The International Commission on Radiological Protection (ICRP) recently estimated the risk of lung cancer associated with radon exposure, and a statement was issued in ICRP Publication 115. This was based on recent epidemiological studies and the results from a joint analysis of cohorts of Czech, French, and German uranium miners, and indicated that the excess relative risk of lung cancer per unit of exposure should be expressed with consideration of chronic exposure over more than 10 years, by modelling time since median exposure, age attained or age at exposure, and taking in account, if possible, interaction between radon and tobacco. The lifetime excess absolute risk (LEAR) calculated from occupational exposure studies is close to 5 × 10−4 per working level month (WLM) (14 × 10−5 per hm J/m3). LEAR values estimated using risk models derived from both miners and domestic exposure studies are in good agreement after accounting for factors such as sex, attained age, and exposure scenario. A sensitivity analysis highlighted the high dependence of background mortality rates on LEAR estimates. Using lung cancer rates among Euro-American males instead of the ICRP reference rates (males and females, and Euro-American and Asian populations), the estimated LEAR is close to 7 × 10−4 per WLM (20 × 10−5 per hm J/m3).

To study the cancer risk related to protracted, low-dose exposure to different industrial uranium compounds, paying attention to their isotopic composition and solubility.

We investigated the incidence, risk factors and outcome of acute renal dysfunction (ARD) in patients with a fractured neck of femur.170 consecutive patients were prospectively included in the Scottish Hip Fracture Audit database and retrospectively analysed. Historically, lack of consensus definition has hindered accurate reporting of ARD. ARD was defined using the 'RIFLE' criteria.27 patients (16%) developed ARD. Risk factors were male sex, vascular disease, hypertension, diabetes, chronic kidney disease and pre-morbid use of nephrotoxic medications (p < 0.01). Inpatient, 30- and 120-day mortality was higher in the ARD group 19%, 22% and 41% respectively, versus 0%, 4% and 13% in the non-ARD group (p < 0.01). Length of hospital stay was significantly longer in the ARD group. Pre- and post-operative complications were 12 and 5 times more frequent respectively in the ARD group (p < 0.01).Awareness of risk factors and serial measurements of renal function allow early identification and focused monitoring of these patients.

Recent epidemiological studies of the association between lung cancer and exposure to radon and its decay products are reviewed. Particular emphasis is given to pooled case-control studies of residential exposures, and to cohorts of underground miners exposed to relatively low levels of radon. The residential and miner epidemiological studies provide consistent estimates of the risk of lung cancer, with significant associations observed at average annual concentrations of approximately 200 Bq/m³ and cumulative occupational levels of approximately 50 working level months (WLM), respectively. Based on recent results from combined analyses of epidemiological studies of miners, a lifetime excess absolute risk of 5 × 10⁻⁴ per WLM [14 × 10⁻⁵ per (mJh/m³)] should now be used as the nominal probability coefficient for radon- and radon-progeny-induced lung cancer, replacing the previous Publication 65 (ICRP, 1993) value of 2.8 × 10⁻⁴ per WLM [8 × 10⁻⁵ per (mJh/m³)]. Current knowledge of radon-associated risks for organs other than the lungs does not justify the selection of a detriment coefficient different from the fatality coefficient for radon-induced lung cancer. Publication 65 (ICRP, 2003) recommended that doses from radon and its progeny should be calculated using a dose conversion convention based on epidemiological data. It is now concluded that radon and its progeny should be treated in the same way as other radionuclides within the ICRP system of protection; that is, doses from radon and its progeny should be calculated using ICRP biokinetic and dosimetric models. ICRP will provide dose coefficients per unit exposure to radon and its progeny for different reference conditions of domestic and occupational exposure, with specified equilibrium factors and aerosol characteristics.

