МЕДИЦИНА КАТАСТРОФ №3•2021
https://doi.org/10.33266/2070-1004-2021-3
Оригинальная статья
Сравнение риска смертности от сóлидных раков после радиационных инцидентов и профессионального облучения
Котеров А.Н. 1, Ушенкова Л.Н. 1, Калинина М.В. 1, Бирюков А.П. 1
1 ФГБУ «ГНЦ – Федеральный медицинский биофизический центр им. А.И.Бурназяна» ФМБА России, Москва, Россия
УДК [331.43 + 614.8-052 + 632.118.3]: 616-006
С. 34-41
Резюме. Цель исследования – сравнение избыточного относительного риска смертности (ERR на 1 Зв) от сóлидных раков при остром – катастрофическом или аварийном и профессиональном – фракционированном или хроническом – облучении.
Материалы и методы исследования. Материалы исследования: поддерживаемая база данных (база источников) по работникам ядерной индустрии из примерно 40 стран, на основе которой проведен объединяющий анализ данных для определения интегральной величины ERR на 1 Гр по смертности от сóлидных раков; показатели когорт, подвергавшихся катастрофическому и аварийному облучению: когорта LSS пострадавших от атомных бомбардировок в Японии; резиденты реки Теча – радиоактивное загрязнение в результате выбросов ПО «Маяк»; российские ликвидаторы аварии на Чернобыльской АЭС.
Результаты исследования и их анализ. Сравнение величины ERR смертности от сóлидных раков на 1 Зв для работников мировой ядерной индустрии (объединяющий анализ данных 37 исследований) с показателями когорты LSS; резидентов на реке Теча и ликвидаторов аварии на Чернобыльской АЭС – продемонстрировало отсутствие поддающихся логике и принципиальных отличий, причем риски для двух последних когорт были наиболее высокими.
Хотя полученные данные отчасти подтверждают подход Научного комитета по действию атомной радиации ООН, согласно которому канцерогенные эффекты острого (катастрофического или аварийного) и профессионального (фракционированного или хронического) лучевых воздействий не зависят от фактора мощности дозы (DDREF), тем не менее, с учетом биологических механизмов и данных радиобиологических экспериментов, этот вопрос не может считаться однозначно решенным.
Исходя из ERR на 1 Зв, из средней дозы внешнего облучения, а также из величины ежегодной фоновой смертности от рака в России и США ожидаемая прибавка смертности от раков для 100 тыс. работников ядерной индустрии составит в среднем 32–69 чел. за 10 лет – 0,032–0,069% от группы. Подобные риски, в связи со множеством канцерогенных нелучевых факторов жизни и работы, равно как и с колебаниями фонового значения, невозможно учитывать в практике медицины катастроф и здравоохранения.
Ключевые слова: аварийное облучение, катастрофическое облучение, ликвидаторы аварии на Чернобыльской АЭС, пострадавшие от атомных бомбардировок, работники ядерной индустрии, резиденты реки Теча, риск смертности, сóлидные раки, фракционированное облучение, хроническое облучение
Для цитирования: Котеров А.Н., Ушенкова Л.Н., Калинина М.В., Бирюков А.П. Сравнение риска смертности от сóлидных раков после радиационных инцидентов и профессионального облучения // Медицина катастроф. 2021. №3. С. 34-41. https://doi.org/10.33266/2070-1004-2021-3-34-41
СПИСОК ИСТОЧНИКОВ / REFERENCES
- UNSCEAR 1958. Report to the General Assembly, with Scientific Annexes. Annex G. Mammalian Somatic Effects. United Nations. New York, 1958;153–171.
- UNSCEAR 1962. Report to the General Assembly, with Scientific Annexes. Annex D. Somatic Effects of Radiation. United Nations. New York, 1962;118–206.
- UNSCEAR 2000. Report to the General Assembly, with Scientific Annex G. Biological Effects at Low Radiation Doses. United Nations. New York, 2000;73–175.
- Berrington de Gonzalez A., Bouville A., Rajaraman P., Schubauer-Berigan M. Ionizing Radiation. In: ‘Schottenfeld and Fraumeni Cancer Epidemiology and Prevention’. Fourth Edition. Ed. by Thun M.J., et al. New York, Oxford University Press. Printed by Sheridan Books, Inc., USA, 2018;227–248.
- UNSCEAR 2012. Report to the General Assembly, with Scientific Annexes. Annex A. Attributing Health Effects to Ionizing Radiation Exposure and Inferring Risks. United Nations. New York, 2015;86 p.
- Muirhead C.R., Cox R., Stather J.W., et al. Estimates of Late Radiation Risks to the UK Population. Documents of the NRPB. 1993;4;4:13–157.
- UNSCEAR 1993. Report to the General Assembly, with Scientific Annex. Annex F. Influence of Dose and Dose Rate on Stochastic Effects of Radiation. United Nations. New York, 1993;619–727.
- ICRP Publication 103. The 2007 Recommendations of the International Commission on Radiological Protection. Annals of the ICRP. Ed. by J. Valentin. Amsterdam – New York, Elsevier, 2007. 329 p.
- National Research Council, Division on Earth and Life Studies, Board on Radiation Effects Research, Committee to Assess Health Risks from Exposure to Low Levels of Ionizing Radiation. Health Risks from Exposure to Low Levels of Ionizing Radiation: BEIR VII. Phase 2. National Academies Press, 2006. 422 p.
- Ozasa K., Shimizu Y., Suyama A., et al. Studies of the Mortality of Atomic Bomb Survivors, Report 14, 1950–2003: An Overview of Cancer and Noncancer Diseases. Radiat. Res. 2012; 177;3:229–243. https://doi.org/10.1667/rr2629.1.
- Cardis E., Vrijheid M., Blettner M., et al. Risk of Cancer After Low Doses of Ionising Radiation: Retrospective Cohort Study in 15-Countries. Brit. Med. J. 2005;331;7508:77–82. https://doi.org/10.1136/bmj.38499.599861.E0.
- Cardis E., Vrijheid M., Blettner M., et al. The 15-Country Collaborative Study of Cancer Risk Among Radiation Workers in the Nuclear Industry: Estimates of Radiation-Related Cancer Risks. Radiat Res. 2007;167;4:396–416. https://doi.org/10.1667/RR0553.1.
