Studies of cancer risk among Chernobyl liquidators: materials and methods

Relationship between follow-up periods and the low-dose ranges with statistically significant radiation-induced risk of all solid cancers in the Russian cohort of Chernobyl emergency workers

Radiation-induced risks for all solid cancer incidence and mortality were studied in the cohort of Russian Chernobyl emergency workers. The cohort included 69,440 persons with documented individual radiation dose accrued over the time of working in the Chernobyl zone. The mean age at entry into the zone of recovery operations was 33.9 years and accumulated radiation dose was 132.9 mGy. A total of 6981 solid cancer incident cases and 4272 deaths occurred in this cohort from 1992 to 2017. Three follow-up periods were studied: 1992-2009, 1992-2013, and 1992-2017. For each follow-up period, the lowest dose range with statistically significant (p < 0.05) radiation-induced risk of all solid cancer incidence and mortality were obtained. For the incidence of all solid cancer during the follow-up period 1992-2009, this lowest dose range was estimated to be 0-250 mGy with an excess relative risk per dose of ERR Gy^-1 = 0.51 and 95% confidence interval (CI) (0.02; 1.05) Gy^-1. For the period 1992-2013, the lowest dose range was 0-175 mGy with ERR Gy^-1 = 0.85 (95% CI 0.03; 1.78), while for the whole follow-up period 1992-2017, it was 0-175 mGy with ERR Gy^-1 = 0.81 (95% CI 0.08; 1.62). For mortality from all solid cancers during the follow-up period 1992-2009, the lowest dose range with statistically significant radiation-induced risk was estimated to be 0-225 mGy with ERR Gy^-1 = 1.07 (95% CI 0.31; 0.97). For the period 1992-2013, the lowest dose range was 0-225 mGy with ERR Gy^-1 = 0.86 (95% CI 0.23; 1.58), while for the whole follow-up period 1992-2017, the lowest dose range was 0-200 mGy with ERR Gy^-1 = 0.82 (95% CI 0.10; 1.65). Thus, it was found that the minimal level of significant exposure (D_min), for which a statistically significant radiation-induced risk of all solid cancers was obtained for Russian emergency workers (with individual doses of 0 - D_min), decreases with increasing duration of cohort observation, both for cancer incidence and mortality.

Is the Linear No-Threshold Dose-Response Paradigm Still Necessary for the Assessment of Health Effects of Low Dose Radiation?

Inevitable human exposure to ionizing radiation from man-made sources has been increased with the proceeding of human civilization and consequently public concerns focus on the possible risk to human health. Moreover, Fukushima nuclear power plant accidents after the 2011 East-Japan earthquake and tsunami has brought the great fear and anxiety for the exposure of radiation at low levels, even much lower levels similar to natural background. Health effects of low dose radiation less than 100 mSv have been debated whether they are beneficial or detrimental because sample sizes were not large enough to allow epidemiological detection of excess effects and there was lack of consistency among the available experimental data. We have reviewed an extensive literature on the low dose radiation effects in both radiation biology and epidemiology, and highlighted some of the controversies therein. This article could provide a reasonable view of utilizing radiation for human life and responding to the public questions about radiation risk. In addition, it suggests the necessity of integrated studies of radiobiology and epidemiology at the national level in order to collect more systematic and profound information about health effects of low dose radiation.

Incidence and mortality of solid cancer among emergency workers of the Chernobyl accident: assessment of radiation risks for the follow-up period of 1992-2009

This paper presents the results of a retrospective cohort study of cancer incidence and mortality among emergency workers of the Chernobyl accident, for the follow-up period 1992-2009. The cohort selected for analysis consists of 67,568 emergency workers who worked in the Chernobyl exclusion zone in 1986-1987. External radiation whole-body absorbed dose varied from 0.0001 gray (Gy) to 1.24 Gy, with a median of 0.102 Gy. Over the follow-up period 1992-2009, a total of 4,002 solid cancers of different sites were identified as the result of annual compulsory health examination, and a total of 2,442 deaths from all solid cancers in the study cohort were reported. Poisson regression was applied for the analysis of cancer incidence and mortality. The analysis of the standardized incidence ratio (SIR) has shown a statistically significant increase in cancer incidence in the cohort as compared with baseline cancer incidence among males of Russia. The average excess over the entire follow-up period is 18 % [SIR = 1.18, 95 % confidence interval (CI) 1.15; 1.22]. In contrast, however, no increase in the mortality from all cancers among the emergency workers as compared to the baseline mortality in Russian men was found. Values of excess relative risk of cancer incidence and mortality per 1 Gy (ERR Gy(-1)) are 0.47 (95 % CI 0.03; 0.96, p value = 0.034) and 0.58 (95 % CI 0.002; 1.25, p value = 0.049), respectively. These values are statistically significant.

