Relationship between follow-up periods and the low-dose ranges with statistically significant radiation-induced risk of all solid cancers in the Russian cohort of Chernobyl emergency workers.

Radiation-induced risks for all solid cancer incidence and mortality were studied in the cohort of Russian Chernobyl emergency workers. The cohort included 69,440 persons with documented individual radiation dose accrued over the time of working in the Chernobyl zone. The mean age at entry into the zone of recovery operations was 33.9 years and accumulated radiation dose was 132.9 mGy. A total of 6981 solid cancer incident cases and 4272 deaths occurred in this cohort from 1992 to 2017. Three follow-up periods were studied: 1992-2009, 1992-2013, and 1992-2017. For each follow-up period, the lowest dose range with statistically significant (p < 0.05) radiation-induced risk of all solid cancer incidence and mortality were obtained. For the incidence of all solid cancer during the follow-up period 1992-2009, this lowest dose range was estimated to be 0-250 mGy with an excess relative risk per dose of ERR Gy-1 = 0.51 and 95% confidence interval (CI) (0.02; 1.05) Gy-1. For the period 1992-2013, the lowest dose range was 0-175 mGy with ERR Gy-1 = 0.85 (95% CI 0.03; 1.78), while for the whole follow-up period 1992-2017, it was 0-175 mGy with ERR Gy-1 = 0.81 (95% CI 0.08; 1.62). For mortality from all solid cancers during the follow-up period 1992-2009, the lowest dose range with statistically significant radiation-induced risk was estimated to be 0-225 mGy with ERR Gy-1 = 1.07 (95% CI 0.31; 0.97). For the period 1992-2013, the lowest dose range was 0-225 mGy with ERR Gy-1 = 0.86 (95% CI 0.23; 1.58), while for the whole follow-up period 1992-2017, the lowest dose range was 0-200 mGy with ERR Gy-1 = 0.82 (95% CI 0.10; 1.65). Thus, it was found that the minimal level of significant exposure (Dmin), for which a statistically significant radiation-induced risk of all solid cancers was obtained for Russian emergency workers (with individual doses of 0 - Dmin), decreases with increasing duration of cohort observation, both for cancer incidence and mortality.

[Non-Parametric Analysis of Radiation Risks of Mortality among Chernobyl Clean-Up Workers].

Analysis of the relationship between dose and mortality from cancer and circulation diseases in the cohort of Chernobyl clean-up workers based on the data from the National Radiation and Epidemiological Registry was performed. Medical and dosimetry information on the clean-up workers, males, who got radiation doses from April 26, 1986 to April 26, 1987, which was accumulated from 1992 to 2012, was used for the analysis. The total size of the cohort was 42929 people, 12731 deaths were registered in the cohort, among them 1893 deaths from solid cancers and 5230 deaths were from circulation diseases. An average age of the workers was 39 years in 1992 and the mean dose was 164 mGy. The dose-effect relationship was estimated with the use of non-parametric analysis of survival with regard to concurrence of risks of mortality. The risks were estimated in 6 dose groups of similar size (1-70, 70-130, 130-190, 190-210, 210-230 and.230-1000 mGy). The group "1-70 mGy" was used as control. Estimated dose-effect relationship related to cancers and circulation diseases is described approximately with a linear model, coefficient of determination (the proportion of variability explained by the linear model) for cancers was 23-25% and for circulation diseases - 2-13%. The slope coefficient of the dose-effect relationship normalized to 1 Gy for the ratio of risks for cancers in the linear model was 0.47 (95% CI: -0.77, 1.71), and for circulation diseases it was 0.22 (95% CI: -0.58, 1.02). Risks coefficient (slope coefficient of excess mortality at a dose of 1 Gy) for solid cancers was 1.94 (95% CI: - 3.10, 7.00) x 10(-2) and for circulation diseases it was 0.67 (95% CI: -9.61, 11.00) x 10(-2). 137 deaths from radiation-induced cancers and 47 deaths from circulation diseases were registered during a follow up period.

