Health Risks of Ionizing Radiation: - Clark University

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Site-specific risks were all compatible with a linear dose-response model (see Table 4-1). Genderspecific risks were significantly different for skin cancer and cancers of the digestive, respiratory, and excretory (kidney and bladder) systems; in all cases the ERR estimates for females were 2- to 4fold higher than for males 7 . Age at exposure was a significant factor in the risks of skin, breast, and thyroid cancer and cancers of the digestive system and central nervous system (Figure 4-6). Land et al. (2003) reanalyzed the breast cancer incidence in depth and reaffirmed that risk was higher with exposure before age 20 8 . Skin cancer risk was further explored by Ron et al. (1998). This study found an overall ERR of 0.62/Sv (90% CI 0.23-1.3) for non-melanoma skin cancer. The risk of basal cell carcinoma, a subtype of skin cancer, was higher (ERR 1.9/Sv) and was found to depend significantly on age at exposure. Atomic Bomb Survivors 49 The risk of basal cell carcinoma after exposure at ages 0-9, for example, had an ERR of 21/Sv (4-73). The liver cancer risk estimate was improved with better pathology review by Cologne et al. (1999). This study found an ERR of 0.81/Sv (0.32-1.43) and this was similar for males and females. Risk appeared to be higher after exposure at ages 10-30. Sharp et al. (2003) demonstrated that liver cancer risk was increased dramatically with combined risk factors of radiation and the hepatitis C virus 9 . 4.4.2 Incidence of leukemia and related cancers Preston et al. (1994) analyzed the incidence of cancers of the blood and lymph through 1987. These include leukemias, lymphomas, and multiple myeloma, a cancer that originates in the liquid part of blood and lymph and infiltrates bone marrow. Leukemia was subdivided into subtypes: acute lymphocytic Figure 4-6. Incidence ERR by age at exposure for selected cancer sites (based on data from Thompson et al. 1994). 7 Estimates of ERR/Sv (females/males) were 1.4/0.4 (nonmelanoma skin), 0.5/0.3 (digestive system), 1.7/0.4 (respiratory system), and 2.3/0.7 (kidney and urinary organs) 8 ERR estimates were 3.9, 2.8, 2.7, 1.3 and 0.5/Sv after exposure at ages 0-4, 5-14, 15-19, 20-39, and 40+, respectively. 9 The ERR estimate was 58/Sv (2.0-∞) for HCV-positive, cirrhosis-free hepatocellular carcinoma.
50 Atomic Bomb Survivors (ALL), acute myeloid (AML), chronic myeloid (CML) and adult T-cell leukemia (ATL). A fourth subtype, chronic lymphocytic leukemia (CLL), is typically not associated with radiation. The study found strong evidence for radiation induced risks of all leukemia subtypes except ATL, some evidence for a lymphoma risk, and no significant evidence for a multiple myeloma risk. The shapes of the dose-response curves and the effects of age and gender appeared to be distinctly different among these diseases. The pattern of ALL risk was consistent with a linear dose-response model having a high risk coefficient (ERR 10.3/ Sv, 4.3-25). Risk appeared higher for childhood exposures and declined over time. CML risk was also consistent with a linear dose-response model and a decline in risk over time. Age at exposure was not found to have a significant effect on risk; the average ERR estimate for this subtype was 6.2/Sv. The dose-response pattern for AML was nonlinear, concave-up, and less dependent on age at exposure or time since exposure. The estimated ERR at 1 Sv was 3.3 (Preston et al. 1994). It is important to point out that the LSS followup began in 1950, five years after the bombings. Leukemia has a latent period of as few as 2 years, so a significant number of early cases were probably missed. Preston et al. (1994), after considering some information about these early cases, estimated that leukemia risk estimates might have been 10-15% higher if these early cases had been included. Results for the other diseases studied by these authors were inconclusive. ATL is endemic to Nagasaki and rare in Hiroshima and has been associated with the HTLV-1 virus. Of the 25 ATL cases in the cohort, 24 were from Nagasaki, suggesting that the virus may have independently caused the leukemia cases. Furthermore, when analysis was limited to Nagasaki there was no evidence of a doseresponse pattern. There was some evidence of an increased risk of