1 / 49

NUCLEAR ENERGY AND HEALTH RISKS

NUCLEAR ENERGY AND HEALTH RISKS. A QUEBEC PERSPECTIVE ÉRIC NOTEBAERT MD, MSc President, HPGS ( Quebec Chapter of PGS ) Associate Professor of Medicine, University of Montreal September 26th, 2009. PLAN. 1. Risks for the general population 2. Mechanisms and models used

morrisa
Télécharger la présentation

NUCLEAR ENERGY AND HEALTH RISKS

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. NUCLEAR ENERGY AND HEALTH RISKS A QUEBEC PERSPECTIVE ÉRIC NOTEBAERT MD, MSc President, HPGS ( Quebec Chapter of PGS ) Associate Professor of Medicine, University of Montreal September 26th, 2009

  2. PLAN • 1. Risks for the general population • 2. Mechanisms and models used • 3. The CANDU and the tritium problem • 4. Six canadian studies • 6. What is going on in Quebec ? • 7. Conclusions

  3. RISKS FOR THE GENERAL POPULATION • Three major recent publications • Baker P.J. et Hoel D.G.: Meta-analysis 2007 136 sites, 8 countries. • Mangano J. et Sherman J.D.:Meta-analysis 2008 51 sites, USA 67 Counties. • Kaatsch P., Spix C., Jung I. et Blettner M. 2008 16 sites, Germany, KiKK study. Case-Control study.

  4. Meta-analysis No. 1 :Baker PJ • CHILDHOOD LEUKEMIAS • 136 Nuclear power plants, uranium mines, reprocessing sites, weapons sites. • 17studiesgrouped together. • 8 Countries: UK, Germany, Canada, Scotland, Spain, USA, France and Japan. • Majority of the studies: Increased incidence, but not statistically significant.

  5. Meta-analysis No. 1: Baker PJ European Journal of Cancer Care 2007:16:355-363

  6. Meta-analysis No 1: Baker PJ Fixed effects: Biggest studies have a biggest influence on the results. Random effects: More appropriate if important heterogeneity ( as here ).

  7. Meta-analysis No. 1: Baker PJ • CONCLUSIONS: • No publication bias. • Incidence: Fixed and random effect: Meta-SIR all ≥ 1. Statistically significant. • Marked increase in the 0-9 y.o. group. • Death risk mainly increased in the 0-9 y.o. group < 16 km. • Association ≠ Cause→effect.

  8. Meta-analysis No.2: Mangano. • CHILD LEUKEMIA DEATH RATES • 51 US Nuclear reactors • 67 Counties • Population : 25 000 000. • Divided in 3: • Nuclear plants that started 1957-1970 (oldest) • Nuclear plants that started 1971 – 1981 (newest) • Nuclear plants started in 1957-1981, and shut down. European Journal of Cancer Care 2008;17:416-418

  9. Meta-analysis No.2: Mangano

  10. Meta-analysis No. 2: Mangano • CONCLUSIONS: Mortality: • ↑ 13.9% Mortality near older plants 57-70 • ↑ 9.4% Mortality near newer plants 71-81 • ↓ 5.5% Mortality near plants started in 57-81 and later shut down • Total 1292 deaths. • Statistically significatif.

  11. Meta-analyse No. 2: Mangano • CONCLUSIONS. • Radiation effect more severe among babies, children than adults. • Biggest plant has the highest incidence ↑: +29.5% • Association ≠ causality. • Bias are possible: Other pollutants ? Demographic differences ( poverty – proximity to medical facilities )? • Global context in the USA: Evolution from 1975 to 2004: ↑ Incidence of leukemias 28.7% ↓ Mortality of 49.0%

  12. Study No. 3: KiKK • CHILDHOOD LEUKEMIAS • 16 Nuclear power plants • Germany. • Case-control study. • 593 cases / 1766 controls. • Government-sponsored and results accepted by the Govt. Deutsches Arzteblatt International 2008;105(42):725-732

  13. Study No.3: KiKKResults:

  14. Study No. 3: KiKK

  15. Study No. 3: KiKK • CONCLUSIONS: • Risks are clearly linked to proximity to nuclear reactors. • Statistically significatif, at ≤ 5 km. • Risks appear to extend as far as 70 km to the nuclear reactors. • Association ≠ causality.