Incidence and mortality of solid cancer among emergency workers of the Chernobyl accident: assessment of radiation risks for the follow-up period of 1992-2009.

This paper presents the results of a retrospective cohort study of cancer incidence and mortality among emergency workers of the Chernobyl accident, for the follow-up period 1992-2009. The cohort selected for analysis consists of 67,568 emergency workers who worked in the Chernobyl exclusion zone in 1986-1987. External radiation whole-body absorbed dose varied from 0.0001 gray (Gy) to 1.24 Gy, with a median of 0.102 Gy. Over the follow-up period 1992-2009, a total of 4,002 solid cancers of different sites were identified as the result of annual compulsory health examination, and a total of 2,442 deaths from all solid cancers in the study cohort were reported. Poisson regression was applied for the analysis of cancer incidence and mortality. The analysis of the standardized incidence ratio (SIR) has shown a statistically significant increase in cancer incidence in the cohort as compared with baseline cancer incidence among males of Russia. The average excess over the entire follow-up period is 18 % [SIR = 1.18, 95 % confidence interval (CI) 1.15; 1.22]. In contrast, however, no increase in the mortality from all cancers among the emergency workers as compared to the baseline mortality in Russian men was found. Values of excess relative risk of cancer incidence and mortality per 1 Gy (ERR Gy(-1)) are 0.47 (95 % CI 0.03; 0.96, p value = 0.034) and 0.58 (95 % CI 0.002; 1.25, p value = 0.049), respectively. These values are statistically significant.

Leukemia incidence in the Russian cohort of Chernobyl emergency workers.

Of all potentially radiogenic cancers, leukemia, a type of cancer of the blood, has the highest risk attributable to ionizing radiation. Despite this, the quantitative estimation of radiation risk of a leukemia demands studying very large exposed cohorts, because of the very low level of this disease in unexposed populations and because of the tendency for its radiation risk to decrease with time. At present, the Japanese cohort of atomic bomb survivors is still the primary source of data that allows analysis of radiation-induced leukemia and the underlying dose-response relationship. The second large cohort that would allow to study radiation-induced leukemia is comprised of individuals who were exposed due to the accident of the Chernobyl nuclear power plant in 1986. The objective of the present study was to estimate radiation risks of leukemia incidence among the Russian cohort of Chernobyl emergency workers, for different time periods after the accident. Twenty-five years after the Chernobyl accident and based on the results of the present study, one can conclude that the radiation risk of leukemia incidence derived from the Russian cohort of Chernobyl emergency workers is similar to that derived from the cohort of atomic bomb survivors: The time-averaged excess relative risk per Gray (ERR Gy(-1)) equals 4.98 for the Russian cohort and 3.9 for the life span study (LSS) cohort; excess absolute risk decreases with time after exposure at an annual rate of 9% for the Russian cohort, and of 6.5% for the LSS cohort. Thus, the excess in risk of leukemia incidence in a population due to a single exposure is restricted in time after exposure by the period of about 15 years.

Assessment of Radiological Hazard of Radioactive Waste Using Effective or Organ Doses: How This May Affect Final Waste Disposal.

ABSTRACT: The radiological hazard of spent nuclear fuel and radioactive waste slows down further development of nuclear energy systems. The authors evaluate timescales required to reduce the radiological hazard of accumulated waste to the reference level of natural uranium that had been consumed by the nuclear energy system. The estimate of this time scale depends on the radiological hazard metric used in the calculations. In this study, two metrics are compared: (1) the committed effective dose based on ICRP Publication 72 and (2) the lifetime radiation risk calculated with use of organ doses and recent radiation risk models recommended by ICRP. The effective dose of the waste reaches the reference level 300 y after the accumulation of waste, while lifetime attributable risk of waste converges to natural uranium in 100 y. Thus, the lifetime attributable risk (LAR) metric is more appropriate to estimate the time requirements for radioactive waste storage and disposal. The effective dose metric significantly overestimates this timescale as it is not intended for quantifying radiation-related risks.

