Attributable mortality to radon exposure in Galicia, Spain. Is it necessary to act in the face of this health problem?

<p>Abstract</p> <p>Background</p> <p>Radon is the second risk factor for lung cancer after tobacco consumption and therefore it is necessary to know the burden of disease due to its exposure. The objective of this study is to estimate radon-attributable lung cancer mortality in Galicia, a high emission area located at the Northwest Spain.</p> <p>Methods</p> <p>A prevalence-based attribution method was applied. Prevalence of tobacco use and radon exposure were obtained from a previously published study of the same area. Attributable mortality was calculated for each of six possible risk categories, based on radon exposure and smoking status. Two scenarios were used, with 37 Bq/m³and 148 Bq/m³as the respective radon exposure thresholds. As the observed mortality we used lung cancer mortality for 2001 from the Galician mortality registry.</p> <p>Results</p> <p>Mortality exclusively attributable to radon exposure ranged from 3% to 5% for both exposure thresholds, respectively. Attributable mortality to combined exposure to radon and smoking stood at around 22% for exposures above 148 Bq/m³. Applying the United States Environmental Protection Agency (EPA) action level, radon has a role in 25% of all lung cancers.</p> <p>Conclusions</p> <p>Although the estimates have been derived from a study with a relatively limited sample size, these results highlight the importance of radon exposure as a cause of lung cancer and its effect in terms of disease burden. Radon mitigation activities in the study area must therefore be enforced.</p

Risk assessment for potential radiation-induced cancer after lung and bone marrow exposure during interventional cardiology procedures

Interventional cardiology procedures (ICPs), while providing important benefits to patients, also contribute to their radiation exposure, in particular for the organs surrounding the heart. This paper addresses the issue of radiation exposure to the lung and bone marrow related to coronary interventions in terms of organ doses for coronary angiography (CA) and percutaneous transluminal coronary angioplasty (PTCA), and risk assessment of potential radiation-induced cancer. Dosimetric information on 2095 ICPs from French patients was collected. The median lung dose for CA alone was 34 mGy for men and 22 mGy for women and the median bone marrow dose was 8 mGy and 4 mGy, respectively; doses were slightly higher for CA and ad hoc PTCA and nearly twice as high for CA and elective PTCA. Based on the French national mortality registry and Biological Effects of Ionising Radiation VII models, spontaneous and radiation-induced lung cancers and leukaemia were estimated. For men and women aged at least 60 years old at the first ICP, excess risk of potentially fatal cancers attributable to radiation ranged from 0.4% to 4%. This study provides evidence of the potential risk of radiation-induced cancer after an ICP. The limitations of such calculations are due to the difficulty of taking into account patients’ possibly shorter life expectancy than in the general population, linked to their comorbidities and coronary disease. Nevertheless, risk estimates can be used to illustrate the beneficial role of optimisation of doses delivered to the patient

Interventional cardiology irradiation: clinical and dosimetric aspects of treated population

Context: Minimally invasive interventional cardiology procedures (ICP) have been widely used over the last 10 years, but can involve potentially high radiation doses to the patients. Although deterministic effects of ionising radiation are likely to occur in that field, stochastic effects, in particular radiation-induced cancers, have never been investigated in a population of adult patients. As a first step toward such investigation, a study was conducted with the view of characterizing clinical features and analysing variation factors of dosimetric data, based on a population undergoing ICP. Material and methods: A total of 1,591 patients who underwent 1 to 5 ICP, either coronarography and/or angioplasty, during the year 2005, at the Saint-Gatien Clinic in Tours (France), were included. Individual clinical characteristics were registered, dose-area product (DAP) values were recorded and patients organ doses to lung, sophagus, bone marrow and breast were assessed by a mathematical modelling. A logistic regression to test associations between high doses and clinical and technical factors was used. Results: Mean age of patients was 68 years. More than 60% of them had hypertension, 60% hypercholesterolemia and 25% diabetes. One patient out of three was smoker or ex-smoker, with higher percentage of patients aged less than 60 years. As for dosimetry, patient mean cumulative DAP value was 78.9 Gy.cm² and the mean effective dose was 15.8 mSv. The corresponding estimated mean organ doses were: 62.3 mGy for lung, 54.9 mGy for sophagus, 17.0 mGy for bone marrow and 5.6 mGy for breast. Based on univariate analysis, high DAP values (> 200 Gy.cm²) were significantly associated with gender, high body mass index, diabetes, hypertension, previous heart bypass, previous myocardial infarction, number of ICP, type of ICP (coronarography and/or angioplasty) and operator. In multivariate analysis, some of these factors remained significant: body mass index (OR=1.16, 95%CI=[1.10-1.21]), previous heart bypass (OR=3.13 [2.14-6.32]) and increased number of ICP (OR=3.82 [1.82-4.20]). Odds ratios were even higher when comparing coronary angioplasties to coronarographies (OR=20.72 [7.77-55.27]). Operator effect was also observed with an increased risk for one operator among the three others (OR=1.91 [1.15-3.18]). Conclusion: Radiation doses received by patients undergoing ICP can widely vary according to clinical characteristics but also technical characteristics of procedures. In order to plan epidemiological studies on the harmful stochastic effect of ionising radiation induced by ICP, such factors, which may be associated with higher DAP values, should be taken into account when designing epidemiological studies on highly irradiated patients

