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Grellier J, Atkinson W, Bérard P, Bingham D, Birchall A, Blanchardon E, Bull R, Guseva Canu I, Challeton-de Vathaire C, Cockerill R, Do MT, Engels H, Figuerola J, Foster A, Holmstock L, Hurtgen C, Laurier D, Puncher M, Riddell AE, Samson E, Thierry-Chef I, Tirmarche M, Vrijheid M, Cardis E. Risk of Lung Cancer Mortality in Nuclear Workers from Internal Exposure to Alpha Particle-emitting Radionuclides. Epidemiology 2017; 28:675-684. [PMID: 28520643 PMCID: PMC5540354 DOI: 10.1097/ede.0000000000000684] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Accepted: 05/15/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Carcinogenic risks of internal exposures to alpha-emitters (except radon) are poorly understood. Since exposure to alpha particles-particularly through inhalation-occurs in a range of settings, understanding consequent risks is a public health priority. We aimed to quantify dose-response relationships between lung dose from alpha-emitters and lung cancer in nuclear workers. METHODS We conducted a case-control study, nested within Belgian, French, and UK cohorts of uranium and plutonium workers. Cases were workers who died from lung cancer; one to three controls were matched to each. Lung doses from alpha-emitters were assessed using bioassay data. We estimated excess odds ratio (OR) of lung cancer per gray (Gy) of lung dose. RESULTS The study comprised 553 cases and 1,333 controls. Median positive total alpha lung dose was 2.42 mGy (mean: 8.13 mGy; maximum: 316 mGy); for plutonium the median was 1.27 mGy and for uranium 2.17 mGy. Excess OR/Gy (90% confidence interval)-adjusted for external radiation, socioeconomic status, and smoking-was 11 (2.6, 24) for total alpha dose, 50 (17, 106) for plutonium, and 5.3 (-1.9, 18) for uranium. CONCLUSIONS We found strong evidence for associations between low doses from alpha-emitters and lung cancer risk. The excess OR/Gy was greater for plutonium than uranium, though confidence intervals overlap. Risk estimates were similar to those estimated previously in plutonium workers, and in uranium miners exposed to radon and its progeny. Expressed as risk/equivalent dose in sieverts (Sv), our estimates are somewhat larger than but consistent with those for atomic bomb survivors.See video abstract at, http://links.lww.com/EDE/B232.
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Affiliation(s)
- James Grellier
- From the ISGlobal, Centre for Research in Environmental Epidemiology, Barcelona, Spain; Universitat Pompeu Fabra, Barcelona, Spain; CIBER Epidemiología y Salud Pública, Madrid, Spain; Department of Epidemiology and Biostatistics, Imperial College, London, United Kingdom; Nuvia Limited, Didcot, United Kingdom; Commissariat à l’Energie Atomique, Fontenay-aux-Roses, France; Atomic Weapons Establishment, Aldermaston, United Kingdom; Public Health England, Didcot & Moor Row, United Kingdom; Institut de Radioprotection et de Sûreté Nucléaire, Fontenay-aux-Roses, France; Institut de Veille Sanitaire, Saint Maurice, France; Occupational Cancer Research Centre, Toronto, ON, Canada; Studiecentrum voor Kernenergie • Centre d’Étude de l’énergie Nucléaire, Mol, Belgium; UK Atomic Energy Authority, Culham, United Kingdom; Autorité de Sûreté Nucléaire, Paris, France; and International Agency for Research on Cancer, Lyon, France
| | - Will Atkinson