- Vrijheid M., Cardis E., Ashmore P., et al. Ionizing Radiation and Risk of Chronic Lymphocytic Leukemia in the 15-Country Study of Nuclear Industry Workers. Radiat. Res 2008;170;5:661–665. https://doi.org/10.1667/RR1443.1
- UNSCEAR 2017. Report to the General Assembly, with Scientific Annexes. Annex B. Epidemiological Studies of Cancer Risk Due to Low-Dose-Rate Radiation from Environmental Sources. United Nations. New York, 2018;65–184.
- UNSCEAR 2019. Report to the General Assembly, with Scientific Annexes. Annex A. Evaluation of Selected Health Effects and Inherence of Risk Due to Radiation Exposure. United Nations. New York, 2020;65–184.
- Ruhm W., Woloschak G.E., Shore R.E. Dose and Dose-Rate Effects of Ionizing Radiation: a Discussion in the Light of Radiological Protection. Radiat. Environ. Biophys. 2015;54;4:379–401. https://doi.org/10.1007/s00411-015-0613-6.
- Wakeford R. Nuclear Worker Studies: Promise and Pitfalls. Br. J. Cancer. 2014;110;1:1–3. https://doi.org/10.1038/bjc.2013.713.
- Dauer L.T., Brooks A.L., Hoel D.G., et al. Review and Evaluation of Updated Researches on the Health Effects Associated with Low-Dose Ionizing Radiation. Addition to BEIR-VII. Radiat. Prot. Dosim. 2010;140;2:103–136. https://doi.org/10.1093/rpd/ncq141.
- Blettner M., Sauerbrei W., Schlehofer B., et al. Traditional Reviews, Meta-Analyses and Pooled Analyses in Epidemiology. Int. J. Epidemiol. 1999;28;1:1–9. https://doi.org/10.1093/ije/28.1.1.
- Bravata D.M., Olkin I. Simple Pooling Versus Combining in Meta-Analysis. Eval. Health Prof. 2001;24;2:218–230. https://doi.org/10.1177/01632780122034885.
- Mostarac P., Malaric R., Hegedusi H. Comparison of Outliers Elimination Algorithms. Proc. 7th Intern. Conf., Smolenice, Slovakia. Measurement. 2009;49–52. Also Table ‘Chauvenet’s Criterion for Rejecting a Reading’: https://chetaero.files.wordpress.com/2016/11/chauvenet.pdf (address data 2021/03/21).
- Beral V., Fraser P., Carpenter L., et al. Mortality of Employees of the Atomic Weapons Establishment, 1951–1982. British Med. J. 1988;297;6651:757–770. https://doi.org/10.1136/bmj.297.6651.757.
- Fraser P.L., Carpenter N., Maconochie C., et al. Cancer Mortality and Morbidity in Employees of the United Kingdom Atomic Energy Authority, 1946–86. Brit. J. Cancer. 1993;67;3:615–624. https://doi.org/10.1038/bjc.1993.113.
- McGeoghegan D., Binks K. The Mortality and Cancer Morbidity Experience of Workers at the Springfields Uranium Production Facility, 1946–95. J. Radiol. Prot. 2000;20;2:111–137. https://doi.org/10.1088/0952-4746/20/4/303.
- Douglas A.J., Omar R.Z., Smith P.G. Cancer Mortality and Morbidity Among Workers at the Sellafield Plant of British Nuclear Fuels. Brit. J. Cancer. 1994;70;6:1232–1243. https://doi.org/10.1038/sj.bjc.6690207.
- Kendall G.M., Muirhead C.R., Mac Gibbon B.H., et al. Mortality and Occupational Exposure to Radiation: First Analysis of the National Registry for Radiation Workers. Brit. Med. J. 1992;304;6821:220–225. https://doi.org/10.1136/bmj.304.6821.220.
- Russ A., Burns C., Tuler S., Taylor O. Health Risks of Ionizing Radiation: an Overview of Epidemiological Studies. A Report by the Community-Based Hazard Management Program. George Perkins Marsh Institute. Clark University. Worcester, MA 01610-1477. USA. March, 2006. 253 p.
- Gillies M., Haylock R. The Cancer Mortality and Incidence Experience of Workers at British Nuclear Fuels plc, 1946–2005. J. Radiol. Prot. 2014;34;3:595–623. https://doi.org/10.1088/0952-4746/34/3/595.
- Haylock R.G.E., Gillies M., Hunter N., et al. Cancer Mortality and Incidence Following External Occupational Radiation Exposure: An Update of the 3rd Analysis of the UK National Registry for Radiation Workers. Br. J. Cancer. 2018;119;5:631–637. https://doi.org/10.1038/s41416-018-0184-9.
- Gribbin M.A., Weeks J.L., Howe G.R. Cancer Mortality (1956–1985) Among Male Employees of Atomic Energy of Canada Limited with Respect to Occupational Exposure to External Low-Linear-Energy-Transfer Ionizing Radiation. Radiat. Res. 1993;133;3:375–380. https://doi.org/10.2307/3578225.
- Zablotska L.B., Lane R.S., Thompson P.A. A Reanalysis of Cancer Mortality in Canadian Nuclear Workers (1956–1994) Based on Revised Exposure and Cohort Data. Br. J. Cancer. 2014;110;1:214–223. https://doi.org/10.1038/bjc.2013.592.
- Ashmore J.P., Sont W.N., Davies B.F. Analysis of Medical Workers Dose Records from the Canadian National Dose Registry. Radiat. Prot. Dosimetry. 1991;36;2:79–83. https://doi.org/10.1093/oxfordjournals.rpd.a080972.
- Ashmore J.P., Krewski D., Zielinski J.M. Protocol for a Cohort Mortality Study of Occupational Radiation Exposure Based on the National Dose Registry of Canada. Eur. J. Cancer. 1997;33;3:10–S21. https://doi.org/10.1016/S0959-8049(97)00018-X.
- Zielinski J.M., Shilnikova N.S., Krewski D. Canadian National Dose Registry of Radiation Workers: Overview of Research from 1951 through 2007. Int. J. Occup. Med. Environ. Health. 2008;21;4:269–275. https://doi.org/10.2478/v10001-008-0037-5.
- Sont W.N., Zielinski J.M., Ashmore J.P., et al. First Analysis of Cancer Incidence and Occupational Radiation Exposure Based on the National Dose Registry of Canada. Am. J. Epidemiol. 2001;153;4:309–318. https://doi.org/10.1093/aje/153.4.309.