Late cancer and noncancer risks among Chernobyl emergency workers of Russia

The presented work summarizes data on estimated radiation risks among Chernobyl emergency workers of the Russian Federation. In 1991-1998, the excess relative risk (ERR) of death from malignant neoplasm was statistically significant: excess relative risk per 1 Gy (ERR/Gy)=2.11 with 95% confidence interval (CI) (1.31-2.92). In 1991-2001, the ERR estimation for incident solid cancers gives a positive, but statistically insignificant value: ERR/Gy=0.34 with 95% CI (-0.39; 1.22). In 1986-2003, radiation risk for leukemia incidence was investigated. During the first 10 y after the Chernobyl accident (1986-1996) the relative risk (RR) of leukemia (excluding chronic lymphocytic leukemia) was statistically significant: RR=2.2 with 95% CI (1.3-3.8) for emergency workers with doses>0.15 Gy in comparison with less exposed workers. In 1986-2000, a statistically significant dose response was observed for incident cerebrovascular diseases: ERR/Gy=0.39, 95% CI=(0.004; 0.77). For doses>0.15 Gy a statistically significant risk of cerebrovascular diseases as a function of mean daily dose was observed: ERR per 0.1 Gy d(-1)=2.17 with 95% CI=(0.64; 3.69). Different but overlapping cohorts of Russian emergency workers were used for these estimations. No adjustments were made for recognized risk factors for cerebrovascular diseases. All results should be considered as preliminary.

Cancer risk among Chernobyl cleanup workers in Estonia and Latvia, 1986-1998

Two cohorts of Chernobyl cleanup workers from Estonia (4,786 men) and Latvia (5,546 men) were followed from 1986 to 1998 to investigate cancer incidence among persons exposed to ionizing radiation from the Chernobyl accident. Each cohort was identified from various independent sources and followed using nationwide population and mortality registries. Cancers were ascertained by linkage with nationwide cancer registries. Overall, 75 incident cancers were identified in the Estonian cohort and 80 in the Latvian cohort. The combined-cohort standardized incidence ratio (SIR) for all cancers was 1.15 (95% confidence interval (CI) = 0.98-1.34) and for leukemia, 1.53 (95% CI = 0.62-3.17; n = 7). Statistically significant excess cases of thyroid (SIR = 7.06, 95% CI = 2.84-14.55; n = 7) and brain cancer (SIR = 2.14, 95% CI = 1.07-3.83; n = 11) were found, mainly based on Latvian data. However, there was no evidence of a dose response for any of these sites, and the relationship to radiation exposure remains to be established. Excess of thyroid cancer cases observed may have been due to screening, the leukemia cases included 2 unconfirmed diagnoses, and the excess cases of brain tumors may have been a chance finding. There was an indication of increased risk associated with early entry to the Chernobyl area and late follow-up, though not statistically significant. Further follow-up of Chernobyl cleanup workers is warranted to clarify the possible health effects of radiation exposure.

The cancer epidemiology of radiation

Ionizing radiation has been the subject of intense epidemiological investigation. Studies have demonstrated that exposure to moderate-to-high levels can cause most forms of cancer, leukaemia and cancers of the breast, lung and thyroid being particularly sensitive to induction by radiation, especially at young ages at exposure. Predominant among these studies is the Life Span Study of the cohort of survivors of the atomic bombings of Japan in 1945, but substantial evidence is derived from groups exposed for medical reasons, occupationally or environmentally. Notable among these other groups are underground hard rock miners who inhaled radioactive radon gas and its decay products, large numbers of patients irradiated therapeutically and workers who received high doses in the nuclear weapons programme of the former USSR. The degree of carcinogenic risk arising from low levels of exposure is more contentious, but the available evidence points to an increased risk that is approximately proportional to the dose received. Epidemiological investigations of nonionizing radiation have established ultraviolet radiation as a cause of skin cancer. However, the evidence for a carcinogenic effect of other forms of nonionizing radiation, such as those associated with mobile telephones or electricity transmission lines, is not convincing, although the possibility of a link between childhood leukaemia and extremely low-frequency electromagnetic fields cannot be dismissed entirely.