Risk of skin cancer by histological type in a cohort of workers chronically exposed to ionizing radiation


The incidence risk of non-melanoma skin cancer (NMSC), in particular basal cell carcinoma (BCC) and squamous cell carcinoma (SCC), was investigated in a cohort of workers of the Russian nuclear facility, the Mayak Production Association (PA), who had been occupationally exposed to low dose-rate ionizing radiation over prolonged periods. The study cohort included all workers who had been hired at the enterprise in 1948–1982 and followed up to 31.12.2018 (22,377 individuals, 25% of females). The mean cumulative skin absorbed dose of external gamma-ray exposure was 0.50 ± 0.73 Gy (the range of 0.00–8.84 Gy); the mean cumulative skin absorbed dose of neutron exposure was 0.002 ± 0.004 Gy (the range of 0.0000002–0.153 Gy). Relative risk and excess relative risk per unit skin absorbed dose of external exposure (RR and ERR/Gy) were estimated using AMFIT module of EPICURE software. Over the entire follow-up period 295 (84.8%) BCC, 48 (13.8%) SCC and 5 (1.4%) skin appendage cell carcinomas (SACC) were registered among NMSC in members of the study cohort. A significant linear association of the BCC incidence with the cumulative skin absorbed dose of external gamma-ray exposure was observed: ERR/Gy = 0.57 (95% CI 0.24, 1.06). Inclusion of an adjustment for neutron dose in the model resulted in a modest reduction of the BCC risk estimate [ERR/Gy = 0.55 (95% CI 0.23, 1.03)]. No significant association was revealed for SCC incidence with cumulative skin absorbed dose of external gamma-ray exposure [ERR/Gy = 0.14 (95% CI – 0.23, 0.91)]; inclusion of the neutron dose adjustment in the model did not modify the estimated SCC risk. No modification of the BCC and SCC incidence risks by sex, age at hire, attained age and facility type was observed.

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The study was financially supported by the Federal Medical Biological Agency of Russia.

Author information




All authors contributed to the study conception and design. Material preparation and data collection were performed by TVA and VLR. Data compilation, choice of statistical analysis methods and analysis were performed by ESG and MVB. The first draft of the manuscript was written by TVA. Interpretation of the results was provided by TVA, VLR, MVB, ESG. All authors commented on the original and all succeeding versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Tamara V. Azizova.

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No direct contact of researchers with cohort members was required in this record-based epidemiological study. This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Review Board of the Southern Urals Biophysics Institute.

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Azizova, T.V., Bannikova, M.V., Grigoryeva, E.S. et al. Risk of skin cancer by histological type in a cohort of workers chronically exposed to ionizing radiation. Radiat Environ Biophys 60, 9–22 (2021). https://doi.org/10.1007/s00411-020-00883-6

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  • Non-melanoma skin cancer
  • Basal cell carcinoma
  • Squamous cell carcinoma
  • Occupational chronic radiation exposure
  • Mayak worker cohort
  • Risk
  • Incidence