Lung cancer risk among German male uranium miners: a cohort study, 1946-1998.

From 1946 to 1990 extensive uranium mining was conducted in the southern parts of the former German Democratic Republic. The overall workforce included several 100,000 individuals. A cohort of 59,001 former male employees of the Wismut Company was established, forming a large retrospective uranium miners' cohort for the time period 1946-1998. Mean duration of follow-up was 30.5 years with a total of 1 801,630 person-years. Loss to follow-up was low at 5.3%. Of the workers, 16,598 (28.1%) died during the study period. Based on 2388 lung cancer deaths, the radon-related lung cancer risk is evaluated. The excess relative risk (ERR) per working level month (WLM) was estimated as 0.21% (95% CI: 0.18-0.24). It was dependent on time since exposure and on attained age. The highest ERR/WLM was observed 15-24 years after exposure and in the youngest age group (<55 years of age). While a strong inverse exposure-rate effect was detected for high exposures, no significant association was detected at exposures below 100 WLM. Excess relative risk /WLM was not modified by duration of exposure. The results would indicate the need to re-estimate the effects of risk modifying factors in current risk models as duration of exposure did not modify the ERR/WLM and there was only a modest decline of ERR/WLM with increasing time since exposure.

Mortality from cardiovascular diseases in the German uranium miners cohort study, 1946-1998.

An increased risk of cardiovascular diseases after exposure to low doses of ionizing radiation has been suggested among the atomic bomb survivors. Few and inconclusive results on this issue are available from miner studies. A positive correlation between coronary heart disease mortality and radon exposure has been reported in the Newfoundland fluorspar miners study, yet low statistical power due to small sample size was of concern. To get further insight into this controversial issue, data from the German uranium miners cohort study were used, which is by far the largest miner study up to date. The cohort includes 59,001 male subjects who were employed for at least six months between 1946 and 1989 at the former Wismut uranium company in Eastern Germany. Exposure to radon, long-lived radionuclides and external gamma radiation was estimated by using a detailed job-exposure matrix. About 16,598 cohort members were deceased until 31 December 1998, including 5,417 deaths from cardiovascular diseases. Linear Poisson regression models were used to estimate the excess relative risk (ERR) per unit of cumulative radiation exposure after adjusting for attained age and calendar period. No trend in risk of circulatory diseases with increasing cumulative exposure to either radon [ERR per 100 working level month: 0.0006; 95% confidence limit (CI): -0.004 to 0.006], external gamma radiation (ERR per Sv: -0.26, 95% CI: -0.6 to 0.05) or long-lived radionuclides (ERR per 100 kBqh/m3: -0.2, 95% CI: -0.5 to 0.06), respectively, was observed. This was also true for the sub-group heart disease and stroke. Our findings do not support an association between cardiovascular disease mortality and exposure to radiation among miners, yet low doses and uncontrolled confounding hamper interpretation.

The inverse dose-rate effect for radon induced lung cancer: a modified approach for risk modelling.

One of the features of high LET alpha-ray exposure due to radon inhalation is the well-known inverse dose-rate effect. The longer a given dose is delivered to the lung, the higher is its carcinogenic effect. This introduces the problem of risk extrapolation from high levels of radon exposure typical for uranium miners, down to low levels of radon exposure typical for the general population. An analytical model is presented that accounts for dose-rate effects over the entire exposure range. In accordance with radiobiological considerations and microdosimetric implications, the model provides an adequate description of the inverse dose-rate effect in the higher dose range. At the same time, a linear slope at low exposures that is independent of the dose-rate of exposure is attained.

Lung cancer mortality among nuclear workers of the Mayak facilities in the former Soviet Union. An updated analysis considering smoking as the main confounding factor.

A new analysis of lung cancer mortality in a cohort of male Mayak workers who started their employment in the plutonium and reprocessing plants between 1948 and 1958 has been carried out in terms of a relative risk model. The follow-up has been extended until 1999, moreover a new dosimetry system (DOSES2000) has been established. Particular emphasis has been given to a discrimination of the effects of external gamma-exposure and internal alpha-exposure due to incorporated plutonium. This study has also utilized and incorporated the information from a cohort of Mayak reactor workers, who were exposed only externally to gamma-rays. The influence of smoking as the main confounding factor for lung cancer has been studied. The baseline lung cancer mortality rate was not taken from national statistics but was derived from the cohort itself. The estimated excess relative risk for the plutonium alpha-rays was 0.23/Sv (95%CI: 0.16-0.31). The resulting risk coefficient for external gamma-ray exposure was very low with a statistically insignificant estimate of 0.058/Sv (95%CI: -0.072-0.20). The inferred relative risk for smokers was 16.5 (95%CI: 12.6-20.5).