- From the ISGlobal, Centre for Research in Environmental Epidemiology, Barcelona, Spain; Universitat Pompeu Fabra, Barcelona, Spain; CIBER Epidemiología y Salud Pública, Madrid, Spain; Department of Epidemiology and Biostatistics, Imperial College, London, United Kingdom; Nuvia Limited, Didcot, United Kingdom; Commissariat à l’Energie Atomique, Fontenay-aux-Roses, France; Atomic Weapons Establishment, Aldermaston, United Kingdom; Public Health England, Didcot & Moor Row, United Kingdom; Institut de Radioprotection et de Sûreté Nucléaire, Fontenay-aux-Roses, France; Institut de Veille Sanitaire, Saint Maurice, France; Occupational Cancer Research Centre, Toronto, ON, Canada; Studiecentrum voor Kernenergie • Centre d’Étude de l’énergie Nucléaire, Mol, Belgium; UK Atomic Energy Authority, Culham, United Kingdom; Autorité de Sûreté Nucléaire, Paris, France; and International Agency for Research on Cancer, Lyon, France
| | - Philippe Bérard
- From the ISGlobal, Centre for Research in Environmental Epidemiology, Barcelona, Spain; Universitat Pompeu Fabra, Barcelona, Spain; CIBER Epidemiología y Salud Pública, Madrid, Spain; Department of Epidemiology and Biostatistics, Imperial College, London, United Kingdom; Nuvia Limited, Didcot, United Kingdom; Commissariat à l’Energie Atomique, Fontenay-aux-Roses, France; Atomic Weapons Establishment, Aldermaston, United Kingdom; Public Health England, Didcot & Moor Row, United Kingdom; Institut de Radioprotection et de Sûreté Nucléaire, Fontenay-aux-Roses, France; Institut de Veille Sanitaire, Saint Maurice, France; Occupational Cancer Research Centre, Toronto, ON, Canada; Studiecentrum voor Kernenergie • Centre d’Étude de l’énergie Nucléaire, Mol, Belgium; UK Atomic Energy Authority, Culham, United Kingdom; Autorité de Sûreté Nucléaire, Paris, France; and International Agency for Research on Cancer, Lyon, France
| | - Derek Bingham
- From the ISGlobal, Centre for Research in Environmental Epidemiology, Barcelona, Spain; Universitat Pompeu Fabra, Barcelona, Spain; CIBER Epidemiología y Salud Pública, Madrid, Spain; Department of Epidemiology and Biostatistics, Imperial College, London, United Kingdom; Nuvia Limited, Didcot, United Kingdom; Commissariat à l’Energie Atomique, Fontenay-aux-Roses, France; Atomic Weapons Establishment, Aldermaston, United Kingdom; Public Health England, Didcot & Moor Row, United Kingdom; Institut de Radioprotection et de Sûreté Nucléaire, Fontenay-aux-Roses, France; Institut de Veille Sanitaire, Saint Maurice, France; Occupational Cancer Research Centre, Toronto, ON, Canada; Studiecentrum voor Kernenergie • Centre d’Étude de l’énergie Nucléaire, Mol, Belgium; UK Atomic Energy Authority, Culham, United Kingdom; Autorité de Sûreté Nucléaire, Paris, France; and International Agency for Research on Cancer, Lyon, France
| | - Alan Birchall
- From the ISGlobal, Centre for Research in Environmental Epidemiology, Barcelona, Spain; Universitat Pompeu Fabra, Barcelona, Spain; CIBER Epidemiología y Salud Pública, Madrid, Spain; Department of Epidemiology and Biostatistics, Imperial College, London, United Kingdom; Nuvia Limited, Didcot, United Kingdom; Commissariat à l’Energie Atomique, Fontenay-aux-Roses, France; Atomic Weapons Establishment, Aldermaston, United Kingdom; Public Health England, Didcot & Moor Row, United Kingdom; Institut de Radioprotection et de Sûreté Nucléaire, Fontenay-aux-Roses, France; Institut de Veille Sanitaire, Saint Maurice, France; Occupational Cancer Research Centre, Toronto, ON, Canada; Studiecentrum voor Kernenergie • Centre d’Étude de l’énergie Nucléaire, Mol, Belgium; UK Atomic Energy Authority, Culham, United Kingdom; Autorité de Sûreté Nucléaire, Paris, France; and International Agency for Research on Cancer, Lyon, France
| | - Eric Blanchardon
