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Thariat J, Little MP, Zablotska LB, Samson P, O’Banion MK, Leuraud K, Bergom C, Girault G, Azimzadeh O, Bouffler S, Hamada N. Radiotherapy for non-cancer diseases: benefits and long-term risks. Int J Radiat Biol 2024; 100:505-526. [PMID: 38180039 PMCID: PMC11039429 DOI: 10.1080/09553002.2023.2295966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 11/29/2023] [Indexed: 01/06/2024]
Abstract
PURPOSE The discovery of X-rays was followed by a variety of attempts to treat infectious diseases and various other non-cancer diseases with ionizing radiation, in addition to cancer. There has been a recent resurgence of interest in the use of such radiotherapy for non-cancer diseases. Non-cancer diseases for which use of radiotherapy has currently been proposed include refractory ventricular tachycardia, neurodegenerative diseases (e.g. Alzheimer's disease and dementia), and Coronavirus Disease 2019 (COVID-19) pneumonia, all with ongoing clinical studies that deliver radiation doses of 0.5-25 Gy in a single fraction or in multiple daily fractions. In addition to such non-cancer effects, historical indications predominantly used in some countries (e.g. Germany) include osteoarthritis and degenerative diseases of the bones and joints. This narrative review gives an overview of the biological rationale and ongoing preclinical and clinical studies for radiotherapy proposed for various non-cancer diseases, discusses the plausibility of the proposed biological rationale, and considers the long-term radiation risks of cancer and non-cancer diseases. CONCLUSIONS A growing body of evidence has suggested that radiation represents a double-edged sword, not only for cancer, but also for non-cancer diseases. At present, clinical evidence has shown some beneficial effects of radiotherapy for ventricular tachycardia, but there is little or no such evidence of radiotherapy for other newly proposed non-cancer diseases (e.g. Alzheimer's disease, COVID-19 pneumonia). Patients with ventricular tachycardia and COVID-19 pneumonia have thus far been treated with radiotherapy when they are an urgent life threat with no efficient alternative treatment, but some survivors may encounter a paradoxical situation where patients were rescued by radiotherapy but then get harmed by radiotherapy. Further studies are needed to justify the clinical use of radiotherapy for non-cancer diseases, and optimize dose to diseased tissue while minimizing dose to healthy tissue.
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Affiliation(s)
- Juliette Thariat
- Department of Radiation Oncology, Comprehensive Cancer Centre François Baclesse, Caen, France
- Laboratoire de Physique Corpusculaire IN2P3, ENSICAEN/CNRS UMR 6534, Normandie Université, Caen, France
| | - Mark P. Little
- Radiation Epidemiology Branch, National Cancer Institute, Bethesda, Maryland, USA
| | - Lydia B. Zablotska
- Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco (UCSF), San Francisco, California, USA
| | - Pamela Samson
- Department of Radiation Oncology, Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri, USA
| | - M. Kerry O’Banion
- Department of Neuroscience, Del Monte Institute for Neuroscience, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Klervi Leuraud
- Research Department on Biological and Health Effects of Ionizing Radiation (SESANE), Institute for Radiological Protection and Nuclear Safety (IRSN), Fontenay-aux-Roses, France
| | - Carmen Bergom
- Department of Radiation Oncology, Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri, USA
- Cardio-Oncology Center of Excellence, Washington University, St. Louis, Missouri, USA
| | - Gilles Girault
- Comprehensive Cancer Centre François Baclesse, Medical Library, Caen, France
| | - Omid Azimzadeh
- Federal Office for Radiation Protection (BfS), Section Radiation Biology, Neuherberg, Germany
| | - Simon Bouffler
- Radiation Protection Sciences Division, UK Health Security Agency (UKHSA), Chilton, Didcot, UK
| | - Nobuyuki Hamada
- Biology and Environmental Chemistry Division, Sustainable System Research Laboratory, Central Research Institute of Electric Power Industry (CRIEPI), Abiko, Chiba, Japan
