Сравнение риска смертности от солидных раков после радиационных инцидентов и профессионального облучения

Введение. Проблема сравнения медико-биологических эффектов острого облучения (включая аварийное и после ядерных катастроф) с эффектами фракционированного и хронического воздействия возникла с первых этапов развития радиационных дисциплин. В эксперименте было не раз обнаружено, что выход различных последствий лучевой экспозиции снижается в зависимости от уровня (мощности) дозы, поскольку клетки имеют время на восстановление от сублетальных повреждений.

Цель исследования — сравнение избыточного относительного риска (ERR на 1 Зв) смертности от солидных раков при остром — катастрофическом либо аварийном, и профессиональном — фракционированном или хроническом облучении.

Материалы и методы. Поддерживаемая база данных (база источников) по работникам ядерной индустрии из порядка 40 стран, на основе которой проведён объединяющий анализ данных для определения интегральной величины ERR на 1 Гр по смертности от раков для сравнения с показателями когорт, подвергавшихся катастрофическому и аварийному облучению: когорта LSS пострадавших от атомных бомбардировок в Японии, резиденты реки Теча (радиоактивное загрязнение из-за выбросов с ПО «Маяк») и российские ликвидаторы аварии на Чернобыльской АЭС.

Результаты. Сравнение величины ERR смертности от раков на 1 Зв для работников мировой ядерной индустрии (объединяющий анализ данных 37 исследований) с показателями когорты LSS, резидентов на реке Теча и ликвидаторов аварии на Чернобыльской АЭС продемонстрировало отсутствие поддающихся логике и принципиальных отличий, причём риски для двух последних когорт были наиболее высоки.

Хотя полученные данные отчасти подтверждают подход последних лет Научного комитета по действию атомной радиации ООН, согласно которому канцерогенные эффекты острого, аварийного, и фракционированного или хронического лучевых воздействий не зависят от фактора мощности дозы (DDREF), тем не менее, с учётом биологических механизмов и данных радиобиологических экспериментов, этот вопрос не может считаться однозначно решённым.

Выводы. Исходя из ERR на 1 Зв, из средней дозы внешнего облучения, а также из величины ежегодной фоновой смертности от рака в России и США, ожидаемая прибавка смертности от раков для 100 тыс. работников ядерной индустрии составит в среднем 32–69 человек за 10 лет (0,032–0,069% от группы). Подобные риски, в связи со множеством канцерогенных нелучевых факторов жизни и работы, равно как и колебаний фонового значения, невозможно учитывать в практике медицины и здравоохранения.

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