法国、英国和美国工人低剂量电离辐射暴露后的癌症死亡率(INWORKS)：队列研究

SCI

10 September 2023

Cancer mortality after low dose exposure to ionising radiation in workers in France, the United Kingdom, and the United States (INWORKS): cohort study. 

(BMJ, IF: 105.7)

Richardson David B,Leuraud Klervi,Laurier Dominique et al. Cancer mortality after low dose exposure to ionising radiation in workers in France, the United Kingdom, and the United States (INWORKS): cohort study.[J] .BMJ, 2023, 382: e074520.

OBJECTIVE 目的

To evaluate the effect of protracted low dose, low dose rate exposure to ionising radiation on the risk of cancer.

评价长期低剂量、低剂量率电离辐射暴露对癌症风险的影响。

DESIGN 设计

Multinational cohort study.

多国队列研究。

SETTING 背景

Cohorts of workers in the nuclear industry in France, the UK, and the US included in a major update to theInternational Nuclear Workers Study (INWORKS).

法国、英国和美国的核工业工人群体被纳入国际核工人研究(INWORKS)的重大更新。

PARTICIPANTS 参与者

309 932 workers with individual monitoring data for external exposure to ionising radiation and a total follow-up of 10.7 million person years.

309,932名工人，有外部电离辐射暴露的个人监测数据，总共随访1070万人年。

MAIN OUTCOME MEASURES 主要结局测量

Estimates of excess relative rate per gray (Gy) of radiation dose for mortality from cancer.

癌症死亡率的每格雷辐射剂量过量相对率(Gy)的估计。

RESULTS 结果

The study included 103 553 deaths, of which 28 089 were due to solid cancers. The estimated rate of mortalitydue to solid cancer increased with cumulative dose by 52% (90% confidence interval 27% to 77%) per Gy, lagged by 10 years. Restricting the analysis to the low cumulative dose range (0-100 mGy) approximately doubled the estimate of association (and increased the width of its confidence interval), as did restricting the analysis to workers hired in themore recent years of operations when estimates of occupational external penetrating radiation dose were recorded more accurately. Exclusion of deaths from lung cancer and pleural cancer had a modest effect on the estimated magnitude of association, providing indirect evidence that the association was not substantially confounded by smoking or occupational exposure to asbestos.

该研究包括103 553例死亡，其中28 089例死于实体癌。实体癌的估计死亡率随着每Gy累积剂量的增加而增加52%(90%置信区间为27%至77%)，滞后10年。将分析限制在低累积剂量范围(0-100mGy)大约使关联估计增加了一倍(并增加了其置信区间的宽度)，将分析限制在最近几年作业中雇用的工人(当职业外穿透辐射剂量的估计记录得更准确时)也是如此。排除肺癌和胸膜癌导致的死亡对估计的关联程度影响不大，这提供了间接证据，表明这种关联不会因吸烟或职业接触石棉而严重混淆。

CONCLUSIONS 结论

This major update to INWORKS provides a direct estimate of the association between protracted lowdose exposure to ionising radiation and solid cancer mortality based on some of the world's most informative cohorts of radiation workers. The summary estimate of excess relative rate solid cancer mortality per Gy is larger than estimates currently informing radiation protection, and some evidence suggests a steeper slope for the dose-response association in the low dose range than over the full dose range. These results can help to strengthen radiationprotection, especially for low dose exposures that are of primary interest in contemporary medical, occupational, and environmental settings.

INWORKS的这一重大更新提供了对长期低剂量电离辐射暴露与实体癌死亡率之间关系的直接估计，该估计基于世界上一些信息最丰富的辐射工作人员队列。对每Gy固体癌死亡率的超额相对比率的总估计值大于目前关于辐射防护的估计值，而且一些证据表明，在低剂量范围内的剂量-反应关联斜率比在全剂量范围内的斜率更大。这些结果有助于加强辐射防护，特别是对当代医学、职业和环境环境中主要关注的低剂量照射。