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Seyyedsalehi MS, Boffetta P. Occupational asbestos exposure and risk of esophageal cancer: A systematic review and meta-analysis. Int J Cancer 2024; 154:1920-1929. [PMID: 38339891 DOI: 10.1002/ijc.34881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 01/06/2024] [Accepted: 01/23/2024] [Indexed: 02/12/2024]
Abstract
Esophageal cancer (EC), which includes squamous cell carcinoma (ESCC) and adenocarcinoma (EAC), is an important cancer with poor prognosis and high mortality rate. Several occupational exposures have been associated with EC. We aim to investigate the association between occupational asbestos exposure and EC risk, considering types of asbestos and histology of the disease. We included studies mentioned in the list of references in previous reviews and pooled analyses, and we conducted an independent search in PubMed and Scopus. Forest plots of relative risks (RR) were constructed based on the association between occupational asbestos and EC risk. Random-effects models were used to address heterogeneity between 48 independent cohort and case-control studies. We found an association between occupational asbestos exposure and EC (meta-relative risk [RR] = 1.20, 95% confidence interval [CI] = 1.09-1.32; I2 = 58.8%, p-heterogeneity [het] <.001). The results of stratification by job (p-het = .20) indicate an increased RR among asbestos product workers (RR = 1.39, 95% CI = 1.07-1.81), asbestos applicators (RR = 1.41, 95% CI = 1.20-1.67), and construction workers (RR = 1.12, 95% CI = 1.02-1.24). There was no heterogeneity in meta-RR according to outcome (p = .29), geographic region (p = .69), year of publication (p = .59), quality score (p = .73), asbestos type (p = .93), study design (p = .87), and gender (p = .88), control for potential confounders (p = .20), year of first employment (p = .94) and exposure level (p = .43). The stratification analysis by histology type found an increased RR for both ESCC 1.33(1.03-1.71) and EAC 1.45(1.03-2.04) (p-het = .68). We didn't find evidence of publication bias (p = .07). The results of our study suggest that occupational asbestos exposure is associated with an increased risk of EC in both histology types.
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Affiliation(s)
- Monireh Sadat Seyyedsalehi
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
- Cancer Research Center, Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Paolo Boffetta
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
- Stony Brook Cancer Center, Stony Brook University, Stony Brook, New York, USA
- Department of Family, Population and Preventive Medicine, Renaissance School of Medicine, Stony Brook University, Stony Brook, New York, USA
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Kelly-Reif K, Bertke S, Daniels RD, Richardson DB, Schubauer-Berigan MK. Ionizing radiation and solid cancer mortality among US nuclear facility workers. Int J Epidemiol 2023; 52:1015-1024. [PMID: 37253388 PMCID: PMC10527884 DOI: 10.1093/ije/dyad075] [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: 12/12/2022] [Accepted: 05/10/2023] [Indexed: 06/01/2023] Open
Abstract
BACKGROUND The risk of solid cancers from low-level protracted ionizing radiation is not well characterized. Nuclear workers provide valuable information on the effects of ionizing radiation in contemporary exposure scenarios relevant to workers and the public. METHODS We evaluated the association between penetrating ionizing radiation exposure and solid cancer mortality among a pooled cohort of nuclear workers in the USA, with extended follow-up to examine cancers with long latencies. This analysis includes 101 363 workers from five nuclear facilities, with 12 069 solid cancer deaths between 1944 and 2016. The association between cumulative equivalent dose measured in sieverts (Sv) and solid cancer subtypes were modelled as the excess relative rate per Sv (ERR Sv-1) using Cox regression. RESULTS For the association between ionizing radiation exposure and all solid cancer mortality we observed an elevated rate (ERR Sv-1=0.19; 95% CI: -0.10, 0.52), which was higher among a contemporary sub-cohort of workers first hired in 1960 or later (ERR Sv-1= 2.23; 95% CI: 1.13, 3.49). Similarly, we observed an elevated rate for lung cancer mortality (ERR Sv-1= 0.65; 95% CI: 0.09, 1.30) that was higher among contemporary hires (ERR Sv-1= 2.90; 95% CI: 1.00, 5.26). CONCLUSIONS Although concerns remain about confounding, measurement error and precision, this analysis strengthens the evidence base indicating there are radiogenic risks for several solid cancer types.
