Review of the Worker and Public Health Activities Program Administered by the Department of Energy and the Department of Health and Human Services (2006) / Chapter Skim
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2 Scientific Program Assessment: National Institute for Occupational Safety and Health
2 Scientific Program Assessment: National Institute for Occupational Safety and Health
Pages 36-93
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From page 36... ...
, the committee sampled research products at three DOE sites: Hanford, Oak Ridge National Laboratory (ORNL) , and Los Alamos National Laboratory (LANL)
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From page 37... ...
Non-radiologic health studies focused primarily on beryllium-related issues; and 5. The contribution of DOE sites to international studies of cancer mortality among nuclear workers.
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From page 38... ...
has a complex interplay with exposure as well, with most exposures at most sites being received by lower-status workers. Over these studies as a whole, therefore, the committee notes enormous challenges in the evaluation of existing records of exposure, especially chemical and internal radiation exposures, but also in many cases (generally for the early years)
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From page 39... ...
Data from one ongoing case-control study of multiple myeloma at the K-25 facility, which began in 1995, have yet to be analyzed. Much of the work has focused on ORNL (X-10)
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The study found limited evidence of any dose-response relationships for radiogenic cancers. As with the other DOE sites, investigators were not able to control for potential confounding with lifestyle factors or occupational exposures other than ionizing radiation.
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From page 41... ...
A key criticism made by the "Dead Reckoning" monograph (PSR 1992) of pre-MOU occupational radiation exposure studies at DOE sites was their reliance on small sample sizes at single facilities rather than on an overall evaluation of hazards to the entire DOE workforce.
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From page 42... ...
. Furthermore, when properly combined with the IARC pooled analysis, this study could provide important information regarding leukemia risk as a function of protracted exposure to low-dose-rate radiation.2 Multisite Multiple Myeloma Study This study was undertaken by investigators at the University of North Carolina.
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Multisite Female Nuclear Workers Mortality Study The pooled female worker study surveyed the mortality of approximately 68,000 female workers at 12 DOE sites (Wilkinson et al.
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To increase sample size, female workers from 12 DOE sites were considered in the analysis. As noted by the authors, workers received both internal and external radiation exposures.
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From page 45... ...
It is especially notable that approximately 43 percent of cancers were at tumor sites considered to be smoking-related. Since risk estimates for these tumor sites may be seriously biased if tobacco use and radiation exposure are correlated, additional analyses were conducted restricted to solid tumor sites unrelated to smoking.
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From page 46... ...
Even short-term exposures to beryllium fumes, dust, or metal oxides can result in beryllium sensitization and subsequently chronic beryllium disease in some workers.8 As part of an epidemiological research review provided to DOE in 1989, the National Research Council (NRC 1989) recommended that DOE make efforts to quantify exposures to and effects from agents in addition to ionizing radiation.
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From page 47... ...
. Beryllium-related research performed under the MOU followed several lines of scientific investigation including beryllium exposure-disease relationships; the rate of progression from beryllium sensitization to chronic beryllium disease; use of the blood beryllium lymphocyte proliferation test (BeLPT)
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From page 48... ...
Incorporation of the uncertainty of dose estimation into dose-response analysis in DOE and occupational radiation epidemiology studies in general. Assessment of the quality of records for assessing exposure to chemicals, lifestyle-related exposures, and external and internal radiation for the DOE worker cohorts including: · historical worker exposures, · current practices (e.g., for cleanup workers)
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From page 49... ...
estimates that for the PNS workers only about 1 percent or less of the total collective dose was below the detectable limit, which would imply virtually no significant effect of this issue on risk estimation. The relevance of this finding to the DOE sites is not completely clear, but other indications (such as the doseresponse analyses performed by Xue and colleagues for the ORNL cohort, Xue et al.
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The derivation of bias and uncertainty factors for external dose was extended to the DOE sites considered in the multi-site leukemia study by Daniels and Schubauer-Berrigan (2005)
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The identification of this gap by NIOSH in current DOE practice is an important contribution. One project funded extramurally, "Sentinel Exposure Event Surveillance/Evaluation at DOE Sites" (LaMontagne et al.
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Additional studies that NIOSH lists as uncompleted include the following:11 Intramural · Chronic Lymphocytic Leukemia (CLL) · Cohort Mortality Study of Fernald Environmental Management Plant Extramural · Health Effects of Occupational Exposures in Paducah Gaseous Diffu sion Plant Workers · Stochastic Models for Radiation Carcinogenesis: Temporal Factors and Dose-Rate Effects · Susceptibility and Occupational Radiation Risks · Radon and Cigarette Smoking Exposure Assessment in Fernald Workers ACERER continued to provide advice to the Secretary of HHS regarding the OERP research agenda until 2000.
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From page 53... ...
In the A-bomb study the RR per Sv for all non-cancers is about one-third of the number for all solid tumors. This means that "much" larger case-control studies would be necessary to confirm that low protracted doses also raise risks of all non-cancer mortality.
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From page 54... ...
