Cancer mortality in workers at risk of occupational exposure to ionizing radiation in a company in the nuclear sector headquarters in São Paulo

Vieira, Glacy Sabra; Martinez, Maria Carmen; Cardoso, Maria Regina Alves

doi:10.1590/1980-549720240011

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Revista Brasileira de Epidemiologia

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Original Article • Rev. bras. Epidemiol. 27 • 2024 • https://doi.org/10.1590/1980-549720240011 copy

Cancer mortality in workers at risk of occupational exposure to ionizing radiation in a company in the nuclear sector headquarters in São Paulo

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

To compare cancer mortality among workers exposed to gamma and X radiation and the general population of the city of São Paulo, as well as that of the subgroup monitored with those not monitored for gamma and X radiation in a work unit with ionizing radiation based in the city of São Paulo.

Methods:

Between 2016 and 2021, a retrospective open cohort study was carried out with workers who were employed from 08/31/1956 to 12/31/2016 based on data collected at the company and in official institutions. Standardized mortality ratios (SMR) were calculated by sex, age and calendar period of cancers grouped according to type, risk factor and organ system in two analyses: in the external analysis, the mortality of the study population was compared with that of the general population of the city of São Paulo; In the internal analysis, the mortality of the monitored subgroup was compared with that of the subgroup not monitored for gamma and X radiation.

Results:

The external mortality analysis showed SMR=0.224 (95%CI 0.208–0.240) and the healthy worker effect, while the internal mortality analysis showed SMR=0.685 (95%CI 0.618–0.758).

Conclusion:

This study showed lower cancer mortality among exposed workers when compared to mortality in the general population and the healthy worker effect. Among workers monitored for gamma and X radiation, cancer mortality was lower when compared to those not monitored.

Keywords:
Ionizing radiation; Worker; Occupational exposure; Neoplasms., Mortality; Cohort studies

Characteristics		Males		Females		Total
Characteristics		N°	%	N°	%	N°	%
Age range (in years) at the end of follow-up
	15 ├ 35	42	1.0	15	1.0	57	1.0
	35 ├ 50	256	6.1	133	9.1	389	6.9
	50 ├ 60	1,542	36.9	473	32.2	2,015	35.7
	≥60	2,334	55.9	848	57.7	3,182	56.4
Calendar period for employment
	1956 to 1959	45	1.1	9	0.6	54	1.0
	1960 to 1969	274	6.6	106	7.2	380	6.7
	1970 to 1979	1,810	43.4	727	49.5	2,537	45.0
	1980 to 1989	1,857	44.5	488	33.2	2,345	41.6
	1990 to 1999	98	2.3	84	5.7	182	3.2
	2000 to 2016	90	2.2	55	3.7	145	2.6
Length of employment (in years)
	Less than 1.0	930	22.3	255	17.4	1,185	21.0
	1.0 to 4.9	1,621	38.8	457	31.1	2,078	36.8
	5.0 to 9.9	446	10.7	181	12.3	627	11.1
	10.0 to 19.9	342	8.2	163	11.1	505	8.9
	20.0 to 29.9	291	7.0	204	13.9	495	8.8
	30.0 to 39.9	473	11.3	177	12.0	650	11.5
	40.0 to 49.9	69	1.7	32	2.2	101	1.8
	50.0 or more	2	0.0	0	0.0	2	0.0
Characteristics of the position held
	High-level position	273	6.5	183	12.5	456	8.1
	Mid-level position	2,046	49.0	774	52.7	2,820	50.0
	Hybrid position (mid- and higher-level)	1,789	42.9	443	30.2	2,232	39.6
	Unknown	66	1.6	69	4.7	135	2.4
Risk of exposure to gamma and X radiation
	No	1,664	39.9	691	47.0	2,355	41.7
	Yes	2,510	60.1	778	53.0	3,288	58.3
Vital status at the end of follow-up
	Alive	3,532	84.6	1,330	90.5	4,862	86.2
	Died from cancer	139	3.3	57	3.9	196	3.5
	Died from other causes	503	12.1	82	5.6	585	10.4
Total		4,174	100.0	1,469	100.0	5,643	100.0

Characteristics		Males			Females			Total
Characteristics		N°	%	CMR	N°	%	CMR	N°	%	CMR
Causes
	All causes	642	100.0	698.6	139	100.0	431.2	781	100.0	629.2
	All cancers	139	21.7	151.3	57	41.0	176.8	196	25.1	157.9
	All causes except cancer	503	78.3	547.4	82	59.0	254.4	585	74.9	471.3
Organic system
	Digestive	64	46.0	69.6	16	28.1	49.6	80	40.8	64.4
	Respiratory	32	23.0	34.8	10	17.5	31.0	42	21.4	33.8
	Genitourinary	15	10.8	16.3	21	36.8	65.1	36	18.4	29.0
	Hematogenous	13	9.4	14.1	5	8.8	15.5	18	9.2	14.5
	Musculoskeletal	3	2.2	3.3	2	3.5	6.2	5	2.6	4.0
	Eyes and Central Nervous System	6	4.3	6.5	2	3.5	6.2	8	4.1	6.4
	Skin	1	0.7	1.1	1	1.8	3.1	2	1.0	1.6
	Uncertain	5	3.6	5.4	0	0.0	0.0	5	2.6	4.0
Total		139	100.0	151.3	57	100.0	176.8	196	100.0	157.9

			Males				Females				Total
			O	E	SMR	95%CI	O	E	SMR	95%CI	O	E	SMR	95%CI
Causes of death
	All causes		623	2,717.5	0.229	0.462–0.541	137	677.6	0.202	0.170–0.239	760	3,395.0	0.224	0.208–0.240
	All cancers		137	352.0	0.389	0.327–0.460	56	88.0	0.636	0.481–0.826	193	440.0	0.439	0.379–0.505
	All causes except cancer		486	2,365.4	0.205	0.188–0.225	81	589.6	0.137	0.109–0.171	567	2,955.0	0.192	0.176–0.208
Cancer groups
Type
	Solid		119	308.3	0.386	0.320–0.462	51	75.8	0.673	0.501–0.884	170	384.1	0.443	0.379–0.514
		Unspecified	5	18.5	0.270	0.087–0.629	0	5.2	0.000	---. 0.701	5	23.8	0.210	0.068–0.491
		Hematogenous	13	24.9	0.523	0.278–0.894	5	6.9	0.720	0.232–1.679	18	31.8	0.566	0.335–0.895
	Risk factor
		Related to alcoholism	51	138.5	0.368	0.274–0.484	29	37.2	0.779	0.521–1.118	80	175.7	0.455	0.361–0.567
		Related to smoking	96	234.6	0.409	0.331–0.500	26	43.0	0.605	0.395–0.886	122	277.6	0.439	0.365–0.525
		Related to work	94	232.4	0.405	0.327–0.495	48	61.5	0.780	0.575–1.035	142	293.9	0.483	0.537–0.647
		Gamma and X radiation	77	191.0	0.403	0.318–0.504	45	51.5	0.873	0.637–1.168	122	242.5	0.503	0.418–0.601
	Organic system
		Digestive	63	149.7	0.421	0.323–0.538	15	30.2	0.497	0.278–0.820	78	179.9	0.434	0.343–0.541
		Respiratory	32	73.8	0.434	0.297–0.612	10	9.8	1.017	0.487–1.871	42	83.6	0.502	0.362–0.679
		Genitourinary	15	62.1	0.242	0.135–0.399	21	29.5	0.712	0.440–1.088	36	91.6	0.393	0.275–0.544
		Musculoskeletal	3	4.3	0.691	0.139–2.020	2	1.3	1.516	0.170–5.470	5	5.7	0.883	0.285–2.062
		Skin	1	5.8	0.173	0.002–0.961	1	1.2	0.850	0.011–4.715	2	7.0	0.287	0.032–1.036
		Eyes and Central Nervous System	5	11.6	0.432	0.139–1.008	2	3.3	0.608	0.068–2.195	7	14.9	0.471	0.189–0.971
		Endocrine	0	1.5	0.000	---. 2.397	0	0.6	0.000	---. 5.731	0	2.2	0.000	---. 1.690
		Hematopoietic	13	26.0	0.501	0.266–0.856	5	7.2	0.693	0.223–1.616	18	33.2	0.543	0.321–0.857
		Undetermined	5	17.0	0.295	0.095–0.687	0	4.8	0.000	---. 0.761	5	21.8	0.229	0.074–0.535