Background. - While cardiovascular risks associated with high level of ionizing radiation are well-established, long-term effects of low and medium levels of exposure, between 0 and 5 gray (Gy), on the cardiovascular system are debated.Methods. - Available literature was reviewed considering various populations, such as survivors of atomic bombs, nuclear workers, Chernobyl liquidators, radiologists and radiological technologists and patients exposed for medical reasons.Results. - A significant increased risk of cardiovascular diseases associated with low doses of ionizing radiation was observed in 13 studies among the 27 analyzed. The ischemic heart diseases risk was detailed in 16 studies and seven of them showed a significant increase. The cerebrovascular risk was significantly increased in five studies among the 12 considered.Conclusion. - Some epidemiological and experimental data are clearly in favour of an increased cardiovascular risk associated with exposure to low doses. However, given the multifactorial origin of cardiovascular diseases and the lack of a clear pathophysiologic mechanism, epidemiological results have to be carefully interpreted. Further research should be conducted in this area. (C) 2009 Elsevier Masson SAS. All rights reserved.

The conversion of radon exposure into dose is being debated. The UNSCEAR defined a coefficient for conversion of radon concentration into effective dose from dosimetric models and epidemiological studies. The ICRP recommends evaluating the risk associated with radon exposure from epidemiological studies. To account for possible combined exposure to other sources of ionizing radiation, the ICRP adopted, on the basis of the epidemiological follow-up of uranium miners, effective dose conversion conventions which are 10 to 30% lower than the UNSCEAR coefficient. As a consequence, different reference levels for radon concentration can be derived from a single level of effective dose by applying either conversion factor. Still, it should be stressed that these differences are negligible when compared with the uncertainty associated with both dosimetric and epidemiological studies, and that the reference levels are mainly tools to help in reducing radon exposure and the associated risk as low as reasonably achievable.

While cardiovascular risks associated with high level of ionizing radiation are well-established, long-term effects of low and medium levels of exposure, between 0 and 5 gray (Gy), on the cardiovascular system are debated.Available literature was reviewed considering various populations, such as survivors of atomic bombs, nuclear workers, Chernobyl liquidators, radiologists and radiological technologists and patients exposed for medical reasons.A significant increased risk of cardiovascular diseases associated with low doses of ionizing radiation was observed in 13 studies among the 27 analyzed. The ischemic heart diseases risk was detailed in 16 studies and seven of them showed a significant increase. The cerebrovascular risk was significantly increased in five studies among the 12 considered.Some epidemiological and experimental data are clearly in favour of an increased cardiovascular risk associated with exposure to low doses. However, given the multifactorial origin of cardiovascular diseases and the lack of a clear pathophysiologic mechanism, epidemiological results have to be carefully interpreted. Further research should be conducted in this area.

Background. - We conducted a mortality study on a cohort of French nuclear workers employed at Electricite de France (EDF). A first cancer mortality analysis had covered the period 1968-1994. This paper presents results from a mortality analysis including nine additional years of follow-up to cover workers employed from 1968 to 2003.Methods. - The cohort includes 22 393 workers, 97% of whom are males. Employment data were updated using the EDF personnel file. Vital status was ascertained using the French National Registry of Population, and further completed using EDF personnel and pension files. Causes of death were obtained from the National registry of causes of death. Standardised Mortality Ratios (SMR) were computed using national rates as references. Variations of all causes and all cancers SMRs were studied according to demographic and occupational characteristics.Results. - At the study end point (31/12/2003), 74% of workers are still in active employment. Only 0.3% of workers are lost to follow-up. The median duration of follow-up is 20 years. Causes are ascertained for 96% of deaths. The total number of deaths is 874, 307 of which are cancer deaths. SMRs for all causes and cancers show a significant deficit compared to the French national mortality. No significant excess was observed for any of the cancer sites studied. Non-significant excesses are observed for pancreatic, pleural, kidney and brain cancer. Significant variations of all causes SMRs according to age at study entry and attained age are observed. Significant variations of all causes and all cancers SMRs according to diploma at employment are observed, with a reduced SMR for a higher level of diploma.Conclusion. - There is a significant deficit of mortality compared to the general population, reflecting a strong Healthy Worker Effect. Although nine years of follow-up were added, this cohort is made up of young workers, most of whom are still in active service. Regular updating of the follow up of this cohort is planned, aiming for an occupational health surveillance of workers occupationally exposed to ionizing radiation in France. (C) 2009 Elsevier Masson SAS. All rights reserved.

