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Abstract: The objective of this paper is to compare post-2007 epidemiological results for plutonium workers to risk predicted by the software program NIOSH-IREP (IREP for short), which is used to determine the lowest dose for a US veteran to obtain cancer compensation. IREP output and methodology were used to predict excess relative risk per Gy (ERR Gy -1 ) for lung cancer at the 99 th credibility percentile, which is used for compensation decisions. Also estimated were relative biological effectiveness factors (RBE) predicted for workers using IREP methodology. IREP predictions were compared to results for Mayak and Sellafield plutonium workers, separately and pooled. Indications that IREP might underpredict 99 th -percentile lung cancer plutonium risk came from (1) comparison of worker RBEs and (2) from comparison of Sellafield results separately. When Sellafield and Mayak data were pooled, ERR Gy -1 comparisons at the 99 th percentile roughly matched epidemiological data with regression dose range restricted to < 0.05 Gy, the most relevant region to veterans, but overpredicted for the full dose range. When four plausible distributions for lung cancer risk, including both new and old data, were combined using illustrative weighting factors, compensation cutoff dose for lung cancer matched current IREP values unless regression results below 0.05 were chosen for Sellafield, producing a two-fold reduction. A 1997 claim of a dose threshold in lung cancer dose response was not confirmed in later literature. The benefit of the doubt is given to claimants when the science is unclear. The challenge for NIOSH-IREP custodians is dealing with the Sellafield results, which might best match US claimants., Competing Interests: The authors declare no conflicts of interest. Over the last 20 y, the author has prepared pro bono dose and risk analyses for four US veterans with a claim before the US Veterans Administration., (Copyright © 2022 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the Health Physics Society.)

This article introduces the first accident of internal contamination with plutonium (Pu) or americium (Am) in Japan for which treatment was carried out. An accident of internal contamination with Pu and Am occurred at a Pu research facility at Oarai-town of Ibaraki prefecture in Japan. A plastic bag containing these radionuclides ruptured when five workers were inspecting a storage container in a hood. As a consequence, these workers were internally contaminated with Pu and Am. Although contamination on the body surface was observed in all five workers, a positive nasal swab was detected in only three of them. A chelating agent, calcium diethylenetriaminepenta-acetate (CaDTPA), was administered to all of them including the two workers without a positive nasal swab. However, bioassay detected a significant amount of Pu and Am in urine after administration of DTPA in these two workers, whereas the levels of these nuclides were below minimum detectable levels in urine before the administration. Since the prevalence of adverse reactions in DTPAs is low, the present results suggest that administration of DTPA can be used for the diagnosis of internal contamination even when a nasal swab is negative or contamination around body orifices is not detected.

The International Commission on Radiological Protection (ICRP) mandated a task group (Task Group 64) to review recently published epidemiological studies related to cancer risk and incorporated alpha emitters, and to evaluate whether the results might consolidate or challenge assumptions underlying the current radiation protection system. Three major alpha emitters were considered: radon and its decay products, plutonium, and uranium. Results came mainly from cohorts of workers, while for radon, major studies of the general population contributed to a better understanding of the risk of lung cancer at low and chronic exposure. Selection criteria for the review were: assessment of individual exposure of the target organ, long duration of the health survey, availability of attained age at end of follow-up, and adjustment for major co-factors. Task Group 64 is composed of members from ICRP Committees 1 and 2 (because epidemiological and dosimetric expertise were needed) and external experts. A first report (ICRP Publication 115) considered the risk of lung cancer related to inhalation of radon and its decay products. As the estimated excess risk per unit of exposure was higher by a factor of 2 compared with a previous ICRP estimate in 1993, Task Group 64 suggested a reconsideration of the reference levels for the workplace and for the general population. A second report, using the same standardised methodology (lung cancer baselines, population, life expectancy), will include estimation of the cancer risk of nuclear workers exposed to plutonium, focusing on the risk of lung cancer. A comparison of these risks with those of populations exposed to external gamma radiation alone will be made in the near future. For uranium, the results related to the organ-specific dose were too sparse to draw reliable conclusions, despite a recent publication. More research is needed on this topic.

In this study, lung cancer risk from occupational plutonium exposure was analyzed in a pooled cohort of Mayak and Sellafield workers, two of the most informative cohorts in the world with detailed plutonium urine monitoring programs. The pooled cohort comprised 45,817 workers: 23,443 Sellafield workers first employed during 1947-2002 with follow-up until the end of 2005 and 22,374 Mayak workers first employed during 1948-1982 with follow-up until the end of 2008. In the pooled cohort 1,195 lung cancer deaths were observed (789 Mayak, 406 Sellafield) but only 893 lung cancer incidences (509 Mayak, 384 Sellafield, due to truncated follow-up in the incidence analysis). Analyses were performed using Poisson regression models, and were based on doses derived from individual radiation monitoring data using an updated dose assessment methodology developed in the study. There was clear evidence of a linear association between cumulative internal plutonium lung dose and risk of both lung cancer mortality and incidence in the pooled cohort. The pooled point estimates of the excess relative risk (ERR) from plutonium exposure for both lung cancer mortality and incidence were within the range of 5-8 per Gy for males at age 60. The ERR estimates in relationship to external gamma radiation were also significantly raised and in the range 0.2-0.4 per Gy of cumulative gamma dose to the lung. The point estimates of risk, for both external and plutonium exposure, were comparable between the cohorts, which suggests that the pooling of these data was valid. The results support point estimates of relative biological effectiveness (RBE) in the range of 10-25, which is in broad agreement with the value of 20 currently adopted in radiological protection as the radiation weighting factor for alpha particles, however, the uncertainty on this value (RBE = 21; 95% CI: 9-178) is large. The results provide direct evidence that the plutonium risks in each cohort are of the same order of magnitude but the uncertainty on the Sellafield cohort plutonium risk estimates is large, with observed risks consistent with no plutonium risk, and risks five times larger than those observed in the Mayak cohort.