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Affiliation(s)
- Kaitlin Kelly-Reif
- National Institute for Occupational Safety and Health, Cincinnati, OH, USA
| | - Steven Bertke
- National Institute for Occupational Safety and Health, Cincinnati, OH, USA
| | - Robert D Daniels
- National Institute for Occupational Safety and Health, Cincinnati, OH, USA
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Sowers D, Caffrey E, Harris J, Specht A, Hamrick B, Frandsen J, Dant T. The United States Navy and Employees with Cancer: The Time for Change Is Now. HEALTH PHYSICS 2023; 125:147-151. [PMID: 37071047 DOI: 10.1097/hp.0000000000001695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
ABSTRACT The US Navy, including the US Marine Corps and Naval Nuclear Propulsion Program (NNPP), has a robust radiological protection and monitoring program meeting (and typically exceeding, in the name of conservatism) federal law requirements. The program covers the variety of ways in which the Navy produces and uses ionizing radiation and radioactive sources: in medicine, nuclear ship propulsion and repair, industrial and aircraft radiography, and myriad other unique uses in carrying out its vital mission. In executing these programs, thousands of people across the world are employed as active-duty Sailors and Marines, government civilians, and government contractors. These workers include physicians, reactor operators, radiation safety officers, and nuclear repair workers, to name but a few. The health protection standards for these workers are promulgated in the publicly available Navy Medicine P-5055 Radiation Health Protection Manual (NAVMED P-5055), published February 2011 with Change 2 published December 2022, and are applicable to Navy and Marine Corps and NNPP radiation protection programs. The NAVMED P-5055 outlines the individual medical requirements for those qualified and able to receive exposure to ionizing radiation as part of their duties and requires that "Radiation workers receive focused medical examinations to establish whether or not cancer is present which would medically disqualify a person from receiving occupational radiation exposure." Additionally, without scientific or medical basis, the NAVMED P-5055 requires disqualifying those employees who have a history of cancer, cancer therapy, radiation therapy including radiopharmaceuticals received for therapeutic purposes, or bone marrow suppression from drawing dosimetry, entering radiation areas, or handling radioactive material. This policy, which exists regardless of lifetime occupational radiation dose or projected future radiation dose, applies to all cancers except adequately treated basal cell carcinoma. The policy is not supported by relevant scientific and medical literature; does not align with reasonable professional ethical standards; does not conform to US Navy radiological training, which stipulates the assumed increased risk of developing cancer from Navy and Marine Corps and NNPP occupational radiation exposure is small; and removes critical leadership and mentoring capability from the workforce unnecessarily. This article discusses in detail (1) this policy and its ramifications to the Navy and Marine Corps and NNPP workforce and (2) recommendations, benefits, and impacts for the Navy and Marine Corps and NNPP to remove this policy and still maintain a robust radiation protection program.
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Wu CW, Chuang HY, Tsai DL, Kuo TY, Yang CC, Chen HC, Kuo CH. Meta-Analysis of the Association between Asbestos Exposure and Esophageal Cancer. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:11088. [PMID: 34769609 PMCID: PMC8582795 DOI: 10.3390/ijerph182111088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Revised: 10/15/2021] [Accepted: 10/19/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND We conducted a meta-analysis to quantitatively assess the association between asbestos exposure and esophageal cancer. METHODS We systematically collected articles from three electronic databases and calculated the pooled standardized mortality rate (SMR) from the meta-analysis. Subgroup analysis according to the type of asbestos exposure, follow-up years, sample size, industry classification, sex, and high-dose exposure was conducted. RESULTS From 242 studies, 34 cohort studies were included in our meta-analysis. Pooled SMR was positively associated with asbestos exposure and esophageal cancer (pooled SMR = 1.28; 95% confidence interval (CI) 1.19-1.38, p < 0.00001). In the subgroup analysis, (1) chrysolite, (2) four groups with follow-up over ten years, (3) the textile industry and shipyard, (4) both male and female, and (5) eight studies on highest asbestos exposure, all the subgroups showed significantly increased pooled SMRs. CONCLUSION Asbestos exposure was significantly and positively associated with esophageal cancer, especially chrysolite. Considering the long latency period, we suggest that patients should be followed up for cancer, including esophageal cancer, for over ten years.