- Cardis E., Gilbert E.S., Carpenter L., et al. Effects of Low Doses and Low Dose Rates of External Ionizing Radiation: Cancer Mortality among Nuclear Industry Workers in Three Countries. Radiat. Res. 1995;142;2:117–132. https://doi.org/10.2307/3579020.
- Ashmore J.P., Gentner N.E., Osborne R.V. Evaluation of the Results of the Study by the International Agency for Research on Cancer on the Radiogenic Cancer Risk among Workers in the Canadian Nuclear Industry. Unrestricted Report DSP-121100-REPT-001 March 2007. Chalk River Laboratories Information Centre Chalk River, ON: Atomic Energy of Canada Limited. 2007. 112 p.
- Wing S., Shy C.M., Wood J.L., et al. Mortality among Workers at Oak Ridge National Laboratory. Evidence of Radiation Effects in Follow-up Through 1984. J. Am. Med. Assoc. 1991;265;11:1397-402. https://doi.org/10.1001/jama.1991.03460110063025.
- Wing S., Richardson D.B. Age at Exposure to Ionising Radiation and Cancer Mortality among Hanford workers: Follow up Through 1994. Occup. Environ. Med. 2005;62;7:465–472. https://doi.org/10.1136/oem.2005.019760.
- Gilbert E.S., Cragle D.L., Wiggs L.D. Updated Analyses of Combined Mortality Data for Workers at the Hanford Site, Oak Ridge National Laboratory, and Rocky Flats Weapons Plant. Radiat. Res. 1993;136;3:408–421. https://doi.org/10.2307/3578555.
- Frome E.L., Cragle D.L., Watkins J.P., et al. A Mortality Study of Employees of the Nuclear Industry in Oak Ridge, Tennessee. Radiat Res. 1997;148;1:64–80. https://doi.org/10.2307/3579540.
- Ashmore J.P., Gentner N.E., Osborne R.V. Incomplete Data on the Canadian Cohort May Have Affected the Results of the Study by the International Agency for Research on Cancer on the Radiogenic Cancer Risk among Nuclear Industry Workers in 15 Countries. J. Radiol. Prot. 2010;30;2:121–129. https://doi.org/10.1088/0952-4746/30/2/001.
- Metz-Flamant C., Laurent O., Samson E., et al. Mortality Associated with Chronic External Radiation Exposure in the French Combined Cohort of Nuclear Workers. Occup. Environ. Med. 2013;70;9:630–638. https://doi.org/10.1136/oemed-2012-101149.
- Fournier L., Clero E., Samson E., et al. Impact of Considering Non-Occupational Radiation Exposure on the Association Between Occupational Dose and Solid Cancer among French Nuclear Workers. Occup. Environ. Med. 2018;75;3:199–204. https://doi.org/10.1136/oemed-2017-104341.
- Leuraud K., Fournier L., Samson E., et al. Mortality in the French Cohort of Nuclear Workers. Radioprotection. 2017;52;3:199–210. https://doi.org/10.1051/radiopro/2017015.
- Ivanov V.K., Tsyb A.F., Agapov A.M., et al. Concept of Optimisation of the Radiation Protection System in the Nuclear Sector: Management of Individual Cancer Risks and Providing Targeted Health Care. J. Radiol. Prot. 2006;26;4:361–374. https://doi.org/10.1088/0952-4746/26/4/001.
- Shilnikova N.S., Preston D.L., Ron E., et al. Cancer Mortality Risk among Workers at the Mayak Nuclear Complex. Radiat. Res. 2003;159;6:787–798. https://doi.org/10.1667/0033-7587(2003)159[0787:cmrawa]2.0.co;2.
- Akiba S, Mizuno S. The Third Analysis of Cancer Mortality among Japanese Nuclear Workers, 1991-2002: Estimation of Excess Relative Risk Per Radiation Dose. J. Radiol. Prot. 2012;32;1:73–83. https://doi.org/10.1088/0952-4746/32/1/73.
- Kudo S., Ishida J., Yoshimoto K., et al. Direct Adjustment for Confounding by Smoking Reduces Radiation-Related Cancer Risk Estimates of Mortality among Male Nuclear Workers in Japan, 1999–2010. J. Radiol. Prot. 2018;38;1:357–371. https://doi.org/10.1088/1361-6498/aaa65c.
- Zablotska L.B., Ashmore J.P., Howe G.R. Analysis of Mortality Experience Amongst Canadian Nuclear Power Industry Workers Following Chronic Low-Dose Exposure to Ionizing Radiation. Radiat. Res. 2004;161;6:633–641. https://doi.org/10.1667/RR3170.
- Carpenter L., Higgins C., Douglas A., et al. Combined Analysis of Mortality in Three United Kingdom Nuclear Industry Workforces, 1946–1988. Radiat. Res. 1994;138;2:224–238.
- Carpenter L.M., Higgins C.D., Douglas A.J., et al. Cancer Mortality in Relation to Monitoring for Radionuclide Exposure in Three UK Nuclear Industry Workforces. Brit. J. Cancer. 1998;78;9:1224–1232. https://doi.org/10.1038/bjc.1998.659.
- Muirhead C.R., Goodill A.A., Haylock R.G., et al. Occupational Radiation Exposure and Mortality: Second Analysis of the National Registry for Radiation Workers. J. Radiol. Prot. 1999;19;1:3–26. https://doi.org/10.1088/0952-4746/19/1/002.
- Muirhead C.R., O’Hagan. J.A., Haylock R.G.E., et al. Mortality and Cancer Incidence Following Occupational Radiation Exposure: Third Analysis of the National Registry for Radiation Workers. Br. J. Cancer. 2009;100;1:206–212. https://doi.org/10.1038/sj.bjc.6604825.
- Thierry-Chef M., Marshall J.J., Fix F.B., et al. The 15-Country Collaborative Study of Cancer Risk among Radiation Workers in the Nuclear Industry: Study of Errors in Dosimetry. Radiat. Res. 2007;167;4:380–395. https://doi.org/10.1667/RR0552.1.
- Vrijheid M., Cardis E., Blettner M., et al. The 15-Country Collaborative Study of Cancer Risk among Radiation Workers in the Nuclear Industry: Design, Epidemiological Methods and Descriptive Results. Radiat. Res. 2007;167;4:361–379. https://doi.org/10.1667/RR0554.1.
