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Rizik DG, Gosselin KP, Burke RF, Goldstein JA. Comprehensive radiation shield minimizes operator radiation exposure in coronary and structural heart procedures. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2024; 64:70-75. [PMID: 38538447 DOI: 10.1016/j.carrev.2024.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 02/12/2024] [Accepted: 02/21/2024] [Indexed: 06/11/2024]
Abstract
OBJECTIVES This study evaluated the efficacy of a novel comprehensive shield designed to minimize radiation exposure (RE) to Physicians performing coronary and structural heart procedures. BACKGROUND The Protego™ radiation shielding system (Image Diagnostics Inc., Fitchburg, Ma) is designed to provide comprehensive protection from RE and has been State certified sufficient to allow operators to perform procedures without orthopedically burdensome lead aprons. METHODS This single center two-group cohort study assessed the efficacy of this shield in a large number of cardiac procedures (coronary and structural), comparing operator RE compared to standard protection methods (personal lead apparel and "drop down" shield). RESULTS The Protego™ system reduced operator RE by 99 % compared to Standard Protection. RE was significantly lower at both "Head" level by thyroid median dose 0.0 (0.0, 0,0) vs 5.7 (2.9, 8.2) μSv (p < 0.001), as well as waist dose 0.0 (0.0, 0.0) vs 10.0 (5.0, 16.6) μSv (p < 0.001). "Zero" Total RE was documented by Raysafe™ in 64 % (n = 32) of TAVR cases and 73.2 % (n = 183) of the coronary cases utilizing Protego™. In contrast, standard protection did not achieve "Zero" exposure in a single case. These dramatic differences in RE were achieved despite higher fluoroscopy times in the Protego™ arm (11.9 ± 8.6 vs 14.3 ± 12.5 min, p = 0.015). Per case procedural exposure measured by Dose Area Product was higher in the Protego™ group compared to standard protection (115.4 ± 139.2 vs 74.9 ± 69.3, p < 0.001). CONCLUSION The Protego™ shield provides total body RE protection for operators performing both coronary and structural heart procedures. This shield allows procedural performance without the need for personal lead aprons and has potential to reduce catheterization laboratory occupational health hazards.
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Affiliation(s)
- David G Rizik
- Honor Health, Scottsdale, AZ, United States of America.
| | - Kevin P Gosselin
- University of Texas at Tyler, AriTex LLC, Tyler, TX, United States of America
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Xu X, Xie Y, Li H, Wang X, Shi S, Yang Z, Lan Y, Han J, Liu Y. Awareness and preparedness level of medical workers for radiation and nuclear emergency response. Front Public Health 2024; 12:1410722. [PMID: 38952739 PMCID: PMC11215176 DOI: 10.3389/fpubh.2024.1410722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Accepted: 06/03/2024] [Indexed: 07/03/2024] Open
Abstract
Radiological science and nuclear technology have made great strides in the twenty-first century, with wide-ranging applications in various fields, including energy, medicine, and industry. However, those developments have been accompanied by the inherent risks of exposure to nuclear radiation, which is a source of concern owing to its potentially adverse effects on human health and safety and which is of particular relevance to medical personnel who may be exposed to certain cancers associated with low-dose radiation in their working environment. While medical radiation workers have seen a decrease in their occupational exposure since the 1950s thanks to improved measures for radiation protection, a concerning lack of understanding and awareness persists among medical professionals regarding these potential hazards and the required safety precautions. This issue is further compounded by insufficient capabilities in emergency response. This highlights the urgent need to strengthen radiation safety education and training to ensure the well-being of medical staff who play a critical role in radiological and nuclear emergencies. This review examines the health hazards of nuclear radiation to healthcare workers and the awareness and willingness and education of healthcare workers on radiation protection, calling for improved training programs and emergency response skills to mitigate the risks of radiation exposure in the occupational environment, providing a catalyst for future enhancement of radiation safety protocols and fostering of a culture of safety in the medical community.
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Affiliation(s)
- Xinyu Xu
- Department of Occupational and Environmental Health, School of Public Health, Health Science Center, Xi’an Jiaotong University, Xi’an, China
- Global Health Institute, Health Science Center, Xi’an Jiaotong University, Xi’an, China
- Department of Oncology and Occupational Disease, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Yanjun Xie
- Department of Occupational and Environmental Health, School of Public Health, Health Science Center, Xi’an Jiaotong University, Xi’an, China
- Global Health Institute, Health Science Center, Xi’an Jiaotong University, Xi’an, China
| | - Hongqiu Li
- Department of Occupational and Environmental Health, School of Public Health, Health Science Center, Xi’an Jiaotong University, Xi’an, China
- Global Health Institute, Health Science Center, Xi’an Jiaotong University, Xi’an, China
| | - Xining Wang
- Department of Occupational and Environmental Health, School of Public Health, Health Science Center, Xi’an Jiaotong University, Xi’an, China
- Global Health Institute, Health Science Center, Xi’an Jiaotong University, Xi’an, China
| | - Shaoteng Shi
- Department of Occupational and Environmental Health, School of Public Health, Health Science Center, Xi’an Jiaotong University, Xi’an, China
- Global Health Institute, Health Science Center, Xi’an Jiaotong University, Xi’an, China
| | - Zhihao Yang
- Department of Occupational and Environmental Health, School of Public Health, Health Science Center, Xi’an Jiaotong University, Xi’an, China
- Global Health Institute, Health Science Center, Xi’an Jiaotong University, Xi’an, China
| | - Yuemin Lan
- Department of Oncology and Occupational Disease, The Second Affiliated Hospital of Soochow University, Suzhou, China
- State Key Laboratory of Radiation Medicine and Protection, School of Radiation Medicine and Protection, Medical College of Soochow University, Suzhou, China
| | - Jing Han
- Department of Occupational and Environmental Health, School of Public Health, Health Science Center, Xi’an Jiaotong University, Xi’an, China
- Global Health Institute, Health Science Center, Xi’an Jiaotong University, Xi’an, China
| | - Yulong Liu
- Department of Oncology and Occupational Disease, The Second Affiliated Hospital of Soochow University, Suzhou, China
- State Key Laboratory of Radiation Medicine and Protection, School of Radiation Medicine and Protection, Medical College of Soochow University, Suzhou, China
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Lee D, Cha ES, Park S, Sung H, Noh E, Jeong H, Jang WI, Seo S. Cohort Profile: The Korean Radiation Workers Study (KRWS). Int J Epidemiol 2024; 53:dyae060. [PMID: 38628072 DOI: 10.1093/ije/dyae060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 04/05/2024] [Indexed: 04/19/2024] Open
Affiliation(s)
- Dalnim Lee
- National Radiation Emergency Medical Center, Korea Institute of Radiological and Medical Sciences, Seoul, Republic of Korea
| | - Eun Shil Cha
- National Radiation Emergency Medical Center, Korea Institute of Radiological and Medical Sciences, Seoul, Republic of Korea
| | - Soojin Park
