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Körblein A. Statistical modeling of trends in infant mortality after atmospheric nuclear weapons testing. PLoS One 2023; 18:e0284482. [PMID: 37200276 DOI: 10.1371/journal.pone.0284482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 03/31/2023] [Indexed: 05/20/2023] Open
Abstract
The global fallout from atmospheric nuclear weapons testing in the 1950s and 1960s caused by far the greatest exposure of mankind to ionizing radiation. Surprisingly few epidemiological studies of the possible health effects of atmospheric testing have been conducted. Here, long-term trends in infant mortality rates in the United States (U.S.) and five major European countries (EU5) were examined: The United Kingdom, Germany, France, Italy, and Spain. Bell-shaped deviations from a uniformly decreasing secular trend were found beginning in 1950, with maxima around 1965 in the U.S. and 1970 in EU5. From the difference between observed and predicted infant mortality rates, in the period 1950-2000, the overall increase in infant mortality rates was estimated to be 20.6 (90% CI: 18.6 to 22.9) percent in the U.S. and 14.2 (90% CI: 11.7 to 18.3) percent in EU5 which translates to 568,624 (90% CI: 522,359 to 619,705) excess infant deaths in the U.S. and 559,370 (90% CI: 469,308 to 694,589) in the combined five European countries. The results should be interpreted with caution because they rely on the assumption of a uniformly decreasing secular trend if there had been no nuclear tests, but this cannot be verified. It is concluded that atmospheric nuclear weapons testing may be responsible for the deaths of several million babies in the Northern Hemisphere.
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Linear non-threshold (LNT) fails numerous toxicological stress tests: Implications for continued policy use. Chem Biol Interact 2022; 365:110064. [DOI: 10.1016/j.cbi.2022.110064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 06/24/2022] [Accepted: 07/18/2022] [Indexed: 11/16/2022]
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Wollschläger D, Auvinen A, Blettner M, Zeeb H. Methodological considerations for interrupted time series analysis in radiation epidemiology: an overview. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2021; 41:609-618. [PMID: 34261051 DOI: 10.1088/1361-6498/ac149c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 07/14/2021] [Indexed: 06/13/2023]
Abstract
Interrupted time series analysis (ITSA) is a method that can be applied to evaluate health outcomes in populations exposed to ionizing radiation following major radiological events. Using aggregated time series data, ITSA evaluates whether the time trend of a health indicator shows a change associated with the radiological event. That is, ITSA checks whether there is a statistically significant discrepancy between the projection of a pre-event trend and the data empirically observed after the event. Conducting ITSA requires one to consider specific methodological issues due to unique threats to internal validity that make ITSA prone to bias. We here discuss the strengths and limitations of ITSA with respect to bias and confounding, data quality, and statistical aspects. We provide recommendations to strengthen the robustness of ITSA studies and reduce their susceptibility to producing spurious results as a consequence of arbitrary modelling decisions.
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Affiliation(s)
- Daniel Wollschläger
- Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Anssi Auvinen
- Faculty of Social Sciences (Health Sciences), Tampere University, Tampere, Finland
- STUK - Radiation and Nuclear Safety Authority, Helsinki, Finland
| | - Maria Blettner
- Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Hajo Zeeb
- Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany
- Wissenschaftsschwerpunkt Gesundheitswissenschaften, Universität Bremen, Bremen, Germany
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Brooks AL. The impact of dose rate on the linear no threshold hypothesis. Chem Biol Interact 2019; 301:68-80. [PMID: 30763551 DOI: 10.1016/j.cbi.2018.12.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 11/17/2018] [Accepted: 12/11/2018] [Indexed: 12/13/2022]
Abstract
The goal of this manuscript is to define the role of dose rate and dose protraction on the induction of biological changes at all levels of biological organization. Both total dose and the time frame over which it is delivered are important as the body has great capacity to repair all types of biological damage. The importance of dose rate has been recognized almost from the time that radiation was discovered and has been included in radiation standards as a Dose, Dose Rate, Effectiveness Factor (DDREF) and a Dose Rate Effectiveness Factor (DREF). This manuscript will evaluate the role of dose rate at the molecular, cellular, tissue, experimental animals and humans to demonstrate that dose rate is an important variable in estimating radiation cancer risk and other biological effects. The impact of low-dose rates on the Linear-No-Threshold Hypothesis (LNTH) will be reviewed since if the LNTH is not valid it is not possible to calculate a single value for a DDREF or DREF. Finally, extensive human experience is briefly reviewed to show that the radiation risks are not underestimated and that radiation at environmental levels has limited impact on total human cancer risk.