			Males				Females				Total
			O	E	SMR	95%CI	O	E	SMR	95%CI	O	E	SMR	95%CI
Causes of death
	All causes		316	470.6	0.671	0.599–0.750	62	81.3	0.763	0.585–0.978	378	551.9	0.685	0.618–0.758
	All cancers		72	95.3	0.756	0.591–0.952	23	36.1	0.637	0.404–0.956	95	131.4	0.723	0.585–0.884
	All causes except cancer		244	375.4	0.650	0.571–0.737	39	45.2	0.863	0.613–1.179	283	420.6	0.673	0.597–0.756
Cancer groups
	Type
		Solid	62	83.7	0.741	0.568–0.949	20	34.2	0.586	0.357–0.904	82	117.9	0.696	0.553–0.864
		Unspecified	3	0.0	---	---. ---	0	2.2	0.000	---. 1.645	3	2.2	1.344	0.270–3.931
		Hematogenous	7	8.5	0.826	0.331–1.703	3	1.9	1.555	0.312–4.542	10	10.4	0.961	0.460–1.768
	Risk factor
		Related to alcoholism	29	32.8	0.885	0.592–1.271	13	18.3	0.709	0.377–1.213	42	51.1	0.822	0.592–1.111
		Related to smoking	49	68.2	0.719	0.532–0.951	8	20.2	0.395	0.170–0.779	57	88.4	0.645	0.488–0.836
		Related to work	53	61.8	0.858	0.642–1.122	20	31.1	0.643	0.393–0.993	73	92.9	0.786	0.616–0.988
		Gamma and X radiation	44	50.5	0.871	0.633–1.169	19	29.2	0.651	0.392–1.017	63	79.7	0.790	0.607–1.011
	Organic system
		Digestive	36	39.4	0.913	0.639–1.264	6	10.6	0.564	0.206–1.227	42	50.1	0.839	0.604–1.134
		Respiratory	12	28.7	0.418	0.216–.730	3	7.5	0.399	0.080–1.167	15	36.2	0.414	0.232–0.683
		Genitourinary	8	9.9	0.804	0.346–1.584	8	13.8	0.581	0.250–1.145	16	23.7	0.674	0.385–1.095
		Musculoskeletal	2	1.3	1.589	0.178–5.731	2	0.0	---	---. ---	4	1.3	3.177	0.854–8.128
		Skin	0	1.3	0.000	---. 2.911	1	0.0	---	---. ---	1	1.3	0.794	0.010–4.416
		Eyes and Central Nervous System	4	3.1	1.296	0.348–3.314	0	2.2	0.000	---. 1.645	4	5.3	0.752	0.202–1.925
		Endocrine	0	0.0	---	---. ---	0	0.0	---	---. ---	0	0.0	---	---. ---
		Hematopoietic	7	8.5	0.826	0.331–1.703	3	1.9	1.555	0.312–4.542	10	10.4	0.961	0.460. –1.768
		Undetermined	3	3.1	0.972	0.195–2.837	0	0.0	---	---. ---	3	3.1	0.972	0.195–2.837

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[1] CORRESPONDING AUTHOR: Glacy Sabra Vieira. Avenida Professor Lineu Prestes, 2242, Butantã, CEP: 05508-000, São Paulo (SP), Brasil. E-mail: gsvieira@ipen.br