Exposure to ionizing radiation has well-documented long-term effects on cancer rates and other health outcomes in humans. While in vitro experimental studies had demonstrated that the nature of some radiation effects depend on both total dose of the radiation and the dose rate (i.e., the pattern of dose distribution over time), the question of whether or not the carcinogenic effect of radiation exposure depends on the dose rate remains unanswered. Another issue of interest concerns whether or not concomitant exposure to external gamma rays and inhaled plutonium aerosols has any effect on the external exposure effects. The analyses of the present paper focus on the risk of solid cancers at sites other than lung, liver, and bone in Mayak workers. Recent findings are reviewed indicating that there is no evidence of plutonium dose response for these cancers in the Mayak worker cohort. Then the evidence for differences in the external dose effects among workers with and without the potential for exposure to alpha particles from inhaled plutonium is examined. It is found that there is no evidence that exposure to plutonium aerosols significantly affects the risk associated with external exposure. While the Mayak external dose risk estimate of an excess relative risk of 0.16 per Gy is somewhat lower than an appropriately normalized risk estimate from the Life Span Study of Japanese atomic bomb survivors, the uncertainties in these estimates preclude concluding that the external dose excess relative risks of this group of solid cancers differ in the two cohorts.

The objective of the study is the assessment of lifetime in the cohort of Mayak PA workers employed in 1948-1958 and exposed to incorporated Pu-239. The decrease of age at death 5.2 years among males and 6.6 years among females, and after the start of work--6.9 years among males and 7.7 years among females, with the increase of Pu-239 incorporation was shown. The association of the raised mortality rate from tumour causes is shown both among males and females, mainly due to malignant neoplasms of lung and live; which are organs of Pu-239 main deposition. For the first time related to Pu-239 incorporation decrease of age at death from tumour and non-tumour causes of main and secondary organs of deposition both among males and females was revealed. To assess the reduction of lifetime Years of Potential Life Lost (YPLL) were calculated per 10(5) person-years of potential life based on European gender standard. The calculations based on the obtained estimations showed significant dependence of YPLL on the level of Pu-239 incorporation. At that the main contribution to the increase of YPLL, i.e. to lifetime reduction, was due to radiation-induced decrease of the age at death as compared to radiation-induced increase of mortality rates.

New data from the workers at the Mayak nuclear facility near Chelyabinsk, Russia, apparently show a linear increase in the risk of lung cancer with increasing dose. Furthermore, this increase occurs without a threshold. However, these conclusions are at variance with the results reported by other investigators. A possible cause of these inconsistencies could be the lack of application of microdosimetric considerations when discussing "dose" to the lung.

Purpose: Epidemiological studies of the French uranium miners and the plutonium workers at the Mayak nuclear facility have provided excess relative risk (ERR) estimates per unit absorbed lung dose from alpha radiation. The aim of this paper was to review these two studies and to derive values of the relative biological effectiveness (RBE) of alpha particles for the induction of lung cancer., Materials and Methods: We examined and compared the dosimetry assumptions and methodology used in the epidemiological studies of uranium miners and the plutonium workers. Values of RBE were obtained by comparing risk coefficients including comparison of lifetime risks for a given population. To do this, preliminary calculations of lifetime risks following inhalation of plutonium were carried out., Results and Conclusions: Published values of risk per unit dose following inhalation of radon progeny and plutonium were in agreement despite the very different dose distributions within the lungs and the different ways the doses were calculated. Values of RBE around 10-20 were obtained by comparing ERR values, but with wide uncertainty ranges. Comparing lifetime risks gave similar values (10, 19 and 21). This supports the use of a radiation weighting factor of 20 for alpha particles for radiation protection purposes.

Background: Cancer incidence in the Mayak Production Association (PA) cohort was analysed to investigate for the first time whether external gamma-ray and internal plutonium exposure are associated with raised incidence of solid cancers other than lung, liver and bone (other solid cancers)., Methods: The cohort includes 22,366 workers of both sexes who were first employed between 1948 and 1982. A total of 1447 cases of other solid cancers were registered in the follow-up period until 2004. The Poisson regression was used to estimate the excess relative risk (ERR) per unit of cumulative exposure to plutonium and external gamma-ray., Results: A weak association was found between cumulative exposure to external gamma-ray and the incidence of other solid cancers (ERR/Gy=0.07; 95% confidence intervals (CIs): 0.01-0.15), but this association lost its significance after adjusting for internal plutonium exposure. There was no indication of any association with plutonium exposure for other solid cancers. Among 16 individual cancer sites, there was a statistically significant association with external exposure for lip cancer (ERR/Gy=1.74; 95% CI: 0.37; 6.71) and with plutonium exposure for pancreatic cancer (ERR/Gy=1.58; 95% CI; 0.17; 4.77)., Conclusion: This study of Mayak workers does not provide evidence of an increased risk of other solid cancers. The observed increase in the risk of cancer of the lip and pancreas should be treated with caution because of the limited amount of relevant data and because the observations may be simply due to chance.

This paper presents the results of analyses of the incidence of malignant neoplasms in lung, liver, and bone and associated connective tissues among Mayak nuclear workers exposed to both internally incorporated plutonium and to external gamma radiation. The study cohort included 22,373 individuals employed at the reactors and radiochemical and plutonium production facilities of the Mayak nuclear complex during 1948-1982 and followed up to the end of 2004. All analyses were carried out by Poisson regression, and the doses used were derived using a recently available update of organ doses, Mayak doses-2008. There was clear evidence for the linear association between internal plutonium dose and the risk of lung cancer. For males, there was evidence of a significant internal plutonium dose response for all histological types of lung cancer evaluated (adenocarcinoma, squamous-cell, and other epithelial); the estimated excess relative risk (ERR)/Gy for adenocarcinoma was the largest (ERR/Gy = 32.5; 95% CI: 16.3; 71.9), about 11-fold higher than that for squamous-cell lung cancer (ERR/Gy = 3.1; 95% CI: 0.3; 9.1). The relationship between liver cancer risk and plutonium exposure was best described by a linear-quadratic (LQ) function, but the LQ effect was diminished after restricting internal doses <2 Gy. Hepatocellular cancer was the most frequently observed type of liver cancer associated with internal plutonium exposure, and hemangiosarcomas were exclusively observed only at high internal plutonium doses (>4 Gy). For malignant neoplasms of bone and associated connective tissues, the trend was not statistically significant in relation to internal plutonium dose, but a statistically significantly higher risk (RR=13.7; 95% CI= 3.0; 58.5) was found among unmonitored female plutonium workers who were employed in the most hazardous plutonium production facility commissioned prior to 1950.