Latent period in induction of radiogenic solid tumors in the cohort of emergency workers.

The paper presents estimates for the latent period of the induction of radiogenic solid cancers among Chernobyl emergency workers (males) living in six central regions of Russia. The analysis is based on medical and dosimetry data gathered by the National Radiation and Epidemiological Registry over the time period from 1986 to 2005. The cohort includes 59,770 persons who stayed in the exposure zone (30-km zone around the Chernobyl nuclear power plant) in 1986-1987. There were 2,718 cases of solid tumors identified during the follow-up time in this cohort. The mean radiation dose in the cohort is 0.13 Gy. The radiation risk and latent period were estimated using the method of maximum likelihood. The excess relative risk per unit dose was found to be 0.96 (95% confidence interval (CI): 0.3-1.7) and the minimum latent period for induction of solid tumors is 4.0 years (95% CI: 3.3-4.9).

CLINICAL AND DOSIMETRIC INFORMATION TO SUPPORT LONG-TERM COHORT STUDY OF CHERNOBYL CLEAN-UP WORKERS IN RUSSIA.

The article describes the activities of the Russian National Radiation-Epidemiological Registry (NRER) as the unified federal information system for research and management of individual medical and dosimetry data of people exposed to radiation as a result of the Chernobyl accident and other radiological events. The NRER was created for long-term registration of lifetime changes in the health status of the registered people. We present medical and dosimetry data management process, which is carried out in compliance with approved protocols. The scope and content of the information to be collected from external resources are defined in the documents approved by the Russian Ministry of Health. As of 2017 reporting year, the NRER contains medical and dosimetry information on 205 044 clean-up workers of the Chernobyl accident (liquidators), collected during the follow-up period from 1986 to 2016. Using special software for management of data from long-term studies of the Russian cohort of Chernobyl liquidators NRER ensures high quality of radiation-epidemiological information. The results of research activities of the NRER make great contribution to understanding biological and health effects of low-level radiation, molecular mechanisms of the effects, development of actions to early diagnostic of radiation-related diseases to respond to the needs of the affected population while minimizing unnecessary anxiety, improvement of targeting treatments delivery to exposed people at high risk, development of measures to reduce health risks from medical radiological procedures. During the post-Chernobyl period, new methods for estimating radiation doses were developed, some of them can be used for express estimation of radiation dose in the event of radiological emergency.

Radiation Risk of Cardiovascular Diseases in the Cohort of Russian Emergency Workers of the Chernobyl Accident.

This paper continues a series of publications that analyze the impact of radiation on incidence of circulatory system diseases in the cohort of Russian recovery operation workers (liquidators) and presents the results of the analysis of cardiovascular disease (CVD) incidence. The studied cohort consists of 53,772 liquidators who arrived in the Chernobyl accident zone within the first year after the accident (26 April 1986 to 26 April 1987). The individual doses varied from 0.0001 Gy to 1.42 Gy, and the mean external whole body dose in the cohort was 0.161 Gy. A total of 27,456 cases of CVD were diagnosed during the follow-up period 1986-2012 as a result of annual health examinations. A Poisson regression model was applied to estimate radiation risks and other risk factors associated with CVD. The following factors were identified as risk factors for CVD: the dose, duration of the liquidators' work in the Chernobyl zone, and concomitant diseases (diabetes mellitus, hypertension, overweight, and alcohol dependence). The baseline incidence of CVD is statistically significantly (p < 0.001) associated with all studied concomitant diseases. The incidence of CVD has revealed a statistically significant dose response with the lack of a latent period and with the average ERR Gy = 0.47, 95% CI = 0.31, 0.63, p < 0.001. Radiation risks of CVD statistically significantly (p = 0.01) varied with the duration of liquidators' stay in the Chernobyl zone; for those who stayed in the Chernobyl zone less than 6 wk, ERR/Gy = 0.80, 95% CI = 0.53; 1.08, p < 0.001.