- National Radiation Emergency Medical Center, Korea Institute of Radiological and Medical Sciences, Seoul, Republic of Korea
| | - Hyoju Sung
- National Radiation Emergency Medical Center, Korea Institute of Radiological and Medical Sciences, Seoul, Republic of Korea
| | - Eunbi Noh
- National Radiation Emergency Medical Center, Korea Institute of Radiological and Medical Sciences, Seoul, Republic of Korea
| | - Haesu Jeong
- National Radiation Emergency Medical Center, Korea Institute of Radiological and Medical Sciences, Seoul, Republic of Korea
| | - Won-Il Jang
- National Radiation Emergency Medical Center, Korea Institute of Radiological and Medical Sciences, Seoul, Republic of Korea
- Department of Radiation Oncology, Korea Institute of Radiological and Medical Sciences, Seoul, Republic of Korea
| | - Songwon Seo
- National Radiation Emergency Medical Center, Korea Institute of Radiological and Medical Sciences, Seoul, Republic of Korea
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Iavicoli I, Fontana L, Santocono C, Guarino D, Laudiero M, Calabrese EJ. The challenges of defining hormesis in epidemiological studies: The case of radiation hormesis. THE SCIENCE OF THE TOTAL ENVIRONMENT 2023; 902:166030. [PMID: 37544458 DOI: 10.1016/j.scitotenv.2023.166030] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 07/24/2023] [Accepted: 08/01/2023] [Indexed: 08/08/2023]
Abstract
In the current radiation protection system, preventive measures and occupational exposure limits for controlling occupational exposure to ionizing radiation are based on the linear no-threshold extrapolation model. However, currently an increasing body of evidence indicates that this paradigm predicts very poorly biological responses in the low-dose exposure region. In addition, several in vitro and in vivo studies demonstrated the presence of hormetic dose response curves correlated to ionizing radiation low exposure. In this regard, it is noteworthy that also the findings of different epidemiological studies, conducted in different categories of occupationally exposed workers (e.g., healthcare, nuclear industrial and aircrew workers), observed lower rates of mortality and/or morbidity from cancer and/or other diseases in exposed workers than in unexposed ones or in the general population, then suggesting the possible occurrence of hormesis. Nevertheless, these results should be considered with caution since the identification of hormetic response in epidemiological studies is rather challenging because of a number of major limitations. In this regard, some of the most remarkable shortcomings found in epidemiological studies performed in workers exposed to ionizing radiation are represented by lack or inadequate definition of exposure doses, use of surrogates of exposure, narrow dose ranges, lack of proper control groups and poor evaluation of confounding factors. Therefore, considering the valuable role and contribution that epidemiological studies might provide to the complex risk assessment and management process, there is a clear and urgent need to overcome the aforementioned limits in order to achieve an adequate, useful and more real-life risk assessment that should also include the key concept of hormesis. Thus, in the present conceptual article we also discuss and provide possible approaches to improve the capacity of epidemiological studies to identify/define the hormetic response and consequently improve the complex process of risk assessment of ionizing radiation at low exposure doses.
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Affiliation(s)
- Ivo Iavicoli
- Department of Public Health, Section of Occupational Medicine, University of Naples Federico II, Via S. Pansini 5, 80131 Naples, Italy.
| | - Luca Fontana
- Department of Public Health, Section of Occupational Medicine, University of Naples Federico II, Via S. Pansini 5, 80131 Naples, Italy
| | - Carolina Santocono
- Department of Public Health, Section of Occupational Medicine, University of Naples Federico II, Via S. Pansini 5, 80131 Naples, Italy
| | - Davide Guarino
- Department of Public Health, Section of Occupational Medicine, University of Naples Federico II, Via S. Pansini 5, 80131 Naples, Italy
| | - Martina Laudiero
- Department of Public Health, Section of Occupational Medicine, University of Naples Federico II, Via S. Pansini 5, 80131 Naples, Italy
| | - Edward J Calabrese
- Department of Environmental Health Sciences, Morrill I, N344, University of Massachusetts, Amherst, MA 01003, USA
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Milman RJ, McCollough CH, Sechopoulos I. Radiation safety: minimise risks by properly positioning patients, equipment, and operators. BMJ 2023; 381:p1472. [PMID: 37385644 DOI: 10.1136/bmj.p1472] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/01/2023]
Affiliation(s)
- Rebecca J Milman
- Department of Radiology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Cynthia H McCollough
- CT Clinical Innovation Center and X-ray Imaging Core, Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Ioannis Sechopoulos
- Advanced X ray Tomographic Imaging Lab, Department of Medical Imaging, Radboud University Medical Centre, Nijmegen, The Netherlands
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Pilkington I, Sevenoaks H, James E, Eastwood D. Protecting female healthworkers from ionising radiation at work. BMJ 2023; 381:e075406. [PMID: 37045449 DOI: 10.1136/bmj-2023-075406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Affiliation(s)
| | | | - Emily James
- King's College Hospital NHS Foundation Trust, London, UK
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Shetty C, Rizvi SMHA, Sharaf J, Williams KAD, Tariq M, Acharekar MV, Guerrero Saldivia SE, Unnikrishnan SN, Chavarria YY, Akindele AO, Jalkh APC, Eastmond AK, Hamid P. Risk of Gynecological Cancers in Women With Polycystic Ovary Syndrome and the Pathophysiology of Association. Cureus 2023; 15:e37266. [PMID: 37162768 PMCID: PMC10164440 DOI: 10.7759/cureus.37266] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 04/07/2023] [Indexed: 05/11/2023] Open
Abstract
Polycystic ovary syndrome (PCOS) is an endocrine disorder increasingly affecting women in the reproductive age group. The women usually present with menstruation irregularities, hirsutism, weight gain, and acne. There has been ongoing research about the increased risk of gynecological cancers in women with polycystic ovary syndrome compared to those without it. This review aimed to understand the risk of gynecological cancers, endometrial, ovarian, and breast cancer in PCOS, and to study in detail the underlying mechanisms involved. We searched PubMed and Google Scholar databases for studies and selected 10 articles from a total of 19,388 relevant articles. We found an increased risk of endometrial cancer in women with PCOS whereas the risk of ovarian and breast cancer was not increased. A recent study has even reported a reduced risk of ovarian cancer in genetically predicted PCOS. In understanding various medical conditions possibly leading to cancer in these women we found that hyperandrogenism, hyperinsulinemia, unopposed estrogen action, chronic inflammation, and dyslipidemia were major contributors. There is a need for more large-scale cohort studies which will take into consideration other factors leading to cancers in women with PCOS, such as smoking, alcohol, and family history, to substantiate the significance of these associations further. The interventions used to treat PCOS might also affect the risk of cancer and require further probing. This review is an attempt to analyze the risk of cancers of the reproductive system in females with PCOS in coherence with understanding the mechanisms leading to the respective cancers.
