Radiation Risk of Cardiovascular Diseases in the Cohort of Russian Emergency Workers of the Chernobyl Accident.

This paper continues a series of publications that analyze the impact of radiation on incidence of circulatory system diseases in the cohort of Russian recovery operation workers (liquidators) and presents the results of the analysis of cardiovascular disease (CVD) incidence. The studied cohort consists of 53,772 liquidators who arrived in the Chernobyl accident zone within the first year after the accident (26 April 1986 to 26 April 1987). The individual doses varied from 0.0001 Gy to 1.42 Gy, and the mean external whole body dose in the cohort was 0.161 Gy. A total of 27,456 cases of CVD were diagnosed during the follow-up period 1986-2012 as a result of annual health examinations. A Poisson regression model was applied to estimate radiation risks and other risk factors associated with CVD. The following factors were identified as risk factors for CVD: the dose, duration of the liquidators' work in the Chernobyl zone, and concomitant diseases (diabetes mellitus, hypertension, overweight, and alcohol dependence). The baseline incidence of CVD is statistically significantly (p < 0.001) associated with all studied concomitant diseases. The incidence of CVD has revealed a statistically significant dose response with the lack of a latent period and with the average ERR Gy = 0.47, 95% CI = 0.31, 0.63, p < 0.001. Radiation risks of CVD statistically significantly (p = 0.01) varied with the duration of liquidators' stay in the Chernobyl zone; for those who stayed in the Chernobyl zone less than 6 wk, ERR/Gy = 0.80, 95% CI = 0.53; 1.08, p < 0.001.

[Non-Parametric Analysis of Radiation Risks of Mortality among Chernobyl Clean-Up Workers].

Analysis of the relationship between dose and mortality from cancer and circulation diseases in the cohort of Chernobyl clean-up workers based on the data from the National Radiation and Epidemiological Registry was performed. Medical and dosimetry information on the clean-up workers, males, who got radiation doses from April 26, 1986 to April 26, 1987, which was accumulated from 1992 to 2012, was used for the analysis. The total size of the cohort was 42929 people, 12731 deaths were registered in the cohort, among them 1893 deaths from solid cancers and 5230 deaths were from circulation diseases. An average age of the workers was 39 years in 1992 and the mean dose was 164 mGy. The dose-effect relationship was estimated with the use of non-parametric analysis of survival with regard to concurrence of risks of mortality. The risks were estimated in 6 dose groups of similar size (1-70, 70-130, 130-190, 190-210, 210-230 and.230-1000 mGy). The group "1-70 mGy" was used as control. Estimated dose-effect relationship related to cancers and circulation diseases is described approximately with a linear model, coefficient of determination (the proportion of variability explained by the linear model) for cancers was 23-25% and for circulation diseases - 2-13%. The slope coefficient of the dose-effect relationship normalized to 1 Gy for the ratio of risks for cancers in the linear model was 0.47 (95% CI: -0.77, 1.71), and for circulation diseases it was 0.22 (95% CI: -0.58, 1.02). Risks coefficient (slope coefficient of excess mortality at a dose of 1 Gy) for solid cancers was 1.94 (95% CI: - 3.10, 7.00) x 10(-2) and for circulation diseases it was 0.67 (95% CI: -9.61, 11.00) x 10(-2). 137 deaths from radiation-induced cancers and 47 deaths from circulation diseases were registered during a follow up period.

Radiation-epidemiological Study of Cerebrovascular Diseases in the Cohort of Russian Recovery Operation Workers of the Chernobyl Accident.

The paper presents an analysis of the incidence of cerebrovascular diseases (CeVD) in the cohort of Russian workers involved in recovery tasks after the Chernobyl accident. The studied cohort consists of 53,772 recovery operation workers (liquidators) who arrived in the zone of the Chernobyl accident within the first year after this accident (26 April 1986-26 April 1987). The mean external whole body dose in the cohort was 0.161 Gy, while individual doses varied from 0.0001 Gy to 1.42 Gy. During the follow-up period 1986-2012, a total of 23,264 cases of CeVD were diagnosed as a result of annual health examinations. A Poisson regression model was applied for estimation of radiation risks and for an assessment of other risk factors of CeVD. The following factors were considered as risk factors for CeVD: the dose, duration of the liquidators' work in the Chernobyl zone, and the concomitant diseases (hypertension, ischemic heart disease, atherosclerosis, and diabetes). The baseline incidence of CeVD is statistically significantly (p < 0.001) associated with all studied concomitant diseases. The incidence of CeVD has revealed a statistically significant dose response with the lack of a latent period and with the average ERR/Gy = 0.45, 95% CI: (0.28, 0.62), p < 0.001. Radiation risks of CeVD statistically significantly (p = 0.03) varied with the duration of liquidators' stay in the Chernobyl zone; for those who stayed in the Chernobyl zone less than 6 wk, ERR/Gy = 0.64, 95% CI = (0.38; 0.93), p < 0.001. Among studied concomitant diseases, diabetes mellitus statistically significantly (p = 0.002) increases the radiation risk of CeVD: for liquidators with diagnosed diabetes, ERR/Gy = 1.29.