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Affiliation(s)
- Chih-Wei Wu
- Department of Occupational and Environmental Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung City 812, Taiwan; or
- Department of Surgery, Shin Kong Wu Ho Su Memorial Hospital, Taipei City 111, Taiwan
| | - Hung-Yi Chuang
- Department of Occupational and Environmental Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung City 807, Taiwan;
- Graduate Institute of Medicine, Kaohsiung Medical University, Kaohsiung City 812, Taiwan
| | - Dong-Lin Tsai
- Division of Thoracic Surgery, Department of Surgery, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung City 812, Taiwan;
| | - Tzu-Yu Kuo
- Division of Pulmonary Medicine, Department of Internal Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung City 812, Taiwan;
| | - Chen-Cheng Yang
- Department of Occupational and Environmental Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung City 812, Taiwan; or
- Department of Occupational and Environmental Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung City 807, Taiwan;
- Graduate Institute of Medicine, Kaohsiung Medical University, Kaohsiung City 812, Taiwan
| | - Huang-Chi Chen
- Cancer Center, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung City 812, Taiwan;
| | - Chao-Hung Kuo
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung City 812, Taiwan;
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Peterson MK, Mohar I, Lam T, Cook TJ, Engel AM, Lynch H. Critical review of the evidence for a causal association between exposure to asbestos and esophageal cancer. Crit Rev Toxicol 2020; 49:597-613. [PMID: 31965908 DOI: 10.1080/10408444.2019.1692190] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Esophageal cancers comprise about 1% of all cancers diagnosed in the US but are more prevalent in other regions of the world. Several regulatory agencies have classified asbestos as a known human carcinogen, and it is linked to multiple diseases and malignancies, including lung cancer and mesothelioma. In a 2006 review of the epidemiological literature, the Institute of Medicine (IOM) did not find sufficient evidence to demonstrate a causal relationship between asbestos exposure and esophageal cancer. To reevaluate this conclusion, we performed a critical review of the animal toxicological, epidemiological, and mechanism of action literature on esophageal cancer and asbestos, incorporating studies published since 2006. Although there is some evidence in the epidemiological literature for an increased risk of esophageal cancer in asbestos-exposed occupational cohorts, these studies generally did not control for critical esophageal cancer risk factors (e.g. smoking, alcohol consumption). Furthermore, data from animal toxicological studies do not indicate that asbestos exposure increases esophageal cancer risk. Based on our evaluation of the literature, and reaffirming the IOM's findings, we conclude that there is insufficient evidence to demonstrate a causal link between asbestos exposure and esophageal cancer.
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Mumma MT, Sirko JL, Boice JD, Blot WJ. Mesothelioma mortality within two radiation monitored occupational cohorts. Int J Radiat Biol 2019; 98:786-794. [PMID: 31290725 DOI: 10.1080/09553002.2019.1642540] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Purpose: The risk of mesothelioma, including cancers of the pleura and peritoneum, was examined within two large cohorts of workers monitored for exposure to ionizing radiation. Methods and materials: Mortality was assessed among 253,632 workers routinely monitored for external radiation, including 30,724 industrial radiographers (IR) at shipyards, 142,583 workers at nuclear power plants (NPP), and 83,441 IR who had not worked at an NPP or shipyard. Follow-up was from 1969 through 2011. Standardized mortality ratios (SMRs) and 95% confidence intervals (CIs) were computed; observed numbers of deaths from mesothelioma (including cancers of the pleura and peritoneum) and asbestosis were compared with numbers expected based on age-, sex-, and calendar year-specific national mortality rates. Job history and quantitative asbestos exposure data were unavailable, but work at a shipyard was taken as a surrogate for the likelihood of exposure. Cox proportional hazards models were used to estimate hazard ratios (HRs) for mesothelioma in relation to estimated cumulative radiation exposure to the lung. Results: The mean duration of follow-up was 25.3 years (max 42 years). The mean cumulative lung dose was 28.6 mGy (7.3% > 250 mGy). Nearly 20% of the workers had died by 2011. A total of 421 mesothelioma deaths were found (75% occurring after 1999) with increased SMRs among workers monitored in shipyards (SMR 9.97; 95% CI 8.50-11.63) and for NPP workers (SMR 5.55; 95% CI 4.88-6.29), but not for IR who had not worked in shipyards (SMR 1.15; 95% CI 0.53-2.19). Likewise, deaths from asbestosis (n = 189) were also increased for shipyard and NPP workers (SMR = 18.1 and 9.2, respectively), but not among workers who never worked at a shipyard or NPP (SMR = 0.70; n = 1). Radiation dose to the lung was not associated with a statistically meaningful dose-response trend for mesothelioma in the combined cohorts (HR at 100 mGy = 1.10; 95% CI 0.96-1.27; p = .18), nor was mesothelioma risk associated with radiation exposure among IR who had not worked in a shipyard and assumed minimally exposed to asbestos. Conclusions: An elevated rate of death from mesothelioma was observed in two radiation-exposed occupational groups with potential for asbestos exposure. The increased risk of death from asbestosis, combined with little evidence of a rising trend in mesothelioma mortality with increasing radiation exposure, suggests that the mesothelioma (and asbestosis) excess in these workers was due to asbestos exposure in shipyards and power plants and not to occupational low-dose radiation.