  16. 2. MECHANISMS AND MODELS USED BEIR VII: 2006

  17. 2. MECHANISMS AND MODELS • BEIR VII: • USA: National Academy of Sciences. • Committee to Assess Health Risks from Exposure to Low Levels of Ionizing Radiation. • Effects on health of LET: low linear energy transfer • Most comprehensive study done to date on this subject. http://www.nap.edu/catalog/11340.html

  18. 2. MÉCANISMES ET MODÈLES • Average annual radiation on a population: 2.4 mSv/year:

  19. 2. MÉCANISMES ET MODÈLES • Low dose: ≤ 100mSv • CT-scan ( abdomen )= 10-15 mSv • Limit for workers: 50 mSv/y. • Different hypothesis concerning low dose radiation: Risk =or ↓ (hormesis effect) or ↑. • In utero radiation: Risk of cancer ↑ if mother receives a dose ≥ 10 mSv * 100 mSv ≈ 100 Gy ≈ 10 rad ≈ 10 REM

  20. 2. MECHANISMS AND MODELS

  21. 2. MECHANISMS AND MODELS • More appropriate model: ‘Linear No-Threshold’ (LNT). • Risk is a function of age and sex. • There is no thresholdunder which we can say for sure that there is no risk. • 10 mSv → 1/1000 develop cancer. • Other possible risks: ↑ Atherosclerosis – CAD – Stroke – Immunomodulation – Liver diseases – etc But very few data yet.

  22. 2. MECHANISMS AND MODELS • Other publications, other estimates: • Traumatology (‘full body scan’): If ≥ 100mSv: 1/1000 death by thyroid cancer. • Dose 100 mSv: risk of death by cancer: • Baby: 1/100 • Young adult: 1/200 • Adult: 1/1000 ( or 10mSv ≈ 1/10 000 ) • Scan abdo-pelvic: 10-20 mSv: Risk of death: • Baby: 1/1000 • Teenager: 1/2000 • Adult: 1/10 000 AJR:176.Feb 2001 Brenner DJ. Radiology 2004:232. Crit Care Med 2009;37:1336 Brenner DJ. NEJM 2007;357:2277

  23. 3. CANDU AND TRITIUM • CHARACTERISTICS: • Radioactive isotope of hydrogen: 3H. • β emitter short distance. • Generally under the form: tritiated water: 3HOH • Internal emitter: Inhaled / Swallowed. • Biggest emmiter: Candu, Sellafield, La Hague. The hazards of tritium – revisited. Ian Fairlie Medicine, Conflict and Survival.2008;24(4):306

  24. 3. CANDU AND TRITIUM • ‘THE MISUNDERSTOOD NUCLIDE’ • Weak nuclide as β particle has low energy. • But radiobiological effect (RBE) ↑: Low range penetration → cell damage ↑↑. • 3H quickly incorporated in proteins, lipids, and DNA. → ‘OBT’ ( organically bound ) • 3H RBE = 2 or 3, and not 1.

  25. 3. CANDU AND TRITIUM • BEIR VII: • Tritium: Easily fixed on DNA • More fragile cells: Rapid development → organogenesis; genetic material. • Possible results: Spontaneous abortions, sterility, congenital anomalies, hypothyroidism, cancers.

  26. 3. CANDU AND TRITIUM • CERRIE REPORT: 2003. • Committee formed UK Government. • Internal emitter ‘by excellence’ • Suggested: dose coefficient ↑ 10-15 for HTO ( tritiated water ) • Suggested: dose coefficient ↑ by 5 pour OBT ( organically bound tritium ) CEERIE: Committee Examining Radiation Risks of Internal Emitters. 9th meeting. London.

  27. 3. CANDU AND TRITIUM • AGIR REPORT: 2007 • Committee formed by UK Gouvernment • Most comprehensive study on 3H. • RBE between 1.5-3.0. Average = 2.5 • US EPA has adopted 2.5 • AGIR suggests that ICRP ( International Commission on Radiological Protection ) should review its recommendations ( that are more conservative ).