An exploratory epidemiological study was conducted for 319 deceased nuclear workers who had intakes of transuranic radionuclides and histories of employment during the time period from 1943 to 1995. The workers were employed at various facilities throughout the United States, including the Department of Energy defense facilities and uranium mining and milling sites. The majority of individuals were involved in documented radiological incidents during their careers. All had voluntarily agreed to donate their organs or whole body to the United States Transuranium and Uranium Registries. External and internal dose assessments were performed using occupational exposure histories and postmortem concentrations of transuranic radionuclides in critical organs. Statistical data analyses were performed to investigate the potential relationship between radiation exposure and causes of death within this population due to cancers of the lungs, liver, and all sites combined while controlling for the effects of other confounders. No association was found between radiation exposure and death due to cancer (α = 0.05). However, statistically significant associations were found between death due to any type of cancer and smoking (yes or no) (odds ratio = 5.41; 95% CI: 1.42 to 20.67) and rate of cigarette smoking (packs per day) (odds ratio = 2.70; 95% CI: 1.37 to 5.30).

Retrospective study with "case-control" method revealed increased risk of gastric cancer among "Mayak" production association workers subjected to prolonged general external gamma-radiation in overall dose over 3.0 Gy. Major role in gaster cancer among "Mayak" production association workers was played by nonradiation factors: chronic gastritis with hyposecretion, peptic ulcer, cigarette smoking, alcohol abuse.

Two-mutation carcinogenesis models of mice and rats injected with (239)Pu and (226)Ra have been derived extending previous modellings of beagle dogs injected with (239)Pu and (226)Ra and radium dial painters. In all cases statistically significant parameters could be derived fitting data from several research groups jointly. This also lead to similarly parametrised models for (239)Pu and (226)Ra for all species. For each data set not more than five free model parameters were needed to fit the data adequately. From the toxicity ratios of the animal models for (239)Pu and (226)Ra, together with the human model for (226)Ra, an approximate model for the exposure of humans to (239)Pu has been derived. Relative risk calculations with this approximate model are in good agreement with epidemiological findings for the plutonium-exposed Mayak workers. This promising result may indicate new possibilities for estimating risks for humans from animal experiments.

The assessment of the relative biological effectiveness (RBE) for alpha-radiation was held in the cases of inhalation of radon progeny and incorporation of plutonium in lungs. It is based on simulation of lung cancer radiation risk for different types of radiation. Specific radiation risk models developed according to the results of direct epidemiological studies are used for the simulation. These include two published risk models for uranium miners and nuclear workers of the Mayak facilities in the former Soviet Union. Additionally two lung cancer risk models are developed and described for the following cases: population indoor radon exposure and low-linear-energy-transfer reference radiation exposure. By the results of lifetime lung cancer risk simulation the RBE values range from 11 to 12 and from 1.7 to 4.9 for the cases of plutonium incorporation and of radon progeny exposure accordingly. The significant uncertainty of radiation risk models results in significant variation of RBE assessments. Rough estimations of RBE values 90% confidence interval are from unit fraction to 25 and from 2 to 50 for the cases of radon progeny exposure and plutonium incorporation accordingly.

The cohort of nuclear workers at the Mayak Production Association, located in the Russian Federation, is a unique resource for providing information on the health effects of exposure to plutonium as well as the effects of protracted external dose. Lung cancer mortality risks were evaluated in 21,790 Mayak workers, a much larger group than included in previous evaluations of lung cancer risks in this cohort. These analyses, which included 655 lung cancer deaths occurring in the period 1955-2000, were the first to evaluate both excess relative risk (ERR) and excess absolute risk (EAR) models and to give detailed attention to the modifying effects of gender, attained age and age at hire. Lung cancer risks were found to be significantly related to both internal dose to the lung from plutonium and external dose, and risks were described adequately by linear functions. For internal dose, the ERR per gray for females was about four times higher than that for males, whereas the EAR for females was less than half that for males; the ERR showed a strong decline with attained age, whereas the EAR increased with attained age until about age 65 and then decreased. Parallel analyses of lung cancer mortality risks in Mayak workers and Japanese A-bomb survivors were also conducted. Efforts currently under way to improve both internal and external dose estimates, and to develop data on smoking, should result in more accurate risk estimates in the future.

The authors conducted a nested case-control study of the association between lung cancer mortality and cumulative internal lung doses among a cohort of workers employed at the Rocky Flats Plant in Colorado from 1951 to 1989. Cases (n = 180) were individually matched with controls (n = 720) on age, sex, and birth year. Annual doses to the lung from plutonium, americium, and uranium isotopes were calculated for each worker with an internal dosimetry model. Lung cancer risk was elevated among workers with cumulative internal lung doses of more than 400 mSv in several different analytical models. The dose-response relation was not consistent at high doses. Restricting analysis to those employed for 15-25 years produced a statistically significant linear trend with dose (chi-square = 67.2, p < 0.001), suggesting a strong healthy worker survivor effect. The association between age at first internal lung dose and lung cancer mortality was statistically significant (odds ratio = 1.05, 95% confidence interval: 1.01, 1.10). No associations were found between lung cancer mortality and cumulative external penetrating radiation dose or cumulative exposures to asbestos, beryllium, hexavalent chromium, or nickel.

A new analysis of lung cancer mortality in a cohort of male Mayak workers who started their employment in the plutonium and reprocessing plants between 1948 and 1958 has been carried out in terms of a relative risk model. The follow-up has been extended until 1999, moreover a new dosimetry system (DOSES2000) has been established. Particular emphasis has been given to a discrimination of the effects of external gamma-exposure and internal alpha-exposure due to incorporated plutonium. This study has also utilized and incorporated the information from a cohort of Mayak reactor workers, who were exposed only externally to gamma-rays. The influence of smoking as the main confounding factor for lung cancer has been studied. The baseline lung cancer mortality rate was not taken from national statistics but was derived from the cohort itself. The estimated excess relative risk for the plutonium alpha-rays was 0.23/Sv (95%CI: 0.16-0.31). The resulting risk coefficient for external gamma-ray exposure was very low with a statistically insignificant estimate of 0.058/Sv (95%CI: -0.072-0.20). The inferred relative risk for smokers was 16.5 (95%CI: 12.6-20.5).