- From the ISGlobal, Centre for Research in Environmental Epidemiology, Barcelona, Spain; Universitat Pompeu Fabra, Barcelona, Spain; CIBER Epidemiología y Salud Pública, Madrid, Spain; Department of Epidemiology and Biostatistics, Imperial College, London, United Kingdom; Nuvia Limited, Didcot, United Kingdom; Commissariat à l’Energie Atomique, Fontenay-aux-Roses, France; Atomic Weapons Establishment, Aldermaston, United Kingdom; Public Health England, Didcot & Moor Row, United Kingdom; Institut de Radioprotection et de Sûreté Nucléaire, Fontenay-aux-Roses, France; Institut de Veille Sanitaire, Saint Maurice, France; Occupational Cancer Research Centre, Toronto, ON, Canada; Studiecentrum voor Kernenergie • Centre d’Étude de l’énergie Nucléaire, Mol, Belgium; UK Atomic Energy Authority, Culham, United Kingdom; Autorité de Sûreté Nucléaire, Paris, France; and International Agency for Research on Cancer, Lyon, France
| | - Richard Bull
- From the ISGlobal, Centre for Research in Environmental Epidemiology, Barcelona, Spain; Universitat Pompeu Fabra, Barcelona, Spain; CIBER Epidemiología y Salud Pública, Madrid, Spain; Department of Epidemiology and Biostatistics, Imperial College, London, United Kingdom; Nuvia Limited, Didcot, United Kingdom; Commissariat à l’Energie Atomique, Fontenay-aux-Roses, France; Atomic Weapons Establishment, Aldermaston, United Kingdom; Public Health England, Didcot & Moor Row, United Kingdom; Institut de Radioprotection et de Sûreté Nucléaire, Fontenay-aux-Roses, France; Institut de Veille Sanitaire, Saint Maurice, France; Occupational Cancer Research Centre, Toronto, ON, Canada; Studiecentrum voor Kernenergie • Centre d’Étude de l’énergie Nucléaire, Mol, Belgium; UK Atomic Energy Authority, Culham, United Kingdom; Autorité de Sûreté Nucléaire, Paris, France; and International Agency for Research on Cancer, Lyon, France
| | - Irina Guseva Canu
- From the ISGlobal, Centre for Research in Environmental Epidemiology, Barcelona, Spain; Universitat Pompeu Fabra, Barcelona, Spain; CIBER Epidemiología y Salud Pública, Madrid, Spain; Department of Epidemiology and Biostatistics, Imperial College, London, United Kingdom; Nuvia Limited, Didcot, United Kingdom; Commissariat à l’Energie Atomique, Fontenay-aux-Roses, France; Atomic Weapons Establishment, Aldermaston, United Kingdom; Public Health England, Didcot & Moor Row, United Kingdom; Institut de Radioprotection et de Sûreté Nucléaire, Fontenay-aux-Roses, France; Institut de Veille Sanitaire, Saint Maurice, France; Occupational Cancer Research Centre, Toronto, ON, Canada; Studiecentrum voor Kernenergie • Centre d’Étude de l’énergie Nucléaire, Mol, Belgium; UK Atomic Energy Authority, Culham, United Kingdom; Autorité de Sûreté Nucléaire, Paris, France; and International Agency for Research on Cancer, Lyon, France
| | - Cécile Challeton-de Vathaire
- From the ISGlobal, Centre for Research in Environmental Epidemiology, Barcelona, Spain; Universitat Pompeu Fabra, Barcelona, Spain; CIBER Epidemiología y Salud Pública, Madrid, Spain; Department of Epidemiology and Biostatistics, Imperial College, London, United Kingdom; Nuvia Limited, Didcot, United Kingdom; Commissariat à l’Energie Atomique, Fontenay-aux-Roses, France; Atomic Weapons Establishment, Aldermaston, United Kingdom; Public Health England, Didcot & Moor Row, United Kingdom; Institut de Radioprotection et de Sûreté Nucléaire, Fontenay-aux-Roses, France; Institut de Veille Sanitaire, Saint Maurice, France; Occupational Cancer Research Centre, Toronto, ON, Canada; Studiecentrum voor Kernenergie • Centre d’Étude de l’énergie Nucléaire, Mol, Belgium; UK Atomic Energy Authority, Culham, United Kingdom; Autorité de Sûreté Nucléaire, Paris, France; and International Agency for Research on Cancer, Lyon, France
