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Kelly-Reif K, Bertke S, Daniels RD, Richardson DB, Schubauer-Berigan MK. Authors' response: Solid cancer mortality among US radiation workers. Int J Epidemiol 2023; 52:1994-1995. [PMID: 37741933 DOI: 10.1093/ije/dyad132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 09/14/2023] [Indexed: 09/25/2023] Open
Affiliation(s)
- Kaitlin Kelly-Reif
- National Institute for Occupational Safety and Health, Cincinnati, OH, USA
| | - Steven Bertke
- National Institute for Occupational Safety and Health, Cincinnati, OH, USA
| | - Robert D Daniels
- National Institute for Occupational Safety and Health, Cincinnati, OH, USA
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Richardson DB, Leuraud K, Laurier D, Gillies M, Haylock R, Kelly-Reif K, Bertke S, Daniels RD, Thierry-Chef I, Moissonnier M, Kesminiene A, Schubauer-Berigan MK. Cancer mortality after low dose exposure to ionising radiation in workers in France, the United Kingdom, and the United States (INWORKS): cohort study. BMJ 2023; 382:e074520. [PMID: 37586731 PMCID: PMC10427997 DOI: 10.1136/bmj-2022-074520] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/26/2023] [Indexed: 08/18/2023]
Abstract
OBJECTIVE To evaluate the effect of protracted low dose, low dose rate exposure to ionising radiation on the risk of cancer. DESIGN Multinational cohort study. SETTING Cohorts of workers in the nuclear industry in France, the UK, and the US included in a major update to the International Nuclear Workers Study (INWORKS). PARTICIPANTS 309 932 workers with individual monitoring data for external exposure to ionising radiation and a total follow-up of 10.7 million person years. MAIN OUTCOME MEASURES Estimates of excess relative rate per gray (Gy) of radiation dose for mortality from cancer. RESULTS The study included 103 553 deaths, of which 28 089 were due to solid cancers. The estimated rate of mortality due to solid cancer increased with cumulative dose by 52% (90% confidence interval 27% to 77%) per Gy, lagged by 10 years. Restricting the analysis to the low cumulative dose range (0-100 mGy) approximately doubled the estimate of association (and increased the width of its confidence interval), as did restricting the analysis to workers hired in the more recent years of operations when estimates of occupational external penetrating radiation dose were recorded more accurately. Exclusion of deaths from lung cancer and pleural cancer had a modest effect on the estimated magnitude of association, providing indirect evidence that the association was not substantially confounded by smoking or occupational exposure to asbestos. CONCLUSIONS This major update to INWORKS provides a direct estimate of the association between protracted low dose exposure to ionising radiation and solid cancer mortality based on some of the world's most informative cohorts of radiation workers. The summary estimate of excess relative rate solid cancer mortality per Gy is larger than estimates currently informing radiation protection, and some evidence suggests a steeper slope for the dose-response association in the low dose range than over the full dose range. These results can help to strengthen radiation protection, especially for low dose exposures that are of primary interest in contemporary medical, occupational, and environmental settings.
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Affiliation(s)
- David B Richardson
- Department of Environmental and Occupational Health, Program in Public Health, University of California, Irvine, CA, USA
| | - Klervi Leuraud
- Institut de Radioprotection et de Sûreté Nucléaire (IRSN), Fontenay-aux-Roses, France
| | - Dominique Laurier
- Institut de Radioprotection et de Sûreté Nucléaire (IRSN), Fontenay-aux-Roses, France
| | | | | | - Kaitlin Kelly-Reif
- National Institute for Occupational Safety and Health, Cincinnati, OH, USA
| | - Stephen Bertke
- National Institute for Occupational Safety and Health, Cincinnati, OH, USA
| | - Robert D Daniels
- National Institute for Occupational Safety and Health, Cincinnati, OH, USA
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Kelly-Reif K, Bertke S, Daniels RD, Richardson DB, Schubauer-Berigan MK. Ionizing radiation and solid cancer mortality among US nuclear facility workers. Int J Epidemiol 2023; 52:1015-1024. [PMID: 37253388 PMCID: PMC10527884 DOI: 10.1093/ije/dyad075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 12/12/2022] [Accepted: 05/10/2023] [Indexed: 06/01/2023] Open
Abstract
BACKGROUND The risk of solid cancers from low-level protracted ionizing radiation is not well characterized. Nuclear workers provide valuable information on the effects of ionizing radiation in contemporary exposure scenarios relevant to workers and the public. METHODS We evaluated the association between penetrating ionizing radiation exposure and solid cancer mortality among a pooled cohort of nuclear workers in the USA, with extended follow-up to examine cancers with long latencies. This analysis includes 101 363 workers from five nuclear facilities, with 12 069 solid cancer deaths between 1944 and 2016. The association between cumulative equivalent dose measured in sieverts (Sv) and solid cancer subtypes were modelled as the excess relative rate per Sv (ERR Sv-1) using Cox regression. RESULTS For the association between ionizing radiation exposure and all solid cancer mortality we observed an elevated rate (ERR Sv-1=0.19; 95% CI: -0.10, 0.52), which was higher among a contemporary sub-cohort of workers first hired in 1960 or later (ERR Sv-1= 2.23; 95% CI: 1.13, 3.49). Similarly, we observed an elevated rate for lung cancer mortality (ERR Sv-1= 0.65; 95% CI: 0.09, 1.30) that was higher among contemporary hires (ERR Sv-1= 2.90; 95% CI: 1.00, 5.26). CONCLUSIONS Although concerns remain about confounding, measurement error and precision, this analysis strengthens the evidence base indicating there are radiogenic risks for several solid cancer types.
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Affiliation(s)
- Kaitlin Kelly-Reif
- National Institute for Occupational Safety and Health, Cincinnati, OH, USA
| | - Steven Bertke
- National Institute for Occupational Safety and Health, Cincinnati, OH, USA
| | - Robert D Daniels
- National Institute for Occupational Safety and Health, Cincinnati, OH, USA
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DeBono NL, Daniels RD, Beane Freeman LE, Graber JM, Hansen J, Teras LR, Driscoll T, Kjaerheim K, Demers PA, Glass DC, Kriebel D, Kirkham TL, Wedekind R, Filho AM, Stayner L, Schubauer-Berigan MK. Firefighting and Cancer: A Meta-analysis of Cohort Studies in the Context of Cancer Hazard Identification. Saf Health Work 2023; 14:141-152. [PMID: 37389311 PMCID: PMC10300491 DOI: 10.1016/j.shaw.2023.02.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 02/22/2023] [Accepted: 02/27/2023] [Indexed: 03/08/2023] Open
Abstract
Objective We performed a meta-analysis of epidemiological results for the association between occupational exposure as a firefighter and cancer as part of the broader evidence synthesis work of the IARCMonographs program. Methods A systematic literature search was conducted to identify cohort studies of firefighters followed for cancer incidence and mortality. Studies were evaluated for the influence of key biases on results. Random-effects meta-analysis models were used to estimate the association between ever-employment and duration of employment as a firefighter and risk of 12 selected cancers. The impact of bias was explored in sensitivity analyses. Results Among the 16 included cancer incidence studies, the estimated meta-rate ratio, 95% confidence interval (CI), and heterogeneity statistic (I2) for ever-employment as a career firefighter compared mostly to general populations were 1.58 (1.14-2.20, 8%) for mesothelioma, 1.16 (1.08-1.26, 0%) for bladder cancer, 1.21 (1.12-1.32, 81%) for prostate cancer, 1.37 (1.03-1.82, 56%) for testicular cancer, 1.19 (1.07-1.32, 37%) for colon cancer, 1.36 (1.15-1.62, 83%) for melanoma, 1.12 (1.01-1.25, 0%) for non-Hodgkin lymphoma, 1.28 (1.02-1.61, 40%) for thyroid cancer, and 1.09 (0.92-1.29, 55%) for kidney cancer. Ever-employment as a firefighter was not positively associated with lung, nervous system, or stomach cancer. Results for mesothelioma and bladder cancer exhibited low heterogeneity and were largely robust across sensitivity analyses. Conclusions There is epidemiological evidence to support a causal relationship between occupational exposure as a firefighter and certain cancers. Challenges persist in the body of evidence related to the quality of exposure assessment, confounding, and medical surveillance bias.
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Affiliation(s)
- Nathan L. DeBono
- Evidence Synthesis and Classification Branch, International Agency for Research on Cancer, Lyon, France
| | - Robert D. Daniels
- National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Cincinnati, USA
| | - Laura E. Beane Freeman
- Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, USA
| | - Judith M. Graber
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, USA
| | - Johnni Hansen
- Danish Cancer Society Research Centre, Copenhagen, Denmark
| | | | - Tim Driscoll
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | | | - Paul A. Demers
- Occupational Cancer Research Centre, Ontario Health, Toronto, Canada
| | - Deborah C. Glass
- School of Epidemiology and Preventative Medicine, Monash University, Melbourne, Australia
| | - David Kriebel
- Lowell Center for Sustainable Production, University of Massachusetts Lowell, Lowell, USA
| | - Tracy L. Kirkham
- Occupational Cancer Research Centre, Ontario Health, Toronto, Canada
| | - Roland Wedekind
- Evidence Synthesis and Classification Branch, International Agency for Research on Cancer, Lyon, France
| | - Adalberto M. Filho
- Evidence Synthesis and Classification Branch, International Agency for Research on Cancer, Lyon, France
| | - Leslie Stayner
- Evidence Synthesis and Classification Branch, International Agency for Research on Cancer, Lyon, France
- University of Illinois at Chicago, School of Public Health, Division of Epidemiology and Biostatistics
| | - Mary K. Schubauer-Berigan
- Evidence Synthesis and Classification Branch, International Agency for Research on Cancer, Lyon, France
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Singh A, Zeig-Owens R, Cannon M, Webber MP, Goldfarb DG, Daniels RD, Prezant DJ, Boffetta P, Hall CB. All-cause and cause-specific mortality in a cohort of WTC-exposed and non-WTC-exposed firefighters. Occup Environ Med 2023; 80:297-303. [PMID: 36972975 PMCID: PMC10523283 DOI: 10.1136/oemed-2022-108703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 10/17/2022] [Accepted: 03/10/2023] [Indexed: 03/29/2023]
Abstract
OBJECTIVE To compare mortality rates in World Trade Center (WTC)-exposed Fire Department of the City of New York (FDNY) firefighters with rates in similarly healthy, non-WTC-exposed/non-FDNY firefighters, and compare mortality in each firefighter cohort with the general population. METHODS 10 786 male WTC-exposed FDNY firefighters and 8813 male non-WTC-exposed firefighters from other urban fire departments who were employed on 11 September 2001 were included in the analyses. Only WTC-exposed firefighters received health monitoring via the WTC Health Programme (WTCHP). Follow-up began 11 September 2001 and ended at the earlier of death date or 31 December 2016. Death data were obtained from the National Death Index and demographics from the fire departments. We estimated standardised mortality ratios (SMRs) in each firefighter cohort versus US males using demographic-specific US mortality rates. Poisson regression models estimated relative rates (RRs) of all-cause and cause-specific mortality in WTC-exposed versus non-WTC-exposed firefighters, controlling for age and race. RESULTS Between 11 September 2001 and 31 December 2016, there were 261 deaths among WTC-exposed firefighters and 605 among non-WTC-exposed. Both cohorts had reduced all-cause mortality compared with US males (SMR (95% CI)=0.30 (0.26 to 0.34) and 0.60 (0.55 to 0.65) in WTC-exposed and non-WTC-exposed, respectively). WTC-exposed firefighters also had lower rates of all-cause mortality (RR=0.54, 95% CI=0.49 to 0.59) and cancer-specific, cardiovascular-specific and respiratory disease-specific mortality compared with non-WTC-exposed firefighters. CONCLUSION Both firefighter cohorts had lower than expected all-cause mortality. Fifteen years post 11 September 2001, mortality was lower in WTC-exposed versus non-WTC-exposed firefighters. Lower mortality in the WTC-exposed suggests not just a healthy worker effect, but additional factors such as greater access to free health monitoring and treatment that they receive via the WTCHP.
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Affiliation(s)
- Ankura Singh
- Bureau of Health Services, Fire Department of the City of New York, Brooklyn, New York, USA
- Department of Medicine, Montefiore Medical Center, Bronx, New York, USA
| | - Rachel Zeig-Owens
- Bureau of Health Services, Fire Department of the City of New York, Brooklyn, New York, USA
- Department of Medicine, Montefiore Medical Center, Bronx, New York, USA
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Madeline Cannon
- Bureau of Health Services, Fire Department of the City of New York, Brooklyn, New York, USA
- Department of Medicine, Montefiore Medical Center, Bronx, New York, USA
| | - Mayris P Webber
- Bureau of Health Services, Fire Department of the City of New York, Brooklyn, New York, USA
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - David G Goldfarb
- Bureau of Health Services, Fire Department of the City of New York, Brooklyn, New York, USA
- Department of Medicine, Montefiore Medical Center, Bronx, New York, USA
| | - Robert D Daniels
- Division of Science integration, National Institute for Occupational Safety and Health, Cincinnati, Ohio, USA
| | - David J Prezant
- Bureau of Health Services, Fire Department of the City of New York, Brooklyn, New York, USA
- Department of Medicine, Montefiore Medical Center, Bronx, New York, USA
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Paolo Boffetta
- Stony Brook Cancer Center, Stony Brook University, Stony Brook, New York, USA
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Charles B Hall
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
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6
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Pinkerton LE, Bertke S, Dahm MM, Kubale TL, Siegel MR, Hales TR, Yiin JH, Purdue MP, Beaumont JJ, Daniels RD. End-stage renal disease incidence in a cohort of US firefighters from San Francisco, Chicago, and Philadelphia. Am J Ind Med 2022; 65:975-984. [PMID: 36268894 PMCID: PMC9828160 DOI: 10.1002/ajim.23435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 09/29/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Firefighters perform strenuous work in hot environments, which may increase their risk of chronic kidney disease. The purpose of this study was to evaluate the risk of end-stage renal disease (ESRD) and types of ESRD among a cohort of US firefighters compared to the US general population, and to examine exposure-response relationships. METHODS ESRD from 1977 through 2014 was identified through linkage with Medicare data. ESRD incidence in the cohort compared to the US population was evaluated using life table analyses. Associations of all ESRD, systemic ESRD, hypertensive ESRD, and diabetic ESRD with exposure surrogates (exposed days, fire runs, and fire hours) were examined in Cox proportional hazards models adjusted for attained age (the time scale), race, birth date, fire department, and employment duration. RESULTS The incidence of all ESRD was less than expected (standardized incidence ratio (SIR) = 0.79; 95% confidence interval = 0.69-0.89, observed = 247). SIRs for ESRD types were not significantly increased. Positive associations of all ESRD, systemic ESRD, and hypertensive ESRD with exposed days were observed: however, 95% confidence intervals included one. CONCLUSIONS We found little evidence of increased risk of ESRD among this cohort of firefighters. Limitations included the inability to evaluate exposure-response relationships for some ESRD types due to small observed numbers, the limitations of the surrogates of exposure, and the lack of information on more sensitive outcome measures for potential kidney effects.
