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Little MP, Bazyka D, de Gonzalez AB, Brenner AV, Chumak VV, Cullings HM, Daniels RD, French B, Grant E, Hamada N, Hauptmann M, Kendall GM, Laurier D, Lee C, Lee WJ, Linet MS, Mabuchi K, Morton LM, Muirhead CR, Preston DL, Rajaraman P, Richardson DB, Sakata R, Samet JM, Simon SL, Sugiyama H, Wakeford R, Zablotska LB. A Historical Survey of Key Epidemiological Studies of Ionizing Radiation Exposure. Radiat Res 2024; 202:432-487. [PMID: 39021204 PMCID: PMC11316622 DOI: 10.1667/rade-24-00021.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 04/23/2024] [Indexed: 07/20/2024]
Abstract
In this article we review the history of key epidemiological studies of populations exposed to ionizing radiation. We highlight historical and recent findings regarding radiation-associated risks for incidence and mortality of cancer and non-cancer outcomes with emphasis on study design and methods of exposure assessment and dose estimation along with brief consideration of sources of bias for a few of the more important studies. We examine the findings from the epidemiological studies of the Japanese atomic bomb survivors, persons exposed to radiation for diagnostic or therapeutic purposes, those exposed to environmental sources including Chornobyl and other reactor accidents, and occupationally exposed cohorts. We also summarize results of pooled studies. These summaries are necessarily brief, but we provide references to more detailed information. We discuss possible future directions of study, to include assessment of susceptible populations, and possible new populations, data sources, study designs and methods of analysis.
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Affiliation(s)
- Mark P. Little
- Radiation Epidemiology Branch, National Cancer Institute, Bethesda, MD 20892-9778, USA
- Faculty of Health and Life Sciences, Oxford Brookes University, Headington Campus, Oxford, OX3 0BP, UK
| | - Dimitry Bazyka
- National Research Center for Radiation Medicine, Hematology and Oncology, 53 Melnikov Street, Kyiv 04050, Ukraine
| | | | - Alina V. Brenner
- Radiation Effects Research Foundation, 5-2 Hijiyama Park, Minami-ku, Hiroshima 732-0815, Japan
| | - Vadim V. Chumak
- National Research Center for Radiation Medicine, Hematology and Oncology, 53 Melnikov Street, Kyiv 04050, Ukraine
| | - Harry M. Cullings
- Radiation Effects Research Foundation, 5-2 Hijiyama Park, Minami-ku, Hiroshima 732-0815, Japan
| | - Robert D. Daniels
- National Institute for Occupational Safety and Health, Cincinnati, OH, USA
| | - Benjamin French
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Eric Grant
- Radiation Effects Research Foundation, 5-2 Hijiyama Park, Minami-ku, Hiroshima 732-0815, Japan
| | - Nobuyuki Hamada
- Biology and Environmental Chemistry Division, Sustainable System Research Laboratory, Central Research Institute of Electric Power Industry (CRIEPI), 1646 Abiko, Chiba 270-1194, Japan
| | - Michael Hauptmann
- Institute of Biostatistics and Registry Research, Brandenburg Medical School Theodor Fontane, 16816 Neuruppin, Germany
| | - Gerald M. Kendall
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Headington, Oxford, OX3 7LF, UK
| | - Dominique Laurier
- Institute for Radiological Protection and Nuclear Safety, Fontenay aux Roses France
| | - Choonsik Lee
- Radiation Epidemiology Branch, National Cancer Institute, Bethesda, MD 20892-9778, USA
| | - Won Jin Lee
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, South Korea
| | - Martha S. Linet
- Radiation Epidemiology Branch, National Cancer Institute, Bethesda, MD 20892-9778, USA
| | - Kiyohiko Mabuchi
- Radiation Epidemiology Branch, National Cancer Institute, Bethesda, MD 20892-9778, USA
| | - Lindsay M. Morton
- Radiation Epidemiology Branch, National Cancer Institute, Bethesda, MD 20892-9778, USA
| | | | | | - Preetha Rajaraman
- Radiation Effects Research Foundation, 5-2 Hijiyama Park, Minami-ku, Hiroshima 732-0815, Japan
| | - David B. Richardson
- Environmental and Occupational Health, 653 East Peltason, University California, Irvine, Irvine, CA 92697-3957 USA
| | - Ritsu Sakata
- Radiation Effects Research Foundation, 5-2 Hijiyama Park, Minami-ku, Hiroshima 732-0815, Japan
| | - Jonathan M. Samet
- Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado, USA
| | - Steven L. Simon
- Radiation Epidemiology Branch, National Cancer Institute, Bethesda, MD 20892-9778, USA
| | - Hiromi Sugiyama
- Radiation Effects Research Foundation, 5-2 Hijiyama Park, Minami-ku, Hiroshima 732-0815, Japan
| | - Richard Wakeford
- Centre for Occupational and Environmental Health, The University of Manchester, Ellen Wilkinson Building, Oxford Road, Manchester, M13 9PL, UK
| | - Lydia B. Zablotska
- Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, 550 16 Street, 2 floor, San Francisco, CA 94143, USA
