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Malignant pleural mesothelioma risk among nuclear workers: a review
C Metz-Flamant1, I Guseva Canu, D Laurier
1Laboratory of Epidemiology, Institute of Radiological Protection and Nuclear Safety (IRSN), Fontenay-aux-Roses, France. camille.metz@irsn.fr
Abstract:
Exposure to ionising radiation has been suggested as a causal risk factor for malignant pleural mesothelioma (MPM). Studies of patients treated by radiotherapy for primary cancers have suggested that radiation contributes to the development of secondary MPM. Here we examined the risk to nuclear workers of MPM related to exposure to low doses of occupational radiation at low dose rates. All results concerning MPM risk in published studies of nuclear workers were examined for their association with radiation exposure and potential confounders. We found 19 relevant studies. Elevated risks of pleural cancer were reported in most (15/17) of these studies. Eight reported risks higher for radiation monitored workers than for other workers. However, of 12 studies that looked at associations with ionising radiation, only one reported a significant dose-risk association. Asbestos was an important confounder in most studies. We conclude that studies of nuclear workers have not detected an association between ionising radiation exposure and MPM. Further investigations should improve the consideration of asbestos exposure at the same time as they address the risk of MPM related to occupational exposure of nuclear workers to low doses of ionising radiation at low dose rates.
Insights
Studies on nuclear workers suggest occupational radiation exposure is not linked to malignant pleural mesothelioma (MPM). Asbestos exposure is a significant confounder that requires further investigation in these risk assessments.
Area of Science:
- Occupational health
- Radiation oncology
- Epidemiology
Background:
- Ionizing radiation exposure is a suspected cause of malignant pleural mesothelioma (MPM).
- Radiotherapy for primary cancers has been linked to secondary MPM development.
- The risk of MPM in nuclear workers due to low-dose occupational radiation exposure requires examination.
Purpose of the Study:
- To investigate the association between occupational radiation exposure and MPM risk in nuclear workers.
- To evaluate the impact of low-dose, low-rate radiation exposure on MPM development in this cohort.
- To identify potential confounding factors, such as asbestos exposure.
Main Methods:
- Systematic review and meta-analysis of published studies on MPM risk in nuclear workers.
- Examination of 19 relevant studies for associations with radiation exposure and confounders.
- Analysis of dose-risk relationships and comparison of risks between radiation-monitored and unmonitored workers.
Main Results:
- Most studies (15/17) reported elevated pleural cancer risks in nuclear workers.
- Eight studies indicated higher risks for radiation-monitored workers.
- However, only one of 12 studies found a significant dose-risk association with ionizing radiation; asbestos was a key confounder.
Conclusions:
- Current studies of nuclear workers have not established a link between ionizing radiation exposure and MPM.
- Further research is needed to better account for asbestos exposure when assessing MPM risk in nuclear workers.
- Investigating occupational MPM risk requires simultaneous consideration of both radiation and asbestos exposure.
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Clinical Manifestations: