title: Ionising radiation and risk of death from leukaemia and lymphoma in radiation-monitored workers (INWORKS): an international cohort study.
abstract: BACKGROUND
  There is much uncertainty about the risks of leukaemia and lymphoma after repeated or protracted low-dose radiation exposure typical of occupational, environmental, and diagnostic medical settings. We quantified associations between protracted low-dose radiation exposures and leukaemia, lymphoma, and multiple myeloma mortality among radiation-monitored adults employed in France, the UK, and the USA.
  
  
  METHODS
  We assembled a cohort of 308,297 radiation-monitored workers employed for at least 1 year by the Atomic Energy Commission, AREVA Nuclear Cycle, or the National Electricity Company in France, the Departments of Energy and Defence in the USA, and nuclear industry employers included in the National Registry for Radiation Workers in the UK. The cohort was followed up for a total of 8.22 million person-years. We ascertained deaths caused by leukaemia, lymphoma, and multiple myeloma. We used Poisson regression to quantify associations between estimated red bone marrow absorbed dose and leukaemia and lymphoma mortality.
  
  
  RESULTS
  Doses were accrued at very low rates (mean 1.1 mGy per year, SD 2.6). The excess relative risk of leukaemia mortality (excluding chronic lymphocytic leukaemia) was 2.96 per Gy (90% CI 1.17-5.21; lagged 2 years), most notably because of an association between radiation dose and mortality from chronic myeloid leukaemia (excess relative risk per Gy 10.45, 90% CI 4.48-19.65).
  
  
  CONCLUSIONS
  This study provides strong evidence of positive associations between protracted low-dose radiation exposure and leukaemia.
  
  
  BACKGROUND
  Centers for Disease Control and Prevention, Ministry of Health, Labour and Welfare of Japan, Institut de Radioprotection et de Sûreté Nucléaire, AREVA, Electricité de France, National Institute for Occupational Safety and Health, US Department of Energy, US Department of Health and Human Services, University of North Carolina, Public Health England.
authors.forename: Klervi
authors.initials: K
authors.lastname: Leuraud
authors.forename: David B
authors.initials: DB
authors.lastname: Richardson
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Cardis
authors.forename: Robert D
authors.initials: RD
authors.lastname: Daniels
authors.forename: Michael
authors.initials: M
authors.lastname: Gillies
authors.forename: Jacqueline A
authors.initials: JA
authors.lastname: O'Hagan
authors.forename: Ghassan B
authors.initials: GB
authors.lastname: Hamra
authors.forename: Richard
authors.initials: R
authors.lastname: Haylock
authors.forename: Dominique
authors.initials: D
authors.lastname: Laurier
authors.forename: Monika
authors.initials: M
authors.lastname: Moissonnier
authors.forename: Mary K
authors.initials: MK
authors.lastname: Schubauer-Berigan
authors.forename: Isabelle
authors.initials: I
authors.lastname: Thierry-Chef
authors.forename: Ausrele
authors.initials: A
authors.lastname: Kesminiene
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D007938:Leukemia / Q000401:mortality*; D008223:Lymphoma / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000401:mortality; D009381:Neoplasms, Radiation-Induced / Q000401:mortality; D009784:Occupational Diseases / Q000401:mortality*; D016273:Occupational Exposure / Q000009:adverse effects*; D011829:Radiation Dosage; D011834:Radiation Monitoring; D011839:Radiation, Ionizing; D006113:United Kingdom / Q000453:epidemiology; D014481:United States / Q000453:epidemiology