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Milder CM, Howard SC, Ellis ED, Golden AP, Cohen SS, Mumma MT, Leggett RW, French B, Zablotska LB, Boice JD. Third mortality follow-up of the Mallinckrodt uranium processing workers, 1942-2019. Int J Radiat Biol 2024; 100:161-175. [PMID: 37819879 PMCID: PMC10843089 DOI: 10.1080/09553002.2023.2267640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 09/28/2023] [Indexed: 10/13/2023]
Abstract
INTRODUCTION Mallinckrodt Chemical Works was a uranium processing facility during the Manhattan Project from 1942 to 1966. Thousands of workers were exposed to low-dose-rates of ionizing radiation from external and internal sources. This third follow-up of 2514 White male employees updates cancer and noncancer mortality potentially associated with radiation and silica dust. MATERIALS AND METHODS Individual, annualized organ doses were estimated from film badge records (n monitored = 2514), occupational chest x-rays (n = 2514), uranium urinalysis (n = 1868), radium intake through radon breath measurements (n = 487), and radon ambient measurements (n = 1356). Silica dust exposure from pitchblende processing was estimated (n = 1317). Vital status and cause of death determination through 2019 relied upon the National Death Index and Social Security Administration Epidemiological Vital Status Service. The analysis included standardized mortality ratios (SMRs), Cox proportional hazards, and Poisson regression models. RESULTS Vital status was confirmed for 99.4% of workers (84.0% deceased). For a dose weighting factor of 1 for intakes of uranium, radium, and radon decay products, the mean and median lung doses were 65.6 and 29.9 mGy, respectively. SMRs indicated a difference in health outcomes between salaried and hourly workers, and more brain cancer deaths than expected [SMR: 1.79; 95% confidence interval (CI): 1.14, 2.70]. No association was seen between radiation and lung cancer [hazard ratio (HR) at 100 mGy: 0.93; 95%CI: 0.78, 1.11]. The relationship between radiation and kidney cancer observed in the previous follow-up was maintained (HR at 100 mGy: 2.07; 95%CI: 1.12, 3.79). Cardiovascular disease (CVD) also increased significantly with heart dose (HR at 100 mGy: 1.11; 95%CI: 1.02, 1.21). Exposures to dust ≥23.6 mg/m3-year were associated with nonmalignant kidney disease (NMKD) (HR: 3.02; 95%CI: 1.12, 8.16) and kidney cancer combined with NMKD (HR: 2.46; 95%CI: 1.04, 5.81), though without evidence of a dose-response per 100 mg/m3-year. CONCLUSIONS This third follow-up of Mallinckrodt uranium processors reinforced the results of the previous studies. There was an excess of brain cancers compared with the US population, although no radiation dose-response was detected. The association between radiation and kidney cancer remained, though potentially due to few cases at higher doses. The association between levels of silica dust ≥23.6 mg/m3-year and NMKD also remained. No association was observed between radiation and lung cancer. A positive dose-response was observed between radiation and CVD; however, this association may be confounded by smoking, which was unmeasured. Future work will pool these data with other uranium processing worker cohorts within the Million Person Study.
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Affiliation(s)
- Cato M. Milder
- Division of Epidemiology, Vanderbilt University Medical Center, Nashville, TN, USA
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute
| | | | | | | | - Sarah S. Cohen
- EpidStrategies, a Division of ToxStrategies, Inc., Katy, TX
| | | | | | - Benjamin French
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Lydia B. Zablotska
- Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, CA, USA
| | - John D. Boice
- Division of Epidemiology, Vanderbilt University Medical Center, Nashville, TN, USA
- National Council on Radiation Protection and Measurements (NCRP), Bethesda, MD, USA
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Boice JD, Cohen SS, Mumma MT, Golden AP, Howard SC, Girardi DJ, Ellis ED, Bellamy MB, Dauer LT, Eckerman KF, Leggett RW. Mortality among Tennessee Eastman Corporation (TEC) uranium processing workers, 1943-2019. Int J Radiat Biol 2023; 99:208-228. [PMID: 35758985 DOI: 10.1080/09553002.2022.2078003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND There are few occupational studies of women exposed to ionizing radiation. During World War II, the Tennessee Eastman Corporation (TEC) operated an electromagnetic field separation facility of 1152 calutrons to obtain enriched uranium (235U) used for the Hiroshima atomic bomb. Thousands of women were involved in these operations. MATERIALS AND METHODS A new study was conducted of 13,951 women and 12,699 men employed at TEC between 1943 and 1947 for at least 90 days. Comprehensive dose reconstruction techniques were used to estimate lung doses from the inhalation of uranium dust based on airborne measurements. Vital status through 2018/2019 was obtained from the National Death Index, Social Security Death Index, Tennessee death records and online public record databases. Analyses included standardized mortality ratios (SMRs) and Cox proportional hazards models. RESULTS Most workers were hourly (77.7%), white (95.6%), born before 1920 (58.3%), worked in dusty environments (57.0%), and had died (94.9%). Vital status was confirmed for 97.4% of the workers. Women were younger than men when first employed: mean ages 25.0 years and 33.0 years, respectively. The estimated mean absorbed dose to the lung was 32.7 mGy (max 1048 mGy) for women and 18.9 mGy (max 501 mGy) for men. The mean dose to thoracic lymph nodes (TLNs) was 127 mGy. Statistically significant SMRs were observed for lung cancer (SMR 1.25; 95% CI 1.19, 1.31; n = 1654), nonmalignant respiratory diseases (NMRDs) (1.23; 95% CI 1.19, 1.28; n = 2585), and cerebrovascular disease (CeVD) (1.13; 95% CI 1.08, 1.18; n = 1945). For lung cancer, the excess relative rate (ERR) at 100 mGy (95% CI) was 0.01 (-0.10, 0.12; n = 652) among women, and -0.15 (-0.38, 0.07; n = 1002) among men based on a preferred model for men with lung doses <300 mGy. NMRD and non-Hodgkin lymphoma were not associated with estimated absorbed dose to the lung or TLN. CONCLUSIONS There was little evidence that radiation increased the risk of lung cancer, suggesting that inhalation of uranium dust and the associated high-LET alpha particle exposure to lung tissue experienced over a few years is less effective in causing lung cancer than other types of exposures. There was no statistically significant difference in the lung cancer risk estimates between men and women. The elevation of certain causes of death such as CeVD is unexplained and will require additional scrutiny of workplace or lifestyle factors given that radiation is an unlikely contributor since only the lung and lymph nodes received appreciable dose.
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Affiliation(s)
- John D Boice
- National Council on Radiation Protection and Measurements, Bethesda, MD, USA.,Department of Medicine, Division of Epidemiology, Vanderbilt Epidemiology Center and Vanderbilt-Ingram Cancer Center, Nashville, TN, USA
| | | | - Michael T Mumma
- International Epidemiology Institute, Rockville, MD, USA.,Vanderbilt University Medical Center, Nashville, TN, USA
| | - Ashley P Golden
- ORISE Health Studies, Oak Ridge Associated Universities, Oak Ridge, TN, USA
| | - Sara C Howard
- ORISE Health Studies, Oak Ridge Associated Universities, Oak Ridge, TN, USA
| | - David J Girardi
- ORISE Health Studies, Oak Ridge Associated Universities, Oak Ridge, TN, USA
| | - Elizabeth D Ellis
- ORISE Health Studies, Oak Ridge Associated Universities, Oak Ridge, TN, USA
| | - Michael B Bellamy
- Department of Medical Physics and Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Lawrence T Dauer
- Department of Medical Physics and Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Gu Y, Wang J, Wang Y, Xu C, Liu Y, Du L, Wang Q, Ji K, He N, Zhang M, Song H, Sun X, Wang J, Kitahara CM, de Gonzalez AB, Niu K, Liu Q. Low-dose ionizing radiation exposure and risk of leukemia: results from 1950-1995 Chinese medical X-ray workers cohort study and meta-analysis. JOURNAL OF THE NATIONAL CANCER CENTER 2022. [DOI: 10.1016/j.jncc.2022.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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4
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Boice JD, Quinn B, Al-Nabulsi I, Ansari A, Blake PK, Blattnig SR, Caffrey EA, Cohen SS, Golden AP, Held KD, Jokisch DW, Leggett RW, Mumma MT, Samuels C, Till JE, Tolmachev SY, Yoder RC, Zhou JY, Dauer LT. A million persons, a million dreams: a vision for a national center of radiation epidemiology and biology. Int J Radiat Biol 2021; 98:795-821. [PMID: 34669549 PMCID: PMC10594603 DOI: 10.1080/09553002.2021.1988183] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 09/27/2021] [Accepted: 09/28/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Epidemiologic studies of radiation-exposed populations form the basis for human safety standards. They also help shape public health policy and evidence-based health practices by identifying and quantifying health risks of exposure in defined populations. For more than a century, epidemiologists have studied the consequences of radiation exposures, yet the health effects of low levels delivered at a low-dose rate remain equivocal. MATERIALS AND METHODS The Million Person Study (MPS) of U.S. Radiation Workers and Veterans was designed to examine health effects following chronic exposures in contrast with brief exposures as experienced by the Japanese atomic bomb survivors. Radiation associations for rare cancers, intakes of radionuclides, and differences between men and women are being evaluated, as well as noncancers such as cardiovascular disease and conditions such as dementia and cognitive function. The first international symposium, held November 6, 2020, provided a broad overview of the MPS. Representatives from four U.S. government agencies addressed the importance of this research for their respective missions: U.S. Department of Energy (DOE), the Centers for Disease Control and Prevention (CDC), the U.S. Department of Defense (DOD), and the National Aeronautics and Space Administration (NASA). The major components of the MPS were discussed and recent findings summarized. The importance of radiation dosimetry, an essential feature of each MPS investigation, was emphasized. RESULTS The seven components of the MPS are DOE workers, nuclear weapons test participants, nuclear power plant workers, industrial radiographers, medical radiation workers, nuclear submariners, other U.S. Navy personnel, and radium dial painters. The MPS cohorts include tens of thousands of workers with elevated intakes of alpha particle emitters for which organ-specific doses are determined. Findings to date for chronic radiation exposure suggest that leukemia risk is lower than after acute exposure; lung cancer risk is much lower and there is little difference in risks between men and women; an increase in ischemic heart disease is yet to be seen; esophageal cancer is frequently elevated but not myelodysplastic syndrome; and Parkinson's disease may be associated with radiation exposure. CONCLUSIONS The MPS has provided provocative insights into the possible range of health effects following low-level chronic radiation exposure. When the 34 MPS cohorts are completed and combined, a powerful evaluation of radiation-effects will be possible. This final article in the MPS special issue summarizes the findings to date and the possibilities for the future. A National Center for Radiation Epidemiology and Biology is envisioned.
