Mortality risk in the French cohort of uranium miners: extended follow-up 1946-1999.

OBJECTIVES: This paper presents the risk of death from lung cancer and from other causes of death for the French cohort of uranium miners through 1999 and estimates associations with radon exposure. METHODS: The cohort includes men employed as uranium miners for at least 1 year between 1946 and 1990. For each miner, vital status and cause of death were obtained from the national registry, and radon exposure was reconstructed for each year. Standardised mortality ratios were computed with national mortality rates as references. Exposure-risk relationships were estimated by Poisson regression, with a linear excess relative risk (ERR) model and a 5-year lag. RESULTS: The cohort included 5086 miners and 153 063 person-years of exposure. The mean duration of follow-up was 30.1 years. In all 4140 miners exposed to radon, the average cumulative exposure was 36.6 working level months (WLM). There were 1411 deaths of miners <85 years of age. The miners did not differ significantly in overall mortality from the general male population. The analysis confirmed an excess risk of lung cancer death (n = 159; SMR = 1.43; 95% CI: 1.22 to 1.68), which increased significantly with cumulative radon exposure (ERR per 100 WLM = 0.71; 95% CI: 0.29 to 1.35). The ERR per unit exposure was much higher after 1955, when the accuracy of exposure measurement improved substantially (ERR per 100 WLM = 2.00; 95% CI: 0.91 to 3.65). A significant excess of kidney cancer deaths was observed (n = 20; SMR = 2.0; 95% CI: 1.22 to 3.09), which was not associated with cumulative radon exposure. No excess was observed for other causes of death, except silicosis (n = 23; SMR = 7.12; 95% CI: 4.51 to 10.69). CONCLUSIONS: The analysis confirmed the excess risk of death from lung cancer associated with low radon exposure. An excess risk of death from kidney cancer was also observed, apparently not associated with cumulative radon exposure.

External radiation exposure and mortality in a cohort of French nuclear workers.

OBJECTIVE: To analyse the effect of external radiation exposure on the mortality of French nuclear workers. METHODS: A cohort of 29 204 workers employed between 1950 and 1994 at the French Atomic Energy Commission (Commissariat à l'Energie Atomique (CEA)) or at the General Company of Nuclear Fuel (COmpagnie GEnérale des MAtières nucléaires (Cogema, now Areva NC)) was followed up for an average of 17.8 years. Standardised mortality ratios (SMRs) were computed with reference to French mortality rates. Dose-effect relationship were analysed through trend tests and Poisson regression, with linear and log-linear models. RESULTS: The mean exposure to X and gamma radiation was 8.3 mSv (16.9 mSv for exposed worker population). A total of 1842 deaths occurred between 1968 and 1994. A healthy worker effect was observed, the number of deaths in the cohort being 59% of the number expected from national mortality statistics. Among the 21 main cancer sites studied, a statistically significant excess was observed only for skin melanoma, and an excess of borderline statistical significance was observed for multiple myeloma. A dose-effect relationship was observed for leukaemia after exclusion of chronic lymphoid leukaemia (CLL). The relative risk observed for non-CLL leukaemia, n = 20, was 4.1 per 100 mSv (90% CI 1.4 to 12.2), linear model and 2.2 per 100 mSv (90% CI 1.2 to 3.3), log-linear model. Significant dose-effect relationship were also observed for causes of deaths associated with alcohol consumption: mouth and pharynx cancer, cirrhosis and alcoholic psychosis and external causes of death. CONCLUSION: The risk of leukaemia increases with increasing exposure to external radiation; this is consistent with published results on other nuclear workers cohorts.

MEDOR, a didactic tool to support interpretation of bioassay data after internal contamination by actinides.

A didactic software, MEthodes DOsimètriques de REférence (MEDOR), is being developed to provide help in the interpretation of biological data. Its main purpose is to evaluate the pertinence of the application of different models. This paper describes its first version that is focused on inhalation exposure to actinide aerosols. With this tool, sensitivity analysis on different parameters of the ICRP models can be easily done for aerosol deposition, in terms of activity and particle number, actinide biokinetics and doses. The user can analyse different inhalation cases showing either that dose per unit intake cannot be applied if the aerosol contains a low number of particles or that an inhibition of the late pulmonary clearance by particle transport can occur which contributes to a 3-4 fold increase in effective dose as compared with application of default parameters. This underlines the need to estimate systematically the number of deposited particles, as well as to do chest monitoring as long as possible.