Specifically, there were important and outstanding scientific issues addressed by the research under the MOU concerning the effect of chronic low dose exposures, especially in comparison to the extrapolations made from high-dose studies that have been used previously to develop radiation protection standards. It appears to the committee that a major NIOSH effort for improving the epidemiology at DOE sites was to move from cohort mortality studies, relying on the limited amount of data14 available for all workers in a given cohort, to nested 14Generally age, sex, race, and in most cases summaries of employment and external radiation dose history, as well as life status at end of follow-up and cause of death for the deceased.
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From page 55... ...
The same general issue arises in evaluating other studies; for example, the subjects in the female nuclear workers study had a dose distribution that is lower than the cohorts overall, and therefore, studies of female workers have less power to define radiation effects than would studies of cohorts of male and female workers or a cohort of only male workers. Moreover, on an absolute risk scale, females do not appear to be more sensitive than men to radiation in the high dose studies.
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From page 56... ...
Two of the studies reviewed above, the Female Nuclear Workers Study and the Childhood Leukemia Case Control Study, did not result in any peer-reviewed publications. Gaps in the research record include reports from long-delayed studies such the K25 multiple myeloma case-control study.
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From page 57... ...
In combination with the very recent results from the multisite leukemia case-control study, which has relatively little overlap with the IARC study, the leukemia dose-response to this low-dose-rate, protracted exposure should also be better defined. In all likelihood, these findings will impact DOE policy directly by buttressing the current administrative limits of 2 rem per year for occupational exposure with additional empirical evidence for the effects of protracted low-dose-rate radiation exposures on cancer risk.
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From page 58... ...
These other sources of exposure include diagnostic radiation exposures, environmental or residential exposures, or potential radiological exposures resulting from industrial accidents or an act of terrorism. By having this work continue under the auspices of NIOSH, DOE benefits by enhancing the openness and independence with which the studies are conducted, thereby reducing public perceptions of, or actual potential for, conflicts of interest between DOE's responsibilities to the health of its workers and citizens and its other responsibilities and mandates.
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From page 59... ...
DOE should explore the development of a process that captures current exposure data as well as health outcome data for placement in a secure centralized repository: this process should include external radiation exposure, internal radiation expo sure, chemical exposure, medical surveillance (e.g., spirometry, liver func tion tests, smoker versus never smoker) , and biological monitoring, as well as social security number and demographic information (e.g., gender, birth date)
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From page 60... ...
3. Improved Techniques to Reconstruct Past Exposure The committee finds that continued research into the health of the past and current DOE workforce benefits DOE by enhancing methods of reconstructing past exposures and that the continued development of such methodology is important to the evaluation of worker and public health effects at the DOE sites.
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From page 61... ...
The initial phase would be for NIOSH to provide a justification for pooling particular DOE sites and cohorts based on the completeness and accuracy of radiation exposure data and on the site-specific potential for confounding between measured external radiation exposures and unmeasured (e.g., internal radiation, chemical, asbestos) exposures.
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From page 62... ...
examined population-based state cancer registries to determine their feasibility and suitability for occupational studies. Information was collected from statewide cancer registries in 16 states, including those that contained DOE sites and adjacent states.
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From page 63... ...
Gaps in the research record include reports from long-delayed studies such the K-25 multiple myeloma case-control study. While the exposure reconstruction for the myeloma study is especially complex (e.g., internal and external radiation exposures, chemical exposures)
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From page 64... ...
that archive specimens such as blood and DNA to support future studies. ANNEX 2A NIOSH RESEARCH PUBLICATIONS NIOSH provided independently (NIOSH 2005)
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From page 65... ...
SCIENTIFIC PROGRAM ASSESSMENT: NIOSH 65 through literature searches and inspection of the acknowledgments for mention of NIOSH grant numbers." This committee has not included certain categories from the provided list, such as extended abstracts. The committee also notes that the NIOSH Intramural and Extramural catagories are apparently classified as such for NIOSH record-keeping purposes.
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From page 66... ...
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From page 67... ...
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From page 68... ...
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From page 69... ...
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From page 70... ...
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From page 71... ...
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From page 73... ...
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From page 74... ...
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From page 75... ...
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From page 76... ...
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From page 77... ...
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From page 78... ...
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From page 79... ...
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From page 80... ...
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From page 81... ...
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From page 82... ...
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From page 83... ...
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From page 84... ...
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From page 85... ...
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From page 86... ...
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From page 87... ...
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From page 88... ...
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From page 89... ...
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From page 90... ...
1995. Effects of low doses and low dose rates of external ionizing radiation: cancer mortality among nuclear industry workers in three countries.
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From page 91... ...
2006. Biologically based analysis of lung cancer incidence in a large Canadian occupational cohort with low-dose ionizing radiation exposure, and comparison with Japanese atomic bomb survivors.
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From page 92... ...
1997. Case-Control Study of Multiple Myeloma Among Workers Exposed to Ionizing Radiation and Other Physical and Chemical Agents.
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From page 93... ...
2000. A case control study of multiple myeloma at four nuclear facilities.
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