Purpose: To compare quantitative estimates of lifetime cancer risk in humans for exposures to internally deposited radionuclides and external radiation. To assess the possibility that risks from radionuclide exposures may be underestimated., Materials and Methods: Risk estimates following internal exposures can be made for a small number of alpha-particle-emitting nuclides. (1) Lung cancer in underground miners exposed by inhalation to radon-222 gas and its short-lived progeny. Studies of residential (222)Rn exposure are generally consistent with predictions from the miner studies. (2) Liver cancer and leukaemia in patients given intravascular injections of Thorotrast, a thorium-232 oxide preparation that concentrates in liver, spleen and bone marrow. (3) Bone cancer in patients given injections of radium-224, and in workers exposed occupationally to (226)Ra and (228)Ra, mainly by ingestion. (4) Lung cancer in Mayak workers exposed to plutonium-239, mainly by inhalation. Liver and bone cancers were also seen, but the dosimetry is not yet sufficiently good enough to provide quantitative estimates of risks. Comparisons can be made between risk estimates for radiation-induced cancer derived for radionuclide exposure and those derived for the A-bomb survivors, exposed mainly to low-LET (linear energy transfer) external radiation. Data from animal studies, using dogs and rodents, allow comparisons of cancer induction by a range of alpha- and beta-/gamma-emitting radionuclides. They provide information on relative biological effectiveness (RBE), dose-response relationships, dose-rate effects and the location of target cells for different malignancies., Results: For lung and liver cancer, the estimated values of risk per Sv for internal exposure, assuming an RBE for alpha-particles of 20, are reasonably consistent with estimates for external exposure to low-LET radiation. This also applies to bone cancer when risk is calculated on the basis of average bone dose, but consideration of dose to target cells on bone surfaces suggests a low RBE for alpha-particles. Similarly, for leukaemia, the comparison of risks from alpha-irradiation ((232)Th and progeny) and external radiation suggest a low alpha RBE; this conclusion is supported by animal data. Risk estimates for internal exposure are dependent on the assumptions made in calculating dose. Account is taken of the distribution of radionuclides within tissues and the distribution of target cells for cancer induction. For the lungs and liver, the available human and animal data provide support for current assumptions. However, for bone cancer and leukaemia, it may be that changes are required. Bone cancer risk may be best assessed by calculating dose to a 50 micro m layer of marrow adjacent to endosteal (inner) bone surfaces rather than to a single 10 micro m cell layer as currently assumed. Target cells for leukaemia may be concentrated towards the centre of marrow cavities so that the risk of leukaemia from bone-seeking radionuclides, particularly alpha emitters, may be overestimated by the current assumption of uniform distribution of target cells throughout red bone marrow., Conclusions: The lifetime risk estimates considered here for exposure to internally deposited radionuclides and to external radiation are subject to uncertainties, arising from the dosimetric assumptions made, from the quality of cancer incidence and mortality data and from aspects of risk modelling; including variations in baseline rates between populations for some cancer types. Bearing in mind such uncertainties, comparisons of risk estimates for internal emitters and external radiation show good agreement for lung and liver cancers. For leukaemia, the available data suggest that the assumption of an alpha-particle RBE of 20 can result in overestimates of risk. For bone cancer, it also appears that current assumptions will overestimate risks from alpha-particle-emitting nuclides, particularly at low doses.

Chronic exposure to high LET radiation has been shown to cause liver cancer in humans based on studies of patients who received Thorotrast, a colloidal suspension of thorium dioxide formerly used as a radiological contrast agent, and on studies of Russian nuclear weapons workers exposed to internally ingested plutonium. Risk estimates for these exposures and specific subtypes of liver cancer have not been previously reported. Combining published data with tumor registry data pertinent to the Thorotrast cohorts in Germany, Denmark, Portugal, and Japan and to Russian workers, we generally found significantly elevated risks of three major histologic types of liver tumors: hepatocellular carcinoma (HCC), cholangiocarcinoma (CC), and hemangiosarcoma (HS) for Thorotrast exposures. In contrast, HS was the only liver tumor significantly associated with the lower alpha-particle doses experienced by the Russian workers. Excess cases per 1,000 persons exposed to Thorotrast were similar for the three liver cancer subtypes but lower for plutonium exposure. Odds ratios (OR) of HS and CC for Thorotrast were from 26 to 789 and from 1 to 31 times higher than those for HCC, respectively. ORs of liver cirrhosis for Thorotrast exposure ranged from 2.7 (95% confidence interval (CI): 2.2-3.4) to 6.7 (5.1-8.7).

For radiation-related cancer risk evaluation, it is important to assess not only influences of individual risk factors but also their interactive effects (e.g., additive, multiplicative, etc.). Multivariate analysis methods adapted for interactive effects allow such assessments. We have used a multivariate analysis approach to investigate the pair-wise interactions of the previously identified three main etiological factors for lung cancer induction in Russian workers of the Mayak Production Association (PA) nuclear enterprise. These three factors are as follows: (1) body burden of inhaled plutonium-239 (239Pu), an influence on absorbed alpha-radiation dose; (2) cumulative, absorbed external gamma-radiation dose to the lung; and (3) level of cigarette smoking as indicated by a smoking index (SI). The SI represents the cigarettes smoked per day times years smoking. The Mayak PA workers were exposed by inhalation to both soluble and insoluble forms of 239Pu. Based on a cohort of 4,390 persons (77% male), we conducted a nested, case-control study of lung cancer induction using 486 matched cases and controls. Each case was matched to two controls. Matching was based on five factors: sex, year of birth, year work began, profession, and workplace. Three levels of smoking were considered: low (SI = 1 to 499), used as a reference level; middle (SI = 500 to 900); and high (SI = 901 to 2,000). For lung cancer induction, a supra-multiplicative effect was demonstrated for high external gamma-ray doses (> 2.0 Gy) plus high 239Pu intakes (body burden >2.3 kBq). This observation is consistent with the hypothesis of curvilinear dose-response relationships for lung cancer induction by high- and low-LET radiations. The interaction between radiation (external gamma rays or 239Pu body burden) and cigarette smoke was found to depend on the smoking level. For the middle level of smoking in combination with gamma radiation (> 2.0 Gy) or 239Pu body burden (> 2.3 kBq), results were consistent with additive effects. However, for the high level of smoking in combination with gamma radiation (> 2.0 Gy) or 239Pu body burden (> 2.3 kBq), results were consistent with the occurrence of multiplicative effects. These results indicate that low-dose risk estimates for radiation-induced lung cancer derived without adjusting for the influence of cigarette smoking could be greatly overestimated. Further, such systematic error may considerably distort the shape of the risk vs. dose curve and could possibly obscure the presence of a dose threshold for radiation-induced lung cancer.