non-Hodgkin’s lymphoma among males but there was not a significant relationship between dose and ERR. Multiple myeloma was not significantly related to dose in the main analysis, although previous analyses had shown an association with incidence and mortality. Some cases were excluded from the main analysis because they had high doses (>4 Gy) or because their first primary cancer diagnosis was not multiple myeloma. If these cases were included then a significant dose-response relationship was observed (ERR 0.9/Sv, p = 0.02). Little et al. (1999) pooled the leukemia data from the atomic bomb survivors, cervical cancer patients treated with radiation, and ankylosing spondylitis patients also treated with radiation. These medically exposed cohorts received much higher doses than the atomic bomb survivors and therefore contribute more information about high-dose dynamics and little or no information about low-dose effects. These authors used a model that included an exponential decline in risk as doses increase; this accounts for the killing of precancerous cells and has been used to model the risks of the medical exposure in other contexts (see sections 3.3 and 3.4). This analysis demonstrated the differences among leukemia subtypes. When all leukemias were modeled together the cohorts were not showing compatible risk estimates; when leukemia subtypes were modeled independently the cohorts were consistent with each other. 4.5 Incidence of noncancer disease Wong et al. (1993) examined noncancer disease incidence through 1986. This study found significant linear dose-response patterns for thyroid disease (ERR 0.3/Gy, 0.16-0.47), chronic liver disease and cirrhosis (ERR 0.14/Gy, 0.04-0.27), and uterine myoma 10 (ERR 0.46/Gy, 0.27-0.70). Results for Parkinson’s disease were based on 50 cases and were suggestive although not significantly positive (ERR 0.44/Gy, -0.06-1.57). When analysis was restricted to the 1968-1986 time period there was an apparent risk of heart attack among those who were younger than 40 at the time of the bombings (ERR 0.57/Gy, 0.26-1.76). Hayashi et al. (2003) reported a dosedependent increase of certain proteins in the blood (interleukin 6, C-reactive protein) that indicate an inflammatory response. These measurements were made in 1995-1997, so they indicate a longterm change in the status of the blood, and this 10 A uterine myoma is a common benign tumor of the uterine muscle, present in about 40% of adult women and usually asymptomatic.
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Health Risks of Ionizing Radiation:
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Contents List of Tables ...........
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Contents iii Rocky Flats ..........
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Contents v APPENDIX A .............
Page 9 and 10: List of Figures Figure 1-1 Average
Page 11 and 12: We are indeed grateful to those who
Page 13 and 14: 2 Introduction 1.2 A brief history
Page 15 and 16: 4 Introduction Figure 1-2. The evol
Page 17 and 18: 6 Introduction Figure 1-5(a). Alpha
Page 19 and 20: 8 Introduction In epidemiological s
Page 21 and 22: 10 Introduction precision to detect
Page 23 and 24: 12 Introduction available informati
Page 25 and 26: 14 Background Radiation Figure 2-1.
Page 27 and 28: 16 Background Radiation Figure 2-3.
Page 29 and 30: 18 Background Radiation
Page 31 and 32: 20 Medical Exposures Fi
Page 33 and 34: 22 Medical Exposures
Page 35 and 36: 24 Medical Exposures with national
Page 37 and 38: 26 Medical Exposures localized expo
Page 39 and 40: 28 Medical Exposures (2.1-28.7). Th
Page 41 and 42: 30 Medical Exposures posed 2.69 tim
Page 43 and 44: 32 Medical Exposures with diagnosti
Page 45 and 46: 34 Medical Exposures Table 3-1. Stu
Page 55 and 56: 44 Atomic Bomb Survivors Figure 4-2
Page 57 and 58: 46 Atomic Bomb Survivors
Page 59: 48 Atomic Bomb Survivors approximat
Page 63 and 64: 52 Atomic Bomb Survivors of the 8 t
Page 69 and 70: 5 Nuclear Weapons Testing Over 500
Page 71 and 72: 60 Nuclear Weapons Testing by disti
Page 73 and 74: 62 Nuclear Weapons Testing Figure 5
Page 75 and 76: 64 Nuclear Weapons Testing near the
Page 77 and 78: 66 Nuclear Weapons Testing
Page 79 and 80: 68 Nuclear Weapons Testing
Page 81 and 82: 6 RADIATION WORKERS Introduction Th
Page 83 and 84: 72 Radiation Workers • 50 rem (0.
