title: A case control study of multiple myeloma at four nuclear facilities.
abstract: OBJECTIVE
  Reported elevations of multiple myeloma among nuclear workers exposed to external penetrating ionizing radiation, based on small numbers of cases, prompted this multi-facility study of workers at US Department of Energy facilities.
  
  
  METHODS
  Ninety-eight multiple myeloma deaths and 391 age-matched controls were selected from the combined roster of 115,143 workers hired before 1979 at Hanford, Los Alamos National Laboratory, Oak Ridge National Laboratory, and the Savannah River site. These workers were followed for vital status through 1990 (1986 for Hanford). Demographic, work history, and occupational exposure data were derived from personnel, occupational medicine, industrial hygiene, and health physics records. Exposure-disease associations were evaluated using conditional logistic regression.
  
  
  RESULTS
  Cases were disproportionately African American, male, and hired prior to 1948. Lifetime cumulative whole body ionizing radiation dose was not associated with multiple myeloma, however, there was a significant effect of age at exposure, with positive associations between multiple myeloma and doses received at older ages. Dose response associations increased in magnitude with exposure age (from 40 to 50) and lag assumption (from 5 to 15 years), while a likelihood ratio goodness of fit test reached the highest value for cumulative doses received at ages above 45 with a 5-year lag (X2=5.43,1 df; relative risk = 6.9% per 10 mSv). Dose response associations persisted with adjustment for potential confounders.
  
  
  CONCLUSIONS
  Multiple myeloma was associated with low level whole body penetrating ionizing radiation doses at older ages. The exposure age effect is at odds with interpretations of A-bomb survivor studies but in agreement with several studies of cancer among nuclear workers.
authors.affiliation: Department of Epidemiology, School of Public Health, University of North Carolina, Chapel Hill 27599-7400, USA.
authors.forename: S
authors.initials: S
authors.lastname: Wing
authors.forename: D
authors.initials: D
authors.lastname: Richardson
authors.forename: S
authors.initials: S
authors.lastname: Wolf
authors.forename: G
authors.initials: G
authors.lastname: Mihlan
authors.forename: D
authors.initials: D
authors.lastname: Crawford-Brown
authors.forename: J
authors.initials: J
authors.lastname: Wood
mesh_terms: D000367:Age Factors; D000368:Aged; D016022:Case-Control Studies; D004307:Dose-Response Relationship, Radiation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000453:epidemiology / Q000209:etiology*; D009381:Neoplasms, Radiation-Induced / Q000453:epidemiology / Q000209:etiology*; D009678:Nuclear Energy; D009784:Occupational Diseases / Q000453:epidemiology / Q000209:etiology*; D016273:Occupational Exposure / Q000009:adverse effects*; D011829:Radiation Dosage; D011839:Radiation, Ionizing; D014481:United States / Q000453:epidemiology