Numbers and proportions of leukemias in young people and adults induced by radiation of natural origin

Genetic Biomarkers and Their Clinical Implications in B-Cell Acute Lymphoblastic Leukemia in Children

Acute lymphoblastic leukemia (ALL) is a heterogeneous group of hematologic malignancies characterized by abnormal proliferation of immature lymphoid cells. It is the most commonly diagnosed childhood cancer with an almost 80% cure rate. Despite favorable survival rates in the pediatric population, a significant number of patients develop resistance to therapy, resulting in poor prognosis. ALL is a heterogeneous disease at the genetic level, but the intensive development of sequencing in the last decade has made it possible to broaden the study of genomic changes. New technologies allow us to detect molecular changes such as point mutations or to characterize epigenetic or proteomic profiles. This process made it possible to identify new subtypes of this disease characterized by constellations of genetic alterations, including chromosome changes, sequence mutations, and DNA copy number alterations. These genetic abnormalities are used as diagnostic, prognostic and predictive biomarkers that play an important role in earlier disease detection, more accurate risk stratification, and treatment. Identification of new ALL biomarkers, and thus a greater understanding of their molecular basis, will lead to better monitoring of the course of the disease. In this article, we provide an overview of the latest information on genomic alterations found in childhood ALL and discuss their impact on patients' clinical outcomes.

Evaluation of Risk Factors for Pediatric Cancers in the West of Iran

Background: Occurrence of pediatric cancers is affected by maternal, environmental, and hereditary/genetic factors. Objectives: The purpose of this study was to evaluate the correlation between background radiation, ultrasound and other possible risk factors for pediatric cancers incidence indicators. Methods: In a cross-sectional study during 2 years, 103 patients under 14 years were studied. A total of 13 environmental, maternal and hereditary/genetic risk factors were studied, and the study was performed by using a questionnaire, measurement of background radiation, and statistical data. Incidence in the studied sample size at city (ISSSC) and incidence in the studied sample size at area (ISSSA) indicators were defined. Results: The mean age of patients was (6.31 ± 3.22) including 54 (52.4%) males and 49 (47.6%) females. History of repeated ultrasound before gender determination (RUBGD) and repeated ultrasound during pregnancy (RUDP) were statistically higher in solid tumors group. Toxic substances (TS) and pediatric medical ionizing radiation (PMIR) was higher in hematologic malignancies. Statistically significant association were found between of cancer types and Family history of leukemia (FHL), Family history of solid tumors (FHST), Abortion history (AH), Maternal smoking during pregnancy (MSDP), Children’s residence place (CRP), and background radiation (BR) variables. No statistically significant association was found between cancer types and maternal pregnancy age (MPA), IVF baby, and maternal ionizing radiation exposure (MIRE) variables. Conclusions: Pediatric cancers are multifactorial diseases. Increased background radiation is correlated with an increased incidence of all pediatric malignancies. It seems that increasing ultrasound scans might increase the risk of solid tumors in children.

Childhood cancer research in oxford III: The work of CCRG on ionising radiation

BACKGROUND

High doses of ionising radiation are a known cause of childhood cancer and great public and professional interest attaches to possible links between childhood cancer and lower doses, particularly of man-made radiation. This paper describes work done by the Childhood Cancer Research Group (CCRG) on this topic METHODS: Most UK investigations have made use of the National Registry of Childhood Tumours and associated controls. Epidemiological investigations have included national incidence and mortality analyses, geographical investigations, record linkage and case-control studies. Dosimetric studies use biokinetic and dosimetric modelling.

RESULTS

This paper reviews the work of the CCRG on the association between exposure to ionising radiation and childhood cancer, 1975-2014.

CONCLUSION

The work of CCRG has been influential in developing understanding of the causes of 'clusters' of childhood cancer and the risks arising from exposure to ionising radiation both natural and man-made. Some clusters around nuclear installations have certainly been observed, but ionising radiation does not seem to be a plausible cause. The group's work has also been instrumental in discounting the hypothesis that paternal preconception irradiation was a cause of childhood cancers and has demonstrated an increased leukaemia risk for children exposed to higher levels of natural gamma-ray radiation.

Background gamma radiation and childhood cancer in Germany: an ecological study

The relationship of low-dose background gamma radiation and childhood leukaemia was investigated in a number of studies. Results from these studies are inconclusive. Therefore, in the present study 25 years of German childhood cancer data were analyzed using interpolated background annual gamma dose rate per community in an ecological study. The main question was leukaemia; as exploratory questions we investigate central nervous system (CNS) tumours, thyroid carcinomas and diagnoses less likely to be related to radiation. A Poisson regression model was applied and a fractional polynomial model building procedure. As the main sensitivity analysis a community deprivation index was included as a potential confounder. It was found that outdoor background gamma annual dose rates in Germany range roughly from 0.5-1.5 mSv/a with an average of 0.817 mSv/a. No association of annual ambient gamma dose rates with leukaemia incidence was found. Amongst the exploratory analyses, a strong association was found with CNS tumour incidence [rate ratio for 1.5 vs 0.5 mSv/a: 1.35; 95% confidence interval (1.17, 1.57)]. The community level deprivation index was not a confounder. It is concluded that the present study did not confirm an association of annual outdoor ambient gamma dose rate and childhood leukaemia, corresponding to some studies and contrasting others. An association with CNS incidence was found in the exploratory analyses. As this is an ecological study no causal interpretation is possible.