A cohort of 9,285 nuclear workers employed at the French company AREVA NC specializing in the nuclear fuel cycle was established. Vital status, causes of death, employment characteristics and annual exposure to ionizing radiation were reconstructed for each individual over the time period 1977-2004. Standardized mortality ratios (SMRs) were computed using national mortality rates as an external reference. Tests for trends in mortality with duration of employment and cumulative external dose were performed. The all-cause and all-cancer mortality was significantly lower than expected from the French population. No significant excess among cancer sites studied was observed. Significant positive trends with cumulative dose were observed for colon and liver cancer and for respiratory diseases. Isolated significant trends should be carefully interpreted and considered in line with the large number of trend tests performed.

BACKGROUND:We conducted a mortality study on a cohort of French nuclear workers employed at Electricité de France (EDF). A first cancer mortality analysis had covered the period 1968-1994. This paper presents results from a mortality analysis including nine additional years of follow-up to cover workers employed from 1968 to 2003.METHODS:The cohort includes 22393 workers, 97% of whom are males. Employment data were updated using the EDF personnel file. Vital status was ascertained using the French National Registry of Population, and further completed using EDF personnel and pension files. Causes of death were obtained from the National registry of causes of death. Standardised Mortality Ratios (SMR) were computed using national rates as references. Variations of all causes and all cancers SMRs were studied according to demographic and occupational characteristics.RESULTS:At the study end point (31/12/2003), 74% of workers are still in active employment. Only 0.3% of workers are lost to follow-up. The median duration of follow-up is 20 years. Causes are ascertained for 96% of deaths. The total number of deaths is 874, 307 of which are cancer deaths. SMRs for all causes and cancers show a significant deficit compared to the French national mortality. No significant excess was observed for any of the cancer sites studied. Non-significant excesses are observed for pancreatic, pleural, kidney and brain cancer. Significant variations of all causes SMRs according to age at study entry and attained age are observed. Significant variations of all causes and all cancers SMRs according to diploma at employment are observed, with a reduced SMR for a higher level of diploma.CONCLUSION:There is a significant deficit of mortality compared to the general population, reflecting a strong Healthy Worker Effect. Although nine years of follow-up were added, this cohort is made up of young workers, most of whom are still in active service. Regular updating of the follow up of this cohort is planned, aiming for an occupational health surveillance of workers occupationally exposed to ionizing radiation in France.

Introduction: This study has been launched in order to evaluate the mortality of nuclear workers employed at the French company specialized in nuclear fuel cycle (AREVA NC ex COGEMA) and exposed to low level of ionizing radiation. The follow-up of the cohort has been extended recently. We present here a new analysis of the mortality based on an extended follow-up of the cohort by 10 years.