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Little MP, Boerma M, Bernier MO, Azizova TV, Zablotska LB, Einstein AJ, Hamada N. Effects of confounding and effect-modifying lifestyle, environmental and medical factors on risk of radiation-associated cardiovascular disease. BMC Public Health 2024; 24:1601. [PMID: 38879521 PMCID: PMC11179258 DOI: 10.1186/s12889-024-18701-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 04/23/2024] [Indexed: 06/19/2024] Open
Abstract
BACKGROUND Cardiovascular disease (CVD) is the leading cause of death worldwide. It has been known for some considerable time that radiation is associated with excess risk of CVD. A recent systematic review of radiation and CVD highlighted substantial inter-study heterogeneity in effect, possibly a result of confounding or modifications of radiation effect by non-radiation factors, in particular by the major lifestyle/environmental/medical risk factors and latent period. METHODS We assessed effects of confounding by lifestyle/environmental/medical risk factors on radiation-associated CVD and investigated evidence for modifying effects of these variables on CVD radiation dose-response, using data assembled for a recent systematic review. RESULTS There are 43 epidemiologic studies which are informative on effects of adjustment for confounding or risk modifying factors on radiation-associated CVD. Of these 22 were studies of groups exposed to substantial doses of medical radiation for therapy or diagnosis. The remaining 21 studies were of groups exposed at much lower levels of dose and/or dose rate. Only four studies suggest substantial effects of adjustment for lifestyle/environmental/medical risk factors on radiation risk of CVD; however, there were also substantial uncertainties in the estimates in all of these studies. There are fewer suggestions of effects that modify the radiation dose response; only two studies, both at lower levels of dose, report the most serious level of modifying effect. CONCLUSIONS There are still large uncertainties about confounding factors or lifestyle/environmental/medical variables that may influence radiation-associated CVD, although indications are that there are not many studies in which there are substantial confounding effects of these risk factors.
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Affiliation(s)
- Mark P Little
- Radiation Epidemiology Branch, National Cancer Institute, Room 7E546, 9609 Medical Center Drive MSC 9778, Bethesda, MD, 20892-9778, USA.
- Faculty of Health and Life Sciences, Oxford Brookes University, Headington Campus, Oxford, OX3 0BP, UK.
| | - Marjan Boerma
- Division of Radiation Health, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Marie-Odile Bernier
- Institut de Radioprotection et de Sureté Nucléaire, Fontenay Aux Roses, France
| | - Tamara V Azizova
- Clinical Department, Southern Urals Biophysics Institute, Chelyabinsk Region, Ozyorskoe Shosse 19, Ozyorsk, 456780, Russia
| | - Lydia B Zablotska
- Department of Epidemiology and Biostatistics, School of Medicine, University of California San Francisco, 550 16th St 2nd floor, San Francisco, CA, 94143, USA
| | - Andrew J Einstein
- Seymour, Paul, and Gloria Milstein Division of Cardiology, Department of Medicine, and Department of Radiology, Columbia University Irving Medical Center/New York-Presbyterian Hospital, New York, NY, USA
| | - Nobuyuki Hamada
- Biology and Environmental Chemistry Division, Sustainable System Research Laboratory, Central Research Institute of Electric Power Industry (CRIEPI), 1646 Abiko, Chiba 270-1194, Japan
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Milder CM, Howard SC, Ellis ED, Golden AP, Cohen SS, Mumma MT, Leggett RW, French B, Zablotska LB, Boice JD. Third mortality follow-up of the Mallinckrodt uranium processing workers, 1942-2019. Int J Radiat Biol 2024; 100:161-175. [PMID: 37819879 PMCID: PMC10843089 DOI: 10.1080/09553002.2023.2267640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 09/28/2023] [Indexed: 10/13/2023]
Abstract
INTRODUCTION Mallinckrodt Chemical Works was a uranium processing facility during the Manhattan Project from 1942 to 1966. Thousands of workers were exposed to low-dose-rates of ionizing radiation from external and internal sources. This third follow-up of 2514 White male employees updates cancer and noncancer mortality potentially associated with radiation and silica dust. MATERIALS AND METHODS Individual, annualized organ doses were estimated from film badge records (n monitored = 2514), occupational chest x-rays (n = 2514), uranium urinalysis (n = 1868), radium intake through radon breath measurements (n = 487), and radon ambient measurements (n = 1356). Silica dust exposure from pitchblende processing was estimated (n = 1317). Vital status and cause of death determination through 2019 relied upon the National Death Index and Social Security Administration Epidemiological Vital Status Service. The analysis included standardized mortality ratios (SMRs), Cox proportional hazards, and Poisson regression models. RESULTS Vital status was confirmed for 99.4% of workers (84.0% deceased). For a dose weighting factor of 1 for intakes of uranium, radium, and radon decay products, the mean and median lung doses were 65.6 