Olivier Laurent

Relationship between occupational exposure to ionizing radiation and mortality at the French electricity company, period 1961-2003

PurposeEpidemiological studies in nuclear industry workers can produce relevant information to better appreciate the health risks related to chronic external exposure to low doses of ionizing radiation (IR). This work examined the relations between exposure to IR and mortality in workers at the French Electricity Company (EDF), followed up to year 2003.MethodsPermanent staff who had worked for at least 1xa0year at EDF during period 1961–1994 and who had been monitored for exposure to IR were included (nxa0=xa022,393). One-sided trend tests for mortality according to cumulative dose and relative risks at 100xa0mSv were estimated using Poisson regression. Main analyses were stratified on age, sex, calendar time and education.ResultsA total of 874 deaths occurred, and 66 workers were lost to follow-up. Median age at end of follow-up was 48. None of the causes of death investigated increased significantly according to dose, except cerebrovascular diseases (pxa0=xa00.01), but this last observation was based on only 22 cases.ConclusionsThese results do not allow dismissing a possible influence of IR on cancer risk in this population. The cohort is still relatively young and therefore confidence intervals for estimated relative risks remain wide, although they have considerably narrowed since a previous analysis. Chance is a possible explanation for the association between IR and cerebrovascular mortality, due to the low number of cases on which it is based. These results thus need to be stabilized by conducting joint analyses with similar cohorts.

Mortality associated with chronic external radiation exposure in the French combined cohort of nuclear workers

Objective The long-term effects of protracted low level ionising radiation exposure are investigated in a combined analysis of French nuclear workers employed by the Commissariat à lEnergie Atomique (CEA), AREVA Nuclear Cycle (AREVA NC) and Electricité de France (EDF). Associations between cumulative external radiation dose and mortality due to solid cancers, leukaemia and circulatory disease were examined. Methods All workers hired by CEA, AREVA NC and EDF between 1950 and 1994 who were employed for at least 1u2005year, badge-monitored for radiation exposure and alive on 1 January 1968 were included. Individual data of annual exposure to penetrating photons (X-rays and gamma rays) were reconstructed for each worker. Estimates of radiation dose–mortality associations were obtained using a linear excess relative risk (ERR) Poisson regression model. Results Among the 59u2005021 nuclear workers, 2312 died of solid cancer, 78 of leukaemia and 1468 of circulatory diseases during the 1968–2004 period. Approximately 72% of the cohort had a non-zero cumulative radiation dose estimate, with a mean cumulative dose of 22.5u2005mSv. Positive but non-significant ERR/Sv were observed for all solid cancers, leukaemia excluding chronic lymphocytic leukaemia (CLL), ischaemic heart diseases and cerebrovascular diseases. A significant ERR/Sv was found for myeloid leukaemia. Conclusions This is the first combined analysis of major French cohorts of nuclear workers. Results were consistent with risks estimated in other nuclear worker cohorts and illustrate the potential of a further joint international study to yield direct risk estimates in support to radiation protection standards.

Ionizing radiation biomarkers in epidemiological studies - an update.

Recent epidemiology studies highlighted the detrimental health effects of exposure to low dose and low dose rate ionizing radiation (IR): nuclear industry workers studies have shown increased leukaemia and solid tumour risks following cumulative doses of <100mSv and dose rates of <10mGy per year; paediatric patients studies have reported increased leukaemia and brain tumours risks after doses of 30-60mGy from computed tomography scans. Questions arise, however, about the impact of even lower doses and dose rates where classical epidemiological studies have limited power but where subsets within the large cohorts are expected to have an increased risk. Further progress requires integration of biomarkers or bioassays of individual exposure, effects and susceptibility to IR. The European DoReMi (Low Dose Research towards Multidisciplinary Integration) consortium previously reviewed biomarkers for potential use in IR epidemiological studies. Given the increased mechanistic understanding of responses to low dose radiation the current review provides an update covering technical advances and recent studies. A key issue identified is deciding which biomarkers to progress. A roadmap is provided for biomarker development from discovery to implementation and used to summarise the current status of proposed biomarkers for epidemiological studies. Most potential biomarkers remain at the discovery stage and for some there is sufficient evidence that further development is not warranted. One biomarker identified in the final stages of development and as a priority for further research is radiation specific mRNA transcript profiles.

A statistical evaluation of the influence of housing characteristics and geogenic radon potential on indoor radon concentrations in France.