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Affiliation(s)
- Antone L Brooks
- Environmental Science, Washington State University, Richland, WA, USA.
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Kendall GM, Bithell JF, Bunch KJ, Draper GJ, Kroll ME, Murphy MFG, Stiller CA, Vincent TJ. Childhood cancer research in oxford III: The work of CCRG on ionising radiation. Br J Cancer 2018; 119:771-778. [PMID: 30131551 PMCID: PMC6173777 DOI: 10.1038/s41416-018-0182-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 05/26/2018] [Accepted: 06/20/2018] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND High doses of ionising radiation are a known cause of childhood cancer and great public and professional interest attaches to possible links between childhood cancer and lower doses, particularly of man-made radiation. This paper describes work done by the Childhood Cancer Research Group (CCRG) on this topic METHODS: Most UK investigations have made use of the National Registry of Childhood Tumours and associated controls. Epidemiological investigations have included national incidence and mortality analyses, geographical investigations, record linkage and case-control studies. Dosimetric studies use biokinetic and dosimetric modelling. RESULTS This paper reviews the work of the CCRG on the association between exposure to ionising radiation and childhood cancer, 1975-2014. CONCLUSION The work of CCRG has been influential in developing understanding of the causes of 'clusters' of childhood cancer and the risks arising from exposure to ionising radiation both natural and man-made. Some clusters around nuclear installations have certainly been observed, but ionising radiation does not seem to be a plausible cause. The group's work has also been instrumental in discounting the hypothesis that paternal preconception irradiation was a cause of childhood cancers and has demonstrated an increased leukaemia risk for children exposed to higher levels of natural gamma-ray radiation.
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Affiliation(s)
- Gerald M Kendall
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Oxford, OX3 7LF, UK.
| | - John F Bithell
- Department of Statistics, University of Oxford, 24-29 St Giles', Oxford, OX1 3LB, UK
| | - Kathryn J Bunch
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Oxford, OX3 7LF, UK
| | - Gerald J Draper
- Department of Statistics, University of Oxford, 24-29 St Giles', Oxford, OX1 3LB, UK
| | - Mary E Kroll
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Oxford, OX3 7LF, UK
| | - Michael F G Murphy
- Nuffield Department of Women's and Reproductive Health John Radcliffe Hospital, University of Oxford, Oxford, OX3 9DU, UK
| | - Charles A Stiller
- National Cancer Registration and Analysis Service, Public Health England, Chancellor Court, Oxford Business Park South, Oxford, OX4 2GX, UK
| | - Tim J Vincent
- Formerly of Childhood Cancer Research Group, University of Oxford, Oxford, UK
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Cho SG, Kim J, Song HC. Radiation Safety in Nuclear Medicine Procedures. Nucl Med Mol Imaging 2017; 51:11-16. [PMID: 28250853 PMCID: PMC5313457 DOI: 10.1007/s13139-016-0406-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Revised: 02/01/2016] [Accepted: 02/05/2016] [Indexed: 10/22/2022] Open
Abstract
Since the nuclear disaster at the Fukushima Daiichi Nuclear Power Plant in 2011, radiation safety has become an important issue in nuclear medicine. Many structured guidelines or recommendations of various academic societies or international campaigns demonstrate important issues of radiation safety in nuclear medicine procedures. There are ongoing efforts to fulfill the basic principles of radiation protection in daily nuclear medicine practice. This article reviews important principles of radiation protection in nuclear medicine procedures. Useful references, important issues, future perspectives of the optimization of nuclear medicine procedures, and diagnostic reference level are also discussed.
