Examining temporal effects on cancer risk in the international nuclear workers' study.
Examining temporal effects on cancer risk in the international nuclear workers' study.
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DOI：
10.1002/ijc.30544
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发表时间：
2017-03-15
影响因子：
6.4
通讯作者：
Schubauer-Berigan MK
中科院分区：
文献类型：
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作者：
Daniels RD;Bertke SJ;Richardson DB;Cardis E;Gillies M;O'Hagan JA;Haylock R;Laurier D;Leuraud K;Moissonnier M;Thierry-Chef I;Kesminiene A;Schubauer-Berigan MK
该论文延续了国际核工作者研究队列（INWORKS）的系列出版物，该队列由来自法国，英国和美国的308，297名工作者组成，提供了820万人-年的观察结果（最早1944年至最晚2005年）。这些工人的外部辐射暴露主要是光子，导致结肠的估计平均职业吸收剂量为17.4毫戈瑞。累积电离辐射剂量和癌症死亡率之间的关联进行了评价，在一般相对风险模型，描述了修改的超额相对风险（ERR）每戈瑞（戈伊）的时间，因为曝光和曝光时的年龄。方法类似于巢式病例对照研究，使用抽样风险集的条件logistic回归。成果包括：所有实体癌、肺癌、白血病（不包括慢性淋巴细胞性白血病、急性髓性白血病、慢性髓性白血病、多发性骨髓瘤、霍奇金淋巴瘤和非霍奇金淋巴瘤）。随着暴露时间的推移，慢性粒细胞白血病的显著风险异质性是明显的，我们观察到暴露后不久（2-10年）和之后（20-30年）每戈伊估计的ERR增加。我们观察到急性髓细胞白血病的延迟效应，尽管估计值没有统计学意义。实体癌过度风险仅限于35岁以上的暴露，并且在达到年龄之前30年的暴露也会降低。持续性或迟发性影响表明额外的随访可能会告知终身风险。然而，由于分析的局限性和缺乏其他研究的确证性结果，需要谨慎解释结果。
The paper continues the series of publications from the International Nuclear Workers Study cohort (INWORKS) 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.