Patient cumulative radiation exposure in interventional cardiology

Interventional cardiology procedures can involve potentially high doses of radiation to the patients. Stochastic effects of ionising radiation – radiation-induced cancers in the long term – may occur. We analysed clinical characteristics and dosimetric data in a population of patients undergoing interventional cardiology. In all, 1 591 patients who had undergone coronarography and/or angioplasty in the course of a year at the Saint-Gatien Clinic in Tours (France) were included. Information on patients’ individual clinical characteristics and Dose-Area Product values were collected. Organ doses to the lung, oesophagus, bone marrow and breast were mathematically evaluated. The median age of patients was 70 years. Their median cumulative dose-area product value was 48.4 Gy.cm2 for the whole year and the median effective dose was 9.7 mSv. The median organ doses were 41 mGy for the lung, 31 mGy for the oesophagus, 10 mGy for the bone marrow and 4 mGy for the breast. Levels of doses close to the heart appear to be rather high in the case of repeated interventional cardiology procedures. Clinical characteristics should be taken into account when planning epidemiological studies on potential radiation-induced cancers

Uncertainty and sensitivity analysis in assessment of the thyroid cancer risk related to Chernobyl fallout in Eastern France.

International audienceThe increase in the thyroid cancer incidence in France observed over the last 20 years has raised public concern about its association with the 1986 nuclear power plant accident at Chernobyl. At the request of French authorities, a first study sought to quantify the possible risk of thyroid cancer associated with the Chernobyl fallout in France. This study suffered from two limitations. The first involved the lack of knowledge of spontaneous thyroid cancer incidence rates (in the absence of exposure), which was especially necessary to take their trends into account for projections over time; the second was the failure to consider the uncertainties. The aim of this article is to enhance the initial thyroid cancer risk assessment for the period 1991-2007 in the area of France most exposed to the fallout (i.e., eastern France) and thereby mitigate these limitations. We consider the changes over time in the incidence of spontaneous thyroid cancer and conduct both uncertainty and sensitivity analyses. The number of spontaneous thyroid cancers was estimated from French cancer registries on the basis of two scenarios: one with a constant incidence, the other using the trend observed. Thyroid doses were estimated from all available data about contamination in France from Chernobyl fallout. Results from a 1995 pooled analysis published by Ron et al. were used to determine the dose-response relation. Depending on the scenario, the number of spontaneous thyroid cancer cases ranges from 894 (90% CI: 869-920) to 1,716 (90% CI: 1,691-1,741). The number of excess thyroid cancer cases predicted ranges from 5 (90% UI: 1-15) to 63 (90% UI: 12-180). All of the assumptions underlying the thyroid cancer risk assessment are discussed

Chikungunya outbreak in Montpellier, France, September to October 2014.

International audienceIn October 2014, an outbreak of 12 autochthonous chikungunya cases, 11 confirmed and 1 probable, was detected in a district of Montpellier, a town in the south of France colonised by the vector Aedes albopictus since 2010. A case returning from Cameroon living in the affected district was identified as the primary case. The epidemiological investigations and the repeated vector control treatments performed in the area and around places frequented by cases helped to contain the outbreak. In 2014, the chikungunya and dengue surveillance system in mainland France was challenged by numerous imported cases due to the chikungunya epidemic ongoing in the Caribbean Islands. This first significant outbreak of chikungunya in Europe since the 2007 Italian epidemic, however, was due to an East Central South African (ECSA) strain, imported by a traveller returning from West Africa. Important lessons were learned from this episode, which reminds us that the threat of a chikungunya epidemic in southern Europe is real