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The estimated rate of mortality due to solid cancer increased with cumulative dose by 52% (90% confidence interval 27% to 77%) per Gy, lagged by 10 years. Restricting the analysis to the low cumulative dose range (0-100 mGy) approximately doubled the estimate of association (and increased the width of its confidence interval), as did restricting the analysis to workers hired in the more recent years of operations when estimates of occupational external penetrating radiation dose were recorded more accurately. Exclusion of deaths from lung cancer and pleural cancer had a modest effect on the estimated magnitude of association, providing indirect evidence that the association was not substantially confounded by smoking or occupational exposure to asbestos.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This major update to INWORKS provides a direct estimate of the association between protracted low dose exposure to ionising radiation and solid cancer mortality based on some of the world\u2019s most informative cohorts of radiation workers. The summary estimate of excess relative rate solid cancer mortality per Gy is larger than estimates currently informing radiation protection, and some evidence suggests a steeper slope for the dose-response association in the low dose range than over the full dose range. These results can help to strengthen radiation protection, especially for low dose exposures that are of primary interest in contemporary medical, occupational, and environmental settings.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmj-2022-074520","type":"journal-article","created":{"date-parts":[[2023,8,16]],"date-time":"2023-08-16T20:00:29Z","timestamp":1692216029000},"page":"e074520","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":125,"title":["Cancer mortality after low dose exposure to ionising radiation in workers in France, the United Kingdom, and the United States (INWORKS): cohort study"],"prefix":"10.1136","volume":"382","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8550-0212","authenticated-orcid":false,"given":"David B","family":"Richardson","sequence":"first","affiliation":[{"name":"Department of Environmental and Occupational Health, Program in Public Health, University of California, Irvine, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Klervi","family":"Leuraud","sequence":"additional","affiliation":[{"name":"Institut de Radioprotection et de S\u00fbret\u00e9 Nucl\u00e9aire (IRSN), Fontenay-aux-Roses, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dominique","family":"Laurier","sequence":"additional","affiliation":[{"name":"Institut de Radioprotection et de S\u00fbret\u00e9 Nucl\u00e9aire (IRSN), Fontenay-aux-Roses, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Gillies","sequence":"additional","affiliation":[{"name":"UK Health Security Agency, Chilton, Didcot, Oxfordshire, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard","family":"Haylock","sequence":"additional","affiliation":[{"name":"UK Health Security Agency, Chilton, Didcot, Oxfordshire, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kaitlin","family":"Kelly-Reif","sequence":"additional","affiliation":[{"name":"National Institute for Occupational Safety and Health, Cincinnati, OH, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen","family":"Bertke","sequence":"additional","affiliation":[{"name":"National Institute for Occupational Safety and Health, Cincinnati, OH, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert D","family":"Daniels","sequence":"additional","affiliation":[{"name":"National Institute for Occupational Safety and Health, Cincinnati, OH, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isabelle","family":"Thierry-Chef","sequence":"additional","affiliation":[{"name":"Barcelona Institute of Global Health (ISGlobal), Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Monika","family":"Moissonnier","sequence":"additional","affiliation":[{"name":"International Agency for Research on Cancer. 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