The paper discusses the provision of targeted health care to nuclear workers in Russia based on radiation- epidemiological estimates of cancer risks. Cancer incidence rates are analysed for the workers of the Institute of Physical Power Engineering ( the first nuclear installation in the world) who were subjected to individual dosimetric monitoring from 1950 to 2002. The value of excess relative risk for solid cancers was found to be ERR Gy(-1) = 0.24 ( 95% CI: - 4.22; 7.96). It has been shown that 81.8% of the persons covered by individual dosimetric monitoring have potential attributive risk up to 5%, and the risk is more than 10% for 3.7% of the workers. Among the detected cancer cases, 73.5% of the individuals show an attributive risk up to 5% and the risk is in excess of 10% for 3.9% of the workers. Principles for the provision of targeted health care, given voluntary health insurance, are outlined.

Exposure to ionizing radiation increases the risk of cancer in humans. Russian nuclear workers receive low and middle level accumulated dose for the entire period of their occupational activities. The methodology of UNSCEAR model and estimates of attributable risk was implemented for generating potential risk group among the Mayak plant personnel. There are 5,858 workers covered by individual dosimetry monitoring, who have received radiation doses since 1949. It was stated that 2% of the Mayak plant personnel covered by individual dosimetry monitoring should be included in the group of potential risk for radiation-induced cancer. UNSCEAR recommendations for estimating individual radiation risks can be used for generating groups of potential risks among Russian nuclear workers.

As of today it does not seem possible to assess objectively the causality between cancer diseases and professional exposure using clinical evidence only. The medical-dosimetric registries can do little to reveal statistically significant effects in the low dose range and do not provide unambiguous recommendations as to quantifying occurrence of malignant neoplasms in case of protracted exposure. The remaining option is to use the accumulated experience of large-scale epidemiological studies and existing recommendations for probabilistic assessment of possible occurrence of malignant neoplasms associated with professional activity for a given individual with allowance for his personal characteristics. In the paper thse personnel of the Leningrad NPP that were under individual dosimetric monitoring is were grouped with respect to potential risk. The projection methodology recommended by UNSCEAR-94 is used. The source information is personalized data allowing for sex, age and year-by-year dynamics of dose accumulation. A total of 5086 males are considered, their average accumulated dose being 74 mSv. Since the large-scale epidemiological studies have not revealed radiation induction of cancer diseases in the low dose range, in the first stage the cohort of the Leningrad NPP workers with accumulated radiation doses more than 200 mSv was selected. For 289 persons who received accumulated doses more than 200 mSv (5.6% of the whole staff) the following distribution is derived: 138 workers had the attributive risk ranging from 5% to 10%, 7 workers from 10% to 15%. The derived distribution can be used as a basis for administrative decision making. The proposed methodology for assessing individual potential risk of malignant neoplasms associated with professional activity can be used in the practice of NPP radiation safety services.