Work history and radioprotection practices in relation to cancer incidence and mortality in US radiologic technologists performing nuclear medicine procedures

INTRODUCTION

Technologists working in nuclear medicine (NM) are exposed to higher radiation doses than most other occupationally exposed populations. The aim of this study was to estimate the risk of cancer in NM technologists in relation to work history, procedures performed and radioprotection practices.

METHODS

From the US Radiologic Technologists cohort study, 72 755 radiologic technologists who completed a 2003-2005 questionnaire were followed for cancer mortality through 31 December 2012 and for cancer incidence through completion of a questionnaire in 2012-2013. Multivariable-adjusted models were used to estimate HRs for total cancer incidence and mortality by history of ever performing NM procedures and frequency of performing specific diagnostic or therapeutic NM procedures and associated radiation protection measures by decade.

RESULTS

During follow-up (mean=7.5 years), 960 incident cancers and 425 cancer deaths were reported among the 22 360 technologists who worked with NM procedures. We observed no increased risk of cancer incidence (HR 0.96, 95% CI 0.89 to 1.04) or death (HR 1.05, 95% CI 0.93 to 1.19) among workers who ever performed NM procedures. HRs for cancer incidence but not mortality were higher for technologists who began performing therapeutic procedures in 1960 and later compared with the 1950s. Frequency of performing diagnostic or therapeutic NM procedures and use of radioprotection measures were not consistently associated with cancer risk. No clear associations were observed for specific cancers, but results were based on small numbers.

CONCLUSION

Cancer incidence and mortality were not associated with NM work history practices, including greater frequency of procedures performed.

Occupational radiation exposure and glaucoma and macular degeneration in the US radiologic technologists

There are well-documented associations of glaucoma with high-dose radiation exposure, but only a single study suggesting risk of glaucoma, and less conclusively macular degeneration, associated with moderate-dose exposure. We assessed risk of glaucoma and macular degeneration associated with occupational eye-lens radiation dose, using participants from the US Radiologic Technologists Study, followed from the date of surveys in 1994-1998, 2003-2005 to the earliest of diagnosis of glaucoma or macular degeneration, cancer other than non-melanoma skin cancer, or date of last survey (2012-2014). We excluded those with baseline disease or previous radiotherapy history. Cox proportional hazards models with age as timescale were used. There were 1631 cases of newly self-reported doctor-diagnosed cases of glaucoma and 1331 of macular degeneration among 69,568 and 69,969 eligible subjects, respectively. Estimated mean cumulative eye-lens absorbed dose from occupational radiation exposures was 0.058 Gy. The excess relative risk/Gy for glaucoma was -0.57 (95% CI -1.46, 0.60, p = 0.304) and for macular degeneration was 0.32 (95% CI -0.32, 1.27, p = 0.381), suggesting that there is no appreciable risk for either endpoint associated with low-dose and low dose-rate radiation exposure. Since this is the first examination of glaucoma and macular degeneration associated with low-dose radiation exposure, this result needs to be replicated in other low-dose studies.

Assessment of thyroid cancer risk associated with radiation dose from personal diagnostic examinations in a cohort study of US radiologic technologists, followed 1983-2014

OBJECTIVE

To assess whether personal medical diagnostic procedures over life, but particularly those associated with exposure in adulthood, were associated with increased thyroid cancer risk.

DESIGN

Participants from the US Radiologic Technologists Study, a large, prospective cohort, were followed from the date of first mailed questionnaire survey completed during 1983-1989 to the earliest date of self-reported diagnosis of thyroid cancer or of any other cancer than non-melanoma skin cancer (NMSC) in any of three subsequent questionnaires up to the last in 2012-2014.

SETTING

US nationwide, occupational cohort.

PARTICIPANTS

US radiologic technologists with exclusion of: those who reported a previous cancer apart from NMSC on the first questionnaire; those who reported a cancer with an unknown date of diagnosis on any of the questionnaires; and those who did not respond to both the first questionnaire and at least one subsequent questionnaire.

PRIMARY OUTCOME MEASURE

We used Cox proportional hazards models with age as timescale to compute HRs and 95% CI for thyroid cancer in relation to cumulative 5-year lagged diagnostic thyroid dose.