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Srivastava T, Chirikova E, Birk S, Xiong F, Benzouak T, Liu JY, Villeneuve PJ, Zablotska LB. Exposure to Ionizing Radiation and Risk of Dementia: A Systematic Review and Meta-Analysis. Radiat Res 2023; 199:490-505. [PMID: 37293601 PMCID: PMC10249679 DOI: 10.1667/rade-22-00153.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The number of people living with dementia is rising globally as life expectancy increases. Dementia is a multifactorial disease. Due to the ubiquity of radiation exposure in medical and occupational settings, the potential association between radiation and dementia, and its subtypes (Alzheimer's and Parkinson's disease), is of particular importance. There has also been an increased interest in studying radiation induced dementia risks in connection with the long-term manned space travel proposed by The National Aeronautics and Space Administration (NASA). Our aim was to systematically review the literature on this topic, and use meta-analysis to generate a summary measure of association, assess publication bias and explore sources of heterogeneity across studies. We identified five types of exposed populations for this review: 1. survivors of atomic bombings in Japan; 2. patients treated with radiation therapy for cancer or other diseases; 3. occupationally exposed workers; 4. those exposed to environmental radiation; and 5. patients exposed to radiation from diagnostic radiation imaging procedures. We included studies that considered incident or mortality outcomes for dementia and its subtypes. Following PRISMA guidelines, we systematically searched the published literature indexed in PubMed between 2001 and 2022. We then abstracted the relevant articles, conducted a risk-of-bias assessment, and fit random effects models using the published risk estimates. After we applied our eligibility criteria, 18 studies were identified for review and retained for meta-analysis. For dementia (all subtypes), the summary relative risk was 1.11 (95% CI: 1.04, 1.18; P = 0.001) comparing individuals receiving 100 mSv of radiation to those with no exposure. The corresponding summary relative risk for Parkinson's disease incidence and mortality was 1.12 (95% CI 1.07, 1.17; P <0.001). Our results provide evidence that exposure to ionizing radiation increases the risk of dementia. However, our findings should be interpreted with caution due to the small number of included studies. Longitudinal studies with improved exposure characterization, incident outcomes, larger sample size, and the ability to adjust for effects of potential confounders are needed to better assess the possible causal link between ionizing radiation and dementia.
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Affiliation(s)
- Tanvi Srivastava
- Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, San Francisco, California 94143
| | - Ekaterina Chirikova
- Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, San Francisco, California 94143
| | - Sapriya Birk
- Department of Neuroscience, Carleton University, Ottawa, ON, Canada K1S 5B6
| | - Fanxiu Xiong
- Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, San Francisco, California 94143
| | - Tarek Benzouak
- Department of Psychology, Carleton University, Ottawa, ON, Canada K1S 5B6
| | - Jane Y. Liu
- Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, San Francisco, California 94143
| | - Paul J. Villeneuve
- Department of Neuroscience, Carleton University, Ottawa, ON, Canada K1S 5B6
| | - Lydia B. Zablotska
- Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, San Francisco, California 94143
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Anderson JL, Bertke SJ, Yiin J, Kelly-Reif K, Daniels RD. Ischaemic heart and cerebrovascular disease mortality in uranium enrichment workers. Occup Environ Med 2020; 78:105-111. [PMID: 32883719 DOI: 10.1136/oemed-2020-106423] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 06/19/2020] [Accepted: 08/02/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Linear and non-linear dose-response relationships between radiation absorbed dose to the lung from internally deposited uranium and external sources and circulatory system disease (CSD) mortality were examined in a cohort of 23 731 male and 5552 female US uranium enrichment workers. METHODS Rate ratios (RRs) for categories of lung dose and linear excess relative rates (ERRs) per unit lung dose were estimated to evaluate the associations between lung absorbed dose and death from ischaemic heart disease (IHD) and cerebrovascular disease. RESULTS There was a suggestion of modestly increased IHD risk in workers with internal uranium lung dose above 1 milligray (mGy) (RR=1.4, 95% CI 0.76 to 2.3) and a statistically significantly increased IHD risk with external dose exceeding 150 mGy (RR=1.3, 95% CI 1.1 to 1.6) compared with the lowest exposed groups. ERRs per milligray were positive for IHD and uranium internal dose and for both outcomes per gray external dose, although the CIs generally included the null. CONCLUSIONS Non-linear dose-response models using restricted cubic splines revealed sublinear responses at lower internal doses, suggesting that linear models that are common in radioepidemiological cancer studies may poorly describe the association between uranium internal dose and CSD mortality.
