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. 2023 Aug 16:382:e074520.
doi: 10.1136/bmj-2022-074520.

Cancer mortality after low dose exposure to ionising radiation in workers in France, the United Kingdom, and the United States (INWORKS): cohort study

David B Richardson  1 , Klervi Leuraud  2 , Dominique Laurier  2 , Michael Gillies  3 , Richard Haylock  3 , Kaitlin Kelly-Reif  4 , Stephen Bertke  4 , Robert D Daniels  4 , Isabelle Thierry-Chef  5 , Monika Moissonnier  6 , Ausrele Kesminiene  6 , Mary K Schubauer-Berigan  6
Affiliations

Cancer mortality after low dose exposure to ionising radiation in workers in France, the United Kingdom, and the United States (INWORKS): cohort study

David B Richardson et al. BMJ. .

Abstract

Objective: To evaluate the effect of protracted low dose, low dose rate exposure to ionising radiation on the risk of cancer.

Design: Multinational cohort study.

Setting: Cohorts of workers in the nuclear industry in France, the UK, and the US included in a major update to the International Nuclear Workers Study (INWORKS).

Participants: 309 932 workers with individual monitoring data for external exposure to ionising radiation and a total follow-up of 10.7 million person years.

Main outcome measures: Estimates of excess relative rate per gray (Gy) of radiation dose for mortality from cancer.

Results: The study included 103 553 deaths, of which 28 089 were due to solid cancers. The estimated rate of mortality due to solid cancer increased with cumulative dose by 52% (90% confidence interval 27% to 77%) per Gy, lagged by 10 years. Restricting the analysis to the low cumulative dose range (0-100 mGy) approximately doubled the estimate of association (and increased the width of its confidence interval), as did restricting the analysis to workers hired in the more recent years of operations when estimates of occupational external penetrating radiation dose were recorded more accurately. Exclusion of deaths from lung cancer and pleural cancer had a modest effect on the estimated magnitude of association, providing indirect evidence that the association was not substantially confounded by smoking or occupational exposure to asbestos.

Conclusions: This major update to INWORKS provides a direct estimate of the association between protracted low dose exposure to ionising radiation and solid cancer mortality based on some of the world's most informative cohorts of radiation workers. The summary estimate of excess relative rate solid cancer mortality per Gy is larger than estimates currently informing radiation protection, and some evidence suggests a steeper slope for the dose-response association in the low dose range than over the full dose range. These results can help to strengthen radiation protection, especially for low dose exposures that are of primary interest in contemporary medical, occupational, and environmental settings.

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Conflict of interest statement

Competing interests: All authors have completed the ICMJE uniform disclosure form at https://www.icmje.org/disclosure-of-interest/ and declare: support from the US National Cancer Institute, Orano, the French Alternative Energies and Atomic Energy Commission, and Electricité de France; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.

Figures

Fig 1
Fig 1
Relative rate of mortality due to solid cancer by categories of cumulative colon dose, lagged 10 years in INWORKS. Bars indicate 90% confidence intervals, and purple line depicts fitted linear model for change in excess relative rate of solid cancer mortality with dose. Strata: country, age, sex, birth cohort, socioeconomic status, duration employed, neutron monitoring status
See this image and copyright information in PMC

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