Alpha-Particle-Induced Complex Chromosome Exchanges Transmitted through Extra-Thymic Lymphopoiesis In Vitro Show Evidence of Emerging Genomic Instability

Human exposure to high-linear energy transfer α-particles includes environmental (e.g. radon gas and its decay progeny), medical (e.g. radiopharmaceuticals) and occupational (nuclear industry) sources. The associated health risks of α-particle exposure for lung cancer are well documented however the risk estimates for leukaemia remain uncertain. To further our understanding of α-particle effects in target cells for leukaemogenesis and also to seek general markers of individual exposure to α-particles, this study assessed the transmission of chromosomal damage initially-induced in human haemopoietic stem and progenitor cells after exposure to high-LET α-particles. Cells surviving exposure were differentiated into mature T-cells by extra-thymic T-cell differentiation in vitro. Multiplex fluorescence in situ hybridisation (M-FISH) analysis of naïve T-cell populations showed the occurrence of stable (clonal) complex chromosome aberrations consistent with those that are characteristically induced in spherical cells by the traversal of a single α-particle track. Additionally, complex chromosome exchanges were observed in the progeny of irradiated mature T-cell populations. In addition to this, newly arising de novo chromosome aberrations were detected in cells which possessed clonal markers of α-particle exposure and also in cells which did not show any evidence of previous exposure, suggesting ongoing genomic instability in these populations. Our findings support the usefulness and reliability of employing complex chromosome exchanges as indicators of past or ongoing exposure to high-LET radiation and demonstrate the potential applicability to evaluate health risks associated with α-particle exposure.

Radiation-exposed populations: who, why, and how to study

Everyone is exposed to natural and manmade ionizing radiation that can originate from sources in the environment and in medical and occupational settings. There is notable variation, however, among individuals and across populations in the types of sources of radiation and in the frequency, level, and duration of exposure. Adverse health effects associated with radiation exposure have been known for decades, and ionizing radiation exposure has been linked with a broad range of different types of cancer and benign neoplasms as well as birth defects, reproductive effects, and diseases of the circulatory, hematologic, and neurologic systems. Our present understanding of radiation-related health risks derives primarily from multidisciplinary health risk (epidemiologic) studies that provide the key information on radiation-associated health outcomes, quantify radiation-related disease risks, and enhance understanding of mechanisms of radiation-related disease pathogenesis. Such information is central to quantifying risks in relation to benefits; addressing public concerns, including societal and clinical needs in relation to radiation exposure; and providing the database needed for establishing recommendations for radiation protection. Because of the importance of determining risks compared to benefits for all situations where exposure to ionizing radiation might result, it is useful for planning new health risks studies to categorize exposed populations according to the sources and types of radiation. This paper describes a wide range of populations exposed to radiation and the motivation and key methodological criteria that drive the rationale and priority of studying such populations. Also, discussed are alternative methods for evaluating radiation-related health risks in these populations, with a major focus on epidemiologic approaches. This paper concludes with a short summary of major highlights from radiation epidemiologic research and important unanswered questions.Introduction of Exposed Populations (Video 1:29, http://links.lww.com/HP/A22).

Leukaemia incidence in the Techa River Cohort: 1953-2007

BACKGROUND

Little is known about leukaemia risk following chronic radiation exposures at low dose rates. The Techa River Cohort of individuals residing in riverside villages between 1950 and 1961 when releases from the Mayak plutonium production complex contaminated the river allows quantification of leukaemia risks associated with chronic low-dose-rate internal and external exposures.

METHODS

Excess relative risk models described the dose-response relationship between radiation dose on the basis of updated dose estimates and the incidence of haematological malignancies ascertained between 1953 and 2007 among 28 223 cohort members, adjusted for attained age, sex, and other factors.

RESULTS

Almost half of the 72 leukaemia cases (excluding chronic lymphocytic leukaemia (CLL)) were estimated to be associated with radiation exposure. These data are consistent with a linear dose response with no evidence of modification. The excess relative risk estimate was 0.22 per 100 mGy. There was no evidence of significant dose effect for CLL or other haematopoietic malignancies.

CONCLUSION

These analyses demonstrate that radiation exposures, similar to those received by populations exposed as a consequence of nuclear accidents, are associated with long-term dose-related increases in leukaemia risks. Using updated dose estimates, the leukaemia risk per unit dose is about half of that based on previous dosimetry.

Acute lymphoblastic leukaemia

Acute lymphoblastic leukaemia occurs in both children and adults but its incidence peaks between 2 and 5 years of age. Causation is multifactorial and exogenous or endogenous exposures, genetic susceptibility, and chance have roles. Survival in paediatric acute lymphoblastic leukaemia has improved to roughly 90% in trials with risk stratification by biological features of leukaemic cells and response to treatment, treatment modification based on patients' pharmacodynamics and pharmacogenomics, and improved supportive care. However, innovative approaches are needed to further improve survival while reducing adverse effects. Prognosis remains poor in infants and adults. Genome-wide profiling of germline and leukaemic cell DNA has identified novel submicroscopic structural genetic changes and sequence mutations that contribute to leukaemogenesis, define new disease subtypes, affect responsiveness to treatment, and might provide novel prognostic markers and therapeutic targets for personalised medicine.

