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La controverse sur les effets des faibles doses de rayonnements ionisantset la relation linéaire sans seuil

Published online by Cambridge University Press:  28 June 2007

M. Tubiana
Affiliation:
Faculté de Médecine, Centre Antoine Béclère, 45 rue des Saints-Pères, 75006 Paris, France
R. Masse
Affiliation:
11 rue du Haras, Résidence Le Boqueteau, Acacias 2, 91240 Saint-Michel-sur-Orge, France
F. De Vathaire
Affiliation:
INSERM U 605. Institut Gustave Roussy, 39 rue Camille Desmoulins, 94805 Villejuif Cedex, France
D. Averbeck
Affiliation:
Institut Curie, Section de Recherche, Laboratoire Raymond Latarjet, UMR2027 du CNRS, Centre Universitaire d’Orsay, 91405 Orsay Cedex, France
A. Aurengo
Affiliation:
Service Médecine Nucléaire, Hôpital Pitié-Salpêtrière, 75013 Paris, France
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Abstract

Si la publication 99 de la CIPR et le BEIR VII recommandent de maintenir l’usage d’une relation linéaire sans seuil (RLSS) pour estimer l’excès de risque relatif de cancer lié à de faibles doses de rayonnements ionisants (RI), le rapport conjoint de l’Académie des sciences et de l’Académie de médecine (2005) conclut qu’elle conduit à une forte surestimation des risques des faibles et des très faibles doses. Les fondements de la RLSS sont remis en question par de nouvelles données biologiques et de l’expérimentation animale qui montrent que la défense contre les RI met en jeu le micro-environnement cellulaire et le système immunitaire, et que les mécanismes de défense contre les faibles doses de RI sont différents et plus efficaces. Ces cellules lésées par une irradiation à faible dose sont éliminées ; la réparation s’impose à forte dose pour préserver les fonctions tissulaires. Les organismes pluricellulaires réalisent ainsi une défense au moindre coût et au moindre risque contre les RI et les dégâts du métabolisme oxydatif. Les différences entre les défenses contre les faibles et fortes doses sont particulièrement nettes dans le cas de contamination par des émetteurs alpha qui montrent chez l’homme et l’animal des effets à seuil de plusieurs grays. Ces différences remettent en question les résultats des études épidémiologiques qui, pour des raisons de puissance statistique, estiment les risques en fusionnant des données obtenues pour des gammes de doses très étendues, ce qui sous entend implicitement que les mécanismes de cancérogenèse sont similaires quelle que soit la dose. L’estimation des risques des faibles doses de RI doit reposer sur des études spécifiquement limitées aux faibles doses, avec une évaluation précise de facteurs de confusion potentiels. La synthèse des études de cohorte pour lesquelles on dispose des coefficients de risque fondés sur les seules doses inférieures à 100 mSv chez l’adulte ne montre pas d’excès de risque relatif significatif, ni pour les tumeurs solides ni pour les leucémies.

Type
Research Article
Copyright
© EDP Sciences, 2007

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