The possible use of radioactivity dispersal devices by terrorist groups has been recently reported in the news. In this paper, we discuss the threat of terrorist attacks by plutonium, with particular attention to the dispersal of plutonium by explosion or fire. Doses resulting from inhalation of radioactive aerosol induced by a plutonium explosion or fire are simulated using a Gaussian plume model (the HOTSPOT code) for different meteorological conditions. Ground contamination and resuspension of dust are also considered in the simulations. Our simulations suggest that acute effects from a plutonium dispersal attack are very unlikely. For late stochastic effects, the explosion poses a greater hazard than fire. However, even in the worst-case scenario, the dispersed plutonium would cause relatively few excess cancers (around 80 in a city of 2 million inhabitants) after many years from the explosion, and these excess cancers would remain undetected against the background of cancer fatalities.

A model was developed to calculate ambient air concentrations, surface deposition, and lifetime carcinogenic risk with uncertainty from plutonium released to the air from the Rocky Flats Plant between the years 1953 and 1989. The model integrated airborne release estimates and atmospheric dispersion and deposition calculations from 37 years of routine plant operations and episodic releases. Episodic releases included two major fires in 1957 and 1969 that breached the building air filtration systems, and suspension of plutonium contaminated soil from the former 903 waste storage area during high winds. Predicted air concentrations included contributions from site releases and resuspension from contaminated soil. Inhalation was the only exposure pathway considered. Environmental measurements suitable for model validation were lacking for the period when major site releases occurred (1953 to 1970). However, environmental media, such as soil and lake sediment, are natural accumulators and provided evidence of past offsite releases. The geometric mean predicted-to-observed (P/O) ratio for soil was 0.93 with a geometric standard deviation of 1.6. The model systematically underpredicted concentrations near the 903 Area because large, nonrespirable particles that deposited close to the source were not included in release estimates. Plutonium soil inventories for the model domain had P/O ratios ranging from 0.22 to 4.2. The geometric mean P/O ratio for ambient air was 0.90 with a geometric standard deviation of 2.6. Age-dated sediment cores from Standley Lake had a geometric mean P/O ratio of 1.0 with a geometric standard deviation of 1.7. Predicted-to-observed ratios for plutonium inventories in Great Western Reservoir ranged from 0.36 to 1.7. Lifetime cancer incidence risks were calculated for a male laborer scenario who resided in the model domain for the entire assessment time. Maximum cancer risks ranged from 10-6 (5th percentile) to 10(-4) (95th percentile). Most of the exposure was incurred during the 1950's.

The risk per unit dose to the four primary cancer sites for plutonium inhalation exposure (lung, liver, bone, bone marrow) is estimated by combining the risk estimates that are derived from four independent approaches. Each approach represents a fundamentally different source of data from which plutonium risk estimates can be derived. These are: (1) epidemiologic studies of workers exposed to plutonium; (2) epidemiologic studies of persons exposed to low-LET radiation combined with a factor for the relative biological effectiveness (RBE) of plutonium alpha particles appropriate for each cancer site of concern; (3) epidemiologic studies of persons exposed to alpha-emitting radionuclides other than plutonium; and (4) controlled studies of animals exposed to plutonium and other alpha-emitting radionuclides extrapolated to humans. This procedure yielded the following organ-specific estimates of the distribution of mortality risk per unit dose from exposure to plutonium expressed as the median estimate with the 5th to 95th percentiles of the distribution in parentheses: lung 0.13 Gy(-1) (0.022-0.53 Gy(-1)); liver 0.057 Gy(-1) (0.011-0.47 Gy(-1)); bone 0.0013 Gy(-1) (0.000060-0.025 Gy(-1)); bone marrow (leukemia), 0.013 Gy(-1) (0.00061-0.05 Gy(-1)). Because the different tissues do not receive the same dose following an inhalation exposure, the mortality risk per unit intake of activity via inhalation of a 1-microm AMAD plutonium aerosol also was determined. To do this, inhalation dose coefficients based on the most recent ICRP models and accounting for input parameter uncertainties were combined with the risk coefficients described above. The following estimates of the distribution of mortality risk per unit intake were determined for a 1-microm AMAD plutonium aerosol with a geometric standard deviation of 2.5: lung 5.3 x 10(-7) Bq(-1) (0.65-35 x 10(-7) Bq(-1)), liver 1.2 x 10(-7) Bq(-1) (0.091-20 x 10(-7) Bq(-1)), bone 0.11 x 10(-7) Bq(-1) (0.0030-4.3 x 10(-7) Bq(-1)), bone marrow (leukemia) 0.049 x 10(-7) Bq(-1) (0.0017-0.59 x 10(-7) Bq(-1)). The cancer mortality risk for all sites was estimated to be 10 x 10(-7) Bq(-1) (2.1-55 x 10(-7) Bq(-1))--a result that agrees very well with other recent estimates. The large uncertainties in the risks per unit intake of activity reflect the combined uncertainty in the dose and risk coefficients.

Purpose: To compare tumour induction in CBA/H mice, principally osteosarcoma and acute myeloid leukaemia, resulting from exposure to the alpha-emitting nuclides, uranium-233, plutonium-239 and americium-241, and to relate differences between the three nuclides to the pattern of dose delivery within tissues., Materials and Methods: Each nuclide was administered intraperitoneally in citrate solution to three groups of adult male CBA/H mice at levels of activity which gave estimated life-time average skeletal doses of about 0.25-0.3 Gy, 0.5-1 Gy and 1-2 Gy. Animals were carefully monitored and sacrificed as soon as they showed signs of ill health; tumours were identified by standard histopathological techniques., Results: Statistical modelling by Cox regression showed that, considering all three nuclides together, there was a highly significant increase in risk of death from osteosarcoma or myeloid leukaemia with increasing dose rate. For osteosarcoma, the effect was significantly greater for 239Pu than 241Am, while separate analysis for 233U showed no significant increase with increasing dose rate. For example, the increase in relative risk of death from osteosarcoma for an increase in life-time average dose rate to bone of 1 mGyd(-1) was 4.2 (2.7-6.5) for 239Pu, 2.3 (1.4-3.4) for 241Am and 1.1 (0.4-3.1) for 233U. For myeloid leukaemia, there was no significant difference between 239Pu and 241Am in the effect of dose rate. The increase in relative risk from myeloid leukaemia for an increase in average dose rate of 1 mGyd(-1) was 1.8 (1.1-2.8) for 239Pu, 2.0 (1.4-2.9) for 241Am and 1.5 (0.8-2.7) for 233U. Significant increases in renal and hepatic carcinomas were also recorded in animals exposed to 233U and 241Am, respectively. Studies of the distribution of the nuclides within the skeleton, published separately, have shown differences in their retention in individual bones and within bone. The proportions of decays occurring near to endosteal bone surfaces and throughout bone marrow were in the order: 239Pu> 241Am>233U., Conclusions: For osteosarcoma, the relative effectiveness of the nuclides in terms of average bone dose, in the order 239Pu>241Am>233U, is consistent with the proportion of dose delivered near to endosteal surfaces. For myeloid leukaemia, the greater effectiveness of 239Pu and 241Am than 233U is consistent with their accumulation in marrow.

