The 15-Country Collaborative Study of Cancer Risk among Radiation Workers in the Nuclear Industry: Estimates of Radiation-Related Cancer Risks

E. Cardis; M. Vrijheid; M. Blettner; E. Gilbert; M. Hakama; C. Hill; G. Howe; J. Kaldor; C. R. Muirhead; M. Schubauer-Berigan; T. Yoshimura; F. Bermann; G. Cowper; J. Fix; C. Hacker; B. Heinmiller; M. Marshall; I. Thierry-Chef; D. Utterback; Y-O. Ahn; E. Amoros; P. Ashmore; A. Auvinen; J-M. Bae; J. Bernar; A. Biau; E. Combalot; P. Deboodt; A. Diez Sacristan; M. Eklöf; H. Engels; G. Engholm; G. Gulis; R. R. Habib; K. Holan; H. Hyvonen; A. Kerekes; J. Kurtinaitis; H. Malker; M. Martuzzi; A. Mastauskas; A. Monnet; M. Moser; M. S. Pearce; D. B. Richardson; F. Rodriguez-Artalejo; A. Rogel; H. Tardy; M. Telle-Lamberton; I. Turai; M. Usel; K. Veress

doi:10.1667/RR0553.1

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1 April 2007 The 15-Country Collaborative Study of Cancer Risk among Radiation Workers in the Nuclear Industry: Estimates of Radiation-Related Cancer Risks

E. Cardis, M. Vrijheid, M. Blettner, E. Gilbert, M. Hakama, C. Hill, G. Howe, J. Kaldor, C. R. Muirhead, M. Schubauer-Berigan, T. Yoshimura, F. Bermann, G. Cowper, J. Fix, C. Hacker, B. Heinmiller, M. Marshall, I. Thierry-Chef, D. Utterback, Y-O. Ahn, E. Amoros, P. Ashmore, A. Auvinen, J-M. Bae, J. Bernar, A. Biau, E. Combalot, P. Deboodt, A. Diez Sacristan, M. Eklöf, H. Engels, G. Engholm, G. Gulis, R. R. Habib, K. Holan, H. Hyvonen, A. Kerekes, J. Kurtinaitis, H. Malker, M. Martuzzi, A. Mastauskas, A. Monnet, M. Moser, M. S. Pearce, D. B. Richardson, F. Rodriguez-Artalejo, A. Rogel, H. Tardy, M. Telle-Lamberton, I. Turai, M. Usel, K. Veress

Author Affiliations +

E. Cardis,^1,* M. Vrijheid,¹ M. Blettner,² E. Gilbert,³ M. Hakama,^4,5 C. Hill,⁶ G. Howe,⁷ J. Kaldor,⁸ C. R. Muirhead,⁹ M. Schubauer-Berigan,¹⁰ T. Yoshimura,¹¹ F. Bermann,¹² G. Cowper,¹³ J. Fix,¹⁴ C. Hacker,¹⁵ B. Heinmiller,¹⁶ M. Marshall,¹⁷ I. Thierry-Chef,¹ D. Utterback,¹⁰ Y-O. Ahn,¹⁸ E. Amoros,¹ P. Ashmore,¹⁹ A. Auvinen,^4,20 J-M. Bae,²¹ J. Bernar,²² A. Biau,²³ E. Combalot,¹ P. Deboodt,²⁴ A. Diez Sacristan,²⁵ M. Eklöf,²⁶ H. Engels,²⁷ G. Engholm,²⁸ G. Gulis,²⁹ R. R. Habib,³⁰ K. Holan,³¹ H. Hyvonen,²⁰ A. Kerekes,³² J. Kurtinaitis,³³ H. Malker,³⁴ M. Martuzzi,³⁵ A. Mastauskas,³⁶ A. Monnet,³⁷ M. Moser,³⁸ M. S. Pearce,³⁹ D. B. Richardson,⁴⁰ F. Rodriguez-Artalejo,⁴¹ A. Rogel,⁴² H. Tardy,¹ M. Telle-Lamberton,⁴³ I. Turai,³² M. Usel,⁴⁴ K. Veress⁴⁵

