OBJECTIVES--To discover whether direct estimates of the risks of cancer for nuclear workers agree with indirect estimates based on survivors of the atomic bomb; whether relations between age at exposure and risk of cancer are the same for workers and survivors, and whether dosimetry standards are sufficiently uniform to allow pooling of data from different nuclear industrial sites. METHOD--Data from five nuclear sites in the United States were included in a cohort analysis that as well as controlling for all the usual factors also allowed for possible effects of three cancer modulating factors (exposure age, cancer latency, and year of exposure). This analysis was first applied to three distinct cohorts, and then to two sets of pooled data. RESULTS--From each study cohort there was evidence of a risk of cancer related to dose, and evidence that the extra radiogenic cancers had the same overall histological manifestations as naturally occurring cancers and were largely the result of exposures after 50 years of age causing deaths after 70 years. There were, however, significant differences between the five sets of risk estimates. CONCLUSIONS--Although the risks of cancer in nuclear workers were appreciably higher than estimates based on the cancer experiences of survivors of the atomic bomb, some uncertainties remained as there were non-uniform standards of dosimetry in the nuclear sites. The differences between nuclear workers and survivors of the atomic bomb were largely the result of relations between age at exposure and risk of cancer being totally different for workers and survivors and, in the occupational data, there were no signs of the special risks of leukaemia found in atomic bomb data and other studies of effects of high doses.
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