Cancer incidence among Norwegian airline cabin attendants.

BACKGROUND: Cabin crews are exposed to cosmic radiation at work and this may increase their incidence of radiation-induced cancers. Former studies indicate an increased risk of breast cancer. METHODS: A retrospective cohort study was performed. The cohort was established from the files of the Civil Aviation Administration and included people with a valid licence as a cabin attendant between 1950 and 1994. The cohort was linked to the Cancer Registry of Norway. Observed number of cases was compared with expected, based on national rates. Breast cancer incidence was analysed, adjusting for individual fertility variables. RESULTS: A group of 3693 cabin attendants were followed over 72 804 person-years. Among the women, 38 cases of breast cancer were observed (standardized incidence ratio (SIR) = 1.1, 95% CI : 0.8-1.5). Among men excess risks were found for cancers in the upper respiratory and gastric tract (SIR = 6.0, 95% CI : 2.7-11.4) and cancer of the liver (two cases, SIR = 10.8, 95% CI : 1.3-39.2). For both sexes elevated risks were found for malignant melanoma and non-melanoma skin cancer; for men these were SIR = 2.9 (95% CI : 1.1-6.4) and SIR = 9.9 (95% CI : 4.5-18.8) respectively, while for women these were SIR = 1.7 (95% CI : 1.0-2.7) and SIR = 2.9 (95% CI : 1.0-6.9) respectively. For no cancer site was a significant decreased risk found. CONCLUSIONS: An increased risk of radiation-induced cancers was not observed. The excess risks of some other cancers are more probably explained by factors related to lifestyle.

Hatching in zebrafish (Danio rerio) embryos exposed to a 50 Hz magnetic field.

Zebrafish embryos were exposed intra ovo to a 50 Hz AC magnetic field of 1000 microT rms, and the progress of asynchronous hatching was monitored. A statistically significant delay was observed when field exposure started 48 h after fertilization. In contrast, when exposure started 2 h after fertilization, no statistically significant effect was seen. When field exposure was administered together with submaximal doses of progesterone at 48 h postfertilization, the two treatments appeared to delay hatching in an additive manner. Evaluating the progress of hatching in zebrafish embryos seems relevant for exploration of EMF effects on reproduction.

Cancer incidence among Norwegian airline pilots.

OBJECTIVES: In this retrospective cohort study, the cancer incidence of commercial pilots was studied to determine whether exposure at work has any influence on the incidence of cancer. METHODS: The cohort was established from the files of the Civil Aviation Administration and included people who had valid licenses as commercial pilots between 1946 and 1994. Basic data about their flight careers were recorded, and exposure to cosmic radiation was estimated. The cohort was linked to the Cancer Register of Norway. The observed number of cases was compared with that expected based on national rates. RESULTS: A group of 3701 male pilots was followed over 70 560 person-years. There were 200 cases of cancer versus 188.8 expected, with a standardized incidence ratio (SIR) of 1.06 and a 95% confidence interval (95% CI) of 0.92-1.22. No significant decreased risk was found for any cancer site. Excess risks were found for malignant melanoma (22 cases SIR 1.8, 95% CI 1.1-2.7) and nonmelanoma skin cancer (14 cases, SIR 2.4, 95% CI 1.3-4.0). For malignant melanoma, there was a significant trend for the SIR by cumulative dose. CONCLUSIONS: For most cancer sites, the incidence among pilots did not deviate from that of the general population and could not be related to block hours of flight time or dose. It seems more likely that the excess risks of malignant melanoma and skin cancer are explained by factors related to life-style rather than by conditions at work.

[Patient treatment in radiation accidents]. / Pasientbehandling ved strålingsulykker.

Accidental human injury due to ionizing radiation is rare. Industrial accidents are comparatively the most common. Life saving procedures should always have priority to any concern about radiation injury or contamination. The personal risks for emergency medical personnel is negligible when simple measures are taken. Repeated clinical examinations and blood lymphocyte counts should be performed on all patients with suspected radiation injury to allow a diagnosis. The radiation syndrome develops within days or weeks depending on total radiation dose, dose rate and dose distribution. Damage to the bone marrow and gut are the most important. Local radiation injuries to the hands are common in industrial accidents. The Norwegian Radiation Protection Authority should always be called when a potential ionizing radiation accident takes place within Norway.

