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Hexavalent chromium is the main sensitizer in wet cement and a common cause of occupational allergic contact dermatitis (OACD), especially among workers in the construction industry.(1,2) The European Chromium VI directive(3) transposed into national regulations in France and UK respectively on May and January 2005, prohibits selling or using of hydrated cement with more than 0.0002% of chromium. This was achieved through the addition of ferrous sulphate to the dry product, allowing to reduce chromium VI to chromium III which is less sensitizing. This article is protected by copyright. All rights reserved.

Background. - Female breast cancer is the most frequent cancer, both in incidence and mortality. It is well known that exposure to ionizing radiation increases the risk, but some questions remain concerning low dose and low-dose rate effects and cofactors. These potential effects have to be taken into account to carry out adequate risk assessment on medically exposed populations. A literature review is proposed on this issue. Methods. - A Medline research was undertaken. Keywords used were ionizing radiation, breast cancer and epidemiology. More studies were added through references included in the first list of articles. The focus was placed on studies including quantitative dose-effect relationship analyses. Results. - A latency of five to 10 to 13 years is observed in the appearance of risk. The risk diminishes with age at exposure. A diminution with age at risk is also suspected. The excess relative risk per gray varies between 0.3 and 1.5 for an age at first exposure of 25 years. The study of Hiroshima and Nagasaki survivors shows that risk is increased even if doses are restricted to below 0.5 Gy. Above high doses (20 Gy), the risk no longer increases. This can be interpreted as a cell-killing effect. The excess subsists if doses are fractionated, but a diminution of the effect is suspected. Conclusion. - The effects of exposure to levels of doses used for medical diagnostic are very difficult to study in the general population by epidemiological methods. Only studies conducted on very young children could achieve enough power, because of their high radiosensitivity. Available information on the effects of doses above 0.5 Gy allows extrapolation on maximal effects. Models deduced from existing cohorts can be used to assess risk, with their limits due to associated uncertainties. Preston et al. proposed an excess absolute-risk model, which makes estimates from the more comprehensive cohorts compatible. This model has been retained by the 2006 committee "Biological effects of ionizing radiation" (report VII). © 2008 Elsevier Masson SAS.; Position du problème Le cancer du sein est le cancer le plus fréquent chez la femme, tant en incidence qu’en mortalité. Si l’exposition aux rayonnements ionisants est un facteur de risque reconnu du cancer du sein, certaines questions ne sont pas encore résolues : quantification des effets aux faibles doses et débit de doses, influence des cofacteurs. Ces éléments sont indispensables pour mener des évaluations du risque sanitaire valides sur les populations actuellement exposées : patients, public et professionnels de santé. Nous proposons ici une synthèse de la littérature sur le sujet mettant en relief les études incluant une relation dose–effet. Méthodes Le recueil bibliographique a été réalisé à partir de la base de données « Medline ». Les mots clés utilisés étaient « rayonnements ionisants », « cancer du sein », « épidémiologie ». D’autres études ont été ajoutées grâce aux références incluses dans la première liste d’articles. Résultats Selon les études, l’excès de risque observé survient entre cinq et dix à 13 ans après la première exposition. Le risque diminue avec l’âge à l’exposition. Une diminution du risque avec l’âge au diagnostic est également suspectée. L’ordre de grandeur de l’excès de risque relatif par gray varie selon les études entre 0,2 et 1,5 pour un âge à la première exposition de 25 ans. L’étude réalisée sur les survivantes d’Hiroshima et de Nagasaki indique une augmentation du risque pour les doses inférieures à 0,5 Gy. Au-delà de 20 Gy environ, le risque atteint un plateau qui pourrait être expliqué par une augmentation de la mort cellulaire. Le fractionnement de l’exposition ne fait pas disparaître l’effet, mais une diminution de cet effet est suspectée. Conclusion Les effets de l’exposition aux rayonnements ionisants au niveau des doses délivrées actuellement dans un but diagnostic sont très difficiles à étudier par des méthodes épidémiologiques en population générale. Seuls les effets sur l’enfant en très bas âge pourraient éventuellement être abordés avec suffisamment de puissance, étant donnée la radiosensibilité des jeunes enfants. En revanche, les connaissances actuelles sur les effets des doses à partir de 0,5 Sv permettent par extrapolation d’évaluer les effets maximaux. Des modèles issus des cohortes existantes, peuvent être éventuellement utilisés pour des évaluations de risque, avec leurs limites du fait des incertitudes associées. Preston et al. proposent un modèle en excès de risque absolu, qui rend compatibles les estimations issues des principales cohortes fournissant une relation dose–effet et qui a été retenu en 2006 par le comité « Biological effects of ionizing radiation » (rapport VII).

This vast cohort study covers nearly 30 000 workers at CEA and Cogema, with a mean follow-up of 17.8 years. Consistently with previous studies, it found a mortality rate lower than that of the general population. An excess risk of cancer mortality was found only for melanoma, and its association with ionizing radiation remains to be defined. As in the literature, a dose-effect relation was seen for leukemia.