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Affiliation(s)
- Lynne E. Pinkerton
- MaximusMcLeanVirginiaUSA,Division of Field Studies and EngineeringNational Institute for Occupational Safety and HealthCincinnatiOhioUSA
| | - Stephen Bertke
- Division of Field Studies and EngineeringNational Institute for Occupational Safety and HealthCincinnatiOhioUSA
| | - Matthew M. Dahm
- Division of Field Studies and EngineeringNational Institute for Occupational Safety and HealthCincinnatiOhioUSA
| | - Travis L. Kubale
- World Trade Center Health ProgramNational Institute for Occupational Safety and HealthWashingtonDistrict of ColumbiaUSA
| | - Miriam R. Siegel
- Division of Field Studies and EngineeringNational Institute for Occupational Safety and HealthCincinnatiOhioUSA
| | - Thomas R. Hales
- Division of Safety ResearchNational Institute for Occupational Safety and HealthDenverColoradoUSA
| | - James H. Yiin
- Office of Extramural ProgramsNational Institute for Occupational Safety and HealthAtlantaGeorgiaUSA
| | - Mark P. Purdue
- Division of Cancer Epidemiology and GeneticsNational Cancer InstituteRockvilleMarylandUSA
| | - James J. Beaumont
- Department of Public Health SciencesUniversity of California DavisDavisCaliforniaUSA
| | - Robert D. Daniels
- World Trade Center Health ProgramNational Institute for Occupational Safety and HealthWashingtonDistrict of ColumbiaUSA
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7
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Kelly-Reif K, Bertke S, Daniels RD, Richardson DB, Schubauer-Berigan MK. Nonmalignant respiratory disease mortality in male Colorado Plateau uranium miners, 1960-2016. Am J Ind Med 2022; 65:773-782. [PMID: 35941829 PMCID: PMC10031748 DOI: 10.1002/ajim.23419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 04/08/2022] [Revised: 07/17/2022] [Accepted: 07/20/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND To evaluate trends of nonmalignant respiratory disease (NMRD) mortality among US underground uranium miners on the Colorado Plateau, and to estimate the exposure-response association between cumulative radon progeny exposure and NMRD subtype mortality. METHODS Standardized mortality ratios (SMRs) and excess relative rates per 100 working level months (excess relative rate [ERR]/100 WLM) were estimated in a cohort of 4021 male underground uranium miners who were followed from 1960 through 2016. RESULTS We observed elevated SMRs for all NMRD subtypes. Silicosis had the largest SMR (n = 52, SMR = 41.4; 95% confidence interval [CI]: 30.9, 54.3), followed by other pneumoconiosis (n = 49, SMR = 39.6; 95% CI: 29.6, 52.3) and idiopathic pulmonary fibrosis (IPF) (n = 64, SMR = 4.77; 95% CI 3.67, 6.09). SMRs for silicosis increased with duration of employment; SMRs for IPF increased with duration of employment and calendar period. There was a positive association between cumulative radon exposure and silicosis with evidence of modification by smoking (ERR/100 WLM≥10 pack-years = 0.78; 95% CI: 0.05, 24.6 and ERR/100 WLM<10 pack-years = 0.01; 95% CI: -0.03, 0.52), as well as a small positive association between radon and IPF (ERR/100 WLM = 0.06, 95% CI: 0.00, 0.24); these associations were driven by workers with prior employment in hard rock mining. CONCLUSIONS Uranium mining workers had excess NMRD mortality compared with the general population; this excess persisted throughout follow-up. Exposure-response analyses indicated a positive association between radon exposure and IPF and silicosis, but these analyses have limitations due to outcome misclassification and missing information on occupational co-exposures such as silica dust.
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Affiliation(s)
- Kaitlin Kelly-Reif
- National Institute for Occupational Safety and Health, Cincinnati, OH, USA
| | - Stephen Bertke
- National Institute for Occupational Safety and Health, Cincinnati, OH, USA
| | - Robert D Daniels
- National Institute for Occupational Safety and Health, Cincinnati, OH, USA
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Brackbill RM, Butturini E, Cone JE, Ahmadi A, Daniels RD, Farfel MR, Kubale T. Scientific Value of the Sub-Cohort of Children in the World Trade Center Health Registry. Int J Environ Res Public Health 2022; 19:12461. [PMID: 36231761 PMCID: PMC9564973 DOI: 10.3390/ijerph191912461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 09/22/2022] [Accepted: 09/25/2022] [Indexed: 06/16/2023]
Abstract
The World Trade Center Health Registry (WTCHR) was established in 2002 as a public health resource to monitor the health effects from the World Trade Center (WTC) disaster. We evaluated the representativeness of the WTC youth population (<18 years on 11 September 2001) by comparing the distributions of age, gender, race/ethnic groups, and income to 2000 census data for the matched geographic area, including distance from disaster. There were 2379 WTCHR enrolled children living in Lower Manhattan south of Canal Street on 11 September 2001, along with 752 enrolled students who attended school in Lower Manhattan but were not area residents. The WTCHR sub-group of children who were residents was similar to the geographically corresponding census population on age and sex. Black and Hispanic children are moderately overrepresented at 0.9% and 2.4% in the WTCHR compared to 0.8% and 1.7% in census population, respectively, while lower-income households are slightly under-represented, 28.8% in the WTCHR and 30.8% for the corresponding census information. Asian children appear underrepresented at 3.0% participation compared to 6.3% in the census. While the demographics of WTCHR youth are somewhat skewed, the gaps are within expected patterns of under-representation observed in other longitudinal cohorts and can be effectively addressed analytically or through targeted study design.
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Affiliation(s)
- Robert M. Brackbill
- World Trade Center Health Registry, Division of Epidemiology, New York City Department of Health and Mental Hygiene, New York, NY 11101, USA
| | - Emma Butturini
- World Trade Center Health Program Division, National Institute for Occupational Safety and Health, U.S. Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
| | - James E. Cone
- World Trade Center Health Registry, Division of Epidemiology, New York City Department of Health and Mental Hygiene, New York, NY 11101, USA
| | - Ayda Ahmadi
- World Trade Center Health Registry, Division of Epidemiology, New York City Department of Health and Mental Hygiene, New York, NY 11101, USA
| | - Robert D. Daniels
- World Trade Center Health Program Division, National Institute for Occupational Safety and Health, U.S. Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
| | - Mark R. Farfel
- World Trade Center Health Registry, Division of Epidemiology, New York City Department of Health and Mental Hygiene, New York, NY 11101, USA
| | - Travis Kubale
- World Trade Center Health Program Division, National Institute for Occupational Safety and Health, U.S. Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
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Demers PA, DeMarini DM, Fent KW, Glass DC, Hansen J, Adetona O, Andersen MH, Freeman LEB, Caban-Martinez AJ, Daniels RD, Driscoll TR, Goodrich JM, Graber JM, Kirkham TL, Kjaerheim K, Kriebel D, Long AS, Main LC, Oliveira M, Peters S, Teras LR, Watkins ER, Burgess JL, Stec AA, White PA, DeBono NL, Benbrahim-Tallaa L, de Conti A, El Ghissassi F, Grosse Y, Stayner LT, Suonio E, Viegas S, Wedekind R, Boucheron P, Hosseini B, Kim J, Zahed H, Mattock H, Madia F, Schubauer-Berigan MK. Carcinogenicity of occupational exposure as a firefighter. Lancet Oncol 2022; 23:985-986. [PMID: 35780778 DOI: 10.1016/s1470-2045(22)00390-4] [Citation(s) in RCA: 45] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Paul A Demers
- International Agency for Research on Cancer, Lyon, France
| | | | - Kenneth W Fent
- International Agency for Research on Cancer, Lyon, France
| | | | - Johnni Hansen
- International Agency for Research on Cancer, Lyon, France
| | | | | | | | | | | | | | | | | | | | | | - David Kriebel
- International Agency for Research on Cancer, Lyon, France
| | | | - Luana C Main
- International Agency for Research on Cancer, Lyon, France
| | - Marta Oliveira
- International Agency for Research on Cancer, Lyon, France
| | - Susan Peters
- International Agency for Research on Cancer, Lyon, France
| | - Lauren R Teras
- International Agency for Research on Cancer, Lyon, France
| | | | | | - Anna A Stec
- International Agency for Research on Cancer, Lyon, France
| | - Paul A White
- International Agency for Research on Cancer, Lyon, France
| | | | | | - Aline de Conti
- International Agency for Research on Cancer, Lyon, France
| | | | - Yann Grosse
- International Agency for Research on Cancer, Lyon, France
| | | | - Eero Suonio
- International Agency for Research on Cancer, Lyon, France
| | - Susana Viegas
- International Agency for Research on Cancer, Lyon, France
| | | | | | - Bayan Hosseini
- International Agency for Research on Cancer, Lyon, France
| | - Joanne Kim
- International Agency for Research on Cancer, Lyon, France
| | - Hana Zahed
- International Agency for Research on Cancer, Lyon, France
| | - Heidi Mattock
- International Agency for Research on Cancer, Lyon, France
| | - Federica Madia
- International Agency for Research on Cancer, Lyon, France
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Daniels RD, Kubale TL, Reissman DB, Howard J. The World Trade Center Health Program: Twenty years of health effects research. Am J Ind Med 2021; 64:797-802. [PMID: 34558722 PMCID: PMC9631716 DOI: 10.1002/ajim.23273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 06/16/2021] [Accepted: 06/21/2021] [Indexed: 11/14/2022]
Abstract
It has been 20 years since the devastating terrorist attacks on September 11, 2001. Thousands were injured or killed during the attacks and many more are at risk of adverse health stemming from physical, psychological, and emotional stressors born out of the attacks. Private, federal, state, and local resources were gathered soon after the attacks to address impacts to the community, including the health and well-being of both responders and survivors. Many of these efforts are now largely consolidated under the federally mandated World Trade Center (WTC) Health Program. This program provides medical monitoring and treatment of qualifying conditions among the 9/11-exposed population and supports related physical and mental health research. In this commentary, we describe the WTC Health Program, with emphasis on the health-effects research it has funded since inception in 2011. We describe sentinel research publications, and how science has impacted the program. We provide examples relating studies in this special issue to important roles in the WTC Health Program research agenda. Finally, we provide a perspective on future research needs.
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Affiliation(s)
- Robert D. Daniels
- World Trade Center Health Program (WTCHP), Centers for Disease Control and Prevention (CDC) National Institute for Occupational Safety and Health (NIOSH) Washington District Columbia USA
| | - Travis L. Kubale
- World Trade Center Health Program (WTCHP), Centers for Disease Control and Prevention (CDC) National Institute for Occupational Safety and Health (NIOSH) Washington District Columbia USA
| | - Dori B. Reissman
- World Trade Center Health Program (WTCHP), Centers for Disease Control and Prevention (CDC) National Institute for Occupational Safety and Health (NIOSH) Washington District Columbia USA
| | - John Howard
- Office of the Director National Institute for Occupational Safety and Health (NIOSH) Washington District Columbia USA
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Webber MP, Singh A, Zeig-Owens R, Salako J, Skerker M, Hall CB, Goldfarb DG, Jaber N, Daniels RD, Prezant DJ. Cancer incidence in World Trade Center-exposed and non-exposed male firefighters, as compared with the US adult male population: 2001-2016. Occup Environ Med 2021; 78:707-714. [PMID: 34507965 PMCID: PMC8458058 DOI: 10.1136/oemed-2021-107570] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 06/29/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To compare cancer incidence in Fire Department of the City of New York (FDNY) firefighters who worked at the World Trade Center (WTC) site to incidence in a population of non-WTC-exposed firefighters, the Career Firefighter Health Study (CFHS) cohort, and to compare rates from each firefighter cohort to rates in demographically similar US males. METHODS FDNY (N=10 786) and CFHS (N=8813) cohorts included male firefighters who were active on 11 September 2001 (9/11) and were followed until death or 31 December 2016. Cases were identified from 15 state cancer registries. Poisson regression models assessed cancers in each group (FDNY and CFHS) versus US males, and associations between group and cancer rates; these models estimated standardised incidence ratios (SIRs) and adjusted relative rates (RRs), respectively. Secondary analyses assessed surveillance bias and smoking history. RESULTS We identified 915 cancer cases in 841 FDNY firefighters and 1002 cases in 909 CFHS firefighters. FDNY had: higher rates for all cancers (RR=1.13; 95% CI 1.02 to 1.25), prostate (RR=1.39; 95% CI 1.19 to 1.63) and thyroid cancer (RR=2.53; 95% CI 1.37 to 4.70); younger median ages at diagnosis (55.6 vs 59.4; p<0.001, all cancers); and more cases with localised disease when compared with CFHS. Compared with US males, both firefighter cohorts had elevated SIRs for prostate cancer and melanoma. Control for surveillance bias in FDNY reduced most differences. CONCLUSIONS Excess cancers occurred in WTC-exposed firefighters relative to each comparison group, which may partially be explained by heightened surveillance. Two decades post-9/11, clearer understanding of WTC-related risk requires extended follow-up and modelling studies (laboratory or animal based) to identify workplace exposures in all firefighters.