| | - Rupert Cockerill
- From the ISGlobal, Centre for Research in Environmental Epidemiology, Barcelona, Spain; Universitat Pompeu Fabra, Barcelona, Spain; CIBER Epidemiología y Salud Pública, Madrid, Spain; Department of Epidemiology and Biostatistics, Imperial College, London, United Kingdom; Nuvia Limited, Didcot, United Kingdom; Commissariat à l’Energie Atomique, Fontenay-aux-Roses, France; Atomic Weapons Establishment, Aldermaston, United Kingdom; Public Health England, Didcot & Moor Row, United Kingdom; Institut de Radioprotection et de Sûreté Nucléaire, Fontenay-aux-Roses, France; Institut de Veille Sanitaire, Saint Maurice, France; Occupational Cancer Research Centre, Toronto, ON, Canada; Studiecentrum voor Kernenergie • Centre d’Étude de l’énergie Nucléaire, Mol, Belgium; UK Atomic Energy Authority, Culham, United Kingdom; Autorité de Sûreté Nucléaire, Paris, France; and International Agency for Research on Cancer, Lyon, France
| | - Minh T. Do
- From the ISGlobal, Centre for Research in Environmental Epidemiology, Barcelona, Spain; Universitat Pompeu Fabra, Barcelona, Spain; CIBER Epidemiología y Salud Pública, Madrid, Spain; Department of Epidemiology and Biostatistics, Imperial College, London, United Kingdom; Nuvia Limited, Didcot, United Kingdom; Commissariat à l’Energie Atomique, Fontenay-aux-Roses, France; Atomic Weapons Establishment, Aldermaston, United Kingdom; Public Health England, Didcot & Moor Row, United Kingdom; Institut de Radioprotection et de Sûreté Nucléaire, Fontenay-aux-Roses, France; Institut de Veille Sanitaire, Saint Maurice, France; Occupational Cancer Research Centre, Toronto, ON, Canada; Studiecentrum voor Kernenergie • Centre d’Étude de l’énergie Nucléaire, Mol, Belgium; UK Atomic Energy Authority, Culham, United Kingdom; Autorité de Sûreté Nucléaire, Paris, France; and International Agency for Research on Cancer, Lyon, France
| | - Hilde Engels
- From the ISGlobal, Centre for Research in Environmental Epidemiology, Barcelona, Spain; Universitat Pompeu Fabra, Barcelona, Spain; CIBER Epidemiología y Salud Pública, Madrid, Spain; Department of Epidemiology and Biostatistics, Imperial College, London, United Kingdom; Nuvia Limited, Didcot, United Kingdom; Commissariat à l’Energie Atomique, Fontenay-aux-Roses, France; Atomic Weapons Establishment, Aldermaston, United Kingdom; Public Health England, Didcot & Moor Row, United Kingdom; Institut de Radioprotection et de Sûreté Nucléaire, Fontenay-aux-Roses, France; Institut de Veille Sanitaire, Saint Maurice, France; Occupational Cancer Research Centre, Toronto, ON, Canada; Studiecentrum voor Kernenergie • Centre d’Étude de l’énergie Nucléaire, Mol, Belgium; UK Atomic Energy Authority, Culham, United Kingdom; Autorité de Sûreté Nucléaire, Paris, France; and International Agency for Research on Cancer, Lyon, France
| | - Jordi Figuerola
- From the ISGlobal, Centre for Research in Environmental Epidemiology, Barcelona, Spain; Universitat Pompeu Fabra, Barcelona, Spain; CIBER Epidemiología y Salud Pública, Madrid, Spain; Department of Epidemiology and Biostatistics, Imperial College, London, United Kingdom; Nuvia Limited, Didcot, United Kingdom; Commissariat à l’Energie Atomique, Fontenay-aux-Roses, France; Atomic Weapons Establishment, Aldermaston, United Kingdom; Public Health England, Didcot & Moor Row, United Kingdom; Institut de Radioprotection et de Sûreté Nucléaire, Fontenay-aux-Roses, France; Institut de Veille Sanitaire, Saint Maurice, France; Occupational Cancer Research Centre, Toronto, ON, Canada; Studiecentrum voor Kernenergie • Centre d’Étude de l’énergie Nucléaire, Mol, Belgium; UK Atomic Energy Authority, Culham, United Kingdom; Autorité de Sûreté Nucléaire, Paris, France; and International Agency for Research on Cancer, Lyon, France