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Affiliation(s)
- Michael T Mumma
- a International Epidemiology Institute , Rockville , MD , USA.,b Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center , Nashville , TN , USA
| | | | - John D Boice
- c National Council on Radiation Protection and Measurements , Bethesda , MD , USA.,d Vanderbilt Epidemiology Center, Division of Epidemiology, Department of Medicine, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center , Nashville , TN , USA
| | - William J Blot
- a International Epidemiology Institute , Rockville , MD , USA.,d Vanderbilt Epidemiology Center, Division of Epidemiology, Department of Medicine, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center , Nashville , TN , USA.,e Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine , Nashville , TN , USA
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Schubauer-Berigan MK, Daniels RD, Bertke SJ, Tseng CY, Richardson DB. Cancer Mortality through 2005 among a Pooled Cohort of U.S. Nuclear Workers Exposed to External Ionizing Radiation. Radiat Res 2015; 183:620-31. [DOI: 10.1667/rr13988.1] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Mary K. Schubauer-Berigan
- National Institute for Occupational Safety and Health, Division of Surveillance, Hazard Evaluations, and Field Studies, Cincinnati, Ohio; and
| | - Robert D. Daniels
- National Institute for Occupational Safety and Health, Division of Surveillance, Hazard Evaluations, and Field Studies, Cincinnati, Ohio; and
| | - Stephen J. Bertke
- National Institute for Occupational Safety and Health, Division of Surveillance, Hazard Evaluations, and Field Studies, Cincinnati, Ohio; and
| | - Chih-Yu Tseng
- National Institute for Occupational Safety and Health, Division of Surveillance, Hazard Evaluations, and Field Studies, Cincinnati, Ohio; and
| | - David B. Richardson
- University of North Carolina School of Public Health, Department of Epidemiology, Chapel Hill, North Carolina
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Abstract
The U.S. military consists of five armed services: the Army, Navy, Marine Corps, Air Force, and Coast Guard. It directly employs 1.4 million active duty military, 1.3 million National Guard and reserve military, and 700,000 civilian individuals. This paper describes the military guidance used to preserve and maintain the health of military personnel while they accomplish necessary and purposeful work in areas where they are exposed to radiation. It also discusses military exposure cohorts and associated radiogenic disease compensation programs administered by the U.S. Department of Veterans Affairs, the U.S. Department of Justice, and the U.S. Department of Labor. With a few exceptions, the U.S. military has effectively employed ionizing radiation since it was first introduced during the Spanish-American War in 1898. The U.S military annually monitors 70,000 individuals for occupational radiation exposure: ~2% of its workforce. In recent years, the Departments of the Navy (including the Marine Corps), the Army, and the Air Force all have a low collective dose that remains close to 1 person-Sv annually. Only a few Coast Guard individuals are now routinely monitored for radiation exposure. As with the nuclear industry as a whole, the Naval Reactors program has a higher collective dose than the remainder of the U.S. military. The U.S. military maintains occupational radiation exposure records on over two million individuals from 1945 through the present. These records are controlled in accordance with the Privacy Act of 1974 but are available to affected individuals or their designees and other groups performing sanctioned epidemiology studies.Introduction of Radiation Exposure of U.S. Military Individuals (Video 2:19, http://links.lww.com/HP/A30).
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Affiliation(s)
- Paul K Blake
- *Defense Threat Reduction Agency, 8725 John J. Kingman Road, Fort Belvoir, VA 22060-6201; †U.S. Army, 9351 Hall Road, Bldg. 1456, Fort Belvoir, VA 22060-5860
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Pham TM, Sakata R, Grant EJ, Shimizu Y, Furukawa K, Takahashi I, Sugiyama H, Kasagi F, Soda M, Suyama A, Shore RE, Ozasa K. Radiation exposure and the risk of mortality from noncancer respiratory diseases in the life span study, 1950-2005. Radiat Res 2013; 180:539-45. [PMID: 24148011 DOI: 10.1667/rr13421.1] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
An apparent association between radiation exposure and noncancer respiratory diseases (NCRD) in the Life Span Study (LSS) of atomic bomb survivors has been reported, but the biological validity of that observation is uncertain. This study investigated the possibility of radiation causation of noncancer respiratory diseases in detail by examining subtypes of noncancer respiratory diseases, temporal associations, and the potential for misdiagnosis and other confounding factors. A total of 5,515 NCRD diagnoses listed as the underlying cause of death on the death certificate were observed among the 86,611 LSS subjects with estimated weighted absorbed lung doses. Radiation dose-response analyses were conducted using Cox proportional hazard regression for pneumonia/influenza, other acute respiratory infections, chronic obstructive pulmonary disease and asthma. The linear excess relative risks (ERR) per gray (Gy) were 0.17 (95% CI 0.08, 0.27) for all NCRD and 0.20 (CI 0.09, 0.34) for pneumonia/influenza, which accounted for 63% of noncancer respiratory disease deaths. Adjustments for lifestyle and sociodemographic variations had almost no impact on the risk estimates. However, adjustments for indications of cancer and/or cardiovascular disease decreased the risk estimates, with ERR for total noncancer respiratory diseases declined by 35% from 0.17 to 0.11. Although it was impossible to fully adjust for the misdiagnosis of other diseases as noncancer respiratory diseases deaths in this study because of limitations of available data, nevertheless, the associations were reduced or eliminated by the adjustment that could be made. This helps demonstrates that the association between noncancer respiratory diseases and radiation exposure in previous reports could be in part be attributed to coincident cancer and/or cardiovascular diseases.