Page 85 and 86: 74 Radiation Workers work, reports
Page 87 and 88: 76 Radiation Workers Figure 6-5. A
Page 89 and 90: 78 Radiation Workers Figure 6-8. To
Page 93 and 94: 82 Radiation Workers Feed Material
Page 95 and 96: 84 Radiation Workers by Beral et al
Page 99 and 100: 88 Radiation Workers Table 6-1. Leu
Page 101 and 102: 90 Radiation Workers No
Page 103 and 104: 92 Radiation Workers N
Page 105 and 106: 94 Radiation Workers S
Page 107 and 108: 96 Radiation Workers ERR estim
Page 109 and 110: 98 Mayak Workers Table 1. Dose (Gy)
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100 Mayak Workers workers at the ra
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102 Mayak Workers
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104 Uranium Miners enrichment facil
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106 Uranium Miners Samet et al. (19
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108 Uranium Miners were selected 12
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Uranium Miners 111
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9 RADIATION EXPOSURE IN FLIGHT The
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DNA damage (a chemical change in DN
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10 PRECONCEPTION EXPOSURES Several
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of risk in the lowest dose groups,
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found elevated solid cancer risk wi
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preconception doses between 2.5 and
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Table 10-1. Preconception irradiati
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Preconception Exposures 127
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Tracheoesophageal fistula and conge
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cancer were both associated with th
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0.10-4.71) while respiratory system
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elationship was not significant for
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times higher than in less-contamina
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Nuclear Power Accidents 139
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12 COMMUNITIES NEAR NUCLEAR FACILIT
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levels (this could not in itself be
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Figure 12-3. Native Americans from
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of leukemia was measured over a lar
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(RR 1.06; 1.00-1.11) and risks of s
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more that we can say about this app
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Communities Near Nuclear Facilities
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54 observed vs. 46.1 expected death
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13 DISCUSSION Our intention in crea
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myeloid leukemia) was significantly
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0.1-3.5 WLM; this is roughly equiva
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adon (Lubin et al. 1997). These res
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Leukemia Leukemia, a general term t
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vical cancer. The doses to these pa
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England have found it convenient to
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Thyroid disease Thyroid cancer is a
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1986 through 1995. These workers sh
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dence of this disease includes elev
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Analysis of preconception exposure
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Paternal age, education, drinking O
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Gardner et al. 1990 Employed at Sel
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we consider this group of a few hun
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Leukemia risk (excluding CLL) among
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Glossary of Terms for Epidemiology
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Glossary 199 Beta radiation: Stream
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Dosimetry: Measurement or estimatio
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Glossary 203 Hypothyroidism: The cl
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Glossary 205 Metastasis: 1. Movemen
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Glossary 207 waves, ultra violet (U
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Glossary 209 Thyroid Disease: disea
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Bibliography ATSDR. Public Health A
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Bhatia S, Sklar C. Second cancers i
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Bibliography 215 Cavallo D, Tomao P
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Bibliography 217 Department of Ener
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Bibliography 219 Gardner MJ, Hall A
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Haldorsen T, Reitan JB, Tveten U. C
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Bibliography 223 Howe GR, Nair R, N
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of Mayak, A comparison of numerical
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Bibliography 227 Laird NM. Thyroid
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control population. International J
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Bibliography 231 Neel JV, Schull WJ
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2003.160:381-407. Bibliography 233
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Bibliography 235 Saccomanno G, Auer
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Bibliography 237 analysis of cancer
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Bibliography 239 Tokarskaya ZB, Sco
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Journal of Epidemiology 1987.125(2)
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Actinium, 84 Acute lymphocytic leuk
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and Nevada Test Site, 60-61, 62 nuc
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Hashimoto’s thyroiditis, 185 Heal
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studies, 101-2 Medical exposure, 19
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(RERF), 43 Radiation Exposure Compe
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Viruses, 118, 154, 193 West Germany
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