title: [Effects of chronic uranium internal exposure on mortality: results of a pilot study among French nuclear workers].
abstract: BACKGROUND
  This article presents the mortality data compiled among a cohort of workers at risk of internal uranium exposure and discusses the extent to which this exposure might differentiate them from other nuclear workers.
  
  
  METHODS
  The cohort consisted of 2897 Areva-NC-Pierrelatte plant workers, followed from 1st January 1968 through 31st December 2006 (79,892 person-years). Mortality was compared with that of the French population, by calculating Standardized Mortality Ratios (SMR) and 95% confidence intervals (CI95%). External radiation exposure was reconstructed using external dosimetry archives. Internal uranium exposure was assessed using a plant-specific job-exposure-matrix, considering six types of uranium compounds according to their nature (natural and reprocessed uranium [RPU] and solubility [fast-F, moderate-M, and slow-S]). Exposure-effect analyses were performed for causes of death known to be related to external radiation exposure (all cancers and circulatory system diseases) and cancer of uranium target-organs (lung and hematopoietic and lymphatic tissues, HLT).
  
  
  RESULTS
  A significant deficit of mortality from all causes (SMR=0.58; CI95% [0.53-0.63]), all cancers (SMR=0.72; CI95% [0.63-0.82]) and smoking related cancers was observed. Non-significant 30%-higher increase of mortality was observed for cancer of pleura (SMR=2.32; CI95 % [0.75-5.41]), rectum and HLT, notably non-Hodgkin's lymphoma (SMR=1.38; CI95 % [0.63-2.61]) and chronic lymphoid leukemia (SMR=2.36; CI95% [0.64-6.03]). No exposure-effect relationship was found with external radiation cumulative dose. A significant exposure-effect relationship was observed for slowly soluble uranium, particularly RPU, which was associated with an increase in mortality risk reaching 8 to 16% per unit of cumulative exposure score and 10 to 15% per year of exposure duration.
  
  
  CONCLUSIONS
  The Areva-NC-Pierrelatte workers cohort presents a non-significant over-mortality from HLT cancers, notably of lymphoid origin, unrelated to external radiation exposure. The pilot study suggests an association between mortality from the HLT and lung cancers and exposure to slowly soluble RPU compounds. The results of this study should be investigated further in more powerful studies, with a dose-response analysis based on individual assessment of uranium absorbed dose to uranium-target organs.
authors.affiliation: Institut de radioprotection et de sûreté nucléaire, IRSN/PRP-HOM/SRBE/LEPID, laboratoire d'épidémiologie des rayonnements ionisants, BP 17, 92262 Fontenay-aux-Roses cedex, France; Institut de veille sanitaire (InVS), département santé travail (DST), 94415 Saint-Maurice cedex, France. Electronic address: i.guseva-canu@invs.sante.fr.
authors.forename: I
authors.initials: I
authors.lastname: Guseva Canu
authors.affiliation: Institut de radioprotection et de sûreté nucléaire, IRSN/PRP-HOM/SRBE/LEPID, laboratoire d'épidémiologie des rayonnements ionisants, BP 17, 92262 Fontenay-aux-Roses cedex, France.
authors.forename: S
authors.initials: S
authors.lastname: Zhivin
authors.affiliation: Institut de radioprotection et de sûreté nucléaire, IRSN/PRP-HOM/SRBE/LEPID, laboratoire d'épidémiologie des rayonnements ionisants, BP 17, 92262 Fontenay-aux-Roses cedex, France.
authors.forename: J-P
authors.initials: JP
authors.lastname: Garsi
authors.affiliation: Institut de radioprotection et de sûreté nucléaire, IRSN/PRP-HOM/SRBE/LEPID, laboratoire d'épidémiologie des rayonnements ionisants, BP 17, 92262 Fontenay-aux-Roses cedex, France.
authors.forename: S
authors.initials: S
authors.lastname: Caër-Lorho
authors.affiliation: Institut de radioprotection et de sûreté nucléaire, IRSN/PRP-HOM/SRBE/LEPID, laboratoire d'épidémiologie des rayonnements ionisants, BP 17, 92262 Fontenay-aux-Roses cedex, France.
authors.forename: E
authors.initials: E
authors.lastname: Samson
authors.affiliation: Service santé au travail, Areva-NC établissement de Pierrelatte, BP 1, 26701 Pierrelatte cedex, France.
authors.forename: P
authors.initials: P
authors.lastname: Collomb
authors.affiliation: Coordination médicale, Areva, 75009 Paris, France.
authors.forename: A
authors.initials: A
authors.lastname: Acker
authors.affiliation: Institut de radioprotection et de sûreté nucléaire, IRSN/PRP-HOM/SRBE/LEPID, laboratoire d'épidémiologie des rayonnements ionisants, BP 17, 92262 Fontenay-aux-Roses cedex, France.
authors.forename: D
authors.initials: D
authors.lastname: Laurier
mesh_terms: D000328:Adult; D000368:Aged; D002908:Chronic Disease; D015331:Cohort Studies; D004435:Eating; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D055848:Nuclear Power Plants; D009784:Occupational Diseases / Q000401:mortality*; D016273:Occupational Exposure / Q000706:statistics & numerical data*; D010865:Pilot Projects; D011829:Radiation Dosage; D000069079:Radiation Exposure / Q000706:statistics & numerical data*; D014501:Uranium / Q000633:toxicity*; D055815:Young Adult
chemical_list: D014501:Uranium
keywords: Cohort study; Cohorte; Ionizing radiation; Rayonnements ionisants; Uranium