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Affiliation(s)
- Mayris P Webber
- Division of Epidemiology, Department of Epidemiology and Population Health, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA
- Bureau of Health Services, Fire Department of the City of New York, Brooklyn, New York, USA
| | - Ankura Singh
- Bureau of Health Services, Fire Department of the City of New York, Brooklyn, New York, USA
- Pulmonary Medicine Division, Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA
| | - Rachel Zeig-Owens
- Division of Epidemiology, Department of Epidemiology and Population Health, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA
- Bureau of Health Services, Fire Department of the City of New York, Brooklyn, New York, USA
- Pulmonary Medicine Division, Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA
| | - Joke Salako
- Bureau of Health Services, Fire Department of the City of New York, Brooklyn, New York, USA
- Pulmonary Medicine Division, Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA
| | - Molly Skerker
- Bureau of Health Services, Fire Department of the City of New York, Brooklyn, New York, USA
- Pulmonary Medicine Division, Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA
| | - Charles B Hall
- Division of Biostatistics, Department of Epidemiology and Population Health, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA
| | - David G Goldfarb
- Bureau of Health Services, Fire Department of the City of New York, Brooklyn, New York, USA
- Pulmonary Medicine Division, Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA
| | - Nadia Jaber
- Bureau of Health Services, Fire Department of the City of New York, Brooklyn, New York, USA
| | - Robert D Daniels
- World Trade Center Health Program, Centers for Disease Control and Prevention (CDC), National Institute for Occupational Safety and Health (NIOSH), Cincinnati, Ohio, USA
| | - David J Prezant
- Division of Epidemiology, Department of Epidemiology and Population Health, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA
- Bureau of Health Services, Fire Department of the City of New York, Brooklyn, New York, USA
- Pulmonary Medicine Division, Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA
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12
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Daniels RD, Carreón T, Bilics JA, Reissman DB, Howard J. The World Trade Center Health Program: Petitions for adding qualifying health conditions. Am J Ind Med 2021; 64:885-892. [PMID: 34128231 PMCID: PMC8518601 DOI: 10.1002/ajim.23267] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 05/25/2021] [Accepted: 05/27/2021] [Indexed: 12/21/2022]
Abstract
The federally mandated World Trade Center Health Program provides limited health benefits for qualifying health conditions related to the 9/11 terrorist attacks. A qualifying health condition is an illness or health condition for which the member's exposure to airborne toxins, any other hazard, or any other adverse condition resulting from the 9/11 terrorist attacks is considered substantially likely to be a significant factor in aggravating, contributing to, or causing the illness or health condition. These qualifying health conditions are listed in federal regulations. The regulations also provide a process for amending this list. This commentary describes the methods developed for adding health conditions to the list of qualifying health conditions and discusses changes to the list that have occurred during the Program's 2011-2020 period.
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Affiliation(s)
- Robert D. Daniels
- World Trade Center Health Program (WTCHP), Centers for Disease Control and Prevention (CDC), National Institute for Occupational Safety and Health (NIOSH) Washington DC USA
| | - Tania Carreón
- World Trade Center Health Program (WTCHP), Centers for Disease Control and Prevention (CDC), National Institute for Occupational Safety and Health (NIOSH) Washington DC USA
| | - Jessica A. Bilics
- World Trade Center Health Program (WTCHP), Centers for Disease Control and Prevention (CDC), National Institute for Occupational Safety and Health (NIOSH) Washington DC USA
| | - Dori B. Reissman
- World Trade Center Health Program (WTCHP), Centers for Disease Control and Prevention (CDC), National Institute for Occupational Safety and Health (NIOSH) Washington DC USA
| | - John Howard
- National Institute for Occupational Safety and Health (NIOSH) Washington DC USA
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13
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Bertke SJ, Keil AP, Daniels RD. Lung Cancer Mortality and Styrene Exposure in the Reinforced-Plastics Boatbuilding Industry: Evaluation of Healthy Worker Survivor Bias. Am J Epidemiol 2021; 190:1784-1792. [PMID: 33847736 DOI: 10.1093/aje/kwab108] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 04/09/2021] [Accepted: 04/09/2021] [Indexed: 11/15/2022] Open
Abstract
The evidence for styrene's being a human lung carcinogen has been inconclusive. Occupational cohorts within the reinforced-plastics industry are an ideal population in which to study this association because of their relatively high levels of exposure to styrene and lack of concomitant exposures to other known carcinogens. However, healthy worker survivor bias (HWSB), where healthier workers stay employed longer and thus have higher exposure potential, is a likely source of confounding bias for exposure-response associations, in part due to styrene's acute effects. Through December 31, 2016, we studied a cohort of 5,163 boatbuilders exposed to styrene in Washington State who were employed between 1959 and 1978; prior regression analyses had demonstrated little evidence for an exposure-response relationship between styrene exposure and lung cancer mortality. Based on estimates of necessary components of HWSB, we found evidence for a potentially large HWSB. Using g-estimation of a structural nested model to account for HWSB, we estimated that 1 year of styrene exposure at more than 30 parts per million accelerated time to lung cancer death by 2.29 years (95% confidence interval: 1.53, 2.94). Our results suggest possibly strong HWSB in our small cohort and indicate that large, influential studies of styrene-exposed workers may suffer from similar biases, warranting a reassessment of the evidence of long-term health effects of styrene exposure.
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14
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Leuraud K, Richardson DB, Cardis E, Daniels RD, Gillies M, Haylock R, Moissonnier M, Schubauer-Berigan MK, Thierry-Chef I, Kesminiene A, Laurier D. Risk of cancer associated with low-dose radiation exposure: comparison of results between the INWORKS nuclear workers study and the A-bomb survivors study. Radiat Environ Biophys 2021; 60:23-39. [PMID: 33479781 PMCID: PMC7902587 DOI: 10.1007/s00411-020-00890-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 12/19/2020] [Indexed: 05/21/2023]
Abstract
The Life Span Study (LSS) of Japanese atomic bomb survivors has served as the primary basis for estimates of radiation-related disease risks that inform radiation protection standards. The long-term follow-up of radiation-monitored nuclear workers provides estimates of radiation-cancer associations that complement findings from the LSS. Here, a comparison of radiation-cancer mortality risk estimates derived from the LSS and INWORKS, a large international nuclear worker study, is presented. Restrictions were made, so that the two study populations were similar with respect to ages and periods of exposure, leading to selection of 45,625 A-bomb survivors and 259,350 nuclear workers. For solid cancer, excess relative rates (ERR) per gray (Gy) were 0.28 (90% CI 0.18; 0.38) in the LSS, and 0.29 (90% CI 0.07; 0.53) in INWORKS. A joint analysis of the data allowed for a formal assessment of heterogeneity of the ERR per Gy across the two studies (P = 0.909), with minimal evidence of curvature or of a modifying effect of attained age, age at exposure, or sex in either study. There was evidence in both cohorts of modification of the excess absolute risk (EAR) of solid cancer by attained age, with a trend of increasing EAR per Gy with attained age. For leukemia, under a simple linear model, the ERR per Gy was 2.75 (90% CI 1.73; 4.21) in the LSS and 3.15 (90% CI 1.12; 5.72) in INWORKS, with evidence of curvature in the association across the range of dose observed in the LSS but not in INWORKS; the EAR per Gy was 3.54 (90% CI 2.30; 5.05) in the LSS and 2.03 (90% CI 0.36; 4.07) in INWORKS. These findings from different study populations may help understanding of radiation risks, with INWORKS contributing information derived from cohorts of workers with protracted low dose-rate exposures.
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Affiliation(s)
- Klervi Leuraud
- Institut de Radioprotection et de Sûreté Nucléaire (IRSN), Fontenay-aux-Roses, France.
| | - David B Richardson
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC, USA
| | - Elisabeth Cardis
- Center for Research in Environmental Epidemiology, Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- Ciber Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Robert D Daniels
- National Institute for Occupational Safety and Health (NIOSH), Cincinnati, OH, USA
| | - Michael Gillies
- Public Health England Centre for Radiation, Chemical and Environmental Hazards (PHE-CRCE), Chilton, UK
| | - Richard Haylock
- Public Health England Centre for Radiation, Chemical and Environmental Hazards (PHE-CRCE), Chilton, UK
| | | | | | - Isabelle Thierry-Chef
- Center for Research in Environmental Epidemiology, Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- Ciber Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | | | - Dominique Laurier
- Institut de Radioprotection et de Sûreté Nucléaire (IRSN), Fontenay-aux-Roses, France
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15
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Daniels RD, Clouston SAP, Hall CB, Anderson KR, Bennett DA, Bromet EJ, Calvert GM, Carreón T, DeKosky ST, Diminich ED, Finch CE, Gandy S, Kreisl WC, Kritikos M, Kubale TL, Mielke MM, Peskind ER, Raskind MA, Richards M, Sano M, Santiago-Colón A, Sloan RP, Spiro A, Vasdev N, Luft BJ, Reissman DB. A Workshop on Cognitive Aging and Impairment in the 9/11-Exposed Population. Int J Environ Res Public Health 2021; 18:E681. [PMID: 33466931 PMCID: PMC7830144 DOI: 10.3390/ijerph18020681] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 01/09/2021] [Accepted: 01/12/2021] [Indexed: 12/11/2022]
Abstract
The terrorist attacks on 11 September 2001 potentially exposed more than 400,000 responders, workers, and residents to psychological and physical stressors, and numerous hazardous pollutants. In 2011, the World Trade Center Health Program (WTCHP) was mandated to monitor and treat persons with 9/11-related adverse health conditions and conduct research on physical and mental health conditions related to the attacks. Emerging evidence suggests that persons exposed to 9/11 may be at increased risk of developing mild cognitive impairment. To investigate further, the WTCHP convened a scientific workshop that examined the natural history of cognitive aging and impairment, biomarkers in the pathway of neurodegenerative diseases, the neuropathological changes associated with hazardous exposures, and the evidence of cognitive decline and impairment in the 9/11-exposed population. Invited participants included scientists actively involved in health-effects research of 9/11-exposed persons and other at-risk populations. Attendees shared relevant research results from their respective programs and discussed several options for enhancements to research and surveillance activities, including the development of a multi-institutional collaborative research network. The goal of this report is to outline the meeting's agenda and provide an overview of the presentation materials and group discussion.
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Affiliation(s)
- Robert D. Daniels
- World Trade Center Health Program, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Washington, DC 20201, USA; (K.R.A.); (G.M.C.); (T.C.); (T.L.K.); (A.S.-C.); (D.B.R.)
| | - Sean A. P. Clouston
- Renaissance School of Medicine, Stony Brook University, Stony Brook, NY 11794, USA; (S.A.P.C.); (E.J.B.); (E.D.D.); (M.K.); (B.J.L.)
| | - Charles B. Hall
- Department of Epidemiology & Population Health (Biostatistics), Albert Einstein College of Medicine, Bronx, NY 10461, USA;
| | - Kristi R. Anderson
- World Trade Center Health Program, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Washington, DC 20201, USA; (K.R.A.); (G.M.C.); (T.C.); (T.L.K.); (A.S.-C.); (D.B.R.)
| | - David A. Bennett
- Department of Neurological Sciences, Rush Medical College, Rush University, Chicago, IL 60612, USA;
| | - Evelyn J. Bromet
- Renaissance School of Medicine, Stony Brook University, Stony Brook, NY 11794, USA; (S.A.P.C.); (E.J.B.); (E.D.D.); (M.K.); (B.J.L.)
| | - Geoffrey M. Calvert
- World Trade Center Health Program, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Washington, DC 20201, USA; (K.R.A.); (G.M.C.); (T.C.); (T.L.K.); (A.S.-C.); (D.B.R.)
| | - Tania Carreón
- World Trade Center Health Program, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Washington, DC 20201, USA; (K.R.A.); (G.M.C.); (T.C.); (T.L.K.); (A.S.-C.); (D.B.R.)
| | - Steven T. DeKosky
- McKnight Brain Institute, University of Florida, Gainesville, FL 32611, USA;
| | - Erica D. Diminich
- Renaissance School of Medicine, Stony Brook University, Stony Brook, NY 11794, USA; (S.A.P.C.); (E.J.B.); (E.D.D.); (M.K.); (B.J.L.)
| | - Caleb E. Finch
- USC Leonard Davis School of Gerontology, Los Angeles, CA 90089, USA;
| | - Sam Gandy
- Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (S.G.); (M.S.)
| | - William C. Kreisl
- Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, New York, NY 10032, USA;
| | - Minos Kritikos
- Renaissance School of Medicine, Stony Brook University, Stony Brook, NY 11794, USA; (S.A.P.C.); (E.J.B.); (E.D.D.); (M.K.); (B.J.L.)
| | - Travis L. Kubale
- World Trade Center Health Program, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Washington, DC 20201, USA; (K.R.A.); (G.M.C.); (T.C.); (T.L.K.); (A.S.-C.); (D.B.R.)
| | - Michelle M. Mielke
- Division of Epidemiology and Department of Neurology, Department of Health Sciences Research, Mayo Clinic, Rochester, MN 55905, USA;
| | - Elaine R. Peskind
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA 98195, USA;
| | - Murray A. Raskind
- Northwest Mental Illness Research, Education and Clinical Center (MIRECC), VA Puget Sound Health Care System, Seattle, WA 98108, USA;
| | - Marcus Richards
- Faculty of Population Health Sciences, University College London, London WC1E 6BT, UK;
| | - Mary Sano
- Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (S.G.); (M.S.)
| | - Albeliz Santiago-Colón
- World Trade Center Health Program, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Washington, DC 20201, USA; (K.R.A.); (G.M.C.); (T.C.); (T.L.K.); (A.S.-C.); (D.B.R.)
| | - Richard P. Sloan
- Division of Behavioral Medicine, Columbia University, New York, NY 10027, USA;
| | - Avron Spiro
- Boston University Schools of Public Health and Medicine and Veterans Affairs Boston Healthcare System, Boston, MA 02130, USA;
| | - Neil Vasdev
- Azrieli Centre for Neuro-Radiochemistry, Brain Health Imaging Centre, Centre for Addiction and Mental Health (CAMH) & Department of Psychiatry, University of Toronto, Toronto, ON M5S, Canada;
| | - Benjamin J. Luft
- Renaissance School of Medicine, Stony Brook University, Stony Brook, NY 11794, USA; (S.A.P.C.); (E.J.B.); (E.D.D.); (M.K.); (B.J.L.)
| | - Dori B. Reissman
- World Trade Center Health Program, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Washington, DC 20201, USA; (K.R.A.); (G.M.C.); (T.C.); (T.L.K.); (A.S.-C.); (D.B.R.)
