ArticleBMJ (Clinical research ed.)2023
Cancer mortality after low dose exposure to ionising radiation in workers in France, the United Kingdom, and the United States (INWORKS): cohort study.
Article in BMJ (Clinical research ed.), 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 46 papers, 1 of them a synthesis that pooled it.
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Who cites it
46 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Occupational Protection in Interventional Radiology. A Joint Guideline of the Cardiovascular and Interventional Radiological Society of Europe and the Society of Interventional Radiology.Cardiovascular and interventional radiology · 2026Guideline
- Generative AI-based low-dose digital subtraction angiography for intra-operative radiation dose reduction: a randomized controlled trial.Nature medicine · 2026Trial
- The role of cytosolic mitochondrial DNA as a mitochondrial danger signal for stromal fibroblasts in forming the tumor-promoting microenvironment following radiation exposure.Journal of radiation research · 2026Review
- Review
- Diallyl disulfide reduces oxidative stress to mitigate uranium tailings radiation-induced damage to the hematopoietic system.Strahlentherapie und Onkologie : Organ der Deutschen Rontgengesellschaft ... [et al] · 2026Article
- The National Alliance for Radiation Readiness (NARR): Driving Partnerships Within the Radiation Readiness Workforce.Disaster medicine and public health preparedness · 2026Article
- 100 years of Personal Badge Radiation Doses in a Cohort of U.S. Radiologic Technologists: Expanded and Updated Reconstruction, 1916-2020.Radiation research · 2026Article
- Triglyceride-glucose index and structural chromosome aberrations in medical radiation workers: a cross-sectional study with a stratified dosimetry substudy.Frontiers in public health · 2026Article
- Mitochondrial damage and post-translational modifications in radiation-induced heart disease: mechanisms and emerging therapeutic targets.Frontiers in pediatrics · 2026Review
- Limited immune perturbations in mice exposed to sustained low-dose ionizing radiation.Frontiers in immunology · 2026Article
- Long-term environmental background radiation is associated with urinary tract cancer incidence: A population-based study from Finland.Cancer epidemiology · 2025Article
- Low-dose radiation exposure and health outcomes among healthcare workers: a multi-center prospective cohort study.Journal of health, population, and nutrition · 2025Article
- The shield multicentre collaborative: A study of hand surgeons' intraoperative radiation exposure and techniques to limit dosing.Journal of hand and microsurgery · 2025Article
- Risk of incident stroke and heart disease subtypes in a nationwide cohort of Korean radiation workers.Scandinavian journal of work, environment & health · 2025Article
- Cancer Mortality after Protracted Low-level Radiation Exposure for Early and Contemporary Workers in Two Large Occupational Cohorts in the U.S. Million Person Study.Radiation research · 2025Article
- Unraveling cellular dynamic changes in tumor evolution induced by long-term low dose-rate radiation.British journal of cancer · 2025Article
- Protracted exposure to low-dose ionising radiation and cancer incidence among Canadian nuclear power plant workers.Occupational and environmental medicine · 2025Article
- Analysis of intraoperative radiation exposure in paediatric orthopaedic and trauma patients: a comparative cohort study.BMJ paediatrics open · 2025Article
- Radiation Exposure During Contrast-Enhanced Videofluoroscopic Swallow Studies in Dogs and Cats.Veterinary radiology & ultrasound : the official journal of the American College of Veterinary Radiology and the International Veterinary Radiology Association · 2025Article
- Confounding Effects of Lifestyle Factors in Cancer Risk Estimation for Occupational Radiation Exposure.Safety and health at work · 2025Article
Corrections and comments
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Authors and funding
12 authors.
Funding
Abstract
objectiveTo evaluate the effect of protracted low dose, low dose rate exposure to ionising radiation on the risk of cancer.
designMultinational cohort study.
settingCohorts of workers in the nuclear industry in France, the UK, and the US included in a major update to the International Nuclear Workers Study (INWORKS).
participants309 932 workers with individual monitoring data for external exposure to ionising radiation and a total follow-up of 10.7 million person years.
main outcome measuresEstimates of excess relative rate per gray (Gy) of radiation dose for mortality from cancer.
resultsThe study included 103 553 deaths, of which 28 089 were due to solid cancers. The estimated rate of mortality due to solid cancer increased with cumulative dose by 52% (90% confidence interval 27% to 77%) per Gy, lagged by 10 years. Restricting the analysis to the low cumulative dose range (0-100 mGy) approximately doubled the estimate of association (and increased the width of its confidence interval), as did restricting the analysis to workers hired in the more recent years of operations when estimates of occupational external penetrating radiation dose were recorded more accurately. Exclusion of deaths from lung cancer and pleural cancer had a modest effect on the estimated magnitude of association, providing indirect evidence that the association was not substantially confounded by smoking or occupational exposure to asbestos.
conclusionsThis major update to INWORKS provides a direct estimate of the association between protracted low dose exposure to ionising radiation and solid cancer mortality based on some of the world's most informative cohorts of radiation workers. The summary estimate of excess relative rate solid cancer mortality per Gy is larger than estimates currently informing radiation protection, and some evidence suggests a steeper slope for the dose-response association in the low dose range than over the full dose range. These results can help to strengthen radiation protection, especially for low dose exposures that are of primary interest in contemporary medical, occupational, and environmental settings.
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