title: Concept of optimisation of the radiation protection system in the nuclear sector: management of individual cancer risks and providing targeted health care.
abstract: The paper discusses the provision of targeted health care to nuclear workers in Russia based on radiation-epidemiological estimates of cancer risks. Cancer incidence rates are analysed for the workers of the Institute of Physical Power Engineering (the first nuclear installation in the world) who were subjected to individual dosimetric monitoring from 1950 to 2002. The value of excess relative risk for solid cancers was found to be ERR Gy(-1) = 0.24 (95% CI: -4.22; 7.96). It has been shown that 81.8% of the persons covered by individual dosimetric monitoring have potential attributive risk up to 5%, and the risk is more than 10% for 3.7% of the workers. Among the detected cancer cases, 73.5% of the individuals show an attributive risk up to 5% and the risk is in excess of 10% for 3.9% of the workers. Principles for the provision of targeted health care, given voluntary health insurance, are outlined.
authors.affiliation: Medical Radiological Research Centre of Russian Academy of Medical Sciences, 4 Korolev Street, Obninsk 249036, Russia.
authors.forename: V K
authors.initials: VK
authors.lastname: Ivanov
authors.forename: A F
authors.initials: AF
authors.lastname: Tsyb
authors.forename: A M
authors.initials: AM
authors.lastname: Agapov
authors.forename: A P
authors.initials: AP
authors.lastname: Panfilov
authors.forename: O V
authors.initials: OV
authors.lastname: Kaidalov
authors.forename: A I
authors.initials: AI
authors.lastname: Gorski
authors.forename: M A
authors.initials: MA
authors.lastname: Maksioutov
authors.forename: Y V
authors.initials: YV
authors.lastname: Suspitsin
authors.forename: V I
authors.initials: VI
authors.lastname: Vaizer
mesh_terms: D001822:Body Burden; D003695:Delivery of Health Care / Q000458:organization & administration*; D006801:Humans; D015994:Incidence; D009381:Neoplasms, Radiation-Induced / Q000453:epidemiology*; D009688:Nuclear Reactors / Q000706:statistics & numerical data*; D011785:Quality Assurance, Health Care / Q000458:organization & administration*; D011829:Radiation Dosage; D011834:Radiation Monitoring / Q000706:statistics & numerical data*; D011835:Radiation Protection / Q000379:methods*; D012062:Relative Biological Effectiveness; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D012426:Russia / Q000453:epidemiology