and 29.9 mGy, respectively. SMRs indicated a difference in health outcomes between salaried and hourly workers, and more brain cancer deaths than expected [SMR: 1.79; 95% confidence interval (CI): 1.14, 2.70]. No association was seen between radiation and lung cancer [hazard ratio (HR) at 100 mGy: 0.93; 95%CI: 0.78, 1.11]. The relationship between radiation and kidney cancer observed in the previous follow-up was maintained (HR at 100 mGy: 2.07; 95%CI: 1.12, 3.79). Cardiovascular disease (CVD) also increased significantly with heart dose (HR at 100 mGy: 1.11; 95%CI: 1.02, 1.21). Exposures to dust ≥23.6 mg/m3-year were associated with nonmalignant kidney disease (NMKD) (HR: 3.02; 95%CI: 1.12, 8.16) and kidney cancer combined with NMKD (HR: 2.46; 95%CI: 1.04, 5.81), though without evidence of a dose-response per 100 mg/m3-year. CONCLUSIONS This third follow-up of Mallinckrodt uranium processors reinforced the results of the previous studies. There was an excess of brain cancers compared with the US population, although no radiation dose-response was detected. The association between radiation and kidney cancer remained, though potentially due to few cases at higher doses. The association between levels of silica dust ≥23.6 mg/m3-year and NMKD also remained. No association was observed between radiation and lung cancer. A positive dose-response was observed between radiation and CVD; however, this association may be confounded by smoking, which was unmeasured. Future work will pool these data with other uranium processing worker cohorts within the Million Person Study.
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Affiliation(s)
- Cato M. Milder
- Division of Epidemiology, Vanderbilt University Medical Center, Nashville, TN, USA
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute
| | | | | | | | - Sarah S. Cohen
- EpidStrategies, a Division of ToxStrategies, Inc., Katy, TX
| | | | | | - Benjamin French
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Lydia B. Zablotska
- Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, CA, USA
| | - John D. Boice
- Division of Epidemiology, Vanderbilt University Medical Center, Nashville, TN, USA
- National Council on Radiation Protection and Measurements (NCRP), Bethesda, MD, USA
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Levin R, Villanueva CM, Beene D, Cradock AL, Donat-Vargas C, Lewis J, Martinez-Morata I, Minovi D, Nigra AE, Olson ED, Schaider LA, Ward MH, Deziel NC. US drinking water quality: exposure risk profiles for seven legacy and emerging contaminants. JOURNAL OF EXPOSURE SCIENCE & ENVIRONMENTAL EPIDEMIOLOGY 2024; 34:3-22. [PMID: 37739995 PMCID: PMC10907308 DOI: 10.1038/s41370-023-00597-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 08/16/2023] [Accepted: 08/17/2023] [Indexed: 09/24/2023]
Abstract
BACKGROUND Advances in drinking water infrastructure and treatment throughout the 20th and early 21st century dramatically improved water reliability and quality in the United States (US) and other parts of the world. However, numerous chemical contaminants from a range of anthropogenic and natural sources continue to pose chronic health concerns, even in countries with established drinking water regulations, such as the US. OBJECTIVE/METHODS In this review, we summarize exposure risk profiles and health effects for seven legacy and emerging drinking water contaminants or contaminant groups: arsenic, disinfection by-products, fracking-related substances, lead, nitrate, per- and polyfluorinated alkyl substances (PFAS) and uranium. We begin with an overview of US public water systems, and US and global drinking water regulation. We end with a summary of cross-cutting challenges that burden US drinking water systems: aging and deteriorated water infrastructure, vulnerabilities for children in school and childcare facilities, climate change, disparities in access to safe and reliable drinking water, uneven enforcement of drinking water standards, inadequate health assessments, large numbers of chemicals within a class, a preponderance of small water systems, and issues facing US Indigenous communities. RESULTS Research and data on US drinking water contamination show that exposure profiles, health risks, and water quality reliability issues vary widely across populations, geographically and by contaminant. Factors include water source, local and regional features, aging water infrastructure, industrial or commercial activities, and social determinants. Understanding the risk profiles of different drinking water contaminants is necessary for anticipating local and general problems, ascertaining the state of drinking water resources, and developing mitigation strategies. IMPACT STATEMENT Drinking water contamination is widespread, even in the US. Exposure risk profiles vary by contaminant. Understanding the risk profiles of different drinking water contaminants is necessary for anticipating local and general public health problems, ascertaining the state of drinking water resources, and developing mitigation strategies.
