics of biological specimens donated by nuclear workers with lung cancer.Materials and methods: Biological specimens were identified at the Radiobiological Human Tissue Repository (RHTR). It was established at the Southern Urals Biophysics Institute in Russia and has been developed and supported within the bilateral US-Russian Agreement on International Cooperation for Minimization of the Effects of Prolonged Radiation Exposure. Biological specimens were collected from workers of the Russian nuclear production facility Mayak PA who were exposed to gamma radiation and/or alpha particles. To determine a histologic type of lung cancer, immunohistochemistry was used.Results and conclusions: Today biological specimens donated by 343 registrants with lung cancer are available at the RHTR. Among them, 255 donors (74%) are Mayak PA workers hired at the main facilities (reactors, plutonium production, and radiochemical plants) in 1948-1982. These workers donated about 6024 specimens of lung tissues (tumor and tumor-free) stored mostly as formalin-fixed paraffin-embedded tissue blocks (31%) and histology slides (64%); in addition, they donated 1800 specimens of blood/blood components, buccal epithelium cells, and sputum. Among histologic types identified for these lung cancer cases, adenocarcinoma and small cell carcinoma were prevalent. Information about individual doses from external and internal radiation exposure, data on quantitative smoking characteristics and diseases are available for all workers with lung cancer. Complete information on radiation exposure, health status and non-radiation factors annotated to RHTR registrants and the high quality of the available biological specimens are a unique resource for studying biological mechanisms of radiation-induced lung cancer.

Combined effect of alpha particles and cigarette smoke on human lung epithelial cells in vitro

Purpose: The combined toxicity of alpha particles and cigarette smoke to the critical cells in the lungs was investigated to assess the risk of smoking workers who handle naturally occurring radioactive materials. Materials and methods: The toxicity of alpha particles and cigarette smoke extract (CSE) was evaluated in terms of DNA double-strand break (DSB) induction and clonogenic cell death of human lung epithelial cells in vitro. The cells were exposed to alpha particles at doses of up to 0.25 Gy for gamma-H2AX assay and from 1.25 Gy to 5 Gy for clonogenic assay. CSE exposure of the cells was facilitated in the culture medium at CSE concentrations ranging from 1% to 12%. Additional experiments were performed using mouse endothelial cells for comparison. Results: The increases in the levels of DNA DSBs were linearly dependent on radiation dose and CSE concentration. The CSE-treated cells also responded with a linearly increasing number of DNA DSBs to the radiation dose. Both human lung epithelial cells and mouse endothelial cells showed exponential decreases in clonogenic surviving fraction as the dose from alpha particle exposure increased. Both cells responded with the clonogenic surviving fractions decreasing in a linear proportion to the CSE concentration in the culture medium. Conclusion: In our experimental in vitro setup, CSE treatment and alpha particle exposure affected the cells in an additive manner either for DNA DSB production or for clonogenic cell death induction.

Cancer risk following alpha-emitter exposure

The International Commission on Radiological Protection (ICRP) mandated a task group (Task Group 64) to review recently published epidemiological studies related to cancer risk and incorporated alpha emitters, and to evaluate whether the results might consolidate or challenge assumptions underlying the current radiation protection system. Three major alpha emitters were considered: radon and its decay products, plutonium, and uranium. Results came mainly from cohorts of workers, while for radon, major studies of the general population contributed to a better understanding of the risk of lung cancer at low and chronic exposure. Selection criteria for the review were: assessment of individual exposure of the target organ, long duration of the health survey, availability of attained age at end of follow-up, and adjustment for major co-factors. Task Group 64 is composed of members from ICRP Committees 1 and 2 (because epidemiological and dosimetric expertise were needed) and external experts. A first report (ICRP Publication 115) considered the risk of lung cancer related to inhalation of radon and its decay products. As the estimated excess risk per unit of exposure was higher by a factor of 2 compared with a previous ICRP estimate in 1993, Task Group 64 suggested a reconsideration of the reference levels for the workplace and for the general population. A second report, using the same standardised methodology (lung cancer baselines, population, life expectancy), will include estimation of the cancer risk of nuclear workers exposed to plutonium, focusing on the risk of lung cancer. A comparison of these risks with those of populations exposed to external gamma radiation alone will be made in the near future. For uranium, the results related to the organ-specific dose were too sparse to draw reliable conclusions, despite a recent publication. More research is needed on this topic.

