Mortality study of atomic-bomb survivors: implications for assessment of radiation accidents.

To determine the possible late effects of atomic-bomb radiation, the Life Span Study (LSS) cohort of about 120,000 individuals, including 93,000 atomic bomb survivors and 27,000 non-exposed controls, was established by the Radiation Effects Research Foundation (RERF). Mortality in this cohort has been under study since 1950. Deaths are routinely identified through the family registry system and ascertainment is virtually complete. Cancer incidence data for the LSS cohort are also available from the Hiroshima and Nagasaki population-based tumour registry established in 1958. The central finding of the LSS is an increase in cancer risk. Besides the well-known increase in leukaemia, increases in solid cancer such as cancers of the lung, breast, stomach and thyroid have also been demonstrated. Radiation-induced leukaemia occurred 2 to 3 years after exposure, reached its peak within 6 to 8 years after the bombing, and has since declined steadily. However, this has not been true of solid cancer. Radiation-induced solid cancer begins to appear at later ages than such cancer is normally prone to develop, and continues to increase proportionally with the increase in mortality or incidence in the control group as it ages. Survivors who were exposed in the first or second decade of life have just entered the cancer-prone age and have so far exhibited a high relative risk in association with radiation dose. Whether the elevated risk will continue or will fail with time is not yet clear. It is important to continue long-term follow-up of this cohort to document the changes with time since exposure. Beyond cancer risk, increased risk of non-cancer mortality is also suggested, although it is not conclusive.