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Risk of cancer after low doses of ionising radiation: retrospective cohort study in 15 countries

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

BMJ, 2005-07, Vol.331 (7508), p.77-80 [Revista revisada por pares]

England: British Medical Journal Publishing Group

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  • Título:
    Risk of cancer after low doses of ionising radiation: retrospective cohort study in 15 countries
  • Autor: Cardis, E ; Vrijheid, M ; Blettner, M ; Gilbert, E ; Hakama, M ; Hill, C ; Howe, G ; Kaldor, J ; Muirhead, C R ; Schubauer-Berigan, M ; Yoshimura, T ; Bermann, F ; Cowper, G ; Fix, J ; Hacker, C ; Heinmiller, B ; Marshall, M ; Thierry-Chef, I ; Utterback, D ; Ahn, Y-O ; Amoros, E ; Ashmore, P ; Auvinen, A ; Bae, J-M ; Solano, J Bernar ; Biau, A ; Combalot, E ; Deboodt, P ; Sacristan, A Diez ; Eklof, M ; Engels, H ; Engholm, G ; Gulis, G ; Habib, R ; Holan, K ; Hyvonen, H ; Kerekes, A ; Kurtinaitis, J ; Malker, H ; Martuzzi, M ; Mastauskas, A ; Monnet, A ; Moser, M ; Pearce, M S ; Richardson, D B ; Rodriguez-Artalejo, F ; Rogel, A ; Tardy, H ; Telle-Lamberton, M ; Turai, I ; Usel, M ; Veress, K
  • Materias: Bias ; Cancer ; Chronic lymphocytic leukemia ; Collaboration ; Confidence intervals ; Dose-Response Relationship, Drug ; Dosimetry ; Epidemiologic Methods ; Epidemiology ; Estimates ; Female ; Health risk assessment ; Humans ; Ionizing radiation ; Leukemia ; Male ; Mortality ; Neoplasms, Radiation-Induced - mortality ; Nuclear energy ; Nuclear power plants ; Occupational Diseases - mortality ; Power Plants - manpower ; Radiation protection ; Radiotherapy ; Risk Assessment ; Socioeconomic factors ; Studies ; Tobacco smoking ; Workers
  • Es parte de: BMJ, 2005-07, Vol.331 (7508), p.77-80
  • Notas: href:bmj-331-77.pdf
    istex:332E502F346303752D0CDEA28E9553FE5D9297D7
    Correspondence to: E Cardis
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    PMID:15987704
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    ArticleID:bmj.38499.599861.E0
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    SourceType-Scholarly Journals-1
    ObjectType-Feature-1
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    Ethical approval: The study was approved by the IARC ethical review committee and by the relevant ethical committees of the participating countries.
    Correspondence to: E Cardis cardis@iarc.fr
    We are grateful to Richard Doll, Jacques Estève, and Bruce Armstrong who helped to start this study; to the late Len Salmon who inspired the study of errors in doses; to past members of the dosimetry and epidemiology subcommittees (William Murray, Robert Rinsky) and of the international study group (the late E Gubéran, Y Hosoda, T Iwasaki, G Kendall, M Murata, T Rytomaa); to everyone in the participating countries who worked in the collection and validation of the data used in the study; and to the representatives and staff of the nuclear facilities included in the study for their open collaboration. This report uses data obtained from the Radiation Effects Research Foundation (RERF), Hiroshima and Nagasaki, Japan. RERF is a private, non-profit foundation funded by the Japanese Ministry of Health, Labour and Welfare and the US Department of Energy through the National Academy of Sciences. The conclusions in this report are those of the authors and do not necessarily reflect the scientific judgment of RERF or its funding agencies.
    Funding: European Union (contracts F13P-CT930066, F14P-CT96-0062, FIGH-CT1999-20001); US Centers for Disease Control (Co-operative agreement U50/CCU011778); Canadian Nuclear Safety Commission; Japanese Institute for Radiation Epidemiology, Australian Nuclear Science and Technology Organisation; Nuclear Research Center (SCKCEN), Belgium; Health Canada and Statistics Canada; La Ligue Nationale contre le Cancer, France; La Compagnie Générale des Matière Nucléaire, France; Electricité de France; Ministry of Education, Culture, Sports, Science and Technology in Japan; Ministry of Science and Technology (MOST) in Korea; Spanish Nuclear Safety Council; US Department of Energy. These sponsors had no role in study design, data collection, analysis, or interpretation. IT-C received funding from the Association pour la Recherche contre le Cancer (ARC, France); MSP and DBR were the recipients, respectively, of an IARC postdoctoral fellowship and of an ORAU fellowship during their stay at IARC.
