title: Mortality and occupational exposure to radiation: first analysis of the National Registry for Radiation Workers.
abstract: OBJECTIVE
  To study cause specific mortality of radiation workers with particular reference to associations between fatal neoplasms and level of exposure to radiation.
  
  
  METHODS
  Cohort study.
  
  
  METHODS
  United Kingdom.
  
  
  METHODS
  95,217 radiation workers at major sites of the nuclear industry.
  
  
  METHODS
  Cause of death.
  
  
  RESULTS
  Most standardised mortality ratios were below 100: 83 unlagged, 85 with a 10 year lag for all causes; 84 unlagged, 86 lagged for all cancers; and 80 for all known other causes, indicating a "healthy worker effect." The deficit of lung cancer (75 unlagged, 76 lagged) was significant at the 0.1% level. Standardised mortality ratios were significantly raised (214 unlagged, 303 lagged) for thyroid cancer, but there was no evidence for any trend with external recorded radiation dose. Dose of external radiation and mortality from all cancers were weakly correlated (p = 0.10), and multiple myeloma was more strongly correlated (p = 0.06); for leukaemia, excluding chronic lymphatic, the trend was significant (p = 0.03; all tests one tailed). The central estimates of lifetime risk derived from these data were 10.0% per Sv (90% confidence interval less than 0 to 24%) for all cancers and 0.76% per Sv (0.07 to 2.4%) for leukaemia (excluding chronic lymphatic leukaemia). These are, respectively, 2.5 times and 1.9 times the risk estimates recommended by the International Commission on Radiological Protection, but 90% confidence intervals are large and the commission's risk factors fall well within the range. The positive trend with dose for all cancers, from which the risk estimate was derived, was not significant. The positive association between leukaemia (except chronic lymphatic leukaemia) was significant and robust in subsidiary analyses. This study showed no association between radiation exposure and prostatic cancer.
  
  
  CONCLUSIONS
  There is evidence for an association between radiation exposure and mortality from cancer, in particular leukaemia (excluding chronic lymphatic leukaemia) and multiple myeloma, although mortality from these diseases in the study population overall was below that in the general population. The central estimates of risk from this study lie above the most recent estimates of the International Commission on Radiological Protection for leukaemia (excluding chronic lymphatic leukaemia) and for all malignancies. However, the commission's risk estimates are well within the 90% confidence intervals from this study. Analysis of combined cohorts of radiation workers in the United States indicated lower risk estimates than the commission recommends, and when the American data are combined with our analysis the overall risks are close to those estimated by the commission. This first analysis of the National Registry for Radiation Workers does not provide sufficient evidence to justify a revision in risk estimates for radiological protection purposes.
authors.affiliation: National Radiological Protection Board, Chilton, Didcot.
authors.forename: G M
authors.initials: GM
authors.lastname: Kendall
authors.forename: C R
authors.initials: CR
authors.lastname: Muirhead
authors.forename: B H
authors.initials: BH
authors.lastname: MacGibbon
authors.forename: J A
authors.initials: JA
authors.lastname: O'Hagan
authors.forename: A J
authors.initials: AJ
authors.lastname: Conquest
authors.forename: A A
authors.initials: AA
authors.lastname: Goodill
authors.forename: B K
authors.initials: BK
authors.lastname: Butland
authors.forename: T P
authors.initials: TP
authors.lastname: Fell
authors.forename: D A
authors.initials: DA
authors.lastname: Jackson
authors.forename: M A
authors.initials: MA
authors.lastname: Webb
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality; D009369:Neoplasms / Q000401:mortality; D009381:Neoplasms, Radiation-Induced / Q000209:etiology*; D009678:Nuclear Energy; D009784:Occupational Diseases / Q000209:etiology* / Q000401:mortality; D016273:Occupational Exposure / Q000706:statistics & numerical data*; D011829:Radiation Dosage; D012042:Registries; D012307:Risk Factors; D006113:United Kingdom / Q000453:epidemiology