[Effects of sunscreening agents and reactions with ultraviolet radiation]. / Solbeskyttende midlers virkemåte og reaksjoner ved ultrafiolett bestråling.

The use of sunscreens is extensive. During the last few years there have been indications that UV radiation causes breakdown of the sunlight absorbing filters in the sunscreens, i.e. the sunscreens are not photostable. We describe briefly UV propagation in skin, the chemical and physical properties of sunscreens, and how these may react during UV irradiation. We have studied the stability of several sunscreens in vitro. The stability tests were performed by applying a thin film of the sunscreen preparation to the wall of a quartz window, irradiating it with a sun simulator, and measuring the absorbance with spectrophotometry before and during irradiation. The sunscreen agent studied most thoroughly was the UVB filter octyl methoxy cinnamate, but other UVA and UVB filters and some commercial products were also tested. Considerable breakdown of most filters was observed after doses of irradiation equivalent to moderate sun exposure. It can be questioned whether the breakdown products of sunscreens also possess other physical or biological properties. General practitioners should be able to advise their patients on sun protection and the proper use of sunscreens, considering the extensive use of sunscreens and the fact that sunbathing may be a health hazard.

Chromosome analysis of peripheral lymphocytes from persons exposed to radioactive fallout in Norway from the Chernobyl accident.

Chromosome analysis of peripheral lymphocytes from two Norwegian populations (44 reindeer herding South samis from Røros and Snåsa, 12 sheep farmers from Valdres) exposed to fallout from the Chernobyl accident were made. The doses from caesium through the years 1987-1991 were calculated based on whole-body measurements 134Cs and 137Cs giving a total cumulative mean internal dose of 5.54 mSv for the total group of 56 persons. Chromosome aberrations were within the normal range when compared with historical controls with the exception of dicentrics (0.3% per cell, which is a 10-fold increase) and rings (0.07% per cell). A dose-dependent increase in dicentrics and rings based on caesium exposure was not observed.

High-voltage overhead power lines in epidemiology: patterns of time variations in current load and magnetic fields.

In epidemiological studies of electromagnetic fields and health effects, exposure classification is crucial. There is no generally accepted biophysical interaction mechanism, but many studies are based on the hypothesis of a causal relationship with the strength of magnetic field. Some definition of the magnitude of exposure must be used, e.g., mean magnetic flux density, the integral of magnetic flux and time, or a peak value. Magnetic fields around a particular power line depend on the current load. The aim of the present study was to follow variations in line current load in the power supply system of the largest Norwegian city on a yearly, monthly, daily and diurnal basis. Fairly large variations in load were found, but increases in consumption were not necessarily reflected in current load on high voltage lines. The correlation between outdoor temperature and current load varied widely, depending on the type of power station feeding the line in question. The registered time variations are large enough to interfere with epidemiological classification of residences and testing of epidemiological hypotheses.

Relationship between intestinal fibrosis and histopathologic and morphometric changes in consequential and late radiation enteropathy.

Intestinal fibrosis is a marked feature of late radiation enteropathy. This study assessed the time dose fractionation relationships of radiation-induced fibrosis in order to elucidate possible pathogenetic mechanisms. In 290 male Sprague-Dawley rats, a loop of small bowel was transposed to the left side of the scrotum. Three weeks later, the transposed segment was irradiated with either single dose or various fractionated regimens. The animals were observed for radiation-induced intestinal complications and killed in groups, 2 and 26 weeks after completion of irradiation. A semiquantitative histopathologic radiation injury score, morphometry of the submucosa, submucosal arterioles, intestinal surface area, and relative collagen content were used as endpoints. Fibrosis, measured by collagen assay and radiation injury score, increased with total dose, increasing fraction size and reduction in overall treatment time. This paralleled the results of morphometric assessment of mucosal surface area. Differences in vascular morphometry were only statistically significant in response to changes in total dose and fraction size and not with changes in overall treatment time. We conclude that fibrosis increases with increasing observation time, increasing fraction size, increasing total dose, and reduction of interfraction interval. Consequential injury, occurring as a result of disruption of mucosal integrity, seems to be an important mechanism for development of intestinal fibrosis. In contrast, vascular injury is relatively independent of this mechanism.

