In epidemiologic studies, high-chronic arsenic exposure has been associated with cardiovascular disease, despite methodological limitations. At low-moderate arsenic levels, the evidence was inconclusive. Here, we update a previous systematic review (Am J Epidemiol 2005;162:1037–49) examining the association between arsenic exposure and cardiovascular disease. Eighteen studies published since 2005 were combined with 13 studies from the previous review. We calculated pooled relative risks by comparing the highest versus the lowest exposure category across studies. For high exposure (arsenic in drinking water > 50 μg/L), the pooled relative risks (95 % confidence interval) for cardiovascular disease, coronary heart disease, stroke, and peripheral arterial disease were 1.32 (95 % CI:1.05–1.67), 1.89 (95 % CI:1.33–2.69), 1.08 (95 % CI:0.98–1.19), and 2.17 (95 % CI:1.47–3.20), respectively. At low-moderate arsenic levels, the evidence was inconclusive. Our review strengthens the evidence for a causal association between high-chronic arsenic exposure and clinical cardiovascular endpoints. Additional high quality studies are needed at low-moderate arsenic levels.

/pdf/arsenic-exposure-and-cardiovascular-disease-an-updated-335vambuca.pdf

Arsenic exposure and cardiovascular disease: an updated systematic review.

Background Recent studies of the Hiroshima and Nagasaki A-bomb survivors, together with some (but not all) cohorts exposed occupationally or medically to ionizing radiation, have found an increasing trend in mortality from non-malignant disease with increasing radiation dose. The aim of this study was to establish whether such a trend could be found in a large cohort of employees in the UK nuclear industry.

Methods The cohort comprised 64 937 individuals ever employed at the study sites between 1946 and 2002, followed up to 2005; radiation exposures as measured by personal dosimeters (‘film badges’) were available for 42 426 individuals classified as ‘radiation workers’. Poisson regression models were used to investigate the relationship between excess mortality rates and cumulative radiation exposure, using both relative and additive risk models.

Results The cohort shows a pronounced ‘healthy worker’ effect. Overall, socio-economic status as indicated by employment status has a greater influence on mortality than does radiation exposure status. For male radiation workers, there is an apparent dose response for mortality from circulatory system disease [P < 0.001, ERR = 0.65 (90% CI 0.36–0.98) Sv−1]. However there is evidence for inhomogeneity in the apparent dose response (P = 0.016), arising principally at cumulative doses in excess of 300 mSv, when the four categories of employment and radiation exposure status are examined separately.

Conclusions We have found evidence for an association between mortality from non-cancer causes of death, particularly circulatory system disease, and external exposure to ionizing radiation in this cohort. However, the tentative nature of biological mechanisms that might explain such an effect at low chronic doses and the above inhomogeneities in apparent dose–response, mean that the results of our analysis are not consistent with any simple causal interpretation. Further work is required to explain these inhomogeneities, and on the possible role of factors associated with socio-economic status and shift working, before any further conclusions can be drawn.

The non-cancer mortality experience of male workers at British Nuclear Fuels plc, 1946–2005

OBJECTIVE: To follow up cancer incidence and mortality in a group of Swedish battery workers exposed to nickel hydroxide and cadmium oxide. METHODS: 869 workers, employed at least one year between the years 1940 and 1980 were followed up until 1992. Vital status and causes of death were obtained from the Swedish cause of death registry. Cancer morbidity was retrieved from the Swedish cancer registry. Regional reference rates were used to compute the expected numbers of deaths and cancers. RESULTS: Up to 31 December, 1992, a total of 315 deaths (292 in men and 23 in women) had occurred in the cohort. For men, the overall standardised mortality ratio (SMR) was 106 (95% confidence interval (95% CI) 93.7 to 118) and for women 83.8 (95% CI 53.1 to 126). The SMRs for total cancer mortality were 125 (95% CI 98.2 to 157) for men and 69.5 (95% CI 25.5 to 151) for women. The SMR for lung cancer in men was 176 (95% CI 101 to 287). No lung cancers were found among female workers. Up to 31 December, 1991, a total of 118 cancers had occurred in the cohort. A significantly increased standardised incidence ratio (SIR) was found for cancer of the nose and nasal sinuses in men, three cases v 0.36 expected, yielding an SIR of 832 (95% CI 172 to 2430). Applying a 10 year latency period in cohort members exposed to > or = 1000 micrograms cadmium/m3, the SIR was 1107 (95% CI 134 to 4000). Similarly, for cohort members exposed to 2000 micrograms nickel/m3, the SIR was 1080 (95% CI 131 to 3900). CONCLUSION: There was an increased overall risk for lung cancer, but no exposure-response relation between cumulative exposure to cadmium or nickel and risk of lung cancer. There was a highly significant increased risk of cancer of the nose and nasal sinuses, which may be caused by exposure to nickel or cadmium or a combination of both exposures.