The risk of radiation-induced cerebrovascular disease in Chernobyl emergency workers.

The paper deals with estimating radiation risks of non-cancer diseases of the circulatory system among the Chernobyl emergency workers based on data from the Russian National Medical and Dosimetric Registry. The results for the cohort of 61,017 people observed between 1986 and 2000 are discussed. These are essentially updated results for the similar cohort that was studied by authors earlier in 1986-1996. Newly discovered is the statistically significant dose risk of ischemic heart disease [ERR Gy = 0.41, 95% CI = (0.05; 0.78)]. Confirmation is provided for the existence of significant dose risks for essential hypertension [ERR Gy = 0.36, 95% CI = (0.005; 0.71)] and cerebrovascular diseases [ERR Gy = 0.45, 95% CI = (0.11; 0.80)]. In 1996-2000, the assessed ERR Gy for cerebrovascular diseases was 0.22 with 95% CI = (-0.15; 0.58). Special consideration is given to cerebrovascular diseases in the cohort of 29,003 emergency workers who arrived in the Chernobyl zone during the first year after the accident. The statistically significant heterogeneity of the dose risk of cerebrovascular diseases is shown as a function of the duration of stay in the Chernobyl zone: ERR Gy = 0.89 for durations of less than 6 wk, and ERR Gy = 0.39 on average. The at-risk group with respect to cerebrovascular diseases are those who received external radiation doses greater than 150 mGy in less than 6 wk [RR = 1.18, 95% CI = (1.00; 1.40)]. For doses above 150 mGy, the statistically significant risk of cerebrovascular diseases as a function of averaged dose rate (mean daily dose) was observed: ERR per 100 mGy d = 2.17 with 95% CI = (0.64; 3.69). The duration of stay within the Chernobyl zone itself, regardless of the dose factor, had little influence on cerebrovascular disease morbidity: ERR wk = -0.002, with 95% CI = (-0.004; -0.001). The radiation risks in this large-scale cohort study were not adjusted for recognized risk factors such as excessive weight, hypercholesterolemia, smoking, alcohol consumption, and others.

Radiation-epidemiological Study of Cerebrovascular Diseases in the Cohort of Russian Recovery Operation Workers of the Chernobyl Accident.

The paper presents an analysis of the incidence of cerebrovascular diseases (CeVD) in the cohort of Russian workers involved in recovery tasks after the Chernobyl accident. The studied cohort consists of 53,772 recovery operation workers (liquidators) who arrived in the zone of the Chernobyl accident within the first year after this accident (26 April 1986-26 April 1987). The mean external whole body dose in the cohort was 0.161 Gy, while individual doses varied from 0.0001 Gy to 1.42 Gy. During the follow-up period 1986-2012, a total of 23,264 cases of CeVD were diagnosed as a result of annual health examinations. A Poisson regression model was applied for estimation of radiation risks and for an assessment of other risk factors of CeVD. The following factors were considered as risk factors for CeVD: the dose, duration of the liquidators' work in the Chernobyl zone, and the concomitant diseases (hypertension, ischemic heart disease, atherosclerosis, and diabetes). The baseline incidence of CeVD is statistically significantly (p < 0.001) associated with all studied concomitant diseases. The incidence of CeVD has revealed a statistically significant dose response with the lack of a latent period and with the average ERR/Gy = 0.45, 95% CI: (0.28, 0.62), p < 0.001. Radiation risks of CeVD statistically significantly (p = 0.03) varied with the duration of liquidators' stay in the Chernobyl zone; for those who stayed in the Chernobyl zone less than 6 wk, ERR/Gy = 0.64, 95% CI = (0.38; 0.93), p < 0.001. Among studied concomitant diseases, diabetes mellitus statistically significantly (p = 0.002) increases the radiation risk of CeVD: for liquidators with diagnosed diabetes, ERR/Gy = 1.29.