Mechanistic study on lung cancer mortality after radon exposure in the Wismut cohort supports important role of clonal expansion in lung carcinogenesis

Lung cancer mortality after radon exposure in the Wismut cohort was analyzed using the two-stage clonal expansion (TSCE) model. A total of 2996 lung cancer deaths among the 58,695 male workers were observed during the follow-up period between 1946 and 2003. Adjustment to silica exposure was performed to find a more accurate estimation of the risk of radon exposure. An additional analysis with the descriptive excess relative risk (ERR) model was carried out for comparison. The TSCE model that best describes the data is nonlinear in the clonal expansion with radon exposure and has a saturation level at an exposure rate of [Formula: see text]. The excess relative risk decreases with age and shows an inverse exposure rate effect. In comparison with the ERR model, the TSCE model predicts a considerably larger risk for low exposures rates below [Formula: see text]. Comparison to other mechanistic studies of lung cancer after exposure to alpha particles using the TSCE model reveals an extraordinary consistency in the main features of the exposure response, given the diversity in the characteristics of the cohorts and the exposure across different studies. This suggests that a nonlinear response mechanism in the clonal expansion, with some level of saturation at large exposure rates, may be playing a crucial role in the development of lung cancer after alpha particle irradiation.

Revisiting the health effects of psychological stress-its influence on susceptibility to ionizing radiation: a mini-review

Both psychological stress (PS) and ionizing radiation (IR) cause varied detrimental effects on humans. There has been no direct evidence so far showing PS alone could cause cancer; however, long-lasting PS may affect our overall health and ability to cope with cancer. Due to their living conditions and occupations, some people may encounter concurrent exposure to both PS and IR to a high extent. In addition to possible health effects resulting directly from exposure to IR on these people, fear of IR exposure is also a cause of PS. The question of whether PS would influence susceptibility to IR, radiocarcinogenesis in particular, is of great concern by both the academic world and the public. Recently, investigations using animal PS models demonstrated that PS could modulate susceptibility to IR, causing increased susceptibility to radiocarcinogenesis in Trp53-heterozygous mice, hematological toxicity in peripheral blood and elevated chromosome aberration (dicentrics) frequency in splenocytes of Trp53-wild-type mice. To actively reduce health risk from exposure to IR, further studies are needed to cumulate more evidence and provide insights into the mechanisms underlying the alterations in susceptibility due to PS modulation. This mini-review gives a general overview of the significance of PS effects on humans and experimental animals, with a special focus on summarizing the latest weight-of-evidence approaches to radiobiological studies on PS-induced alterations in susceptibility in experimental animal models. The susceptibility being investigated is mainly in the context of the impact of the modulatory effect of PS on radiocarcinogenesis; we seek to improve understanding of the combined effects of exposure to both PS and IR in order to facilitate, via active intervention, strategies for radiation risk reduction.

Beyond two-stage models for lung carcinogenesis in the Mayak workers: implications for plutonium risk

Mechanistic multi-stage models are used to analyze lung-cancer mortality after Plutonium exposure in the Mayak-workers cohort, with follow-up until 2008. Besides the established two-stage model with clonal expansion, models with three mutation stages as well as a model with two distinct pathways to cancer are studied. The results suggest that three-stage models offer an improved description of the data. The best-fitting models point to a mechanism where radiation increases the rate of clonal expansion. This is interpreted in terms of changes in cell-cycle control mediated by bystander signaling or repopulation following cell killing. No statistical evidence for a two-pathway model is found. To elucidate the implications of the different models for radiation risk, several exposure scenarios are studied. Models with a radiation effect at an early stage show a delayed response and a pronounced drop-off with older ages at exposure. Moreover, the dose-response relationship is strongly nonlinear for all three-stage models, revealing a marked increase above a critical dose.