Le laboratoire d'épidémiologie de l'institut de radioprotection et de sûreté nucléaire (IRSN) en collaboration avec le groupe Areva conduit une étude de morbidité sur l'ensemble des travailleurs actifs du site Areva de La Hague. Les données de cette étude sont issues du système Chimed d'enregistrement des maladies mis en place par le service de santé au travail (SST) d'Areva. Dans ce contexte, une validation externe des données médicales du SST d'Areva a été réalisée grâce aux données du registre des cancers du département de la Manche et à celles du registre spécialisé des hémopathies malignes de la Basse-Normandie.Un cas incident est un travailleur pour lequel une pathologie cancéreuse a été enregistrée par un médecin du travail dans la base de données Chimed entre le 01/01/1999 et le 31/12/2009. Le croisement entre la base de données Chimed et la base de données des registres des cancers permet de calculer la sensibilité (capacité à identifier les vrais positifs) et la valeur prédictive positive (probabilité qu'un travailleur classé comme malade ait vraiment la maladie).Les données ont été analysées pour 5211 travailleurs actifs. Après le croisement des deux bases de données, 30 cas de cancer sont présents simultanément dans les deux bases, 23 cas sont retrouvés uniquement dans la base de données des registres, 4 cas ont été enregistrés uniquement dans Chimed. En prenant comme référence les registres des cancers, la sensibilité du système Chimed est de 57 %. La valeur prédictive positive est de 89 %.Étant donné sa faible sensibilité, il n'est pas recommandé d'utiliser la base de données Chimed comme seule source d'information pour la surveillance des cancers chez les travailleurs actifs d'Areva. La surveillance des cancers nécessite que des procédures standardisées et systématiques de codage et d'enregistrement des pathologies tumorales soient mises en place dans les SST.The laboratory of epidemiology of the institute of radioprotection and nuclear safety (IRSN) and the AREVA company are conducting a morbidity study on active workers from the AREVA site of La Hague. Data used for the study are extracted from disease registration system (called Chimed) monitored by the local occupational health department. To assess the quality of this system, we have cross-matched cancer incidence data from two different sources: local occupational health department and cancer registries (used as a gold standard).A cancer case is an AREVA worker who has been diagnosed with cancer and whose diagnosis has been registered in the Chimed database between 01/01/1999 and 31/12/2009. The Chimed database and the cancer registries' database were matched in order to calculate sensitivity (capacity to detect the true positives) and positive predictive value (probability that a worker with a positive screening result has the disease).The population study contains 5211 workers of the AREVA site of La Hague. The cross-matching has provided following results: 30 cases were registered in both sources database, 23 cancer cases were registered by cancer registries but not by Chimed and 4 cases were recorded in the Chimed database but not in the cancer registries. Our results show that Chimed's sensitivity is about 57%, using cancer registries as the gold standard. The positive predictive value is about 89%.Our study has showed that about one cancer case out of two was recorded in the Chimed database. In the present state, the Chimed database cannot be used to perform an exhaustive inventory of cancer cases among active workers. In order to improve nuclear worker cancer surveillance by the local occupational health department, standardized and systematic procedures for cancer data collecting are needed.

L’utilisation du scanner en pédiatrie pose la question du risque de cancer radio-induit à long terme. En collaboration avec la SFIPP, la faisabilité de la mise en place d’une cohorte d’enfants exposés a été testée. Dans 13 services de radiologie pédiatrique, des données démographiques et d’exposition (région anatomique examinée, protocole dosimétrique du service) ont été recueillies pour les enfants soumis à un scanner avant l’âge de 5 ans entre 2000 et 2006. La cohorte comporte 30 000 enfants avec un âge au premier scanner de moins d’ 1 an pour 42 % d’entre eux, de 1 à 2 ans pour 19 %, puis 13 % pour chaque classe d’âge d’un an, jusqu’à 5 ans. Le nombre moyen d’examens par enfant est de 1,5 (1 à 33) et ceux-ci concernent pour 66 % le crâne, 22 % le thorax, 10 % l’abdomen et le pelvis, et enfin pour 2 % d’autres localisations. Cette étude montre qu’il est possible de mettre en place une cohorte d’enfants soumis à un scanner en France. L’évaluation du risque de cancer à long terme sera basée sur l’incidence de cancer jusqu’à 15 ans via les registres pédiatriques de cancer et sur la mortalité pour le suivi ultérieur.