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Jacob P, Rühm W, Walsh L, Blettner M, Hammer G, Zeeb H. Is cancer risk of radiation workers larger than expected? Occup Environ Med 2009; 66:789-96. [PMID: 19570756 PMCID: PMC2776242 DOI: 10.1136/oem.2008.043265] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/13/2009] [Indexed: 11/03/2022]
Abstract
Occupational exposures to ionising radiation mainly occur at low-dose rates and may accumulate effective doses of up to several hundred milligray. The objective of the present study is to evaluate the evidence of cancer risks from such low-dose-rate, moderate-dose (LDRMD) exposures. Our literature search for primary epidemiological studies on cancer incidence and mortality risks from LDRMD exposures included publications from 2002 to 2007, and an update of the UK National Registry for Radiation Workers study. For each (LDRMD) study we calculated the risk for the same types of cancer among the atomic bomb survivors with the same gender proportion and matched quantities for dose, mean age attained and mean age at exposure. A combined estimator of the ratio of the excess relative risk per dose from the LDRMD study to the corresponding value for the atomic bomb survivors was 1.21 (90% CI 0.51 to 1.90). The present analysis does not confirm that the cancer risk per dose for LDRMD exposures is lower than for the atomic bomb survivors. This result challenges the cancer risk values currently assumed for occupational exposures.
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Affiliation(s)
- P Jacob
- Hemholtz Zentrum München, Institute of Radiation Protection, D-85764 Neuherberg, Germany.
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Zaebst DD, Seel EA, Yiin JH, Nowlin SJ, Chen P. Summary of retrospective asbestos and welding fume exposure estimates for a nuclear naval shipyard and their correlation with radiation exposure estimates. JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HYGIENE 2009; 6:404-414. [PMID: 19378213 DOI: 10.1080/15459620902922573] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
In support of a nested case-control study at a U.S. naval shipyard, the results of the reconstruction of historical exposures were summarized, and an analysis was undertaken to determine the impact of historical exposures to potential chemical confounders. The nested case-control study (N = 4388) primarily assessed the relationship between lung cancer and external ionizing radiation. Chemical confounders considered important were asbestos and welding fume (as iron oxide fume), and the chromium and nickel content of welding fume. Exposures to the potential confounders were estimated by an expert panel based on a set of quantitatively defined categories of exposure. Distributions of the estimated exposures and trends in exposures over time were examined for the study population. Scatter plots and Spearman rank correlation coefficients were used to assess the degree of association between the estimates of exposure to asbestos, welding fume, and ionizing radiation. Correlation coefficients were calculated separately for 0-, 15-, 20-, and 25-year time-lagged cumulative exposures, total radiation dose (which included medical X-ray dose) and occupational radiation dose. Exposed workers' estimated cumulative exposures to asbestos ranged from 0.01 fiber-days/cm(3) to just under 20,000 fiber-days/cm(3), with a median of 29.0 fiber-days/cm(3). Estimated cumulative exposures to welding fume ranged from 0.16 mg-days/m(3) to just over 30,000 mg-days/m(3), with a median of 603 mg-days/m(3). Spearman correlation coefficients between cumulative radiation dose and cumulative asbestos exposures ranged from 0.09 (occupational dose) to 0.47 (total radiation dose), and those between radiation and welding fume from 0.14 to 0.47. The estimates of relative risk for ionizing radiation and lung cancer were unchanged when lowest and highest estimates of asbestos and welding fume were considered. These results suggest a fairly large proportion of study population workers were exposed to asbestos and welding fume, that the absolute level of confounding exposure did not affect the risk estimates, and that weak relationships existed between monitored lifetime cumulative occupational radiation dose and asbestos or welding fume.