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Affiliation(s)
- Chaitra Shetty
- Research, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | | | - Joudi Sharaf
- Research, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Kerry-Ann D Williams
- Research, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Maha Tariq
- Research, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Maitri V Acharekar
- Research, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | | | - Sumedha N Unnikrishnan
- Research, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Yeny Y Chavarria
- Research, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Adebisi O Akindele
- Research, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Ana Paula C Jalkh
- Research, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Aziza K Eastmond
- Research, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Pousette Hamid
- Research, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
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Boice JD, Cohen SS, Mumma MT, Howard SC, Yoder RC, Dauer LT. Mortality among medical radiation workers in the United States, 1965-2016. Int J Radiat Biol 2023; 99:183-207. [PMID: 34731066 DOI: 10.1080/09553002.2021.1967508] [Citation(s) in RCA: 22] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Estimates of radiation risks following prolonged exposures at low doses and low-dose rates are uncertain. Medical radiation workers are a major component of the Million Person Study (MPS) of low-dose health effects. Annual personal dose equivalents, HP(10), for individual workers are available to facilitate dose-response analyses for lung cancer, leukemia, ischemic heart disease (IHD) and other causes of death. MATERIALS AND METHODS The Landauer, Inc. dosimetry database identified 109,019 medical and associated radiation workers first monitored 1965-1994. Vital status and cause of death were determined through 2016. Mean absorbed doses to red bone marrow (RBM), lung, heart, and other organs were estimated by adjusting the recorded HP(10) for each worker by scaling factors, accounting for exposure geometry, the energy of the incident photon radiation, sex of the worker and whether an apron was worn. There were 4 exposure scenarios: general radiology characterized by low-energy x-ray exposure with no lead apron use, interventional radiologists/cardiologists who wore aprons, nuclear medicine personnel and radiation oncologists exposed to high-energy photon radiation, and other workers. Standardized mortality ratio (SMR) analyses were performed. Cox proportional hazards models were used to estimate organ-specific radiation risks. RESULTS Overall, 11,433 deaths occurred (SMR 0.60; 95%CI 0.59,0.61), 126 from leukemia other than chronic lymphocytic leukemia (CLL), 850 from lung cancer, and 1654 from IHD. The mean duration of monitoring was 23.7 y. The excess relative rate (ERR) per 100 mGy was estimated as 0.10 (95% CI -0.34, 0.54) for leukemia other than CLL, 0.15 (0.02, 0.27) for lung cancer, and -0.10 (-0.27, 0.06) for IHD. The ERR for lung cancer was 0.16 (0.01, 0.32) among the 55,218 male workers and 0.09 (-0.19, 0.36) among the 53,801 female workers; a difference that was not statistically significant (p-value = 0.23). CONCLUSIONS Medical radiation workers were at increased risk for lung cancer that was higher among men than women, although this difference was not statistically significant. In contrast, the study of Japanese atomic bomb survivors exposed briefly to radiation in 1945 found females to be nearly 3 times the radiation risk of lung cancer compared with males on a relative scale. For medical workers, there were no statistically significant radiation associations with leukemia excluding CLL, IHD or other specific causes of death. Combining these data with other cohorts within the MPS, such as nuclear power plant workers and nuclear submariners, will enable more precise estimates of radiation risks at relatively low cumulative doses.
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Affiliation(s)
- John D Boice
- National Council on Radiation Protection and Measurements, Bethesda, MD, USA.,Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center and Vanderbilt-Ingram Cancer Center, Vanderbilt University, Nashville, TN, USA
| | | | - Michael T Mumma
- International Epidemiology Institute, Rockville, MD, USA.,Vanderbilt University Medical Center, Nashville, TN, USA
| | - Sara C Howard
- ORISE Health Studies Program, Oak Ridge Associated Universities, Oak Ridge, TN, USA
| | | | - Lawrence T Dauer
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Modarai B, Haulon S, Ainsbury E, Böckler D, Vano-Carruana E, Dawson J, Farber M, Van Herzeele I, Hertault A, van Herwaarden J, Patel A, Wanhainen A, Weiss S, Esvs Guidelines Committee, Bastos Gonçalves F, Björck M, Chakfé N, de Borst GJ, Coscas R, Dias NV, Dick F, Hinchliffe RJ, Kakkos SK, Koncar IB, Kolh P, Lindholt JS, Trimarchi S, Tulamo R, Twine CP, Vermassen F, Document Reviewers, Bacher K, Brountzos E, Fanelli F, Fidalgo Domingos LA, Gargiulo M, Mani K, Mastracci TM, Maurel B, Morgan RA, Schneider P. Editor's Choice - European Society for Vascular Surgery (ESVS) 2023 Clinical Practice Guidelines on Radiation Safety. Eur J Vasc Endovasc Surg 2023; 65:171-222. [PMID: 36130680 DOI: 10.1016/j.ejvs.2022.09.005] [Citation(s) in RCA: 39] [Impact Index Per Article: 39.0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 09/15/2022] [Indexed: 01/24/2023]
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Su P, Zhu Z, He J, He R, Feng H, Du P, Lönn L, Konge L, Yin F. Focus on Radiation Protection Improves Both Correct Behavior and Procedural Performance During Simulation-Based Training - A Randomized Comparison. Ann Vasc Surg 2023; 89:302-311. [PMID: 36334895 DOI: 10.1016/j.avsg.2022.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 10/04/2022] [Accepted: 10/05/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND To explore whether simulation-based endovascular training with focus on radiation safety could improve correct behavior without jeopardizing the learning of procedural skills. METHODS Twenty-four residents without previous endovascular experience completed 10 clinical scenarios on a virtual-reality endovascular simulator with software for peripheral endovascular interventions. Participants were randomized to receive feedback (n = 12) or not (n = 12) on radiation protection (RP) performance after each case. Expert assessments were done at the first, second, fourth, seventh, and 10th case on RP and endovascular skills (ES). Automatic simulator metrics on procedure time, contrast dose, handling errors, and estimated radiation exposure to patient and operator were registered. Outcome metrics were analyzed by two-way mixed analysis of variance pairwise comparisons with independent t-tests. Correlations were explored using Pearson's r for internal consistency reliability. RESULTS The RP performance was similar in both groups at their first attempt (P = 0.61), but the feedback group significantly outperformed the control group over time (P < 0.001 for all comparisons). The feedback group was however slower to learn the ES at start (P = 0.047 at second performance), but after 7 attempts no difference was shown (P = 0.59). The feedback group used more time (19.5 vs. 15.3 min; P = 0.007) but less contrast (60 vs. 100 mL; P < 0.001). The number of errors was the same in both groups, but all metrics regarding radiation exposure favored the feedback group (P-values from 0.001 to 0.008). CONCLUSIONS Simulation-based training (SBT) is effective to acquire basic endovascular intervention skills and concurrently learn RP behavior when feedback on radiation culture is provided.