Background. - A pilot study was carried out in the AREVA NC Pierrelatte nuclear facility in order to investigate a possible carcinogenic effect of internal radiation exposure among nuclear workers in France. The objective of this study was to develop a method for retrospective reconstruction of the occupational exposure to internal radiation from uranium and associated chemical exposures.Methods. - A plant- and period-specific job exposure matrix (JEM) was designed. Job groups and exposure agents groups including uranium compounds and other chemical agents known as being carcinogenic, mutagenic or toxic were defined by an expert committee. Exposure was evaluated by active and retired workers included in the evaluator committee. A quantitative assignment of quantity and frequency of handling (both coded from 0 to 3) was performed for each agent groups using a method derived from the Delphi technique.Results. - In all, 23 experts and 353 evaluators participated to the JEM elaboration. A final JEM involved 232 "job-periods" presenting throughout the plant period 1960-2006 and 22 exposure agents groups in use at the plant. Six of them involved uranium compounds classified by their blood-transferability and toxicity characteristics. A first validation of the JEM by experts in radiological protection and industrial hygiene showed an acceptable internal consistency.Conclusion. - In the context of missing past exposure measurement data, the plant- and period-specific job exposure matrices may be considered as a valid alternative for exposure estimation. This method may be applied to other nuclear plants and offers allowance to investigate a possible carcinogenic effect of internal radiation exposure among nuclear workers. (C) 2007 Elsevier Masson SAS. Tons droits reserves.

BACKGROUND:A pilot study was carried out in the AREVA NC Pierrelatte nuclear facility in order to investigate a possible carcinogenic effect of internal radiation exposure among nuclear workers in France. The objective of this study was to develop a method for retrospective reconstruction of the occupational exposure to internal radiation from uranium and associated chemical exposures.METHODS:A plant- and period-specific job exposure matrix (JEM) was designed. Job groups and exposure agents groups including uranium compounds and other chemical agents known as being carcinogenic, mutagenic or toxic were defined by an expert committee. Exposure was evaluated by active and retired workers included in the evaluator committee. A quantitative assignment of quantity and frequency of handling (both coded from 0 to 3) was performed for each agent groups using a method derived from the Delphi technique.RESULTS:In all, 23 experts and 353 evaluators participated to the JEM elaboration. A final JEM involved 232 "job-periods" presenting throughout the plant period 1960-2006 and 22 exposure agents groups in use at the plant. Six of them involved uranium compounds classified by their blood-transferability and toxicity characteristics. A first validation of the JEM by experts in radiological protection and industrial hygiene showed an acceptable internal consistency.CONCLUSION:In the context of missing past exposure measurement data, the plant- and period-specific job exposure matrices may be considered as a valid alternative for exposure estimation. This method may be applied to other nuclear plants and offers allowance to investigate a possible carcinogenic effect of internal radiation exposure among nuclear workers.

Epidemiological evidence of lung cancer risk from radon is known since the early 1960s, when first studies on uranium miners were published. The risk was modeled in terms of relative risk in dependence on cumulated exposure. Since then, follow-up of studies has been extended, which allowed the analysis of modifying factors such as time since exposure (TSE), age at exposure (AE), attained age, and exposure rate. The present analysis was conducted in the frame of the Alpha-Risk European research program and aimed at estimating the lung cancer risk associated to radon exposure among miners with low levels of exposure and good quality of exposure assessment. The large numbers of miners included in the joint study allow a simultaneous analysis of modifying effects using exposure windows, which are appropriate in studies with protracted exposures. The analysis is based on three European cohort studies of uranium miners: Czech, French and German, including 9979, 5086 and 35084 miners, respectively. By the end of follow-up, 921, 159, and 458 lung cancer deaths were observed in these cohorts, respectively. The excess relative risks per working level month (ERR/WLM) for the three studies were 0.0116 (95%CI 0.0076-0.0157), 0.0061 (95%CI 0.0018-0.0105), and 0.0043 (95%CI 0.0028-0.0057), respectively. The different estimates are caused mainly by the so-called inverse effect of exposure rate and by quality of exposure, which both are correlated with time since exposure. We evaluated simultaneously the effects of TSE in 3 windows (5-19 years before, 20-34, 35+) and of AE in 3 windows (-29 years, 30-39, 40+). The analysis showed a strong decrease of the ERR/WLM with TSE (28% in period 20-34 years and 11% after 35 years in comparison to window 5-19). The simultaneous effect of AE was also significant: ERR/WLM for AE more than 40 years was 53% of that for AE below 30). These results will permit to improve our knowledge on the long-term risks associated to radon exposure. The present work was supported by the European Commission (Contract FI6R 516483).