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Affiliation(s)
- D D Zaebst
- National Institute for Occupational Safety and Health, Cincinnati, Ohio 45226, USA.
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Metz-Flamant C, Rogel A, Caër S, Samson E, Laurier D, Acker A, Tirmarche M. Mortality among workers monitored for radiation exposure at the French nuclear fuel company. ARCHIVES OF ENVIRONMENTAL & OCCUPATIONAL HEALTH 2009; 64:242-250. [PMID: 20007120 DOI: 10.1080/19338240903348246] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
A cohort of 9,285 nuclear workers employed at the French company AREVA NC specializing in the nuclear fuel cycle was established. Vital status, causes of death, employment characteristics and annual exposure to ionizing radiation were reconstructed for each individual over the time period 1977-2004. Standardized mortality ratios (SMRs) were computed using national mortality rates as an external reference. Tests for trends in mortality with duration of employment and cumulative external dose were performed. The all-cause and all-cancer mortality was significantly lower than expected from the French population. No significant excess among cancer sites studied was observed. Significant positive trends with cumulative dose were observed for colon and liver cancer and for respiratory diseases. Isolated significant trends should be carefully interpreted and considered in line with the large number of trend tests performed.
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Affiliation(s)
- C Metz-Flamant
- Institut de Radioprotection et de Sûreté Nucléaire (IRSN), DRPH/SRBE/LEPID, Fontenay-aux-roses, France.
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Cancer Admission and Mortality in Workers Exposed to Ionizing Radiation in Korea. J Occup Environ Med 2008; 50:791-803. [DOI: 10.1097/jom.0b013e318167751d] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Seel EA, Zaebst DD, Hein MJ, Liu J, Nowlin SJ, Chen P. Inter-rater agreement for a retrospective exposure assessment of asbestos, chromium, nickel and welding fumes in a study of lung cancer and ionizing radiation. ACTA ACUST UNITED AC 2007; 51:601-10. [PMID: 17846032 DOI: 10.1093/annhyg/mem037] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
A retrospective exposure assessment of asbestos, welding fumes, chromium and nickel (in welding fumes) was conducted at the Portsmouth Naval Shipyard for a nested case-control study of lung cancer risk from external ionizing radiation. These four contaminants were included because of their potential to confound or modify the effect of a lung cancer-radiation relationship. The exposure assessment included three experienced industrial hygienists from the shipyard who independently assessed exposures for 3519 shop/job/time period combinations. A consensus process was used to resolve estimates with large differences. Final exposure estimates were linked to employment histories of the 4388 study subjects to calculate their cumulative exposures. Inter-rater agreement analyses were performed on the original estimates to better understand the estimation process. Although concordance was good to excellent (78-99%) for intensity estimates and excellent (96-99%) for frequency estimates, overall simple kappa statistics indicated only slight agreement beyond chance (kappa < 0.2). Unbalanced distributions of exposure estimates partly contributed to the weak observed overall inter-rater agreement. Pairwise weighted kappa statistics revealed better agreement between two of the three panelists (kappa = 0.19-0.65). The final consensus estimates were similar to the estimates made by these same two panelists. Overall welding fume exposures were fairly stable across time at the shipyard while asbestos exposures were higher in the early years and fell in the mid-1970s. Mean cumulative exposure for all study subjects was 520 fiber-days cc(-1) for asbestos and 1000 mg-days m(-3) for welding fumes. Mean exposure was much lower for nickel (140 microg-days m(-3)) and chromium (45 microg-days m(-3)). Asbestos and welding fume exposure estimates were positively associated with lung cancer in the nested case-control study. The radiation-lung cancer relationship was attenuated by the inclusion of these two confounders. This exposure assessment provided exposure estimates that aided in understanding of the lung cancer-radiation relationship at the shipyard.
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Affiliation(s)
- E A Seel
- National Institute for Occupational Safety and Health, Division of Surveillance, Hazard Evaluations, and Field Studies, 4676 Columbia Parkway, Cincinnati, OH 45226, USA.