Mortality and cancer incidence in Swedish battery workers exposed to cadmium and nickel

Purpose: With increasing utilisation of nuclear technologies in power production, medical and industrial applications, and in a scenario of nuclear terrorism/war, there is an enhanced likelihood of accidental radiation exposure to occupational workers, patients and public. The consequent health effects of the radiation exposure are resultant of interaction of radiation with biological systems and subsequent radiation injury. The present review discusses the knowledge gained in radiation biology that can be exploited for better treatment and management of radiation accident victims.Results: In comparison with planned radiation exposure during diagnosis/therapy, the management of accidental radiation exposure is quite complicated due to uncertainties in dose, duration, organs involved and radionuclides internalised, and hence, require multi-faceted approaches. However, the options available for dosimetry, decorporation of radionuclides and therapeutic protocols of patients are limited, which provides substa...

Radiobiological basis in management of accidental radiation exposure

Incomplete radiation exposure histories, inadequate treatment of internally deposited radionuclides, and failure to account for neutron exposures can be important uncertainties in epidemiologic studies of radiation workers. Organ-specific doses from lifetime occupational exposures and radionuclide intakes were estimated for an epidemiologic study of 5,801 Rocketdyne/Atomics International (AI) radiation workers engaged in nuclear technologies between 1948 and 1999. The entire workforce of 46,970 Rocketdyne/AI employees was identified from 35,042 Kardex work histories cards, 26,136 electronic personnel listings, and 14,189 radiation folders containing individual exposure histories. To obtain prior and subsequent occupational exposure information, the roster of all workers was matched against nationwide dosimetry files from the Department of Energy, the Nuclear Regulatory Commission, the Landauer dosimetry company, the U.S. Army, and the U.S. Air Force. Dosimetry files of other worker studies were also accessed. Computation of organ doses from radionuclide intakes was complicated by the diversity of bioassay data collected over a 40-y period (urine and fecal samples, lung counts, whole-body counts, nasal smears, and wound and incident reports) and the variety of radionuclides with documented intake including isotopes of uranium, plutonium, americium, calcium, cesium, cerium, zirconium, thorium, polonium, promethium, iodine, zinc, strontium, and hydrogen (tritium). Over 30,000 individual bioassay measurements, recorded on 11 different bioassay forms, were abstracted. The bioassay data were evaluated using ICRP biokinetic models recommended in current or upcoming ICRP documents (modified for one inhaled material to reflect site-specific information) to estimate annual doses for 16 organs or tissues taking into account time of exposure, type of radionuclide, and excretion patterns. Detailed internal exposure scenarios were developed and annual internal doses were derived on a case-by-case basis for workers with committed equivalent doses indicated by screening criteria to be greater than 10 mSv to the organ with the highest internal dose. Overall, 5,801 workers were monitored for radiation at Rocketdyne/AI: 5,743 for external exposure and 2,232 for internal intakes of radionuclides; 41,169 workers were not monitored for radiation. The mean cumulative external dose based on Rocketdyne/AI records alone was 10.0 mSv, and the dose distribution was highly skewed with most workers experiencing low cumulative doses and only a few with high doses (maximum 500 mSv). Only 45 workers received greater than 200 mSv while employed at Rocketdyne/AI. However, nearly 32% (or 1,833) of the Rocketdyne/AI workers had been monitored for radiation at other nuclear facilities and incorporation of these doses increased the mean dose to 13.5 mSv (maximum 1,005 mSv) and the number of workers with >200 mSv to 69. For a small number of workers (n=292), lung doses from internal radionuclide intakes were relatively high (mean 106 mSv; maximum 3,560 mSv) and increased the overall population mean dose to 19.0 mSv and the number of workers with lung dose>200 mSv to 109. Nearly 10% of the radiation workers (584) were monitored for neutron exposures (mean 1.2 mSv) at Rocketdyne/AI, and another 2% were monitored for neutron exposures elsewhere. Interestingly, 1,477 workers not monitored for radiation at Rocketdyne/AI (3.6%) were found to have worn dosimeters at other nuclear facilities (mean external dose of 2.6 mSv, maximum 188 mSv). Without considering all sources of occupational exposure, an incorrect characterization of worker exposure would have occurred with the potential to bias epidemiologic results. For these pioneering workers in the nuclear industry, 26.5% of their total occupational dose (collective dose) was received at other facilities both prior to and after employment at Rocketdyne/AI. In addition, a small number of workers monitored for internal radionuclides contributed disproportionately to the number of workers with high lung doses. Although nearly 12% of radiation workers had been monitored for neutron exposures during their career, the cumulative dose levels were small in comparison with other external and internal exposure. Risk estimates based on nuclear worker data must be interpreted cautiously if internally deposited radionuclides and occupational doses received elsewhere are not considered.

