The risk of cancer associated with a broad range of organ doses was estimated in an international study of women with cervical cancer. Among 150,000 patients reported to one of 19 population-based cancer registries or treated in any of 20 oncology clinics, 4188 women with second cancers and 6880 matched controls were selected for detailed study. Radiation doses for selected organs were reconstructed for each patient on the basis of her original radiotherapy records. Very high doses, on the order of several hundred gray, were found to increase the risk of cancers of the bladder [relative risk (RR) = 4.0], rectum (RR = 1.8), vagina (RR = 2.7), and possibly bone (RR = 1.3), uterine corpus (RR = 1.3), cecum (RR = 1.5), and non-Hodgkin's lymphoma (RR = 2.5). For all female genital cancers taken together, a sharp dose-response gradient was observed, reaching fivefold for doses more than 150 Gy. Several gray increased the risk of stomach cancer (RR = 2.1) and leukemia (RR = 2.0). Although cancer of the pancreas was elevated, there was no evidence of a dose-dependent risk. Cancer of the kidney was significantly increased among 15-year survivors. A nonsignificant twofold risk of radiogenic thyroid cancer was observed following an average dose of only 0.11 Gy. Breast cancer was not increased overall, despite an average dose of 0.31 Gy and 953 cases available for evaluation (RR = 0.9); there was, however, a weak suggestion of a dose response among women whose ovaries had been surgically removed. Doses greater than 6 Gy to the ovaries reduced breast cancer risk by 44%. A significant deficit of ovarian cancer was observed within 5 years of radiotherapy; in contrast, a dose response was suggested among 10-year survivors. Radiation was not found to increase the overall risk of cancers of the small intestine, colon, ovary, vulva, connective tissue, breast, Hodgkin's disease, multiple myeloma, or chronic lymphocytic leukemia. For most cancers associated with radiation, risks were highest among long-term survivors and appeared concentrated among women irradiated at relatively younger ages.

This paper studies actual (real) house prices relative to fundamental (real) house values. Such a focus is warranted since housing constitutes a large fraction of most household portfolios, and its characteristics are such that, in contrast to what prevails in financial markets, arbitrage will be limited and hence correction toward 'true' value is likely to be a prolonged process. Using UK data and a time-varying present value approach, our results preclude the existence of an explosive rational bubble due to non-fundamental factors. We further find that intrinsic bubbles have an important role to play in determining actual house prices although price dynamics appear to impact, particularly in periods of strong deviation from fundamental value. Price dynamics are found to be driven by momentum behaviour. Copyright 2006 The Authors Journal compilation (c) 2006 Blackwell Publishing Ltd.

SummaryWe report on the first 18 months of two communities' efforts using methods inspired by community‐based participatory system dynamics for the development, implementation, and evaluation of whole of community efforts to improve the health of children. We apply Foster‐Fishman's theoretical framework for characterizing systems change to describe the initiatives. Bounding the system began with defining leaders more broadly than standard health interventions to be those who had the ability to change environments to improve health, including food retailers, government, and business, and using high‐quality childhood monitoring data to define the problem. Widespread access to junk food, barriers to physical activity, and efforts to promote health predominantly through programmatic approaches were identified as potential root causes. System interactions existed in the form of relationships between stakeholder groups and organizations. The approach described built new relationships and strengthened existing relationships. Willingness in taking risks, changing existing practice, and redesigning health promotion work to have a community development focus, were levers for change. This approach has resulted in hundreds of community‐led actions focused on changing norms and environments. Insights from this approach may be useful to support other communities in translating systems theory into systems practice. Further empirical research is recommended to explore the observations in this paper.

Mortality during 1946-1988 has been analyzed in 75,006 employees of the United Kingdom Atomic Energy Authority, the Atomic Weapons Establishment and the Sellafield plant of British Nuclear Fuels. All-cause mortality was 19% lower than national rates among workers monitored for external radiation exposure and 18% lower among nonmonitored workers. Cancer mortality was also lower than national rates and was similar in the two groups of workers [rate ratio (RR) = 0.96]. Of 29 specific cancer sites examined, only for cancers of the pleura and uterus were there statistically significant excesses of mortality in monitored workers relative to nonmonitored workers [RR = 7.08, two-sided P (2P) = 0.008 and RR = 3.02, 2P = 0.003, respectively]. There was little association between cumulative external radiation and risk of death from all cancers combined 10 or more years after exposure [z for trend = +0.11, one-sided P (1P) = 0.5]. A positive association was observed for leukemia (assuming a 2-year lag between external radiation and increasing risk of death) (1P = 0.009) but not for other cancers associated with external radiation in previous analyses (lung, uterus, prostate and multiple myeloma, all 1P > or = 0.1). Positive associations (1P < or = 0.05) were also observed for melanoma and other skin cancers (1P = 0.03) and ill-defined and secondary cancers (1P = 0.04), but these results are difficult to interpret and, given the number of associations examined, may be chance findings. Estimates of excess relative risk per sievert were -0.02 (95% CI = -0.5-+0.6) for all cancers except leukemia and +4.18 for leukemia (95% CI = +0.4-+13.4). The positive estimates for leukemia contrast with negative values found for workers in the United States, although the confidence intervals obtained in the two studies overlap. While our estimates of risk are compatible with those derived from studies of A-bomb survivors, the statistical uncertainty associated with them is such that the data are consistent with risks ranging from no additional risk to twice the risk for cancers other than leukemia and, for leukemia, from one-fifth to three times the risk in A-bomb survivors.