- Daniels R.D., Bertke S.J., Richardson D.B., et al. Examining Temporal Effects on Cancer Risk in the International Nuclear Workers’ Study. Int. J. Cancer. 2017;140;6:1260–1269. https://doi.org/10.1002/ijc.30544.
- Richardson D.B., Cardis E., Daniels R.D., et al. Risk of Cancer from Occupational Exposure to Ionising Radiation: Retrospective Cohort Study of Workers in France, the United Kingdom, and the United States (INWORKS). Br. Med. J. 2015;351:Article h5359. https://doi.org/10.1136/bmj.h5359.
- Laurier D., Richardson D.B., Cardis E., et al. The International Nuclear Workers Study (Inworks): A Collaborative Epidemiological Study to Improve Knowledge about Health Effects of Protracted Low-Dose Exposure. Radiat. Prot. Dosimetry. 2017;173;1–3:21–25. https://doi.org/10.1093/rpd/ncw314.
- Krestinina L.Y., Preston D.L., Ostroumova E.V., et al. Protracted Radiation Exposure and Cancer Mortality in the Techa River Cohort. Radiat. Res. 2005;164;5:602–611. https://doi.org/10.1667/rr3452.1.
- Ivanov V.K., Karpenko S. V., Kashcheev V.V., et al. Relationship Between Follow-Up Periods and the Low-Dose Ranges with Statistically Significant Radiation-Induced Risk of All Solid Cancers in the Russian Cohort of Chernobyl Emergency Workers. Radiat. Environ. Biophys. 2020;59;3:415–421. https://doi.org/10.1007/s00411-020-00850-1.
- Boice J.D., Jr. Ionizing Radiation. In: ‘Schottenfeld and Fraumeni Cancer Epidemiology and Prevention’. 3th Edition. Ed. by D. Schottenfeld and J.F. Fraumeni. New York, Oxford University Press, 2006. P. 59–293.
- Zeeb H., Merzenich H., Wicke H., Blettner M. Radiation Epidemiology. In: ‘Handbook of Epidemiology’. 2nd Edition. Ed. by W. Ahrens, I. Pigeot. New York, Heidelberg, Dordrecht, London: Springer, 2014. P. 2003–2037.
- Koterov A.N. Causal Criteria in Medical and Biological Disciplines: History, Essence and Radiation Aspect. Report 1. Problem Statement, Conception of Causes and Causation, False Associations. Biol. Bull. Moscow. 2019;46;11:1458–1488. https://doi.org/10.1134/S1062359019110165.
- Koterov A.N., Biryukov A.P. The Possibility of Determining of Anomalies and Pathologies in the Offspring of liquidators of Chernobyl Accident by the Non-Radiation Factors. Int. J. Low Radiation Paris. 2011;8;4:256–312. https://doi.org/10.1504/IJLR.2011.046529.
- Murata M., Miyake T., Inoue Y., et al. Life-Style and Other Characteristics of Radiation Workers at Nuclear Facilities in Japan: Base-Line Data of a Questionnaire Survey. J. Epidemiol. 2002;12;4:310–319. https://doi.org/10.2188/jea.12.310.
- Telle-Lamberton M., Samson E., Caer S., et al. External Radiation Exposure and Mortality in a Cohort of French Nuclear Workers. Occup. Environ. Med. 2007;64;10:694–700. https://doi.org/10.1136/oem.2007.032631.
- Wing S., Richardson D., Stewart A. The Relevance of Occupational Epidemiology to Radiation Protection Standards. New Solut. 1999;9;2:133–151. https://doi.org/10.2190/LBN7-2UAB-NJMQ-HDHA.
- Cole P. The Epidemiologist as an Expert Witness. J. Clin. Epidemiol. 1991;44;Suppl.1: 35–39. https://doi.org/10.1016/0895-4356(91)90173-7.
- USEPA 2002. A Review of the Reference Dose and Reference Concentration Processes. EPA/630/P-02/002F. Final Report. – Washington, DC: Risk Assessment Forum. National Center for Environmental Assessment Office of Research and Development U.S. Environmental Protection Agency, 2002. 192 p.
- Gori G.B. Epidemiologic evidence in public and legal policy: reality or metaphor? Critical Legal Issues. – Washington: Washington Legal Foundation. Working Paper Series. 2004;124:33.
- Aschengrau A., Seage G.R., III. Epidemiology in Public Health. 3rd Edition. Burlington: Jones & Bartlett Learning, LLC, 2014. 596 p.
- Howick J., Glasziou P., Aronson J.K. The Evolution of Evidence Hierarchies: What Can Bradford Hill’s ‘Guidelines for Causation’ Contribute? J. R. Soc. Med. 2009;102;5:186–194. https://doi.org/10.1258/jrsm.2009.090020.
- Clarke B., Gillies D., Illari P., Russo F., Williamson J. The Evidence that Evidence-Based Medicine Omits. Prev. Med. 2013;57;6:745–747. https://doi.org/10.1016/j.ypmed.2012.10.020.
- Hill A.B. The Environment and Disease: Association or Causation? Proc. R. Soc. Med. 1965;58;5:295–300. https://doi.org/10.1177/0141076814562718.
- Hill A.B. Suspended Judgment. Memories of the British Streptomycin Trial in Tuberculosis: the First Randomized Clinical Trial. Control. Clin. Trials. 1990;11;2:77–79. https://doi.org/10.1016/0197-2456(90)90001-i.
- Hill A.B. Medical Ethics and Controlled Trials. Br. Med. J. 1963;1;5337:1043–1049. https://doi.org/10.1136/bmj.1.5337.1043.
- Ferlay J., Soerjomataram I., Dikshit R. Cancer Incidence and Mortality Worldwide: Sources, Methods and Major Patterns in GLOBOCAN 2012. Int. J. Cancer. 2015;136;5:359–386. https://doi.org/10.1002/ijc.29210.
- Siegel R.L., Miller K.D., Jemal A. Cancer Statistics, 2020. CA Cancer J. Clin. 2019;69:7–34. https://doi.org/10.3322/caac.21590.