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Affiliation(s)
- Sang-Geon Cho
- Department of Nuclear Medicine, Medical Radiation Safety Research Center, Chonnam National University Hospital, 42 Jebong-ro, Dong-gu, 501-757 Gwang-ju, Korea
| | - Jahae Kim
- Department of Nuclear Medicine, Medical Radiation Safety Research Center, Chonnam National University Hospital, 42 Jebong-ro, Dong-gu, 501-757 Gwang-ju, Korea
| | - Ho-Chun Song
- Department of Nuclear Medicine, Medical Radiation Safety Research Center, Chonnam National University Hospital, 42 Jebong-ro, Dong-gu, 501-757 Gwang-ju, Korea
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Laurier D, Grosche B, Auvinen A, Clavel J, Cobaleda C, Dehos A, Hornhardt S, Jacob S, Kaatsch P, Kosti O, Kuehni C, Lightfoot T, Spycher B, Van Nieuwenhuyse A, Wakeford R, Ziegelberger G. Childhood leukaemia risks: from unexplained findings near nuclear installations to recommendations for future research. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2014; 34:R53-R68. [PMID: 24938793 DOI: 10.1088/0952-4746/34/3/r53] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Recent findings related to childhood leukaemia incidence near nuclear installations have raised questions which can be answered neither by current knowledge on radiation risk nor by other established risk factors. In 2012, a workshop was organised on this topic with two objectives: (a) review of results and discussion of methodological limitations of studies near nuclear installations; (b) identification of directions for future research into the causes and pathogenesis of childhood leukaemia. The workshop gathered 42 participants from different disciplines, extending widely outside of the radiation protection field. Regarding the proximity of nuclear installations, the need for continuous surveillance of childhood leukaemia incidence was highlighted, including a better characterisation of the local population. The creation of collaborative working groups was recommended for consistency in methodologies and the possibility of combining data for future analyses. Regarding the causes of childhood leukaemia, major fields of research were discussed (environmental risk factors, genetics, infections, immunity, stem cells, experimental research). The need for multidisciplinary collaboration in developing research activities was underlined, including the prevalence of potential predisposition markers and investigating further the infectious aetiology hypothesis. Animal studies and genetic/epigenetic approaches appear of great interest. Routes for future research were pointed out.
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Affiliation(s)
- D Laurier
- Institut de Radioprotection et de Sûreté Nucléaire (IRSN), BP 17, F-92262 Fontenay-aux-Roses Cedex, France
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Wakeford R. The risk of leukaemia in young children from exposure to tritium and carbon-14 in the discharges of German nuclear power stations and in the fallout from atmospheric nuclear weapons testing. RADIATION AND ENVIRONMENTAL BIOPHYSICS 2014; 53:365-379. [PMID: 24477409 DOI: 10.1007/s00411-014-0516-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Accepted: 01/18/2014] [Indexed: 06/03/2023]
Abstract
Towards the end of 2007, the results were published from a case-control study (the "KiKK Study") of cancer in young children, diagnosed <5 years of age during 1980-2003 while resident near nuclear power stations in western Germany. The study found a tendency for cases of leukaemia to live closer to the nearest nuclear power station than their matched controls, producing an odds ratio that was raised to a statistically significant extent for residence within 5 km of a nuclear power station. The findings of the study received much publicity, but a detailed radiological risk assessment demonstrated that the radiation doses received by young children from discharges of radioactive material from the nuclear reactors were much lower than those received from natural background radiation and far too small to be responsible for the statistical association reported in the KiKK Study. This has led to speculation that conventional radiological risk assessments have grossly underestimated the risk of leukaemia in young children posed by exposure to man-made radionuclides, and particular attention has been drawn to the possible role of tritium and carbon-14 discharges in this supposedly severe underestimation of risk. Both (3)H and (14)C are generated naturally in the upper atmosphere, and substantial increases in these radionuclides in the environment occurred as a result of their production by atmospheric testing of nuclear weapons during the late 1950s and early 1960s. If the leukaemogenic effect of these radionuclides has been seriously underestimated to the degree necessary to explain the KiKK Study findings, then a pronounced increase in the worldwide incidence of leukaemia among young children should have followed the notably elevated exposure to (3)H and (14)C from nuclear weapons testing fallout. To investigate this hypothesis, the time series of incidence rates of leukaemia among young children <5 years of age at diagnosis has been examined from ten cancer registries from three continents and both hemispheres, which include registration data from the early 1960s or before. No evidence of a markedly increased risk of leukaemia in young children following the peak of above-ground nuclear weapons testing, or that incidence rates are related to level of exposure to fallout, is apparent from these registration rates, providing strong grounds for discounting the idea that the risk of leukaemia in young children from (3)H or (14)C (or any other radionuclide present in both nuclear weapons testing fallout and discharges from nuclear installations) has been grossly underestimated and that such exposure can account for the findings of the KiKK Study.