Mortality among the Chernobyl emergency workers: estimation of radiation risks (preliminary analysis).

This paper presents results of the analysis of mortality among Chernobyl accident emergency workers who are resident in Russia. The analysis is based on information for the cohort of emergency workers (males) from six regions of Russia including 65,905 persons with documented external doses in the range 0.005-03 Sv. These data were gathered during the period 1991 to 1998 and cover a total of 426,304 follow-up person-y. In this period, 4,995 deaths occurred in the cohort under study. The mortality analysis was performed for four groups of causes of death (ICD-9 codes): (1) malignant neoplasms (140-239); (2) cardiovascular diseases (390-459); (3) injuries, poisoning and violent deaths, (800-999); and (4) the remainder (other than the above). The standardized mortality rate for groups 1, 3, and 4 is less than unity and varies from 0.6 to 0.9. For group 2 (death from cardiovascular diseases) the standardized mortality rate conforms with the control within 95% confidence intervals. The control was the mortality rate (males) for the corresponding ages in Russia in general and the internal control, the spontaneous mortality among emergency workers, derived from the equation of the observed and expected number of cases in the followed up cohort. Dose response of mortality was studied. Statistically significant radiation risks were obtained for mortality from malignant neoplasms (515 cases) and cardiovascular diseases (1,728 cases). The values of the excess relative risk per unit dose (ERR Sv(-1)) for malignant neoplasms and cardiovascular diseases are estimated as 2.11 (1.31, 2.92 95% CI) and 0.54 (0.18,0.91 95% CI) (for external control), 2.04 (0.45, 4.31 95% CI) and 0.79 (0.07, 1.64 95% CI) (for internal control), respectively. The risk of death from all noncancer causes is close to zero and not statistically significant.

Radiation-epidemiological analysis of incidence of non-cancer diseases among the Chernobyl liquidators.

The work is concerned with assessment of radiation risks for non-cancer disease among the Chernobyl liquidators from 1986 to 1996. As of 1 January 1999, the Russian National Medical and Dosimetric Registry contains medical and dosimetric data for 174,000 liquidators. The cohort of 68,309 liquidators for whom best verified medical data are available is discussed. The dose dependency of incidence of non-cancer diseases was estimated by the cohort method and using the software package Epicure. For some classes of non-cancer diseases among liquidators, statistically significant estimates of radiation risk were derived for the first time. The highest excess relative risk per 1 Gy was found for cerebrovascular diseases; ERR Gy(-1)=1.17 at the 95% confidence interval (0.45; 1.88).

Thyroid cancer incidence among adolescents and adults in the Bryansk region of Russia following the Chernobyl accident.

Thyroid cancer incidence in the Bryansk region, the most contaminated area of Russia after the Chernobyl accident, is analyzed for the residents aged 15-69 y at the time of the accident (about 1 million persons according to the 1989 census) for the period from 1986 to 1998. Sex and age standardized incidence rates are presented and compared to the whole Russian population rates (SIR analysis). Also, a geographical correlation analysis is performed for incidence rates and mean thyroid doses at the district level, which provides a basis for preliminary estimation of radiation associated risks for the period 1991-1998 (to allow for a potential five year latent period). Thyroid doses were estimated based on the State official document "Methodology for reconstruction of dose from iodine radioisotopes in residents of the Russian Federation exposed to radioactive contamination as a result of the Chernobyl accident in 1986" (2000). Altogether, 1,051 thyroid cancer cases were detected in the Bryansk oncological dispensary from 1986 to 1998 and 769 from 1991 to 1998. Histological confirmation was available for 87% and 95% of these cases, respectively. Standardized incidence ratios (SIR) were 1.27 (95% CI = 0.92, 1.73) for the period 1986-1990 and 1.45 (95% CI = 1.20, 1.73) for the period 1991-1998 for males and 1.94 (95% CI = 1.70, 2.20) and 1.96 (95% CI = 1.82, 2.1) for females. The excess relative risk per 1 Gy (using external control) estimate for the period 1991-1998 was -0.4 (95% CI = -3.5, 2.7), -1.3 (95% CI = -2.8, 0.1) for males and females, respectively, and -0.6 (95% CI = -2.1, 0.8) for both sexes. Using internal controls, the excess relative risk (ERR(1Gy)) per unit dose of 1 Gy was found to be 0.7 with 95% CI (-2.3, 5.2) for males, -0.9 with 95% CI (-2.4, 0.8) for females and 0.0 with 95% CI (-1.4, 1.7) for males and females together. These results are discussed in the light of the quality of information available on thyroid cancer cases and screening campaigns carried out after the Chernobyl accident.

