Dosimetry and epidemiologicalstudies in Sweden after theChernobyl accident

Martin Tondel
associate professor
Occupational and Environmental Medicine
Department of Medical Sciences
Uppsala University
Sweden30-120

Fukushima
City200km

160 kmTokyoChiba

250 km30-100100 kmhttp://www.stralsakerhetsmyndigheten.se/Yrkesverksam/Miljoovervakning/Radioaktiva-amnen/Helkroppsmatning/* Wildboar 13,000 Bq/kg
August 2017*

Ground deposition
Cs-137 in 1986
[kBq m-2]
120
90
8060
40
30
20
10532

Increase of regional total cancer incidence innorth Sweden due to the Chernobyl accident?
J Epidemiol Community Health 2004 Dec;58(12):1011-6

Authors´ affiliations

Martin Tondel, Peter Hjalmarsson, Olav Axelson
Division of Occupational and Environmental Medicine, Department ofMolecular and Clinical Medicine, Faculty of Health Sciences, Linköping
University, Linköping, Sweden

Lennart Hardell
Department of Oncology, Örebro University Hospital, Örebro, Sweden

Göran Carlsson
Department of Health Policy, Västernorrland County Council, Härnösand,SwedenInhabitants in 7 out of 21 counties in Sweden
0-60 years old 1986
Same address, Dec 31, 1985 and Dec 31, 1987

Parishes (n=450) classified
by ground deposition ofCaesium-137
Caesium-137 kBq/m2(parishes)
80-120

(1)

60-79

(9)

40-59

(42)

30-39

(41)

3-29(240)<3(117)

MH-IRR and ERR adjusted for:A. Population density by parish

B. Population density by municipality (H-regions)
C. Lungcancer 1988-1996 by municipality (proxyfor smoking)D. Total cancer incidence 1986-1987(geographic difference)

Population and cancer cases by parish exposure
Cs-137 kBq/m2(parishes)

Population 1988(%)

Cancer cases
1988-1996<3(117)359,509 (31.4)

6,691

3-29(240)

527,812 (46.2)

10,37830-39(41)92,323(8.1)

1,827

40-59(42)124,862 (10.9)

2,744

60-79(9)21,625(1.9)

40180-120 (1)17,051

(1.5)

368

Total

1,143,182 (100.0)

22,409

Total cancer○1988-1996

MH-IRR(95% CL)
1,5
1.5
1,45
1,4
1.4
1,35
1,3
1.3
1,25
1,2
1.2
1,15
1.1
1,1

1,05
1.0
10,95 0

20

40

60

0.9
0,90,85

Cs-137 kBq/m2

80

100

Conclusion
Unless attributable to chance or remaining
uncontrolled confounding, a slight exposure
related increase in total cancer incidence
has occurred in northern Sweden after theChernobyl accident.

Increased incidence of malignancies in Sweden after
the Chernobyl accident–a promoting effect?
Am J Ind Med 2006 Mar;49(3):159-68

Authors´ affiliations

Martin Tondel, Peter Lindgren, Bodil Persson
Division of Occupational and Environmental Medicine, Department of Molecularand Clinical Medicine, Faculty of Health Sciences, Linköping University, Linköping,
SwedenPeter Hjalmarsson
Department of Health and Society, Division of Social Medicine and Public HealthScience, Linköping University, Linköping, Sweden

Lennart Hardell
Department of Oncology, University Hospital, Örebro, Sweden

Inhabitants in 8 out of 21 counties in Sweden

0-60 years old 1986
Same address, Dec 31, 1985 and Dec 31, 1987

Dwelling coordinate (100 m) National Land Survey of Sweden
Digital maps (200 x 200 m) Geological Survey of Sweden (TGR)
and Swedish Radiation Protection Authority (Cs-137)

GIS-technique to match dwelling coordinate with TGR and Cs-137
Categories for TGR and Cs-137 with the same proportions ofpopulation (30-25-20-15-5-5%)

Analogue map with isolines

5-10

11-20

21-3031-40

Digital map 200 x 200 m

41-60

Cs-137 kBq/m2

61-80

81-200MH-IRR and ERR adjusted for:A. Population density by parish
B. Population density by municipality (H-regions)
C. Lungcancer 1988-1999 by municipality (proxyfor smoking)D. Total cancer incidence 1986-1987 (geographicdifference)
E. Terrestrial Gamma Radiation (TGR)Total cancer