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Affiliation(s)
- Richard Wakeford
- Centre for Occupational and Environmental Health, Institute of Population Health, The University of Manchester, Ellen Wilkinson Building, Oxford Road, Manchester, M13 9PL, UK,
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Wakeford R. The risk of childhood leukaemia following exposure to ionising radiation--a review. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2013; 33:1-25. [PMID: 23296257 DOI: 10.1088/0952-4746/33/1/1] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Since the early years of follow-up of the Japanese atomic-bomb survivors, it has been apparent that childhood leukaemia has a particular sensitivity to induction by ionising radiation, the excess relative risk (ERR) being expressed as a temporal wave with time since exposure. This pattern has been generally confirmed by studies of children treated with radiotherapy. Case-control studies of childhood leukaemia and antenatal exposure to diagnostic x-rays, a recent large cohort study of leukaemia following CT examinations of young people, and a recent large case-control study of natural background γ-radiation and childhood leukaemia have found evidence of raised risks following low-level exposure. These findings indicate that an ERR/Sv for childhood leukaemia of ~50, which may be derived from risk models based upon the Japanese atomic-bomb survivors, is broadly applicable to low dose or low dose-rate exposure circumstances.
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Affiliation(s)
- Richard Wakeford
- Dalton Nuclear Institute, The University of Manchester, Pariser Building-G Floor, Sackville Street, Manchester M13 9PL, UK.
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Mobbs SF, Muirhead CR, Harrison JD. Risks from ionising radiation: an HPA viewpoint paper for Safegrounds. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2011; 31:289-307. [PMID: 21865619 DOI: 10.1088/0952-4746/31/3/r01] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Safegrounds is a forum for developing and disseminating good practice guidance on the management of radioactively contaminated land on nuclear and defence sites in the UK. This review has been provided to Safegrounds as a summary of the basis for current radiation risk estimates and the International Commission on Radiological Protection (ICRP) protection system, in a form that will be accessible to a wide range of stakeholders. Safegrounds has also received viewpoint papers from other members who contend that the ICRP methodology results in substantial underestimates of risk, particularly for internal emitters. There is an extensive literature on the risks of radiation exposure, regularly reviewed by the United Nations Scientific Committee on the Effects of Atomic Radiation (UNSCEAR) and other expert groups. These data provide a sound basis for the system of protection recommended by ICRP. The available epidemiological and experimental evidence supports the application of cancer risk estimates derived for acute, high dose, external exposures to low dose exposures to external and internal sources. In the context of radioactively contaminated land on nuclear and defence sites, the national standards for the cleaning up of land and for waste disposal correspond to very low doses, two orders of magnitude less than average annual doses in the UK from natural background radiation (10-20 µSv compared with 2-3 mSv). Risks at such very low doses can only be estimated on the basis of observations after exposure of population groups at much higher doses. The estimated risks at these very low doses, while uncertain, are as likely to be overestimates as underestimates.
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Affiliation(s)
- S F Mobbs
- Health Protection Agency, Centre for Radiation, Chemical and Environmental Hazards, Chilton, Didcot, Oxon, UK.
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Kendall G, Little MP, Wakeford R. Numbers and proportions of leukemias in young people and adults induced by radiation of natural origin. Leuk Res 2011; 35:1039-43. [PMID: 21334745 PMCID: PMC3998761 DOI: 10.1016/j.leukres.2011.01.023] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2010] [Revised: 01/21/2011] [Accepted: 01/24/2011] [Indexed: 11/22/2022]
Abstract
Natural sources contribute a large fraction of the radiation exposure of the general public. Under the linear no-threshold hypothesis risk decreases in proportion to decreasing dose without a threshold. We use recent estimates of doses to the red bone marrow to calculate the number and proportion of cases of leukemia in England induced by natural radiation. We calculate that about 5% of cases of leukemia, excluding chronic lymphocytic leukemia, up to the age of 80 years are induced by this background radiation. In young people up to the age of 25 years the attributable fraction is about 15%, substantially lower than a previous estimate.
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Affiliation(s)
- Gerald Kendall
- Childhood Cancer Research Group, University of Oxford, Oxford, UK.
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13
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Wakeford R, Little MP, Kendall GM. Risk of childhood leukemia after low-level exposure to ionizing radiation. Expert Rev Hematol 2010; 3:251-4. [PMID: 21082976 PMCID: PMC3076706 DOI: 10.1586/ehm.10.25] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Richard Wakeford
- Dalton Nuclear Institute, The University of Manchester, Pariser Building – G Floor, PO Box 88, Sackville Street, Manchester, M60 1QD, UK
| | - Mark P Little
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College Faculty of Medicine, Norfolk Place, London, W2 1PG, UK
| | - Gerald M Kendall
- Childhood Cancer Research Group, University of Oxford, Richards Building, Old Road Campus, Headington, Oxford, OX3 7LG, UK
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