Radiation-epidemiological studies of thyroid cancer incidence in Russia after the Chernobyl accident (estimation of radiation risks, 1991-2008 follow-up period).

This study presents an analysis of the thyroid cancer incidence in the population of the most contaminated territories of Bryansk, Kaluga, Oryol and Tula oblasts affected by the Chernobyl accident. The follow-up period is 1991-2008, and the cohort size is 309 130 people. For that period 978 thyroid cancer cases were detected. The excess relative risk per 1 Gy (ERR/Gy) is found to be statistically significant for children and adolescents (0-17 y of age) at the time of the Chernobyl accident (ERR/Gy=3.22; 95 % confidence interval (1.56; 5.81). In boys, the ERR/Gy was higher than in girls -6.54 and 2.24, respectively. A statistically significant decrease in ERR/Gy with time since exposure, by a factor of 0.37 per 10 y, was observed for the whole cohort and for boys separately, but not for girls. No radiation risks of a thyroid cancer among people of 18 y of age at exposure and older were found.

Formation of potential radiation risk groups to render timely targeted medical care: lessons of Chernobyl.

The paper discusses technology for establishing potential cancer risk groups, based on methods of molecular and radiation epidemiology. Assay of gene mutations at the T-cell receptor (TCR) locus as the method of molecular epidemiology was used for measuring the frequency of TCR-mutations in 320 nuclear workers of the Institute of Physics and Power Engineering (IPPE). The method of radiation epidemiology was applied to the estimation of attributable risk fraction (ARF) for solid cancers in these groups. The main estimates of radiation risk after the Chernobyl accident are in close agreement with the International Commission on Radiological Protection (ICRP) Publication, 103 models published in 2007. In nuclear workers of the IPPE with ARF ≥ 10%, the increased level of TCR-mutations occurs more often (risk ratio=9.7; 95% CI: 2.9; 32.1).

Risk of thyroid cancer among Chernobyl emergency workers of Russia.

The presented paper deals with the thyroid cancer incidence in selected cohorts of emergency workers of Russia. In 1986-2003, a total of 87 cases of thyroid cancer were observed. Based on these data, a statistically significant increase in thyroid cancer incidence was found above the reference level for the male population of Russia, corresponding to a standardized incidence rate (SIR) of SIR = 3.47 [95% confidence interval (CI): 2.80; 4.25]. The highest incidence rate (SIR = 6.62, 95% CI: 4.63; 9.09) was shown for those emergency workers who took part in the early recovery operations in April-July 1986. The estimated SIR value increases to 7.97 (95% CI: 5.24; 11.52) after allowing for a 10 years latent period of Chernobyl-related thyroid cancers. These results indicate that the exposure to incorporated (131)I was the major risk factor of thyroid cancer among Chernobyl emergency workers. No statistically significant relationship was found for the thyroid cancer incidence and external radiation dose.