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Affiliation(s)
- Peizhu Su
- Department of Gastroenterology, The First People's Hospital of Foshan, Foshan, Guangdong, China; Guangdong Academy for Medical Simulation (GAMS), Guangzhou, China
| | - Zhengrong Zhu
- Department of Vascular and Thyroid Surgery, The First People's Hospital of Foshan, Foshan, Guangdong, China
| | - Jiawei He
- Department of Radiology, The First People's Hospital of Foshan, Foshan, Guangdong, China
| | - Rong He
- Department of Radiology, The First People's Hospital of Foshan, Foshan, Guangdong, China
| | - Huahai Feng
- Department of Neurology, The First People's Hospital of Foshan, Foshan, Guangdong, China
| | - Pu Du
- Department of Neurology, The First People's Hospital of Foshan, Foshan, Guangdong, China
| | - Lars Lönn
- Department of Radiology, Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Lars Konge
- Guangdong Academy for Medical Simulation (GAMS), Guangzhou, China; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Copenhagen Academy for Medical Education and Simulation (CAMES), Copenhagen, Denmark.
| | - Fang Yin
- Department of Post-graduate Education, The First People's Hospital of Foshan, Foshan, Guangdong, China
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Rabah M, Allen S, Abbas AE, Dixon S. A novel comprehensive radiation shielding system eliminates need for personal lead aprons in the catheterization laboratory. Catheter Cardiovasc Interv 2023; 101:79-86. [PMID: 36453459 DOI: 10.1002/ccd.30490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 10/27/2022] [Accepted: 11/02/2022] [Indexed: 12/04/2022]
Abstract
OBJECTIVES This clinical study evaluated the efficacy of a novel radiation shielding system for the cardiac catheterization laboratory designed to provide comprehensive protection that obviates the need for personal lead aprons. BACKGROUND Invasive Cardiologists are exposed to occupational health hazards related directly to radiation exposure (RE) and indirectly to the orthopedic burden of wearing only partially protective lead aprons. Innovations to reduce these risks are warranted. A novel comprehensive shielding system (ProtegoTM , Image Diagnostics Inc, Fitchburg, Ma) has been validated in pre-clinical studies to provide excellent radiation protection, sufficient for the State of Michigan to certify it for use without need for personal lead aprons. METHODS This clinical analysis measured RE to a single Physician operator utilizing the ProtegoTM shield (and not wearing personal lead apron) during routine cardiac catheterization procedures (diagnostic and interventional). RE was measured at both thyroid and waist level with a real-time dosimetry system (RaysafeTM , Billdal, Sweden), calculated on a median per case basis (mrems). Additional parameters collected included procedure type, access site, per case fluoroscopy time, and patient factors including body mass index. RESULTS In n=98 cases (25% diagnostic, 75% interventional including 22% chronic total occlusions), median/case RE was 0.4 mrems (thyroid) and 0.2 mrems (waist). RE=0 in 12 cases. In no case did radiation exposure exceed 3.2 mrems. CONCLUSION The ProtegoTM shield system provides excellent RE protection to the Physician operator, without the need for personal lead aprons and has the potential to reduce catheterization laboratory occupational health hazards.
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Affiliation(s)
- Maher Rabah
- Department of Cardiovascular Medicine, Beaumont Hospitals, Royal Oak, Michigan, USA
| | - Sorcha Allen
- Department of Cardiovascular Medicine, Beaumont Hospitals, Royal Oak, Michigan, USA
| | - Amr E Abbas
- Department of Cardiovascular Medicine, Beaumont Hospitals, Royal Oak, Michigan, USA
| | - Simon Dixon
- Department of Cardiovascular Medicine, Beaumont Hospitals, Royal Oak, Michigan, USA
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Radiation Exposure and Lifetime Attributable Risk of Cancer Incidence and Mortality from Low- and Standard-Dose CT Chest: Implications for COVID-19 Pneumonia Subjects. Diagnostics (Basel) 2022; 12:diagnostics12123043. [PMID: 36553050 PMCID: PMC9777015 DOI: 10.3390/diagnostics12123043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 11/25/2022] [Accepted: 11/29/2022] [Indexed: 12/07/2022] Open
Abstract
Since the novel coronavirus disease 2019 (COVID-19) outbreak, there has been an unprecedented increase in the acquisition of chest computed tomography (CT) scans. Nearly 616 million people have been infected by COVID-19 worldwide to date, of whom many were subjected to CT scanning. CT exposes the patients to hazardous ionizing radiation, which can damage the genetic material in the cells, leading to stochastic health effects in the form of heritable genetic mutations and increased cancer risk. These probabilistic, long-term carcinogenic effects of radiation can be seen over a lifetime and may sometimes take several decades to manifest. This review briefly describes what is known about the health effects of radiation, the lowest dose for which there exists compelling evidence about increased radiation-induced cancer risk and the evidence regarding this risk at typical CT doses. The lifetime attributable risk (LAR) of cancer from low- and standard-dose chest CT scans performed in COVID-19 subjects is also discussed along with the projected number of future cancers that could be related to chest CT scans performed during the COVID-19 pandemic. The LAR of cancer Incidence from chest CT has also been compared with those from other radiation sources, daily life risks and lifetime baseline risk.
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Tran TVT, Rubino C, Allodji R, Andruccioli M, Bardet S, Diallo I, Dottorini M, Garsi J, Hall P, Henry-Amar M, Lamart S, Le Thai F, Lönn S, Ricard M, Schvartz C, Schlumberger M, Journy N, de Vathaire F. Breast cancer risk among thyroid cancer survivors and the role of I-131 treatment. Br J Cancer 2022; 127:2118-2124. [PMID: 36224404 PMCID: PMC9726818 DOI: 10.1038/s41416-022-01982-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 08/07/2022] [Accepted: 09/05/2022] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Female thyroid cancer survivors are more likely to have a higher risk of breast cancer compared to the general population, and the underlying causes are yet to be understood. The potential role of I-131 treatment on this association remains controversial. METHODS We pooled individual data of women who were treated for differentiated thyroid cancer from 1934 to 2005 in France, Italy and Sweden. Standardized incidence ratios (SIRs) for breast cancer were estimated by comparison with age, sex and calendar-year expected values of the general population in each country. We estimated breast cancer risk in relation to I-131 treatment using time-dependent Poisson models. RESULTS Of 8475 women (mean age at diagnosis: 45 years, range 2-90 years), 335 were diagnosed with breast cancer [SIR = 1.52, 95% confidence interval (CI): 1.36-1.69] during a median follow-up time of 12.7 years since diagnosis. Overall, breast cancer risk did not differ between women treated or not with I-131 (relative risk=1.07, 95% CI 0.84-1.35). However, breast cancer risk increased with increasing cumulative I-131 activity, without significant departure from linearity (excess relative risk per 100 mCi=17%, 95% CI: 2% to 38%). The higher risk associated with a cumulative I-131 activity of ≥100 mCi and ≥400 mCi was translated into 4 (95% CI -4 to 13) and 42 (95% CI -8 to 93) excess breast cancer cases per 10,000 person-years, respectively. CONCLUSIONS An elevated risk was observed for the highest cumulative administered activity (>=400 mCi), and a significant dose-dependent association was observed among thyroid cancer survivors who were treated with I-131. However, overall, I-131 treatment might only explain partly the increase in breast cancer risk among female thyroid cancer survivors.
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Affiliation(s)
- Thi-Van-Trinh Tran
- Radiation Epidemiology Team, INSERM U1018, Center for Research in Epidemiology and Population Health (CESP), F-94805, Villejuif Cedex, France.
- Department of Research, Gustave Roussy, F-94805, Villejuif Cedex, France.
- University of Paris Saclay, Kremlin-Bicêtre, France.
| | - Carole Rubino
- Radiation Epidemiology Team, INSERM U1018, Center for Research in Epidemiology and Population Health (CESP), F-94805, Villejuif Cedex, France.
- Department of Research, Gustave Roussy, F-94805, Villejuif Cedex, France.