[Causes of death of COGEMA active workers, 1980-1995]. / Causes de décès des travailleurs actifs de la COGEMA, 1980-1995.

BACKGROUND: Populations exposed to risks at work show a deficit in deaths in comparison with the national population, the "healthy worker effect". This effect has been observed among former nuclear workers. The aim of our cross-sectional study was to evaluate the mortality in a metallurgy worker population, and to study the impact of the choice of the reference population on the estimation of the Standardized Mortality Ratio (SMR). METHODS: The studied population was the COGEMA Metallurgy Department workers, aged 25 years to 64, during the period 1980-1995 in two regions of France (North--La Hague; South--Cadarache, Marcoule, Miramas and Pierrelatte). In order to account for geographical variability and the difference in mortality between the working population and the non-working population, we used several reference populations: national population, regional population, "working" national population (farmers not present in COGEMA and non-workers excluded), and "working" regional population. RESULTS: All SMRs were increased when we used a "working" regional reference compared with the national reference population. Among men, eight pathologies presented a significant deficit with a national reference, whereas only two pathologies showed a deficit with the "working" regional reference. CONCLUSION: The use of a reference population close to the study population enabled us to reduce the Healthy Worker Effect among metallurgy workers at COGEMA plants.

Characterisation of protracted low-level exposure to uranium in the workplace: A comparison of two approaches.

Retrospective estimates of internal doses received by workers in the nuclear industry following intake of radionuclides, based on bioassay data, are a benchmark method in epidemiological studies. Nonetheless, full information relative to thousands of people included in an epidemiological cohort is rarely available, thus implying difficulties to estimate exposure precisely. To evaluate the cumulative exposure to uranium in a cohort of the AREVA NC Pierrelatte plant workers, we compared the epidemiological Job Exposure Matrix (JEM) method with the dosimetric method based on biological monitoring of exposure for 30 workers randomly selected within the cohort. A moderate to strong correlation was observed between the estimators resulting from the two approaches, thereby validating the JEM as a tool that can be used to characterise cumulative exposure to uranium in the cohort. In addition, this study showed that the JEM is a valuable complement to the interpretation of bioassy, (1) in providing information on exposure periods as well as on physical and chemical form of the radionuclides and (2) in compensating for the lack of exposure data regarding the very earliest periods. Combining the two methods may improve the precision in reconstructing cumulative exposure for epidemiological studies.

Lung cancer risk in the French cohort of uranium miners.

The French cohortof uranium miners includes 5098 miners,and 125 lung cancer deaths have been observed. The relationship between radon exposure and risk of lung cancer is estimated using relative risk models, which allow investigation of time dependent modifying factors such as the period of exposure, time since exposure and exposure rate. A linear exposure-response relationship is observed. The main modifier is the period of exposure before or after 1956: the excess relative risk after introduction of ventilation in the French mines is eight times higher than before. The decrease in risk with time since exposure and exposure rate disappears when period of exposure is taken into account. Compared to most of the uranium miner studies, this cohort constitutes a population exposed to low levels and low rates of radon for a long duration. The extension of the French cohort leads to an important increase in its statistical power. Exposure rate effect will be further investigated, in the framework of a European collaborative research project aiming at the synthesis of the effects of radon exposure at low dose and low dose rate.

Epidemiological and molecular evidence of a monophyletic infection with Staphylococcus aureus causing a purulent dermatitis in a dairy farmer and multiple cases of mastitis in his cows.

An epidemiological and molecular investigation of a cutaneous suppurative infection with Staphylococcus aureus in a dairy farmer, occurring concurrently with an outbreak of clinical mastitis in his herd, was carried out. A common aetiology for the diseases in the farmer and his cows was established by combining clinical evidence with a molecular genomic analysis of the bacterial isolates using pulsed field gel electrophoresis of DNA macro-restriction fragments. This case indicates the possibility of the emergence and circulation of anthropozoonotic clones of S. aureus in dairy herds. It also provides further evidence of the severe impact of infection with highly virulent clones on dairy lactating cattle.