Lauriston S. Taylor lecture on radiation protection and measurements: when does risk assessment get fuzzy?

This article examines the question, "Is risk assessment fuzzy, or is it a quantitative science?" In the context of this paper, risk assessment is defined as the estimation of health risk to people from exposure to radioactive materials and chemicals when they are released to the environment by a source. Today we employ risk assessment to investigate past, present, and future exposures, and the outcomes of the analysis are used for determining compliance with regulations, emergency response, facility design, and health impacts to populations from historical exposures (dose reconstruction). Risk assessment has become an essential component of government policy and decision-making, and it is clear it will be used increasingly in the future. It has undergone a dramatic evolution since the early 1970s both as a scientific methodology and also in how it is used. The key to understanding risk assessment is to explain the basic components and unique disciplines that meld it together. Each element requires skills in fundamental sciences such as engineering, physics, mathematics, and physiology in order to produce information required for the next step. As each step is developed, a clear interdependence emerges, resulting in a science that is quantitative and reliable and provides a tool for many purposes. In the end, however, it is how we communicate the results that becomes the most important component. Introduction of the Taylor Lecture (Video 1:36, http://links.lww.com/HP/A19).

Occupational and environmental causes of lung cancer

Because tobacco smoking is a potent carcinogen, secondary causes of lung cancer are often diminished in perceived importance. The goal of this review is to describe the occurrence and recent findings of the 27 agents currently listed by the International Agency for Research on Cancer (IARC) as lung carcinogens. The IARC's updated assessments of lung carcinogens provide a long-overdue resource for consensus opinions on the carcinogenic potential of various agents. Supplementary new information, with a focus on analytic epidemiologic studies that has become available since IARC's most recent evaluation, are also discussed.

Comparison of mortality and incidence solid cancer risk after radiation exposure in the Techa River Cohort

In the present paper, analysis of solid cancer mortality and incidence risk after radiation exposure in the Techa River Cohort in the Southern Urals region of Russia is described. Residents along the Techa River received protracted exposure to ionizing radiation in the 1950s due to the releases of radioactive materials from the Mayak Production Association. The current follow-up through December 2003 includes individuals exposed on the Techa riverside within the Chelyabinsk and Kurgan oblasts using mortality data, and within the Chelyabinsk oblast using incidence data. The analysis was performed by means of the biologically based two-stage clonal expansion (TSCE) model and conventional excess relative risk models. For the mortality and incidence cohorts, central estimates of the excess relative risk per dose of 0.85 Gy(-1) (95% CI 0.36; 1.38) and 0.91 Gy(-1) (95% CI 0.35; 1.52) were found, respectively. For both the mortality and incidence cohorts, the best description of the radiation risk was achieved with the same TSCE model including a lifelong radiation effect on the promotion rate of initiated cells. An increase in the excess risk with attained age was observed, whereas no significant change of risk with age at exposure was seen. Direct comparison of the mortality and incidence cohorts showed that the excess relative risk estimates agreed very well in both cohorts, as did the excess absolute risk and the hazard after correction for the different background rates.

Breast cancer risk among Swedish hemangioma patients and possible consequences of radiation-induced genomic instability

Breast cancer incidence among 17,158 female Swedish hemangioma patients was analyzed with empirical excess relative risk models and with a biologically-based model of carcinogenesis. The patients were treated in infancy mainly by external application of radium-226. The mean and median absorbed doses to the breast were 0.29 and 0.04Gy, and a total of 678 breast cancer cases have been observed. Both models agree very well in the risk estimates with an excess relative risk and excess absolute risk at the age of 50 years, about the mean age of breast cancer incidence, of 0.25Gy(-1)(95% CI 0.14; 0.37) and 30.7 (10(5) BYR Gy)(-1) (95% CI 16.9; 42.8), respectively. Models incorporating effects of radiation-induced genomic instability were developed and applied to the hemangioma cohort. The biologically-based description of the radiation risk was significantly improved with a model of genomic instability at an early stage of carcinogenesis.