Bone cancer mortality risks were evaluated in 11,000 workers who started working at the "Mayak" Production Association in 1948-1958 and who were exposed to both internally deposited plutonium and external gamma radiation. Comparisons with Russian and U.S. general population rates indicate excess mortality, especially among females, plutonium plant workers, and workers with external doses exceeding 1 Sv. Comparisons within the Mayak worker cohort, which evaluate the role of plutonium body burden with adjustment for cumulative external dose, indicate excess mortality among workers with burdens estimated to exceed 7.4 kBq (relative risk = 7.9; 95% CI = 1.6-32) and among workers in the plutonium plant who did not have routine plutonium monitoring data based on urine measurements (relative risk = 4.1; 95% CI = 1.2-14). In addition, analyses treating the estimated plutonium body burden as a continuous variable indicate increasing risk with increasing burden (P < 0.001). Because of limitations in current plutonium dosimetry, no attempt was made to quantify bone cancer risks from plutonium in terms of organ dose, and risk from external dose could not be reliably evaluated.

Liver cancer mortality risks were evaluated in 11,000 workers who started working at the "Mayak" Production Association in 1948-1958 and who were exposed to both internally deposited plutonium and external gamma radiation. Comparisons with Russian liver cancer incidence rates indicate excess risk, especially among those with detectable plutonium body burdens and among female workers in the plutonium plant. Comparisons within the Mayak worker cohort which evaluate the role of plutonium body burden with adjustment for cumulative external dose indicate excess risk among workers with burdens estimated to exceed 7.4 kBq (relative risk = 17; 95% CI = 8. 0-36) and among workers in the plutonium plant who did not have routine plutonium monitoring data based on urine measurements (relative risk = 2.8; 95% CI = 1.3-6.2). In addition, analyses treating the estimated plutonium body burden as a continuous variable indicate increasing risk with increasing burden (P < 0.001). Relative risks tended to be higher for females than for males, probably because of the lower baseline risk and the higher levels of plutonium measured in females. Because of limitations in current plutonium dosimetry, no attempt was made to quantify liver cancer risks from plutonium in terms of organ dose, and risk from external dose could not be reliably evaluated.

Investigation of a possible increase in sensitivity to occurrence of radionuclide-induced skeletal malignancy with increasing body size was analyzed among 358 beagles injected as young adults with either 226Ra or monomeric 239Pu and maintained for their lifespans. Corresponding analyses were performed for about 240 other beagles injected as young adults with 90Sr, 228Ra, or 228Th. Body masses at the time of injection ranged between about 5.6 and 16 kg. Logistic regression analysis using body mass and cumulative skeletal radiation dose as the independent variables indicated that there could not be established a dependency of tumor occurrence upon body mass, although skeletal dose was found to be significantly correlated with occurrence of bone cancer. Regression analysis indicated that for any dosage group there could not be established a correlation between body mass and skeletal dose. Each dosage group having similar injected kBq kg(-1) for each nuclide was divided into 2 subgroups of equal size, one containing the less massive dogs and the other containing the more massive dogs. These subgroups within a roughly uniform value of skeletal dose-rate were compared by Fisher's Exact Test, and the less massive subgroups were combined within each nuclide for an additional, separate analysis against the combined more massive subgroups using the same method. In only one instance (the dosage group given 3607 kBq 90Sr kg(-1)) was there indicated a substantially greater tumor occurrence among dogs in the more massive subgroup (p = 0.061). However, for the group given 0.382 kBq 239Pu kg(-1) there was indicated a significant difference between subgroups, but the effect was exactly opposite to that found for the highest level 90Sr dogs in that the less massive subgroup had a higher relative tumor occurrence than the most massive (p = 0.042). For all groups with a p-value < 0.10, a possible correlation was investigated between survival and body mass at injection (since bone tumor occurrence might be a function of longevity), but a significant relationship could not be determined. No significant differences could be established between the combined more massive and the combined less massive subgroups for any radionuclide. We conclude that, for the conditions in our experiment, relative size within a species does not contribute importantly to the sensitivity (lifetime occurrence) for induction of skeletal malignancy.

The mortality of all 14 319 workers employed at the Sellafield plant of British Nuclear Fuels between 1947 and 1975 was studied up to the end of 1992, and cancer incidence was examined from 1971 to 1986, in relation to their exposures to plutonium and to external radiation. The cancer mortality rate was 5% lower than that of England and Wales and 3% less than that of Cumbria. The significant excesses of deaths from cancer of the pleura and thyroid found in an earlier study persist with further follow-up (14 observed, 4.0 expected for pleura; 6 observed, 2.2 expected for thyroid). All of the deaths from pleural cancer were among radiation workers. For neither site was there a significant association between the risk of the cancer and accumulated radiation dose. There were significant deficits of deaths from cancers of mouth and pharynx, liver and gall bladder, and larynx and leukaemia when compared with the national rates. Among all radiation workers, there was a significant positive association between accumulated external radiation dose and mortality from cancers of ill-defined and secondary sites (10-year lag, P = 0.04), leukaemia (no lag, P = 0.03; 2-year lag, P = 0.05), multiple myeloma (20-year lag, P = 0.02), all lymphatic and haematopoietic cancers (20-year lag, P= 0.03) and all causes of death combined (20-year lag, P= 0.008). Among plutonium workers, there were significant excesses of deaths from cancer of the breast (6 observed, 2.6 expected) and ill-defined and secondary cancers (29 observed, 20.1 expected). No significant positive trends were observed between the risk of deaths from cancers of any specific site, or all cancers combined, and cumulative plutonium and external radiation doses. For no cancer site was there a significant excess of cancer registrations compared with rates for England and Wales. Analysis of trends in cancer incidence showed significant increases in risk with cumulative plutonium plus external radiation doses for all lymphatic and haematopoietic neoplasms for 0-, 10- and 20-year lag periods. Taken as a whole, our findings do not suggest that workers at Sellafield who have been exposed to plutonium are at an overall significantly increased risk of cancer compared with other radiation workers.

