From the aISGlobal, Centre for Research in Environmental Epidemiology, Barcelona, Spain; bUniversitat Pompeu Fabra, Barcelona, Spain; cCIBER Epidemiología y Salud Pública, Madrid, Spain; dDepartment of Epidemiology and Biostatistics, Imperial College, London, United Kingdom; eNuvia Limited, Didcot, United Kingdom; fCommissariat à l’Energie Atomique, Fontenay-aux-Roses, France; gAtomic Weapons Establishment, Aldermaston, United Kingdom; hPublic Health England, Didcot & Moor Row, United Kingdom; iInstitut de Radioprotection et de Sûreté Nucléaire, Fontenay-aux-Roses, France; JInstitut de Veille Sanitaire, Saint Maurice, France; kOccupational Cancer Research Centre, Toronto, ON, Canada; lStudiecentrum voor Kernenergie • Centre d’Étude de l’énergie Nucléaire, Mol, Belgium; mUK Atomic Energy Authority, Culham, United Kingdom; nAutorité de Sûreté Nucléaire, Paris, France; and oInternational Agency for Research on Cancer, Lyon, France.
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Background:Carcinogenic risks of internal exposures to alpha-emitters (except radon) are poorly understood. Since exposure to alpha particles—particularly through inhalation—occurs in a range of settings, understanding consequent risks is a public health priority. We aimed to quantify dose–response relationships between lung dose from alpha-emitters and lung cancer in nuclear workers.Methods:We conducted a case–control study, nested within Belgian, French, and UK cohorts of uranium and plutonium workers. Cases were workers who died from lung cancer; one to three controls were matched to each. Lung doses from alpha-emitters were assessed using bioassay data. We estimated excess odds ratio (OR) of lung cancer per gray (Gy) of lung dose.Results:The study comprised 553 cases and 1,333 controls. Median positive total alpha lung dose was 2.42 mGy (mean: 8.13 mGy; maximum: 316 mGy); for plutonium the median was 1.27 mGy and for uranium 2.17 mGy. Excess OR/Gy (90% confidence interval)—adjusted for external radiation, socioeconomic status, and smoking—was 11 (2.6, 24) for total alpha dose, 50 (17, 106) for plutonium, and 5.3 (−1.9, 18) for uranium.Conclusions:We found strong evidence for associations between low doses from alpha-emitters and lung cancer risk. The excess OR/Gy was greater for plutonium than uranium, though confidence intervals overlap. Risk estimates were similar to those estimated previously in plutonium workers, and in uranium miners exposed to radon and its progeny. Expressed as risk/equivalent dose in sieverts (Sv), our estimates are somewhat larger than but consistent with those for atomic bomb survivors.See video abstract at, http://links.lww.com/EDE/B232.