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2015 ; 351
(ä): h5359
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Risk of cancer from occupational exposure to ionising radiation: retrospective
cohort study of workers in France, the United Kingdom, and the United States
(INWORKS)
#MMPMID26487649
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
BMJ
2015[Oct]; 351
(ä): h5359
PMID26487649
show ga
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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