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Affiliation(s)
- Jeri L Anderson
- National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Cincinnati, Ohio, USA
| | - Stephen J Bertke
- National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Cincinnati, Ohio, USA
| | - James Yiin
- National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Cincinnati, Ohio, USA
| | - Kaitlin Kelly-Reif
- National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Cincinnati, Ohio, USA
| | - Robert Douglas Daniels
- National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Cincinnati, Ohio, USA
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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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Qu SG, Gao J, Tang B, Yu B, Shen YP, Tu Y. Low-dose ionizing radiation increases the mortality risk of solid cancers in nuclear industry workers: A meta-analysis. Mol Clin Oncol 2018; 8:703-711. [PMID: 29725540 DOI: 10.3892/mco.2018.1590] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 02/28/2018] [Indexed: 11/05/2022] Open
Abstract
Low-dose ionizing radiation (LDIR) may increase the mortality of solid cancers in nuclear industry workers, but only few individual cohort studies exist, and the available reports have low statistical power. The aim of the present study was to focus on solid cancer mortality risk from LDIR in the nuclear industry using standard mortality ratios (SMRs) and 95% confidence intervals. A systematic literature search through the PubMed and Embase databases identified 27 studies relevant to this meta-analysis. There was statistical significance for total, solid and lung cancers, with meta-SMR values of 0.88, 0.80, and 0.89, respectively. There was evidence of stochastic effects by IR, but more definitive conclusions require additional analyses using standardized protocols to determine whether LDIR increases the risk of solid cancer-related mortality.
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Affiliation(s)
- Shu-Gen Qu
- Department of Radiation Health, Research Center of Radiation Protection and Nuclear Safety, School of Radiation Medicine and Protection, Medical College of Soochow University, Suzhou, Jiangsu 215123, P.R. China
| | - Jin Gao
- Department of Radiation Health, Research Center of Radiation Protection and Nuclear Safety, School of Radiation Medicine and Protection, Medical College of Soochow University, Suzhou, Jiangsu 215123, P.R. China
| | - Bo Tang
- Department of Radiation Health, Research Center of Radiation Protection and Nuclear Safety, School of Radiation Medicine and Protection, Medical College of Soochow University, Suzhou, Jiangsu 215123, P.R. China
| | - Bo Yu
- Department of Radiation Health, Research Center of Radiation Protection and Nuclear Safety, School of Radiation Medicine and Protection, Medical College of Soochow University, Suzhou, Jiangsu 215123, P.R. China
| | - Yue-Ping Shen
- Department of Health Statistics, School of Public Health, Medical College of Soochow University, Suzhou, Jiangsu 215123, P.R. China
| | - Yu Tu
- Department of Radiation Health, Research Center of Radiation Protection and Nuclear Safety, School of Radiation Medicine and Protection, Medical College of Soochow University, Suzhou, Jiangsu 215123, P.R. China
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Zablotska LB, Fenske N, Schnelzer M, Zhivin S, Laurier D, Kreuzer M. Analysis of mortality in a pooled cohort of Canadian and German uranium processing workers with no mining experience. Int Arch Occup Environ Health 2017; 91:91-103. [PMID: 28940040 PMCID: PMC5752750 DOI: 10.1007/s00420-017-1260-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 09/11/2017] [Indexed: 10/25/2022]
Abstract
PURPOSE Long-term health risks of occupational exposures to uranium processing were examined to better understand potential differences with uranium underground miners and nuclear reactor workers. METHODS A cohort study of mortality of workers from Port Hope, Canada (1950-1999) and Wismut, Germany (1946-2008) employed in uranium milling, refining, and processing was conducted. Poisson regression was used to evaluate the association between cumulative exposures to radon decay products (RDP) and gamma-rays and causes of death potentially related to uranium processing. RESULTS The pooled cohort included 7431 workers (270,201 person-years of follow-up). Mean RDP exposures were lower than in miners while gamma-ray doses were higher than in reactor workers. Both exposures were highly correlated (weighted rho = 0.81). Radiation risks of lung cancer and cardiovascular diseases (CVD) in males were increased but not statistically significant and compatible with risks estimated for miners and reactor workers, respectively. Higher RDP-associated CVD risks were observed for exposures 5-14 years prior to diagnosis compared to later exposures and among those employed <5 years. Radiation risks of solid cancers excluding lung cancer were increased, but not statistically significant, both for males and females, while all other causes of death were not associated with exposures. CONCLUSIONS In the largest study of uranium processing workers to systematically examine radiation risks of multiple outcomes from RDP exposures and gamma-rays, estimated radiation risks were compatible with risks reported for uranium miners and nuclear reactor workers. Continued follow-up and pooling with other cohorts of uranium processing workers are necessary for future comparisons with other workers of the nuclear fuel cycle.
