Abstract
Chronic exposure to ionizing radiation from uranium legacy sites remains a significant public health concern in Northern Kazakhstan. This review evaluates epidemiological, clinical, and environmental evidence published between 2000 and 2025, with particular emphasis on studies conducted during 2014–2023 in the Stepnogorsk region among populations residing near former uranium mining sites. Residents were exposed to annual external gamma doses of approximately 1.0–3.5 mSv and radon-related doses of up to 1.2 mSv. Cancer registry analyses revealed 1913 malignancy cases in the exposed group (vs. 358 controls), with digestive (29%) and respiratory (17%) cancers predominating. Early signs of chronic radiation syndrome (CRS) were consistently observed, including olfactory dysfunction, immunosuppression, vestibular disturbances, hematologic anomalies, and elevated chromosomal aberrations (1.3–1.5× baseline). Non-cancer morbidity was also elevated, including hypertension (32% vs. 24%), chronic bronchitis (14% vs. 8%), and reduced forced expiratory volume in one second (FEV1; −9.7%), indicating broader systemic effects. These results underscore the need for targeted public health strategies incorporating CRS biomarker screening, cancer surveillance, personal dosimetry, and environmental remediation in uranium-impacted communities.