Radon-222 is a radioactive natural gas produced by the decay of radium-226, known to be the main contributor to natural background radiation exposure. Effective risk management needs to determine the areas in which the density of buildings with high radon levels is likely to be highest. Predicting radon exposure from the location and characteristics of a dwelling could also contribute to epidemiological studies. Beginning in the nineteen-eighties, a national radon survey consisting in more than 10,000 measurements of indoor radon concentrations was conducted in French dwellings by the Institute for Radiological Protection and Nuclear Safety (IRSN). Housing characteristics, which may influence radon accumulation in dwellings, were also collected. More recently, the IRSN generated a French geogenic radon potential map based on the interpretation of geological features. The present study analyzed the two datasets to investigate the factors influencing indoor radon concentrations using statistical modeling and to determine the optimum use of the information on geogenic radon potential that showed the best statistical association with indoor radon concentration. The results showed that the variables associated with indoor radon concentrations were geogenic radon potential, building material, year of construction, foundation type, building type and floor level. The model, which included the surrounding geogenic radon potential (i.e. the average geogenic radon potential within a disc of radius 20xa0km centered on the indoor radon measurement point) and variables describing house-specific factors and lifestyle explained about 20% of the overall variability of the logarithm of radon concentration. The surrounding geogenic radon potential was fairly closely associated with the local average indoor radon concentration. The prevalence of exposure to radon above specific thresholds and the average exposures to radon clearly increased with increasing classes of geogenic radon potential. Combining the two datasets enabled improved assessment of radon exposure in a given area in France.

Mortality (1968–2008) in a French cohort of uranium enrichment workers potentially exposed to rapidly soluble uranium compounds

Objectives Until recently, enrichment of uranium for civil and military purposes in France was carried out by gaseous diffusion using rapidly soluble uranium compounds. We analysed the relationship between exposure to soluble uranium compounds and exposure to external γ-radiation and mortality in a cohort of 4688 French uranium enrichment workers who were employed between 1964 and 2006. Methods Data on individual annual exposure to radiological and non-radiological hazards were collected for workers of the AREVA NC, CEA and Eurodif uranium enrichment plants from job-exposure matrixes and external dosimetry records, differentiating between natural, enriched and depleted uranium. Cause-specific mortality was compared with the French general population via standardised mortality ratios (SMR), and was analysed via Poisson regression using log-linear and linear excess relative risk models. Results Over the period of follow-up, 131u2005161 person-years at risk were accrued and 21% of the subjects had died. A strong healthy worker effect was observed: all causes SMR=0.69, 95% CI 0.65 to 0.74. SMR for pleural cancer was significantly increased (2.3, 95% CI 1.06 to 4.4), but was only based on nine cases. Internal uranium and external γ-radiation exposures were not significantly associated with any cause of mortality. Conclusions This is the first study of French uranium enrichment workers. Although limited in statistical power, further follow-up of this cohort, estimation of internal uranium doses and pooling with similar cohorts should elucidate potential risks associated with exposure to soluble uranium compounds.

Cancer and non-cancer mortality among French uranium cycle workers: The TRACY cohort

Objectives The health effects of internal contamination by radionuclides, and notably by uranium, are poorly characterised. New cohorts of uranium workers are needed to better examine these effects. This paper analyses for the first time the mortality profile of the French cohort of uranium cycle workers. It considers mortality from cancer and non-cancer causes. Methods The cohort includes workers employed at least 6u2005months between 1958 and 2006 in French companies involved in the production of nuclear fuel. Vital status and causes of death were collected from French national registries. Workers were followed-up from 1 January 1968 to 31 December 2008. Standardised mortality ratios (SMRs) were computed based on mortality rates for the French general population. Results The cohort includes 12u2005649 workers (88% men). The average length of follow-up is 27u2005years and the mean age at the end of the study is 60u2005years. Large mortality deficits are observed for non-cancer causes of death such as non-cancer respiratory diseases (SMR=0.51 (0.41 to 0.63)) and circulatory diseases (SMR=0.68 (0.62 to 0.74)). A mortality deficit of lower magnitude is also observed for all cancers combined (SMR (95% CI): 0.76 (0.71 to 0.81)). Pleural mesothelioma is elevated (SMR=2.04 (1.19 to 3.27)). Conclusions A healthy worker effect is observed in this new cohort of workers involved in the uranium cycle. Collection of individual information on internal uranium exposure as well as other risk factors is underway, to allow for the investigation of uranium-related risks.

Concerted Uranium Research in Europe (CURE): toward a collaborative project integrating dosimetry, epidemiology and radiobiology to study the effects of occupational uranium exposure.

The potential health impacts of chronic exposures to uranium, as they occur in occupational settings, are not well characterized. Most epidemiological studies have been limited by small sample sizes, and a lack of harmonization of methods used to quantify radiation doses resulting from uranium exposure. Experimental studies have shown that uranium has biological effects, but their implications for human health are not clear. New studies that would combine the strengths of large, well-designed epidemiological datasets with those of state-of-the-art biological methods would help improve the characterization of the biological and health effects of occupational uranium exposure. The aim of the European Commission concerted action CURE (Concerted Uranium Research in Europe) was to develop protocols for such a future collaborative research project, in which dosimetry, epidemiology and biology would be integrated to better characterize the effects of occupational uranium exposure. These protocols were developed from existing European cohorts of workers exposed to uranium together with expertise in epidemiology, biology and dosimetry of CURE partner institutions. The preparatory work of CURE should allow a large scale collaborative project to be launched, in order to better characterize the effects of uranium exposure and more generally of alpha particles and low doses of ionizing radiation.

Residential Exposure to Natural Background Radiation and Risk of Childhood Acute Leukemia in France, 1990 - 2009.