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Affiliation(s)
- Ronnie Levin
- Harvard TH Chan School of Public Health, Boston, MA, USA.
| | - Cristina M Villanueva
- ISGlobal, Barcelona, Spain
- CIBER epidemiología y salud pública (CIBERESP), Madrid, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Daniel Beene
- Community Environmental Health Program, College of Pharmacy, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
- University of New Mexico Department of Geography & Environmental Studies, Albuquerque, NM, USA
| | | | - Carolina Donat-Vargas
- ISGlobal, Barcelona, Spain
- CIBER epidemiología y salud pública (CIBERESP), Madrid, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - Johnnye Lewis
- Community Environmental Health Program, College of Pharmacy, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Irene Martinez-Morata
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Darya Minovi
- Center for Science and Democracy, Union of Concerned Scientists, Washington, DC, USA
| | - Anne E Nigra
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Erik D Olson
- Natural Resources Defense Council, Washington, DC, USA
| | | | - Mary H Ward
- Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
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Rathod AM, Verpaele S, Kelvin M, Sullivan KV, Leybourne MI. Uranium: an overview of physicochemical properties, exposure assessment methodologies, and health effects of environmental and occupational exposure. ENVIRONMENTAL GEOCHEMISTRY AND HEALTH 2023; 45:1183-1200. [PMID: 35711076 DOI: 10.1007/s10653-022-01293-x] [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: 10/20/2021] [Accepted: 04/30/2022] [Indexed: 06/15/2023]
Abstract
Uranium is chemo- and radiotoxic element which can cause multifactorial health hazards. Natural and anthropogenic uranium contamination raises concerns about potential public health problems. Natural contamination plays a significant role with regard to uranium exposure in the general population, whereas anthropogenic contamination leads to occupational uranium exposure, particularly in nuclear industry workers. In this review, we present a state-of-the-art status concerning uranium-induced health risks with a focus on epidemiological findings of uranium processing and enrichment plant workers. We provide a general overview of physicochemical properties of uranium and analytical methods for measuring or monitoring uranium, describe environmental and occupational exposure scenarios, and discuss the challenges for objectively investigating risks from uranium exposure.
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Affiliation(s)
- Abhisha M Rathod
- Department of Geoscience and Geological Engineering, Queen's University, 99 University Avenue, Kingston, ON, K7L 3N6, Canada
- Arthur B. McDonald Canadian Astroparticle Physics Research Institute, Queen's University, 64 Bader Lane, Kingston, ON, K7L 3N6, Canada
- Neuroscience and Mental Health Institute, University of Alberta, Edmonton, AB, T6G 2S2, Canada
| | - Steven Verpaele
- Nickel Institute, Health and Environment Public Policy, Brussels, Belgium
| | - Michelle Kelvin
- Department of Geoscience and Geological Engineering, Queen's University, 99 University Avenue, Kingston, ON, K7L 3N6, Canada
| | - Kaj V Sullivan
- Department of Geoscience and Geological Engineering, Queen's University, 99 University Avenue, Kingston, ON, K7L 3N6, Canada
| | - Matthew I Leybourne
- Department of Geoscience and Geological Engineering, Queen's University, 99 University Avenue, Kingston, ON, K7L 3N6, Canada.
- Arthur B. McDonald Canadian Astroparticle Physics Research Institute, Queen's University, 64 Bader Lane, Kingston, ON, K7L 3N6, Canada.
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Milder CM, Howard SC, Ellis ED, Deppen SA. Deep Breaths: A Systematic Review of the Potential Effects of Employment in the Nuclear Industry on Mortality from Non-Malignant Respiratory Disease. Radiat Res 2022; 198:396-429. [PMID: 35943867 PMCID: PMC9704034 DOI: 10.1667/rade-21-00014.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 07/05/2022] [Indexed: 11/03/2022]
Abstract
Ionizing radiation is an established carcinogen, but its effects on non-malignant respiratory disease (NMRD) are less clear. Cohorts exposed to multiple risk factors including radiation and toxic dusts conflate these relationships, and there is a need for clarity in previous findings. This systematic review was conducted to survey the body of existing evidence for radiation effects on NMRD in global nuclear worker cohorts. A PubMed search was conducted for studies with terms relating to radiation or uranium and noncancer respiratory outcomes. Papers were limited to the most recent report within a single cohort published between January 2000 and December 2020. Publication quality was assessed based upon UNSCEAR 2017 criteria. In total, 31 papers were reviewed. Studies included 29 retrospective cohorts, one prospective cohort, and one longitudinal cohort primarily comprising White men from the U.S., Canada and Western Europe. Ten studies contained subpopulations of uranium miners or millers. Papers reported standardized mortality ratio (SMR) analyses, regression analyses, or both. Neither SMR nor regression analyses consistently showed a relationship between radiation exposure and NMRD. A meta-analysis of excess relative risks (ERRs) for NMRD did not present evidence for a dose-response (overall ERR/Sv: 0.07; 95% CI: -0.07, 0.21), and results for more specific outcomes were inconsistent. Significantly elevated SMRs for NMRD overall were observed in two studies among the subpopulation of uranium miners and millers (combined n = 4229; SMR 1.42-1.43), indicating this association may be limited to mining and milling populations and may not extend to other nuclear workers. A quality review showed limited capacity of 17 out of 31 studies conducted to provide evidence for a causal relationship between radiation and NMRD; the higher-quality studies showed no consistent relationship. All elevated NMRD SMRs were among mining and milling cohorts, indicating different exposure profiles between mining and non-mining cohorts; future pooled cohorts should adjust for mining exposures or address mining cohorts separately.