RESULTS

There were 414 self-reported thyroid cancers (n=275 papillary) in a cohort of 76 415 persons. Cumulative thyroid dose was non-significantly positively associated with total (excess relative risk/Gy=2.29 (95% CI -0.91 to 7.01, p=0.19)) and papillary thyroid cancer (excess relative risk/Gy=4.15 (95% CI -0.39, 11.27, p=0.08)) risk. These associations were not modified by age at, or time since, exposure and were independent of occupational exposure.

CONCLUSION

Our study provides weak evidence that thyroid dose from diagnostic radiation procedures over the whole of life, in particular associated with exposure in adulthood, influences adult thyroid cancer risk.

Pleural abnormalities and exposure to elongate mineral particles in Minnesota iron ore (taconite) workers

BACKGROUND

Iron ore (taconite) mining and processing are an important industry in northern Minnesota and western Michigan. Concerns around exposures have centered largely on exposure to non-asbestiform amphibole elongate mineral particles (EMPs) found in the eastern portion of the Minnesota iron range.

METHODS

A cross sectional survey was undertaken of current and former taconite workers and spouses along with a detailed exposure assessment. Participants provided an occupational history and had a chest radiograph performed.

RESULTS

A total of 1188 workers participated. Potential exposures to non-amphibole EMPs were evident across multiple jobs in all active mines. Pleural abnormalities were found in 16.8% of workers. There was an association of pleural abnormalities with cumulative EMP exposure that was not specific to the eastern portion of the range.

CONCLUSION

There was evidence of a mild to moderate increase in pleural abnormalities in this population of miners, associated with geographically non-specific cumulative EMP exposure.

Seroprevalence of brucellosis in goats and sheep in Thailand: Results from the Thai National Brucellosis Surveillance System from 2013 to 2015

In Thailand, brucellosis re-emerged in humans in 2003 and is considered a public health risk to goat farmers as the disease is endemic in small ruminants. The Thai Department of Livestock Development (DLD) established a nationwide surveillance system for brucellosis in goats and sheep in 1997. Using data from this surveillance system, we describe the seroprevalence of brucellosis from 2013 to 2015 in small ruminants and the spatial distribution of the disease throughout Thailand. Surveillance data collected included the number of animals and herds tested, the province of the animal and herd and the laboratory results. Seroprevalence was estimated at both the animal and herd levels. During the 3-year period, 443,561 goats and sheep were tested for brucellosis by the DLD throughout Thailand using the Rose Bengal Plate Test (RBPT) and the enzyme-linked immunosorbent assay test for Brucella. Among the 3 years, 2013 had the highest proportion of herds that tested positive for brucellosis at 13.80% (95% CI, 12.52, 15.16). Overall, this study found that brucellosis seroprevalence in small ruminants is decreasing throughout Thailand. However, there is variability in the spread of the disease with provinces in the eastern and western regions of Thailand having higher proportions of animals and herds testing positive. Overall provinces in the south had the lowest proportion of animals and herds testing positive for brucellosis. Periodic review of surveillance data documents the impact of the current brucellosis control programme and supports a targeted response in higher prevalence regions when there are limited financial resources for control measures.

Occupational radiation exposure and thyroid cancer incidence in a cohort of U.S. radiologic technologists, 1983-2013

Although childhood exposure to ionizing radiation is a well-established risk factor for thyroid cancer, the risk associated with adulthood exposure remains unclear. We prospectively examined the association between cumulative, low-to-moderate dose occupational radiation exposure to the thyroid and thyroid cancer incidence in the U.S. Radiologic Technologists cohort. The study included 89,897 members who completed at least two of four mailed questionnaires and were cancer-free at the time of the first questionnaire. Cumulative occupational thyroid radiation dose (mean = 57 mGy, range = 0-1,600 mGy) was estimated based on self-reported work histories, historical data and, during the years 1960-1997, 783,000 individual film badge measurements. During follow-up, we identified 476 thyroid cancer cases. We used Poisson regression to estimate excess relative risk of thyroid cancer per 100 milliGray (ERR/100 mGy) absorbed dose to the thyroid gland. After adjusting for attained age, sex, birth year, body mass index and pack-years smoked, we found no association between thyroid dose and thyroid cancer risk (ERR/100 mGy = -0.05, 95% CI <-0.10, 0.34). In this large cohort study of radiologic technologists, protracted, low-to-moderate dose ionizing radiation exposure to the thyroid gland in adulthood was not associated with an increased risk of thyroid cancer.

