Occupational exposure

The effects of low-grade protracted exposure to radiation in older age as seen in nuclear workers and individuals living in high-risk areas are at least intriguing. Several case-controlled studies reported an increased risk of MM among nuclear workers exposed to external penetrating ionizing radiation. In the international combined analyses of mortality data on 95,673 workers, more than 85.4% men, employed for at least 6 months in the nuclear industry in the United States, United Kingdom, and Canada, were monitored for external exposure to ionizing radiation. The analyses covered a total of 2,124,526 person-years at risk and 15,825 deaths, 3976 of which were due to cancer. Among the 31 specific types of cancers studied, a significant association was observed only for MM (P = 0.037; 44 deaths).76 In the Sellafield British nuclear plant the cancer mortality and incidence among 14,282 workers employed between 1947 and 1975 were studied up to 1988.

Overall cancer mortality and incidence were 4% and 10%, respectively, less than that of the England and Wales populations. Among radiation workers there were significant positive correlations between accumulated radiation dose and mortality from cancers of ill-defined and secondary sites and for leukemia, but the association with MM was quite weak.77 A study of workers at US Department of Energy facilities identified 98 MM cases/deaths and compared them to 391 age-matched controls selected from 115,143 workers at three sites. Cases were disproportionately African-American males; all were hired prior to 1948. Lifetime cumulative whole body ionizing radiation dose was not associated with MM; however, there was a positive association between MM risk and doses received at an older age.78 The French Atomic Energy reviewed the cancer death for all workers between 1950 and 1968, after several deaths from cancer were reported in the mid 1980s. The cohort was followed up to 1990. The numbers of deaths from all causes and from all cancer sites were 44 and 21, respectively. No excess of cancer deaths was reported for the study period. The risk of death from all cancer sites increased with the duration of exposure to chemicals. The authors conclude, "the results do not justify the impression of an excess of cancer in workers of atomic facilities."79

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