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Affiliation(s)
- Cato M. Milder
- Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Sara C. Howard
- Health Studies Program, Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee
| | - Elizabeth D. Ellis
- Health Studies Program, Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee
| | - Stephen A. Deppen
- Department of Thoracic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
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Zhang Y, Lu L, Chen C, Field RW, D'Alton M, Kahe K. Does protracted radon exposure play a role in the development of dementia? ENVIRONMENTAL RESEARCH 2022; 210:112980. [PMID: 35189101 PMCID: PMC9081166 DOI: 10.1016/j.envres.2022.112980] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 01/17/2022] [Accepted: 02/17/2022] [Indexed: 06/10/2023]
Abstract
Radon is a ubiquitous radioactive gas that decays into a series of solid radioactive decay products. Radon, and its decay products, enter the human body primarily through inhalation and can be delivered to various tissues including the brain through systemic circulation. It can also reach the brain by neuronal pathways via the olfactory system. While ionizing radiation has been suggested as a risk factor of dementia for decades, studies exploring the possible role of radon exposure in the development of Alzheimer's Diseases (AD) and other dementias are sparse. We systematically reviewed the literature and found several lines of evidence suggesting that radon decay products (RDPs) disproportionally deposit in the brain of AD patients with selective accumulation within the protein fractions. Ecologic study findings also indicate a significant positive correlation between geographic-level radon distribution and AD mortality in the US. Additionally, pathologic studies of radon shed light on the potential pathways of radon decay product induced proinflammation and oxidative stress that may result in the development of dementia. In summary, there are plausible underlying biological mechanisms linking radon exposure to the risk of dementia. Since randomized clinical trials on radon exposure are not feasible, well-designed individual-level epidemiologic studies are urgently needed to elucidate the possible association between radon (i.e., RDPs) exposure and the onset of dementia.
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Affiliation(s)
- Yijia Zhang
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, NY, 10032, USA; Department of Epidemiology, Columbia University Irving Medical Center, New York, NY, 10032, USA
| | - Liping Lu
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, NY, 10032, USA; Department of Epidemiology, Columbia University Irving Medical Center, New York, NY, 10032, USA
| | - Cheng Chen
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, NY, 10032, USA; Department of Epidemiology, Columbia University Irving Medical Center, New York, NY, 10032, USA
| | - R William Field
- Department of Occupational and Environmental Health and Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA, 52242, USA
| | - Mary D'Alton
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, NY, 10032, USA
| | - Ka Kahe
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, NY, 10032, USA; Department of Epidemiology, Columbia University Irving Medical Center, New York, NY, 10032, USA.
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Lu L, Zhang Y, Chen C, Field RW, Kahe K. Radon exposure and risk of cerebrovascular disease: a systematic review and meta-analysis in occupational and general population studies. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2022; 29:45031-45043. [PMID: 35460001 PMCID: PMC9209369 DOI: 10.1007/s11356-022-20241-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 04/09/2022] [Indexed: 06/14/2023]
Abstract
Although it is biologically plausible, findings relating radon exposure to the risk of cerebrovascular disease (CeVD) are inconsistent and inconclusive. To investigate whether radon exposure was associated with the risk of CeVD, we qualitatively and quantitatively summarized the literature on radon and CeVD in both occupational and general populations. A search of PubMed, Embase, Scopus, and Web of Science was performed for peer-reviewed articles published through March 2022. Studies were excluded if radon exposure was not assessed separately from other ionizing radiation. In the meta-analysis, excess relative risks (ERRs) were converted to relative risks (RRs), and the pooled RRs and 95% confidence intervals (CIs) were determined using the random-effects model (DerSimonian and Laird). In the systematic review, nine eligible studies were summarized. Six occupational studies indicated inconsistent associations between cumulative radon exposure and CeVD mortality among mine workers. With available data from four updated occupational studies (99,730 mine workers and 2745 deaths), the pooled RR of radon exposure with CeVD mortality showed a non-significant association (1.10, 95% CI 0.92, 1.31). Three studies (841,270 individuals and 24,288 events) conducted in general populations consistently demonstrated a significant inverse relationship between residential radon exposure and risk of CeVD. The existing literature suggested a potential link between radon exposure and CeVD risk in general population. The inconsistent association in occupationally exposed populations may be explained by different methods of radon assessment and other methodological issues. Since radon exposure is a common public health issue, more rigorously designed epidemiologic studies, especially in the general population are warranted.