  28. 3. CANDU AND TRITIUM • OFFICIAL ACCEPTABLE LIMITS: • Canada-Quebec: 7000 Bq/L • USA: 740 Bq/L • Europe: 100 Bq/L • Objective California: 18 Bq/L

  29. 3. CANDU AND TRITIUM • BAPE REPPORT - March 2005 • ‘Canal de rejet’: 420 Bq/L • Surface water, winter: 60 000 Bq/L • Underwater: 20 000 Bq/L • ‘Eau de résurgence’: 1 000 Bq/L • Air: 0.23-1.17 Bq/m3 ( N: 0.05 Bq/m3 ) • Milk: Some data 30 Bq/L ( N: 5 Bq/L )

  30. 4. SIX CANADIAN STUDIES • LIMITS OF EXISTING STUDIES • 1. RCT: ‘gold-standard’. Obviously none. • 2. COHORT STUDIES. Confounding factors/ Needs a huge population. • 3. CASE-CONTROL STUDIES: Bias ( memory, etc… ) • 4. ECOLOGIC STUDIES Can show a relationship. No cause / effect.

  31. 4. SIX CANADIAN STUDIES • 3 OTHER IMPORTANTS POINTS: • ‘Healthy worker effect’ • Statistically significant. If ‘n’ too small: Even if not statistically significant, may be important. • Clinically significant. Deadly disease: Even if small number, may be important.

  32. 4. SIX CANADIAN STUDIES • 1. CHILDHOOD LEUKEMIA AROUND CANADIAN NUCLEAR FACILITIES 1 & 2. Clarke et al 1989 – 1991 • Funded by Canada Atomic Energy Ltd. • Ecologic study. • Radius: 25km from Ontario Power Plants. • ‘n’ small. • Phase 1: 0-4 y.o. / Phase 2: Ad 14 y.o.. • Phase 2: ↑ incidence leukemias, but not statistically significant • CRITIQUE: small ‘N’, large radius.

  33. 4. SIX CANADIAN STUDIES • 2. OCCUPATIONAL EXPOSURE OF FATHERS TO IONIZING RADIATION AND THE RISK OF LEUKEMIA IN OFFSPRING – A CASE-CONTROL STUDY. McLaughlin et al. 1992. • 112 children with cancer and 890 controls. • Children living near a nuclear plant 1950-1988 • ‘Total body’ exposure, tritium, radon and radon ‘progeny’. • ↑ Incidence of leukemia, mostly among children of fathers working in uranium mines. Not statistically significant ( small ‘n’ ).

  34. 4. SIX CANADIAN STUDIES • 3. TRITIUM RELEASES FROM THE PICKERING NUCLEAR GENERATING STATION AND BIRTH DEFECTS AND INFANT MORTALITY IN NEARBY COMMUNITIES 1971-1988. Johnson & Rouleau 1991. • Ecological study. Congenital malformations, neonatal mortality, spontaneous abortions. • 25 km from Pickering • ↑ Stat. significant: Down Syndrome, correlation with tritium air. • Association: Malformation CNS and tritium air. • Small ‘n’, hence correlations. Nothing is statistically significant.

  35. 4. SIX CANADIAN STUDIES • 4. RISK OF CONGENITAL ANOMALIES IN CHILDERN OF PARENTS OCCUPATIONALLY EXPOSED TO LOW LEVEL IONIZING RADIATION. Green et al. 1997 • Case-control. • Financed by Ontario-Hydro. • Fathers of children born 1979-1986 with congenital anomaly. Vs other fathers. • Father’s radiation dose ? • ↑ Irradiation amongst fathers children with congenital anomaly. • Small ‘n’. Not statistically significant.

  36. 4. SIX CANADIAN STUDIES • 5. ANALYSIS OF MORTALITY AMONG CANADIAN NUCLEAR POWER INDUSTRY WORKERS AFTER CHRONIC LOW-DOSE EXPOSURE TO IONIZING RADIATION: Zablotska et al. 2004 • 45 000 workers. • Ontario, Quebec, New Brunswick • 1957-1994 • Leukemia death ↑ function of the received radiation dose • LEUKEMIA: ERR / Sv: 52.5 Statistically significant • SOLID CANCERS : ERR / Sv: 2.8 Almost stat. signif.