| | - Adrian Foster
- From the ISGlobal, Centre for Research in Environmental Epidemiology, Barcelona, Spain; Universitat Pompeu Fabra, Barcelona, Spain; CIBER Epidemiología y Salud Pública, Madrid, Spain; Department of Epidemiology and Biostatistics, Imperial College, London, United Kingdom; Nuvia Limited, Didcot, United Kingdom; Commissariat à l’Energie Atomique, Fontenay-aux-Roses, France; Atomic Weapons Establishment, Aldermaston, United Kingdom; Public Health England, Didcot & Moor Row, United Kingdom; Institut de Radioprotection et de Sûreté Nucléaire, Fontenay-aux-Roses, France; Institut de Veille Sanitaire, Saint Maurice, France; Occupational Cancer Research Centre, Toronto, ON, Canada; Studiecentrum voor Kernenergie • Centre d’Étude de l’énergie Nucléaire, Mol, Belgium; UK Atomic Energy Authority, Culham, United Kingdom; Autorité de Sûreté Nucléaire, Paris, France; and International Agency for Research on Cancer, Lyon, France
| | - Luc Holmstock
- From the ISGlobal, Centre for Research in Environmental Epidemiology, Barcelona, Spain; Universitat Pompeu Fabra, Barcelona, Spain; CIBER Epidemiología y Salud Pública, Madrid, Spain; Department of Epidemiology and Biostatistics, Imperial College, London, United Kingdom; Nuvia Limited, Didcot, United Kingdom; Commissariat à l’Energie Atomique, Fontenay-aux-Roses, France; Atomic Weapons Establishment, Aldermaston, United Kingdom; Public Health England, Didcot & Moor Row, United Kingdom; Institut de Radioprotection et de Sûreté Nucléaire, Fontenay-aux-Roses, France; Institut de Veille Sanitaire, Saint Maurice, France; Occupational Cancer Research Centre, Toronto, ON, Canada; Studiecentrum voor Kernenergie • Centre d’Étude de l’énergie Nucléaire, Mol, Belgium; UK Atomic Energy Authority, Culham, United Kingdom; Autorité de Sûreté Nucléaire, Paris, France; and International Agency for Research on Cancer, Lyon, France
| | - Christian Hurtgen
- From the ISGlobal, Centre for Research in Environmental Epidemiology, Barcelona, Spain; Universitat Pompeu Fabra, Barcelona, Spain; CIBER Epidemiología y Salud Pública, Madrid, Spain; Department of Epidemiology and Biostatistics, Imperial College, London, United Kingdom; Nuvia Limited, Didcot, United Kingdom; Commissariat à l’Energie Atomique, Fontenay-aux-Roses, France; Atomic Weapons Establishment, Aldermaston, United Kingdom; Public Health England, Didcot & Moor Row, United Kingdom; Institut de Radioprotection et de Sûreté Nucléaire, Fontenay-aux-Roses, France; Institut de Veille Sanitaire, Saint Maurice, France; Occupational Cancer Research Centre, Toronto, ON, Canada; Studiecentrum voor Kernenergie • Centre d’Étude de l’énergie Nucléaire, Mol, Belgium; UK Atomic Energy Authority, Culham, United Kingdom; Autorité de Sûreté Nucléaire, Paris, France; and International Agency for Research on Cancer, Lyon, France
| | - Dominique Laurier