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Yiin JH, Silver SR, Daniels RD, Zaebst DD, Seel EA, Kubale TL. A Nested Case-Control Study of Lung Cancer Risk and Ionizing Radiation Exposure at the Portsmouth Naval Shipyard. Radiat Res 2007; 168:341-8. [PMID: 17705634 DOI: 10.1667/rr0843.1] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2006] [Accepted: 04/16/2007] [Indexed: 11/03/2022]
Abstract
Results have been inconsistent between studies of lung cancer risk and ionizing radiation exposures among workers at the Portsmouth Naval Shipyard (PNS). The purpose of this nested case-control study was to evaluate the relationship between lung cancer risk and external ionizing radiation exposure while adjusting for potential confounders that included gender, radiation monitoring status, smoking habit surrogates (socioeconomic status and birth cohort), welding fumes and asbestos. By incidence density sampling, we age-matched 3,291 controls selected from a cohort of 37,853 civilian workers employed at PNS between 1952 and 1992 with 1,097 lung cancer deaths from among the same cohort. Analyses using conditional logistic regression were conducted in various model forms: log-linear (main), linear excess relative risk (ERR), and categorical. Lung cancer risk was positively associated with occupational dose (OR = 1.02 at 10 mSv; 95% CI 0.99- 1.04) but flattened after the inclusion of work-related medical X-ray doses (OR = 1.00; 95% CI 0.98-1.03) in multivariate analyses. Similar risk estimates were observed in the linear ERR model at 10 mSv of cumulative exposure with a 15-year lag.
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Affiliation(s)
- James H Yiin
- Division of Surveillance, Hazard Evaluations, and Field Studies, National Institute for Occupational Safety and Health, Cincinnati, OH 45226, USA.
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Silver SR, Hiratzka SL, Schubauer-Berigan MK, Daniels RD. Chronic lymphocytic leukemia radiogenicity: a systematic review. Cancer Causes Control 2007; 18:1077-93. [PMID: 17694421 DOI: 10.1007/s10552-007-9048-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2006] [Accepted: 07/19/2007] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Chronic lymphocytic leukemia (CLL) is generally considered to be non-radiogenic and is excluded from several programs that compensate workers for illnesses resulting from occupational exposures. Questions about whether this exclusion is justified prompted a Congressional mandate to the National Institute for Occupational Safety and Health (NIOSH) to, further, examine the radiogenicity of CLL. This study revisits the question of CLL radiogenicity by examining epidemiologic evidence from occupationally and medically-exposed populations. METHODS A systematic review of radiation-exposed cohorts was conducted to investigate the association between radiation and CLL. Exploratory power calculations for a pooled occupational study were performed to examine the feasibility of assessing CLL radiogenicity epidemiologically. RESULTS There is a bias against reporting CLL results, because of the disease's presumed non-radiogenicity. In medical cohort studies that provide risk estimates for CLL, risk is elevated, though non-significantly, in almost all studies with more than 15 years average follow-up. The results of occupational studies are less consistent. CONCLUSIONS Studies with adequate follow-up time and power are needed to better understand CLL radiogenicity. Power analyses show that a pooled study might detect risk on the order of radiation induced non-CLL leukemia, but is unlikely to detect smaller risks.
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Affiliation(s)
- Sharon R Silver
- Division of Surveillance, Hazard Evaluations, and Field Studies (DSHEFS), National Institute for Occupational Safety and Health (NIOSH), Cincinnati, OH, USA.
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Boice JD, Cohen SS, Mumma MT, Dupree Ellis E, Eckerman KF, Leggett RW, Boecker BB, Brill AB, Henderson BE. Mortality among Radiation Workers at Rocketdyne (Atomics International), 1948–1999. Radiat Res 2006; 166:98-115. [PMID: 16808626 DOI: 10.1667/rr3582.1] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
A retrospective cohort mortality study was conducted of workers engaged in nuclear technology development and employed for at least 6 months at Rocketdyne (Atomics International) facilities in California, 1948-1999. Lifetime occupational doses were derived from company records and linkages with national dosimetry data sets. International Commission on Radiation Protection (ICRP) biokinetic models were used to estimate radiation doses to 16 organs or tissues after the intake of radionuclides. Standardized mortality ratios (SMRs) compared the observed numbers of deaths with those expected in the general population of California. Cox proportional hazards models were used to evaluate dose-response trends over categories of cumulative radiation dose, combining external and internal organ-specific doses. There were 5,801 radiation workers, including 2,232 monitored for radionuclide intakes. The mean dose from external radiation was 13.5 mSv (maximum 1 Sv); the mean lung dose from external and internal radiation combined was 19.0 mSv (maximum 3.6 Sv). Vital status was determined for 97.6% of the workers of whom 25.3% (n = 1,468) had died. The average period of observation was 27.9 years. All cancers taken together (SMR 0.93; 95% CI 0.84-1.02) and all leukemia excluding chronic lymphocytic leukemia (CLL) (SMR 1.21; 95% CI 0.69-1.97) were not significantly elevated. No SMR was significantly increased for any cancer or for any other cause of death. The Cox regression analyses revealed no significant dose-response trends for any cancer. For all cancers excluding leukemia, the RR at 100 mSv was estimated as 1.00 (95% CI 0.81-1.24), and for all leukemia excluding CLL it was 1.34 (95% CI 0.73-2.45). The nonsignificant increase in leukemia (excluding CLL) was in accord with expectation from other radiation studies, but a similar nonsignificant increase in CLL (a malignancy not found to be associated with radiation) tempers a causal interpretation. Radiation exposure has not caused a detectable increase in cancer deaths in this population, but results are limited by small numbers and relatively low career doses.