- Cogliano V.J., Baan R.A., Straif K., et al. The Science and Practice of Carcinogen Identification and Evaluation. Environ. Health Perspect. 2004;112;13:1269–1274. https://doi.org/10.1289/ehp.6950.
Материал поступил в редакцию 18.03.21; статья принята после рецензирования 01.06.21; статья принята к публикации 10.09.21
DISASTER MEDICINE No. 3•2021
https://doi.org/10.33266/2070-1004-2021-3
Original article
Comparison of the Risk of Mortality from Solid Cancers after Radiation Incidents and Occupational Exposures
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Koterov A.N.1, Ushenkova L.N.1, Kalinina M.V.1, Biryukov A.P.1
1 State Research Center – Burnasyan Federal Medical Biophysical Center of Federal Medical Biological Agency, Moscow, Russian Federation
UDC [331.43 + 614.8-052 + 632.118.3]: 616-006
Pp. 34-41
Abstract. The purpose of the study was to compare the excess relative risk of mortality (ERR per 1 Sv) from solid cancers during acute — catastrophic or accidental and occupational, fractionated or chronic — exposure.
Study materials and methods. Materials of the study: maintained database (source database) on nuclear industry workers from about 40 countries, based on which a pooled analysis of data was conducted to determine the integral value of ERR per 1 Gy for mortality from solid cancers; indicators of cohorts exposed to catastrophic and accidental radiation: the cohort LSS victims of the atomic bombings in Japan; residents of the Techa River — radioactive contamination resulting from releases from «Mayak» production association; Russian liquidators of the Chernobyl nuclear accident.
Study results and analysis. Comparison of the ERR of 1 Sv deaths from solid cancers for workers in the global nuclear industry (pooling analysis of data from 37 studies) with those of the LSS cohort; Techa River residents and Chernobyl accident liquidators showed no logical and principled differences, with the risks for the latter two cohorts being the highest.
Although the findings partly support the approach of the UN Scientific Committee on the Effects of Atomic Radiation that the carcinogenic effects of acute (catastrophic or accidental) and occupational (fractionated or chronic) radiation exposure are independent of the dose rate factor (DDREF), this issue cannot be considered unequivocally resolved, given the biological mechanisms and radiobiological experimental data.
Based on the ERR per 1 Sv, the average external dose, and the annual background cancer mortality rates in Russia and the United States, the expected cancer mortality increase for 100,000 workers in the nuclear industry would be an average of 32-69 people over 10 years — 0.032-0.069% of the group. Such risks, due to multiple carcinogenic non-radiation factors of life and work, as well as fluctuating background values, cannot be taken into account in the practice of disaster medicine and public health.
Key words: atomic bomb victims, catastrophic exposure, Chernobyl accident liquidators, chronic exposure, emergency exposure, fractionated exposure, mortality risk, nuclear industry workers, solid cancers, Techa River residents
For citation: Koterov A.N., Ushenkova L.N., Kalinina M.V., Biryukov A.P.
Comparison of the Risk of Mortality from Solid Cancers after Radiation Incidents and Occupational Exposures. Meditsina katastrof = Disaster Medicine. 2021;3:34-41 (In Russ.). https://doi.org/10.33266/2070-1004-2021-3-34-41
REFERENCES / СПИСОК ИСТОЧНИКОВ
- UNSCEAR 1958. Report to the General Assembly, with Scientific Annexes. Annex G. Mammalian Somatic Effects. United Nations. New York, 1958;153–171.
- UNSCEAR 1962. Report to the General Assembly, with Scientific Annexes. Annex D. Somatic Effects of Radiation. United Nations. New York, 1962;118–206.
- UNSCEAR 2000. Report to the General Assembly, with Scientific Annex G. Biological Effects at Low Radiation Doses. United Nations. New York, 2000;73–175.
- Berrington de Gonzalez A., Bouville A., Rajaraman P., Schubauer-Berigan M. Ionizing Radiation. In: ‘Schottenfeld and Fraumeni Cancer Epidemiology and Prevention’. Fourth Edition. Ed. by Thun M.J., et al. New York, Oxford University Press. Printed by Sheridan Books, Inc., USA, 2018;227–248.
- UNSCEAR 2012. Report to the General Assembly, with Scientific Annexes. Annex A. Attributing Health Effects to Ionizing Radiation Exposure and Inferring Risks. United Nations. New York, 2015;86 p.
- Muirhead C.R., Cox R., Stather J.W., et al. Estimates of Late Radiation Risks to the UK Population. Documents of the NRPB. 1993;4;4:13–157.
- UNSCEAR 1993. Report to the General Assembly, with Scientific Annex. Annex F. Influence of Dose and Dose Rate on Stochastic Effects of Radiation. United Nations. New York, 1993;619–727.
- ICRP Publication 103. The 2007 Recommendations of the International Commission on Radiological Protection. Annals of the ICRP. Ed. by J. Valentin. Amsterdam – New York, Elsevier, 2007. 329 p.
- National Research Council, Division on Earth and Life Studies, Board on Radiation Effects Research, Committee to Assess Health Risks from Exposure to Low Levels of Ionizing Radiation. Health Risks from Exposure to Low Levels of Ionizing Radiation: BEIR VII. Phase 2. National Academies Press, 2006. 422 p.
- Ozasa K., Shimizu Y., Suyama A., et al. Studies of the Mortality of Atomic Bomb Survivors, Report 14, 1950–2003: An Overview of Cancer and Noncancer Diseases. Radiat. Res. 2012; 177;3:229–243. https://doi.org/10.1667/rr2629.1.
- Cardis E., Vrijheid M., Blettner M., et al. Risk of Cancer After Low Doses of Ionising Radiation: Retrospective Cohort Study in 15-Countries. Brit. Med. J. 2005;331;7508:77–82. https://doi.org/10.1136/bmj.38499.599861.E0.
- Cardis E., Vrijheid M., Blettner M., et al. The 15-Country Collaborative Study of Cancer Risk Among Radiation Workers in the Nuclear Industry: Estimates of Radiation-Related Cancer Risks. Radiat Res. 2007;167;4:396–416. https://doi.org/10.1667/RR0553.1.
- Vrijheid M., Cardis E., Ashmore P., et al. Ionizing Radiation and Risk of Chronic Lymphocytic Leukemia in the 15-Country Study of Nuclear Industry Workers. Radiat. Res 2008;170;5:661–665. https://doi.org/10.1667/RR1443.1
- UNSCEAR 2017. Report to the General Assembly, with Scientific Annexes. Annex B. Epidemiological Studies of Cancer Risk Due to Low-Dose-Rate Radiation from Environmental Sources. United Nations. New York, 2018;65–184.