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Affiliation(s)
- John D. Boice
- National Council on Radiation Protection and Measurements, Bethesda, MD, USA
- Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Brian Quinn
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Armin Ansari
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Steve R. Blattnig
- National Aeronautics and Space Administration Langley Research Center, Hampton, VA, USA
| | - Emily A. Caffrey
- Radian Scientific, LLC, Huntsville, AL, and Risk Assessment Corporation, Neeses, SC, USA
| | - Sarah S. Cohen
- EpidStrategies, a division of ToxStrategies, Inc, Cary, NC, USA
| | | | - Kathryn D. Held
- National Council on Radiation Protection and Measurements, Bethesda, MD, USA
- Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | - Derek W. Jokisch
- Francis Marion University, Florence, SC, USA
- Oak Ridge National Laboratory, Oak Ridge, TN, USA
| | | | - Michael T. Mumma
- Vanderbilt University School of Medicine, Nashville, TN, USA
- International Epidemiology Institute, Rockville, MD, USA
| | | | | | | | | | - Joey Y. Zhou
- United States Department of Energy, Gaithersburg, MD, USA
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Suman S, Kumar S, Moon BH, Angdisen J, Kallakury BVS, Datta K, Fornace AJ. Effects of dietary aspirin on high-LET radiation-induced prostaglandin E2 levels and gastrointestinal tumorigenesis in Apc 1638N/+ mice. LIFE SCIENCES IN SPACE RESEARCH 2021; 31:85-91. [PMID: 34689954 PMCID: PMC9808916 DOI: 10.1016/j.lssr.2021.09.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 08/18/2021] [Accepted: 09/03/2021] [Indexed: 05/21/2023]
Abstract
Inevitable exposure to high-LET ionizing radiation (IR) present in galactic cosmic radiation (GCR) could enhance gastrointestinal (GI) cancer incidence among astronauts undertaking deep space exploration and GI-cancer mortality has been predicted to far exceed NASA's limit of < 3% REID (Radiation exposure-induced death) from cancer. Therefore, the development of countermeasure agents against high-LET radiation-induced GI cancer is needed to safeguard astronauts during and after an outer space mission. The cyclooxygenase-2/prostaglandin E2 (COX2/PGE2) mediated activation of pro-inflammatory and oncogenic signaling has been reported to play an important role in persistent inflammation and GI-tumorigenesis after high-LET radiation exposure. Therefore, aspirin, a well-known inhibitor of the COX/PGE2 pathway, was evaluated as a potential countermeasure against 28Si-induced PGE2 and tumorigenesis in Apc1638N/+, a murine model of human GI-cancer. Animals were fed either standard or aspirin supplemented diet (75, 150, or 300 mg/day of human equivalent dose) starting at the age of 4 weeks and continued till the end of the study, while mice were exposed to 28Si-ions (300 MeV/n; 69 keV/μm) at the age of 8 weeks. Serum PGE2 level, GI tumor size (>2mm2), number, and cluster (>5 adjoining tumors) were analyzed at 150 days post-exposure. Aspirin led to a significant reduction in PGE2 in a dose-dependent manner but did not reduce 28Si-induced GI tumorigenesis even at the highest (300 mg/day) dose. In summary, this study suggests that aspirin could reduce high-LET IR-induced pro-inflammatory PGE2 levels, however, lacks the ability to reduce high-LET IR-induced GI tumorigenesis in Apc1638N/+ mice.
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Affiliation(s)
- Shubhankar Suman
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC 20057, USA.
| | - Santosh Kumar
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC 20057, USA
| | - Bo-Hyun Moon
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC 20057, USA
| | - Jerry Angdisen
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC 20057, USA
| | | | - Kamal Datta
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC 20057, USA; Department of Biochemistry and Molecular & Cellular Biology and Department of Oncology, Georgetown University Medical Center, Washington, DC 20057, USA
| | - Albert J Fornace
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC 20057, USA; Department of Biochemistry and Molecular & Cellular Biology and Department of Oncology, Georgetown University Medical Center, Washington, DC 20057, USA
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Williamson MR, Klug MG, Schwartz GG. Brain cancer incidence rates and the presence of nuclear reactors in US states: a hypothesis-generating study. ENVIRONMENTAL GEOCHEMISTRY AND HEALTH 2021; 43:3967-3975. [PMID: 33768349 PMCID: PMC8463636 DOI: 10.1007/s10653-021-00896-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 03/14/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND The etiology of brain cancer is poorly understood. The only confirmed environmental risk factor is exposure to ionizing radiation. Because nuclear reactors emit ionizing radiation, we examined brain cancer incidence rates in the USA in relation to the presence of nuclear reactors per state. METHODS Data on brain cancer incidence rates per state for Whites by sex for three age groups (all ages, 50 and older, and under 50) were obtained from cancer registries. The location, number, and type of nuclear reactor, i.e., power or research reactor, was obtained from public sources. We examined the association between these variables using multivariate linear regression and ANOVA. RESULTS Brain cancer incidence rates were not associated with the number of nuclear power reactors. Conversely, incidence rates per state increased with the number of nuclear research reactors. This was significant for both sexes combined and for males in the 'all ages' category (β = 0.08, p = 0.0319 and β = 0.12, p = 0.0277, respectively), and for both sexes combined in the'50 and older' category (β = 0.18, p = 0.0163). Brain cancer incidence rates for counties with research reactors were significantly higher than the corresponding rates for their states overall (p = 0.0140). These findings were not explicable by known confounders. CONCLUSIONS Brain cancer incidence rates are positively associated with the number of nuclear research reactors per state. These findings merit further exploration and suggest new opportunities for research in brain cancer epidemiology.
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Affiliation(s)
- Mark R Williamson
- Department of Population Health, School of Medicine & Health Sciences, University of North Dakota, 1301 N Columbia Rd Stop 9037, Grand Forks, ND, 58202-9037, USA
| | - Marilyn G Klug
- Department of Population Health, School of Medicine & Health Sciences, University of North Dakota, 1301 N Columbia Rd Stop 9037, Grand Forks, ND, 58202-9037, USA
| | - Gary G Schwartz
- Department of Population Health, School of Medicine & Health Sciences, University of North Dakota, 1301 N Columbia Rd Stop 9037, Grand Forks, ND, 58202-9037, USA.
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Boice JD, Cohen SS, Mumma MT, Golden AP, Howard SC, Girardi DJ, Ellis ED, Bellamy MB, Dauer LT, Samuels C, Eckerman KF, Leggett RW. Mortality among workers at the Los Alamos National Laboratory, 1943-2017. Int J Radiat Biol 2021; 98:722-749. [PMID: 34047625 DOI: 10.1080/09553002.2021.1917784] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND During World War II (WWII), the Manhattan Engineering District established a secret laboratory in the mountains of northern New Mexico. The mission was to design, construct and test the first atomic weapon, nicknamed 'The Gadget' that was detonated at the TRINITY site in Alamogordo, NM. After WWII, nuclear weapons research continued, and the laboratory became the Los Alamos National Laboratory (LANL). MATERIALS AND METHODS The mortality experience of 26,328 workers first employed between 1943 and 1980 at LANL was determined through 2017. Included were 6157 contract workers employed by the ZIA Company. Organ dose estimates for each worker considered all sources of exposure, notably photons, neutrons, tritium, 238Pu and 239Pu. Vital status determination included searches within the National Death Index, Social Security Administration and New Mexico State Mortality Files. Standardized Mortality Ratios (SMR) and Cox regression models were used in the analyses. RESULTS Most workers (55%) were hired before 1960, 38% had a college degree, 25% were female, 81% white, 13% Hispanic and 60% had died. Vital status was complete, with only 0.1% lost to follow-up. The mean dose to the lung for the 17,053 workers monitored for radiation was 28.6 weighted-mGy (maximum 16.8 weighted-Gy) assuming a Dose Weighting Factor of 20 for alpha particle dose to lung. The Excess Relative Risk (ERR) at 100 weighted-mGy was 0.01 (95%CI -0.02, 0.03; n = 839) for lung cancer. The ERR at 100 mGy was -0.43 (95%CI -1.11, 0.24; n = 160) for leukemia other than chronic lymphocytic leukemia (CLL), -0.06 (95%CI -0.16, 0.04; n = 3043) for ischemic heart disease (IHD), and 0.29 (95%CI 0.02, 0.55; n = 106) for esophageal cancer. Among the 6499 workers with measurable intakes of plutonium, an increase in bone cancer (SMR 2.44; 95%CI 0.98, 5.03; n = 7) was related to dose. The SMR for berylliosis was significantly high, based on 4 deaths. SMRs for Hispanic workers were significantly high for cancers of the stomach and liver, cirrhosis of the liver, nonmalignant kidney disease and diabetes, but the excesses were not related to radiation dose. CONCLUSIONS There was little evidence that radiation increased the risk of lung cancer or leukemia. Esophageal cancer was associated with radiation, and plutonium intakes were linked to an increase of bone cancer. IHD was not associated with radiation dose. More precise evaluations will await the pooled analysis of workers with similar exposures such as at Rocky Flats, Savannah River and Hanford.