The effects of smoking and lung health on the organ retention of different plutonium compounds in the Mayak PA workers

The purpose of this study was to determine the effects of smoking and lung health on the pulmonary and extrapulmonary retention after inhalation of different chemical forms of plutonium with different solubilities in workers from the Mayak Production Association (Ozersk, Russia). Samples of lung, pulmonary lymph nodes, liver and skeleton were obtained from 800 workers who died between 1962-2000. The chemical form of plutonium aerosols, smoking history and presence of lung disease were determined. In workers with normal lung status, all plutonium chemical classes were about equally distributed between the lung parenchyma and pulmonary lymph nodes. The more insoluble chemical forms of plutonium had a greater retention in pulmonary than systemic tissues regardless of smoking history or lung health status. A history of smoking did, however, result in a significantly greater retention of less soluble chemical forms of plutonium in pulmonary tissues of workers with no lung disease. In workers with lung disease, smoking did not significantly influence the terminal organ retention of the different chemical forms of plutonium. These initial data can be used to modify dosimetry and biokinetics models used for estimating radiation risks from plutonium in humans.

Lung, liver and bone cancer mortality in Mayak workers

Workers at the Mayak nuclear facility in the Russian Federation offer the only adequate human data for evaluating cancer risks from exposure to plutonium. Risks of mortality from cancers of the lung, liver and bone, the organs receiving the largest doses from plutonium, were evaluated in a cohort of 17,740 workers initially hired 1948-1972 using, for the first time, recently improved individual organ dose estimates. Excess relative risk (ERR) models were used to evaluate risks as functions of internal (plutonium) dose, external (primarily gamma) dose, gender, attained age and smoking. By December 31, 2003, 681 lung cancer deaths, 75 liver cancer deaths and 30 bone cancer deaths had occurred. Of these 786 deaths, 239 (30%) were attributed to plutonium exposure. Significant plutonium dose-response relationships (p < 0.001) were observed for all 3 endpoints, with lung and liver cancer risks reasonably described by linear functions. At attained age 60, the ERRs per Gy for lung cancer were 7.1 for males and 15 for females; the averaged-attained age ERRs for liver cancer were 2.6 and 29 for males and females, respectively; those for bone cancer were 0.76 and 3.4. This study is the first to present and compare dose-response analyses for cancers of all 3 organs. The unique Mayak cohort with its high exposures and well characterized doses has allowed quantification of the plutonium dose-response for lung, liver and bone cancer risks based on direct human data. These results will play an important role in plutonium risk assessment.

Analysis of solid cancer mortality in the techa river cohort using the two-step clonal expansion model

In this study the solid cancer mortality data in the Techa River Cohort in the Southern Urals region of Russia was analyzed. The cohort received protracted exposure in the 1950s due to the releases of radioactive materials from the Mayak plutonium complex. The Extended Techa River Cohort includes 29,849 people who resided along the Techa River between 1950 and 1960 and were followed from January 1, 1950 through December 31, 1999. The analysis was done within the framework of the biologically based two-stage clonal expansion (TSCE) model. It was found that about 2.6% of the 1854 solid cancer deaths (excluding 18 bone cancer cases) could be related to radiation exposure. At age 63, which is the mean age for solid cancer deaths, the excess relative risk (ERR) and excess absolute risk (EAR) were found to be 0.76 Gy(-1) (95% CI 0.23; 1.29) and 33.0 (10(4) PY Gy)(-1) (95% CI 9.8; 52.6), respectively. These risk estimates are consistent with earlier excess relative risk analyses for the same cohort. The change in the ERR with age was investigated in detail, and an increase in risk with attained age was observed. Furthermore, the data were tested for possible signs of genomic instability, and it was found that the data could be described equally well by a model incorporating effects of genomic instability. Results from the TSCE models indicated that radiation received at older ages might have stronger biological effects than exposure at younger ages.