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16
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Hauptmann M, Daniels RD, Cardis E, Cullings HM, Kendall G, Laurier D, Linet MS, Little MP, Lubin JH, Preston DL, Richardson DB, Stram DO, Thierry-Chef I, Schubauer-Berigan MK, Gilbert ES, Berrington de Gonzalez A. Epidemiological Studies of Low-Dose Ionizing Radiation and Cancer: Summary Bias Assessment and Meta-Analysis. J Natl Cancer Inst Monogr 2020; 2020:188-200. [PMID: 32657347 PMCID: PMC8454205 DOI: 10.1093/jncimonographs/lgaa010] [Citation(s) in RCA: 83] [Impact Index Per Article: 20.8] [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: 03/18/2020] [Accepted: 03/26/2020] [Indexed: 07/27/2023] Open
Abstract
BACKGROUND Ionizing radiation is an established carcinogen, but risks from low-dose exposures are controversial. Since the Biological Effects of Ionizing Radiation VII review of the epidemiological data in 2006, many subsequent publications have reported excess cancer risks from low-dose exposures. Our aim was to systematically review these studies to assess the magnitude of the risk and whether the positive findings could be explained by biases. METHODS Eligible studies had mean cumulative doses of less than 100 mGy, individualized dose estimates, risk estimates, and confidence intervals (CI) for the dose-response and were published in 2006-2017. We summarized the evidence for bias (dose error, confounding, outcome ascertainment) and its likely direction for each study. We tested whether the median excess relative risk (ERR) per unit dose equals zero and assessed the impact of excluding positive studies with potential bias away from the null. We performed a meta-analysis to quantify the ERR and assess consistency across studies for all solid cancers and leukemia. RESULTS Of the 26 eligible studies, 8 concerned environmental, 4 medical, and 14 occupational exposure. For solid cancers, 16 of 22 studies reported positive ERRs per unit dose, and we rejected the hypothesis that the median ERR equals zero (P = .03). After exclusion of 4 positive studies with potential positive bias, 12 of 18 studies reported positive ERRs per unit dose (P = .12). For leukemia, 17 of 20 studies were positive, and we rejected the hypothesis that the median ERR per unit dose equals zero (P = .001), also after exclusion of 5 positive studies with potential positive bias (P = .02). For adulthood exposure, the meta-ERR at 100 mGy was 0.029 (95% CI = 0.011 to 0.047) for solid cancers and 0.16 (95% CI = 0.07 to 0.25) for leukemia. For childhood exposure, the meta-ERR at 100 mGy for leukemia was 2.84 (95% CI = 0.37 to 5.32); there were only two eligible studies of all solid cancers. CONCLUSIONS Our systematic assessments in this monograph showed that these new epidemiological studies are characterized by several limitations, but only a few positive studies were potentially biased away from the null. After exclusion of these studies, the majority of studies still reported positive risk estimates. We therefore conclude that these new epidemiological studies directly support excess cancer risks from low-dose ionizing radiation. Furthermore, the magnitude of the cancer risks from these low-dose radiation exposures was statistically compatible with the radiation dose-related cancer risks of the atomic bomb survivors.
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Affiliation(s)
- Michael Hauptmann
- Correspondence to: Michael Hauptmann, Institute of Biostatistics and Registry Research, Brandenburg Medical School Theodor Fontane. Fehrbelliner Straße 38, 16816 Neuruppin, Germany (e-mail: )
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17
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Daniels RD, Kendall GM, Thierry-Chef I, Linet MS, Cullings HM. Strengths and Weaknesses of Dosimetry Used in Studies of Low-Dose Radiation Exposure and Cancer. J Natl Cancer Inst Monogr 2020; 2020:114-132. [PMID: 32657346 PMCID: PMC7667397 DOI: 10.1093/jncimonographs/lgaa001] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [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: 01/03/2020] [Accepted: 01/07/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND A monograph systematically evaluating recent evidence on the dose-response relationship between low-dose ionizing radiation exposure and cancer risk required a critical appraisal of dosimetry methods in 26 potentially informative studies. METHODS The relevant literature included studies published in 2006-2017. Studies comprised case-control and cohort designs examining populations predominantly exposed to sparsely ionizing radiation, mostly from external sources, resulting in average doses of no more than 100 mGy. At least two dosimetrists reviewed each study and appraised the strengths and weaknesses of the dosimetry systems used, including assessment of sources and effects of dose estimation error. An overarching concern was whether dose error might cause the spurious appearance of a dose-response where none was present. RESULTS The review included 8 environmental, 4 medical, and 14 occupational studies that varied in properties relative to evaluation criteria. Treatment of dose estimation error also varied among studies, although few conducted a comprehensive evaluation. Six studies appeared to have known or suspected biases in dose estimates. The potential for these biases to cause a spurious dose-response association was constrained to three case-control studies that relied extensively on information gathered in interviews conducted after case ascertainment. CONCLUSIONS The potential for spurious dose-response associations from dose information appeared limited to case-control studies vulnerable to recall errors that may be differential by case status. Otherwise, risk estimates appeared reasonably free of a substantial bias from dose estimation error. Future studies would benefit from a comprehensive evaluation of dose estimation errors, including methods accounting for their potential effects on dose-response associations.
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Affiliation(s)
- Robert D Daniels
- Division of Science Integration, National Institute for Occupational Safety and Health, Cincinnati, OH
| | - Gerald M Kendall
- Cancer Epidemiology Unit, NDPH, University of Oxford, Oxford, UK
| | - Isabelle Thierry-Chef
- Barcelona Institute for Global Health, Barcelona, Catalonia, Spain
- Universitat Pompeu Fabra, Barcelona, Catalonia, Spain
- CIBER Epidemiología y Salud Pública, Madrid, Spain
| | - Martha S Linet
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD
| | - Harry M Cullings
- Department of Statistics, Radiation Effects Research Foundation, Hiroshima, Japan
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18
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Affiliation(s)
- Konrad Reinhart
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany.
- Berlin Institute of Health, Campus Virchow-Klinikum, Berlin, Germany.
- Institute of Infectious Diseases and Infection Control, Jena University Hospital, Jena, Germany.
| | - R D Daniels
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - D Schwarzkopf
- Institute of Infectious Diseases and Infection Control, Jena University Hospital, Jena, Germany
| | - N Kissoon
- Department of Pediatrics, Emergency Medicine and Critical Care, University of British Columbia, Vancouver, Canada
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19
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Berrington de Gonzalez A, Daniels RD, Cardis E, Cullings HM, Gilbert E, Hauptmann M, Kendall G, Laurier D, Linet MS, Little MP, Lubin JH, Preston DL, Richardson DB, Stram D, Thierry-Chef I, Schubauer-Berigan MK. Epidemiological Studies of Low-Dose Ionizing Radiation and Cancer: Rationale and Framework for the Monograph and Overview of Eligible Studies. J Natl Cancer Inst Monogr 2020; 2020:97-113. [PMID: 32657348 PMCID: PMC7610154 DOI: 10.1093/jncimonographs/lgaa009] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [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: 12/02/2019] [Accepted: 03/13/2020] [Indexed: 12/21/2022] Open
Abstract
Whether low-dose ionizing radiation can cause cancer is a critical and long-debated question in radiation protection. Since the Biological Effects of Ionizing Radiation report by the National Academies in 2006, new publications from large, well-powered epidemiological studies of low doses have reported positive dose-response relationships. It has been suggested, however, that biases could explain these findings. We conducted a systematic review of epidemiological studies with mean doses less than 100 mGy published 2006-2017. We required individualized doses and dose-response estimates with confidence intervals. We identified 26 eligible studies (eight environmental, four medical, and 14 occupational), including 91 000 solid cancers and 13 000 leukemias. Mean doses ranged from 0.1 to 82 mGy. The excess relative risk at 100 mGy was positive for 16 of 22 solid cancer studies and 17 of 20 leukemia studies. The aim of this monograph was to systematically review the potential biases in these studies (including dose uncertainty, confounding, and outcome misclassification) and to assess whether the subset of minimally biased studies provides evidence for cancer risks from low-dose radiation. Here, we describe the framework for the systematic bias review and provide an overview of the eligible studies.
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Affiliation(s)
| | - Robert D Daniels
- National Institute for Occupational Safety and Health, Cincinnati, OH, USA
| | - Elisabeth Cardis
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Catalonia, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Catalonia, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | | | - Ethel Gilbert
- Division of Cancer Epidemiology & Genetics, Radiation Epidemiology Branch, Bethesda, MD, USA
| | - Michael Hauptmann
- Department of Epidemiology and Biostatistics, Netherlands Cancer Institute, Amsterdam, the Netherlands
- Brandenburg Medical School Theodor Fontane, Institute of Biostatistics and Registry Research, Neuruppin, Germany
| | | | | | - Martha S Linet
- Division of Cancer Epidemiology & Genetics, Radiation Epidemiology Branch, Bethesda, MD, USA
| | - Mark P Little
- Division of Cancer Epidemiology & Genetics, Radiation Epidemiology Branch, Bethesda, MD, USA
| | - Jay H Lubin
- Division of Cancer Epidemiology & Genetics, Radiation Epidemiology Branch, Bethesda, MD, USA
| | | | | | - Daniel Stram
- University of Southern California, Los Angeles, CA
| | - Isabelle Thierry-Chef
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Catalonia, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Catalonia, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
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Marques MM, Berrington de Gonzalez A, Beland FA, Browne P, Demers PA, Lachenmeier DW, Bahadori T, Barupal DK, Belpoggi F, Comba P, Dai M, Daniels RD, Ferreccio C, Grigoriev OA, Hong YC, Hoover RN, Kanno J, Kogevinas M, Lasfargues G, Malekzadeh R, Masten S, Newton R, Norat T, Pappas JJ, Queiroz Moreira C, Rodríguez T, Rodríguez-Guzmán J, Sewram V, Zeise L, Benbrahim-Tallaa L, Bouvard V, Cree IA, El Ghissassi F, Girschik J, Grosse Y, Hall AL, Turner MC, Straif K, Korenjak M, McCormack V, Müller K, Schüz J, Zavadil J, Schubauer-Berigan MK, Guyton KZ. Advisory Group recommendations on priorities for the IARC Monographs. Lancet Oncol 2019; 20:763-764. [DOI: 10.1016/s1470-2045(19)30246-3] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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21
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Bertke SJ, Yiin JH, Daniels RD. Cancer mortality update with an exposure response analysis among styrene-exposed workers in the reinforced plastics boatbuilding industry. Am J Ind Med 2018; 61:566-571. [PMID: 29638005 DOI: 10.1002/ajim.22853] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2018] [Indexed: 11/08/2022]
Abstract
BACKGROUND There is sparse and inconsistent evidence of an association between styrene exposure and cancer. METHODS This study examines mortality patterns in a previously studied cohort of 5201 workers employed in two Washington boat-building facilities, extending follow-up 5 years. Standardized mortality ratios (SMR) were calculated using state rates as referent. Cox regression calculated rate ratios (RR) per year employed in styrene-exposed exposed jobs. RESULTS No excess deaths from lymphohematopoietic cancers (LHCs) were observed (SMR: 0.99, 95%CI: 0.74-1.30) when compared to the referent population; however, the relative risk increased with duration of employment in internal analyses. Conversely, lung cancer mortality was significantly elevated (SMR: 1.24, 95%CI: 1.08-1.41), but there was no evidence of a dose-response relationship. CONCLUSION We found evidence that occupational exposure to styrene was associated with increased LHC risk, while no such association was observed for lung cancer.
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Affiliation(s)
- Stephen J. Bertke
- National Institute for Occupational Safety and Health; Cincinnati Ohio
| | - James H. Yiin
- National Institute for Occupational Safety and Health; Cincinnati Ohio
| | - Robert D. Daniels
- National Institute for Occupational Safety and Health; Cincinnati Ohio
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22
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Abstract
BACKGROUND Toluene Diisocyanate (TDI) is a known respiratory sensitizer linked to occupational asthma (OA). To better manage worker risks, an appropriate characterization of the TDI-OA dose-risk relationship is needed. METHODS The literature was reviewed for data suitable for dose-response modeling. Previous study data were fit to models to derive prospective occupational exposure limits (OELs), using benchmark dose (BMD) and low-dose extrapolation approaches. RESULTS Data on eight TDI-exposed populations were suitable for analysis. There were 118 OA cases in a population contributing 13 590 person-years. The BMD-based OEL was 0.4 ppb. The OEL based on low-dose extrapolation to working lifetime extra risk of 1/1000 was 0.3 ppb. CONCLUSIONS This study synthesized epidemiologic data to characterize the TDI-OA dose-risk relationship. This approach yielded prospective OEL estimates below recent recommendations by the American Conference of Governmental Industrial Hygienists, but given significant study limitations, this should be interpreted with caution. Confirmatory research is needed.