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Affiliation(s)
- Liping Lu
- Department of Obstetrics and Gynecology and Department of Epidemiology, Columbia University Irving Medical Center, 622 West 168th Street, New York, NY, 10032, USA
| | - Yijia Zhang
- Department of Obstetrics and Gynecology and Department of Epidemiology, Columbia University Irving Medical Center, 622 West 168th Street, New York, NY, 10032, USA
| | - Cheng Chen
- Department of Obstetrics and Gynecology and Department of Epidemiology, Columbia University Irving Medical Center, 622 West 168th Street, New York, NY, 10032, USA
| | - Robert William Field
- Department of Occupational and Environmental Health and Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA, 52242, USA
| | - Ka Kahe
- Department of Obstetrics and Gynecology and Department of Epidemiology, Columbia University Irving Medical Center, 622 West 168th Street, New York, NY, 10032, USA.
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Golden AP, Milder CM, Ellis ED, Anderson JL, Boice JD, Bertke SJ, Zablotska LB. Cohort profile: four early uranium processing facilities in the US and Canada. Int J Radiat Biol 2021; 97:833-847. [PMID: 33970767 PMCID: PMC10201456 DOI: 10.1080/09553002.2021.1917786] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 03/31/2021] [Accepted: 04/02/2021] [Indexed: 12/22/2022]
Abstract
PURPOSE Pooling of individual-level data for workers involved in uranium refining and processing (excluding enrichment) may provide valuable insights into risks from occupational uranium and external ionizing radiation exposures. METHODS Data were pooled for workers from four uranium processing facilities (Fernald, Mallinckrodt and Middlesex from the U.S.; and Port Hope, Canada). Employment began as early as the 1930s and follow-up was as late as 2017. Workers were exposed to high concentrations of uranium, radium, and their decay products, as well as gamma radiation and ambient radon decay products. Exposure and outcome data were harmonized using similar definitions and dose reconstruction methods. Standardized mortality ratios (SMR) were estimated. RESULTS In total, 560 deaths from lung cancer, 503 non-malignant respiratory diseases, 67 renal diseases, 1,596 ischemic heart diseases, and 101 dementia and Alzheimer's disease (AD) were detected in the pooled cohort of over 12,400 workers (∼1,300 females). Mean cumulative doses were 45 millisievert for whole-body external ionizing radiation exposure and 172 milligray for lung dose from radon decay products. Only SMR for dementia and AD among males was statistically significant (SMR=1.29; 95% confidence interval: 1.04, 1.54). CONCLUSIONS This is the largest study to date to examine long-term health risks of uranium processing workers.
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Affiliation(s)
- Ashley P. Golden
- Oak Ridge Associated Universities, Health Studies Program, Oak Ridge, Tennessee
| | - Cato M. Milder
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center and Vanderbilt-Ingram Cancer Center, Nashville, Tennessee, USA
| | - Elizabeth D. Ellis
- Oak Ridge Associated Universities, Health Studies Program, Oak Ridge, Tennessee
| | - Jeri L. Anderson
- National Institute for Occupational Safety and Health, Division of Field Studies and Engineering, Cincinnati, Ohio
| | - John D. Boice
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center and Vanderbilt-Ingram Cancer Center, Nashville, Tennessee, USA
- National Council on Radiation Protection and Measurements (NCRP), Bethesda, Maryland
| | - Stephen J. Bertke
- National Institute for Occupational Safety and Health, Division of Field Studies and Engineering, Cincinnati, Ohio
| | - Lydia B. Zablotska
- Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, 550 16th Street, San Francisco, CA, U.S.A
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10
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Belloni M, Guihenneuc C, Rage E, Ancelet S. A Bayesian hierarchical approach to account for left-censored and missing radiation doses prone to classical measurement error when analyzing lung cancer mortality due to γ-ray exposure in the French cohort of uranium miners. RADIATION AND ENVIRONMENTAL BIOPHYSICS 2020; 59:423-437. [PMID: 32567014 DOI: 10.1007/s00411-020-00859-6] [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: 09/13/2019] [Accepted: 06/13/2020] [Indexed: 06/11/2023]
Abstract
Epidemiological data on cohorts of occupationally exposed uranium miners are currently used to assess health risks associated with chronic exposure to low doses of ionizing radiation. Nevertheless, exposure uncertainty is ubiquitous and questions the validity of statistical inference in these cohorts. This paper highlights the flexibility and relevance of the Bayesian hierarchical approach to account for both missing and left-censored (i.e. only known to be lower than a fixed detection limit) radiation doses that are prone to measurement error, when estimating radiation-related risks. Up to the authors' knowledge, this is the first time these three sources of uncertainty are dealt with simultaneously in radiation epidemiology. To illustrate the issue, this paper focuses on the specific problem of accounting for these three sources of uncertainty when estimating the association between occupational exposure to low levels of γ-radiation and lung cancer mortality in the post-55 sub-cohort of French uranium miners. The impact of these three sources of dose uncertainty is of marginal importance when estimating the risk of death by lung cancer among French uranium miners. The corrected excess hazard ratio (EHR) is 0.81 per 100 mSv (95% credible interval: [0.28; 1.75]). Interestingly, even if the 95% credible interval of the corrected EHR is wider than the uncorrected one, a statistically significant positive association remains between γ-ray exposure and the risk of death by lung cancer, after accounting for dose uncertainty. Sensitivity analyses show that the results obtained are robust to different assumptions. Because of its flexible and modular nature, the Bayesian hierarchical models proposed in this work could be easily extended to account for high proportions of missing and left-censored dose values or exposure data, prone to more complex patterns of measurement error.