Lung cancer risk of Mayak workers: modelling of carcinogenesis and bystander effect

Lung cancer mortality in the period of 1948-2002 has been analysed for 6,293 male workers of the Mayak Production Association, for whose information on smoking, annual external doses and annual lung doses due to plutonium exposures was available. Individual likelihoods were maximized for the two-stage clonal expansion (TSCE) model of carcinogenesis and for an empirical risk model. Possible detrimental and protective bystander effects on mutation and malignant transformation rates were taken into account in the TSCE model. Criteria for non-nested models were used to evaluate the quality of fit. Data were found to be incompatible with the model including a detrimental bystander effect. The model with a protective bystander effect did not improve the quality of fit over models without a bystander effect. The preferred TSCE model was sub-multiplicative in the risks due to smoking and internal radiation, and more than additive. Smoking contributed 57% to the lung cancer deaths, the interaction of smoking and radiation 27%, radiation 10%, and others cause 6%. An assessment of the relative biological effectiveness of plutonium was consistent with the ICRP recommended value of 20. At age 60 years, the excess relative risk (ERR) per lung dose was 0.20 (95% CI: 0.13; 0.40) Sv(-1), while the excess absolute risk (EAR) per lung dose was 3.2 (2.0; 6.2) per 10(4) PY Sv. With increasing age attained the ERR decreased and the EAR increased. In contrast to the atomic bomb survivors, a significant elevated lung cancer risk was also found for age attained younger than 55 years. For cumulative lung doses below 5 Sv, the excess risk depended linearly on dose. The excess relative risk was significantly lower in the TSCE model for ages attained younger than 55 than that in the empirical model. This reflects a model uncertainty in the results, which is not expressed by the standard statistical uncertainty bands.

Uncertainties analysis for the plutonium dosimetry model, doses-2005, using Mayak bioassay data

The Doses-2005 model is a combination of the International Commission on Radiological Protection (ICRP) models modified using data from the Mayak Production Association cohort. Surrogate doses from inhaled plutonium can be assigned to approximately 29% of the Mayak workers using their urine bioassay measurements and other history records. The purpose of this study was to quantify and qualify the uncertainties in the estimates for radiation doses calculated with the Doses-2005 model by using Monte Carlo methods and perturbation theory. The average uncertainty in the yearly dose estimates for most organs was approximately 100% regardless of the transportability classification. The relative source of the uncertainties comes from three main sources: 45% from the urine bioassay measurements, 29% from the Doses-2005 model parameters, and 26% from the reference masses for the organs. The most significant reduction in the overall dose uncertainties would result from improved methods in bioassay measurement with additional improvements generated through further model refinement. Additional uncertainties were determined for dose estimates resulting from changes in the transportability classification and the smoking toggle. A comparison was performed to determine the effect of using the model with data from either urine bioassay or autopsy data; no direct correlation could be established. Analysis of the model using autopsy data and incorporation of results from other research efforts that have utilized plutonium ICRP models could improve the Doses-2005 model and reduce the overall uncertainty in the dose estimates.

Smoking and hormesis as confounding factors in radiation pulmonary carcinogenesis

Confounding factors in radiation pulmonary carcinogenesis are passive and active cigarette smoke exposures and radiation hormesis. Significantly increased lung cancer risk from ionizing radiation at lung doses < 1 Gy is not observed in never smokers exposed to ionizing radiations. Residential radon is not a cause of lung cancer in never smokers and may protect against lung cancer in smokers. The risk of lung cancer found in many epidemiological studies was less than the expected risk (hormetic effect) for nuclear weapons and power plant workers, shipyard workers, fluoroscopy patients, and inhabitants of high-dose background radiation. The protective effect was noted for low- and mixed high- and low-linear energy transfer (LET) radiations in both genders. Many studies showed a protection factor (PROFAC) > 0.40 (40% avoided) against the occurrence of lung cancer. The ubiquitous nature of the radiation hormesis response in cellular, animal, and epidemio-logical studies negates the healthy worker effect as an explanation for radiation hormesis. Low-dose radiation may stimulate DNA repair/apoptosis and immunity to suppress and eliminate cigarette-smoke-induced transformed cells in the lung, reducing lung cancer occurrence in smokers.