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Affiliation(s)
- Robert D. Daniels
- National Institute for Occupational Safety and Health (NIOSH); Cincinnati, Ohio
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23
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Richardson DB, Cardis E, Daniels RD, Gillies M, Haylock R, Leuraud K, Laurier D, Moissonnier M, Schubauer-Berigan MK, Thierry-Chef I, Kesminiene A. Site-specific Solid Cancer Mortality After Exposure to Ionizing Radiation: A Cohort Study of Workers (INWORKS). Epidemiology 2018; 29:31-40. [PMID: 28991003 PMCID: PMC5875434 DOI: 10.1097/ede.0000000000000761] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND There is considerable scientific interest in associations between protracted low-dose exposure to ionizing radiation and the occurrence of specific types of cancer. METHODS Associations between ionizing radiation and site-specific solid cancer mortality were examined among 308,297 nuclear workers employed in France, the United Kingdom, and the United States. Workers were monitored for external radiation exposure and follow-up encompassed 8.2 million person-years. Radiation-mortality associations were estimated using a maximum-likelihood method and using a Markov chain Monte Carlo method, the latter used to fit a hierarchical regression model to stabilize estimates of association. RESULTS The analysis included 17,957 deaths attributable to solid cancer, the most common being lung, prostate, and colon cancer. Using a maximum-likelihood method to quantify associations between radiation dose- and site-specific cancer, we obtained positive point estimates for oral, esophagus, stomach, colon, rectum, pancreas, peritoneum, larynx, lung, pleura, bone and connective tissue, skin, ovary, testis, and thyroid cancer; in addition, we obtained negative point estimates for cancer of the liver and gallbladder, prostate, bladder, kidney, and brain. Most of these estimated coefficients exhibited substantial imprecision. Employing a hierarchical model for stabilization had little impact on the estimated associations for the most commonly observed outcomes, but for less frequent cancer types, the stabilized estimates tended to take less extreme values and have greater precision than estimates obtained without such stabilization. CONCLUSIONS The results provide further evidence regarding associations between low-dose radiation exposure and cancer.
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Abstract
Exposure to naturally occurring radon is unavoidable and is second only to smoking as a direct cause of lung cancer in the USA. The literature for existing information on US occupations that are prone to increased radon exposures was reviewed. Current recommendations and applicable protective standards against occupational radon exposure that are applicable to US workers are discussed. Exposure varied widely among several working populations, most of whom were employed in industries that were unrelated to the uranium fuel cycle. Radon protection standards differed among agencies and have not changed since the height of domestic uranium production in the 1970s. In contrast, European countries are adopting recommendations by the International Commission on Radiation Protection to set a reference level near a derived annual exposure of about one working level month, which is 25% of the level currently established for US miners.
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Affiliation(s)
- Robert D. Daniels
- Corresponding author; 1090 Tusculum Avenue, Mailstop C-15, Cincinnati, OH 45226. ; Phone: (513) 533-8329, Fax: (513) 533-8224
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25
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Gillies M, Richardson DB, Cardis E, Daniels RD, O’Hagan JA, Haylock R, Laurier D, Leuraud K, Moissonnier M, Schubauer-Berigan MK, Thierry-Chef I, Kesminiene A. Mortality from Circulatory Diseases and other Non-Cancer Outcomes among Nuclear Workers in France, the United Kingdom and the United States (INWORKS). Radiat Res 2017; 188:276-290. [PMID: 28692406 PMCID: PMC5651512 DOI: 10.1667/rr14608.1] [Citation(s) in RCA: 83] [Impact Index Per Article: 11.9] [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: 11/03/2022]
Abstract
Positive associations between external radiation dose and non-cancer mortality have been found in a number of published studies, primarily of populations exposed to high-dose, high-dose-rate ionizing radiation. The goal of this study was to determine whether external radiation dose was associated with non-cancer mortality in a large pooled cohort of nuclear workers exposed to low-dose radiation accumulated at low dose rates. The cohort comprised 308,297 workers from France, United Kingdom and United States. The average cumulative equivalent dose at a tissue depth of 10 mm [Hp(10)] was 25.2 mSv. In total, 22% of the cohort were deceased by the end of follow-up, with 46,029 deaths attributed to non-cancer outcomes, including 27,848 deaths attributed to circulatory diseases. Poisson regression was used to investigate the relationship between cumulative radiation dose and non-cancer mortality rates. A statistically significant association between radiation dose and all non-cancer causes of death was observed [excess relative risk per sievert (ERR/Sv) = 0.19; 90% CI: 0.07, 0.30]. This was largely driven by the association between radiation dose and mortality due to circulatory diseases (ERR/Sv = 0.22; 90% CI: 0.08, 0.37), with slightly smaller positive, but nonsignificant, point estimates for mortality due to nonmalignant respiratory disease (ERR/Sv = 0.13; 90% CI: -0.17, 0.47) and digestive disease (ERR/Sv = 0.11; 90% CI: -0.36, 0.69). The point estimate for the association between radiation dose and deaths due to external causes of death was nonsignificantly negative (ERR = -0.12; 90% CI: <-0.60, 0.45). Within circulatory disease subtypes, associations with dose were observed for mortality due to cerebrovascular disease (ERR/Sv = 0.50; 90% CI: 0.12, 0.94) and mortality due to ischemic heart disease (ERR/Sv = 0.18; 90% CI: 0.004, 0.36). The estimates of associations between radiation dose and non-cancer mortality are generally consistent with those observed in atomic bomb survivor studies. The findings of this study could be interpreted as providing further evidence that non-cancer disease risks may be increased by external radiation exposure, particularly for ischemic heart disease and cerebrovascular disease. However, heterogeneity in the estimated ERR/Sv was observed, which warrants further investigation. Further follow-up of these cohorts, with the inclusion of internal exposure information and other potential confounders associated with lifestyle factors, may prove informative, as will further work on elucidating the biological mechanisms that might cause these non-cancer effects at low doses.
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Affiliation(s)
- Michael Gillies
- Public Health England Centre for Radiation, Chemical and Environmental Hazards (PHE-CRCE), Chilton, United Kingdom
| | - David B. Richardson
- Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina
| | - Elisabeth Cardis
- ISGlobal, Center for Research in Environmental Epidemiology (ISGlobal), Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Robert D. Daniels
- National Institute for Occupational Safety and Health, Cincinnati, Ohio
| | - Jacqueline A. O’Hagan
- Public Health England Centre for Radiation, Chemical and Environmental Hazards (PHE-CRCE), Chilton, United Kingdom
| | - Richard Haylock
- Public Health England Centre for Radiation, Chemical and Environmental Hazards (PHE-CRCE), Chilton, United Kingdom
| | - Dominique Laurier
- Institut de Radioprotection et de Sûreté Nucléaire (IRSN), PRP-HOM/SRBE/LEPID, 92262 Fontenay-aux-Roses, France
| | - Klervi Leuraud
- Institut de Radioprotection et de Sûreté Nucléaire (IRSN), PRP-HOM/SRBE/LEPID, 92262 Fontenay-aux-Roses, France
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26
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Gillies M, Richardson DB, Cardis E, Daniels RD, O'Hagan JA, Haylock R, Laurier D, Leuraud K, Moissonnier M, Schubauer-Berigan MK, Thierry-Chef I, Kesminiene A. Mortality from Circulatory Diseases and other Non-Cancer Outcomes among Nuclear Workers in France, the United Kingdom and the United States (INWORKS). Radiat Res 2017. [PMID: 28692406 DOI: 10.1667/rr14608] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Abstract
Positive associations between external radiation dose and non-cancer mortality have been found in a number of published studies, primarily of populations exposed to high-dose, high-dose-rate ionizing radiation. The goal of this study was to determine whether external radiation dose was associated with non-cancer mortality in a large pooled cohort of nuclear workers exposed to low-dose radiation accumulated at low dose rates. The cohort comprised 308,297 workers from France, United Kingdom and United States. The average cumulative equivalent dose at a tissue depth of 10 mm [Hp(10)] was 25.2 mSv. In total, 22% of the cohort were deceased by the end of follow-up, with 46,029 deaths attributed to non-cancer outcomes, including 27,848 deaths attributed to circulatory diseases. Poisson regression was used to investigate the relationship between cumulative radiation dose and non-cancer mortality rates. A statistically significant association between radiation dose and all non-cancer causes of death was observed [excess relative risk per sievert (ERR/Sv) = 0.19; 90% CI: 0.07, 0.30]. This was largely driven by the association between radiation dose and mortality due to circulatory diseases (ERR/Sv = 0.22; 90% CI: 0.08, 0.37), with slightly smaller positive, but nonsignificant, point estimates for mortality due to nonmalignant respiratory disease (ERR/Sv = 0.13; 90% CI: -0.17, 0.47) and digestive disease (ERR/Sv = 0.11; 90% CI: -0.36, 0.69). The point estimate for the association between radiation dose and deaths due to external causes of death was nonsignificantly negative (ERR = -0.12; 90% CI: <-0.60, 0.45). Within circulatory disease subtypes, associations with dose were observed for mortality due to cerebrovascular disease (ERR/Sv = 0.50; 90% CI: 0.12, 0.94) and mortality due to ischemic heart disease (ERR/Sv = 0.18; 90% CI: 0.004, 0.36). The estimates of associations between radiation dose and non-cancer mortality are generally consistent with those observed in atomic bomb survivor studies. The findings of this study could be interpreted as providing further evidence that non-cancer disease risks may be increased by external radiation exposure, particularly for ischemic heart disease and cerebrovascular disease. However, heterogeneity in the estimated ERR/Sv was observed, which warrants further investigation. Further follow-up of these cohorts, with the inclusion of internal exposure information and other potential confounders associated with lifestyle factors, may prove informative, as will further work on elucidating the biological mechanisms that might cause these non-cancer effects at low doses.
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Affiliation(s)
- Michael Gillies
- a Public Health England Centre for Radiation, Chemical and Environmental Hazards (PHE-CRCE), Chilton, United Kingdom
| | - David B Richardson
- b Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina
| | - Elisabeth Cardis
- c ISGlobal, Center for Research in Environmental Epidemiology (ISGlobal), Barcelona, Spain
- d Universitat Pompeu Fabra (UPF), Barcelona, Spain
- e CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Robert D Daniels
- f National Institute for Occupational Safety and Health, Cincinnati, Ohio
| | - Jacqueline A O'Hagan
- a Public Health England Centre for Radiation, Chemical and Environmental Hazards (PHE-CRCE), Chilton, United Kingdom
| | - Richard Haylock
- a Public Health England Centre for Radiation, Chemical and Environmental Hazards (PHE-CRCE), Chilton, United Kingdom
| | - Dominique Laurier
- g Institut de Radioprotection et de Sûreté Nucléaire (IRSN), PRP-HOM/SRBE/LEPID, 92262 Fontenay-aux-Roses, France
| | - Klervi Leuraud
- g Institut de Radioprotection et de Sûreté Nucléaire (IRSN), PRP-HOM/SRBE/LEPID, 92262 Fontenay-aux-Roses, France
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27
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Laurier D, Richardson DB, Cardis E, Daniels RD, Gillies M, O'Hagan J, Hamra GB, Haylock R, Leuraud K, Moissonnier M, Schubauer-Berigan MK, Thierry-Chef I, Kesminiene A. The International Nuclear Workers Study (Inworks): A Collaborative Epidemiological Study to Improve Knowledge About Health Effects of Protracted Low-Dose Exposure. Radiat Prot Dosimetry 2017; 173:21-25. [PMID: 27885078 DOI: 10.1093/rpd/ncw314] [Citation(s) in RCA: 28] [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] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
INWORKS is a multinational cohort study, gathering 308 297 workers in the nuclear industry in France, the United Kingdom and the United States of America, with detailed individual monitoring data for external exposure to ionising radiation. Over a mean duration of follow-up of 27 y, the number of observed deaths was 66 632, including 17 957 deaths due to solid cancers, 1791 deaths due to haematological cancers and 27 848 deaths due to cardiovascular diseases. Mean individual cumulative external dose over the period 1945-2005 was 25 mSv. Analyses demonstrated a significant association between red bone marrow dose and the risk of leukaemia (excluding chronic lymphocytic leukaemia) and between colon dose and the risk of solid cancers. INWORKS assembled some of the strongest evidence to strengthen the scientific basis for the protection of adults from low dose, low-dose rate, exposures to ionising radiation.