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Affiliation(s)
- John D Boice
- National Council on Radiation Protection and Measurements, Bethesda, MD, USA.,Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center and Vanderbilt-Ingram Cancer Center, Nashville, TN, USA
| | | | - Michael T Mumma
- International Epidemiology Institute, Rockville, MD, USA.,International Epidemiology Field Station, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Ashley P Golden
- ORISE Health Studies Program, Oak Ridge Associated Universities, Oak Ridge, TN, USA
| | - Sara C Howard
- ORISE Health Studies Program, Oak Ridge Associated Universities, Oak Ridge, TN, USA
| | - David J Girardi
- ORISE Health Studies Program, Oak Ridge Associated Universities, Oak Ridge, TN, USA
| | | | - Michael B Bellamy
- Department of Medical Physics and Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Lawrence T Dauer
- Department of Medical Physics and Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Golden AP, Milder CM, Ellis ED, Anderson JL, Boice JD, Bertke SJ, Zablotska LB. Cohort profile: four early uranium processing facilities in the US and Canada. Int J Radiat Biol 2021; 97:833-847. [DOI: 10.1080/09553002.2021.1917786] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Ashley P. Golden
- Health Studies Program, Oak Ridge Associated Universities, Oak Ridge, TN, USA
| | - Cato M. Milder
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center and Vanderbilt-Ingram Cancer Center, Nashville, TN, USA
| | - Elizabeth D. Ellis
- Health Studies Program, Oak Ridge Associated Universities, Oak Ridge, TN, USA
| | - Jeri L. Anderson
- Division of Field Studies and Engineering, National Institute for Occupational Safety and Health, Cincinnati, OH, USA
| | - John D. Boice
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center and Vanderbilt-Ingram Cancer Center, Nashville, TN, USA
- National Council on Radiation Protection and Measurements (NCRP), Bethesda, MD, USA
| | - Stephen J. Bertke
- Division of Field Studies and Engineering, National Institute for Occupational Safety and Health, Cincinnati, OH, USA
| | - Lydia B. Zablotska
- Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, CA, USA
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Martinez NE, Jokisch DW, Dauer LT, Eckerman KF, Goans RE, Brockman JD, Tolmachev SY, Avtandilashvili M, Mumma MT, Boice JD, Leggett RW. Radium dial workers: back to the future. Int J Radiat Biol 2021; 98:750-768. [PMID: 33900890 PMCID: PMC10563809 DOI: 10.1080/09553002.2021.1917785] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 04/01/2021] [Accepted: 04/02/2021] [Indexed: 12/16/2022]
Abstract
PURPOSE This paper reviews the history of the radium dial workers in the United States, summarizes the scientific progress made since the last evaluation in the early 1990s, and discusses current progress in updating the epidemiologic cohort and applying new dosimetric models for radiation risk assessment. BACKGROUND The discoveries of radiation and radioactivity led quickly to medical and commercial applications at the turn of the 20th century, including the development of radioluminescent paint, made by combining radium with phosphorescent material and adhesive. Workers involved with the painting of dials and instruments included painters, handlers, ancillary workers, and chemists who fabricated the paint. Dial painters were primarily women and, prior to the mid to late 1920s, would use their lips to give the brush a fine point, resulting in high intakes of radium. The tragic experience of the dial painters had a significant impact on industrial safety standards, including protection measures taken during the Manhattan Project. The dial workers study has formed the basis for radiation protection standards for intakes of radionuclides by workers and the public. EPIDEMIOLOGIC APPROACH The mortality experience of 3,276 radium dial painters and handlers employed between 1913 and 1949 is being determined through 2019. The last epidemiologic follow-up was 30 years ago when most of these workers were still alive. Nearly 65% were born before 1920, 37.5% were teenagers when first hired, and nearly 50% were hired before 1930 when the habit of placing brushes in mouths essentially stopped. Comprehensive dose reconstruction techniques are being applied to estimate organ doses for each worker related to the intake of 226Ra, 228Ra, and associated photon exposures. Time dependent dose-response analyses will estimate lifetime risks for specific causes of death. DISCUSSION The study of radium dial workers is part of the Million Person Study of low-dose health effects that is designed to evaluate radiation risks among healthy American workers and veterans. Despite being one of the most important and influential radiation effects studies ever conducted, shifting programmatic responsibilities and declining funding led to the termination of the radium program of studies in the early 1990s. Renewed interest and opportunity have arisen. With scientific progress made in dosimetric methodology and models, the ability to perform a study over the entire life span, and the potential applicability to other scenarios such as medicine, environmental contamination and space exploration, the radium dial workers have once again come to the forefront.
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Affiliation(s)
- Nicole E. Martinez
- Department of Environmental Engineering and Earth Sciences, Clemson University, Clemson, SC, USA
- Center for Radiation Protection Knowledge, Oak Ridge National Laboratory, Oak Ridge, TN, USA
| | - Derek W. Jokisch
- Center for Radiation Protection Knowledge, Oak Ridge National Laboratory, Oak Ridge, TN, USA
- Department of Physics and Engineering, Francis Marion University, Florence, SC, USA
| | - Lawrence T. Dauer
- Department of Medical Physics and Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Keith F. Eckerman
- Center for Radiation Protection Knowledge, Oak Ridge National Laboratory, Oak Ridge, TN, USA
| | | | - John D. Brockman
- Department of Chemistry, University of Missouri, Columbia, MO, USA
| | - Sergey Y. Tolmachev
- United States Transuranium and Uranium Registries, College of Pharmacy and Pharmaceutical Sciences, Washington State University, Richland, WA, USA
| | - Maia Avtandilashvili
- United States Transuranium and Uranium Registries, College of Pharmacy and Pharmaceutical Sciences, Washington State University, Richland, WA, USA
| | - Michael T. Mumma
- International Epidemiology Institute, Rockville, MD, USA
- Department of Medicine, Division of Epidemiology, Vanderbilt Epidemiology Center and Vanderbilt-Ingram Cancer Center, Nashville, TN, USA
| | - John D. Boice
- Department of Medicine, Division of Epidemiology, Vanderbilt Epidemiology Center and Vanderbilt-Ingram Cancer Center, Nashville, TN, USA
- National Council on Radiation Protection and Measurements, Bethesda, MD, USA
| | - Richard W. Leggett
- Center for Radiation Protection Knowledge, Oak Ridge National Laboratory, Oak Ridge, TN, USA
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Monastero RN, Meliker JR. Incidence of brain and spinal cord cancer and county-level radon levels in New Jersey, Wisconsin, Minnesota, Pennsylvania, and Iowa, USA. ENVIRONMENTAL GEOCHEMISTRY AND HEALTH 2020; 42:389-395. [PMID: 31309376 DOI: 10.1007/s10653-019-00368-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 07/03/2019] [Indexed: 06/10/2023]
Abstract
Ionizing radiation at diagnostic and therapeutic doses is a known contributor to the development of brain and spinal cord (CNS) cancer. However, little is known about risk from exposure to radon, a natural radiation source which the general population is exposed to residentially and environmentally. This study investigated correlations between mean county radon levels and CNS cancer incidence in five highly populated and radon-enriched US states (Minnesota, mean radon level 4.6 pCi/L; Wisconsin, 5.7 pCi/L; Pennsylvania, 8.6 pCi/L; Iowa, 6.1 pCi/L; and New Jersey, 4.4 pCi/L). Mean radon levels per county were accessed through AirChek, which provides publicly available radon data measured in residences and workplaces. CNS cancer incidence data were accessed through the states' health department websites and span differing amounts of time due to the publicly accessible nature of the data, though all time spans were over 10 years. Negative binomial regressions were run to assess correlations between mean radon and CNS cancer incidence per county. Quantile maps were constructed and Moran's I was calculated to assess spatial autocorrelation in residuals; no spatial autocorrelation was evident. Iowa was the only state with a significant positive association between radon and CNS incidence; no associations were detected in other states, and a negative association was observed in the 5 states combined. This study does not provide evidence that radon is a risk factor for CNS cancer; however, the possibility of an association cannot be ruled out due to limitations of the study, principally its ecologic nature and lack of individual-level exposure data.
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Affiliation(s)
- Rebecca N Monastero
- School of Medicine, Stony Brook University, HSC L3, Rm 071, Stony Brook, NY, 11794, USA.
| | - Jaymie R Meliker
- School of Medicine, Stony Brook University, HSC L3, Rm 071, Stony Brook, NY, 11794, USA
- Department of Family, Population, and Preventive Medicine, Program in Public Health, Stony Brook University, HSC L3, Rm 071, Stony Brook, NY, 11794, USA
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Krstev S, Knutsson A. Occupational Risk Factors for Prostate Cancer: A Meta-analysis. J Cancer Prev 2019; 24:91-111. [PMID: 31360689 PMCID: PMC6619854 DOI: 10.15430/jcp.2019.24.2.91] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 03/20/2019] [Accepted: 03/20/2019] [Indexed: 01/20/2023] Open
Abstract
Prostate cancer is the second most common cancer in men worldwide. There are many occupational factors that have been suggested to cause prostate cancer. Our aim was to evaluate the evidence for causality by a literature review of occupational factors. We searched literature in Medline and SCOPUS from 1966 to June 30, 2015 to identify occupational risk factors for prostate cancer. The following risk factors were selected: farmers/agricultural workers, pesticides - whole group, and separately organophosphate and organochlorine pesticides, carbamates and triazines, cadmium, chromium, cutting fluids, acrylonitrile, rubber manufacturing, whole body vibration, shift work, flight personnel, ionizing radiation, and occupational physical activity. For each factor a literature search was performed and presented as meta-analysis of relative risk and heterogeneity (Q and I2 index). A total of 168 original studies met the inclusion criteria with 90,688 prostate cancer cases. Significantly increased risks were observed for the following occupational exposures: pesticides (metaRR = 1.15, 95% confidence interval [CI] = 1.01-1.32; I2 = 84%), and specifically group of organochlorine pesticides (meta relative risk [metaRR] = 1.08, 95% CI = 1.03-1.14; I2 = 0%), chromium (metaRR = 1.19, 95% CI = 1.07-1.34; I2 = 31%), shift work (metaRR = 1.25, 95% CI = 1.05-1.49; I2 = 78%) and pilots (metaRR = 1.41, 95% CI = 1.02-1.94; I2 = 63%) and occupational physical activity in cohort studies (metaRR = 0.87, 95% CI = 0.81-0.94; I2 = 0%). The literature review supports a causal association for a few of the previously suggested factors.
