Risk of cancer from occupational exposure to ionising radiation: retrospective cohort study of workers in France, the United Kingdom, and the United States (INWORKS) via The bmj


Study question Is protracted exposure to low doses of ionising radiation associated with an increased risk of solid cancer?

Methods In this cohort study, 308 297 workers in the nuclear industry from France, the United Kingdom, and the United States with detailed monitoring data for external exposure to ionising radiation were linked to death registries. Excess relative rate per Gy of radiation dose for mortality from cancer was estimated. Follow-up encompassed 8.2 million person years. Of 66 632 known deaths by the end of follow-up, 17 957 were due to solid cancers.

Study answer and limitations Results suggest a linear increase in the rate of cancer with increasing radiation exposure. The average cumulative colon dose estimated among exposed workers was 20.9 mGy (median 4.1 mGy). The estimated rate of mortality from all cancers excluding leukaemia increased with cumulative dose by 48% per Gy (90% confidence interval 20% to 79%), lagged by 10 years. Similar associations were seen for mortality from all solid cancers (47% (18% to 79%)), and within each country. The estimated association over the dose range of 0-100 mGy was similar in magnitude to that obtained over the entire dose range but less precise. Smoking and occupational asbestos exposure are potential confounders; however, exclusion of deaths from lung cancer and pleural cancer did not affect the estimated association. Despite substantial efforts to characterise the performance of the radiation dosimeters used, the possibility of measurement error remains.

What this study adds The study provides a direct estimate of the association between protracted low dose exposure to ionising radiation and solid cancer mortality. Although high dose rate exposures are thought to be more dangerous than low dose rate exposures, the risk per unit of radiation dose for cancer among radiation workers was similar to estimates derived from studies of Japanese atomic bomb survivors. Quantifying the cancer risks associated with protracted radiation exposures can help strengthen the foundation for radiation protection standards.

Funding, competing interests, data sharing Support from the US Centers for Disease Control and Prevention; Ministry of Health, Labour and Welfare of Japan; Institut de Radioprotection et de Sûreté Nucléaire; AREVA; Electricité de France; US National Institute for Occupational Safety and Health; US Department of Energy; and Public Health England. Data are maintained and kept at the International Agency for Research on Cancer.

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5 Responses to Risk of cancer from occupational exposure to ionising radiation: retrospective cohort study of workers in France, the United Kingdom, and the United States (INWORKS) via The bmj

  1. norma field says:

    This report calls for revived awareness of the Petkau Effect:
    “In 1972, a researcher in Canada, Dr. Abram Petkau, found that when cells were irradiated slowly, a smaller total dose was needed to cause damage. Since this critical discovery it has been verified that a small dose of radiation over a long time is more damaging than one larger dose. Imagine the ramifications! This means that the small amounts of radiation that are released from the everyday operation of the world’s 400 nuclear plants are doing much more damage than calculated.

    This discovery, known as the “Petkau Effect,” showed that the amounts of radiation that are legally released from nuclear power plants, combined with the leaks, spills, and accidents, are a cause of extreme damage to our health because continuous low-level exposures produce hundreds to thousands of times more free radicals than the same dose delivered at one time, as in an X ray, for example.
    Dr. Ernest Sternglass, retired Emeritus Professor of Radiological Physics at the University of Pittsburgh and a pioneering researcher in the field of radiation health, explains in his 1978 book Secret Fallout the implications of this new understanding: “Doses of radiation delivered slowly and continuously over extended periods of time are hundreds of times as damaging biologically as short, high intensity exposures of the same total dose. This was made clear in 1972 by Dr. Abram Petkau who discovered that at low doses of radiation absorbed at low rates, the dominant biological damage is produced by highly toxic molecules called free radicals.”

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