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Affiliation(s)
- Dominique Laurier
- Institut de Radioprotection et de Sûreté Nucléaire (IRSN), 91190 Fontenay-aux-Roses, France
| | - David B Richardson
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC, USA
| | | | - Robert D Daniels
- National Institute for Occupational Safety and Health, Cincinnati, Ohio, USA
| | - Michael Gillies
- Public Health England Centre for Radiation, Chemical and Environmental Hazards (PHE-CRCE), Chilton, UK
| | - Jackie O'Hagan
- Public Health England Centre for Radiation, Chemical and Environmental Hazards (PHE-CRCE), Chilton, UK
| | - Ghassan B Hamra
- Department of Environmental and Occupational Health, Drexel University School of Public Health, Philadelphia, PA, USA
| | - Richard Haylock
- Public Health England Centre for Radiation, Chemical and Environmental Hazards (PHE-CRCE), Chilton, UK
| | - Klervi Leuraud
- Institut de Radioprotection et de Sûreté Nucléaire (IRSN), 91190 Fontenay-aux-Roses, France
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28
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Daniels RD, Bertke SJ, Richardson DB, Cardis E, Gillies M, O'Hagan JA, Haylock R, Laurier D, Leuraud K, Moissonnier M, Thierry-Chef I, Kesminiene A, Schubauer-Berigan MK. Examining temporal effects on cancer risk in the international nuclear workers' study. Int J Cancer 2017; 140:1260-1269. [PMID: 27914102 PMCID: PMC5286034 DOI: 10.1002/ijc.30544] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [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: 09/20/2016] [Accepted: 11/16/2016] [Indexed: 11/12/2022]
Abstract
The paper continues the series of publications from the International Nuclear Workers Study cohort that comprises 308,297 workers from France, the United Kingdom and the United States, providing 8.2 million person-years of observation from a combined follow-up period (at earliest 1944 to at latest 2005). These workers' external radiation exposures were primarily to photons, resulting in an estimated average career absorbed dose to the colon of 17.4 milligray. The association between cumulative ionizing radiation dose and cancer mortality was evaluated in general relative risk models that describe modification of the excess relative risk (ERR) per gray (Gy) by time since exposure and age at exposure. Methods analogous to a nested-case control study using conditional logistic regression of sampled risks sets were used. Outcomes included: all solid cancers, lung cancer, leukemias excluding chronic lymphocytic, acute myeloid leukemia, chronic myeloid leukemia, multiple myeloma, Hodgkin lymphoma and non-Hodgkin lymphoma. Significant risk heterogeneity was evident in chronic myeloid leukemia with time since exposure, where we observed increased ERR per Gy estimates shortly after exposure (2-10 year) and again later (20-30 years). We observed delayed effects for acute myeloid leukemia although estimates were not statistically significant. Solid cancer excess risk was restricted to exposure at age 35+ years and also diminished for exposure 30 years prior to attained age. Persistent or late effects suggest additional follow-up may inform on lifetime risks. However, cautious interpretation of results is needed due to analytical limitations and a lack of confirmatory results from other studies.
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Affiliation(s)
- Robert D. Daniels
- National Institute for Occupational Safety and Health (NIOSH), Cincinnati, Ohio, USA
| | - Stephen J. Bertke
- National Institute for Occupational Safety and Health (NIOSH), Cincinnati, Ohio, USA
| | - David B. Richardson
- Department of Epidemiology. University of North Carolina. Chapel Hill, NC, USA
| | - Elisabeth Cardis
- ISGlobal, Center for Research in Environmental Epidemiology (CREAL), Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Michael Gillies
- Public Health England Centre for Radiation, Chemical and Environmental Hazards (PHE-CRCE), Chilton, UK
| | - Jacqueline A. O'Hagan
- Public Health England Centre for Radiation, Chemical and Environmental Hazards (PHE-CRCE), Chilton, UK
| | - Richard Haylock
- Public Health England Centre for Radiation, Chemical and Environmental Hazards (PHE-CRCE), Chilton, UK
| | - Dominique Laurier
- Institut de Radioprotection et de Sûreté Nucléaire (IRSN). Fontenay-aux-Roses, France
| | - Klervi Leuraud
- Institut de Radioprotection et de Sûreté Nucléaire (IRSN). Fontenay-aux-Roses, France
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29
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Pinkerton LE, Yiin JH, Daniels RD, Fent KW. Response to Goodman et al. Am J Ind Med 2017; 60:223-225. [PMID: 28079281 DOI: 10.1002/ajim.22681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/04/2016] [Indexed: 11/10/2022]
Affiliation(s)
- Lynne E. Pinkerton
- Industrywide Studies Branch, Division of Surveillance, Hazard Evaluations, and Field Studies; National Institute for Occupational Safety and Health; Cincinnati Ohio
| | - James H. Yiin
- Industrywide Studies Branch, Division of Surveillance, Hazard Evaluations, and Field Studies; National Institute for Occupational Safety and Health; Cincinnati Ohio
| | - Robert D. Daniels
- Industrywide Studies Branch, Division of Surveillance, Hazard Evaluations, and Field Studies; National Institute for Occupational Safety and Health; Cincinnati Ohio
| | - Kenneth W. Fent
- Industrywide Studies Branch, Division of Surveillance, Hazard Evaluations, and Field Studies; National Institute for Occupational Safety and Health; Cincinnati Ohio
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30
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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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Moir W, Zeig-Owens R, Daniels RD, Hall CB, Webber MP, Jaber N, Yiin JH, Schwartz T, Liu X, Vossbrinck M, Kelly K, Prezant DJ. Post-9/11 cancer incidence in World Trade Center-exposed New York City firefighters as compared to a pooled cohort of firefighters from San Francisco, Chicago and Philadelphia (9/11/2001-2009). Am J Ind Med 2016; 59:722-30. [PMID: 27582474 DOI: 10.1002/ajim.22635] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [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: 07/11/2016] [Indexed: 11/06/2022]
Abstract
BACKGROUND We previously reported a modest excess of cancer in World Trade Center (WTC)-exposed firefighters versus the general population. This study aimed to separate the potential carcinogenic effects of firefighting and WTC exposure by comparing to a cohort of non-WTC-exposed firefighters. METHODS Relative rates (RRs) for all cancers combined and individual cancer subtypes from 9/11/2001 to 12/31/2009 were modeled using Poisson regression comparing 11,457 WTC-exposed firefighters to 8,220 urban non-WTC-exposed firefighters. RESULTS Compared with non-WTC-exposed firefighters, there was no difference in the RR of all cancers combined for WTC-exposed firefighters (RR = 0.96, 95%CI: 0.83-1.12). Thyroid cancer was significantly elevated (RR = 3.82, 95%CI: 1.07-20.81) from 2001 to 2009; this was attenuated (RR = 3.43, 95%CI: 0.94-18.94) and non-significant when controlling for possible surveillance bias. Prostate cancer was elevated during the latter half (2005-2009; RR = 1.38, 95%CI: 1.01-1.88). CONCLUSIONS Further follow-up is needed to assess the relationship between WTC exposure and cancers with longer latency periods. Am. J. Ind. Med. 59:722-730, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- William Moir
- Department of Medicine; Montefiore Medical Center; Bronx New York
- Bureau of Health Services; Fire Department of the City of New York; Brooklyn New York
| | - Rachel Zeig-Owens
- Department of Medicine; Montefiore Medical Center; Bronx New York
- Bureau of Health Services; Fire Department of the City of New York; Brooklyn New York
| | - Robert D. Daniels
- Education and Information Division; National Institute for Occupational Safety and Health; Cincinnati Ohio
| | - Charles B. Hall
- Division of Biostatistics; Department of Epidemiology and Population Health, Albert Einstein College of Medicine; Bronx New York
| | - Mayris P. Webber
- Bureau of Health Services; Fire Department of the City of New York; Brooklyn New York
- Department of Epidemiology and Population Health; Albert Einstein College of Medicine; Bronx New York
| | - Nadia Jaber
- Bureau of Health Services; Fire Department of the City of New York; Brooklyn New York
| | - James H. Yiin
- Division of Surveillance; Hazard Evaluations, and Field Studies, National Institute for Occupational Safety and Health; Cincinnati Ohio
| | - Theresa Schwartz
- Department of Medicine; Montefiore Medical Center; Bronx New York
- Bureau of Health Services; Fire Department of the City of New York; Brooklyn New York
| | - Xiaoxue Liu
- Department of Medicine; Montefiore Medical Center; Bronx New York
- Bureau of Health Services; Fire Department of the City of New York; Brooklyn New York
| | - Madeline Vossbrinck
- Department of Medicine; Montefiore Medical Center; Bronx New York
- Bureau of Health Services; Fire Department of the City of New York; Brooklyn New York
| | - Kerry Kelly
- Bureau of Health Services; Fire Department of the City of New York; Brooklyn New York
| | - David J. Prezant
- Bureau of Health Services; Fire Department of the City of New York; Brooklyn New York
- Pulmonary Medicine Division; Montefiore Medical Center; Bronx New York
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Pinkerton LE, Yiin JH, Daniels RD, Fent KW. Mortality among workers exposed to toluene diisocyanate in the US polyurethane foam industry: Update and exposure-response analyses. Am J Ind Med 2016; 59:630-43. [PMID: 27346061 DOI: 10.1002/ajim.22622] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2016] [Indexed: 11/08/2022]
Abstract
BACKGROUND Mortality among 4,545 toluene diisocyante (TDI)-exposed workers was updated through 2011. The primary outcome of interest was lung cancer. METHODS Life table analyses, including internal analyses by exposure duration and cumulative TDI exposure, were conducted. RESULTS Compared with the US population, all cause and all cancer mortality was increased. Lung cancer mortality was increased but was not associated with exposure duration or cumulative TDI exposure. In post hoc analyses, lung cancer mortality was associated with employment duration in finishing jobs, but not in finishing jobs involving cutting polyurethane foam. CONCLUSIONS Dermal exposure, in contrast to inhalational exposure, to TDI is expected to be greater in finishing jobs and may play a role in the observed increase in lung cancer mortality. Limitations include the lack of smoking data, uncertainty in the exposure estimates, and exposure estimates that reflected inhalational exposure only. Am. J. Ind. Med. 59:630-643, 2016. 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)
- Lynne E. Pinkerton
- Industrywide Studies Branch, Division of Surveillance, Hazard Evaluations, and Field Studies; National Institute for Occupational Safety and Health; Cincinnati Ohio
| | - James H. Yiin
- Industrywide Studies Branch, Division of Surveillance, Hazard Evaluations, and Field Studies; National Institute for Occupational Safety and Health; Cincinnati Ohio
| | - Robert D. Daniels
- Industrywide Studies Branch, Division of Surveillance, Hazard Evaluations, and Field Studies; National Institute for Occupational Safety and Health; Cincinnati Ohio
| | - Kenneth W. Fent
- Industrywide Studies Branch, Division of Surveillance, Hazard Evaluations, and Field Studies; National Institute for Occupational Safety and Health; Cincinnati Ohio
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Hamra GB, Richardson DB, Cardis E, Daniels RD, Gillies M, O'Hagan JA, Haylock R, Laurier D, Leuraud K, Moissonnier M, Schubauer-Berigan M, Thierry-Chef I, Kesminiene A. Cohort Profile: The International Nuclear Workers Study (INWORKS). Int J Epidemiol 2016; 45:693-9. [PMID: 26150557 PMCID: PMC4703555 DOI: 10.1093/ije/dyv122] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Ghassan B Hamra
- Department of Environmental and Occupational Health, Drexel University, Philadelphia, PA, USA,
| | - David B Richardson
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC, USA
| | - Elisabeth Cardis
- Center for Research in Environmental Epidemiology, Barcelona, Spain, Universitat Pompeu Fabra, Barcelona, Spain, CIBER Epidemiología y Salud Pública, Madrid, Spain
| | - Robert D Daniels
- National Institute for Occupational Safety and Health, Cincinnati, OH, USA
| | - Michael Gillies
- Public Health England Centre for Radiation, Chemical and Environmental Hazards, Chilton, UK
| | - Jacqueline A O'Hagan
- Public Health England Centre for Radiation, Chemical and Environmental Hazards, Chilton, UK
| | - Richard Haylock
- Public Health England Centre for Radiation, Chemical and Environmental Hazards, Chilton, UK
| | - Dominique Laurier
- Institute for Radiological Protection and Nuclear Safety, Fontenay aux Roses, France and
| | - Klervi Leuraud
- Institute for Radiological Protection and Nuclear Safety, Fontenay aux Roses, France and
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Yiin JH, Daniels RD, Kubale TL, Dunn KL, Stayner LT. A study update of mortality in workers at a phosphate fertilizer production facility. Am J Ind Med 2016; 59:12-22. [PMID: 26523937 PMCID: PMC4913354 DOI: 10.1002/ajim.22542] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [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: 10/04/2015] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To evaluate the mortality experience among 3,199 workers employed 1951-1976 at a phosphate fertilizer production plant in central Florida 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. Lung cancer and leukemia risks were further analyzed using conditional logistic regression. RESULTS The mortality due to all-causes (SMR = 1.07, 95% confidence interval [CI] 1.02-1.13, observed deaths [n] = 1,473), all-cancers (SMR = 1.16, 95%CI 1.06-1.28, n = 431), and a priori outcomes of interests including lung cancer (SMR = 1.32, 95%CI = 1.13-1.53, n = 168) and leukemia (SMR = 1.74, 95%CI = 1.11-2.62, n = 23) were statistically significantly elevated. Regression modeling on employment duration or estimated radiation scores did not show exposure-response relation with lung cancer or leukemia mortality. CONCLUSION SMR results showed increased lung cancer and leukemia mortality in a full cohort of the phosphate fertilizer production facility. There was, however, no exposure-response relation observed among cases and matched controls.