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Affiliation(s)
- Lydia B Zablotska
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA.
| | - Nora Fenske
- Department of Radiation Protection and Health, Federal Office for Radiation Protection, Neuherberg, Germany
| | - Maria Schnelzer
- Department of Radiation Protection and Health, Federal Office for Radiation Protection, Neuherberg, Germany
| | - Sergey Zhivin
- French National Institute of Health and Medical Research, INSERM, Paris, France
| | - Dominique Laurier
- Institute for Radiological Protection and Nuclear Safety, IRSN, Fontenay-Aux-Roses, France
| | - Michaela Kreuzer
- Department of Radiation Protection and Health, Federal Office for Radiation Protection, Neuherberg, Germany
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Yiin JH, Anderson JL, Daniels RD, Bertke SJ, Fleming DA, Tollerud DJ, Tseng CY, Chen PH, Waters KM. Mortality in a combined cohort of uranium enrichment workers. Am J Ind Med 2017; 60:96-108. [PMID: 27753121 PMCID: PMC5708885 DOI: 10.1002/ajim.22668] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/23/2016] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To examine the patterns of cause-specific mortality and relationship between internal exposure to uranium and specific causes in a pooled cohort of 29,303 workers employed at three former uranium enrichment facilities in the United States with follow-up through 2011. METHODS Cause-specific standardized mortality ratios (SMRs) for the full cohort were calculated with the U.S. population as referent. Internal comparison of the dose-response relation between selected outcomes and estimated organ doses was evaluated using regression models. RESULTS External comparison with the U.S. population showed significantly lower SMRs in most diseases in the pooled cohort. Internal comparison showed positive associations of absorbed organ doses with multiple myeloma, and to a lesser degree with kidney cancer. CONCLUSION In general, these gaseous diffusion plant workers had significantly lower SMRs than the U.S. POPULATION The internal comparison however, showed associations between internal organ doses and diseases associated with uranium exposure in previous studies. Am. J. Ind. Med. 60:96-108, 2017. Published 2016. This article is a U.S. Government work and is in the public domain in the USA.
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Affiliation(s)
- James H. Yiin
- Division of Surveillance, Hazard Evaluations, and Field Studies, National Institute for Occupational Safety and Health, Cincinnati, Ohio
| | - Jeri L. Anderson
- Division of Surveillance, Hazard Evaluations, and Field Studies, National Institute for Occupational Safety and Health, Cincinnati, Ohio
| | - Robert D. Daniels
- Division of Surveillance, Hazard Evaluations, and Field Studies, National Institute for Occupational Safety and Health, Cincinnati, Ohio
| | - Stephen J. Bertke
- Division of Surveillance, Hazard Evaluations, and Field Studies, National Institute for Occupational Safety and Health, Cincinnati, Ohio
| | - Donald A. Fleming
- Division of Surveillance, Hazard Evaluations, and Field Studies, National Institute for Occupational Safety and Health, Cincinnati, Ohio
| | - David J. Tollerud
- School of Public Health and Information Sciences, University of Louisville, Louisville, Kentucky
| | - Chih-Yu Tseng
- Division of Surveillance, Hazard Evaluations, and Field Studies, National Institute for Occupational Safety and Health, Cincinnati, Ohio
| | - Pi-Hsueh Chen
- Division of Surveillance, Hazard Evaluations, and Field Studies, National Institute for Occupational Safety and Health, Cincinnati, Ohio
| | - Kathleen M. Waters
- Division of Surveillance, Hazard Evaluations, and Field Studies, National Institute for Occupational Safety and Health, Cincinnati, Ohio
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Abstract