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Affiliation(s)
- Srmena Krstev
- Serbian Institute of Occupational Health, Belgrade,
Serbia
| | - Anders Knutsson
- Department of Health Sciences, Mid Sweden University, Sundsvall,
Sweden
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Abstract
PURPOSE The study of low dose and low-dose rate exposure is of immeasurable value in understanding the possible range of health effects from prolonged exposures to radiation. The Million Person Study (MPS) of low-dose health effects was designed to evaluate radiation risks among healthy American workers and veterans who are more representative of today's populations than are the Japanese atomic bomb survivors exposed briefly to high-dose radiation in 1945. A million persons were needed for statistical reasons to evaluate low-dose and dose-rate effects, rare cancers, intakes of radioactive elements, and differences in risks between women and men. METHODS AND MATERIALS The MPS consists of five categories of workers and veterans exposed to radiation from 1939 to the present. The U.S. Department of Energy (DOE) Health and Mortality study began over 40 years ago and is the source of ∼360,000 workers. Over 25 years ago, the National Cancer Institute (NCI) collaborated with the U.S. Nuclear Regulatory Commission (NRC) to effectively create a cohort of nuclear power plant workers (∼150,000) and industrial radiographers (∼130,000). For over 30 years, the Department of Defense (DoD) collected data on aboveground nuclear weapons test participants (∼115,000). At the request of NCI in 1978, Landauer, Inc., (Glenwood, IL) saved their dosimetry databases which became the source of a cohort of ∼250,000 medical and other workers. RESULTS Overall, 29 individual cohorts comprise the MPS of which 21 have been or are under active study (∼810,000 persons). The remaining eight cohorts (∼190,000 persons) will be studied as resources become available. The MPS is a national effort with critical support from the NRC, DOE, National Aeronautics and Space Administration (NASA), DoD, NCI, the Centers for Disease Control and Prevention (CDC), the Environmental Protection Agency (EPA), Landauer, Inc., and national laboratories. CONCLUSIONS The MPS is designed to address the major unanswered question in radiation risk understanding: What is the level of health effects when exposure is gradual over time and not delivered briefly. The MPS will provide scientific understandings of prolonged exposure which will improve guidelines to protect workers and the public; improve compensation schemes for workers, veterans and the public; provide guidance for policy and decision makers; and provide evidence for or against the continued use of the linear nonthreshold dose-response model in radiation protection.
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Affiliation(s)
- John D Boice
- a National Council on Radiation Protection and Measurements , Bethesda , MD , USA.,b Department of Medicine, Division of Epidemiology , Vanderbilt Epidemiology Center and Vanderbilt-Ingram Cancer Center , Nashville , TN , USA
| | | | - Michael T Mumma
- d International Epidemiology Institute , Rockville , MD , USA
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Golden AP, Ellis ED, Cohen SS, Mumma MT, Leggett RW, Wallace PW, Girardi D, Watkins JP, Shore RE, Boice JD. Updated mortality analysis of the Mallinckrodt uranium processing workers, 1942–2012. Int J Radiat Biol 2019; 98:701-721. [DOI: 10.1080/09553002.2019.1569773] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
| | | | | | | | | | | | - David Girardi
- Oak Ridge Associated Universities, Oak Ridge, TN, USA
| | | | - Roy E. Shore
- Epidemiology Division, New York University School of Medicine, NewYork, NY, USA
- Radiation Effects Research Foundation, Hiroshima, Japan
| | - John D. Boice
- National Council on Radiation Protection and Measurements, Bethesda, MD, USA
- Department of Medicine, Division of Epidemiology, Vanderbilt Epidemiology Center and Vanderbilt-Ingram Cancer Center, Nashville, TN, USA
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Golden AP, Cohen SS, Chen H, Ellis ED, Boice JD. Evaluation of statistical modeling approaches for epidemiologic studies of low-dose radiation health effects. Int J Radiat Biol 2019; 98:572-579. [DOI: 10.1080/09553002.2018.1554924] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
| | | | - Heidi Chen
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center and Vanderbilt-Ingram Cancer Center, Nashville, TN, USA
| | | | - John D. Boice
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center and Vanderbilt-Ingram Cancer Center, Nashville, TN, USA
- National Council on Radiation Protection and Measurements, Bethesda, MD, USA
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Hagemeyer D, Nichols G, Mumma MT, Boice JD, Brock TA. 50 Years of the Radiation Exposure Information and Reporting System. Int J Radiat Biol 2018; 98:568-571. [DOI: 10.1080/09553002.2018.1540896] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
| | | | | | - John D. Boice
- National Council on Radiation Protection and Measurements, Bethesda, MD, USA
- Division of Epidemiology Department of Medicine, Vanderbilt Epidemiology Center and Vanderbilt-Ingram Cancer Center, Nashville, TN, USA
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Dauer LT, Bouville A, Toohey RE, Boice JD, Beck HL, Eckerman KF, Hagemeyer D, Leggett RW, Mumma MT, Napier B, Pryor KH, Rosenstein M, Schauer DA, Sherbini S, Stram DO, Thompson JL, Till JE, Yoder RC, Zeitlin C. Dosimetry and uncertainty approaches for the million person study of low-dose radiation health effects: overview of the recommendations in NCRP Report No. 178. Int J Radiat Biol 2018; 98:600-609. [DOI: 10.1080/09553002.2018.1536299] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Lawrence T. Dauer
- Radiology and Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | | | - John D. Boice
- National Council on Radiation Protection and Measurements, Bethesda, MD, USA
- Vanderbilt Epidemiology Center, Division of Epidemiology, Department of Medicine, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | | | | | | | | | - Bruce Napier
- Pacific Northwest National Laboratory, Richland, WA, USA
| | - Kathy H. Pryor
- Pacific Northwest National Laboratory, Richland, WA, USA
| | - Marvin Rosenstein
- National Council on Radiation Protection and Measurements, Bethesda, USA
| | | | - Sami Sherbini
- U.S. Nuclear Regulatory Commission, Washington, DC, USA
| | | | | | | | | | - Cary Zeitlin
- Leidos Innovations Corporation, Houston, TX, USA
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Kocher DC, Apostoaei AI, Hoffman FO, Trabalka JR. Probability Distribution of Dose and Dose-Rate Effectiveness Factor for use in Estimating Risks of Solid Cancers From Exposure to Low-Let Radiation. HEALTH PHYSICS 2018; 114:602-622. [PMID: 29697512 PMCID: PMC5922807 DOI: 10.1097/hp.0000000000000838] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
This paper presents an analysis to develop a subjective state-of-knowledge probability distribution of a dose and dose-rate effectiveness factor for use in estimating risks of solid cancers from exposure to low linear energy transfer radiation (photons or electrons) whenever linear dose responses from acute and chronic exposure are assumed. A dose and dose-rate effectiveness factor represents an assumption that the risk of a solid cancer per Gy at low acute doses or low dose rates of low linear energy transfer radiation, RL, differs from the risk per Gy at higher acute doses, RH; RL is estimated as RH divided by a dose and dose-rate effectiveness factor, where RH is estimated from analyses of dose responses in Japanese atomic-bomb survivors. A probability distribution to represent uncertainty in a dose and dose-rate effectiveness factor for solid cancers was developed from analyses of epidemiologic data on risks of incidence or mortality from all solid cancers as a group or all cancers excluding leukemias, including (1) analyses of possible nonlinearities in dose responses in atomic-bomb survivors, which give estimates of a low-dose effectiveness factor, and (2) comparisons of risks in radiation workers or members of the public from chronic exposure to low linear energy transfer radiation at low dose rates with risks in atomic-bomb survivors, which give estimates of a dose-rate effectiveness factor. Probability distributions of uncertain low-dose effectiveness factors and dose-rate effectiveness factors for solid cancer incidence and mortality were combined using assumptions about the relative weight that should be assigned to each estimate to represent its relevance to estimation of a dose and dose-rate effectiveness factor. The probability distribution of a dose and dose-rate effectiveness factor for solid cancers developed in this study has a median (50th percentile) and 90% subjective confidence interval of 1.3 (0.47, 3.6). The harmonic mean is 1.1, which implies that the arithmetic mean of an uncertain estimate of the risk of a solid cancer per Gy at low acute doses or low dose rates of low linear energy transfer radiation is only about 10% less than the mean risk per Gy at higher acute doses. Data were also evaluated to define a low acute dose or low dose rate of low linear energy transfer radiation, i.e., a dose or dose rate below which a dose and dose-rate effectiveness factor should be applied in estimating risks of solid cancers.