Purpose: To investigate the effects of preconception paternal irradiation (PPI) from injected 239Pu on the susceptibility to induction of lympho-haemopoietic malignancy by subsequent irradiation or exposure to a chemical carcinogen., Materials and Methods: The male CBA/H and DBA2 mouse was injected with 0, 128 or 256 Bqg(-1) 239Pu 12 weeks before mating with the normal CBA/H and C57B1 female respectively. CBA/H offspring were exposed to 3.3 Gy gamma-rays total body irradiation: BDF1 offspring were injected with 50 mg kg(-1) methyl nitrosourea (MNU). The offspring were assayed for changes in bone marrow progenitor cell numbers and chromosome aberrations and were followed up for subsequent induction of neoplasia., Results: While the untreated mouse showed a normal distribution for cellularity, spleen colony-forming units (CFU-S) and fibroblastoid colony-forming units (CFU-F), significant numbers of PPI offspring presented levels outside the normal range. There was a tendency for them also to show increased, dose-related, levels of chromosomal aberrations. Offspring treated with irradiation or MNU developed an increased incidence of lympho-haemopoietic malignancies., Conclusions: These studies have shown that PPI results in offspring that are more susceptible to the induction of lymphohaemopoietic malignancy on encountering a secondary carcinogenic insult. This may be linked to inherited chromosomal instability and abnormal kinetics of haemopoiesis. The experiments indicate a potential mechanism by which an increased incidence of leukaemia may be linked to PPI.

It was shown on the basis of retrospective investigation of 500 workers at a nuclear enterprise (162 cases of lung cancer, 338 persons as matching control) that the interaction of external gamma-irradiation (> 2.0 Gy) and the body-burden of 239Pu (> 9.3 kBq) at lung cancer incidence in multiplicative. Combined influence of smoking and radiation factors was found dependent on smoking index (SI): it changed from additive up to multiplicative and than to antagonistic with the increase of the smoking effect. The received results could be explained on the basis of a two-mutation model of radiation carcinogenesis.

About 1,500 tonnes of plutonium, 1,200 tonnes civilian, are now in world stockpiles, of which 200 tonnes have been separated from spent fuel in reprocessing plants. This will rise to 300 tonnes by the year 2000. Such reactor-grade plutonium contains a higher proportion of isotopes other than Pu-239, which progressively increases with longer burn-up. These isotopes have an increased risk of causing cancer, particularly if inhaled. Possible cancer rates from scattering of such plutonium in a city centre (e.g. by terrorist activity) are considered, and the implications of these calculations for the wisdom of continued reprocessing of spent nuclear reactor fuel are discussed.

The "dose-response" mechanism has been studied for three main histological types of tumor in a cohort of 500 workers occupationally exposed to different doses of radiation (162 patients with lung cancer and 338 practically healthy persons) using the "case-control" method and multifactorial logic regression procedure. A non-linear threshold dependence was established for incorporated plutonium, with the threshold being at 8 kBq to correspond to 80 kGy. This relationship has been particularly distinct in cases of adenocarcinoma. No significant results have been obtained for the "dose-response" relationship in chronic external exposure to gamma irradiation. Said dependence for tobacco smoking appeared to be linear. Most pronounced variations were recorded for squamous cell carcinoma.

Adenocarcinoma frequency in Pu incorporation-related lung cancer patients among plutonium workers was found to be 74% versus 33% in control. Each histological pattern of lung cancer appeared to be related to several etiological factors but in varying degree. Incorporated Pu proved the strongest factor in adenocarcinoma development. Its odds ratio (OR) was 6.9, while that for smoking-4.3. However, smoking appeared to be the most significant factor in squamous cell carcinoma genesis (OR-6.8). Among other factors were chronic obstructive pathology of the lung (OR-3.9) and reduced body weight (OR-2.1). The OR for Pu incorporation was 3.9. Squamous cell carcinomas were traced to reduced body weight (OR-2.9), heavy smoking (smoking index more than 500) (OR-3.5). However, no significant relationship has been established between carcinogenesis and Pu incorporation.

A case-control study using logistic regression included 500 employees of the nuclear works (162 patients with lung carcinoma and 338 healthy controls). After examination of radiation and nonradiation causative factors 5 proved statistically significant. For them the following chance proportions were obtained: smoking 6.6, plutonium pneumosclerosis 4.6, plutonium incorporation 3.1, chronic nonspecific pulmonary diseases 2.1, external gamma-radiation 1.6. Attributive risk for the total of the radiation factors makes up 25% at the most while of the nonradiation factors at least 70%.

Although alpha-emitting plutonium is easily distributed in the skeleton via circulation and subsequently induces bone tumors, there is little evidence that hematopoietic neoplasias are highly induced even though bone marrow stem cells are irradiated internally by alpha particles. We injected groups of female C3H strain mice with doses of 239Pu citrate from 500 to 10000 Bq to investigate the dose-related spectrum of tumor types induced during a lifetime. Survival time was reduced strikingly in all the injected mice due to much earlier induction of bone and lymphoid tumors as compared to the control animals that showed a variety of soft tissue tumors after a longer period of survival. Induction of osterosarcomas was dose-dependent, being maximal in 70% of the animals that received a mean skeletal dose of 10 Gy or less, but was 48% or less at 20 Gy or more. Non-thymic lymphomas accompanied by lymphocytic leukemia were observed in only 4-6% of the animals that received a dose of 10 Gy or less whereas it was maximal in 17-19% at 20 Gy or more. In contrast, there were no bone tumors in the control animals, rather thymic lymphomas or histiocytic lymphomas were found very late in 20% and other soft tissue tumors, including lung, liver and ovary tumors, were noted in 60%. Neither myeloid leukemia nor other myelogenous neoplasias were found in the control and 239Pu-injected animals that received a mean skeletal dose of 3 Gy or more. These results indicate that the differential induction of bone tumors and hematopoietic tumors in mice depends on the dose range and the time after the injection of plutonium.