- University of Paris Saclay, Kremlin-Bicêtre, France.
| | - Rodrigue Allodji
- Radiation Epidemiology Team, INSERM U1018, Center for Research in Epidemiology and Population Health (CESP), F-94805, Villejuif Cedex, France
- Department of Research, Gustave Roussy, F-94805, Villejuif Cedex, France
- University of Paris Saclay, Kremlin-Bicêtre, France
| | - Milena Andruccioli
- Department of Nuclear Medicine, Sant'Anna Hospital, via Napoleona 60, 22100, Como, Italy
| | - Stéphane Bardet
- Department of Nuclear Medicine and Thyroid Unit, Centre François Baclesse, Caen, France
| | - Ibrahima Diallo
- Radiation Epidemiology Team, INSERM U1018, Center for Research in Epidemiology and Population Health (CESP), F-94805, Villejuif Cedex, France
- Department of Research, Gustave Roussy, F-94805, Villejuif Cedex, France
- University of Paris Saclay, Kremlin-Bicêtre, France
| | - Massimo Dottorini
- Department of Diagnostic Imaging, Nuclear Medicine Unit, Perugia General Hospital, Perugia, Italy
| | - Jérome Garsi
- Radiation Epidemiology Team, INSERM U1018, Center for Research in Epidemiology and Population Health (CESP), F-94805, Villejuif Cedex, France
- Department of Research, Gustave Roussy, F-94805, Villejuif Cedex, France
- University of Paris Saclay, Kremlin-Bicêtre, France
| | - Per Hall
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, 171 65, Stockholm, Sweden
- Department of Oncology, Södersjukhuset, 118 83, Stockholm, Sweden
| | - Michel Henry-Amar
- Centre de Traitement des Données du Cancéropôle Nord-Ouest, Plateforme de Recherche Clinique Ligue Contre le Cancer, Centre François Baclesse, 3 Avenue Général Harris, 14076, Caen, Cedex 5, France
| | - Stephanie Lamart
- Laboratoire d'Évaluation de la Dose Interne, Institut de Radioprotection et de Sûreté Nucléaire, IRSN/PSE-SANTE/SDOS/LEDI, 31 avenue de la Division Leclerc, 92260, Fontenay-aux-Roses, France
| | | | - Stefan Lönn
- Department of Research and Development, Region Halland, Halmstad, Sweden
| | - Marcel Ricard
- Department of Physics, Gustave Roussy and Paris Saclay University, Villejuif, France
| | - Claire Schvartz
- Nuclear medicine-thyroid Unit, Institut Godinot, 1, rue du Général-Koenig, 51100, Reims, France
- Thyroid Cancer Registry of Marne-Ardennes, Institut Godinot, 1, rue du Général-Koenig, 51100, Reims, France
| | - Martin Schlumberger
- Department of Nuclear Medicine and Endocrine Oncology, Gustave Roussy and University Paris-Saclay, 94800, Villejuif, France
| | - Neige Journy
- Radiation Epidemiology Team, INSERM U1018, Center for Research in Epidemiology and Population Health (CESP), F-94805, Villejuif Cedex, France
- Department of Research, Gustave Roussy, F-94805, Villejuif Cedex, France
- University of Paris Saclay, Kremlin-Bicêtre, France
| | - Florent de Vathaire
- Radiation Epidemiology Team, INSERM U1018, Center for Research in Epidemiology and Population Health (CESP), F-94805, Villejuif Cedex, France.
- Department of Research, Gustave Roussy, F-94805, Villejuif Cedex, France.
- University of Paris Saclay, Kremlin-Bicêtre, France.
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14
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Liu D, Linet MS, Albert PS, Landgren AM, Kitahara CM, Iwan A, Clerkin C, Kohler B, Alexander BH, Penberthy L. Ascertainment of Incident Cancer by US Population-Based Cancer Registries Versus Self-Reports and Death Certificates in a Nationwide Cohort Study, the US Radiologic Technologists Study. Am J Epidemiol 2022; 191:2075-2083. [PMID: 35872590 PMCID: PMC10144614 DOI: 10.1093/aje/kwac121] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 03/23/2022] [Accepted: 07/06/2022] [Indexed: 02/01/2023] Open
Abstract
Follow-up of US cohort members for incident cancer is time-consuming, is costly, and often results in underascertainment when the traditional methods of self-reporting and/or medical record validation are used. We conducted one of the first large-scale investigations to assess the feasibility, methods, and benefits of linking participants in the US Radiologic Technologists (USRT) Study (n = 146,022) with the majority of US state or regional cancer registries. Follow-up of this cohort has relied primarily on questionnaires (mailed approximately every 10 years) and linkage with the National Death Index. We compared the level of agreement and completeness of questionnaire/death-certificate-based information with that of registry-based (43 registries) incident cancer follow-up in the USRT cohort. Using registry-identified first primary cancers from 1999-2012 as the gold standard, the overall sensitivity was 46.5% for self-reports only and 63.0% for both self-reports and death certificates. Among the 37.0% false-negative reports, 27.8% were due to dropout, while 9.2% were due to misreporting. The USRT cancer reporting patterns differed by cancer type. Our study indicates that linkage to state cancer registries would greatly improve completeness and accuracy of cancer follow-up in comparison with questionnaire self-reporting. These findings support ongoing development of a national US virtual pooled registry with which to streamline cohort linkages.
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Affiliation(s)
- Danping Liu
- Correspondence to Dr. Danping Liu, Biostatistics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, 9609 Medical Center Drive, Room 7E630, Rockville, MD 20850 (e-mail: )
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15
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Bulliard JL, Bovio N, Arveux P, Bergeron Y, Chiolero A, Fournier E, Germann S, Konzelmann I, Maspoli M, Rapiti E, Canu IG. Occupational Factors and Socioeconomic Differences in Breast Cancer Risk and Stage at Diagnosis in Swiss Working Women. Cancers (Basel) 2022; 14:cancers14153713. [PMID: 35954377 PMCID: PMC9367372 DOI: 10.3390/cancers14153713] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 07/12/2022] [Accepted: 07/28/2022] [Indexed: 12/07/2022] Open
Abstract
Socioeconomic differences in breast cancer (BC) incidence are driven by differences in lifestyle, healthcare use and occupational exposure. Women of high socioeconomic status (SES) have a higher risk of BC, which is diagnosed at an earlier stage, than in low SES women. As the respective effects of occupation and SES remain unclear, we examined the relationships between occupation-related variables and BC incidence and stage when considering SES. Female residents of western Switzerland aged 18−65 years in the 1990 or 2000 census, with known occupation, were linked with records of five cancer registries to identify all primary invasive BC diagnosed between 1990 and 2014 in this region. Standardized incidence ratios (SIRs) were computed by occupation using general female population incidence rates, with correction for multiple comparisons. Associations between occupation factors and BC incidence and stage at diagnosis were analysed by negative binomial and multinomial logistic regression models, respectively. The cohort included 381,873 women-years and 8818 malignant BC, with a mean follow-up of 14.7 years. Compared with reference, three occupational groups predominantly associated with a high socioprofessional status had SIRs > 1: legal professionals (SIR = 1.68, 95%CI: 1.27−2.23), social science workers (SIR = 1.29; 95%CI: 1.12−1.49) and some office workers (SIR = 1.14; 95%CI: 1.09−1.20). Conversely, building caretakers and cleaners had a reduced incidence of BC (SIR = 0.69, 95%CI: 0.59−0.81). Gradients in BC risk with skill and socioprofessional levels persisted when accounting for SES. A higher incidence was generally associated with a higher probability of an early-stage BC. Occupation and SES may both contribute to differences in risk and stage at diagnosis of BC.