The risk of childhood leukaemia following exposure to ionising radiation--a review

Since the early years of follow-up of the Japanese atomic-bomb survivors, it has been apparent that childhood leukaemia has a particular sensitivity to induction by ionising radiation, the excess relative risk (ERR) being expressed as a temporal wave with time since exposure. This pattern has been generally confirmed by studies of children treated with radiotherapy. Case-control studies of childhood leukaemia and antenatal exposure to diagnostic x-rays, a recent large cohort study of leukaemia following CT examinations of young people, and a recent large case-control study of natural background γ-radiation and childhood leukaemia have found evidence of raised risks following low-level exposure. These findings indicate that an ERR/Sv for childhood leukaemia of ~50, which may be derived from risk models based upon the Japanese atomic-bomb survivors, is broadly applicable to low dose or low dose-rate exposure circumstances.

Uranium mine proximity, immune function, and Helicobacter pylori infection in Tajikistan

Tajikistan is a country with numerous abandoned uranium mines and individuals residing in close proximity to these sites. Inspection of one of these sites next to the town of Taboshar revealed uncontrolled waste with elevated radiation levels. Convenience samples of subjects likely to have been exposed to uranium mining (i.e., combined living near wastes and former miners) and unexposed subjects (living far from mines and never working in mining) were recruited. There was a higher prevelance of Helicobacter pylori (H. pylori) infection among the exposed and there were significantly more virulent infections involving CagA. Histolological examination of the stomach showed more gastric atrophy in the exposed group. Exposed individuals also had lower percentage of T lymphocytes, fewer T-helper cells, significant imbalance in the immunoregulation index, and significantly higher levels of cytotoxic lymphocytes. There were also reduced levels of immunoglobulin (Ig) M and IgG in the exposed group. These findings are consistent with adverse effects on immune functioning that might increase the rate of development of infectious disease, However, lack of control for confounding factors and lack of individual exposure assessment limit conclusions that can be drawn. Further research that addresses these limitations of this analysis is needed.

Occurrence of ²¹⁰Po and biological effects of low-level exposure: the need for research

BACKGROUND

Polonium-210 (²¹⁰Po) concentrations that exceed 1 Bq/L in drinking-water supplies have been reported from four widely separated U.S. states where exposure to it went unnoticed for decades. The radionuclide grandparents of ²¹⁰Po are common in sediments, and segments of the public may be chronically exposed to low levels of ²¹⁰Po in drinking water or in food products from animals raised in contaminated areas.

OBJECTIVES

We summarized information on the environmental behavior, biokinetics, and toxicology of ²¹⁰Po and identified the need for future research.

METHODS

Potential linkages between environmental exposure to ²¹⁰Po and human health effects were identified in a literature review.

DISCUSSION

²¹⁰Po accumulates in the ovaries where it kills primary oocytes at low doses. Because of its radiosensitivity and tendency to concentrate ²¹⁰Po, the ovary may be the critical organ in determining the lowest injurious dose for ²¹⁰Po. ²¹⁰Po also accumulates in the yolk sac of the embryo and in the fetal and placental tissues. Low-level exposure to ²¹⁰Po may have subtle, long-term biological effects because of its tropism towards reproductive and embryonic and fetal tissues where exposure to a single alpha particle may kill or damage critical cells. ²¹⁰Po is present in cigarettes and maternal smoking has several effects that appear consistent with the toxicology of ²¹⁰Po.

CONCLUSIONS

Much of the important biological and toxicological research on ²¹⁰Po is more than four decades old. New research is needed to evaluate environmental exposure to ²¹⁰Po and the biological effects of low-dose exposure to it so that public health officials can develop appropriate mitigation measures where necessary.

Radiation risks: critical analysis and commentary

OBJECTIVES

1) To review and summarize what is known about the health risks of radiation. 2) To compare risks from medical imaging to background radiation and to exposure from nuclear accidents.

METHODS

Literature review and summative critical analysis.

RESULTS

Over the past several years, physicians and patients have become increasingly aware of the potential risks of radiation exposure from medical imaging. The Fukushima disaster further heightened public awareness of hazards associated with radiation and radioactivity. In the case of medical imaging, small but real risks of cancer and other radiation-induced disease must be balanced against potential benefits of improved diagnostic accuracy. The ethical principle of autonomy tells us that patients should be informed of potential benefits and harms of radiation imaging, and should participate in shared decision making. In the case of nuclear power, benefits and especially harms are exceptionally difficult to estimate accurately. Nevertheless, we know that hazards from today's nuclear power plants will persist for many years, affecting future generations not benefiting from electrical power generated today.

CONCLUSIONS

A deeper and more widespread understanding of potential benefits and harms of personal and societal choices relating to radiation exposure may lead to improved medical and societal decision-making.