Cataract Risk in a Cohort of U.S. Radiologic Technologists Performing Nuclear Medicine Procedures

Purpose To estimate the risk of cataract in a cohort of nuclear medicine (NM) radiologic technologists on the basis of their work histories and radiation protection practices. Materials and Methods In the years 2003-2005 and 2012-2013, 42 545 radiologic technologists from a U.S. prospective study completed questionnaires in which they provided information regarding their work histories and cataract histories. Cox proportional hazards models, stratified according to birth-year cohort (born before 1940 or born in 1940 or later) and adjusted for age, sex, and race, were used to estimate hazard ratios (HRs) for the risk of cataract in radiologic technologists according to NM work history practices according to decade. Results During the follow-up period (mean follow-up, 7½ years), 7137 incident cataracts were reported. A significantly increased risk of cataract (HR, 1.08; 95% confidence interval [CI]: 1.03, 1.14) was observed among workers who performed an NM procedure at least once-as opposed to never. Risks of cataract were increased in the group who had performed a diagnostic (HR, 1.07; 95% CI: 1.01, 1.12) or therapeutic (HR, 1.10; 95% CI: 1.04, 1.17) NM procedure. Risks were higher for those who had first performed diagnostic NM procedures in the 1980s to early 2000s (HR, 1.30; 95% CI: 1.08, 1.58) and those who had performed therapeutic NM procedures in the 1970s (HR, 1.11; 95% CI: 1.01, 1.23) and in the 1980s to early 2000s (HR, 1.14; 95% CI: 1.02, 1.29). With the exception of a significantly increased risk associated with performing therapeutic NM procedures without shielding the radiation source in the 1980s (HR, 1.32; 95% CI: 1.04, 1.67), analyses revealed no association between cataract risk and specific radiation protection technique used. Conclusion An increased risk of cataract was observed among U.S. radiologic technologists who had performed an NM procedure at least once. This association should be examined in future studies incorporating estimated lens doses. © RSNA, 2017.

Acetylcholinesterase activity and time after a peak pesticide-use period among Ecuadorian children

PURPOSE

Mother's Day (May) is a holiday with substantial demand for flowers, associated with heightened flower production and escalated pesticide use. The effect of spray seasons on pesticide exposures of children living in agricultural communities but who do not work in agriculture is poorly understood. In this study, we estimated the association of time after Mother's Day harvest with children's acetylcholinesterase (AChE) activity. AChE is a physiological marker of organophosphate/carbamate pesticide exposures that may take up to 3 months to normalize after its inhibition.

METHODS

We examined 308 children, aged 4-9 years, in Ecuadorian agricultural communities during a low flower-production season but within 63-100 days (mean: 81.5 days, SD: 10.9) after Mother's Day harvest. We quantified AChE activity (mean: 3.14 U/mL, SD: 0.49) from a single finger-stick sample.

RESULTS

We observed positive linear associations between time after the harvest and AChE among participants living near plantations. The associations were strongest among participants living within 233 m [(0.15 U/mL (95% CI 0.02, 0.28)], slightly weaker among participants living within 234-532 m [0.11 U/mL (0.00, 0.23)], and not associated among participants at greater distances. Similar findings were observed across categories of areas of flower plantations within 500 m of homes.

CONCLUSIONS

These cross-sectional findings suggest that a peak pesticide-use period can decrease AChE activity of children living near plantations. These seasonal pesticide exposures could induce short- and long-term developmental alterations in children. Studies assessing exposures at multiple times in relation to pesticide spray seasons among children who do not work in agriculture are needed.

Workers' compensation loss prevention representative contact and risk of lost-time injury in construction policyholders

INTRODUCTION

Insurance loss prevention (LP) representatives have access and contact with businesses and employees to provide targeted safety and health resources. Construction firms, especially those smaller in size, are a high-risk population. This research evaluated the association between LP rep contact and risk for lost-time injuries in construction policyholders.

METHODS

Workers' compensation data were utilized to track LP rep contact with policyholders and incidence of lost-time injury over time. Survival analysis with repeated events modeling calculated hazard ratios (HR) and 95% confidence intervals (CI).

RESULTS

Compared no LP contact, one contact was associated with a 27% reduction of risk (HR=0.73, CI=0.65-0.82), two with a 41% (HR=0.59, CI=0.51-0.68), and three or more contacts with a 28% reduction of risk (HR=0.72, CI=0.65-0.81).