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Affiliation(s)
- John D Boice
- International Epidemiology Institute, Rockville, Maryland 20850, USA.
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Kubale TL, Daniels RD, Yiin JH, Couch J, Schubauer-Berigan MK, Kinnes GM, Silver SR, Nowlin SJ, Chen PH. A nested case-control study of leukemia mortality and ionizing radiation at the Portsmouth Naval Shipyard. Radiat Res 2006; 164:810-9. [PMID: 16296888 DOI: 10.1667/rr3473.1] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
A nested case-control study using conditional logistic regression was conducted to evaluate the exposure-response relationship between external ionizing radiation exposure and leukemia mortality among civilian workers at the Portsmouth Naval Shipyard (PNS), Kittery, Maine. The PNS civilian workers received occupational radiation exposure while performing construction, overhaul, repair and refueling activities on nuclear-powered submarines. The study age-matched 115 leukemia deaths with 460 controls selected from a cohort of 37,853 civilian workers employed at PNS between 1952 and 1992. In addition to radiation doses received in the workplace, a secondary analysis incorporating doses from work-related medical X rays and other occupational radiation exposures was conducted. A significant positive association was found between leukemia mortality and external radiation exposure, adjusting for gender, radiation worker status, and solvent exposure duration (OR = 1.08 at 10 mSv of exposure; 95% CI = 1.01, 1.16). Solvent exposure (including benzene and carbon tetrachloride) was also significantly associated with leukemia mortality adjusting for radiation dose, radiation worker status, and gender. Incorporating doses from work-related medical X rays did not change the estimated leukemia risk per unit of dose.
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Affiliation(s)
- Travis L Kubale
- Division of Surveillance, Hazard Evaluations, and Field Studies (DSHEFS), National Institute for Occupational Safety and Health (NIOSH), Cincinnati, Ohio 45226, USA.
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Yiin JH, Schubauer-Berigan MK, Silver SR, Daniels RD, Kinnes GM, Zaebst DD, Couch JR, Kubale TL, Chen PH. Risk of Lung Cancer and Leukemia from Exposure to Ionizing Radiation and Potential Confounders among Workers at the Portsmouth Naval Shipyard. Radiat Res 2005; 163:603-13. [PMID: 15913392 DOI: 10.1667/rr3373] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Significantly elevated lung cancer deaths and statistically significantly positive linear trends between leukemia mortality and radiation exposure were reported in a previous analysis of Portsmouth Naval Shipyard workers. The purpose of this study was to conduct a modeling-based analysis that incorporates previously unanalyzed confounders in exploring the exposure-response relationship between cumulative external ionizing radiation exposure and mortality from these cancers among radiation-monitored workers in this cohort. The main analyses were carried out with Poisson regression fitted with maximum likelihood in linear excess relative risk models. Sensitivity analyses varying model components and using other regression models were conducted. The positive association between lung cancer risk and ionizing radiation observed previously was no longer present after adjusting for socioeconomic status (smoking surrogate) and welding fume and asbestos exposures. Excesses of leukemia were found to be positively, though not significantly, associated with external ionizing radiation, with or without including potential confounders. The estimated excess relative risk was 10.88% (95% CI -0.90%, 38.77%) per 10 mSv of radiation exposure, which was within the ranges of risk estimates in previous epidemiological studies (-4.1 to 19.0%). These results are limited by many factors and are subject to uncertainties of the exposure and confounder estimates.
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Affiliation(s)
- James H Yiin
- Division of Surveillance, Hazard Evaluations, and Field Studies, National Institute for Occupational Safety and Health, Cincinnati, Ohio 45226, USA.
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Telle-Lamberton M. Les études épidémiologiques sur les travailleurs exposés aux faibles doses de rayonnements ionisants. ARCH MAL PROF ENVIRO 2005. [DOI: 10.1016/s1775-8785(05)79055-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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