Skin treatment with bepanthen cream versus no cream during radiotherapy--a randomized controlled trial.

In several radiotherapy departments, dexpanthenol cream (Bepanthen 'Roche') has been used extensively to ameliorate acute radiotherapy skin reactions. The evidence base for this practice is obscure as no randomized trials have been performed. In the present clinical prospective study of 86 patients we have compared Bepanthen cream with no topical ointment at all. The cream was applied on randomly selected parts of treatment fields in laryngeal and breast cancer patients, and so each patient acted as his own control. Seven patients were withdrawn from analysis. Scoring of skin reactions in 16 laryngeal and 63 breast cancer patients was performed without knowledge of which area that had been given cream or not. Endpoints were a modified skin reaction grading according to EORTC/RTOG, and itching/pain in treated fields. The study did not indicate any clinically important benefits of using Bepanthen cream for ameliorating radiogenic skin reactions under the conditions applied.

Incidence of cancer among workers in Norwegian hydroelectric power companies.

OBJECTIVES: The goal of this study was to examine whether exposure to electric or magnetic fields is related to cancer. METHODS: The study cohort consisted of 5088 men who had worked for at least one year between 1920 and 1991 for any of eight participating companies which produce and distribute hydroelectric power in Norway. The occupational exposure of these workers included extremely low-frequency electromagnetic fields. Incident cancer cases identified from the Cancer Registry of Norway were analyzed on the basis of the standardized incidence ratio with the Norwegian male population as reference. RESULTS: The incidence of cancer was close to unity for the cohort. The standardized incidence ratio for lymphoma was below unity, whereas those for leukemia and brain tumors were similar to those expected. Calculated cumulative exposure to electric or magnetic fields was not associated with the incidence of leukemia or brain tumors, but an excess of malignant melanoma was shown for the highest category of magnetic field exposure. An analysis of combined possible exposure to oils containing polychlorinated biphenyls and exposure to magnetic fields or possible exposure to electric sparks gave standardized incidence ratios of 265 and 280, respectively, for the higher exposure category. CONCLUSIONS: These results do not support the assumption of a possible association between exposure to electromagnetic fields and leukemia and brain tumors. The possible association between exposure to polychlorinated biphenyls or magnetic fields and risk of malignant melanoma should be further evaluated in future studies.

Influence of fractionation schedule on development of intestinal complications following localized irradiation. An experimental study in the rat.

This study examined the relationship among time-dose-fractionation, development of intestinal complications, and histopathologic radiation injury in rat small bowel. In 177 rats, a functional loop of rat ileum was surgically transposed to the left scrotum. Three weeks later, fractionated irradiation was delivered to the transposed intestine as 2.8 Gy or 5.6 Gy daily fractions, or as 2.8 Gy twice daily with 12 hours' interval. Eleven experimental groups received total doses ranging from 28 Gy to 90 Gy. The animals were observed for intestinal complications, and groups of animals were killed 2 and 26 weeks after completion of irradiation for assessment of injury. Radiation injury was assessed by a semiquantitative histopathologic scoring system and by the frequency of lethal intestinal complications. Both increased fraction size and reduced overall treatment time increased the severity of subacute and chronic radiation injury, as well as frequency of intestinal complications. We conclude that rapidly proliferating cells (mucosal epithelium) play a pivotal role in the pathogenesis of radiation enteropathy and mechanisms other than radiation-induced mitotic cell death are pathogenetically involved.

[Radiation accidents and radiation disasters]. / Strålingsulykker og strålingskatastrofer.

Accidents and disasters involving ionizing radiation are rare. Such accidents may occur not only at nuclear power stations but also in medicine and in industry. Only fairly large radiation doses can give acute medical effects. Symptoms and signs depend on the actual dose, and on what parts of the body are irradiated. In connection with a radiation accident, the main points are to recognize in the first place that radiation may be involved, and to have some knowledge of the actual source. Risk of localized irradiation from industrial sources, especially of hands, is a problem that is often overlooked. The paper reviews the principles for action by local health officers, the pathogenesis of radiation injury and early medical management. Some information is also given on the Norwegian system of contingency preparedness against nuclear accidents.

Influence of interferon and radiation on serotonin content in primary carcinoid cell cultures.