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Affiliation(s)
- David C Kocher
- *Oak Ridge Center for Risk Analysis, Inc., 102 Donner Drive, Oak Ridge, TN 37830; †Deceased
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Till JE, Beck HL, Grogan HA, Caffrey EA. A review of dosimetry used in epidemiological studies considered to evaluate the linear no-threshold (LNT) dose-response model for radiation protection. Int J Radiat Biol 2017; 93:1128-1144. [DOI: 10.1080/09553002.2017.1337280] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Samson E, Piot I, Zhivin S, Richardson DB, Laroche P, Serond AP, Laurier D, Laurent O. Cancer and non-cancer mortality among French uranium cycle workers: the TRACY cohort. BMJ Open 2016; 6:e010316. [PMID: 27048635 PMCID: PMC4823425 DOI: 10.1136/bmjopen-2015-010316] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES The health effects of internal contamination by radionuclides, and notably by uranium, are poorly characterised. New cohorts of uranium workers are needed to better examine these effects. This paper analyses for the first time the mortality profile of the French cohort of uranium cycle workers. It considers mortality from cancer and non-cancer causes. METHODS The cohort includes workers employed at least 6 months between 1958 and 2006 in French companies involved in the production of nuclear fuel. Vital status and causes of death were collected from French national registries. Workers were followed-up from 1 January 1968 to 31 December 2008. Standardised mortality ratios (SMRs) were computed based on mortality rates for the French general population. RESULTS The cohort includes 12,649 workers (88% men). The average length of follow-up is 27 years and the mean age at the end of the study is 60 years. Large mortality deficits are observed for non-cancer causes of death such as non-cancer respiratory diseases (SMR=0.51 (0.41 to 0.63)) and circulatory diseases (SMR=0.68 (0.62 to 0.74)). A mortality deficit of lower magnitude is also observed for all cancers combined (SMR (95% CI): 0.76 (0.71 to 0.81)). Pleural mesothelioma is elevated (SMR=2.04 (1.19 to 3.27)). CONCLUSIONS A healthy worker effect is observed in this new cohort of workers involved in the uranium cycle. Collection of individual information on internal uranium exposure as well as other risk factors is underway, to allow for the investigation of uranium-related risks.
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Affiliation(s)
- Eric Samson
- Institut de Radioprotection et de Sureté Nucléaire (IRSN), Laboratoire d’épidémiologie des rayonnements ionisants (PRP-HOM/SRBE/LEPID), Fontenay aux Roses, France
| | | | - Sergey Zhivin
- Institut de Radioprotection et de Sureté Nucléaire (IRSN), Laboratoire d’épidémiologie des rayonnements ionisants (PRP-HOM/SRBE/LEPID), Fontenay aux Roses, France
| | - David B Richardson
- Institut de Radioprotection et de Sureté Nucléaire (IRSN), Laboratoire d’épidémiologie des rayonnements ionisants (PRP-HOM/SRBE/LEPID), Fontenay aux Roses, France
- Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina, USA
| | | | | | - Dominique Laurier
- Institut de Radioprotection et de Sureté Nucléaire (IRSN), Laboratoire d’épidémiologie des rayonnements ionisants (PRP-HOM/SRBE/LEPID), Fontenay aux Roses, France
| | - Olivier Laurent
- Institut de Radioprotection et de Sureté Nucléaire (IRSN), Laboratoire d’épidémiologie des rayonnements ionisants (PRP-HOM/SRBE/LEPID), Fontenay aux Roses, France
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Dinocourt C, Legrand M, Dublineau I, Lestaevel P. The neurotoxicology of uranium. Toxicology 2015; 337:58-71. [PMID: 26277741 DOI: 10.1016/j.tox.2015.08.004] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Revised: 08/05/2015] [Accepted: 08/11/2015] [Indexed: 11/26/2022]
Abstract
The brain is a target of environmental toxic pollutants that impair cerebral functions. Uranium is present in the environment as a result of natural deposits and release by human applications. The first part of this review describes the passage of uranium into the brain, and its effects on neurological functions and cognitive abilities. Very few human studies have looked at its cognitive effects. Experimental studies show that after exposure, uranium can reach the brain and lead to neurobehavioral impairments, including increased locomotor activity, perturbation of the sleep-wake cycle, decreased memory, and increased anxiety. The mechanisms underlying these neurobehavioral disturbances are not clearly understood. It is evident that there must be more than one toxic mechanism and that it might include different targets in the brain. In the second part, we therefore review the principal mechanisms that have been investigated in experimental models: imbalance of the anti/pro-oxidant system and neurochemical and neurophysiological pathways. Uranium effects are clearly specific according to brain area, dose, and time. Nonetheless, this review demonstrates the paucity of data about its effects on developmental processes and the need for more attention to the consequences of exposure during development.
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Affiliation(s)
- Céline Dinocourt
- Institut de Radioprotection et de Sûreté Nucléaire (IRSN), Pôle de la Radioprotection de l'Homme, Service de Radiobiologie et d'Epidémiologie, Laboratoire de Radiotoxicologie Expérimentale, BP 17, F-92262 Fontenay-aux-Roses, France.
| | - Marie Legrand
- Institut de Radioprotection et de Sûreté Nucléaire (IRSN), Pôle de la Radioprotection de l'Homme, Service de Radiobiologie et d'Epidémiologie, Laboratoire de Radiotoxicologie Expérimentale, BP 17, F-92262 Fontenay-aux-Roses, France.
| | - Isabelle Dublineau
- Institut de Radioprotection et de Sûreté Nucléaire (IRSN), Pôle de la Radioprotection de l'Homme, Service de Radiobiologie et d'Epidémiologie, Laboratoire de Radiotoxicologie Expérimentale, BP 17, F-92262 Fontenay-aux-Roses, France.
| | - Philippe Lestaevel
- Institut de Radioprotection et de Sûreté Nucléaire (IRSN), Pôle de la Radioprotection de l'Homme, Service de Radiobiologie et d'Epidémiologie, Laboratoire de Radiotoxicologie Expérimentale, BP 17, F-92262 Fontenay-aux-Roses, France.
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Abstract
Leukemia is a complex disease, which only became better understood during the last decades following the development of new laboratory techniques and diagnostic methods. Despite our improved understanding of the physiology of the disease, little is yet known about the causes of leukemia. A variety of potential risk factors have been suggested so far, including personal habits and lifestyle, and a wide range of occupational or environmental exposures. A causal association with leukemia has only been documented to date for ionizing radiation, benzene and treatment with cytostatic drugs, but there is an ongoing scientific debate on the possible association of leukemia with a number of other work-related hazards. In this article, we have reviewed scientific studies, published over the past 5 years, which investigated potential associations between leukemia and exposure to occupational risk factors. The systematic literature review took place via electronic databases, using specific search criteria, and independent reviewers have further filtered the search results to identify the number of articles, presented in our paper. A large number of studies included in the review referred to the effects of ionizing radiation, where new data suggest that the effects of exposure to small doses of ionizing radiation should probably be reevaluated. Some other works appear to substantiate a potential association of the disease with certain pesticides. Further research is also suggested regarding the role of infectious agents or exposure to certain chemicals like formaldehyde or butadiene in the pathogenesis of leukemia.
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Shrinkage methods enhanced the accuracy of parameter estimation using Cox models with small number of events. J Clin Epidemiol 2013; 66:743-51. [PMID: 23566374 DOI: 10.1016/j.jclinepi.2013.02.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2012] [Revised: 01/22/2013] [Accepted: 02/04/2013] [Indexed: 11/23/2022]
Abstract
OBJECTIVE When the number of events is small during Cox regression analysis, it is unclear what alternative analytical strategies can be used and when this type of alternative approach is needed. This study explores several analytical strategies in this situation. STUDY DESIGN AND SETTING Simulations and sensitivity analyses were performed on data with numbers of events per predictive variable (EPVs) below 10 using a Cox model with a partial likelihood (PL), Firth's penalized likelihood, or the Bayesian approach. RESULTS For scenarios involving binary predictors with an EPV of six or less, the simulations showed that the Firth and Bayesian approaches were more accurate than was PL. The performances of various approaches were similar when the EPV was greater than six in the binary predictor. Furthermore, the performances involving continuous predictors were similar, regardless of the EPV. The bias and precision of the parameter estimates using Bayesian analysis depended on the selection of priors. CONCLUSIONS When the EPV is six or less, the results for categorical predictors tend to be too conservative. Firth's estimator may be a good alternative in this situation. Appropriate choices of priors when using Bayesian analysis should increase the accuracy of the parameter estimates, although this requires expertise.
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Pernot E, Hall J, Baatout S, Benotmane MA, Blanchardon E, Bouffler S, El Saghire H, Gomolka M, Guertler A, Harms-Ringdahl M, Jeggo P, Kreuzer M, Laurier D, Lindholm C, Mkacher R, Quintens R, Rothkamm K, Sabatier L, Tapio S, de Vathaire F, Cardis E. Ionizing radiation biomarkers for potential use in epidemiological studies. MUTATION RESEARCH-REVIEWS IN MUTATION RESEARCH 2012; 751:258-286. [DOI: 10.1016/j.mrrev.2012.05.003] [Citation(s) in RCA: 135] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2012] [Revised: 05/04/2012] [Accepted: 05/28/2012] [Indexed: 02/07/2023]
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Daniels RD, Bertke S, Waters KM, Schubauer-Berigan MK. Risk of leukaemia mortality from exposure to ionising radiation in US nuclear workers: a pooled case-control study. Occup Environ Med 2012; 70:41-8. [PMID: 23000827 DOI: 10.1136/oemed-2012-100906] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To follow-up on earlier studies of the leukaemogenicity of occupational ionising radiation exposure. METHODS We conducted a nested case-control analysis of leukaemia mortality in a pooled cohort of US nuclear workers followed through 2005. Each case was matched to four controls on attained age. Exposures were estimated from available records. General relative risk models were used to estimate the excess relative risk (ERR) of leukaemia, excluding chronic lymphocytic (CLL), acute myeloid leukaemia, chronic myeloid leukaemia and CLL while controlling for potential confounders. Preferred exposure lags and time-windows of risks were calculated using joint maximum likelihood. Dose-response was also examined using linear, linear-quadratic, categorical and restricted cubic spline models. RESULTS There were 369 leukaemia deaths in 105 245 US nuclear workers. The adjusted ERR for non-CLL leukaemia was 0.09 (95% CI -0.17 to 0.65) per 100 mGy. Elevated non-CLL risks were observed from exposures occurring 6-14 years prior to attained age of cases (ERR per 100 mGy=1.9; 95% CI <0 to 8.0). Lagged models indicated non-linearity of risk at very low (<10 mGy) and high (>100 mGy) doses, which contributed to the imprecision of results in linear models. Similar risk attenuation was not evident in time-windows-based models. CONCLUSIONS Risk estimates were in reasonable agreement with previous estimates, with the temporality of non-CLL leukaemia risk as a dominant factor in dose-response analyses. Future research should focus on methods that improve evaluations of the dose-response, particularly in the low-dose range.