PURPOSE Uranium is a heavy metal with alpha radioactivity. We state the hypothesis that uranium exposure is harmful to human kidneys and carcinogenic to body tissues. Therefore, we review epidemiological studies from people with known long-lasting uranium exposure. MATERIALS AND METHODS Three meta-analyses are performed using clinical studies published in the PubMed database and applying RevMan 5.3 from the Cochrane Collaboration to calculate the outcome. The first two meta-analyses examine the standardized mortality ratio (SMR) and the standardized incidence ratio for any cancers of uranium workers who were operating in areas ranging from uranium processing to the assembly of final uranium products. The third meta-analysis evaluates the nephrotoxic risk in uranium workers as well as soldiers and of individuals with exposure to drinking water containing uranium. RESULTS Overall and contrasting to our hypothesis, the tumor risk is significantly lower for uranium workers than for control groups (SMR = 0.90 with a 95% confidence interval of 0.84 to 0.96). In addition and also contrasting to our hypothesis, the risk of nephrotoxicity is not increased either. This holds for both the incidence and the mortality due to renal cell carcinoma or due to acute kidney injury or chronic kidney disease. In contrast, a significantly better creatinine clearance is found for the uranium cohort as compared to the control groups (mean difference = 7.66 with a 95% confidence interval of 0.12 to 15.2). CONCLUSION Our hypothesis that a chronic uranium exposure is associated with an increased risk of cancer mortality or of kidney failure is refuted by clinical data. The decreased risk may result from better medical surveillance of uranium workers.
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Affiliation(s)
- Leonhard Stammler
- Nephrology, Department of Internal Medicine 1, Ulm University, Ulm, Germany
| | | | - Benjamin Mayer
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Frieder Keller
- Nephrology, Department of Internal Medicine 1, Ulm University, Ulm, Germany
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Laurent O, Gomolka M, Haylock R, Blanchardon E, Giussani A, Atkinson W, Baatout S, Bingham D, Cardis E, Hall J, Tomasek L, Ancelet S, Badie C, Bethel G, Bertho JM, Bouet S, Bull R, Challeton-de Vathaire C, Cockerill R, Davesne E, Ebrahimian T, Engels H, Gillies M, Grellier J, Grison S, Gueguen Y, Hornhardt S, Ibanez C, Kabacik S, Kotik L, Kreuzer M, Lebacq AL, Marsh J, Nosske D, O'Hagan J, Pernot E, Puncher M, Rage E, Riddell T, Roy L, Samson E, Souidi M, Turner MC, Zhivin S, Laurier D. Concerted Uranium Research in Europe (CURE): toward a collaborative project integrating dosimetry, epidemiology and radiobiology to study the effects of occupational uranium exposure. J Radiol Prot 2016; 36:319-345. [PMID: 27183135 DOI: 10.1088/0952-4746/36/2/319] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The potential health impacts of chronic exposures to uranium, as they occur in occupational settings, are not well characterized. Most epidemiological studies have been limited by small sample sizes, and a lack of harmonization of methods used to quantify radiation doses resulting from uranium exposure. Experimental studies have shown that uranium has biological effects, but their implications for human health are not clear. New studies that would combine the strengths of large, well-designed epidemiological datasets with those of state-of-the-art biological methods would help improve the characterization of the biological and health effects of occupational uranium exposure. The aim of the European Commission concerted action CURE (Concerted Uranium Research in Europe) was to develop protocols for such a future collaborative research project, in which dosimetry, epidemiology and biology would be integrated to better characterize the effects of occupational uranium exposure. These protocols were developed from existing European cohorts of workers exposed to uranium together with expertise in epidemiology, biology and dosimetry of CURE partner institutions. The preparatory work of CURE should allow a large scale collaborative project to be launched, in order to better characterize the effects of uranium exposure and more generally of alpha particles and low doses of ionizing radiation.
