title: Examining temporal effects on cancer risk in the international nuclear workers' study.
abstract: The paper continues the series of publications from the International Nuclear Workers Study cohort that comprises 308,297 workers from France, the United Kingdom and the United States, providing 8.2 million person-years of observation from a combined follow-up period (at earliest 1944 to at latest 2005). These workers' external radiation exposures were primarily to photons, resulting in an estimated average career absorbed dose to the colon of 17.4 milligray. The association between cumulative ionizing radiation dose and cancer mortality was evaluated in general relative risk models that describe modification of the excess relative risk (ERR) per gray (Gy) by time since exposure and age at exposure. Methods analogous to a nested-case control study using conditional logistic regression of sampled risks sets were used. Outcomes included: all solid cancers, lung cancer, leukemias excluding chronic lymphocytic, acute myeloid leukemia, chronic myeloid leukemia, multiple myeloma, Hodgkin lymphoma and non-Hodgkin lymphoma. Significant risk heterogeneity was evident in chronic myeloid leukemia with time since exposure, where we observed increased ERR per Gy estimates shortly after exposure (2-10 year) and again later (20-30 years). We observed delayed effects for acute myeloid leukemia although estimates were not statistically significant. Solid cancer excess risk was restricted to exposure at age 35+ years and also diminished for exposure 30 years prior to attained age. Persistent or late effects suggest additional follow-up may inform on lifetime risks. However, cautious interpretation of results is needed due to analytical limitations and a lack of confirmatory results from other studies.
authors.affiliation: Education and Information Division (EID), National Institute for Occupational Safety and Health (NIOSH), Cincinnati, OH, USA.
authors.forename: Robert D
authors.initials: RD
authors.lastname: Daniels
authors.affiliation: Division of Surveillance, Hazard Evaluations, and Field Studies (DSHEFS), National Institute for Occupational Safety and Health (NIOSH), Cincinnati, OH, USA.
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Bertke
authors.affiliation: Department of Epidemiology, University of North Carolina, Chapel Hill, NC, USA.
authors.forename: David B
authors.initials: DB
authors.lastname: Richardson
authors.affiliation: Radiation Programme, ISGlobal, Center for Research in Environmental Epidemiology (CREAL), Barcelona, Spain.|Universitat Pompeu Fabra (UPF), Barcelona, Spain.|CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Cardis
authors.affiliation: Radiation Effects Department, Public Health England Centre for Radiation, Chemical and Environmental Hazards (PHE-CRCE), Chilton, UK.
authors.forename: Michael
authors.initials: M
authors.lastname: Gillies
authors.affiliation: Radiation Effects Department, Public Health England Centre for Radiation, Chemical and Environmental Hazards (PHE-CRCE), Chilton, UK.
authors.forename: Jacqueline A
authors.initials: JA
authors.lastname: O'Hagan
authors.affiliation: Radiation Effects Department, Public Health England Centre for Radiation, Chemical and Environmental Hazards (PHE-CRCE), Chilton, UK.
authors.forename: Richard
authors.initials: R
authors.lastname: Haylock
authors.affiliation: Service de Radiobiologie et d'Epidémiologie, Institut de Radioprotection et de Sûreté Nucléaire (IRSN), Fontenay-aux-Roses, France.
authors.forename: Dominique
authors.initials: D
authors.lastname: Laurier
authors.affiliation: Service de Radiobiologie et d'Epidémiologie, Institut de Radioprotection et de Sûreté Nucléaire (IRSN), Fontenay-aux-Roses, France.
authors.forename: Klervi
authors.initials: K
authors.lastname: Leuraud
authors.affiliation: Section of Environment and Radiation, International Agency for Research on Cancer (IARC), Lyon, France.
authors.forename: Monika
authors.initials: M
authors.lastname: Moissonnier
authors.affiliation: Section of Environment and Radiation, International Agency for Research on Cancer (IARC), Lyon, France.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Thierry-Chef
authors.affiliation: Section of Environment and Radiation, International Agency for Research on Cancer (IARC), Lyon, France.
authors.forename: Ausrele
authors.initials: A
authors.lastname: Kesminiene
authors.affiliation: Division of Surveillance, Hazard Evaluations, and Field Studies (DSHEFS), National Institute for Occupational Safety and Health (NIOSH), Cincinnati, OH, USA.
authors.forename: Mary K
authors.initials: MK
authors.lastname: Schubauer-Berigan
mesh_terms: D000328:Adult; D000367:Age Factors; D017668:Age of Onset; D000368:Aged; D016022:Case-Control Studies; D004307:Dose-Response Relationship, Radiation; D005260:Female; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D019337:Hematologic Neoplasms / Q000209:etiology / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000401:mortality*; D009381:Neoplasms, Radiation-Induced / Q000209:etiology / Q000401:mortality; D009784:Occupational Diseases / Q000209:etiology / Q000401:mortality; D016273:Occupational Exposure / Q000009:adverse effects*; D000069079:Radiation Exposure / Q000009:adverse effects*; D012306:Risk; D013997:Time Factors; D006113:United Kingdom / Q000453:epidemiology; D014481:United States / Q000453:epidemiology
keywords: cancer; dose-response; epidemiology; longitudinal studies; mortality studies