- From the ISGlobal, Centre for Research in Environmental Epidemiology, Barcelona, Spain; Universitat Pompeu Fabra, Barcelona, Spain; CIBER Epidemiología y Salud Pública, Madrid, Spain; Department of Epidemiology and Biostatistics, Imperial College, London, United Kingdom; Nuvia Limited, Didcot, United Kingdom; Commissariat à l’Energie Atomique, Fontenay-aux-Roses, France; Atomic Weapons Establishment, Aldermaston, United Kingdom; Public Health England, Didcot & Moor Row, United Kingdom; Institut de Radioprotection et de Sûreté Nucléaire, Fontenay-aux-Roses, France; Institut de Veille Sanitaire, Saint Maurice, France; Occupational Cancer Research Centre, Toronto, ON, Canada; Studiecentrum voor Kernenergie • Centre d’Étude de l’énergie Nucléaire, Mol, Belgium; UK Atomic Energy Authority, Culham, United Kingdom; Autorité de Sûreté Nucléaire, Paris, France; and International Agency for Research on Cancer, Lyon, France
| | - Matthew Puncher
- From the ISGlobal, Centre for Research in Environmental Epidemiology, Barcelona, Spain; Universitat Pompeu Fabra, Barcelona, Spain; CIBER Epidemiología y Salud Pública, Madrid, Spain; Department of Epidemiology and Biostatistics, Imperial College, London, United Kingdom; Nuvia Limited, Didcot, United Kingdom; Commissariat à l’Energie Atomique, Fontenay-aux-Roses, France; Atomic Weapons Establishment, Aldermaston, United Kingdom; Public Health England, Didcot & Moor Row, United Kingdom; Institut de Radioprotection et de Sûreté Nucléaire, Fontenay-aux-Roses, France; Institut de Veille Sanitaire, Saint Maurice, France; Occupational Cancer Research Centre, Toronto, ON, Canada; Studiecentrum voor Kernenergie • Centre d’Étude de l’énergie Nucléaire, Mol, Belgium; UK Atomic Energy Authority, Culham, United Kingdom; Autorité de Sûreté Nucléaire, Paris, France; and International Agency for Research on Cancer, Lyon, France
| | - Anthony E. Riddell
- From the ISGlobal, Centre for Research in Environmental Epidemiology, Barcelona, Spain; Universitat Pompeu Fabra, Barcelona, Spain; CIBER Epidemiología y Salud Pública, Madrid, Spain; Department of Epidemiology and Biostatistics, Imperial College, London, United Kingdom; Nuvia Limited, Didcot, United Kingdom; Commissariat à l’Energie Atomique, Fontenay-aux-Roses, France; Atomic Weapons Establishment, Aldermaston, United Kingdom; Public Health England, Didcot & Moor Row, United Kingdom; Institut de Radioprotection et de Sûreté Nucléaire, Fontenay-aux-Roses, France; Institut de Veille Sanitaire, Saint Maurice, France; Occupational Cancer Research Centre, Toronto, ON, Canada; Studiecentrum voor Kernenergie • Centre d’Étude de l’énergie Nucléaire, Mol, Belgium; UK Atomic Energy Authority, Culham, United Kingdom; Autorité de Sûreté Nucléaire, Paris, France; and International Agency for Research on Cancer, Lyon, France
| | - Eric Samson
- From the ISGlobal, Centre for Research in Environmental Epidemiology, Barcelona, Spain; Universitat Pompeu Fabra, Barcelona, Spain; CIBER Epidemiología y Salud Pública, Madrid, Spain; Department of Epidemiology and Biostatistics, Imperial College, London, United Kingdom; Nuvia Limited, Didcot, United Kingdom; Commissariat à l’Energie Atomique, Fontenay-aux-Roses, France; Atomic Weapons Establishment, Aldermaston, United Kingdom; Public Health England, Didcot & Moor Row, United Kingdom; Institut de Radioprotection et de Sûreté Nucléaire, Fontenay-aux-Roses, France; Institut de Veille Sanitaire, Saint Maurice, France; Occupational Cancer Research Centre, Toronto, ON, Canada; Studiecentrum voor Kernenergie • Centre d’Étude de l’énergie Nucléaire, Mol, Belgium; UK Atomic Energy Authority, Culham, United Kingdom; Autorité de Sûreté Nucléaire, Paris, France; and International Agency for Research on Cancer, Lyon, France
| | - Isabelle Thierry-Chef