MH-IRR▪ 1988-1999,(95% CL)
1,5
1.5
1,3

1,45

1,4

1.4
1,35
1,2

1,3
1.3

1,25
1,2
1,1
1.2

1,15

1,1
1.1
1,051
1
1.0
0,95 00,90,90.90,850102030204060
Cs-137 kBq/m2

Cs-137 kBq/m2

40508060100

Conclusion
Increase in the incidence of total malignancies
related to increasing caesium radiation in thetime period 1988-1991 which contributes tothe increase in the follow-up period 19881999.
After control for confounding factors thisincrease can be seen in MH-IRR, EAR andERR.

Total cancer incidence in relation to 137Cs
fallout in the most contaminated counties in
Sweden after the Chernobyl nuclear power
plant accident: a register-based study

BMJ Open. 2016;6:e011924

Alinaghizadeh Hassan1, Wålinder Robert1,Vingård Eva1, Tondel Martin1
1 Occupational and Environmental Medicine, Department ofMedical Sciences, Uppsala University, Uppsala, Sweden

BMJ Open. 2016;6:e011924

BMJ Open. 2016;6:e011924

Cumulative exposure
1986-1990

137Cs kBq/m2

Cancer 1991-2010(n)

Adjusted HR*(95% CI)

Q1

0.00 - 45.40

19,7721.00 (ref)Q2-3

45.41 - 118.80

41,2571.03 (1.01 - 1.05)

Q4

118.81 - 564.71

21,4661.05 (1.03 - 1.07)*age, sex, residence, pre-Chernobyl incidence 1980-1985

Conclusion• a small overall exposure – response pattern of thetotal cancer incidence related to a 5-year cumulative
137Cs exposure based on the place of residence• given the limitations in our exposure assessment,
small risk estimates and overlapping CIs, we cannot
claim causal inferenceJECH 2004

AJIM 2006

BMJ Open 2016

Counties

783

Individuals

1,143,182

1,137,106734,537

1988-96 (9 y)1988-99 (12 y)

1991-2010 (20 y)

Malignancies

22,40933,851

82,495

Person-years

10,115,849

13,391,362

12,672,699

Exposure byParish 1986-87

Coordinate 1986-87Coordinate 1986-90

Exp to Cs-137

kBq/m2nGy/hkBq y/m2

Confounding
factors

Age, pop density x 2, lungcancer, cancer preChernobyl

as JECH + TGR

Age, sex,urban/rural, cancer
pre-Chernobyl

Risk estimates

MH-IRR, Poisson
regression-RR, EAR, ERR

MH-IRR, ERR, EAR

HRTime periods

one

threeone

ERR per 100
kBq/m2 (95% CL)

0.11(0.03;0.20)

0.10(0.00;0.23)--Exp related cases

849 (3.79%)

1,278 (3.78%)

2,401 (2.91%)

Follow-up (years)

Estimated lifetime effective dose to hunters andtheir families in the three most contaminatedcounties in Sweden after the Chernobyl nuclear
power plant accident in 1986 - A pilot study

J Environ Radioact 2017;177:241-249
Tondel Martin1, Rääf Christopher2, Wålinder Robert1,Mamour Afrah3, Isaksson Mats3
1 Occupational and Environmental Medicine, Department of MedicalSciences, Uppsala University, Uppsala, Sweden
2 Radiation Physics, Department of Translational medicine, LundUniversity, Malmö, Sweden
3 Department of Radiation Physics, Institute of Clinical Sciences,

Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden

Aims
Develop algorithms for calculating projected
lifetime effective dose for hunters and theirfamily members (internal and external doses)

Method

CountyVästernorrland
UppsalaGävleborg

Licence for a
Total population
hunting(n=803,702)
weapon(n=15,689)
Mean
Mean(n)(n)age
age
261,081 40.65 5,999 49.10
254,932 37.40 3,782 49.28
287,689 40.74 5,908 48.01