Background: Exposures to high-dose ionizing radiation and high-dose rate ionizing radiation are established risk factors for childhood acute leukemia (AL). The risk of AL following exposure to lower doses due to natural background radiation (NBR) has yet to be conclusively determined. Methods: AL cases diagnosed over 1990–2009 (9,056 cases) were identified and their municipality of residence at diagnosis collected by the National Registry of Childhood Cancers. The Geocap study, which included the 2,763 cases in 2002–2007 and 30,000 population controls, was used for complementary analyses. NBR exposures were modeled on a fine scale (36,326 municipalities) based on measurement campaigns and geological data. The power to detect an association between AL and dose to the red bone marrow (RBM) fitting UNSCEAR (United Nations Scientific Committee on the Effects of Atomic Radiation) predictions was 92%, 45% and 99% for exposure to natural gamma radiation, radon and total radiation, respectively. Results: AL risk, irrespective of subtype and age group, was not associated with the exposure of municipalities to radon or gamma radiation in terms of yearly exposure at age reached, cumulative exposure or RBM dose. There was no confounding effect of census-based socio-demographic indicators, or environmental factors (road traffic, high voltage power lines, vicinity of nuclear plants) related to AL in the Geocap study. Conclusions: Our findings do not support the hypothesis that residential exposure to NBR increases the risk of AL, despite the large size of the study, fine scale exposure estimates and wide range of exposures over France. However, our results at the time of diagnosis do not rule out a slight association with gamma radiation at the time of birth, which would be more in line with the recent findings in the UK and Switzerland. Citation: Demoury C, Marquant F, Ielsch G, Goujon S, Debayle C, Faure L, Coste A, Laurent O, Guillevic J, Laurier D, Hémon D, Clavel J. 2017. Residential exposure to natural background radiation and risk of childhood acute leukemia in France, 1990–2009. Environ Health Perspect 125:714–720;u2002http://dx.doi.org/10.1289/EHP296

Cohorte des travailleurs du nucléaire à Électricité de France : mortalité des agents statutaires sur la période 1968–2003

BACKGROUNDnWe conducted a mortality study on a cohort of French nuclear workers employed at Electricité de France (EDF). A first cancer mortality analysis had covered the period 1968-1994. This paper presents results from a mortality analysis including nine additional years of follow-up to cover workers employed from 1968 to 2003.nnnMETHODSnThe cohort includes 22393 workers, 97% of whom are males. Employment data were updated using the EDF personnel file. Vital status was ascertained using the French National Registry of Population, and further completed using EDF personnel and pension files. Causes of death were obtained from the National registry of causes of death. Standardised Mortality Ratios (SMR) were computed using national rates as references. Variations of all causes and all cancers SMRs were studied according to demographic and occupational characteristics.nnnRESULTSnAt the study end point (31/12/2003), 74% of workers are still in active employment. Only 0.3% of workers are lost to follow-up. The median duration of follow-up is 20 years. Causes are ascertained for 96% of deaths. The total number of deaths is 874, 307 of which are cancer deaths. SMRs for all causes and cancers show a significant deficit compared to the French national mortality. No significant excess was observed for any of the cancer sites studied. Non-significant excesses are observed for pancreatic, pleural, kidney and brain cancer. Significant variations of all causes SMRs according to age at study entry and attained age are observed. Significant variations of all causes and all cancers SMRs according to diploma at employment are observed, with a reduced SMR for a higher level of diploma.nnnCONCLUSIONnThere is a significant deficit of mortality compared to the general population, reflecting a strong Healthy Worker Effect. Although nine years of follow-up were added, this cohort is made up of young workers, most of whom are still in active service. Regular updating of the follow up of this cohort is planned, aiming for an occupational health surveillance of workers occupationally exposed to ionizing radiation in France.

External radiation dose and cancer mortality among French nuclear workers: considering potential confounding by internal radiation exposure

ObjectivesFrench nuclear workers have detailed records of their occupational exposure to external radiation that have been used to examine associations with subsequent cancer mortality. However, some workers were also exposed to internal contamination by radionuclides. This study aims to assess the potential for bias due to confounding by internal contamination of estimates of associations between external radiation exposure and cancer mortality.MethodsA cohort of 59,004 workers employed for at least 1xa0year between 1950 and 1994 by CEA (Commissariat à l’Energie Atomique), AREVA NC, or EDF (Electricité de France) and badge-monitored for external radiation exposure were followed through 2004 to assess vital status and cause of death. A flag based on a workstation–exposure matrix defined four levels of potential for internal contamination. Standardized mortality ratios were assessed for each level of the internal contamination indicator. Poisson regression was used to quantify associations between external radiation exposure and cancer mortality, adjusting for potential internal contamination.ResultsFor solid cancer, the mortality deficit tended to decrease as the levels of potential for internal contamination increased. For solid cancer and leukemia excluding chronic lymphocytic leukemia, adjusting the dose–response analysis on the internal contamination indicator did not markedly change the excess relative risk per Sievert of external radiation dose.ConclusionsThis study suggests that in this cohort, neglecting information on internal dosimetry while studying the association between external dose and cancer mortality does not generate a substantial bias. To investigate more specifically the health effects of internal contamination, an effort is underway to estimate organ doses due to internal contamination.