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Affiliation(s)
- Olivier Laurent
- Institute for Radiological Protection and Nuclear Safety (IRSN), Fontenay aux Roses, France
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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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Anderson JL, Apostoaei AI, Yiin JH, Fleming DA, Tseng CY, Chen PH. Internal exposure to uranium in a pooled cohort of gaseous diffusion plant workers. Radiat Prot Dosimetry 2016; 168:471-7. [PMID: 26113578 PMCID: PMC4690811 DOI: 10.1093/rpd/ncv357] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Accepted: 05/22/2015] [Indexed: 05/27/2023]
Abstract
Intakes and absorbed organ doses were estimated for 29 303 workers employed at three former US gaseous diffusion plants as part of a study of cause-specific mortality and cancer incidence in uranium enrichment workers. Uranium urinalysis data (>600 000 urine samples) were available for 58 % of the pooled cohort. Facility records provided uranium gravimetric and radioactivity concentration data and allowed estimation of enrichment levels of uranium to which workers may have been exposed. Urine data were generally recorded with facility department numbers, which were also available in study subjects' work histories. Bioassay data were imputed for study subjects with no recorded sample results (33 % of pooled cohort) by assigning department average urine uranium concentration. Gravimetric data were converted to 24-h uranium activity excretion using department average specific activities. Intakes and organ doses were calculated assuming chronic exposure by inhalation to a 5-µm activity median aerodynamic diameter aerosol of soluble uranium. Median intakes varied between 0.31 and 0.74 Bq d(-1) for the three facilities. Median organ doses for the three facilities varied between 0.019 and 0.051, 0.68 and 1.8, 0.078 and 0.22, 0.28 and 0.74, and 0.094 and 0.25 mGy for lung, bone surface, red bone marrow, kidneys, and liver, respectively. Estimated intakes and organ doses for study subjects with imputed bioassay data were similar in magnitude.
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Affiliation(s)
- Jeri L Anderson
- Division of Surveillance, Hazard Evaluations and Field Studies (DSHEFS), National Institute for Occupational Safety and Health (NIOSH), 1090 Tusculum Ave., MS R-14., Cincinnati, OH 45226, USA
| | | | - James H Yiin
- Division of Surveillance, Hazard Evaluations and Field Studies (DSHEFS), National Institute for Occupational Safety and Health (NIOSH), 1090 Tusculum Ave., MS R-14., Cincinnati, OH 45226, USA
| | - Donald A Fleming
- Division of Surveillance, Hazard Evaluations and Field Studies (DSHEFS), National Institute for Occupational Safety and Health (NIOSH), 1090 Tusculum Ave., MS R-14., Cincinnati, OH 45226, USA
| | - Chih-Yu Tseng
- Division of Surveillance, Hazard Evaluations and Field Studies (DSHEFS), National Institute for Occupational Safety and Health (NIOSH), 1090 Tusculum Ave., MS R-14., Cincinnati, OH 45226, USA
| | - Pi-Hsueh Chen
- Division of Surveillance, Hazard Evaluations and Field Studies (DSHEFS), National Institute for Occupational Safety and Health (NIOSH), 1090 Tusculum Ave., MS R-14., Cincinnati, OH 45226, USA
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Zhivin S, Guseva Canu I, Samson E, Laurent O, Grellier J, Collomb P, Zablotska LB, Laurier D. Mortality (1968–2008) in a French cohort of uranium enrichment workers potentially exposed to rapidly soluble uranium compounds. Occup Environ Med 2015; 73:167-74. [DOI: 10.1136/oemed-2015-103142] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Accepted: 10/28/2015] [Indexed: 12/28/2022]
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Abstract
PURPOSE Physicochemical properties of uranium, including isotopic composition and solubility, are determinants of its toxicity. We reviewed epidemiological studies in civilian and military workers known to be exposed to uranium with different physicochemical properties to investigate its long-term effects, such as cancerous and circulatory diseases. MATERIALS AND METHODS We systematically searched the Pubmed and the Scopus databases to identify studies of uranium- processing workers (published between 1980 and 2013) and veterans of the wars in the Persian Gulf and the Balkans (published between 1991 and 2013) in which defined outcomes, such as lung, lymphohematopoietic, kidney cancers, and circulatory diseases were examined. RESULTS from these studies in terms of risk of each health outcome (mortality or incidence) and analyses of dose-response relationship were examined to present the impact of uranium physicochemical properties on the observed results. RESULTS Twenty-seven articles were reviewed. There is some evidence for increased lung cancer risk among uranium-processing workers. The evidence is less strong for lymphohematopoietic cancer. We found that most of the studies insufficiently assessed the physicochemical properties of uranium and some of them used proxies for the exposure assessment and risk estimation analyses. Studies of veterans of the wars in the Persian Gulf and the Balkans are uninformative in respect to internal uranium exposure. CONCLUSIONS Existing epidemiological data on the physicochemical properties of uranium and associated health outcomes are inconclusive. Further studies among certain groups of uranium-processing workers (uranium-enrichment and fuel-fabrication workers) could contribute to our knowledge of the health effects of uranium with respect to its physicochemical properties.