- From the ISGlobal, Centre for Research in Environmental Epidemiology, Barcelona, Spain; Universitat Pompeu Fabra, Barcelona, Spain; CIBER Epidemiología y Salud Pública, Madrid, Spain; Department of Epidemiology and Biostatistics, Imperial College, London, United Kingdom; Nuvia Limited, Didcot, United Kingdom; Commissariat à l’Energie Atomique, Fontenay-aux-Roses, France; Atomic Weapons Establishment, Aldermaston, United Kingdom; Public Health England, Didcot & Moor Row, United Kingdom; Institut de Radioprotection et de Sûreté Nucléaire, Fontenay-aux-Roses, France; Institut de Veille Sanitaire, Saint Maurice, France; Occupational Cancer Research Centre, Toronto, ON, Canada; Studiecentrum voor Kernenergie • Centre d’Étude de l’énergie Nucléaire, Mol, Belgium; UK Atomic Energy Authority, Culham, United Kingdom; Autorité de Sûreté Nucléaire, Paris, France; and International Agency for Research on Cancer, Lyon, France
| | - Margot Tirmarche
- From the ISGlobal, Centre for Research in Environmental Epidemiology, Barcelona, Spain; Universitat Pompeu Fabra, Barcelona, Spain; CIBER Epidemiología y Salud Pública, Madrid, Spain; Department of Epidemiology and Biostatistics, Imperial College, London, United Kingdom; Nuvia Limited, Didcot, United Kingdom; Commissariat à l’Energie Atomique, Fontenay-aux-Roses, France; Atomic Weapons Establishment, Aldermaston, United Kingdom; Public Health England, Didcot & Moor Row, United Kingdom; Institut de Radioprotection et de Sûreté Nucléaire, Fontenay-aux-Roses, France; Institut de Veille Sanitaire, Saint Maurice, France; Occupational Cancer Research Centre, Toronto, ON, Canada; Studiecentrum voor Kernenergie • Centre d’Étude de l’énergie Nucléaire, Mol, Belgium; UK Atomic Energy Authority, Culham, United Kingdom; Autorité de Sûreté Nucléaire, Paris, France; and International Agency for Research on Cancer, Lyon, France
| | - Martine Vrijheid
- From the ISGlobal, Centre for Research in Environmental Epidemiology, Barcelona, Spain; Universitat Pompeu Fabra, Barcelona, Spain; CIBER Epidemiología y Salud Pública, Madrid, Spain; Department of Epidemiology and Biostatistics, Imperial College, London, United Kingdom; Nuvia Limited, Didcot, United Kingdom; Commissariat à l’Energie Atomique, Fontenay-aux-Roses, France; Atomic Weapons Establishment, Aldermaston, United Kingdom; Public Health England, Didcot & Moor Row, United Kingdom; Institut de Radioprotection et de Sûreté Nucléaire, Fontenay-aux-Roses, France; Institut de Veille Sanitaire, Saint Maurice, France; Occupational Cancer Research Centre, Toronto, ON, Canada; Studiecentrum voor Kernenergie • Centre d’Étude de l’énergie Nucléaire, Mol, Belgium; UK Atomic Energy Authority, Culham, United Kingdom; Autorité de Sûreté Nucléaire, Paris, France; and International Agency for Research on Cancer, Lyon, France
| | - Elisabeth Cardis
- From the ISGlobal, Centre for Research in Environmental Epidemiology, Barcelona, Spain; Universitat Pompeu Fabra, Barcelona, Spain; CIBER Epidemiología y Salud Pública, Madrid, Spain; Department of Epidemiology and Biostatistics, Imperial College, London, United Kingdom; Nuvia Limited, Didcot, United Kingdom; Commissariat à l’Energie Atomique, Fontenay-aux-Roses, France; Atomic Weapons Establishment, Aldermaston, United Kingdom; Public Health England, Didcot & Moor Row, United Kingdom; Institut de Radioprotection et de Sûreté Nucléaire, Fontenay-aux-Roses, France; Institut de Veille Sanitaire, Saint Maurice, France; Occupational Cancer Research Centre, Toronto, ON, Canada; Studiecentrum voor Kernenergie • Centre d’Étude de l’énergie Nucléaire, Mol, Belgium; UK Atomic Energy Authority, Culham, United Kingdom; Autorité de Sûreté Nucléaire, Paris, France; and International Agency for Research on Cancer, Lyon, France
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