- UNSCEAR 2019. Report to the General Assembly, with Scientific Annexes. Annex A. Evaluation of Selected Health Effects and Inherence of Risk Due to Radiation Exposure. United Nations. New York, 2020;65–184.
- Ruhm W., Woloschak G.E., Shore R.E. Dose and Dose-Rate Effects of Ionizing Radiation: a Discussion in the Light of Radiological Protection. Radiat. Environ. Biophys. 2015;54;4:379–401. https://doi.org/10.1007/s00411-015-0613-6.
- Wakeford R. Nuclear Worker Studies: Promise and Pitfalls. Br. J. Cancer. 2014;110;1:1–3. https://doi.org/10.1038/bjc.2013.713.
- Dauer L.T., Brooks A.L., Hoel D.G., et al. Review and Evaluation of Updated Researches on the Health Effects Associated with Low-Dose Ionizing Radiation. Addition to BEIR-VII. Radiat. Prot. Dosim. 2010;140;2:103–136. https://doi.org/10.1093/rpd/ncq141.
- Blettner M., Sauerbrei W., Schlehofer B., et al. Traditional Reviews, Meta-Analyses and Pooled Analyses in Epidemiology. Int. J. Epidemiol. 1999;28;1:1–9. https://doi.org/10.1093/ije/28.1.1.
- Bravata D.M., Olkin I. Simple Pooling Versus Combining in Meta-Analysis. Eval. Health Prof. 2001;24;2:218–230. https://doi.org/10.1177/01632780122034885.
- Mostarac P., Malaric R., Hegedusi H. Comparison of Outliers Elimination Algorithms. Proc. 7th Intern. Conf., Smolenice, Slovakia. Measurement. 2009;49–52. Also Table ‘Chauvenet’s Criterion for Rejecting a Reading’: https://chetaero.files.wordpress.com/2016/11/chauvenet.pdf (address data 2021/03/21).
- Beral V., Fraser P., Carpenter L., et al. Mortality of Employees of the Atomic Weapons Establishment, 1951–1982. British Med. J. 1988;297;6651:757–770. https://doi.org/10.1136/bmj.297.6651.757.
- Fraser P.L., Carpenter N., Maconochie C., et al. Cancer Mortality and Morbidity in Employees of the United Kingdom Atomic Energy Authority, 1946–86. Brit. J. Cancer. 1993;67;3:615–624. https://doi.org/10.1038/bjc.1993.113.
- McGeoghegan D., Binks K. The Mortality and Cancer Morbidity Experience of Workers at the Springfields Uranium Production Facility, 1946–95. J. Radiol. Prot. 2000;20;2:111–137. https://doi.org/10.1088/0952-4746/20/4/303.
- Douglas A.J., Omar R.Z., Smith P.G. Cancer Mortality and Morbidity Among Workers at the Sellafield Plant of British Nuclear Fuels. Brit. J. Cancer. 1994;70;6:1232–1243. https://doi.org/10.1038/sj.bjc.6690207.
- Kendall G.M., Muirhead C.R., Mac Gibbon B.H., et al. Mortality and Occupational Exposure to Radiation: First Analysis of the National Registry for Radiation Workers. Brit. Med. J. 1992;304;6821:220–225. https://doi.org/10.1136/bmj.304.6821.220.
- Russ A., Burns C., Tuler S., Taylor O. Health Risks of Ionizing Radiation: an Overview of Epidemiological Studies. A Report by the Community-Based Hazard Management Program. George Perkins Marsh Institute. Clark University. Worcester, MA 01610-1477. USA. March, 2006. 253 p.
- Gillies M., Haylock R. The Cancer Mortality and Incidence Experience of Workers at British Nuclear Fuels plc, 1946–2005. J. Radiol. Prot. 2014;34;3:595–623. https://doi.org/10.1088/0952-4746/34/3/595.
- Haylock R.G.E., Gillies M., Hunter N., et al. Cancer Mortality and Incidence Following External Occupational Radiation Exposure: An Update of the 3rd Analysis of the UK National Registry for Radiation Workers. Br. J. Cancer. 2018;119;5:631–637. https://doi.org/10.1038/s41416-018-0184-9.
- Gribbin M.A., Weeks J.L., Howe G.R. Cancer Mortality (1956–1985) Among Male Employees of Atomic Energy of Canada Limited with Respect to Occupational Exposure to External Low-Linear-Energy-Transfer Ionizing Radiation. Radiat. Res. 1993;133;3:375–380. https://doi.org/10.2307/3578225.
- Zablotska L.B., Lane R.S., Thompson P.A. A Reanalysis of Cancer Mortality in Canadian Nuclear Workers (1956–1994) Based on Revised Exposure and Cohort Data. Br. J. Cancer. 2014;110;1:214–223. https://doi.org/10.1038/bjc.2013.592.
- Ashmore J.P., Sont W.N., Davies B.F. Analysis of Medical Workers Dose Records from the Canadian National Dose Registry. Radiat. Prot. Dosimetry. 1991;36;2:79–83. https://doi.org/10.1093/oxfordjournals.rpd.a080972.
- Ashmore J.P., Krewski D., Zielinski J.M. Protocol for a Cohort Mortality Study of Occupational Radiation Exposure Based on the National Dose Registry of Canada. Eur. J. Cancer. 1997;33;3:10–S21. https://doi.org/10.1016/S0959-8049(97)00018-X.
- Zielinski J.M., Shilnikova N.S., Krewski D. Canadian National Dose Registry of Radiation Workers: Overview of Research from 1951 through 2007. Int. J. Occup. Med. Environ. Health. 2008;21;4:269–275. https://doi.org/10.2478/v10001-008-0037-5.
- Sont W.N., Zielinski J.M., Ashmore J.P., et al. First Analysis of Cancer Incidence and Occupational Radiation Exposure Based on the National Dose Registry of Canada. Am. J. Epidemiol. 2001;153;4:309–318. https://doi.org/10.1093/aje/153.4.309.
