A causal relationship between protracted exposure to low-dose rate radiation and health effects remains unclear despite extensive international studies of nuclear workers. One potential reason is that radiation epidemiological studies that adjust for tobacco smoking, which heavily influences mortality, have been limited. In the present study, we examined radiation-related cancer risk by directly assessing the possible confounding effect of smoking, using data from two questionnaire surveys performed among Japanese nuclear workers in 1997 and 2003. Mortality follow-up was carried out for 71 733 male respondents for an average of 8.2 years during the observation period of 1999-2010. The mean cumulative dose was 25.5 mSv at the end of the follow-up period. Estimates of excess relative risk per Sv (ERRs/Sv) were obtained by Poisson regression. By adjusting for smoking directly on the basis of a linear dose-response model, we quantified the confounding effects of smoking on radiation risks. Statistically significant ERRs/Sv were found for all causes, all diseases, all non-cancer diseases, and liver cancer: 0.97 (90% confidence interval: 0.23, 1.78), 1.32 (0.40, 2.34), 1.87 (0.47, 3.49), and 4.78 (0.09, 11.68), respectively, without adjustment for smoking. However, the ERRs/Sv were no longer statistically significant after adjustment for smoking: 0.45 (-0.22, 1.19), 0.77 (-0.08, 1.72), 1.28 (-0.03, 2.79), and 3.89 (-0.46, 10.34), respectively. The ERRs/Sv for all cancers excluding leukaemia and lung cancer were not significant before adjustment for smoking, but declined after adjustment for smoking. The present study demonstrates that in this cohort of workers, smoking heavily distorts radiation risk estimates of mortality. The possibility of confounding by smoking depends on how strongly smoking is correlated with radiation exposure. If a correlation between smoking and radiation dose is suggested, smoking is an important confounder when assessing the radiation and health risks.

Estimation of cancer risk based on the organ-absorbed dose is underway for the Japanese Epidemiological Study on Low-Dose Radiation Effects (J-EPISODE). The reconstruction method for the organ-absorbed dose follows the approach adopted in the IARC 15-Country Collaborative Study, which examined the dosemeter response to photon exposure for the old film badge (FB) type, a multi-element FB and a thermoluminescence dosemeter. Until 2000, the dosemeters used in Japan were almost the same in the IARC study, so IARC study data could be used as they were. However, since 2000, the type of dosemeter has been replaced with active personal dosemeters (hereafter called electronic personal dosemeters), radio-photoluminescent glass dosemeters (Glass badge) and optically stimulated luminescence dosemeters (Luminess badge). Hence, it was necessary to collect these data again. A dosemeter response experiment was conducted using a device that irradiated an anthropomorphic phantom in the Japan Atomic Energy Agency calibration laboratories. The aim of the paper is to provide a conversion factor from reading in terms of Hp(10) to air kerma for realistic conditions for further conversion from air kerma to organ-absorbed dose. The obtained dosemeter responses for the dosemeter types currently used in Japan were consistent with those in the IARC study. These data will be utilized for J-EPISODE in reconstructing the organ-absorbed dose.

In order to reconstruct organ-absorbed dose from recorded dose for risk estimation in nuclear worker cohort, the preceding study of the International Agency for Research on Cancer (IARC) 15-Country Collaborative Study estimated the organ dose conversion factor from the recorded dose of Hp(10) under the assumption that on average, in the nuclear power plants (NPPs), 10% of the dose received by workers was due to photon energies ranging from 100 to 300 keV and 90% from photon energies ranging from 300 to 3000 keV, with the average geometry being 50% in the antero-posterior geometry and 50% in the isotropic geometry. Similar examination was conducted at the Japanese Epidemiological Study on Low-Dose Radiation Effects (J-EPISODE). Literature survey disclosed that Japanese electric power companies had jointly conducted the research on energy distribution and incidence direction distribution of gamma rays in working environments during periodical inspection and maintenance as well as during operation in the 1980s. The analysis of the survey results on photon energy and geometry distribution of Japanese NPPs demonstrated appropriateness in applying the IARC study assumption for nuclear workers in Japan and reconstructing organ-absorbed dose in the J-EPISODE. These results in Japan also provide strong evidence to support the robustness and generality of the IARC study assumption, which was estimated based on the judgment of experts at nuclear facilities around the world.

Supplemental digital content is available in the text.

An evaluation of cancer risk based on organ-absorbed dose is underway for the Japanese Epidemiological Study on Low-Dose Radiation Effects (J-EPISODE), which has analyzed health effects in association with radiation exposure evaluated with the personal dose equivalent H p (10). Although the concept of effective dose and its operational definition of H p (10) are widely used for radiological protection purposes, effective dose is not recommended for epidemiological evaluation. Organ-absorbed dose was instead adopted for the IARC 15-Country Collaborative study (15-Country study), the International Nuclear Workers Study (INWORKS), the Mayak worker study, and the Life Span Study (LSS) of atomic bomb survivors. The reconstruction method in J-EPISODE followed in principle the approach adopted in the 15-Country Study. As part of the approach of J-EPISODE, a conversion factor from photon dosimeter reading to air kerma was developed using dosimeter response data, which were measured by the experiment using an anthropomorphic phantom, and it was confirmed that the 15-Country study’s assumption of photon energy and geometry distribution in a work environment applied to Japanese nuclear workers. This article focuses on a method for reconstructing the conversion factor from photon dosimeter reading to organ-absorbed photon dose for a Japanese nuclear worker cohort. The model for estimating the conversion factor was defined under the assumption of a lognormal distribution from three concerned bias factors: (1) a dosimeter reading per air kerma, i.e., dosimeter response; (2) an organ-absorbed dose per air kerma; and (3) a factor relating to the differences in dose concepts and calibration practices between the roentgen dosimeter era and the present. Dosimeter response data were cited from the companion paper. Data on organ-absorbed photon dose per air kerma were estimated using a voxel phantom with the average Japanese adult male height and weight. The bias factor for the recorded dose in the roentgen era was defined, considering the backscatter radiation from the human body. The estimated values of organ-absorbed photon dose per air kerma were almost the same as those in ICRP Publication 116, revealing that the effect of differences in body size was almost negligible. The conversion factors from dosimeter reading to organ-absorbed dose were estimated by period (the roentgen era or from then), nuclear facility type (nuclear power plant or other), dosimeter type, and tissue or organ. The estimated conversion factors ranged from 0.7 to 0.9 (Gy Sv −1 ). The estimated cumulative organ-absorbed photon dose for the participants of J-EPISODE demonstrated that organ-absorbed dose values were approximately 0.8 times the recorded doses if neglecting dose-unit differences. J-EPISODE reconstructed an organ-absorbed dose conversion factor and will evaluate the risk of cancer mortality and morbidity using the organ-absorbe...