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Original article
Impact of considering non-occupational radiation exposure on the association between occupational dose and solid cancer among French nuclear workers
  1. Lucie Fournier,
  2. Enora Cléro,
  3. Eric Samson,
  4. Sylvaine Caër-Lorho,
  5. Dominique Laurier,
  6. Klervi Leuraud
  1. Institut de Radioprotection et de Sûreté Nucléaire (IRSN), Fontenay-aux-Roses, France
  1. Correspondence to Dr Klervi Leuraud, Institut de Radioprotection et de Sûreté Nucléaire (IRSN), Fontenay-aux-Roses 92262, France; klervi.leuraud{at}


Objectives The French nuclear worker cohort allows for the assessment of cancer risk associated with occupational radiation exposure, but workers are also exposed to medical and environmental radiation which can be of the same order of magnitude. This study aims to examine the impact of non-occupational radiation exposures on the dose-risk analysis between occupational radiation exposure and cancer mortality.

Methods The cohort included workers employed before 1995 for at least one year by CEA, AREVA NC or EDF and badge-monitored for external radiation exposure. Monitoring results were used to calculate occupational individual doses. Scenarios of work-related X-ray and environmental exposures were simulated. Poisson regression was used to quantify associations between occupational exposure and cancer mortality adjusting for non-occupational radiation exposure.

Results The mean cumulative dose of external occupational radiation was 18.4 mSv among 59 004 workers. Depending on the hypotheses made, the mean cumulative work-related X-ray dose varied between 3.1 and 9.2 mSv and the mean cumulative environmental dose was around 130 mSv. The unadjusted excess relative rate of cancer per Sievert (ERR/Sv) was 0.34 (90% CI −0.44 to 1.24). Adjusting for environmental radiation exposure did not substantially modify this risk coefficient, but it was attenuated by medical exposure (ERR/Sv point estimate between 0.15 and 0.23).

Conclusions Occupational radiation risk estimates were lower when adjusted for work-related X-ray exposures. Environmental exposures had a very slight impact on the occupational exposure risk estimates. In any scenario of non-occupational exposure considered, a positive but insignificant excess cancer risk associated with occupational exposure was observed.

  • ionising radiation
  • cancer
  • risk assessment
  • epidemiology
  • longitudinal studies

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  • Contributors LF conducted the analyses and was lead author of the manuscript. LF, DL and KL conceived and designed the study. EC participated in the estimation of the environmental exposure of the French population. SCL and ES managed the data. The manuscript has been read and approved by all authors.

  • Competing interests The construction of the French nuclear worker cohort was done by the Institut de Radioprotection et de Sûreté Nucléaire (IRSN) with partial funding from AREVA and Electricité de France (EDF).

  • Ethics approval The Commission Nationale de l’Informatique et des Libertés (CNIL).

  • Provenance and peer review Not commissioned; externally peer reviewed.