Formation of potential radiation risk groups to render timely targeted medical care: lessons of Chernobyl.

The paper discusses technology for establishing potential cancer risk groups, based on methods of molecular and radiation epidemiology. Assay of gene mutations at the T-cell receptor (TCR) locus as the method of molecular epidemiology was used for measuring the frequency of TCR-mutations in 320 nuclear workers of the Institute of Physics and Power Engineering (IPPE). The method of radiation epidemiology was applied to the estimation of attributable risk fraction (ARF) for solid cancers in these groups. The main estimates of radiation risk after the Chernobyl accident are in close agreement with the International Commission on Radiological Protection (ICRP) Publication, 103 models published in 2007. In nuclear workers of the IPPE with ARF ≥ 10%, the increased level of TCR-mutations occurs more often (risk ratio=9.7; 95% CI: 2.9; 32.1).

Latent period in induction of radiogenic solid tumors in the cohort of emergency workers.

The paper presents estimates for the latent period of the induction of radiogenic solid cancers among Chernobyl emergency workers (males) living in six central regions of Russia. The analysis is based on medical and dosimetry data gathered by the National Radiation and Epidemiological Registry over the time period from 1986 to 2005. The cohort includes 59,770 persons who stayed in the exposure zone (30-km zone around the Chernobyl nuclear power plant) in 1986-1987. There were 2,718 cases of solid tumors identified during the follow-up time in this cohort. The mean radiation dose in the cohort is 0.13 Gy. The radiation risk and latent period were estimated using the method of maximum likelihood. The excess relative risk per unit dose was found to be 0.96 (95% confidence interval (CI): 0.3-1.7) and the minimum latent period for induction of solid tumors is 4.0 years (95% CI: 3.3-4.9).

Cancer incidence among nuclear workers in Russia based on data from the Institute of Physics and Power Engineering: a preliminary analysis.

One group that has the potential to be exposed to radiation is workers in the nuclear industry. Results of a systematic medical follow-up and dosimetric monitoring of these workers can form the basis for a study of the relationship between cancer incidence and radiation dose. As part of such efforts in Russia, a major institution of the nuclear industry with an established medical care unit, archiving capabilities, and dosimetry department was selected: the Institute of Physics and Power Engineering (IPPE) in Obninsk. In the study, a comparative analysis of cancer incidence rates for the IPPE workers and for the general population of Russia in 1991-1997 was carried out. The subjects were the IPPE workers hired before 1981. This restriction was imposed to reduce the uncertainty associated with the possible latent period in the development of solid cancers. Thus the possibility of including persons who already had the disease at the time when they were hired was minimized. The analysis is based on information about 158 cancer cases, including 24 cancers in persons under individual dosimetric monitoring. A statistically significant excess in cancer incidence was found among the IPPE workers compared with a comparison population (the general population of Russia) for some types of cancers. The SIR values for all cancers (ICD-9: 140-208) is 0.93 (95% CI 0.76, 1.12) for males and 1.42 (95% CI 1.06, 1.87) for females. A statistically significant excess for all cancers was also observed for residents of Obninsk compared to the control comparison population. The corresponding SIR value was 1.20 (95% CI 1.12, 1.28) for males and 1.58 (95% CI 1.49, 1.69) for females. An important reason for the observed excess in cancer incidence compared to the control population may be the higher level of health care in the so-called nuclear cities of Russia which may have resulted in increased diagnosis and registration of cancers. A statistically significant dependence of the cancer incidence on the dose of ionizing radiation was not established. The excess relative risk per gray for all types of cancer was 0.91 (95% CI -2.75, 4.61) for males and 0.40 (95% CI -6.94, 7.83) for females. These estimates should be considered to be preliminary, as the number of cases considered in the analysis of the dose response is small (17 males and 7 females).

Dynamics of thyroid cancer incidence in Russia following the Chernobyl accident.

This paper presents an analysis of thyroid cancer incidence in the territories of Russia most contaminated after the Chernobyl accident. In the work, data on incidence in the Bryansk, Kaluga, Orel and Tula regions (5298000 persons) are used. Altogether, 2599 cases of thyroid cancer are considered from 1982 to 1995. Of them, 143 cases were among the population who were children and adolescents at the time of the accident in 1986. The work uses the approach based on comparison of distributions of thyroid cancer cases by age at diagnosis and age at exposure. It has been shown that since 1991 the age structure of the incidence has changed significantly with a growing proportion of cases among children and adolescents. The change in the structure occurred due to the radiation factor, specifically as a result of exposure of thyroid to incorporated 131I. It has been shown that the standardised incidence ratio (SIR) of thyroid cancer among children who were 0-4 years at exposure in 1991-6 was 6 to 10 times higher than among adults. On the average, SIR for children and adolescents at the time of exposure is about three times higher than in adults.