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Affiliation(s)
- Sergey Zhivin
- Institut de Radioprotection et de Sûreté Nucléaire, IRSN/PRP-HOM/SRBE/LEPID , BP 17, 92262 Fontenay-aux-Roses , France
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Guseva Canu I, Zhivin S, Garsi JP, Caër-Lorho S, Samson E, Collomb P, Acker A, Laurier D. Effets de la contamination chronique à l’uranium sur la mortalité : bilan d’une étude-pilote chez les travailleurs de l’industrie nucléaire en France. Rev Epidemiol Sante Publique 2014; 62:339-50. [DOI: 10.1016/j.respe.2014.09.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Revised: 09/02/2014] [Accepted: 09/19/2014] [Indexed: 12/31/2022] Open
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Zhivin S, Laurier D, Caër-Lorho S, Acker A, Guseva Canu I. Impact of chemical exposure on cancer mortality in a French cohort of uranium processing workers. Am J Ind Med 2013; 56:1262-71. [PMID: 24009194 DOI: 10.1002/ajim.22231] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/02/2013] [Indexed: 01/31/2023]
Abstract
BACKGROUND Nuclear workers may be exposed to a variety of chemical hazards, in addition to radiation. We examined the effect of chemical exposures on cancer mortality among French uranium processing workers at the AREVA NC Pierrelatte facility. METHODS A cohort of 2,897 uranium processing workers employed for at least 6 months was followed from 1968 through 2006. Exposure to uranium and potentially carcinogenic chemicals was assessed with a plant-specific job-exposure matrix. Mortality hazard ratios (HRs) for cancers of the lung, lymphohematopoietic system, kidney and bladder, brain and central nervous system (BCNS), and prostate were estimated for each specific chemical exposure, with Cox regression models stratified for sex and calendar period and adjusted for socioeconomic status. Additional adjustments enabled us to examine the effect of co-exposure to uranium and other chemicals. RESULTS Exposure to aromatic solvents was associated with increased risk of BCNS malignancies after adjustment for other chemicals (HR=6.53, 95% CI=1.14-37.41; n=6) and for other chemicals and uranium (HR=7.26, 95% CI=0.90-58.19) in the annual exposure status model. Selected groups of lymphohematopoietic cancers were found associated with solvent exposure. Inconclusive results were found regarding chromium (VI) exposure, since only 2 workers died from lung cancer among 109 exposed. CONCLUSION Based on our pilot study, it seemed important to take into account chemical exposures in the analyses of cancer mortality among French uranium processing workers.
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Affiliation(s)
- Sergey Zhivin
- Laboratoire d'Epidémioloeie; Institut de Radioprotection et de Sûreté Nucléaire (IRSN); Fontenay-aux-Roses; France
| | - Dominique Laurier
- Laboratoire d'Epidémioloeie; Institut de Radioprotection et de Sûreté Nucléaire (IRSN); Fontenay-aux-Roses; France
| | - Sylvaine Caër-Lorho
- Laboratoire d'Epidémioloeie; Institut de Radioprotection et de Sûreté Nucléaire (IRSN); Fontenay-aux-Roses; France
| | - Alain Acker
- AREVA Group; Medical Coordination Section; Paris; France
| | - Irina Guseva Canu
- Laboratoire d'Epidémioloeie; Institut de Radioprotection et de Sûreté Nucléaire (IRSN); Fontenay-aux-Roses; France
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Guseva Canu I, Faust S, Knieczak E, Carles M, Samson E, Laurier D. Estimating historic exposures at the European Gaseous Diffusion plants. Int J Hyg Environ Health 2013; 216:499-507. [DOI: 10.1016/j.ijheh.2012.07.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2012] [Revised: 07/05/2012] [Accepted: 07/17/2012] [Indexed: 10/27/2022]
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Schubauer-Berigan MK, Hein MJ, Raudabaugh WM, Ruder AM, Silver SR, Spaeth S, Steenland K, Petersen MR, Waters KM. Update of the NIOSH life table analysis system: a person-years analysis program for the windows computing environment. Am J Ind Med 2011; 54:915-24. [PMID: 22068723 DOI: 10.1002/ajim.20999] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2011] [Indexed: 11/09/2022]
Abstract