    Competing interests: C Hacker, B Heinmiller, H Hyvonen, M Marshall, A Rogel, J Bernar Solano, M Eklöf, and K Holan are (or have been in the past five years) employees of the nuclear industry or have links to the nuclear industry in their country. They were appointed to the international study group and or the dosimetry subcommittee as experts because of their critical knowledge and experience in historical radiation protection practices and dosimetry. None of them had influence on decisions concerning analysis of the results.
    Contributors: ECa designed and coordinated the international study, took part in data analysis, interpretation, and writing of the paper, and is guarantor. MV took part in data analysis, interpretation, and writing of the paper for the international study. As members of the epidemiology subcommittee MB, EG, MH, CHi, GH, JKa, CM, MS-B, and TY contributed to the conception and design, the development of the analytical strategy, and the analysis and interpretation of the data of the international study. They also contributed to the collection and validation of data in their own countries. As members of the dosimetry subcommittee FB, GC, JJF, CHa, BH, MMarshall, IT-C, and DU developed the protocol for the study of errors in doses, collected data on dosimetry practices, and participated in the review and analysis of dosimetry questionnaires and in the identification and quantification of errors in photon dose estimates. The study of errors in doses was the topic of IT-C's PhD dissertation and postdoctoral fellowship, and she was involved in all of the steps of data acquisition, validation, and analysis and in the planning and conducting of the dosimetry experiments and the derivation of the dosimetric bias conversion factors. The other members of the international study group (YOA, PA, AA, JMB, JBS, AB, PD, ADS, ME, HE, GE, LMG, GG, RH, KH, HH, AK, JKu, HM, AMa, IT, MU) took part in the design of the common protocol and were responsible for implementation of the core protocol and the collection and validation of data in their countries. FR-A, AR, MT-L, and KV coordinated data collection or otherwise contributed to data acquisition, analysis, and interpretation of data at the national level in their countries. EA, ECo, AMo, and HT were responsible for management of the international database and for data validation and analysis at IARC. MMartuzzi and DBR assisted in validation of the data at the international level, implementation of the protocol at the national level, and provided assistance to national collaborators through contacts and site visits. MSP assisted in the validation and analysis of the international dataset. All authors critically reviewed earlier drafts for important intellectual content and approved the final version of the paper.
  • Descripción: Objectives To provide direct estimates of risk of cancer after protracted low doses of ionising radiation and to strengthen the scientific basis of radiation protection standards for environmental, occupational, and medical diagnostic exposures. Design Multinational retrospective cohort study of cancer mortality. Setting Cohorts of workers in the nuclear industry in 15 countries. Participants 407 391 workers individually monitored for external radiation with a total follow-up of 5.2 million person years. Main outcome measurements Estimates of excess relative risks per sievert (Sv) of radiation dose for mortality from cancers other than leukaemia and from leukaemia excluding chronic lymphocytic leukaemia, the main causes of death considered by radiation protection authorities. Results The excess relative risk for cancers other than leukaemia was 0.97 per Sv, 95% confidence interval 0.14 to 1.97. Analyses of causes of death related or unrelated to smoking indicate that, although confounding by smoking may be present, it is unlikely to explain all of this increased risk. The excess relative risk for leukaemia excluding chronic lymphocytic leukaemia was 1.93 per Sv (< 0 to 8.47). On the basis of these estimates, 1-2% of deaths from cancer among workers in this cohort may be attributable to radiation. Conclusions These estimates, from the largest study of nuclear workers ever conducted, are higher than, but statistically compatible with, the risk estimates used for current radiation protection standards. The results suggest that there is a small excess risk of cancer, even at the low doses and dose rates typically received by nuclear workers in this study.
  • Editor: England: British Medical Journal Publishing Group
  • Idioma: Inglés
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