A comprehensive dose reconstruction methodology for former rocketdyne/atomics international radiation workers

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/pdf/mortality-experience-of-male-workers-at-a-uk-tin-smelter-4kogrvgvys.pdf

Mortality experience of male workers at a UK tin smelter

Background Studies of nuclear workers have focused mainly on the experience of male workers. To date, little has been published specifically on the experience offemale workers in the nuclear industry. Methods We report on the mortality, cancer morbidity, and tracing experience of the 6,376 females ever employed at the British Nuclear Fuels Ltd. plant at Sellafield to the end of 1998. These workers have accumulated 142,337 person-years of experience. Results Radiation workers were exposed to low doses of radiation. No statistically significant associations were noted between mortality or cancer morbidity and cumulative assessed organ-specific internal plutonium dose or cumulative external whole body radiation dose overall, or for any of the individual disease groupings examined. The power of the study was insufficient to detect the risks indicated in other radiation studies. Conclusion This study offers reassurance that there is no detrimental effect on the health of the female workers from occupational exposures at Sellafield.

Mortality and cancer morbidity experience of female workers at the British Nuclear Fuels Sellafield plant, 1946-1998.

This paper studies the mortality and cancer morbidity of the 470 male workers involved in tackling the 1957 Sellafield Windscale fire or its subsequent clean-up. Workers were followed up for 50 years to 2007, extending the follow-up of a previously published cohort study on the Windscale fire by 10 years. The size of the study population is small, but the cohort is of interest because of the involvement of the workers in the accident. Significant excesses of deaths from diseases of the circulatory system (standardised mortality ratio (SMR) = 120, 95% CI = 103–138; 194 deaths) driven by ischaemic heart disease (IHD) (SMR = 133, 95% CI = 112–157, 141 deaths) were found when compared with the population of England and Wales but not when compared with the population of Northwest England (SMR = 105, 95% CI = 90–120 and SMR = 115, 95% CI = 97–136 respectively). When compared with those workers in post at the time of the fire but not directly involved in the fire the mortality rate from IHD among those involved in tackling the fire was raised but not statistically significantly (rate ratio (RR) = 1.11, 95% CI = 0.92–1.33). A RR of 1.11 is consistent with an excess relative risk of 0.65 Sv − 1 as reported in an earlier study of non-cancer mortality in the British Nuclear Fuels plc cohort of which these workers are a small but significant part. There was a statistically significant difference in lung cancer mortality (RR = 2.18, 95% CI = 1.05–4.52) rates between workers who had received higher recorded external doses during the fire and those who had received lower external doses. Comparison of the mortality rates of workers directly involved in the accident with workers in post, but not so involved, showed no significant differences overall. On the basis of the use of a propensity score the average effect of involvement in the Windscale fire on all causes of death was − 2.13% (se = 3.64%, p = 0.56) though this difference is not statistically significant. The average effect of involvement in the Windscale fire was − 5.53% (se = 3.81, p = 0.15) for all cancers mortality and 6.60% (se = 4.03%, p = 0.10) for IHD mortality though neither figure was statistically significant. This analysis of the mortality and cancer morbidity experience of those Sellafield workers involved in the 1957 Windscale fire does not reveal any measurable effect of the fire upon their health. Although this study has low statistical power for detecting small adverse effects, due to the relatively small number of workers, it does provide reassurance that no significant health effects are associated with the 1957 Windscale fire even after 50 years of follow-up.

https://iopscience.iop.org/article/10.1088/0952-4746/30/3/001/pdf

Mortality and cancer registration experience of the Sellafield workers known to have been involved in the 1957 Windscale accident: 50 year follow-up

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Mortality experience of male workers at a UK tin smelter

Mortality and cancer morbidity experience of female workers at the British Nuclear Fuels Sellafield plant, 1946-1998.

Mortality and cancer registration experience of the Sellafield workers known to have been involved in the 1957 Windscale accident: 50 year follow-up