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Affiliation(s)
- Robert D Daniels
- National Institute for Occupational Safety and Health (NIOSH), Division of Surveillance, Hazard Evaluations, and Field Studies (DSHEFS), Industrywide Studies Branch (IWSB), Cincinnati, OH 45226, USA.
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25
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Fallahian NA, Brey RR, Tivis RD, Piland NF, Simpson DR. Cancer deaths and occupational exposure in a group of plutonium workers. HEALTH PHYSICS 2012; 102:443-452. [PMID: 22378206 DOI: 10.1097/hp.0b013e31823dc308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
An exploratory epidemiological study was conducted for 319 deceased nuclear workers who had intakes of transuranic radionuclides and histories of employment during the time period from 1943 to 1995. The workers were employed at various facilities throughout the United States, including the Department of Energy defense facilities and uranium mining and milling sites. The majority of individuals were involved in documented radiological incidents during their careers. All had voluntarily agreed to donate their organs or whole body to the United States Transuranium and Uranium Registries. External and internal dose assessments were performed using occupational exposure histories and postmortem concentrations of transuranic radionuclides in critical organs. Statistical data analyses were performed to investigate the potential relationship between radiation exposure and causes of death within this population due to cancers of the lungs, liver, and all sites combined while controlling for the effects of other confounders. No association was found between radiation exposure and death due to cancer (α = 0.05). However, statistically significant associations were found between death due to any type of cancer and smoking (yes or no) (odds ratio = 5.41; 95% CI: 1.42 to 20.67) and rate of cigarette smoking (packs per day) (odds ratio = 2.70; 95% CI: 1.37 to 5.30).
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Affiliation(s)
- Naz Afarin Fallahian
- Bloomsburg University, Department of Physics and Engineering Technology, 400 East 2nd Street, Bloomsburg, PA 17815-1301, USA.
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Uranium carcinogenicity in humans might depend on the physical and chemical nature of uranium and its isotopic composition: results from pilot epidemiological study of French nuclear workers. Cancer Causes Control 2011; 22:1563-73. [DOI: 10.1007/s10552-011-9833-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2010] [Accepted: 08/13/2011] [Indexed: 10/17/2022]
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Boice JD, Cohen SS, Mumma MT, Ellis ED, Eckerman KF, Leggett RW, Boecker BB, Brill AB, Henderson BE. Updated Mortality Analysis of Radiation Workers at Rocketdyne (Atomics International), 1948–2008. Radiat Res 2011; 176:244-58. [DOI: 10.1667/rr2487.1] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Daniels RD, Schubauer-Berigan MK. A meta-analysis of leukaemia risk from protracted exposure to low-dose gamma radiation. Occup Environ Med 2011; 68:457-64. [PMID: 20935290 PMCID: PMC3095477 DOI: 10.1136/oem.2009.054684] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2010] [Indexed: 01/18/2023]
Abstract
CONTEXT More than 400,000 workers annually receive a measurable radiation dose and may be at increased risk of radiation-induced leukaemia. It is unclear whether leukaemia risk is elevated with protracted, low-dose exposure. OBJECTIVE We conducted a meta-analysis examining the relationship between protracted low-dose ionising radiation exposure and leukaemia. DATA SOURCES Reviews by the National Academies and United Nations provided a summary of informative studies published before 2005. PubMed and Embase databases were searched for additional occupational and environmental studies published between 2005 and 2009. STUDY SELECTION We selected 23 studies that: (1) examined the association between protracted exposures to ionising radiation and leukaemia excluding chronic lymphocytic subtype; (2) were a cohort or nested case-control design without major bias; (3) reported quantitative estimates of exposure; and (4) conducted exposure-response analyses using relative or excess RR per unit exposure. METHODS Studies were further screened to reduce information overlap. Random effects models were developed to summarise between-study variance and obtain an aggregate estimate of the excess RR at 100 mGy. Publication bias was assessed by trim and fill and Rosenthal's file drawer methods. RESULTS We found an ERR at 100 mGy of 0.19 (95% CI 0.07 to 0.32) by modelling results from 10 studies and adjusting for publication bias. Between-study variance was not evident (p=0.99). CONCLUSIONS Protracted exposure to low-dose gamma radiation is significantly associated with leukaemia. Our estimate agreed well with the leukaemia risk observed among exposed adults in the Life Span Study (LSS) of atomic bomb survivors, providing increased confidence in the current understanding of leukaemia risk from ionising radiation. However, unlike the estimates obtained from the LSS, our model provides a precise, quantitative summary of the direct estimates of excess risk from studies of protracted radiation exposures.
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Affiliation(s)
- R D Daniels
- Division of Surveillance, Hazard Evaluations, and Field Studies, National Institute for Occupational Safety and Health, US Centers for Disease Control and Prevention, 4676 Columbia Pkwy, R-14, Cincinnati, OH 45226, USA.
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Shore RE. Implications of radiation epidemiologic data for risk assessment and radiation protection. HEALTH PHYSICS 2011; 100:306-308. [PMID: 21595078 DOI: 10.1097/hp.0b013e3182050493] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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Metz-Flamant C, Guseva Canu I, Laurier D. Malignant pleural mesothelioma risk among nuclear workers: a review. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2011; 31:9-23. [PMID: 21346295 DOI: 10.1088/0952-4746/31/1/r01] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Exposure to ionising radiation has been suggested as a causal risk factor for malignant pleural mesothelioma (MPM). Studies of patients treated by radiotherapy for primary cancers have suggested that radiation contributes to the development of secondary MPM. Here we examined the risk to nuclear workers of MPM related to exposure to low doses of occupational radiation at low dose rates. All results concerning MPM risk in published studies of nuclear workers were examined for their association with radiation exposure and potential confounders. We found 19 relevant studies. Elevated risks of pleural cancer were reported in most (15/17) of these studies. Eight reported risks higher for radiation monitored workers than for other workers. However, of 12 studies that looked at associations with ionising radiation, only one reported a significant dose-risk association. Asbestos was an important confounder in most studies. We conclude that studies of nuclear workers have not detected an association between ionising radiation exposure and MPM. Further investigations should improve the consideration of asbestos exposure at the same time as they address the risk of MPM related to occupational exposure of nuclear workers to low doses of ionising radiation at low dose rates.
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Affiliation(s)
- C Metz-Flamant
- Laboratory of Epidemiology, Institute of Radiological Protection and Nuclear Safety (IRSN), Fontenay-aux-Roses, France.
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31
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Boice JD. Lauriston S. Taylor lecture: radiation epidemiology--the golden age and future challenges. HEALTH PHYSICS 2011; 100:59-76. [PMID: 21399414 DOI: 10.1097/hp.0b013e3181f9797d] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Epidemiology is the study of the distribution and causes of disease in humans. Studies of human populations exposed to ionizing radiation have been conducted for nearly 100 y during the "Golden Age of Radiation Epidemiology." Radiation epidemiology is now so sophisticated that human studies are the basis for radiation protection standards and for compensation schemes in response to claims of ill health from prior exposures. The studies of exposed human populations are very broad and include not only the Japanese atomic bomb survivors, but also patients given radiotherapy for cancer, patients treated with radiation for nonmalignant disease, patients given diagnostic radiation, persons with intakes of radionuclides, workers exposed to occupational radiation, and communities exposed to environmental sources of radiation. But there is more to be learned, and future knowledge may be advanced from new and continued occupational studies of the early radiation workers, atomic veterans, medically exposed patients, and populations living in areas of high natural background radiation. The interaction between radiation and underlying genetic susceptibilities is an important emerging area of research. It is indeed an honor to be included among the Lauriston S. Taylor Lecturers.
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Affiliation(s)
- John D Boice
- International Epidemiology Institute, 1455 Research Boulevard, Suite 550, Rockville, MD 20850, USA.
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Wagner SE, Burch JB, Bottai M, Puett R, Porter D, Bolick-Aldrich S, Temples T, Wilkerson RC, Vena JE, Hébert JR. Groundwater uranium and cancer incidence in South Carolina. Cancer Causes Control 2010; 22:41-50. [PMID: 21080052 DOI: 10.1007/s10552-010-9669-4] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2010] [Accepted: 10/09/2010] [Indexed: 12/29/2022]
Abstract
OBJECTIVE This ecologic study tested the hypothesis that census tracts with elevated groundwater uranium and more frequent groundwater use have increased cancer incidence. METHODS Data sources included: incident total, leukemia, prostate, breast, colorectal, lung, kidney, and bladder cancers (1996-2005, SC Central Cancer Registry); demographic and groundwater use (1990 US Census); and groundwater uranium concentrations (n = 4,600, from existing federal and state databases). Kriging was used to predict average uranium concentrations within tracts. The relationship between uranium and standardized cancer incidence ratios was modeled among tracts with substantial groundwater use via linear or semiparametric regression, with and without stratification by the proportion of African Americans in each area. RESULTS A total of 134,685 cancer cases were evaluated. Tracts with ≥50% groundwater use and uranium concentrations in the upper quartile had increased risks for colorectal, breast, kidney, prostate, and total cancer compared to referent tracts. Some of these relationships were more likely to be observed among tracts populated primarily by African Americans. CONCLUSION SC regions with elevated groundwater uranium and more groundwater use may have an increased incidence of certain cancers, although additional research is needed since the design precluded adjustment for race or other predictive factors at the individual level.