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Affiliation(s)
- Jean-Luc Bulliard
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, 1010 Lausanne, Switzerland; (N.B.); (P.A.); (S.G.); (I.G.C.)
- Neuchâtel and Jura Cancer Registry, 2000 Neuchâtel, Switzerland;
- Correspondence:
| | - Nicolas Bovio
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, 1010 Lausanne, Switzerland; (N.B.); (P.A.); (S.G.); (I.G.C.)
| | - Patrick Arveux
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, 1010 Lausanne, Switzerland; (N.B.); (P.A.); (S.G.); (I.G.C.)
| | - Yvan Bergeron
- Fribourg Cancer Registry, 1701 Fribourg, Switzerland;
| | - Arnaud Chiolero
- Population Health Laboratory (#PopHealthLab), University of Fribourg, 1700 Fribourg, Switzerland;
- Valais Cancer Registry, Valais Health Observatory, 1950 Sion, Switzerland;
| | - Evelyne Fournier
- Geneva Cancer Registry, University of Geneva, 1211 Geneva, Switzerland; (E.F.); (E.R.)
| | - Simon Germann
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, 1010 Lausanne, Switzerland; (N.B.); (P.A.); (S.G.); (I.G.C.)
| | | | - Manuela Maspoli
- Neuchâtel and Jura Cancer Registry, 2000 Neuchâtel, Switzerland;
| | - Elisabetta Rapiti
- Geneva Cancer Registry, University of Geneva, 1211 Geneva, Switzerland; (E.F.); (E.R.)
| | - Irina Guseva Canu
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, 1010 Lausanne, Switzerland; (N.B.); (P.A.); (S.G.); (I.G.C.)
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16
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Machi Jr A, Moreira Perez M, Luciano da Veiga G, Cristiano Pereira E, Adami F, da Costa Aguiar Alves B, Luiz Affonso Fonseca F. Expression of DNA repair genes in association with ionizing radiation. ACTA BIO-MEDICA : ATENEI PARMENSIS 2022; 93:e2022232. [PMID: 35775781 PMCID: PMC9335411 DOI: 10.23750/abm.v93i3.12140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 09/14/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND AIM DNA repair systems are functionally essential for the maintenance of life and among these, we can highlight the MutS system, subdivided into MutSα (hMSH2 and hMSH6) and MutSβ (hMSH2 and hMSH3). The objective of this study was to analyze the expression of hMSH2 and hMSH6 repair genes in radiology technicians exposed to low radiation doses. METHODS Thirty workers occupationally exposed to ionizing radiation and twenty-five non-exposed were included in this study. Gene expression was analyzed by qPCR. Peripheral blood samples were collected from both groups for total RNA isolation. RESULTS It was observed a five-fold increase (p=0.006) in the hMSH2 repair gene expression in those exposed to radiation and a weak but significant correlation (p=0.041) with the hMSH6 genes when we associated the number of hours of exposure with gene expression. CONCLUSIONS The longer the exposure time, the greater the activation of this component of the repair system. APPLICATION TO PRACTICE Blood count parameters could did not alter with radiation exposure. X-rays used by radiology technicians in imaging tests can damage the DNA to the point of activating the MutS repair system and that there is a greater tendency of expression of this system in professionals that had undergone longer exposure.
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Affiliation(s)
- Amaury Machi Jr
- Laboratório de Análises Clínicas do Centro Universitário Faculdade de Medicina do ABC, Santo André, SP, Brazil
| | - Matheus Moreira Perez
- Laboratório de Análises Clínicas do Centro Universitário Faculdade de Medicina do ABC, Santo André, SP, Brazil
| | - Glaucia Luciano da Veiga
- Laboratório de Análises Clínicas do Centro Universitário Faculdade de Medicina do ABC, Santo André, SP, Brazil
| | - Edimar Cristiano Pereira
- Departamento de Ciências Farmacêuticas da Universidade Federal de São Paulo, Diadema, SP, Brazil
| | - Fernando Adami
- Laboratório de Epidemiologia e Análise de Dados do Centro Universitário Faculdade de Medicina do ABC, Santo André, SP, Brazil
| | | | - Fernando Luiz Affonso Fonseca
- Laboratório de Análises Clínicas do Centro Universitário Faculdade de Medicina do ABC, Santo André, SP, Brazil, Departamento de Ciências Farmacêuticas da Universidade Federal de São Paulo, Diadema, SP, Brazil
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17
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Salcido-Rios J, McNamara DA, VanOosterhout S, VanLoo L, Redmond M, Parker JL, Madder RD. Suspended lead suit and physician radiation doses during coronary angiography. Catheter Cardiovasc Interv 2021; 99:981-988. [PMID: 34967086 DOI: 10.1002/ccd.30047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 11/16/2021] [Accepted: 11/25/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVE This study was performed to evaluate physician radiation doses with the use of a suspended lead suit. BACKGROUND Interventional cardiologists face substantial occupational risks from chronic radiation exposure and wearing heavy lead aprons. METHODS Head-level physician radiation doses, collected using real-time dosimeters during consecutive coronary angiography procedures, were compared with the use of a suspended lead suit versus conventional lead aprons. Multiple linear regression analyses were completed using physician radiation doses as the response and testing patient variables (body mass index, age, sex), procedural variables (right heart catheterization, fractional flow reserve, percutaneous coronary intervention, radial access), and shielding variables (radiation-absorbing pad, accessory lead shield, suspended lead suit) as the predictors. RESULTS Among 1054 coronary angiography procedures, 691 (65.6%) were performed with a suspended lead suit and 363 (34.4%) with lead aprons. There was no significant difference in dose area product between groups (61.7 [41.0, 94.9] mGy·cm2 vs. 64.6 [42.9, 96.9] mGy·cm2 , p = 0.20). Median head-level physician radiation doses were 10.2 [3.2, 35.5] μSv with lead aprons and 0.2 [0.1, 0.9] μSv with a suspended lead suit (p < 0.001), representing a 98.0% reduced dose with suspended lead. In the fully adjusted regression model, the use of a suspended lead suit was independently associated with a 93.8% reduction (95% confidence interval: -95.0, -92.3; p < 0.001) in physician radiation dose. CONCLUSION Compared to conventional lead aprons, the use of a suspended lead suit during coronary angiography was associated with marked reductions in head-level physician radiation doses.