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Affiliation(s)
- James H. Yiin
- Division of Surveillance, Hazard Evaluations, and Field Studies, National Institute for Occupational Safety and Health, CDC, Cincinnati, Ohio
| | - Robert D. Daniels
- Division of Surveillance, Hazard Evaluations, and Field Studies, National Institute for Occupational Safety and Health, CDC, Cincinnati, Ohio
| | - Travis L. Kubale
- Division of Surveillance, Hazard Evaluations, and Field Studies, National Institute for Occupational Safety and Health, CDC, Cincinnati, Ohio
| | - Kevin L. Dunn
- Division of Surveillance, Hazard Evaluations, and Field Studies, National Institute for Occupational Safety and Health, CDC, Cincinnati, Ohio
| | - Leslie T. Stayner
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, Illinois
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Richardson DB, Cardis E, Daniels RD, Gillies M, O'Hagan JA, Hamra GB, Haylock R, Laurier D, Leuraud K, Moissonnier M, Schubauer-Berigan MK, Thierry-Chef I, Kesminiene A. Risk of cancer from occupational exposure to ionising radiation: retrospective cohort study of workers in France, the United Kingdom, and the United States (INWORKS). BMJ 2015. [PMID: 26487649 DOI: 10.1136/bmjh5359] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
STUDY QUESTION Is protracted exposure to low doses of ionising radiation associated with an increased risk of solid cancer? METHODS In this cohort study, 308,297 workers in the nuclear industry from France, the United Kingdom, and the United States with detailed monitoring data for external exposure to ionising radiation were linked to death registries. Excess relative rate per Gy of radiation dose for mortality from cancer was estimated. Follow-up encompassed 8.2 million person years. Of 66,632 known deaths by the end of follow-up, 17,957 were due to solid cancers. STUDY ANSWER AND LIMITATIONS Results suggest a linear increase in the rate of cancer with increasing radiation exposure. The average cumulative colon dose estimated among exposed workers was 20.9 mGy (median 4.1 mGy). The estimated rate of mortality from all cancers excluding leukaemia increased with cumulative dose by 48% per Gy (90% confidence interval 20% to 79%), lagged by 10 years. Similar associations were seen for mortality from all solid cancers (47% (18% to 79%)), and within each country. The estimated association over the dose range of 0-100 mGy was similar in magnitude to that obtained over the entire dose range but less precise. Smoking and occupational asbestos exposure are potential confounders; however, exclusion of deaths from lung cancer and pleural cancer did not affect the estimated association. Despite substantial efforts to characterise the performance of the radiation dosimeters used, the possibility of measurement error remains. WHAT THIS STUDY ADDS The study provides a direct estimate of the association between protracted low dose exposure to ionising radiation and solid cancer mortality. Although high dose rate exposures are thought to be more dangerous than low dose rate exposures, the risk per unit of radiation dose for cancer among radiation workers was similar to estimates derived from studies of Japanese atomic bomb survivors. Quantifying the cancer risks associated with protracted radiation exposures can help strengthen the foundation for radiation protection standards. FUNDING, COMPETING INTERESTS, DATA SHARING Support from the US Centers for Disease Control and Prevention; Ministry of Health, Labour and Welfare of Japan; Institut de Radioprotection et de Sûreté Nucléaire; AREVA; Electricité de France; US National Institute for Occupational Safety and Health; US Department of Energy; and Public Health England. Data are maintained and kept at the International Agency for Research on Cancer.
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Affiliation(s)
- David B Richardson
- Department of Epidemiology, School of Public Health, University of North Carolina, Chapel Hill, NC 27599, USA
| | - Elisabeth Cardis
- Center for Research in Environmental Epidemiology, Barcelona, Spain Universitat Pompeu Fabra, Barcelona, Spain CIBER Epidemiología y Salud Pública, Madrid, Spain
| | - Robert D Daniels
- National Institute for Occupational Safety and Health, Cincinnati, OH, USA
| | - Michael Gillies
- Public Health England Centre for Radiation, Chemical and Environmental Hazards, Chilton, UK
| | - Jacqueline A O'Hagan
- Public Health England Centre for Radiation, Chemical and Environmental Hazards, Chilton, UK
| | - Ghassan B Hamra
- Department of Environmental and Occupational Health, Drexel University School of Public Health, Philadelphia, PA, USA
| | - Richard Haylock
- Public Health England Centre for Radiation, Chemical and Environmental Hazards, Chilton, UK
| | - Dominique Laurier
- Institut de Radioprotection et de Sûreté Nucléaire, Fontenay-aux-Roses, France
| | - Klervi Leuraud
- Institut de Radioprotection et de Sûreté Nucléaire, Fontenay-aux-Roses, France
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Richardson DB, Cardis E, Daniels RD, Gillies M, O'Hagan JA, Hamra GB, Haylock R, Laurier D, Leuraud K, Moissonnier M, Schubauer-Berigan MK, Thierry-Chef I, Kesminiene A. Risk of cancer from occupational exposure to ionising radiation: retrospective cohort study of workers in France, the United Kingdom, and the United States (INWORKS). BMJ 2015; 351:h5359. [PMID: 26487649 PMCID: PMC4612459 DOI: 10.1136/bmj.h5359] [Citation(s) in RCA: 221] [Impact Index Per Article: 24.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/09/2015] [Indexed: 12/01/2022]
Abstract
STUDY QUESTION Is protracted exposure to low doses of ionising radiation associated with an increased risk of solid cancer? METHODS In this cohort study, 308,297 workers in the nuclear industry from France, the United Kingdom, and the United States with detailed monitoring data for external exposure to ionising radiation were linked to death registries. Excess relative rate per Gy of radiation dose for mortality from cancer was estimated. Follow-up encompassed 8.2 million person years. Of 66,632 known deaths by the end of follow-up, 17,957 were due to solid cancers. STUDY ANSWER AND LIMITATIONS Results suggest a linear increase in the rate of cancer with increasing radiation exposure. The average cumulative colon dose estimated among exposed workers was 20.9 mGy (median 4.1 mGy). The estimated rate of mortality from all cancers excluding leukaemia increased with cumulative dose by 48% per Gy (90% confidence interval 20% to 79%), lagged by 10 years. Similar associations were seen for mortality from all solid cancers (47% (18% to 79%)), and within each country. The estimated association over the dose range of 0-100 mGy was similar in magnitude to that obtained over the entire dose range but less precise. Smoking and occupational asbestos exposure are potential confounders; however, exclusion of deaths from lung cancer and pleural cancer did not affect the estimated association. Despite substantial efforts to characterise the performance of the radiation dosimeters used, the possibility of measurement error remains. WHAT THIS STUDY ADDS The study provides a direct estimate of the association between protracted low dose exposure to ionising radiation and solid cancer mortality. Although high dose rate exposures are thought to be more dangerous than low dose rate exposures, the risk per unit of radiation dose for cancer among radiation workers was similar to estimates derived from studies of Japanese atomic bomb survivors. Quantifying the cancer risks associated with protracted radiation exposures can help strengthen the foundation for radiation protection standards. FUNDING, COMPETING INTERESTS, DATA SHARING Support from the US Centers for Disease Control and Prevention; Ministry of Health, Labour and Welfare of Japan; Institut de Radioprotection et de Sûreté Nucléaire; AREVA; Electricité de France; US National Institute for Occupational Safety and Health; US Department of Energy; and Public Health England. Data are maintained and kept at the International Agency for Research on Cancer.
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Affiliation(s)
- David B Richardson
- Department of Epidemiology, School of Public Health, University of North Carolina, Chapel Hill, NC 27599, USA
| | - Elisabeth Cardis
- Center for Research in Environmental Epidemiology, Barcelona, Spain Universitat Pompeu Fabra, Barcelona, Spain CIBER Epidemiología y Salud Pública, Madrid, Spain
| | - Robert D Daniels
- National Institute for Occupational Safety and Health, Cincinnati, OH, USA
| | - Michael Gillies
- Public Health England Centre for Radiation, Chemical and Environmental Hazards, Chilton, UK
| | - Jacqueline A O'Hagan
- Public Health England Centre for Radiation, Chemical and Environmental Hazards, Chilton, UK
| | - Ghassan B Hamra
- Department of Environmental and Occupational Health, Drexel University School of Public Health, Philadelphia, PA, USA
| | - Richard Haylock
- Public Health England Centre for Radiation, Chemical and Environmental Hazards, Chilton, UK
| | - Dominique Laurier
- Institut de Radioprotection et de Sûreté Nucléaire, Fontenay-aux-Roses, France
| | - Klervi Leuraud
- Institut de Radioprotection et de Sûreté Nucléaire, Fontenay-aux-Roses, France
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Schubauer-Berigan MK, Leuraud K, Richardson DB, Cardis E, Daniels RD, Gillies M, O'Hagan JA, Hamra GB, Haylock R, Laurier D, Moissonnier M, Thierry-Chef I, Kesminiene A. INWORKS study: risk of leukaemia from protracted radiation exposure - Authors' reply. Lancet Haematol 2015; 2:e405-6. [PMID: 26686041 DOI: 10.1016/s2352-3026(15)00201-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Accepted: 09/18/2015] [Indexed: 11/16/2022]
Affiliation(s)
| | - Klervi Leuraud
- Institut de Radioprotection et de Sûreté Nucléaire, BP 17 Fontenay aux Roses Cedex, France.
| | - David B Richardson
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC, USA
| | - Elisabeth Cardis
- Center for Research in Environmental Epidemiology, Barcelona, Spain; Universitat Pompeu Fabra, Barcelona, Spain; CIBER Epidemiología y Salud Pública, Madrid, Spain
| | - Robert D Daniels
- National Institute for Occupational Safety and Health, Cincinnati, OH, USA
| | - Michael Gillies
- Public Health England Centre for Radiation, Chemical and Environmental Hazards, Chilton, UK
| | - Jacqueline A O'Hagan
- Public Health England Centre for Radiation, Chemical and Environmental Hazards, Chilton, UK
| | - Ghassan B Hamra
- Department of Environmental and Occupational Health, Drexel University School of Public Health, Philadelphia, PA, USA
| | - Richard Haylock
- Public Health England Centre for Radiation, Chemical and Environmental Hazards, Chilton, UK
| | - Dominique Laurier
- Institut de Radioprotection et de Sûreté Nucléaire, BP 17 Fontenay aux Roses Cedex, France
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Dahm MM, Bertke S, Allee S, Daniels RD. Creation of a retrospective job-exposure matrix using surrogate measures of exposure for a cohort of US career firefighters from San Francisco, Chicago and Philadelphia. Occup Environ Med 2015; 72:670-7. [PMID: 26163543 DOI: 10.1136/oemed-2014-102790] [Citation(s) in RCA: 13] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Accepted: 06/22/2015] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To construct a cohort-specific job-exposure matrix (JEM) using surrogate metrics of exposure for a cancer study on career firefighters from the Chicago, Philadelphia and San Francisco Fire Departments. METHODS Departmental work history records, along with data on historical annual fire-runs and hours, were collected from 1950 to 2009 and coded into separate databases. These data were used to create a JEM based on standardised job titles and fire apparatus assignments using several surrogate exposure metrics to estimate firefighters' exposure to the combustion byproducts of fire. The metrics included duration of exposure (cumulative time with a standardised exposed job title and assignment), fire-runs (cumulative events of potential fire exposure) and time at fire (cumulative hours of potential fire exposure). RESULTS The JEM consisted of 2298 unique job titles alongside 16,174 fire apparatus assignments from the three departments, which were collapsed into 15 standardised job titles and 15 standardised job assignments. Correlations were found between fire-runs and time at fires (Pearson coefficient=0.92), duration of exposure and time at fires (Pearson coefficient=0.85), and duration of exposure and fire-runs (Pearson coefficient=0.82). Total misclassification rates were found to be between 16-30% when using duration of employment as an exposure surrogate, which has been traditionally used in most epidemiological studies, compared with using the duration of exposure surrogate metric. CONCLUSIONS The constructed JEM successfully differentiated firefighters based on gradient levels of potential exposure to the combustion byproducts of fire using multiple surrogate exposure metrics.
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Affiliation(s)
- Matthew M Dahm
- Division of Surveillance, Hazard Evaluations, and Field Studies, National Institute for Occupational Safety and Health, Cincinnati, Ohio, USA
| | - Stephen Bertke
- Division of Surveillance, Hazard Evaluations, and Field Studies, National Institute for Occupational Safety and Health, Cincinnati, Ohio, USA
| | | | - Robert D Daniels
- Division of Surveillance, Hazard Evaluations, and Field Studies, National Institute for Occupational Safety and Health, Cincinnati, Ohio, USA
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Leuraud K, Richardson DB, Cardis E, Daniels RD, Gillies M, O'Hagan JA, Hamra GB, Haylock R, Laurier D, Moissonnier M, Schubauer-Berigan MK, Thierry-Chef I, Kesminiene A. Ionising radiation and risk of death from leukaemia and lymphoma in radiation-monitored workers (INWORKS): an international cohort study. Lancet Haematol 2015; 2:e276-81. [PMID: 26436129 PMCID: PMC4587986 DOI: 10.1016/s2352-3026(15)00094-0] [Citation(s) in RCA: 262] [Impact Index Per Article: 29.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND There is much uncertainty about the risks of leukaemia and lymphoma after repeated or protracted low-dose radiation exposure typical of occupational, environmental, and diagnostic medical settings. We quantified associations between protracted low-dose radiation exposures and leukaemia, lymphoma, and multiple myeloma mortality among radiation-monitored adults employed in France, the UK, and the USA. METHODS We assembled a cohort of 308,297 radiation-monitored workers employed for at least 1 year by the Atomic Energy Commission, AREVA Nuclear Cycle, or the National Electricity Company in France, the Departments of Energy and Defence in the USA, and nuclear industry employers included in the National Registry for Radiation Workers in the UK. The cohort was followed up for a total of 8.22 million person-years. We ascertained deaths caused by leukaemia, lymphoma, and multiple myeloma. We used Poisson regression to quantify associations between estimated red bone marrow absorbed dose and leukaemia and lymphoma mortality. FINDINGS Doses were accrued at very low rates (mean 1.1 mGy per year, SD 2.6). The excess relative risk of leukaemia mortality (excluding chronic lymphocytic leukaemia) was 2.96 per Gy (90% CI 1.17-5.21; lagged 2 years), most notably because of an association between radiation dose and mortality from chronic myeloid leukaemia (excess relative risk per Gy 10.45, 90% CI 4.48-19.65). INTERPRETATION This study provides strong evidence of positive associations between protracted low-dose radiation exposure and leukaemia. FUNDING Centers for Disease Control and Prevention, Ministry of Health, Labour and Welfare of Japan, Institut de Radioprotection et de Sûreté Nucléaire, AREVA, Electricité de France, National Institute for Occupational Safety and Health, US Department of Energy, US Department of Health and Human Services, University of North Carolina, Public Health England.