Cancer incidence among liquidators of the Chernobyl accident: solid tumors, 1986-1995.

The paper considers information about cancer incidence (solid tumors) among liquidators of the Chernobyl accident, which occurred in April 1986. The information was accumulated in the Russian National Medical and Dosimetric Registry (RNMDR) in the period from 1986 to early 1996. The RNMDR contains individual dosimetric and annual check-up data on liquidators resident in Russia. This paper presents results for male liquidators who had no oncological diseases before arrival to the 30-km zone and for whom the following information was available: confirmed dose of external radiation, birth date, date of arrival to the 30-km zone, time spent in the 30-km zone, and results of medical check-ups. The number of liquidators under study is 114,504, i.e., about 68% of all those registered in the RNMDR. The average dose of the studied cohort is 108 mGy; the average age at first arrival to the 30-km zone is 34.3 y; the total number of person-y is 797,781. The cohort of liquidators is briefly characterized. Cancer incidence in liquidators is compared to that of the population of Russia as a whole by calculating standardized incidence ratio (SIR). The values of SIR with 95% confidence intervals for all solid tumors and malignant neoplasms of the digestive system were 1.23 (1.15; 1.31) and 1.11 (1.01; 1.24), respectively. Assessment of radiation risks for the same classes of diseases has revealed a statistically significant increase in cancer incidence with external radiation dose. This study also shows that statistically significant excesses in the incidence of malignant neoplasms of the respiratory system have not been observed.

Cancer risks in the Kaluga oblast of the Russian Federation 10 years after the Chernobyl accident.

Cancer morbidity and mortality were studied in areas of the Kaluga oblast contaminated with radionuclides. The main objective of the study was to assess the influence of radiation exposure on existing levels of cancer morbidity and mortality. Time trends and relative population risks were analysed. Based on this analysis, it was concluded that the current levels of morbidity from cancers among the populations residing in the studied areas were primarily a result of a complex of factors which predated the exposure from the Chernobyl accident. However, there seems to be an unfavourable trend concerning malignant neoplasms of the respiratory organs for women residing in the contaminated areas. To date, no statistically significant effect of radiation on cancer morbidity (except for thyroid cancer in women) has been noted. The levels of cancer morbidity and mortality in the contaminated areas generally reflect the changes in cancer incidence in the oblast as a whole. The findings are consistent with international data on latent periods for the induction of radiogenic cancers and the biological effects for similar levels of exposure to populations residing in contaminated territories. Further studies are necessary in order to monitor possible effects that are related to the accident.

Leukaemia and thyroid cancer in emergency workers of the Chernobyl accident: estimation of radiation risks (1986-1995).

This work focuses on the direct epidemiological assessment of the risks of radiation-induced leukaemia and thyroid cancer in emergency workers (EW) after the Chernobyl accident. The Russian National Medical Dosimetric Registry (RNMDR) contains data for 168,000 EW as of January 1, 1996. The analysis relates to 48 leukaemias and 47 thyroid cancers, diagnosed and verified. Radiation risks are estimated by comparing the EW data with national data for a male population of the same age distribution. For leukaemia, an excess relative risk per Gy (ERR/Gy) of 4.30 (95% CI: 0.83, 7.75) is obtained, while the excess absolute risk per 10(4) person-years (PY) Gy (EAR/10(4)PY Gy) is found to be 1.31 (95% CI: 0.23, 2.39); for thyroid cancer an ERR/Gy of 5.31 (95% CI: 0.04, 10.58) is obtained, and an EAR/10(4)PY Gy of 1.15 (95% CI: 0.08, 2.22).

Thyroid cancer among "liquidators" of the Chernobyl accident.

In 1986, immediately after the Chernobyl accident, the USSR Ministry of Health adopted a large scale programme of establishing an All-Union Distributed Registry of persons affected by radiation due to the accident. The registry was based at the Medical Radiological Research Centre of the Russian Academy of Medical Sciences (MRRC RAMS). In 1992, when the USSR was dissolved, this registry database contained information on 659,000 persons, including 284,000 Chernobyl accident emergency workers ("liquidators"). Currently, the Russian National Medical Dosimetric Registry (RNMDR) contains data on 435,276 persons, including 167,862 liquidators. This paper reviews the data for 47 verified thyroid cancers in the liquidator subgroup of the RNMDR. Analyses show that there is an excess relative risk of thyroid cancer per Gy of 5.31 (95% confidence intervals 0.04 and 10.58) and an excess absolute risk of thyroid cancer per 10(4) person-years per Gy of 1.15 (95% confidence intervals 0.08 and 2.22).