A total of 22 552 workers employed by the Atomic Weapons Establishment between 1951 and 1982 were followed up for an average of 18*6 years. Of the 3115 who died, 865 (28%) died of cancer. Mortality was 23% lower than the national average for all causes ofdeath and 18% lower for cancer. These low rates were consistent with the findings in other workforces in the nuclear industry and reflect, at least in part, the selection of healthy people to work in the industry and the disproportionate recruitment of people from the higher social classes.At some time during their employment 9389 (42%) of the workers were monitored for exposure to radiation, the average cumulative whole body exposure to external radiation being 7*8 mSv. Their mortality was generally similar to that of other employees, even when exposures were lagged by 10 years. The rate ratio after a 10 year lag in workers with a radiation record compared with other workers was 1*01 (95% confidence interval 0-92 to 1.10) for all causes of death and 1-06 (0.89 to 1-27) for all malignant neoplasms. The only significant differences were for prostatic cancer (rate ratio 2*23; 95% confidence interval 1*13 to 4.40) and for cancers of ill defined and secondary sites (rate ratio 2*37; 1-23 to 4.56). Cancers of lymphatic and haemopoietic tissues were notable for their low occurrence in the study population, with only four deaths from leukaemia and two from multiple myeloma in workers with a radiation record, 9 16 and 3*55 deaths respectively being expected on the basis of national rates.Among workers who had a radiation record 3742 (40%) were also monitored for possible internal exposure to plutonium, 3044 (32%) to uranium, 1562 (17%) to tritium, 638 (7%) to polonium, and 281 (3%) to actinium. In these workers mortality from malignant neoplasms as a whole was not increased, but after a 10 year lag death rates from prostatic and renal cancers were generally more than twice the national average, these excesses arising in a small group of workers monitored for exposure to multiple radionucfides. Though mortality from lung cancer in workers monitored for exposure to plutonium was below the national average, it was some two thirds higher than in other radiation workers, the excess being of borderline statistical significance.Mortality from malignant neoplasms as a whole showed a weak and non-significant increasing trend with increasing level of cumulative whole body exposure to external radiation. When the exposures were lagged by 10 years the trend became stronger and significant, the estimated increase in relative risk per 10 mSv being 7*6% (95% confidence interval 0*4% to 15.3%). This trend was confined almost entirely to workers who were also monitored for exposure to radionuclides (p<0001), the main contributions coming from lung cancer and prostatic cancer. Exposures of the lung and prostate from internal sources of radiation were not quantified, except for the contribution from tritium. It was therefore not possible to assess the extent to which the associati...

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Background: The workforce of the UK Atomic Energy Authority has been the subject of several previous epidemiological investigations. Aims: To detect and investigate associations between mortality rates and employment in a substantially increased cohort size and follow up extended to 1997. Methods and Results: The new cohort included 51 367 employees, of whom 10 249 were dead. Mortality rates for all workers were low compared to national rates, as were rates in radiation workers and for workers monitored for internal contamination. For radiation workers all cause mortality and all cancer mortality were significantly lower than for non-radiation workers. There was no overall trend of increasing mortality with radiation dose. There was little evidence of raised mortality from leukaemia. The association of prostatic cancer with radiation dose was much less significant than in previous reports. However, the relatively high mortality from uterine cancers among radiation workers remained, though the numbers were very small. The association was with endometrial rather than cervical cancer. Mortality from cancer of the pleura was high among radiation workers, but was not correlated with dose. Conclusion: Overall, radiation workers at UKAEA showed no excess mortality. The previously detected association of prostate cancer with high radiation dose may have been a statistical artefact or a risk associated with discontinued activities. Endometrial cancer occurred at higher rates in female radiation workers, but, because there was no correlation with dose, may well be due to something other than their radiation exposure. Cancer of the pleura in radiation workers was almost certainly related to past asbestos exposure.

The relationship between breast cancer and radiation treatment for cervical cancer was evaluated in an international study of 953 women who subsequently developed breast cancer and 1,806 matched controls. Radiation doses to the breast (average 0.31 Gy) and ovaries (average 32 Gy) were reconstructed for exposed subjects on the basis of their original radiotherapy records. Overall, 88% of the breast cancer cases and 89% of the controls received radiation treatment [relative risk (RR) = 0.88; 95% confidence interval (CI) = 0.7-1.2]. Among women with intact ovaries (561 cases, 1,037 controls), radiotherapy was linked to a significant 35% reduction in breast cancer risk, attributable in all likelihood to the cessation of ovarian function. Ovarian doses of 6 Gy were sufficient to reduce breast cancer risk but larger doses did not reduce risk further. This saturation-type response is probably due to the killing of a critical number of ovarian cells. Cervical cancer patients without ovaries (145 cases, 284 controls) were analyzed separately because such women are at especially low natural risk for breast cancer development. In theory, any effect of low-dose breast exposure, received incidentally during treatment for cervical cancer, should be more readily detectable. Among women without ovaries, there was a slight increase in breast cancer risk (RR = 1.07; 95% CI = 0.6-2.0), and a suggestion of a dose response with the RR being 1.0, 0.7, 1.5 and 3.1 for breast doses of 0, 0.01-0.24, 0.25-0.49 and 0.50+ Gy, respectively. However, this trend of increasing RR was not statistically significant. If low-dose radiation increases the risk of breast cancer among women over age 40 years, it appears that the risk is much lower than would be predicted from studies of younger women exposed to higher doses.