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Affiliation(s)
- Sara E Wagner
- College of Public Health, Department of Epidemiology and Biostatistics, Paul D. Coverdell Center for Biomedical and Health Sciences, University of Georgia, 500 D.W. Brooks Drive, Athens, GA 30602-7396, USA.
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Yousif L, Blettner M, Hammer GP, Zeeb H. Testicular cancer risk associated with occupational radiation exposure: a systematic literature review. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2010; 30:389-406. [PMID: 20798474 DOI: 10.1088/0952-4746/30/3/r01] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Testicular cancer is a rare disease, affecting mainly young men aged 15-49. There have been some recent reports that it might be associated with radiation exposure. We have systematically reviewed this topic. English-language articles published between 1990 and 2008 studying the relationship between occupational radiation exposure and testicular cancer were included. Risk of bias was assessed using a modified version of the EPHPP checklist. For ionising radiation we subdivided study populations into occupational groups. No pooled analysis was performed due to the heterogeneity of studies. Seven case-control and 30 cohort studies were included in the review. For radiation workers, one incidence study showed a significant increase and four showed no effect. Eight mortality studies did not indicate an effect while four showed a non-significant increase. Incidence among persons with military exposure was not increased in two studies and non-significantly increased in another two. Among aircrew studies, one showed no effect against five with slight increases. Medical exposure studies showed no increases. For EMF exposure, three studies showed no effect, two reported a significant and four a non-significant increase in incidence. Overall, there was very limited evidence for associations between occupational ionising radiation and testicular cancer, while there were some positive associations for EMF. Testicular cancer mortality is generally low and was not associated with radiation. New incidence studies are recommended to investigate the association between radiation exposure and testicular cancer where exposure is better specified and individually estimated.
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Affiliation(s)
- Lamya Yousif
- Department of Epidemiology, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center, Johannes Gutenberg-University Mainz, Mainz, Germany.
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Dauer LT, Brooks AL, Hoel DG, Morgan WF, Stram D, Tran P. Review and evaluation of updated research on the health effects associated with low-dose ionising radiation. RADIATION PROTECTION DOSIMETRY 2010; 140:103-136. [PMID: 20413418 DOI: 10.1093/rpd/ncq141] [Citation(s) in RCA: 108] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
While radiation health risks at low doses have traditionally been estimated from high-dose studies, we have reviewed recent literature and concluded that the mechanisms of action for many biological endpoints may be different at low doses from those observed at high doses; that acute doses <100 mSv may be too small to allow epidemiological detection of excess cancers given the background of naturally occurring cancers; that low-dose radiation research should use holistic approaches such as systems-based methods to develop models that define the shape of the dose-response relationship; and that these results should be combined with the latest epidemiology to produce a comprehensive understanding of radiation effects that addresses both damage, likely with a linear effect, and response, possibly with non-linear consequences. Continued research is needed to understand how radiobiology and epidemiology advances should be used to effectively model radiation worker risks.
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Affiliation(s)
- Lawrence T Dauer
- Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
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Park ES, Moon K, Kim HN, Lee WJ, Jin YW. [Radiation exposure and cancer mortality among nuclear power plant workers: a meta-analysis]. J Prev Med Public Health 2010; 43:185-92. [PMID: 20383052 DOI: 10.3961/jpmph.2010.43.2.185] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES We conducted a meta-analysis to investigate the relationship between low external doses of ionizing radiation exposure and the risk of cancer mortality among nuclear power plant workers. METHODS We searched MEDLINE using key words related to low dose and cancer risk. The selected articles were restricted to those written in English from 1990 to January 2009. We excluded those studies with no fit to the selection criteria and we included the cited references in published articles to minimize publication bias. Through this process, a total of 11 epidemiologic studies were finally included. RESULTS We found significant decreased deaths from all cancers (SMR = 0.75, 95% CI = 0.62 - 0.90), all cancers excluding leukemia, solid cancer, mouth and pharynx, esophagus, stomach, rectum, liver and gallbladder, pancreas, lung, prostate, lymphopoietic and hematopoitic cancer. The findings of this meta-analysis were similar with those of the 15 Country Collaborative Study conducted by the International Agency for Research on Cancer. A publication bias was found only for liver and gallbladder cancer (p = 0.015). Heterogeneity was observed for all cancers, all cancers excluding leukemia, solid cancer, esophagus, colon and lung cancer. CONCLUSIONS Our findings of low mortality for stomach, rectum, liver and gallbladder cancers may explained by the health worker effect. Yet further studies are needed to clarify the low SMR of cancers, for which there is no useful screening tool, in nuclear power plant workers.
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Affiliation(s)
- Eun Sook Park
- Radiation Health Research Institute, Korea Hydro & Nuclear Power Co., Ltd., Korea
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Jacob P, Rühm W, Walsh L, Blettner M, Hammer G, Zeeb H. Is cancer risk of radiation workers larger than expected? Occup Environ Med 2009; 66:789-96. [PMID: 19570756 PMCID: PMC2776242 DOI: 10.1136/oem.2008.043265] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/13/2009] [Indexed: 11/03/2022]
Abstract
Occupational exposures to ionising radiation mainly occur at low-dose rates and may accumulate effective doses of up to several hundred milligray. The objective of the present study is to evaluate the evidence of cancer risks from such low-dose-rate, moderate-dose (LDRMD) exposures. Our literature search for primary epidemiological studies on cancer incidence and mortality risks from LDRMD exposures included publications from 2002 to 2007, and an update of the UK National Registry for Radiation Workers study. For each (LDRMD) study we calculated the risk for the same types of cancer among the atomic bomb survivors with the same gender proportion and matched quantities for dose, mean age attained and mean age at exposure. A combined estimator of the ratio of the excess relative risk per dose from the LDRMD study to the corresponding value for the atomic bomb survivors was 1.21 (90% CI 0.51 to 1.90). The present analysis does not confirm that the cancer risk per dose for LDRMD exposures is lower than for the atomic bomb survivors. This result challenges the cancer risk values currently assumed for occupational exposures.
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Affiliation(s)
- P Jacob
- Hemholtz Zentrum München, Institute of Radiation Protection, D-85764 Neuherberg, Germany.
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37
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Irradiations à faibles doses et risque de pathologie cardiovasculaire : revue des études épidémiologiques. Rev Epidemiol Sante Publique 2009; 57:347-59. [DOI: 10.1016/j.respe.2009.04.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2008] [Revised: 02/17/2009] [Accepted: 04/15/2009] [Indexed: 12/20/2022] Open
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38
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Guseva Canu I, Cardis E, Metz-Flamant C, Caër-Lorho S, Auriol B, Wild P, Laurier D, Tirmarche M. French cohort of the uranium processing workers: mortality pattern after 30-year follow-up. Int Arch Occup Environ Health 2009; 83:301-8. [PMID: 19701767 DOI: 10.1007/s00420-009-0455-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2009] [Accepted: 07/23/2009] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To investigate mortality among nuclear workers with potential internal exposure to uranium. METHODS The cohort included 2,709 workers employed at the AREVA NC Pierrelatte plant for at least 6 months (72,787 person-years). This plant processed uranium enrichment during the period 1960-1996 and chemical conversion since 1980. Mortality was compared to the national and regional mortality rates available for the period 1968-2005. For causes of death of interest with respect to occupational exposure, mortality trends according to occupational characteristics were assessed. RESULTS As expected, an important healthy worker effect (all causes SMR = 0.55 (95% CI: 0.50-0.61), n = 411; all cancers SMR = 0.70 (95% CI: 0.60-0.81), n = 193) was observed. Among cancer sites a priori related to uranium exposure, only mortality for lymphatic cancer was increased among potentially exposed workers (SMR = 1.49 (95% CI: 0.68-2.82); n = 9). An important increase in mortality from pleural cancer was observed (SMR = 2.85 (95% CI: 0.93-6.66), n = 5); none of the deceased workers were exposed to radiation whereas all handled asbestos. CONCLUSION In spite of limited statistical power, results show consistency with previous studies of nuclear workers potentially exposed to uranium. Further investigation based on more precise uranium exposure data should allow the estimation of uranium hazard effects among this cohort.
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Affiliation(s)
- Irina Guseva Canu
- Institut de Radioprotection et de Sûreté Nucléaire, Service de Radiobiologie et d'Epidémiologie, BP 17, 92262, Fontenay-aux-Roses, France.