- Cardis E., Gilbert E.S., Carpenter L., et al. Effects of Low Doses and Low Dose Rates of External Ionizing Radiation: Cancer Mortality among Nuclear Industry Workers in Three Countries. Radiat. Res. 1995;142;2:117–132. https://doi.org/10.2307/3579020.
- Ashmore J.P., Gentner N.E., Osborne R.V. Evaluation of the Results of the Study by the International Agency for Research on Cancer on the Radiogenic Cancer Risk among Workers in the Canadian Nuclear Industry. Unrestricted Report DSP-121100-REPT-001 March 2007. Chalk River Laboratories Information Centre Chalk River, ON: Atomic Energy of Canada Limited. 2007. 112 p.
- Wing S., Shy C.M., Wood J.L., et al. Mortality among Workers at Oak Ridge National Laboratory. Evidence of Radiation Effects in Follow-up Through 1984. J. Am. Med. Assoc. 1991;265;11:1397-402. https://doi.org/10.1001/jama.1991.03460110063025.
- Wing S., Richardson D.B. Age at Exposure to Ionising Radiation and Cancer Mortality among Hanford workers: Follow up Through 1994. Occup. Environ. Med. 2005;62;7:465–472. https://doi.org/10.1136/oem.2005.019760.
- Gilbert E.S., Cragle D.L., Wiggs L.D. Updated Analyses of Combined Mortality Data for Workers at the Hanford Site, Oak Ridge National Laboratory, and Rocky Flats Weapons Plant. Radiat. Res. 1993;136;3:408–421. https://doi.org/10.2307/3578555.
- Frome E.L., Cragle D.L., Watkins J.P., et al. A Mortality Study of Employees of the Nuclear Industry in Oak Ridge, Tennessee. Radiat Res. 1997;148;1:64–80. https://doi.org/10.2307/3579540.
- Ashmore J.P., Gentner N.E., Osborne R.V. Incomplete Data on the Canadian Cohort May Have Affected the Results of the Study by the International Agency for Research on Cancer on the Radiogenic Cancer Risk among Nuclear Industry Workers in 15 Countries. J. Radiol. Prot. 2010;30;2:121–129. https://doi.org/10.1088/0952-4746/30/2/001.
- Metz-Flamant C., Laurent O., Samson E., et al. Mortality Associated with Chronic External Radiation Exposure in the French Combined Cohort of Nuclear Workers. Occup. Environ. Med. 2013;70;9:630–638. https://doi.org/10.1136/oemed-2012-101149.
- Fournier L., Clero E., Samson E., et al. Impact of Considering Non-Occupational Radiation Exposure on the Association Between Occupational Dose and Solid Cancer among French Nuclear Workers. Occup. Environ. Med. 2018;75;3:199–204. https://doi.org/10.1136/oemed-2017-104341.
- Leuraud K., Fournier L., Samson E., et al. Mortality in the French Cohort of Nuclear Workers. Radioprotection. 2017;52;3:199–210. https://doi.org/10.1051/radiopro/2017015.
- Ivanov V.K., Tsyb A.F., Agapov A.M., et al. Concept of Optimisation of the Radiation Protection System in the Nuclear Sector: Management of Individual Cancer Risks and Providing Targeted Health Care. J. Radiol. Prot. 2006;26;4:361–374. https://doi.org/10.1088/0952-4746/26/4/001.
- Shilnikova N.S., Preston D.L., Ron E., et al. Cancer Mortality Risk among Workers at the Mayak Nuclear Complex. Radiat. Res. 2003;159;6:787–798. https://doi.org/10.1667/0033-7587(2003)159[0787:cmrawa]2.0.co;2.
- Akiba S, Mizuno S. The Third Analysis of Cancer Mortality among Japanese Nuclear Workers, 1991-2002: Estimation of Excess Relative Risk Per Radiation Dose. J. Radiol. Prot. 2012;32;1:73–83. https://doi.org/10.1088/0952-4746/32/1/73.
- Kudo S., Ishida J., Yoshimoto K., et al. Direct Adjustment for Confounding by Smoking Reduces Radiation-Related Cancer Risk Estimates of Mortality among Male Nuclear Workers in Japan, 1999–2010. J. Radiol. Prot. 2018;38;1:357–371. https://doi.org/10.1088/1361-6498/aaa65c.
- Zablotska L.B., Ashmore J.P., Howe G.R. Analysis of Mortality Experience Amongst Canadian Nuclear Power Industry Workers Following Chronic Low-Dose Exposure to Ionizing Radiation. Radiat. Res. 2004;161;6:633–641. https://doi.org/10.1667/RR3170.
- Carpenter L., Higgins C., Douglas A., et al. Combined Analysis of Mortality in Three United Kingdom Nuclear Industry Workforces, 1946–1988. Radiat. Res. 1994;138;2:224–238.
- Carpenter L.M., Higgins C.D., Douglas A.J., et al. Cancer Mortality in Relation to Monitoring for Radionuclide Exposure in Three UK Nuclear Industry Workforces. Brit. J. Cancer. 1998;78;9:1224–1232. https://doi.org/10.1038/bjc.1998.659.
- Muirhead C.R., Goodill A.A., Haylock R.G., et al. Occupational Radiation Exposure and Mortality: Second Analysis of the National Registry for Radiation Workers. J. Radiol. Prot. 1999;19;1:3–26. https://doi.org/10.1088/0952-4746/19/1/002.
- Muirhead C.R., O’Hagan. J.A., Haylock R.G.E., et al. Mortality and Cancer Incidence Following Occupational Radiation Exposure: Third Analysis of the National Registry for Radiation Workers. Br. J. Cancer. 2009;100;1:206–212. https://doi.org/10.1038/sj.bjc.6604825.
- Thierry-Chef M., Marshall J.J., Fix F.B., et al. The 15-Country Collaborative Study of Cancer Risk among Radiation Workers in the Nuclear Industry: Study of Errors in Dosimetry. Radiat. Res. 2007;167;4:380–395. https://doi.org/10.1667/RR0552.1.
- Vrijheid M., Cardis E., Blettner M., et al. The 15-Country Collaborative Study of Cancer Risk among Radiation Workers in the Nuclear Industry: Design, Epidemiological Methods and Descriptive Results. Radiat. Res. 2007;167;4:361–379. https://doi.org/10.1667/RR0554.1.