Huntersample(n=30)(n)
101010

Mean
age
51.00
46.80
42.70

Familymembers tohunters(n=55)
Mean(n)age
1828.56
1535.00
2227.91

Method
External dose:• 134Cs, 137Cs, short-lived• Occupancy factor• Shielding snow, building• Physical decay• Migration and weathering

Internal dose:• 134Cs, 137Cs• Transfer to internal dose
• age
• Sex
• Weight

Projected lifetime effective doses, Elf (mSv) cumulated for each individual
to 79.9 y for men and 83.7 y for women, respectively

Conclusion• Possible to use register data to develop
algorithms for calculating projected lifetime
effective dose for hunters and their family
members• The lifetime dose for the individuals is dominatedby the internal-dose contribution, basically drivenby county, male sex and age

References
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Tondel M, Carlsson G, Hardell L, Eriksson M, Jakobsson S, Flodin U, Sköldestig Å, Axelson O. Incidence of neoplasms in ages 019 y in parts of Sweden with high 137Cs fallout after the Chernobyl accident. Health Physics 1996;71:947-950
Tondel M, Hjalmarsson P, Hardell L, Carlsson G, Axelson O. Increase of regional total cancer incidence in north Sweden due tothe Chernobyl accident? J Epidemiol Community Health 2004;58:1011-1016.
Tondel M, Arynchyn A, Jönsson P, Persson B, Tagesson C. Urinary 8-hydroxydeoxyguanosine in Belarussian children relates tourban living rather than radiation dose after the Chernobyl accident: a pilot study. Arch Environ Contam Toxicol 2005;48:515-519.
Tondel M, Lindgren P, Hjalmarsson P, Hardell L, Persson B. Increased incidence of malignancies in Sweden after the Chernobyl
accident – a promoting effect? Am J Ind Med 2006;49:159-168.
Tondel M, Lindgren P, Garvin P, Persson B. Parish classification or dwelling coordinate for exposure assessment in environmental
epidemiology - a comparative study using Geographical Information System. Sci Total Environ. 2008;405:324-329.
Alinaghizadeh H, Tondel M, Walinder R. Cancer incidence in northern Sweden before and after the Chernobyl nuclear power plant
accident. Radiat Environ Biophys. 2014;53:495-504
Alinaghizadeh H, Wålinder R, Vingård E, Tondel M. Total cancer incidence in relation to 137Cs fallout in the most contaminatedcounties in Sweden after the Chernobyl nuclear power plant accident: a register-based study. BMJ Open. 2016;6:e011924
Svendsen ER, Yamaguchi I, Tsuda T, Guimaraes JR, Tondel M. Risk Communication Strategies: Lessons Learned from Previous
Disasters with a Focus on the Fukushima Radiation Accident. Curr Environ Health Rep. 2016 Dec;3(4):348-359.
Tondel M, Rääf C, Wålinder R, Mamour A, Isaksson M. Estimated effective dose to hunters and their families in the three mostcontaminated counties in Sweden after the Chernobyl Nuclear Power Plant Accident in 1986 – a pilot study. J Environ Radioact
2017;177:241-249.
Jönsson M, Tondel M, Isaksson M, Finck R, Wålinder R, Mamour A, Rääf C. Modelling the external radiation exposure from theChernobyl fallout using data from the Swedish municipality measurement system. J Environ Radioact. 2017;178-179:16-27.
Tondel M, Granath G, Wålinder R. 137Cs activity in Sweden after the Chernobyl Nuclear Power Plant accident in relation toquaternary geology and land use. Appl Geochem 2017;87:38-43
Rääf C, Tondel M, Isaksson M. A model for estimating the total absorbed dose to the thyroid in Swedish inhabitants following theChernobyl Nuclear Power Plant accident: Implications for existing international estimates and future model applications. J Radiol
Prot. 2019 Feb 8. [Epub ahead of print]
Isaksson M, Tondel M, Wålinder R, Rääf C. Modelling the effective dose to a population from fallout after a nuclear power plant
accident-A scenario-based study with mitigating actions. PLoS One. 2019 Apr 9;14(4):e0215081.

Epidemiological studies afterFDNPP accident?
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Which health outcomes to study
Vulnerable groups
Study design
Case definition
Confounding factors
Exposure assessment
Statistical power
Ethical considerations
Collaboration