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Affiliation(s)
- M Belloni
- PSE-SANTE/SESANE/LEPID, Institut de Radioprotection et de Sûreté Nucléaire, Fontenay-aux-Roses, France.
| | - C Guihenneuc
- UR 7537, Faculté de Pharmacie de Paris, Université de Paris, Paris, France
| | - E Rage
- PSE-SANTE/SESANE/LEPID, Institut de Radioprotection et de Sûreté Nucléaire, Fontenay-aux-Roses, France
| | - S Ancelet
- PSE-SANTE/SESANE/LEPID, Institut de Radioprotection et de Sûreté Nucléaire, Fontenay-aux-Roses, France
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11
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Rump A, Eder S, Lamkowski A, Hermann C, Abend M, Port M. A quantitative comparison of the chemo- and radiotoxicity of uranium at different enrichment grades. Toxicol Lett 2019; 313:159-168. [PMID: 31276769 DOI: 10.1016/j.toxlet.2019.07.004] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 06/24/2019] [Accepted: 07/01/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The radiotoxic effects of uranium are often in the focus of the public fears but the chemical toxic effects of uranium are reported to surpass radiation effects. As there is no uranium isotope that is not radioactive, it is not possible to study chemical effects fully independently from radiation effects. In order to quantitate and compare radio- and chemotoxicity, we determined the median lethal doses of uranium due to its chemical toxicity and calculated the absorbed radiological doses resulting from the ingestion or inhalation of corresponding amounts depending on the isotopic enrichment grade. Committed effective doses over 50 years are related to the stochastic health effects like cancer occurrence and can be converted to a loss of statistical life time (mean loss 0.4 day / mSv). The equivalent doses absorbed within a short time frame permits conclusion on the induction of deterministic effects (e.g. acute radiation sickness). METHOD Simulations were based on the biokinetic models of the International Commission for Radioprotection and performed using Integrated Modules for Bioassay Analysis software. Results were compared with the doses given by the calculator of the WISE uranium project. The fractions of the total doses absorbed within different time periods were derived from the respective areas under the activity-time curves in the whole body. RESULTS The distribution of the total dose on the organs and tissues depends on the invasion pathway and the solubility of the compound. In the case of inhalation, the absorption of the total dose is more protracted than after ingestion. The incorporation of depleted or natural uranium in lethal amounts due to nephrotoxicity does not lead to deterministic radiation effects and is associated with committed effective doses reaching at most about 200 mSv (proposed possible threshold for therapeutic interventions after accidental radionuclide incorporation). The inhalation of low enriched uranium leads to higher effective doses up to 690 mSv, but they are still insufficient to cause acute deterministic effects. Even highly enriched uranium seems not to induce radiation nephropathy, but deterministic effects on the hematopoetic system cannot be excluded in particularly sensitive patients. But the equivalent doses to the lungs associated with the inhalation of poorly soluble compounds of highly enriched uranium are in a range that may induce radiation pneumonitis. CONCLUSION Our findings give clear evidence that for depleted and natural uranium chemical toxicity is much more marked than radiotoxicity. However, this conclusion must not be drawn for enriched and in particular highly enriched compounds that besides stochastic effects may even cause deterministic radiation effects.
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Affiliation(s)
- A Rump
- Bundeswehr Institute of Radiobiology, Munich, Germany.
| | - S Eder
- Bundeswehr Institute of Radiobiology, Munich, Germany
| | - A Lamkowski
- Bundeswehr Institute of Radiobiology, Munich, Germany
| | - C Hermann
- Bundeswehr Institute of Radiobiology, Munich, Germany
| | - M Abend
- Bundeswehr Institute of Radiobiology, Munich, Germany
| | - M Port
- Bundeswehr Institute of Radiobiology, Munich, Germany
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12
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Helmig S, Lochnit G, Schneider J. Comparative proteomic analysis in serum of former uranium miners with and without radon induced squamous lung cancer. J Occup Med Toxicol 2019; 14:9. [PMID: 30923558 PMCID: PMC6419832 DOI: 10.1186/s12995-019-0228-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 02/26/2019] [Indexed: 11/10/2022] Open
Abstract
SUMMARY Former uranium miners of the Wismut Company, East Germany, have been exposed to ionizing radiation from radon decay products and therefore were at high risk for lung cancer. Since histological types of cancer in the so called Wismut cohort revealed an association of high radon exposure with a higher relative frequency of squamous cell carcinoma (SqCC), we used comparative proteomic analysis to identify differentially expressed proteins in serum exposed uranium miners with SqCC. METHODE Pooled sera of exposed former uranium miners without lung disease and pooled sera of former uranium miners with SqCC were analysed by 2-D gel electrophoresis. MALDI-TOF-MS was performed from reproducable, significantly, at least 5-fold up-regulated protein spots. Proteins were identified by MASCOT peptide mass fingerprint search. Additionally a receiver operating characteristic curve for CYFRA 21-1 was created. RESULTS The protein spots were identified as Keratin 10 (K10), Keratin 1 (K1), complement factor H (CFH) and a haptoglobin (Hpt) fragment. The sensitivity for CYFRA 21-1 reveals 60% at a specifity of 95 and 80% at a specifity of 80%. Plotting the sensitivity against specifity reveals an AUC of 0.88. CONCLUSION In SqCC Keratin 10 and 1 were strongly induced. This was associated with CYFRA 21-1, confirming the cytokeratin fragment as a tumormarker.