Radiation-epidemiological studies of thyroid cancer incidence among children and adolescents in the Bryansk oblast of Russia after the Chernobyl accident (1991-2001 follow-up period).

In this study, thyroid cancer incidence (follow-up period: 1991-2001) has been analyzed, including persons who were exposed as children at an age between 0 and 17 years and who are living in the Bryansk oblast, the worst contaminated area of Russia after the Chernobyl accident. According to the census of 1989, the population of this oblast comprises 375 thousand people. Thyroid doses from incorporated radioiodine isotopes -- both for the thyroid cancer cases and the study population -- were determined based on the official methodology approved by the Russian Scientific Commission on Radiation Protection. Between 1991 and 2001, a total of 199 thyroid cancer cases were diagnosed at cancer centers (the so-called oncological dispensaries) of the investigated regions. The performed analysis relies on medical and dosimetric information available from the Russian National Medical and Dosimetric Registry which was established after the Chernobyl accident. Diagnoses were confirmed histologically for 95% of the cases. The analysis described revealed statistically significant radiation risk only for those exposed as children at an age of 0-9 years. In this group, the standardized incidence ratio (the national incidence rate was used as a reference) in the considered time period is estimated to be 6.7 (5.1, 8.6 95%CI) and 14.6 (10.3, 20.2 95%CI) for girls and boys, respectively. The risk dependence on age at exposure has also been studied. It has been shown that the smaller the age the higher the risk. For girls whose age at exposure was 0-4 years, the excess relative risk per 1 Gy for the period 1991-2001 was 45.3 (5.2, 9,953 95%CI; with internal control) and 28.8 (4.3, 2,238 95%CI; with external control), respectively. For boys whose age at exposure was 0-9 years the corresponding excess relative risk per 1 Gy was 68.6 (10.0, 4,520 95%CI) and 177.4 (-276, 10(6) 95%CI), respectively. Dependence of radiation risk on time was studied, with the focus on two follow-up periods 1991-1996 and 1997-2001, respectively. In 1997-2001 the radiation risk is shown to decrease among girls, and increase among boys.

Concept of optimisation of the radiation protection system in the nuclear sector: management of individual cancer risks and providing targeted health care.

The paper discusses the provision of targeted health care to nuclear workers in Russia based on radiation-epidemiological estimates of cancer risks. Cancer incidence rates are analysed for the workers of the Institute of Physical Power Engineering (the first nuclear installation in the world) who were subjected to individual dosimetric monitoring from 1950 to 2002. The value of excess relative risk for solid cancers was found to be ERR Gy(-1) = 0.24 (95% CI: -4.22; 7.96). It has been shown that 81.8% of the persons covered by individual dosimetric monitoring have potential attributive risk up to 5%, and the risk is more than 10% for 3.7% of the workers. Among the detected cancer cases, 73.5% of the individuals show an attributive risk up to 5% and the risk is in excess of 10% for 3.9% of the workers. Principles for the provision of targeted health care, given voluntary health insurance, are outlined.

Thyroid cancer incidence among liquidators of the Chernobyl accident. Absence of dependence of radiation risks on external radiation dose.

The increase of thyroid cancer incidence rate among children living in the Chernobyl contaminated territories of Belarus, Russia and Ukraine has widely been accepted. Our current work deals with thyroid cancer incidence in the cohort of liquidators (99024 persons) living in 6 regions of Russia: North-West, Volgo-Vyatsky, Central-Chernozemny, Povolzhsky, North-Caucasus and Urals. In the period 1986-1998, a total of 58 thyroid cancer cases were detected in this cohort. We found a statistically significant increase of the thyroid cancer incidence rate in liquidators as compared to the baseline (male population of Russia) level (SIR=4.33, 95% CI: 3.29; 5.60). It was demonstrated that there is no dependence of incidence rates due to external radiation exposure (ERR/Gy=-2.23, 95% CI: -4.67; 0.22).