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Affiliation(s)
- Jose Salcido-Rios
- Division of Cardiology, Frederik Meijer Heart and Vascular Institute, Spectrum Health, Grand Rapids, Michigan, USA
| | - David A McNamara
- Division of Cardiology, Frederik Meijer Heart and Vascular Institute, Spectrum Health, Grand Rapids, Michigan, USA
| | - Stacie VanOosterhout
- Division of Cardiology, Frederik Meijer Heart and Vascular Institute, Spectrum Health, Grand Rapids, Michigan, USA
| | - Lisa VanLoo
- Division of Cardiology, Frederik Meijer Heart and Vascular Institute, Spectrum Health, Grand Rapids, Michigan, USA
| | - Meaghan Redmond
- Division of Cardiology, Frederik Meijer Heart and Vascular Institute, Spectrum Health, Grand Rapids, Michigan, USA
| | - Jessica L Parker
- Division of Cardiology, Frederik Meijer Heart and Vascular Institute, Spectrum Health, Grand Rapids, Michigan, USA
| | - Ryan D Madder
- Division of Cardiology, Frederik Meijer Heart and Vascular Institute, Spectrum Health, Grand Rapids, Michigan, USA
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18
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Barańska A, Błaszczuk A, Kanadys W, Malm M, Drop K, Polz-Dacewicz M. Oral Contraceptive Use and Breast Cancer Risk Assessment: A Systematic Review and Meta-Analysis of Case-Control Studies, 2009-2020. Cancers (Basel) 2021; 13:cancers13225654. [PMID: 34830807 PMCID: PMC8616467 DOI: 10.3390/cancers13225654] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 11/09/2021] [Indexed: 11/16/2022] Open
Abstract
To perform a meta-analysis of case-control studies that addressed the association between oral contraceptive pills (OC) use and breast cancer (BrCa), PubMED (MEDLINE), Embase, and the Cochrane Library were searched to identify case-control studies of OC and BrCa published between 2009 and 2020. We used the DerSimonian-Laird method to compute pooled odds ratios (ORs) and confidence intervals (CIs), and the Mantel-Haenszel test to assess the association between OC use and cancer. Forty-two studies were identified that met the inclusion criteria and we included a total of 110,580 women (30,778 into the BrCa group and 79,802 into the control group, of which 15,722 and 38,334 were using OC, respectively). The conducted meta-analysis showed that the use of OC was associated with a significantly increased risk of BrCa in general, OR = 1.15, 95% CI: 1.01 to 1.31, p = 0.0358. Regarding other risk factors for BrCa, we found that increased risk was associated significantly with early menarche, nulliparous, non-breastfeeding, older age at first parity, postmenopause, obesity, smoking, and family history of BrCa. Despite our conclusion that birth control pills increase the cancer risk being supported by extensive previous studies and meta-analyzes, further confirmation is required.
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Affiliation(s)
- Agnieszka Barańska
- Department of Medical Informatics and Statistics with E-Learning Lab, Medical University of Lublin, 20-090 Lublin, Poland;
- Correspondence:
| | - Agata Błaszczuk
- Department of Virology with SARS Laboratory, Medical University of Lublin, 20-059 Lublin, Poland; (A.B.); (M.P.-D.)
| | - Wiesław Kanadys
- Specialistic Medical Center Czechow, Gynecology Unit, 20-848 Lublin, Poland;
| | - Maria Malm
- Department of Medical Informatics and Statistics with E-Learning Lab, Medical University of Lublin, 20-090 Lublin, Poland;
| | - Katarzyna Drop
- Department of Language, Rhetoric and Media Law, John Paul II Catholic University, 20-950 Lublin, Poland;
| | - Małgorzata Polz-Dacewicz
- Department of Virology with SARS Laboratory, Medical University of Lublin, 20-059 Lublin, Poland; (A.B.); (M.P.-D.)
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19
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Wilson-Stewart KS, Fontanarosa D, Malacova E, Trapp JV. Comparison of patient and staff temple dose during fluoroscopically guided coronary angiography, implantable cardiac devices, and electrophysiology procedures. Phys Med 2021; 90:142-149. [PMID: 34649045 DOI: 10.1016/j.ejmp.2021.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 09/03/2021] [Accepted: 09/17/2021] [Indexed: 11/28/2022] Open
Abstract
There is a paucity of literature comparing patient and staff dose during coronary angiography (CA), implantable cardiac devices, permanent pacemakers (PPM) and electrophysiology (EP) procedures and little noting dose to staff other than cardiologists. This study sought to compare patient and occupational dose during a range of fluoroscopically guided cardiac procedures. Radiation dose levels for the patients (n = 1651), cardiologists (n = 24), scrub (n = 32) and scout nurses (n = 35) were measured in a prospective single-centre study between February 2017 and August 2019. A comparison of dose during CA, device implantation, PPM insertion and EP studies was performed. Three angiographic units were used, with dosimeters worn on the temple of staff. Results indicated that occupational dose during PPM was significantly higher than other procedures. The cardiologist had the highest mean dose during biventricular implantable cardioverter-defibrillators; levels were approximately five times that of 'normal' pacemaker insertions. Transcatheter aortic valve implantations (TAVI) were associated with relatively high mean doses for both staff and patients and had a statistically significant higher (>2 times) mean patient dose area product than all other categories. TAVI workups were also related to higher mean cardiologist and scrub nurse dose. It was observed that the mean scrub nurse dose can exceed that of the cardiologist. The highest mean dose for Scout nurses were recorded during EP studies. Given the significantly higher temple dose associated with PPM insertion, cardiologists should consider utilizing ceiling mounted lead shields, lead glasses and/or skull caps where possible. Efforts should also be made to minimize the use of DSA during TAVI and TAVI workups to reduce cardiologist, nurse and patient dose.
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Affiliation(s)
- Kelly S Wilson-Stewart
- School of Chemistry and Physics, Faulty of Science, Queensland Univeristy of Technology, 2 George Street, Brisbane, QLD 4000, Australia; Greenslopes Private Hospital, Ramsay Health Care, Newdegate Street, Greenslopes, Brisbane, QLD 4120, Australia.
| | - Davide Fontanarosa
- School of Clinical Sciences, Faculty of Health, Queensland University of Technology, 2 George Street, Brisbane, QLD 4000, Australia; Centre for Biomedical Technologies (CBT), Queensland University of Technology, Brisbane, QLD 4000, Australia
| | - Eva Malacova
- School of Clinical Sciences, Faculty of Health, Queensland University of Technology, 2 George Street, Brisbane, QLD 4000, Australia; QMIR Berghofer Medical Research Institute, 200 Herston Road, Herston, QLD 4006, Australia
| | - Jamie V Trapp
- School of Chemistry and Physics, Faulty of Science, Queensland Univeristy of Technology, 2 George Street, Brisbane, QLD 4000, Australia
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20
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Wan RCW, Chau WW, Tso CY, Tang N, Chow SKH, Cheung WH, Wong RMY. Occupational hazard of fluoroscopy: An invisible threat to orthopaedic surgeons. JOURNAL OF ORTHOPAEDICS, TRAUMA AND REHABILITATION 2021. [DOI: 10.1177/22104917211035547] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The use of fluoroscopy is widespread within different medical specialties. Improper protection may cause significant radiation hazard to medical personnel. To evaluate the concepts on radiation safety and fluoroscopy use among orthopaedic surgeons and to reflect our current training on this issue, a survey was distributed to perform an audit in our department, an academic unit. Twenty-eight orthopaedic surgeons replied. Amongst our participants, 96.4% used a lead apron at all times. Only 33% used a thyroid shield, 67% never used radiation goggles and 96% never used radiation protection gloves. 53.6% and 46.4% of participants position the fluoroscopy incorrectly in the anteroposterior and lateral positions, respectively, during use. There is clearly a need for improved safety amongst orthopaedic surgeons. A literature review was further performed, showing the hazards of fluoroscopy for doctors, including the risk of cataracts, radiation dermatitis, skin cancer and thyroid cancer. Hazards specific to females, including breast cancer risk, and in-utero irradiation of foetus were also thoroughly discussed. Recommendations towards radiation safety and practical measures to reduce fluoroscopy radiation hazard during procedure were made. Education and training to doctors on this invisible hazard is strongly advised.