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39
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Goodman JE, Nascarella MA, Valberg PA. Ionizing radiation: a risk factor for mesothelioma. Cancer Causes Control 2009; 20:1237-54. [DOI: 10.1007/s10552-009-9357-4] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2008] [Accepted: 04/23/2009] [Indexed: 02/01/2023]
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40
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Romanenko AY, Finch SC, Hatch M, Lubin JH, Bebeshko VG, Bazyka DA, Gudzenko N, Dyagil IS, Reiss RF, Bouville A, Chumak VV, Trotsiuk NK, Babkina NG, Belyayev Y, Masnyk I, Ron E, Howe GR, Zablotska LB. The Ukrainian-American study of leukemia and related disorders among Chornobyl cleanup workers from Ukraine: III. Radiation risks. Radiat Res 2009; 170:711-20. [PMID: 19138038 DOI: 10.1667/rr1404.1] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2008] [Accepted: 08/11/2008] [Indexed: 01/09/2023]
Abstract
Leukemia is one of the cancers most susceptible to induction by ionizing radiation, but the effects of lower doses delivered over time have not been quantified adequately. After the Chornobyl (Chernobyl) accident in Ukraine in April 1986, several hundred thousand workers who were involved in cleaning up the site and its surroundings received fractionated exposure, primarily from external gamma radiation. To increase our understanding of the role of protracted low-dose radiation exposure in the etiology of leukemia, we conducted a nested case-control study of leukemia in a cohort of cleanup workers identified from the Chornobyl State Registry of Ukraine. The analysis is based on 71 cases of histologically confirmed leukemia diagnosed in 1986-2000 and 501 age- and residence-matched controls selected from the same cohort. Study subjects or their proxies were interviewed about their cleanup activities and other relevant factors. Individual bone marrow radiation doses were estimated by the RADRUE dose reconstruction method (mean dose = 76.4 mGy, SD = 213.4). We used conditional logistic regression to estimate leukemia risks. The excess relative risk (ERR) of total leukemia was 3.44 per Gy [95% confidence interval (CI) 0.47-9.78, P < 0.01]. The dose response was linear and did not differ significantly by calendar period of first work in the 30-km Chornobyl zone, duration or type of work. We found a similar dose-response relationship for chronic and non-chronic lymphocytic leukemia [ERR = 4.09 per Gy (95% CI < 0-14.41) and 2.73 per Gy (95% CI < 0-13.50), respectively]. To further clarify these issues, we are extending the case-control study to ascertain cases for another 6 years (2001-2006).
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Boice JD, Bigbee WL, Mumma MT, Tarone RE, Blot WJ. County mortality and cancer incidence in relation to living near two former nuclear materials processing facilities in Pennsylvania--an update. HEALTH PHYSICS 2009; 96:128-137. [PMID: 19131734 DOI: 10.1097/01.hp.0000327664.79349.d4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
A previous county mortality study of populations living near two nuclear materials processing and fabrication facilities in Westmoreland and Armstrong counties in Pennsylvania (1950-1995) was extended through 2004. Noncancer mortality (1996-2004) and cancer incidence (1990-2004) were also evaluated. Among the Westmoreland and Armstrong populations, 10,547 cancer deaths occurred during the period 1996 through 2004 and the relative risk (RR) based on comparisons with six demographically similar counties in western Pennsylvania was 0.97, that is, almost exactly as expected, and no different from our previously published analyses covering the years 1950-1995. The results based on cancer incidence data were very similar to those based on cancer mortality data. Over the years 1990 though 2004, 39,350 incident cancers were reported among residents of Armstrong and Westmoreland counties and the RR based on the six demographically similar counties was 0.99, that is, almost exactly as expected. The number of deaths from nonmalignant conditions was 36,565 and very close to the number expected (RR 1.01). Overall, no increases in cancer or nonmalignant diseases could be attributed to living in counties with nuclear materials processing and fabrication facilities.
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Affiliation(s)
- John D Boice
- International Epidemiology Institute, 1455 Research Boulevard, Suite 550, Rockville, MD 20850, USA.
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Sanders CL. PREVENTION OF CIGARETTE SMOKE INDUCED LUNG CANCER BY LOW LET IONIZING RADIATION. NUCLEAR ENGINEERING AND TECHNOLOGY 2008. [DOI: 10.5516/net.2008.40.7.539] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Boice JD, Cohen SS, Mumma MT, Chadda B, Blot WJ. A cohort study of uranium millers and miners of Grants, New Mexico, 1979-2005. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2008; 28:303-325. [PMID: 18714128 DOI: 10.1088/0952-4746/28/3/002] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
A cohort mortality study of workers engaged in uranium milling and mining activities near Grants, New Mexico, during the period from 1955 to 1990 was conducted. Vital status was determined through 2005 and standardised mortality ratio (SMR) analyses were conducted for 2745 men and women alive after 1978 who were employed for at least six months. Overall, mortality from all causes (SMR 1.15; 95% CI 1.07-1.23; n = 818) and all cancers (SMR 1.22; 95% CI 1.07-1.38; n = 246) was greater than expected on the basis of US mortality rates. Increased mortality, however, was seen only among the 1735 underground uranium miners and was due to malignant (SMR 2.17; 95% CI 1.75-2.65; n = 95) and non-malignant (SMR 1.64; 95% CI 1.23-2.13; n = 55) respiratory diseases, cirrhosis of the liver (SMR 1.79; n = 18) and external causes (SMR 1.65; n = 58). The lung cancer excess likely is attributable to the historically high levels of radon in uranium mines of the Colorado Plateau, combined with the heavy use of tobacco products. No statistically significant elevation in any cause of death was seen among the 904 non-miners employed at the Grants uranium mill. Among 718 mill workers with the greatest potential for exposure to uranium ore, no statistically significant increase in any cause of death of a priori interest was seen, i.e., cancers of the lung, kidney, liver, or bone, lymphoma, non-malignant respiratory disease, renal disease or liver disease. Although the population studied was relatively small, the follow-up was long (up to 50 yrs) and complete. In contrast to miners exposed to radon and radon decay products, for uranium mill workers exposed to uranium dusts and mill products there was no clear evidence of uranium-related disease.
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Affiliation(s)
- John D Boice
- International Epidemiology Institute, Rockville, MD 20850, USA.
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Linet MS, Schubauer-Berigan MK, Weisenburger DD, Richardson DB, Landgren O, Blair A, Silver S, Field RW, Caldwell G, Hatch M, Dores GM. Chronic lymphocytic leukaemia: an overview of aetiology in light of recent developments in classification and pathogenesis. Br J Haematol 2008; 139:672-86. [PMID: 18021081 DOI: 10.1111/j.1365-2141.2007.06847.x] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
This overview of the epidemiology of chronic lymphocytic leukaemia (CLL) summarizes the evolution of classification and coding systems and describes the intersection of pathogenesis and aetiology. The role of the putative precursor to CLL, monoclonal B-cell lymphocytosis (MBL), is considered, and ideas for future investigations of the MBL-CLL relationship are outlined. We discuss the epidemiology of CLL, focusing on descriptive patterns and methodological considerations. Postulated risk factors are reviewed including the role of ionizing and non-ionizing radiation, occupational and environmental chemical exposures, medical conditions and treatments, and lifestyle and genetic factors. We conclude by raising key questions that need to be addressed to advance our understanding of CLL aetiology. Recommendations for future epidemiological studies are given, including the standardization of reporting of CLL across cancer registries, the clarification of the natural history of MBL, and the circumvention of the methodological shortcomings of prior epidemiological investigations in relation to radiation, chemical exposures and infectious agents.
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Affiliation(s)
- Martha S Linet
- DCEG/Radiation Epidemiology Branch, National Cancer Institute, Bethesda, MD, USA.
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Canu IG, Ellis ED, Tirmarche M. Cancer risk in nuclear workers occupationally exposed to uranium-emphasis on internal exposure. HEALTH PHYSICS 2008; 94:1-17. [PMID: 18091147 DOI: 10.1097/01.hp.0000281195.63082.e3] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Workers involved in the nuclear fuel cycle have a potential for internal exposure to uranium. The present review of epidemiological studies of these workers aims to elucidate the relationship between occupational internal uranium exposure and cancer risk. Eighteen cohort and 5 nested case-control studies published since 1980 are reviewed. Workers occupationally exposed to uranium appear to be at increased risk of mortality from neoplasms of the lung, larynx, and lymphatic and haematopoietic tissue. Currently available evidence for a positive association between internal exposure to uranium and the risk of cancer is limited. The common weaknesses in reviewed studies include low statistical power and inaccurate assessment of internal exposure to uranium. Further investigations should focus on precise assessment of occupational exposure and address the issue of potential confounders.
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Affiliation(s)
- Irina Guseva Canu
- Radiobiolgy and Epidemiology Department, Institute of Radioprotection and Nuclear Safety, France.
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Schubauer-Berigan MK, Daniels RD, Fleming DA, Markey AM, Couch JR, Ahrenholz SH, Burphy JS, Anderson JL, Tseng CY. Chronic lymphocytic leukaemia and radiation: findings among workers at five US nuclear facilities and a review of the recent literature. Br J Haematol 2007; 139:799-808. [DOI: 10.1111/j.1365-2141.2007.06843.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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47
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Boice JD, Marano DE, Cohen SS, Mumma MT, Blot WJ, Brill AB, Fryzek JP, Henderson BE, McLaughlin JK. Mortality among Rocketdyne workers who tested rocket engines, 1948-1999. J Occup Environ Med 2007; 48:1070-92. [PMID: 17033507 DOI: 10.1097/01.jom.0000240661.33413.b5] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The objective of this study was to evaluate potential health risks associated with testing rocket engines. METHODS A retrospective cohort mortality study was conducted of 8372 Rocketdyne workers employed 1948 to 1999 at the Santa Susana Field Laboratory (SSFL). Standardized mortality ratios (SMRs) and 95% confidence intervals (CIs) were calculated for all workers, including those employed at specific test areas where particular fuels, solvents, and chemicals were used. Dose-response trends were evaluated using Cox proportional hazards models. RESULTS SMRs for all cancers were close to population expectations among SSFL workers overall (SMR = 0.89; CI = 0.82-0.96) and test stand mechanics in particular (n = 1651; SMR = 1.00; CI = 0.86-1.16), including those likely exposed to hydrazines (n = 315; SMR = 1.09; CI = 0.75-1.52) or trichloroethylene (TCE) (n = 1111; SMR = 1.00; CI = 0.83-1.19). Nonsignificant associations were seen between kidney cancer and TCE, lung cancer and hydrazines, and stomach cancer and years worked as a test stand mechanic. No trends over exposure categories were statistically significant. CONCLUSION Work at the SSFL rocket engine test facility or as a test stand mechanic was not associated with a significant increase in cancer mortality overall or for any specific cancer.
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Affiliation(s)
- John D Boice
- International Epidemiology Institute, Rockville, Maryland 20850, USA.
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