  37. 4. SIX CANADIAN STUDIES • 5. Zablotska et al study. 2004. F.Up • Table 5:

  38. 4. SIX CANADIAN STUDIES • 6. RADIATION AND HEALTH IN DURHAM REGION STUDY. Whitby, Ontario. 2007. • Ecologic. Pickering et Darlington areas. • Impossible to conclude that there is a causal link. • Chromosomic anomalies and cancers • Linked by municipalities, not by real proximity to a nuclear plant. • People who have always been living there, newcomers, people who moved out of the area. • Data started in 1983 ( Pickering opened in 1971 )

  39. 4. SIX CANADIAN STUDIES • 6. DURHAM Study 2007. F.Up • RESULTS: • ↑ Statistically significant neural tube defect 81-92 à 03-04. • ↑ Incidence Down. • ↑ Significant leukemia amongst ♂ in Darlington 1993-04. • ↑ Significant cancer thyroid amongst ♂ in Ajax-Pickering. • ↑ Marked incidence of cancers amongst ♀ and ♂ after the opening of Darlington. • ↑ Breat cancers in Ajax-Pickering 1981-92. • ↑ Incidence of multiple myeloma amongst ♀ and ♂ in Durham and Oshawa-Whitby.

  40. CONCLUSIONS - INTERNATIONAL AND CANADIAN STUDIES • Oldest studies: • Methodology poorer. • Small ‘n’. • Tendencies in the majority of studies. • More recent studies: The last 5 years: • Methodology has improved. • Meta-analysis. • Statistically significant results. • Very few Canadian studies – And the Canadian Commission on Nuclear Safety does not plan nor want to do anyone in the future !

  41. 5. AND WHAT ABOUT QUEBEC ? • BAPE 2005: • Refurbishment of G-2 does not have to be submited to any environmental assessment ! • Public debate is an absolute necessity • Public Health Department of the Mauricie area: Same position.

  42. 5. AND WHAT ABOUT QUEBEC ? • August 2008: Quebec Govt. announces the refurbishment of G-2. • Dozens of environmental groups protest in the medias. • Creation of the Mouvement pour Sortir le Québec du Nucléaire: More that 80 groups join the coalition. • October 2008: Letter HPGS: É Notebaert and 34 physicians: Asking a moratorium on the project and a public debate about G-2.

  43. 5. AND WHAT ABOUT QUEBEC ? • January 2009: Canadian Commission on Nuclear Safety Public relations operation in the Bécancour area. • February 2009: Creation of TAP: Tritium Allerte Publique • Marsh 2009: Québec-Sciences: Spécial No. Nuclear energy. • Marsh 2009: Sept-Iles: Citizens are opposed to nuclear mining in the area.

  44. 5. AND WHAT ABOUT QUEBEC ? • May 2009: City of Amqui joins the MSQN. • May 2009: HPGS wrote to 1300 physicians regions of G-2 and Sept-Iles • May 2009: Sept-Iles: Forum on uranium • May 2009: Trois-Rivières: People in the streets.

  45. 5. AND WHAT ABOUT QUEBEC ? • May 2009: Union des Municipalités du Québec is in favor of the cessation of nuclear energy in quebec. • June 2009: Quebec Govt refuses the long term disposal of nuclear wastes in the province. • June 2009: HPGS asks the CCNS to correct what it publicly declared: That there is no risk to human health ≤100mSv • July 2009: HPGS asks the Quebec Govt to reconsider its standards for acceptable 3H in water ( 7000Bq/L).

  46. 5. AND WHAT ABOUT QUEBEC ? • July 2009: Quebec Govt announces that it will review all the Hydro-Quebec ‘STRATEGIC PLAN’ this fall. • September 2009: Campaign launched: Avecenergie.com of the Fondation-Rivières and NatureQuébec: No place for nuclear energy. • October 2009: Conference HPGS - Mouvement Vert Mauricie – Artistes pour la Paix : Pour Un Québec Vert Hors du Nucléaire.

  47. 6. CONCLUSIONS • New studies of a better quality and meta-analysis confirm that there are very serious health risks with nuclear energy. • BEIR VII model: LNT widely accepted. There is no such thing as a totally safe level. • Tritium levels in H2O should be immediately lowered to safer standards..

  48. 6. CONCLUSIONS • Intergenerational principle of equity. • Many other issues not discussed here: Nuclear wastes; renewable energies to develop; risks of accidents; terrorism; links with nuclear weapons; costs; etc… • Nuclear energy is becoming a ‘hot topic’ now in Quebec. Getting very political. • There is a real possibility of success.

  49. QUESTIONS ?

More Related