CONCLUSIONS

LP reps appear to be a valuable partner in efforts to reduce injury burden. Their presence or contact with policyholders is consistent with reduction in overall incidence of lost-time injuries.

PRACTICAL APPLICATIONS

Reduction in lost-time injuries, resulting in reduced workers' compensation costs for policyholders and insurance companies, builds a business-case for safety and injury prevention. LP reps are often a low or no-cost benefit for insurance policyholders and may be an important injury prevention resource for small firms and/or those with lack of safety resources and staff.

Hyperthyroidism, Hypothyroidism, and Cause-Specific Mortality in a Large Cohort of Women

BACKGROUND

The prevalence of hyperthyroidism and hypothyroidism is 0.5-4% in iodine-replete communities, but it is 5-10 times higher in women than in men. Those conditions are associated with a broad range of metabolic disorders and cardiovascular diseases. Biological evidence of a role of thyroid hormones in carcinogenesis also exists. However, the association between thyroid dysfunction and cardiovascular disease or cancer mortality risk remains controversial. In a large cohort of women, the associations of hyperthyroidism and hypothyroidism with cause-specific mortality were evaluated after nearly 30 years of follow-up.

METHODS

The prospective study included 75,076 women aged 20-89 years who were certified as radiologic technologists in the United States in 1926-1982, completed baseline questionnaires in 1983-1998 from which medical history was ascertained, and reported no malignant disease or benign thyroid disease except thyroid dysfunction. A passive follow-up of this cohort was performed through the Social Security Administration database and the National Death Index-Plus. Cause-specific mortality risks were compared according to self-reported thyroid status, with proportional hazards models adjusted for baseline year and age, race/ethnicity, body mass index, family history of breast cancer, and life-style and reproductive factors.

RESULTS

During a median follow-up of 28 years, 2609 cancer, 1789 cardiovascular or cerebrovascular, and 2442 other non-cancer deaths were recorded. Women with hyperthyroidism had an elevated risk of breast cancer mortality after 60 years of age (hazard ratio [HR] = 2.04 [confidence interval (CI) 1.16-3.60], 13 cases in hyperthyroid women) compared to women without thyroid disease. Hypothyroid women had increased mortality risks for diabetes mellitus (HR = 1.58 [CI 1.03-2.41], 27 cases in hypothyroid women), cardiovascular disease (HR = 1.20 [CI 1.01-1.42], 179 cases), and cerebrovascular disease (HR = 1.45 [CI 1.01-2.08], 35 cases, when restricting the follow-up to ≥10 years after baseline). Other causes of death were not associated with hyperthyroidism or hypothyroidism, though there was a suggestion of an elevated risk of ovarian cancer mortality in hyperthyroid women based on very few cases.

CONCLUSION

The excess mortality risks observed in a large, prospective 30-year follow-up of patients with thyroid dysfunction require confirmation, and, if replicated, further investigation will be needed because of the clinical implications.

A comprehensive assessment of exposures to respirable dust and silica in the taconite mining industry

This study assessed the present-day levels (year 2010-2011) of exposure to respirable dust (RD) and respirable silica (RS) in taconite mines and evaluated how the mining process influences exposure concentrations. Personal samples (n = 679) were collected to assess exposure levels of workers to RD and RS at six mines in the Mesabi Iron Range of Minnesota. The RD and RS concentrations were measured using the National Institute for Occupational Safety and Health (NIOSH) 0600 and NIOSH 7500, respectively. Between-mine, between-SEG (similar exposure groups), within-SEG, and within-worker components of variability for RD and RS exposures were estimated using a two- or three-way nested random-effects ANOVA model. The majority of RD concentrations across all mines were below the Mine Safety and Health Administration (MSHA) Permissible Exposure Limit (PEL). The highest concentrations of RD were often observed in either the Pelletizing or Crushing departments, which are inherently dusty operations. With a few exceptions, the concentrations of RS in the crushing and concentrating processes were higher than those in the other mining processes, as well as higher than the American Conference of Governmental Industrial Hygienists (ACGIH) Threshold Limit Value (TLV) for RS. The magnetic separation and flotation processes in the concentrating department reduced the levels of RS significantly, and lowered the percentage of quartz in RD in the pelletizing department. There was little variability among the six mines or between the two mineralogically distinct zones for either RD or RS exposures. The between-SEG variability for RS did not differ substantially across most of the mines and was a major component of exposure variance. The within-SEG (or between-worker) variance component was typically the smallest because in many instances one worker from a SEG within a mine was monitored multiple times. Some of these findings were affected by the degree of censoring in each SEG and mine, characteristics of the taconite rock, seasonal effects during sampling, or the tasks assigned to each job in that mine.