- Daniels R.D., Bertke S.J., Richardson D.B., et al. Examining Temporal Effects on Cancer Risk in the International Nuclear Workers’ Study. Int. J. Cancer. 2017;140;6:1260–1269. https://doi.org/10.1002/ijc.30544.
- Richardson D.B., Cardis E., Daniels R.D., et al. Risk of Cancer from Occupational Exposure to Ionising Radiation: Retrospective Cohort Study of Workers in France, the United Kingdom, and the United States (INWORKS). Br. Med. J. 2015;351:Article h5359. https://doi.org/10.1136/bmj.h5359.
- Laurier D., Richardson D.B., Cardis E., et al. The International Nuclear Workers Study (Inworks): A Collaborative Epidemiological Study to Improve Knowledge about Health Effects of Protracted Low-Dose Exposure. Radiat. Prot. Dosimetry. 2017;173;1–3:21–25. https://doi.org/10.1093/rpd/ncw314.
- Krestinina L.Y., Preston D.L., Ostroumova E.V., et al. Protracted Radiation Exposure and Cancer Mortality in the Techa River Cohort. Radiat. Res. 2005;164;5:602–611. https://doi.org/10.1667/rr3452.1.
- Ivanov V.K., Karpenko S. V., Kashcheev V.V., et al. Relationship Between Follow-Up Periods and the Low-Dose Ranges with Statistically Significant Radiation-Induced Risk of All Solid Cancers in the Russian Cohort of Chernobyl Emergency Workers. Radiat. Environ. Biophys. 2020;59;3:415–421. https://doi.org/10.1007/s00411-020-00850-1.
- Boice J.D., Jr. Ionizing Radiation. In: ‘Schottenfeld and Fraumeni Cancer Epidemiology and Prevention’. 3th Edition. Ed. by D. Schottenfeld and J.F. Fraumeni. New York, Oxford University Press, 2006. P. 59–293.
- Zeeb H., Merzenich H., Wicke H., Blettner M. Radiation Epidemiology. In: ‘Handbook of Epidemiology’. 2nd Edition. Ed. by W. Ahrens, I. Pigeot. New York, Heidelberg, Dordrecht, London: Springer, 2014. P. 2003–2037.
- Koterov A.N. Causal Criteria in Medical and Biological Disciplines: History, Essence and Radiation Aspect. Report 1. Problem Statement, Conception of Causes and Causation, False Associations. Biol. Bull. Moscow. 2019;46;11:1458–1488. https://doi.org/10.1134/S1062359019110165.
- Koterov A.N., Biryukov A.P. The Possibility of Determining of Anomalies and Pathologies in the Offspring of liquidators of Chernobyl Accident by the Non-Radiation Factors. Int. J. Low Radiation Paris. 2011;8;4:256–312. https://doi.org/10.1504/IJLR.2011.046529.
- Murata M., Miyake T., Inoue Y., et al. Life-Style and Other Characteristics of Radiation Workers at Nuclear Facilities in Japan: Base-Line Data of a Questionnaire Survey. J. Epidemiol. 2002;12;4:310–319. https://doi.org/10.2188/jea.12.310.
- Telle-Lamberton M., Samson E., Caer S., et al. External Radiation Exposure and Mortality in a Cohort of French Nuclear Workers. Occup. Environ. Med. 2007;64;10:694–700. https://doi.org/10.1136/oem.2007.032631.
- Wing S., Richardson D., Stewart A. The Relevance of Occupational Epidemiology to Radiation Protection Standards. New Solut. 1999;9;2:133–151. https://doi.org/10.2190/LBN7-2UAB-NJMQ-HDHA.
- Cole P. The Epidemiologist as an Expert Witness. J. Clin. Epidemiol. 1991;44;Suppl.1: 35–39. https://doi.org/10.1016/0895-4356(91)90173-7.
- USEPA 2002. A Review of the Reference Dose and Reference Concentration Processes. EPA/630/P-02/002F. Final Report. – Washington, DC: Risk Assessment Forum. National Center for Environmental Assessment Office of Research and Development U.S. Environmental Protection Agency, 2002. 192 p.
- Gori G.B. Epidemiologic evidence in public and legal policy: reality or metaphor? Critical Legal Issues. – Washington: Washington Legal Foundation. Working Paper Series. 2004;124:33.
- Aschengrau A., Seage G.R., III. Epidemiology in Public Health. 3rd Edition. Burlington: Jones & Bartlett Learning, LLC, 2014. 596 p.
- Howick J., Glasziou P., Aronson J.K. The Evolution of Evidence Hierarchies: What Can Bradford Hill’s ‘Guidelines for Causation’ Contribute? J. R. Soc. Med. 2009;102;5:186–194. https://doi.org/10.1258/jrsm.2009.090020.
- Clarke B., Gillies D., Illari P., Russo F., Williamson J. The Evidence that Evidence-Based Medicine Omits. Prev. Med. 2013;57;6:745–747. https://doi.org/10.1016/j.ypmed.2012.10.020.
- Hill A.B. The Environment and Disease: Association or Causation? Proc. R. Soc. Med. 1965;58;5:295–300. https://doi.org/10.1177/0141076814562718.
- Hill A.B. Suspended Judgment. Memories of the British Streptomycin Trial in Tuberculosis: the First Randomized Clinical Trial. Control. Clin. Trials. 1990;11;2:77–79. https://doi.org/10.1016/0197-2456(90)90001-i.
- Hill A.B. Medical Ethics and Controlled Trials. Br. Med. J. 1963;1;5337:1043–1049. https://doi.org/10.1136/bmj.1.5337.1043.
- Ferlay J., Soerjomataram I., Dikshit R. Cancer Incidence and Mortality Worldwide: Sources, Methods and Major Patterns in GLOBOCAN 2012. Int. J. Cancer. 2015;136;5:359–386. https://doi.org/10.1002/ijc.29210.
- Siegel R.L., Miller K.D., Jemal A. Cancer Statistics, 2020. CA Cancer J. Clin. 2019;69:7–34. https://doi.org/10.3322/caac.21590.
- Cogliano V.J., Baan R.A., Straif K., et al. The Science and Practice of Carcinogen Identification and Evaluation. Environ. Health Perspect. 2004;112;13:1269–1274. https://doi.org/10.1289/ehp.6950.
The material was received 18.03.21; the article after peer review procedure 01.06.21; the Editorial Board accepted the article for publication 10.09.21