PDF(Pubmed)
Abstract：
To evaluate the effect of protracted low dose, low dose rate exposure to ionising radiation on the risk of cancer.
Multinational cohort study.
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).
309 932 workers with individual monitoring data for external exposure to ionising radiation and a total follow-up of 10.7 million person years.
Estimates of excess relative rate per gray (Gy) of radiation dose for mortality from cancer.
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.
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.
Multinational cohort study.
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).
309 932 workers with individual monitoring data for external exposure to ionising radiation and a total follow-up of 10.7 million person years.
Estimates of excess relative rate per gray (Gy) of radiation dose for mortality from cancer.
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.
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.
摘要：
目的：评估长期低剂量的效果，低剂量率暴露于电离辐射对癌症的风险。
方法：多国队列研究。
方法：法国核工业工人队列，英国,和美国包括在国际核工人研究（INWORKS）的重大更新。
方法：309932名工人，他们有电离辐射外部暴露的个人监测数据，总随访时间为1,070万人年。
方法：估计癌症死亡率的辐射剂量的每灰色相对比率（Gy）。
结果：该研究包括103553例死亡，其中28089例是由于实体癌。实体癌导致的估计死亡率随累积剂量每Gy增加52%(90%置信区间27%至77%)，落后10年。将分析限制在低累积剂量范围（0-100mGy），使关联估计增加了大约两倍（并增加了其置信区间的宽度），在更准确地记录职业外部穿透性辐射剂量的估计时，将分析限制在最近几年运营中雇用的工人也是如此。排除肺癌和胸膜癌的死亡对估计的关联程度有适度的影响。提供间接证据，证明该关联并未因吸烟或职业接触石棉而造成实质性混淆。
结论：INWORKS的这一重大更新基于世界上一些信息最丰富的放射工作者队列，提供了对长期低剂量电离辐射暴露与实体癌死亡率之间关系的直接估计。每Gy实体癌死亡率的相对比率的汇总估计值大于目前告知辐射防护的估计值。一些证据表明，在低剂量范围内，剂量-反应关联的斜率比在全剂量范围内更陡。这些结果有助于加强辐射防护，特别是对于当代医学中最感兴趣的低剂量暴露，职业,和环境设置。
方法：多国队列研究。
方法：法国核工业工人队列，英国,和美国包括在国际核工人研究（INWORKS）的重大更新。
方法：309932名工人，他们有电离辐射外部暴露的个人监测数据，总随访时间为1,070万人年。
方法：估计癌症死亡率的辐射剂量的每灰色相对比率（Gy）。
结果：该研究包括103553例死亡，其中28089例是由于实体癌。实体癌导致的估计死亡率随累积剂量每Gy增加52%(90%置信区间27%至77%)，落后10年。将分析限制在低累积剂量范围（0-100mGy），使关联估计增加了大约两倍（并增加了其置信区间的宽度），在更准确地记录职业外部穿透性辐射剂量的估计时，将分析限制在最近几年运营中雇用的工人也是如此。排除肺癌和胸膜癌的死亡对估计的关联程度有适度的影响。提供间接证据，证明该关联并未因吸烟或职业接触石棉而造成实质性混淆。
结论：INWORKS的这一重大更新基于世界上一些信息最丰富的放射工作者队列，提供了对长期低剂量电离辐射暴露与实体癌死亡率之间关系的直接估计。每Gy实体癌死亡率的相对比率的汇总估计值大于目前告知辐射防护的估计值。一些证据表明，在低剂量范围内，剂量-反应关联的斜率比在全剂量范围内更陡。这些结果有助于加强辐射防护，特别是对于当代医学中最感兴趣的低剂量暴露，职业,和环境设置。