The Economic Impact for Farm Injury in Minnesota, 2004-2010

Only 2% of Minnesota's employed population worked in agriculture between the years 2005 and 2012. However, this small portion of the state's employed population accounted for 31% of total work-related deaths in the state during that same time period. During a similar time period, 2007-2013, the contribution of agriculture to Minnesota's gross domestic product increased from approximately 1.5% to about 2.3%. This article describes the economic impact of injuries related to farm work between the years 2004 and 2010. Using hospital discharge data and the Census of Fatal Occupational Injuries (CFOI), estimates of the number of injuries and fatalities related to agricultural work were compiled. A cost of illness model was applied to these injury and fatality estimates to calculate the related indirect and direct costs in 2010 dollars. Estimated total costs, in 2010 dollars, ranged between $21 and $31 million annually over the 7-year study period. The majority of the costs were attributable to indirect costs, such as lost productivity at work and home. Fatal injuries accrued the largest proportion of the estimated costs followed by hospitalized and nonhospitalized injuries. A sensitivity analysis was performed to evaluate the impact each selected data source had upon the cost estimate. The magnitude of the costs associated with these injuries argues for better surveillance of injury related to agriculture to prioritize resources and evaluate intervention and prevention programs.

A review of mortality associated with elongate mineral particle (EMP) exposure in occupational epidemiology studies of gold, talc, and taconite mining

BACKGROUND

Mining of gold, taconite, and talc may involve exposure to elongate mineral particles (EMP). The involved EMPs are typically non-asbestiform, include dimensions that regulatory definitions exclude, and have been less studied.

METHODS

A review of the literature was undertaken for this exposure and occupational epidemiological studies that occur in gold, talc, and taconite mining.

RESULTS

Quantitative EMP exposure information in these industries is incomplete. However, there are consistent findings of pneumoconiosis in each of these types of mining. A recent case-control study suggests a possible association between this exposure and mesothelioma. Lung cancer is inconsistently reported in these industries and is an unlikely outcome of non-asbestiform EMP exposure. There is evidence of cardiovascular mortality excess across all of these types of mining.

CONCLUSIONS

Non-malignant respiratory disease and cardiovascular mortality have been consistently increased in these industries. Further investigation, including additional insights for the role of non-asbestiform EMP, is warranted. Am. J. Ind. Med. 59:1047-1060, 2016. © 2016 Wiley Periodicals, Inc.

Historical Patterns in the Types of Procedures Performed and Radiation Safety Practices Used in Nuclear Medicine From 1945-2009

The authors evaluated historical patterns in the types of procedures performed in diagnostic and therapeutic nuclear medicine and the associated radiation safety practices used from 1945-2009 in a sample of U.S. radiologic technologists. In 2013-2014, 4,406 participants from the U.S. Radiologic Technologists (USRT) Study who previously reported working with medical radionuclides completed a detailed survey inquiring about the performance of 23 diagnostic and therapeutic radionuclide procedures and the use of radiation safety practices when performing radionuclide procedure-related tasks during five time periods: 1945-1964, 1965-1979, 1980-1989, 1990-1999, and 2000-2009. An overall increase in the proportion of technologists who performed specific diagnostic or therapeutic procedures was observed across the five time periods. Between 1945-1964 and 2000-2009, the median frequency of diagnostic procedures performed substantially increased (from 5 wk to 30 wk), attributable mainly to an increasing frequency of cardiac and non-brain PET scans, while the median frequency of therapeutic procedures performed modestly decreased (from 4 mo to 3 mo). Also a notable increase was observed in the use of most radiation safety practices from 1945-1964 to 2000-2009 (e.g., use of lead-shielded vials during diagnostic radiopharmaceutical preparation increased from 56 to 96%), although lead apron use dramatically decreased (e.g., during diagnostic imaging procedures, from 81 to 7%). These data describe historical practices in nuclear medicine and can be used to support studies of health risks for nuclear medicine technologists.