Purpose of the study: To analyze the effects of external radiation exposure on mortality of French nuclear workers. Method: A cohort of 29,204 workers employed between 1950 and 1994 at the French Atomic Energy Commission (Commissariat à l'énergie atomique: CEA) or at the General Company of Nuclear Fuel (Compagnie Générale des Matières nucléaires: COGEMA, now Areva NC) was followed up for an average of 17.8 years. Standardized Mortality Ratios (SMRs) were computed with reference to French mortality rates. Dose-effect relationships were analyzed through trend tests and Poisson regressions. Results: The mean exposure to X and gamma radiation was 8.3 mSv (16.9 mSv for exposed worker population). A total of 1,842 deaths occurred between 1968 and 1994, for 3,117 expected from the national mortality statistics. Among the 21 main cancer sites studied, a statistically significant excess was observed for skin melanoma, and an excess of borderline statistical significance was observed for multiple myeloma. A dose-effect relationship was observed for leukaemia after exclusion of chronic lymphoid leukaemia (CLL). The relative risk observed for non CLL leukaemia, n = 20, at 100 mSv was 2.2, CI90% = [1.2; 3.3]. Significant dose-effect relationships were also observed for causes of deaths associated with alcohol consumption: mouth and pharynx cancer, cirrhosis and alcoholic psychosis and external causes of death. Conclusion: The risk of leukaemia increases with increasing exposure to external radiation; this is consistent with published results on other nuclear workers cohorts. © 2007. Elsevier Masson SAS.; Objectif Analyser les effets de l’exposition aux rayonnements ionisants sur la mortalité des travailleurs de l’industrie nucléaire. Méthode Une cohorte de 29 204 travailleurs employés entre 1950 et 1994 au Commissariat à l’énergie atomique (CEA) ou à la Compagnie Générale des Matières nucléaires (Cogema, devenue Areva NC) a été suivie pendant 17,8 ans en moyenne. La mortalité de la population a été comparée à celle de la population française par la méthode des rapports de mortalité standardisés (SMR : Standardized Mortality Ratio). L’association entre l’exposition aux rayonnements ionisants et le risque de décès a été analysée par des tests de tendance et par des régressions de Poisson. Résultats L’exposition moyenne cumulée aux rayons X et gamma a été de 8,3 mSv sur la période (16,9 mSv pour la population exposée). Un total de 1 842 décès est survenu entre 1968 et 1994, pour 3 117 décès attendus d’après les statistiques de mortalité nationales. Parmi les 21 localisations de cancer étudiées, il a été observé un excès statistiquement significatif de mélanome malin et un excès de myélome multiple à la limite de la significativité. Une association entre l’exposition aux rayons X et gamma et le risque de leucémie (hors leucémie lymphoïde chronique) a été observée sur la base de 20 décès par leucémie. Le risque relatif estimé pour une exposition de 100 mSv comparé à une exposition nulle était de 2,2, IC90 % = [1,2 ;3,3]. Des relations dose-effet statistiquement significatives ont également été observées pour des causes de décès associées à la consommation d’alcool : cancer de la cavité buccale et du pharynx, cirrhose et psychose alcoolique, et causes externes de décès. Conclusion Le risque de leucémie croît avec la dose de rayons X et gamma au sein de la cohorte. Ceci est cohérent avec les résultats déjà publiés sur l’épidémiologie des travailleurs du nucléaire.

Background To improve occupational health public policies and to facilitate coordinated research within the European Union to reduce the incidence of occupational diseases (ODs), it is important to know what OD surveillance systems exist and how they compare. Monitoring trends in occupational diseases and tracing new and emerging risks in a network (Modernet) participants are well placed to provide this information as most either contribute data to and/or are involved in the management of OD systems. Aims To identify and describe OD surveillance systems in Modernet countries with the longer-term objective of identifying a core template to be used on a large scale. Methods A questionnaire sent to Modernet participants, seeking structured information about the OD surveillance system(s) in their country. Results Overall 14 countries (70%) provided information for 33 OD systems, among them 11 compensation-based (CB) systems. Six countries provided information for non-CB systems reporting for any type of OD. The other systems reported either only ODs from a prescribed list, or specific diagnoses or diagnostic groups, with reports to most schemes being physician-based. Data collected varied but all systems collected diagnosis, age, gender, date reported and occupation (and/or industry) and most collected information on exposure. Conclusions This review provides information beneficial to both policy makers and researchers by identifying data sources useable to measure OD trends in European countries and opening the way to future work, both on trend comparisons within Europe and on the definition of a core template to extend OD surveillance on a larger scale.

Working Group 2; Cost Action IS1002—Monitoring trends in Occupational Diseases and tracing new and Emerging Risks in a NETwork (MODERNET); International audience; Objectives: The European Union (EU) strategy for health and safety at work underlines the need to reduce the incidence of occupational diseases (OD), but European statistics to evaluate this common goal are scarce. We aim to estimate and compare changes in incidence over time for occupational asthma, contact dermatitis, noise-induced hearing loss (NIHL), carpal tunnel syndrome (CTS) and upper limb musculoskeletal disorders across 10 European countries.Methods: OD surveillance systems that potentially reflected nationally representative trends in incidence within Belgium, the Czech Republic, Finland, France, Italy, the Netherlands, Norway, Spain, Switzerland and the UK provided data. Case counts were analysed using a negative binomial regression model with year as the main covariate. Many systems collected data from networks of 'centres', requiring the use of a multilevel negative binomial model. Some models made allowance for changes in compensation or reporting rules.Results: Reports of contact dermatitis and asthma, conditions with shorter time between exposure to causal substances and OD, were consistently declining with only a few exceptions. For OD with physical causal exposures there was more variation between countries. Reported NIHL was increasing in Belgium, Spain, Switzerland and the Netherlands and decreasing elsewhere. Trends in CTS and upper limb musculoskeletal disorders varied widely within and between countries.Conclusions: This is the first direct comparison of trends in OD within Europe and is consistent with a positive impact of European initiatives addressing exposures relevant to asthma and contact dermatitis. Taking a more flexible approach allowed comparisons of surveillance data between and within countries without harmonisation of data collection methods.