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Affiliation(s)
- Klervi Leuraud
- Institut de Radioprotection et de Sûreté Nucléaire, Fontenay-aux-Roses, France
| | - David B Richardson
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC, USA
| | - Elisabeth Cardis
- Center for Research in Environmental Epidemiology, Barcelona, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
- CIBER Epidemiología y Salud Pública, Madrid, Spain
| | - Robert D Daniels
- National Institute for Occupational Safety and Health, Cincinnati, OH, USA
| | - Michael Gillies
- Public Health England Centre for Radiation, Chemical and Environmental Hazards, Chilton, UK
| | - Jacqueline A O'Hagan
- Public Health England Centre for Radiation, Chemical and Environmental Hazards, Chilton, UK
| | - Ghassan B Hamra
- Department of Environmental and Occupational Health, Drexel University School of Public Health, Philadelphia, PA, USA
| | - Richard Haylock
- Public Health England Centre for Radiation, Chemical and Environmental Hazards, Chilton, UK
| | - Dominique Laurier
- Institut de Radioprotection et de Sûreté Nucléaire, Fontenay-aux-Roses, France
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Schubauer-Berigan MK, Daniels RD, Bertke SJ, Tseng CY, Richardson DB. Cancer Mortality through 2005 among a Pooled Cohort of U.S. Nuclear Workers Exposed to External Ionizing Radiation. Radiat Res 2015; 183:620-31. [DOI: 10.1667/rr13988.1] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Mary K. Schubauer-Berigan
- National Institute for Occupational Safety and Health, Division of Surveillance, Hazard Evaluations, and Field Studies, Cincinnati, Ohio; and
| | - Robert D. Daniels
- National Institute for Occupational Safety and Health, Division of Surveillance, Hazard Evaluations, and Field Studies, Cincinnati, Ohio; and
| | - Stephen J. Bertke
- National Institute for Occupational Safety and Health, Division of Surveillance, Hazard Evaluations, and Field Studies, Cincinnati, Ohio; and
| | - Chih-Yu Tseng
- National Institute for Occupational Safety and Health, Division of Surveillance, Hazard Evaluations, and Field Studies, Cincinnati, Ohio; and
| | - David B. Richardson
- University of North Carolina School of Public Health, Department of Epidemiology, Chapel Hill, North Carolina
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Daniels RD, Bertke S, Dahm MM, Yiin JH, Kubale TL, Hales TR, Baris D, Zahm SH, Beaumont JJ, Waters KM, Pinkerton LE. Exposure-response relationships for select cancer and non-cancer health outcomes in a cohort of U.S. firefighters from San Francisco, Chicago and Philadelphia (1950-2009). Occup Environ Med 2015; 72:699-706. [PMID: 25673342 DOI: 10.1136/oemed-2014-102671] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Accepted: 01/26/2015] [Indexed: 02/06/2023]
Abstract
OBJECTIVES To examine exposure-response relationships between surrogates of firefighting exposure and select outcomes among previously studied US career firefighters. METHODS Eight cancer and four non-cancer outcomes were examined using conditional logistic regression. Incidence density sampling was used to match each case to 200 controls on attained age. Days accrued in firefighting assignments (exposed-days), run totals (fire-runs) and run times (fire-hours) were used as exposure surrogates. HRs comparing 75th and 25th centiles of lagged cumulative exposures were calculated using loglinear, linear, log-quadratic, power and restricted cubic spline general relative risk models. Piecewise constant models were used to examine risk differences by time since exposure, age at exposure and calendar period. RESULTS Among 19,309 male firefighters eligible for the study, there were 1333 cancer deaths and 2609 cancer incidence cases. Significant positive associations between fire-hours and lung cancer mortality and incidence were evident. A similar relation between leukaemia mortality and fire-runs was also found. The lung cancer associations were nearly linear in cumulative exposure, while the association with leukaemia mortality was attenuated at higher exposure levels and greater for recent exposures. Significant negative associations were evident for the exposure surrogates and colorectal and prostate cancers, suggesting a healthy worker survivor effect possibly enhanced by medical screening. CONCLUSIONS Lung cancer and leukaemia mortality risks were modestly increasing with firefighter exposures. These findings add to evidence of a causal association between firefighting and cancer. Nevertheless, small effects merit cautious interpretation. We plan to continue to follow the occurrence of disease and injury in this cohort.
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Affiliation(s)
- Robert D Daniels
- Division of Surveillance, Hazard Evaluations, and Field Studies, National Institute for Occupational Safety and Health, Cincinnati, Ohio, USA
| | - Stephen Bertke
- Division of Surveillance, Hazard Evaluations, and Field Studies, National Institute for Occupational Safety and Health, Cincinnati, Ohio, USA
| | - Matthew M Dahm
- Division of Surveillance, Hazard Evaluations, and Field Studies, National Institute for Occupational Safety and Health, Cincinnati, Ohio, USA
| | - James H Yiin
- Division of Surveillance, Hazard Evaluations, and Field Studies, National Institute for Occupational Safety and Health, Cincinnati, Ohio, USA
| | - Travis L Kubale
- Division of Surveillance, Hazard Evaluations, and Field Studies, National Institute for Occupational Safety and Health, Cincinnati, Ohio, USA
| | - Thomas R Hales
- Division of Surveillance, Hazard Evaluations, and Field Studies, National Institute for Occupational Safety and Health, Cincinnati, Ohio, USA
| | - Dalsu Baris
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Gaithersburg, Maryland, USA
| | - Shelia H Zahm
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Gaithersburg, Maryland, USA
| | - James J Beaumont
- UC Davis Department of Public Health Sciences, University of California Davis, Davis, California, USA
| | - Kathleen M Waters
- Division of Surveillance, Hazard Evaluations, and Field Studies, National Institute for Occupational Safety and Health, Cincinnati, Ohio, USA
| | - Lynne E Pinkerton
- Division of Surveillance, Hazard Evaluations, and Field Studies, National Institute for Occupational Safety and Health, Cincinnati, Ohio, USA
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Hamra GB, MacLehose R, Richardson D, Bertke S, Daniels RD. Modelling complex mixtures in epidemiologic analysis: additive versus relative measures for differential effectiveness. Occup Environ Med 2013; 71:141-6. [DOI: 10.1136/oemed-2013-101665] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Daniels RD, Kubale TL, Yiin JH, Dahm MM, Hales TR, Baris D, Zahm SH, Beaumont JJ, Waters KM, Pinkerton LE. Mortality and cancer incidence in a pooled cohort of US firefighters from San Francisco, Chicago and Philadelphia (1950-2009). Occup Environ Med 2013; 71:388-97. [PMID: 24142974 DOI: 10.1136/oemed-2013-101662] [Citation(s) in RCA: 196] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To examine mortality patterns and cancer incidence in a pooled cohort of 29 993 US career firefighters employed since 1950 and followed through 2009. METHODS Mortality and cancer incidence were evaluated by life table methods with the US population referent. Standardised mortality (SMR) and incidence (SIR) ratios were determined for 92 causes of death and 41 cancer incidence groupings. Analyses focused on 15 outcomes of a priori interest. Sensitivity analyses were conducted to examine the potential for significant bias. RESULTS Person-years at risk totalled 858 938 and 403 152 for mortality and incidence analyses, respectively. All-cause mortality was at expectation (SMR=0.99, 95% CI 0.97 to 1.01, n=12 028). There was excess cancer mortality (SMR=1.14, 95% CI 1.10 to 1.18, n=3285) and incidence (SIR=1.09, 95% CI 1.06 to 1.12, n=4461) comprised mainly of digestive (SMR=1.26, 95% CI 1.18 to 1.34, n=928; SIR=1.17, 95% CI 1.10 to 1.25, n=930) and respiratory (SMR=1.10, 95% CI 1.04 to 1.17, n=1096; SIR=1.16, 95% CI 1.08 to 1.24, n=813) cancers. Consistent with previous reports, modest elevations were observed in several solid cancers; however, evidence of excess lymphatic or haematopoietic cancers was lacking. This study is the first to report excess malignant mesothelioma (SMR=2.00, 95% CI 1.03 to 3.49, n=12; SIR=2.29, 95% CI 1.60 to 3.19, n=35) among US firefighters. Results appeared robust under differing assumptions and analytic techniques. CONCLUSIONS Our results provide evidence of a relation between firefighting and cancer. The new finding of excess malignant mesothelioma is noteworthy, given that asbestos exposure is a known hazard of firefighting.
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Affiliation(s)
- Robert D Daniels
- Division of Surveillance, Hazard Evaluations, and Field Studies, National Institute for Occupational Safety and Health, Cincinnati, Ohio, USA
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Silver SR, Bertke SJ, Hein MJ, Daniels RD, Fleming DA, Anderson JL, Pinney SM, Hornung RW, Tseng CY. Mortality and ionising radiation exposures among workers employed at the Fernald Feed Materials Production Center (1951-1985). Occup Environ Med 2013; 70:453-63. [PMID: 23322915 PMCID: PMC4553946 DOI: 10.1136/oemed-2012-100768] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [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: 11/04/2022]
Abstract
OBJECTIVES To examine mortality patterns and dose-response relations between ionising radiation and mortality outcomes of a priori interest in 6409 uranium workers employed for at least 30 days (1951-1985), and followed through 2004. METHODS Cohort mortality was evaluated through standardised mortality ratios (SMR). Linear excess relative risk (ERR) regression models examined associations between cause-specific mortality and exposures to internal ionising radiation from uranium deposition, external gamma and x-ray radiation, and radon decay products, while adjusting for non-radiologic covariates. RESULTS Person-years at risk totalled 236 568 (mean follow-up 37 years), and 43% of the cohort had died. All-cause mortality was below expectation only in salaried workers. Cancer mortality was significantly elevated in hourly males, primarily from excess lung cancer (SMR=1.25, 95% CI 1.09 to 1.42). Cancer mortality in salaried males was near expectation, but lymphohaematopoietic malignancies were significantly elevated (SMR=1.52, 95% CI 1.06 to 2.12). A positive dose-response relation was observed for intestinal cancer, with a significant elevation in the highest internal organ dose category and a significant dose-response with organ dose from internal uranium deposition (ERR=1.5 per 100 μGy, 95% CI 0.12 to 4.1). CONCLUSIONS A healthy worker effect was observed only in salaried workers. Hourly workers had excess cancer mortality compared with the US population, although there was little evidence of a dose-response trend for any cancer evaluated except intestinal cancer. The association between non-malignant respiratory disease and radiation dose observed in previous studies was not apparent, possibly due to improved exposure assessment, different outcome groupings, and extended follow-up.
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Affiliation(s)
- Sharon R Silver
- Division of Surveillance, Hazard Evaluations, and Field Studies, National Institute for Occupational Safety and Health, Cincinnati, OH 45226, USA.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Anderson JL, Daniels RD, Fleming DA, Tseng CY. Exposure assessment for a cohort of workers at a former uranium processing facility. J Expo Sci Environ Epidemiol 2012; 22:324-330. [PMID: 22534696 DOI: 10.1038/jes.2012.20] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2011] [Accepted: 02/06/2012] [Indexed: 05/31/2023]
Abstract
Exposure was assessed for a cohort of 6409 workers at a former uranium processing facility as part of a mortality study. Workers at the facility had potential for exposure to a wide variety of radiological and chemical agents including uranium, thorium, radon, external ionizing radiation, acid mists, asbestos, and various solvents. Organ dose from internal exposure to uranium was assessed, along with dose from external ionizing radiation and exposure to radon. Qualitative assessment of exposure to thorium, acid mists, asbestos, coal dust, welding fumes, and other chemicals was also performed. Mean cumulative organ dose from internal uranium exposure ranged from 1.1 mGy (lung) to 6.7 μGy (pancreas). Mean cumulative external ionizing radiation dose was 13.4 mGy. Mean cumulative radon exposure was 26 working level months (WLMs). The chemical agents to which the largest numbers of study subjects were exposed were acid mists, machining fluids, and a tributyl phosphate/kerosene mixture used in the refining process.
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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), Cincinnati, OH, USA.
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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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Yiin JH, Anderson JL, Daniels RD. Response to U.S. NRC comments. Radiat Res 2010. [DOI: 10.1667/rr1958.1.r] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Yiin JH, Anderson JL, Daniels RD, Seel EA, Fleming DA, Waters KM, Chen PH. A Nested Case-Control Study of Multiple Myeloma Risk and Uranium Exposure among Workers at the Oak Ridge Gaseous Diffusion Plant. Radiat Res 2009; 171:637-45. [DOI: 10.1667/rr1607.1] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Schubauer-Berigan MK, Daniels RD, Pinkerton LE. Radon exposure and mortality among white and American Indian uranium miners: an update of the Colorado Plateau cohort. Am J Epidemiol 2009; 169:718-30. [PMID: 19208723 DOI: 10.1093/aje/kwn406] [Citation(s) in RCA: 102] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Studies of uranium miners on the US Colorado Plateau have identified associations between exposure to radon progeny and risk of lung cancer. This study added 15 years of mortality follow-up for the 4,137 miners (primarily white or American Indian) in the Colorado Plateau cohort. The cohort experienced 209 new lung cancer deaths. For white miners, the standardized mortality ratio for lung cancer compared with the regional population was 3.99 (95% confidence interval: 3.43, 4.62) for the period 1991-2005. For American Indian miners, the lung cancer standardized mortality ratio was 3.27 (95% confidence interval: 2.19, 4.73). These standardized mortality ratios have not declined substantially since the 1980s. Internally standardized rate ratios by radon exposure category over the entire follow-up period are similar to those based on earlier follow-up, although estimates within smoking categories demonstrated improved precision. The apparent interaction between radon and smoking in causing lung cancer remains submultiplicative but greater than additive. Mortality rates from silicosis remain highly elevated in the cohort. Elevated mortality rates were observed from interstitial pulmonary fibrosis, multiple myeloma, and non-Hodgkin lymphoma. Significant trends were observed with increased radon exposure in silicosis and pulmonary fibrosis mortality and in the incidence of diabetes-related end-stage renal disease among white miners.
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