Cancer Risks in U.S. Radiologic Technologists Working With Fluoroscopically Guided Interventional Procedures, 1994-2008

OBJECTIVE

The purpose of this study was to examine risks of cancer incidence and mortality among U.S. radiation technologists performing or assisting with fluoroscopically guided interventional procedures.

SUBJECTS AND METHODS

A nationwide prospective cohort of 90,957 radiologic technologists, who responded to a 1994-1998 survey that collected information on whether they had ever worked with fluoroscopically guided interventional procedures, was followed through completion of a subsequent cohort survey during 2003-2005 (for cancer incidence) or December 31, 2008 (for cancer mortality). Sex-adjusted hazard ratios (HRs) and 95% CIs were calculated by use of Cox proportional hazards models for incidence and mortality from all cancers other than nonmelanoma skin cancer and for specific cancer outcomes in participants who reported ever performing fluoroscopically guided interventional procedures compared with technologists who never performed these procedures.

RESULTS

The analysis showed an approximately twofold increased risk of brain cancer mortality (HR, 2.55; 95% CI, 1.48-4.40) and modest elevations in incidence of melanoma (HR, 1.30; 95% CI, 1.05-1.61) and in breast cancer incidence (HR, 1.16; 95% CI, 1.02-1.32) but not mortality (HR, 1.07; 95% CI, 0.69-1.66) among technologists who performed fluoroscopically guided interventional procedures compared with those who never performed these procedures. Although there was a small suggestive increase in incidence of all cancers combined, excluding nonmelanoma skin cancers (HR, 1.08; 95% CI, 1.00-1.17), mortality from all cancers combined, excluding nonmelanoma skin cancers, was not elevated (HR, 1.00; 95% CI, 0.88-1.14). We similarly observed no elevated risk of cancers of the thyroid, skin other than melanoma, prostate, lung, or colon and rectum or of leukemia that was not chronic lymphocytic leukemia among workers who performed fluoroscopically guided interventional procedures.

CONCLUSION

We observed elevated risks of brain cancer, breast cancer, and melanoma among technologists who performed fluoroscopically guided interventional procedures. Although exposure to low-dose radiation is one possible explanation for these increased risks, these results may also be due to chance or unmeasured confounding by nonradiation risk factors. Our results must be confirmed in other studies, preferably with individual radiation dose data.

A case-control study of mesothelioma in Minnesota iron ore (taconite) miners

OBJECTIVES

An excess of mesothelioma has been observed in iron ore miners in Northeastern Minnesota. Mining and processing of taconite iron ore generate exposures that include elongate mineral particles (EMPs) of amphibole and non-amphibole origin. We conducted a nested case-control study of mesothelioma in a cohort of 68,737 iron ore miners (haematite and taconite ore miners) to evaluate the association between mesothelioma, employment and EMP exposures from taconite mining.

METHODS

Mesothelioma cases (N=80) were identified through the Minnesota Cancer Surveillance System (MCSS) and death certificates. Four controls of similar age were selected for each case with 315 controls ultimately eligible for inclusion. Mesothelioma risk was evaluated by estimating rate ratios and 95% CIs with conditional logistic regression in relation to duration of taconite industry employment and cumulative EMP exposure [(EMP/cc)×years], defined by the National Institute for Occupational Safety and Health (NIOSH) 7400 method. Models were adjusted for employment in haematite mining and potential exposure to commercial asbestos products used in the industry.

RESULTS

All mesothelioma cases were male and 57 of the cases had work experience in the taconite industry. Mesothelioma was associated with the number of years employed in the taconite industry (RR=1.03, 95% CI 1.00 to 1.06) and cumulative EMP exposure (RR=1.10, 95% CI 0.97 to -1.24). No association was observed with employment in haematite mining.

CONCLUSIONS

These results support an association between mesothelioma and employment duration and possibly EMP exposure in taconite mining and processing. The type of EMP was not determined. The potential role of commercial asbestos cannot be entirely ruled out.

Occupational ionising radiation and risk of basal cell carcinoma in US radiologic technologists (1983-2005)

OBJECTIVE

To determine risk for incident basal cell carcinoma from cumulative low-dose ionising radiation in the US radiologic technologist cohort.

