Analysis of the association between ionizing radiation and mortality in uranium workers from five plants involved in the nuclear fuel production cycle in France.

PURPOSE: The aim is to investigate associations between mortality and exposure to ionizing radiation in a cohort of uranium workers with potential for internal and external radiation exposures. METHODS: Workers employed for at least 6 months between 1958 and 2006 in five plants involved in the French nuclear fuel cycle were included and followed up between 1968 and 2013. Cause-specific standardized mortality ratios were calculated. Analyses of associations between individual cumulative radiation dose (both internal and external, lagged by 5-15 years) and mortality were conducted using Poisson regression. RESULTS: The cohort includes 4541 workers. The mean cumulative external dose was 11.12 mGy. Mean cumulative internal doses ranged, depending on modelling hypotheses, from 0.05 to 0.09 mGy (liver) and from 4.22 to 10.90 mGy (lung). At the end of the follow-up, 838 workers were deceased and 28 lost to follow-up. A healthy worker effect was observed. The risk of prostate and lung cancers mortality was significantly higher for workers exposed to cumulative external dose above 50 mGy compared to non-exposed, but these associations were based only on three cases and became non-significant, although of similar magnitude, after adjustment for smoking. Associations with internal dose showed no consistent pattern. CONCLUSIONS: For the first time, a study was conducted in a French cohort of uranium workers with a complete reconstruction of internal dose. Results are preliminary and must be interpreted with caution because of the limited cohort size and significant sources of uncertainty. Future steps of this study will overcome these limitations.

First mortality analysis in the French cohort of uranium millers (F-Millers), period 1968-2013.

PURPOSE: Epidemiological studies in cohorts of uranium millers can be informative to improve knowledge of the health effects of uranium, but are very rare. The aim of this study was to analyze, for the first time, mortality in a French cohort of uranium millers. METHODS: The F-Millers cohort includes permanent contract workers employed at least 6 months at French uranium milling plants. Vital status and causes of death were obtained from national registries between 1968 and 2013, in order to perform comparisons with French national and local mortality rates by computing standardized mortality ratios (SMRs) with 95% confidence intervals (95% CI). RESULTS: The cohort includes 1291 workers. The average duration of follow-up is 32.1 years. At the end of follow-up, 448 workers were deceased and 13 lost to follow-up. We observed a significant deficit of mortality for all causes combined when the national reference was considered (SMR 0.81; 95% CI [0.74;0.89]), but no significant difference when the local reference was considered (SMR 0.97; 95% CI [0.88;1.07]). Significant excesses were observed only in a subgroup of 552 workers hired at the manufacturing unit, mainly when the local reference was considered. CONCLUSION: No significant excess of mortality was observed at the scale of the full cohort. The cause-specific excesses of mortality observed in the subgroup of workers hired at the manufacturing unit were based on small number of cases, but would warrant further investigations. Undertaking analytical studies and combined analyses of cohorts of uranium millers would help to study the influence of potential risk factors and obtain more precise results.

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.