Female Wistar strain rats were exposed to a single inhalation of a submicron-size aerosol of high-fired 239PuO2 to investigate pulmonary carcinogenesis during lifespan periods. The absorbed lung doses of the exposed animals ranged from 0.6 to 12 Gy and were well correlated with the initial lung deposition (ILD) of 0.1 to 2.3 kBq. Survival and induction of primary lung tumors in 116 exposed rats were compared with those in 56 untreated control rats in respect to lung doses received. Mean survival time was greatly reduced, and the cumulative incidence of total lung tumors was markedly increased to 90-100% in rats that received more than 4 Gy, whereas of the controls only one animal (1.8%) died of primary lung tumors. Primary but benign adenomas were present in exposed animals given 1.0 Gy or less, and the incidence of adenomas was 22-25% at 4-5 Gy, but decreased sharply to 3-5% at 6-8 Gy. In contrast, no malignant carcinomas, including adenocarcinomas, adenosquamous carcinomas and squamous cell carcinomas, developed at a dose of less than 1.0 Gy, whereas they were present in 75% or more of the rats given 4-10 Gy, but only in 55% at 12 Gy. Although there were no clear differences in the dose and time required for induction among the carcinoma types, all tended to develop in earlier periods after inhalation than adenomas. Despite the limited number of exposed animals that received lower doses, results suggest that malignant lung carcinomas are highly and early induced and have a different dose-effect relationship than benign adenomas at doses of more than 1 Gy after inhalation exposure to 239PuO2.

The health hazards associated with exposure to low levels of plutonium are reviewed since, though the world may escape a nuclear war, there may be virtually permanent contamination of the biosphere by plutonium from a number of sources. It would seem that it is possible to offer workers in the nuclear industry an acceptable level of protection but that low levels of pollution around such sites may build up until there is a hazard for people in the vicinity. The cases of childhood leukaemia found in the vicinity of the Sellafield facility may or may not be related to contamination in the area; however, plutonium is a potent carcinogen, and the foetus seems to be particularly vulnerable to it. The disposal of nuclear waste must be monitored more closely, and it is suggested that the International Atomic Energy Agency should take on this added responsibility.

The distribution of skeletal malignancies among our beagles injected with 239Pu as young adults roughly seems to follow the distribution of skeletal mass and skeletal 239Pu. These findings are similar to those we reported previously for a group of dogs given 26Ra. Although there were differences in tumor distribution between the animals given 226Ra and those given 239Pu, most of them were not statistically significant; however, the radium dogs seemed to show a greater sensitivity to bone tumor origin in the tibia, while there may have been a tendency among the plutonium dogs toward increased relative sensitivity in the scapula, lumbar vertebrae, sacrum, and ribs. In contrast, the most common site for the formation of naturally-occurring bone malignancy in the dog is the distal radius. Perhaps there were too few tumors and too few dogs to establish statistical significance. A correlation between tumor location and at least two anatomical-physiological factors in the skeleton indicated that these two factors (site-specific bone turnover rate and percent of red marrow at the site, which is correlated with vascularity) may influence the appearance of malignancies both individually and in combination. Except for the femur, there appeared to be no difference between the relative distribution of skeletal malignancies of low-level (30 Bq-2 Bq kg-1 injected) and high-level (3-122 kBq kg-1) dogs. Distribution of bone tumors between the axial and appendicular skeleton was 50% vs. 50% for 239Pu (42 and 42), but it was 39% axial vs. 61% appendicular (22 and 35, respectively) for dogs given 226Ra. This difference was not significant (p > 0.2).

Results of the analysis of dynamic body burdens of Pu in adult inhabitants of Chelyabinsk-65 (not occupationally exposed) and different areas of the Gomel region are presented for 1990-1991. The data are based on radiochemical analyses of Pu in human organs and tissues. Comparison with the published data on global Pu and our data for human autopsies (Ufa, Russia) revealed that estimates of Pubody burdens in Chelyabinsk-65 residents were up to 30 times higher than global levels and depended on the period of residence in town. The Pu body contents of Gomel citizens 4-5 years after the Chernobyl accident are on average 3-4 times higher than the global levels. Activity of Pu-238 in various organs constitutes 4.7-26.0% (on the average 13.5 +/- 5.0%) of the total alpha-activity of Pu-238 and Pu-239, 240. The expected number of cancers induced by incorporated plutonium is approximately the same for the two population groups despite their different sizes and does not differ from the global level by more than one order of magnitude.

Pulmonary cancer site was studied in 131 workers engaged into radioactive chemicals production and 178 examinees of control group. All examinees died in 1965-1989. Incorporation of plutonium-239 increased the number of lower lobe pulmonary cancers (upper-0.49; medium-0.06; lower-0.45) compared to 0.72; 0.03; 0.25 in control group. Ratio of cancer sites attributing to plutonium-239 was calculated for various levels of relative risk. Cancer site in the lower lobe appeared to show high probability attributing to plutonium-239 with relative risk over 1.39; in the case of upper lobe the relative risk was 3.67.

Female young adult, SPF, Wistar rats, obtained from the same supplier over an 18-month period, were examined in a life-span study with inhaled 239PuO2. Nonpulmonary tumors were evaluated both in 1052 rats comprising 16 controls groups and in 2105 exposed rats. Tumors in the pituitary gland, mammary glands, uterus, and thyroid glands, in order of decreasing prevalence, accounted for 90% of all tumors. Uterine tumors comprised 55% of all nonpulmonary malignant tumors. A substantial variability in tumor incidence was seen in most organs and for most tumor types among the 16 cohort subgroups, which was not explained by husbandry conditions or mortality patterns. The incidence of thyroid tumors ranged from 0 to 21% and uterine tumors from 14 to 45% among control cohorts. Pulmonary metastases were seen in 12% of all rats irrespective of treatment, two thirds of which were uterine adenocarcinomas that appeared histologically similar to some primary lung adenocarcinomas. A tumor incidence of about 1.5% was associated with metal identification ear tags. Except in the lung, no significant difference was found in tumor location or type between control and exposed rats. A twofold or greater increase in tumors in exposed rats was found in Zymbal gland, bladder, brain, and liver; tumor incidence in each organ was < 1%.