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Affiliation(s)
- Simone Helmig
- Institute and Outpatient Clinic for Occupational and Social Medicine, Justus-Liebig-University Giessen, Aulweg 129, D-35392, Giessen, Germany
| | - Günter Lochnit
- Institute of Biochemistry, Friedrichstraße 24, Justus-Liebig-University Giessen, D-35392, Giessen, Germany
| | - Joachim Schneider
- Institute and Outpatient Clinic for Occupational and Social Medicine, Justus-Liebig-University Giessen, Aulweg 129, D-35392, Giessen, Germany
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Zander A, Paunesku T, Woloschak G. Radiation databases and archives - examples and comparisons. Int J Radiat Biol 2019; 95:1378-1389. [PMID: 30676164 DOI: 10.1080/09553002.2019.1572249] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Studies of ionizing radiation effects through the archiving of data began with standardizing medical treatments in the early 1900s shortly after the discovery of X-rays. Once the breadth of the delayed effects of ionizing radiation was recognized, the need for long-term follow up became apparent. There are now many human archives of data from nuclear disasters and accidents, occupational exposures, and medical procedures. Planned animal irradiation experiments began around the time of the Cold War and included a variety of doses, fractions, dose rates, and types of ionizing radiation. The goal of most of these studies was to supplement information coming from human data through carefully planned experimental conditions and immediate and uninterrupted data collection. This review aims to highlight major archives and databases that have shaped the field of radiation biology and provide a broad range of the types of datasets currently available. By preserving all of these data and tissue sets, radiation biologists can combine databases and conduct large-scale analyses of detailed existing data and perform new assays with cutting edge scientific approaches.
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Affiliation(s)
- Alia Zander
- Feinberg School of Medicine, Radiation Oncology, Northwestern University , Chicago , IL , USA
| | - Tatjana Paunesku
- Feinberg School of Medicine, Radiation Oncology, Northwestern University , Chicago , IL , USA
| | - Gayle Woloschak
- Feinberg School of Medicine, Radiation Oncology, Northwestern University , Chicago , IL , USA
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Golden AP, Ellis ED, Cohen SS, Mumma MT, Leggett RW, Wallace PW, Girardi D, Watkins JP, Shore RE, Boice JD. Updated mortality analysis of the Mallinckrodt uranium processing workers, 1942–2012. Int J Radiat Biol 2019; 98:701-721. [DOI: 10.1080/09553002.2019.1569773] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
| | | | | | | | | | | | - David Girardi
- Oak Ridge Associated Universities, Oak Ridge, TN, USA
| | | | - Roy E. Shore
- Epidemiology Division, New York University School of Medicine, NewYork, NY, USA
- Radiation Effects Research Foundation, Hiroshima, Japan
| | - John D. Boice
- National Council on Radiation Protection and Measurements, Bethesda, MD, USA
- Department of Medicine, Division of Epidemiology, Vanderbilt Epidemiology Center and Vanderbilt-Ingram Cancer Center, Nashville, TN, USA
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15
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Golden AP, Cohen SS, Chen H, Ellis ED, Boice JD. Evaluation of statistical modeling approaches for epidemiologic studies of low-dose radiation health effects. Int J Radiat Biol 2019; 98:572-579. [DOI: 10.1080/09553002.2018.1554924] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
| | | | - Heidi Chen
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center and Vanderbilt-Ingram Cancer Center, Nashville, TN, USA
| | | | - John D. Boice
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center and Vanderbilt-Ingram Cancer Center, Nashville, TN, USA
- National Council on Radiation Protection and Measurements, Bethesda, MD, USA
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16
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Davesne E, Laurent O, Samson E, Jovanovic I, Bouet S, Challeton-de Vathaire C, Blanchardon E. Internal dose assessment for the French cohort of uranium workers. BIO WEB OF CONFERENCES 2019. [DOI: 10.1051/bioconf/20191403007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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