Carcinoids are in general thought to be radioresistent, and have not been subjected to radiation therapy, except for palliative purposes. Clinical experience has indicated that interferons might enhance radiation effect and toxicity. In order to examine the effect of radiation, the combination of radiation and interferon, and the usefulness of the main metabolic product of primary cell cultures--serotonin--as a response indicator, we exposed primary carcinoid cell cultures with and without interferon pretreatment to radiation (2 Gy and 8 Gy). Irradiation alone had no effect on the serotonin content of the medium at the low dose (2 Gy) and even at the high dose (8 gy) the effect was not significant. When cells were preincubated with 1,000 IU/ml alpha-interferon, however, irradiation with 8 Gy induced a significant reduction of the hormone concentration in the medium on day 12 to 54.9 +/- 8.0% of the control value (p = 0.026). We think our model may provide a useful tool for further exploration of these mechanisms.

Birth defects in Norway by levels of external and food-based exposure to radiation from Chernobyl.

In Norway, external doses of radiation resulting from fallout from the Chernobyl nuclear accident were estimated from detailed measurements, including soil deposition patterns. Internal doses were estimated from measurements of radioactive cesium in meat and milk supplies. The doses were calculated as average monthly doses for each of 454 municipalities during 36 consecutive months after the accident in spring 1986. Prospectively collected data on all newborns listed in the Medical Birth Registry of Norway who were conceived in the period May 1983-April 1989 were used to assess possible dose-response relations between estimated external and food-based exposures and congenital malformations and some other conditions. A positive association was observed between total radiation dose (external plus food-based) and hydrocephaly, while a negative association was observed for Down's syndrome. However, an important conclusion of the study was that no associations were found for conditions previously reported to be associated with radiation, i.e., small head circumference, congenital cataracts, anencephaly, spina bifida, and low birth weight. Potential sources of bias, including exposure misclassification and incomplete ascertainment of cases, are discussed.

Area and time distribution of external and internal doses from Chernobyl fallout: the lack of correlation in Norway.

Population doses from external radiation and internal food-based radioactivity were calculated each month for each municipality for 3 y immediately following the Chernobyl contamination in Norway. The main polluted regions are sparsely populated but comprise important food production areas. The external dose data base was calculated based on fallout deposition and measurements in dwellings, whereas the totally independent internal dose data base was calculated on a large number of food measurements and knowledge of both the food distribution system and the countermeasures taken. The internal dose in the densely populated municipalities was comparably higher than expected from local deposition, despite the fact that countermeasures had some effect. Thus, the correlation between internal and external dose for individual municipalities is rather weak. This study shows that a traditional deposition/transfer factor approach may be inappropriate if used in countries with large variation in population density and agricultural ecosystems and in combination with effective countermeasures.

Tolerance of rat small intestine to localized single dose and fractionated irradiation.

The tolerance of rat small intestine to localized single-dose and fractionated irradiation was assessed. In 168 rats, bilateral orchiectomy was performed and a loop of small intestine was transposed to the left part of the scrotum. Beginning 3 weeks postoperatively, single dose (18-24 Gy) or fractionated (4.2 Gy or 5.6 Gy per fraction) x-irradiation was delivered to the transposed intestine. The animals were observed for complications, and groups of animals were killed 2 and 26 weeks after completion of irradiation for assessment of injury. Mortality (i.e. the occurrence of lethal intestinal complications) and a semiquantitative histopathologic scoring system were used as endpoints to assess the degree of radiation injury. The most frequent intestinal complications were enterocutaneous fistula formation and intestinal obstruction. Logistic regression analysis ov complications data was used to estimate LD50 values and the alpha/beta ratio. There was good correlation between histopathologic scores and the incidence of lethal complications. The estimated LD50 values were 22.1 +/- 0.5 Gy, 37.0 +/- 4.4 Gy and 51.0 +/- 5.3 Gy for the single dose regimen and the fractionated regimens of 5.6 Gy and 4.2 Gy respectively. The estimated alpha/beta ratio was 10.7 +/- 2.4 Gy. The goodness of fit of the linear-quadratic isoeffect model to our data was satisfactory. Our results indicate that acute mucosal damage may be pathogenetically involved in the development of intestinal complications.