Cancer Mortality among Military Participants at U.S. Nuclear Weapons Tests

描述（由申请人提供）：将对12.5万名参加过1946年至1958年间在内华达试验场或太平洋试验场230次地面大气核武器试验中的一次或多次试验的美国原子退伍军人进行终身癌症风险量化。将对个别原子退伍军人的辐射剂量作出可靠的估计，这在以前的调查中是不可能的。剂量重建方法的进步将使剂量-反应评估和风险量化成为可能。将寻求关于长期低剂量暴露于外部和内部辐射，包括吸入和摄入钚、铀和放射性裂变产物后的特定癌症风险的新知识。先前的研究发现了白血病和其他几种癌症的过量，但不可能对辐射剂量进行可靠的估计。要验证的假设是，大约50至60年前长期暴露在低剂量辐射下，可能与白血病和其他疾病（包括冠心病）的发病率增加有关。另外20年的死亡率数据将增强我们发现在七个有最高记录的大气试验系列（即CASTLE、GREENHOUSE、REDWING、UPSHOT- KNOTHOLE、PLUMBBOB、CROSSROADS和HARDTACK i）中出现的军事人员中任何与辐射有关的风险的能力。统计方法的新发展将用于解释估计辐射剂量的不确定性。初步估计表明，剂量范围很广，从最小剂量（< 1毫西弗或0.10雷姆）到超过900毫西弗（或90雷姆）。将对所有死亡原因进行评估，并对所有死于白血病和甲状腺癌、唾液腺癌、男性乳腺癌、肝癌和骨癌（即以前报告的癌症增加的癌症）以及整个队列中1%的随机样本的辐射剂量进行重建。重点将放在白血病上，据估计已经发生了1000多例。CT x射线以及放射性核素成像（如PET扫描）的广泛使用突出表明，需要对慢性低剂量照射后的终生辐射风险进行准确估计，因为人群累积剂量可能很大。随着社会讨论核能和相关核废料的扩大以及恐怖分子用“脏弹”进行袭击的可能性，对接触放射性物质的人的风险进行评估变得更加重要。因此，拟议的研究为解决重要的公共卫生和社会问题提供了一个独特、及时和具有成本效益的机会，利用了国防部在过去30年中已经开发的详细辐射剂量和退伍军人数据。最后，拟议的项目对退伍军人及其家属很重要，因为它可以更好地了解与他们以前服兵役有关的健康风险。

DESCRIPTION (provided by applicant): The lifetime risk of cancer will be quantified among 125,000 United States atomic veterans who participated at one or more of the 230 aboveground atmospheric nuclear weapons tests at the Nevada Test Site or the Pacific Proving Ground between 1946 and 1958. Reliable estimates of radiation dose for individual atomic veterans will be made which were not possible in previous investigations. Advances in dose reconstruction methods will permit dose-response evaluations and risk quantification. New knowledge will be sought on specific cancer risks following protracted low-dose exposure to external and internal radiation, including the inhalation and ingestion of plutonium, uranium and radioactive fission products. Previous studies identified excesses of leukemia and several other cancers, but reliable estimates of radiation dose were not possible. The hypothesis to be tested is that chronic low-dose radiation exposure some 50 to 60 years ago can be linked to increases in leukemia and other diseases, including coronary heart disease. An additional 20 years of mortality data will enhance our ability to uncover any radiation-related risks among military personnel present at one or more of the seven atmospheric test series with the highest recorded exposures, i.e., CASTLE, GREENHOUSE, REDWING, UPSHOT- KNOTHOLE, PLUMBBOB, CROSSROADS and HARDTACK I. New developments in statistical methodologies will be applied to account for the uncertainty in the estimated radiation doses. Preliminary estimates indicate a broad range of doses from minimal (< 1 mSv or 0.10 rem) to over 900 mSv (or 90 rem). All causes of death will be evaluated, and radiation doses will be reconstructed for all veterans who died of leukemia and cancers of the thyroid, salivary gland, male breast, liver and bone, i.e., for cancers previously reported to be increased, as well as on a 1% random sample of the entire cohort. The focus will be on leukemia for which over 1,000 cases are estimated to have occurred. The proliferating use of CT x-ray as well as radionuclide imaging (e.g., PET scans) highlights the need for accurate estimates of lifetime radiation risk following chronic low-dose exposures for which cumulative population doses could be substantial. The evaluation of risks among persons with exposure to radioactive substances assumes greater importance as society debates expansion of nuclear energy and associated nuclear waste and the possibility of terrorist attacks with "dirty bombs." The proposed study thus provides a unique, timely and cost-effective opportunity to address important public health and societal issues, taking advantage of detailed radiation dose and veteran data already developed by the Department of Defense over the past 30 years. Finally, the proposed project is important to veterans and their families in providing a better understanding of the health risks associated with their prior military service. Public Health Relevance: Atomic veterans who participated in any of the 230 atmospheric nuclear weapons tests at the Nevada Test Site and the Pacific Proving Ground between 1946 and 1958 could have been exposed to various types of radiation including gamma rays, alpha particles and intakes of radioactive substances such as plutonium, uranium and fallout products. Results of this study will provide new knowledge on the lifetime risk of cancer following relatively low-dose exposures received gradually over time. Such information is helpful in understanding the very long-term consequences of radiation exposures and assumes greater importance today in light of the proliferating use of CT x-ray and radionuclide imaging, the possible expansion of nuclear power, and concerns over nuclear waste disposal and terrorist attacks with "dirty bombs."