BACKGROUND Person-years analysis is a fundamental tool of occupational epidemiology. A life table analysis system (LTAS), previously developed by the National Institute for Occupational Safety and Health, was limited by its platform and analysis and reporting capabilities. We describe the updating of LTAS for the Windows operating system (LTAS.NET) with improved properties. SOFTWARE DEVELOPMENT PROCESS A group of epidemiologists, programmers, and statisticians developed software, platform, and computing requirements. Statistical methods include the use of (indirectly) standardized mortality ratios, (directly) standardized rate ratios, confidence intervals, and P values based on the normal approximation and exact Poisson methods, and a trend estimator for linear exposure-response associations. SOFTWARE FEATURES We show examples using LTAS.NET to stratify and analyze multiple fixed and time-dependent variables. Data import, stratification, and reporting options are highly flexible. Users may export stratified data for Poisson regression modeling. CONCLUSIONS LTAS.NET incorporates improvements that will facilitate more complex person-years analysis of occupational cohort data.
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Affiliation(s)
- Mary K Schubauer-Berigan
- Division of Surveillance, Hazard Evaluations, and Field Studies, Industrywide Studies Branch, National Institute for Occupational Safety and Health, Cincinnati, Ohio 45226, USA.
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Guseva Canu I, Jacob S, Cardis E, Wild P, Caër S, Auriol B, Garsi JP, Tirmarche M, Laurier D. 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] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2010] [Accepted: 08/13/2011] [Indexed: 10/17/2022]
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Bahr DE, Aldrich TE, Seidu D, Brion GM, Tollerud DJ, Muldoon S, Reinhart N, Youseefagha A, McKinney P, Hughes T, Chan C, Rice C, Brewer DE, Freyberg RW, Mohlenkamp AM, Hahn K, Hornung R, Ho M, Dastidar A, Freitas S, Saman D, Ravdal H, Scutchfield D, Eger KJ, Minor S. Occupational exposure to trichloroethylene and cancer risk for workers at the Paducah Gaseous Diffusion Plant. Int J Occup Med Environ Health 2011; 24:67-77. [PMID: 21468904 PMCID: PMC5053621 DOI: 10.2478/s13382-011-0007-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2010] [Accepted: 12/01/2010] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE The Paducah Gaseous Diffusion Plant (PGDP) became operational in 1952; it is located in the western part of Kentucky. We conducted a mortality study for adverse health effects that workers may have suffered while working at the plant, including exposures to chemicals. MATERIALS AND METHODS We studied a cohort of 6820 workers at the PGDP for the period 1953 to 2003; there were a total of 1672 deaths to cohort members. Trichloroethylene (TCE) is a specific concern for this workforce; exposure to TCE occurred primarily in departments that clean the process equipment. The Life Table Analysis System (LTAS) program developed by NIOSH was used to calculate the standardized mortality ratios for the worker cohort and standardized rate ratio relative to exposure to TCE (the U.S. population is the referent for ageadjustment). LTAS calculated a significantly low overall SMR for these workers of 0.76 (95% CI: 0.72-0.79). A further review of three major cancers of interest to Kentucky produced significantly low SMR for trachea, bronchus, lung cancer (0.75, 95% CI: 0.72-0.79) and high SMR for Non-Hodgkin's lymphoma (NHL) (1.49, 95% CI: 1.02-2.10). RESULTS No significant SMR was observed for leukemia and no significant SRRs were observed for any disease. Both the leukemia and lung cancer results were examined and determined to reflect regional mortality patterns. However, the Non-Hodgkin's Lymphoma finding suggests a curious amplification when living cases are included with the mortality experience. CONCLUSIONS Further examination is recommended of this recurrent finding from all three U.S. Gaseous Diffusion plants.
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Affiliation(s)
- Debra E Bahr
- College of Public Health, University of Kentucky, Lexington, KY, USA
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