METHODS

We analysed 65,719 Caucasian technologists who were cancer-free at baseline (1983-1989 or 1994-1998) and answered a follow-up questionnaire (2003-2005). Absorbed radiation dose to the skin in mGy for estimated cumulative occupational radiation exposure was reconstructed for each technologist based on badge dose measurements, questionnaire-derived work history and protection practices, and literature information. Radiation-associated risk was assessed using Poisson regression and included adjustment for several demographic, lifestyle, host and sun exposure factors.

RESULTS

Cumulative mean absorbed skin dose (to head/neck/arms) was 55.8 mGy (range 0-1735 mGy). For lifetime cumulative dose, we did not observe an excess radiation-related risk (excess relative risk/Gy=-0.01 (95% CI -0.43 to 0.52). However, we observed that basal cell carcinoma risk was increased for radiation dose received before age 30 (excess relative risk/Gy=0.59, 95% CI -0.11 to 1.42) and before 1960 (excess relative risk/Gy=2.92, 95% CI 1.39 to 4.45).

CONCLUSIONS

Basal cell carcinoma risk was unrelated to low-dose radiation exposure among radiologic technologists. Because of uncertainties in dosimetry and sensitivity to model specifications, both our null results and our findings of excess risk for dose received before age 30 and exposure before 1960 should be interpreted with caution.

Female Estrogen-Related Factors and Incidence of Basal Cell Carcinoma in a Nationwide US Cohort

Purpose

UV radiation exposure is the primary risk factor for basal cell carcinoma (BCC), the most common human malignancy. Although the photosensitizing properties of estrogens have been recognized for decades, few studies have examined the relationship between reproductive factors or exogenous estrogen use and BCC.

Methods

Using data from the US Radiologic Technologists Study, a large, nationwide, prospective cohort, we assessed the relationship between reproductive factors, exogenous estrogen use, and first primary BCC while accounting for sun exposure, personal sun sensitivity, and lifestyle factors for geographically dispersed women exposed to a wide range of ambient UV radiation.

Results

Elevated risk of BCC was associated with late age at natural menopause (hazard ratio [HR] for ≥ 55 years v 50 to 54 years, 1.50; 95% CI, 1.04 to 2.17) and any use of menopausal hormone therapy (MHT; HR, 1.16; 95% CI, 1.03 to 1.30; P for trend for duration = .001). BCC risk was most increased among women reporting natural menopause who used MHT for 10 or more years versus women who never used MHT (HR, 1.97; 95% CI, 1.35 to 2.87). Risk of BCC was not associated with age at menarche, parity, age at first birth, infertility, use of diethylstilbestrol by participant's mother, age at hysterectomy, or use of oral contraceptives.

Conclusion

These analyses confirm a previous finding of increased risk of BCC associated with MHT. Novel findings of increased BCC risk associated with MHT in women experiencing natural menopause and for late age at natural menopause warrant further investigation. Users of MHT may constitute an additional high-risk group in need of more frequent skin cancer screening.

Cancer incidence among Minnesota taconite mining industry workers

PURPOSE

To evaluate cancer incidence among Minnesota taconite mining workers.

METHODS

We evaluated cancer incidence between 1988 and 2010 in a cohort of 40,720 Minnesota taconite mining workers used between 1937 and 1983. Standardized incidence ratios (SIRs) with 95% confidence intervals (CIs) were estimated by comparing numbers of incident cancers with frequencies in the Minnesota Cancer Surveillance System. SIRs for lung cancer by histologic subtypes were also estimated. We adjusted for out-of-state migration and conducted a probabilistic bias analysis for smoking-related cancers.

RESULTS

A total of 5700 cancers were identified, including 51 mesotheliomas and 973 lung cancers. The SIRs for lung cancer and mesothelioma were 1.3 (95% CI = 1.2-1.4) and 2.4 (95% CI = 1.8-3.2), respectively. Stomach, laryngeal, and bladder cancers were also elevated. However, adjusting for potential confounding by smoking attenuated the estimates for lung (SIR = 1.1, 95% CI = 1.0-1.3), laryngeal (SIR = 1.2, 95% CI = 0.8-1.6), oral (SIR = 0.9, 95% CI = 0.7-1.2), and bladder cancers (SIR = 1.0, 95% CI = 0.8-1.1).

CONCLUSIONS

Taconite workers may have an increased risk for certain cancers. Lifestyle and work-related factors may play a role in elevated morbidity. The extent to which mining-related exposures contribute to disease burden is being investigated.