Lung cancer mortality among male nuclear workers of the Mayak facilities in the former Soviet Union.

An analysis of lung cancer mortality in a cohort of 1,669 Mayak workers who started their employment in the plutonium and reprocessing plants between 1948 and 1958 has been carried out in terms of a relative risk model. Particular emphasis has been given to a discrimination of the effects of external gamma-ray exposure and internal alpha-particle exposure due to incorporated plutonium. This study has also used the information from a cohort of 2,172 Mayak reactor workers who were exposed only to external gamma rays. The baseline lung cancer mortality rate has not been taken from national statistics but has been derived from the cohort itself. For both alpha particles and gamma rays, the results of the analysis are consistent with linear dose dependences. The estimated excess relative risk per unit organ dose equivalent in the lung due to the plutonium alpha particles at age 60 equals, according to the present study, 0.6/Sv, with a radiation weighting factor of 20 for alpha particles. The 95% confidence range is 0.39/Sv to 1.0/Sv. For the gamma-ray component, the present analysis suggests an excess relative risk for lung cancer mortality at age 60 of 0.20/Sv, with, however, a large 95% confidence range of-0.04/Sv to 0.69/Sv.

Induction of malignant bone tumors in radium-224 patients: risk estimates based on the improved dosimetry.

Mainly between 1945 and 1955, several thousand German patients with ankylosing spondylitis, tuberculosis, or--in a few cases--other diseases received multiple injections of the short-lived alpha-particle emitter radium-224. In the early 1950s, the follow-up of 899 patients was initiated, and the study has continued since then. It includes most of the high-dose patients and nearly all of those treated as children or juveniles, i.e. under the age of 21. In the study cohort, 56 malignant bone tumors occurred in a temporal wave that peaked 8 years after exposure, whereas less than one case would have been expected during the follow-up. Most of the malignant bone tumors were osteosarcomas and fibrous-histiocytic sarcomas. A new analysis has now been performed, primarily because an improved dosimetry resulted in modified bone surface doses, especially for those treated at younger ages. A significant increase in bone tumor risk with decreasing age at exposure is now demonstrated. The earlier finding of an inverse protraction factor is confirmed. In the new formulation, the dependence on dose rate or duration applies only at higher doses; i.e., the initial slope of the dose dependence is unrelated to dose rate or exposure duration, which is in contrast to earlier analyses but is in agreement with microdosimetric considerations and general radiobiological experience.

Lung cancer in nuclear workers of Mayak. A comparison of numerical procedures.

Lung cancer mortality was analyzed among 4279 nuclear workers of the Mayak facilities in the former Soviet Union, who were exposed to chronic irradiation both externally and internally from incorporated plutonium. The analysis was carried out in terms of a relative risk model. It was shown that an earlier estimate of the excess relative risk for lung cancer, that exceeds the value employed by ICRP by a factor of roughly 2, as well as an earlier estimated latency period of 24 years for lung cancer induction were the result of the numerical procedure chosen. In another recently published case control study, a purely quadratic, threshold-type dose response to incorporated plutonium was deduced. In the present calculations, no evidence for a departure from linearity in dose response was suggested. Principal aim of this study has been the comparison to methods used in the earlier cohort analysis. More detailed risk modelling on the basis of the most recent follow-up will be required.

A hybrid likelihood algorithm for risk modelling.

The risk of radiation-induced cancer is assessed through the follow-up of large cohorts, such as atomic bomb survivors or underground miners who have been occupationally exposed to radon and its decay products. The models relate to the dose, age and time dependence of the excess tumour rates, and they contain parameters that are estimated in terms of maximum likelihood computations. The computations are performed with the software package EPI-CURE, which contains the two main options of person-by person regression or of Poisson regression with grouped data. The Poisson regression is most frequently employed, but there are certain models that require an excessive number of cells when grouped data are used. One example involves computations that account explicitly for the temporal distribution of continuous exposures, as they occur with underground miners. In past work such models had to be approximated, but it is shown here that they can be treated explicitly in a suitably reformulated person-by person computation of the likelihood. The algorithm uses the familiar partitioning of the log-likelihood into two terms, L1 and L0. The first term, L1, represents the contribution of the 'events' (tumours). It needs to be evaluated in the usual way, but constitutes no computational problem. The second term, L0, represents the event-free periods of observation. It is, in its usual form, unmanageable for large cohorts. However, it can be reduced to a simple form, in which the number of computational steps is independent of cohort size. The method requires less computing time and computer memory, but more importantly it leads to more stable numerical results by obviating the need for grouping the data. The algorithm may be most relevant to radiation risk modelling, but it can facilitate the modelling of failure-time data in general.