with mortality registries and, where they exist, with national tumor (and other disease) registries. Where national dose registries cannot be set up, cohort studies based on records of nuclear installations are a useful alternative. It is noted that the power of individual cohort studies at the local and even national levels is limited. To maximize the information about the effects of low-dose, protracted exposures from these studies, it is therefore necessary to combine data across cohorts and countries. Most studies published to date have been based on relatively short follow-up periods, and the majority of workers were still young at the end of follow-up. Extended mortality follow-up over the next decades—and, where possible, cancer morbidity follow-up—of these workers, as they enter an age range when cancer incidence and mortality rates increase, will provide useful improvements of the direct cancer risk estimates drawn from these studies of exposure to low-dose, low-LET radiation. It is also important to continue follow-up of workers exposed to relatively high doses, that is, workers at the Mayak nuclear facility and workers involved in the Chernobyl cleanup.

Environmental Radiation Studies

Ecologic studies of populations living around nuclear facilities and of other environmentally exposed populations do not contain individual estimates of radiation dose or provide a direct quantitative estimate of risk in relation to radiation dose. This limits the interpretation of these data.

Several cohort studies have reported health outcomes among persons exposed to environmental radiation. No consistent or generalizable information is contained in these studies. Four ecologic studies of populations exposed to natural background did not find any association between disease rates and indicators of high background levels of radiation exposure. Ecologic studies of children of adults exposed to radiation while working at the Sellafield nuclear facility in Great Britain have suggested some increased risk of leukemia and lymphoma associated with individual dose, but the findings are based on small numbers of cases and the results across studies are not consistent.

Evidence from ecologic studies does not indicate an increased risk of leukemia among persons exposed in utero to radiation from Chernobyl or an increase in rates of childhood leukemia. In contrast to a considerable body of evidence regarding the risk of thyroid cancer in persons exposed to external radiation, there is relatively little information regarding the risk of thyroid cancer in humans exposed internally to 131I. There is some evidence of a small increase in thyroid cancer associated with exposure to 131I from therapeutic and diagnostic uses, but the findings are inconsistent and the small increases in thyroid cancer observed in some studies may be due to the underlying thyroid condition and not radiation exposure.

Results from external environmental exposures to 131I have been inconsistent. The most informative findings are from studies of individuals exposed to radiation after the Chernobyl accident. Recent evidence indicates that exposure to radiation from Chernobyl is associated with an increased risk of thyroid cancer and that the relationship is dose dependent. The quantitative estimate of excess thyroid cancer risk is generally consistent with estimates from other radiation-exposed populations and is observed in both males and females. Iodine deficiency appears to be an important modifier of risk, enhancing the risk of thyroid cancer following radiation exposure.

Ecologic studies of persons exposed to environmental sources of ionizing radiation have not been useful in developing risk estimates. Exposure levels are low, the studies relate to exposure of populations rather than individuals, and there is minimal possibility of follow-up of exposed individuals. The few exceptions to these circumstances are populations where there is unusual exposure because of accidents involving radiation exposure or long-term releases of relatively high levels of ionizing radiation (e.g., Chernobyl, Hanford).

Research Need 10. Future environmental radiation studies

In general, additional ecologic studies of persons exposed to low levels of radiation from environmental sources are not recommended. However, if disasters occur in which a local population is exposed to unusually high levels of radiation, it is important that there be a rapid response not only for the prevention of further exposure but also for the establishment of scientific evaluation of the possible effects of exposure. The data collected should include basic demographic information on individuals, estimates of acute and possible continuing exposure, the nature of the ionizing radiation, and the means of following these individuals for many years. The possibility of enrolling a comparable nonexposure population should be considered. Studies of persons exposed environmentally as a result of the Chernobyl disaster or as a result of releases from the Mayak nuclear facility should continue.

INTEGRATION OF BIOLOGY AND EPIDEMIOLOGY

This chapter highlights the ways in which cellular, molecular, and animal data can be integrated with epidemiologic findings in order to develop coherent judgments on the health effects of low-LET radiation. Emphasis is placed on data integration for the purposes of modeling these health risks. The principal conclusions from this work are the following:



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