Objectives: This paper presents the risk of death from lung cancer and from other causes of death for the French cohort of uranium miners through 1999 and estimates associations with radon exposure.Methods: The cohort includes men employed as uranium miners for at least 1 year between 1946 and 1990. For each miner, vital status and cause of death were obtained from the national registry, and radon exposure was reconstructed for each year. Standardised mortality ratios were computed with national mortality rates as references. Exposure-risk relationships were estimated by Poisson regression, with a linear excess relative risk (ERR) model and a 5-year lag.Results: The cohort included 5086 miners and 153 063 person-years of exposure. The mean duration of follow-up was 30.1 years. In all 4140 miners exposed to radon, the average cumulative exposure was 36.6 working level months (WLM). There were 1411 deaths of miners,85 years of age. The miners did not differ significantly in overall mortality from the general male population. The analysis confirmed an excess risk of lung cancer death (n = 159; SMR = 1.43; 95% CI: 1.22 to 1.68), which increased significantly with cumulative radon exposure (ERR per 100 WLM = 0.71; 95% CI: 0.29 to 1.35). The ERR per unit exposure was much higher after 1955, when the accuracy of exposure measurement improved substantially (ERR per 100 WLM = 2.00; 95% CI: 0.91 to 3.65). A significant excess of kidney cancer deaths was observed (n = 20; SMR = 2.0; 95% CI: 1.22 to 3.09), which was not associated with cumulative radon exposure. No excess was observed for other causes of death, except silicosis (n = 23; SMR = 7.12; 95% CI: 4.51 to 10.69).Conclusions: The analysis confirmed the excess risk of death from lung cancer associated with low radon exposure. An excess risk of death from kidney cancer was also observed, apparently not associated with cumulative radon exposure.

Purpose of the study. Radon is a radioactive gas of natural origin; it is produced by the disintegration of uranium and radium located in the earth's crust. Radon is present in the outdoor air and concentrates in houses and other buildings, with highest radon concentrations in dwellings built on granitic subsoils. Radon is known to be a human lung carcinogen. Studies of underground miners exposed occupationally have consistently demonstrated an increased risk of lung cancer. Similar observations have been made in animal studies.Method. However, there is little direct information on the risk of lung cancer that is associated with exposure to residential radon, for which concentrations are usually much lower than those of miners and the conditions of exposure are different. For this purpose, residential case: control studies have been carried out in Europe, United States and China. But lack of statistical power prevented most of them from showing a significant risk. To deal with this problem, several joint analyses have been conducted in recent years. In joint analyses, individual data on smoking habits, occupational exposure, and on radon exposure history, based on long-term measurements in all the dwellings occupied by the subjects over the 30 past decades, have been assembled in a uniform manner.Results. Assessing the lung cancer risk associated with indoor radon exposure is not easy: the risk is low and uncertainties in assessing exposure may underestimate the risk. Large-scale studies are able to show a significant association between lung cancer risk and indoor radon exposure, to precise the combined effect of smoking history and radon exposure on lung cancer development and to estimate the lung cancer risk due to radon among never-smokers. The best evidence would come from the Word Pooling Study (including all the 24 individual indoor radon studies), which is actually under-way. This international project is supported by the EC under the program Alpharisk, coordinated in France by the Institute for Radiological and Nuclear Safety (IRSN).Conclusion. These joint analyses report a significant lung cancer risk associated with indoor radon exposure, even for low radon concentrations. The relative risk of lung cancer from indoor radon exposure is about the same for both smokers and non-smokers; however because the baseline lung cancer rate for smokers is much higher than for never-smokers, absolute risks of lung cancer from residential radon are much higher for smokers and recent ex-smokers than for never-smokers. These results are crucial to the development of policies to reduce radon exposure in homes in parallel with national programs to reduce cigarette-smoking habits. (c) 2008 Elsevier Masson SAS. All rights reserved.