¹aInternational Agency for Research on Cancer, Lyon, France
²bInstitut für Medizinische Biometrie, University of Mainz, Germany
³cRadiation Epidemiology Branch, Division of Epidemiology and Genetics, National Cancer Institute, Be
⁴dUniversity of Tampere, Tampere, Finland
⁵eFinnish Cancer Registry, Helsinki, Finland
⁶fInstitut Gustave-Roussy, Villejuif, France
⁷gDepartment of Epidemiology, Mailman School of Public Health, Columbia University, New York, New Yor
⁸hNational Centre in HIV Epidemiology and Clinical Research, Sydney, Australia
⁹iRadiation Protection Division, Health Protection Agency, Chilton, Didcot, United Kingdom
¹⁰jNational Institute for Occupational Safety and Health, Cincinnati, Ohio
¹¹kDepartment of Clinical Epidemiology, Institute of Industrial Ecological Sciences, University of Occ
¹²lConseiller Médical du CEA, Paris, France
¹³mAtomic Energy Commission of Canada, Deep River, Ontario, Canada (deceased)
¹⁴nDade Moeller & Associates, Richland, Washington
¹⁵oRadiation Protection Services, Safety and Radiation Science, Australian Nuclear Science and Technol
¹⁶pAECL Radiation Biology and Health Physics Branch, Chalk River Laboratories, Ontario, Canada
¹⁷qTwin Trees, Besselslea Road, Blewbury, Didcot, United Kingdom
¹⁸rDepartment of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea
¹⁹sRadiation Protection Bureau, Health Canada, Ottawa, Canada, currently at McLaughlin Centre for Popu
²⁰tSTUK—Radiation and Nuclear Safety Authority, Helsinki, Finland
²¹uDepartment of Preventive Medicine, Cheju National University College of Medicine, Chejudo, Korea
²²vUNESA, Madrid, Spain
²³wInstitut de Radioprotection et de Sûreté Nucléaire DESTQ/DEAS, Le Vésinet, France
²⁴xThe Nuclear Research Centre (SCK.CEN), Radiation Protection Division, Mol, Belgium; currently at IA
²⁵yConsejo de Seguridad Nuclear, Madrid, Spain
²⁶zStatens Vattenfallsverk Forsmark, Osthammer, Sweden
²⁷The Nuclear Research Centre (SCK.CEN), Radiation Protection Division, Mol, Belgium and the Federal A
²⁸National Board of Health and Welfare, Stockholm, Sweden
²⁹Department of Hygiene and Epidemiology, Faculty of Health Care and Social Work, Trnava University, D
³⁰Faculty of Health Sciences, American University of Beirut, Lebanon
³¹Slovenske Elektrárne a.s., Bratislava, Slovak Republic
³²National “Frederic Joliot-Curie” Research Institute for Radiobiology and Radiohygiene of the Nationa
³³Lithuanian Cancer Registry, Vilnius University Oncology Institute, Vilnius, Lithuania
³⁴Midsweden Research and Development Center, Sundsvall Hospital, Sundsvall, Sweden
³⁵WHO European Centre for Environment and Health, Rome, Italy
³⁶Radiation Protection Center, Vilnius, Lithuania
³⁷Serono International S.A., Geneva, Switzerland
³⁸Federal Office of Public Health, Bern, Switzerland
³⁹Paediatric and Lifecourse Epidemiology Research Group, School of Clinical Medical Sciences, Universi
⁴⁰Department of Epidemiology, School of Public Health, Chapel Hill, North Carolina
⁴¹Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autonoma de Mad
⁴²Service Central d'Appui en Santé au travail, Electricité de France, Paris, France
⁴³Institut de Radioprotection et de Sûreté Nucléaire, Fontenay-aux-Roses, France
⁴⁴Medical Inspectorate of Factories, Geneva, Switzerland
⁴⁵Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, Budapest, Hungary

^*Address for correspondence: International Agency for Research on Cancer, 150, Cours Albert Thomas, 69372 Lyon Cedex 08, France; cardis@iarc.fr

Radiation Research, 167(4):396-416 (2007). https://doi.org/10.1667/RR0553.1

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Abstract

Cardis, E., Vrijheid, M., Blettner, M., Gilbert, E., Hakama, M., Hill, C., Howe, G., Kaldor, J., Muirhead, C. R., Schubauer-Berigan, M., Yoshimura, T., Bermann, F., Cowper, G., Fix, J., Hacker, C., Heinmiller, B., Marshall, M., Thierry-Chef, I., Utterback, D., Ahn, Y-O., Amoros, E., Ashmore, P., Auvinen, A., Bae, J-M., Bernar, J. S., Biau, A., Combalot, E., Deboodt, P., Diez Sacristan, A., Eklöf, M., Engels, H., Engholm, G., Gulis, G., Habib, R. R., Holan, K., Hyvonen, H., Kerekes, A., Kurtinaitis, J., Malker, H., Martuzzi, M., Mastauskas, A., Monnet, A., Moser, M., Pearce, M. S., Richardson, D. B., Rodriguez-Artalejo, F., Rogel, A., Tardy, H., Telle-Lamberton, M., Turai, I., Usel, M. and Veress, K. The 15-Country Collaborative Study of Cancer Risk among Radiation Workers in the Nuclear Industry: Estimates of Radiation-Related Cancer Risks. Radiat. Res. 167, 396– 416 (2007).

A 15-Country collaborative cohort study was conducted to provide direct estimates of cancer risk following protracted low doses of ionizing radiation. Analyses included 407,391 nuclear industry workers monitored individually for external radiation and 5.2 million person-years of follow-up. A significant association was seen between radiation dose and all-cause mortality [excess relative risk (ERR) 0.42 per Sv, 90% CI 0.07, 0.79; 18,993 deaths]. This was mainly attributable to a dose-related increase in all cancer mortality (ERR/Sv 0.97, 90% CI 0.28, 1.77; 5233 deaths). Among 31 specific types of malignancies studied, a significant association was found for lung cancer (ERR/Sv 1.86, 90% CI 0.49, 3.63; 1457 deaths) and a borderline significant (P = 0.06) association for multiple myeloma (ERR/Sv 6.15, 90% CI <0, 20.6; 83 deaths) and ill-defined and secondary cancers (ERR/Sv 1.96, 90% CI −0.26, 5.90; 328 deaths). Stratification on duration of employment had a large effect on the ERR/Sv, reflecting a strong healthy worker survivor effect in these cohorts. This is the largest analytical epidemiological study of the effects of low-dose protracted exposures to ionizing radiation to date. Further studies will be important to better assess the role of tobacco and other occupational exposures in our risk estimates.

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