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Affiliation(s)
- Raymond CW Wan
- Department of Orthopaedics & Traumatology, Prince of Wales Hospital, Hong Kong
| | - Wai W Chau
- Department of Orthoapedics & Traumatology, The Chinese University of Hong Kong, Hong Kong
| | - Chi Y Tso
- Department of Orthopaedics & Traumatology, Prince of Wales Hospital, Hong Kong
| | - Ning Tang
- Department of Orthopaedics & Traumatology, Prince of Wales Hospital, Hong Kong
| | - Simon KH Chow
- Department of Orthoapedics & Traumatology, The Chinese University of Hong Kong, Hong Kong
| | - Wing-Hoi Cheung
- Department of Orthoapedics & Traumatology, The Chinese University of Hong Kong, Hong Kong
| | - Ronald MY Wong
- Department of Orthoapedics & Traumatology, The Chinese University of Hong Kong, Hong Kong
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21
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He CQ, Mao L, Yao J, Zhao WC, Huang B, Hu N, Long DX. The Threshold Effects of Low-Dose-Rate Radiation on miRNA-Mediated Neurodevelopment of Zebrafish. Radiat Res 2021; 196:633-646. [PMID: 34399425 DOI: 10.1667/rade-20-00265.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 07/29/2021] [Indexed: 11/03/2022]
Abstract
The biological effects and regulatory mechanisms of low-dose and low-dose-rate radiation are still rather controversial. Therefore, in this study we investigated the effects of low-dose-rate radiation on zebrafish neurodevelopment and the role of miRNAs in radiation-induced neurodevelopment. Zebrafish embryos received prolonged gamma-ray irradiation (0 mGy/h, 0.1 mGy/h, 0.2 mGy/h, 0.4 mGy/h) during development. Neurodevelopmental indicators included mortality, malformation rate, swimming speed, as well as the morphology changes of the lateral line system and brain tissue. Additionally, spatiotemporal expression of development-related miRNAs (dre-miR-196a-5p, dre-miR-210-3p, dre-miR-338) and miRNA processing enzymes genes (Dicer and Drosha) were assessed by qRT-PCR and whole mount in situ hybridization (WISH). The results revealed a decline in mortality, malformation and swimming speed, with normal histological and morphological appearance, in zebrafish that received 0.1 mGy/h; however, increased mortality, malformation and swimming speed were observed, with pathological changes, in zebrafish that received 0.2 mGy/h and 0.4 mGy/h. The expression of miRNA processing enzyme genes was altered after irradiation, and miRNAs expression was downregulated in the 0.1 mGy/h group, and upregulated in the 0.2 mGy/h and 0.4 mGy/h groups. Furthermore, ectopic expression of dre-miR-210-3p, Dicer and Drosha was also observed in the 0.4 mGy/h group. In conclusion, the effect of low-dose and low-dose-rate radiation on neurodevelopment follows the threshold model, under the regulation of miRNAs, excitatory effects occurred at a dose rate of 0.1 mGy/h and toxic effects occurred at a dose rate of 0.2 mGy/h and 0.4 mGy/h.
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Affiliation(s)
- Chu-Qi He
- School of Public Health, University of South China, Hengyang 421001, PR China.,Hunan Province Key Laboratory of Typical Environmental Pollution and Health Hazards, Hengyang, Hunan 421001, China
| | - Liang Mao
- School of Public Health, University of South China, Hengyang 421001, PR China.,Hunan Province Key Laboratory of Typical Environmental Pollution and Health Hazards, Hengyang, Hunan 421001, China
| | - Jin Yao
- School of Public Health, University of South China, Hengyang 421001, PR China.,Hunan Province Key Laboratory of Typical Environmental Pollution and Health Hazards, Hengyang, Hunan 421001, China
| | - Wei-Chao Zhao
- School of Public Health, University of South China, Hengyang 421001, PR China.,Hunan Province Key Laboratory of Typical Environmental Pollution and Health Hazards, Hengyang, Hunan 421001, China
| | - Bo Huang
- School of Public Health, University of South China, Hengyang 421001, PR China.,Hunan Province Key Laboratory of Typical Environmental Pollution and Health Hazards, Hengyang, Hunan 421001, China
| | - Nan Hu
- Key Discipline Laboratory for National Defense for Biotechnology in Uranium Mining and Hydrometallurgy, University of South China, Hengyang, Hunan 421001, China
| | - Ding-Xin Long
- School of Public Health, University of South China, Hengyang 421001, PR China.,Hunan Province Key Laboratory of Typical Environmental Pollution and Health Hazards, Hengyang, Hunan 421001, China
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22
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Villoing D, Borrego D, Preston DL, Alexander BH, Rose A, Salasky M, Linet MS, Lee C, Kitahara CM. Trends in Occupational Radiation Doses for U.S. Radiologic Technologists Performing General Radiologic and Nuclear Medicine Procedures, 1980-2015. Radiology 2021; 300:605-612. [PMID: 34156301 DOI: 10.1148/radiol.2021204501] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Background Occupational doses to most medical radiation workers have declined substantially since the 1950s because of improvements in radiation protection practices. However, different patterns may have emerged for radiologic technologists working with nuclear medicine because of the higher per-procedure doses and increasing workloads. Purpose To summarize annual occupational doses during a 36-year period for a large cohort of U.S. radiologic technologists and to compare dose between general radiologic technologists and those specializing in nuclear medicine procedures. Materials and Methods Annual personal dose equivalents (referred to as doses) from 1980 to 2015 were summarized for 58 434 (62%) participants in the U.S. Radiologic Technologists (USRT) cohort who responded to the most recent mailed work history survey (years 2012-2014) and reported never regularly performing interventional procedures. Doses were partitioned according to the performance of nuclear medicine (yes or no, frequency, procedure type) by calendar year. Annual dose records were described by using summary statistics (eg, median and 25th and 75th percentiles). Results Median annual doses related to performance of general radiologic procedures decreased from 0.60 mSv (interquartile range [IQR], 0.10-1.9 mSv) in 1980 to levels below the limits of detection by 2015, whereas annual doses related to performance of nuclear medicine procedures remained relatively high during this period (median, 1.2 mSv; IQR, 0.12-3.0 mSv). Higher median annual doses were associated with more frequent (above vs below the median) performance of diagnostic nuclear medicine procedures (≥35 vs <35 times per week; 1.6 mSv [IQR, 0.30-3.3 mSv] and 0.9 mSv [IQR, 0.10-2.6 mSv]). Higher and more variable annual doses were associated with more frequent performance of cardiac nuclear medicine (≥10 times per week) and PET (nine or more times per week) examinations (median, 1.6 mSv [IQR, 0.30-2.2 mSv] and 2.2 mSv [IQR, 0.10-4.6 mSv], respectively). Conclusion Annual doses to U.S. radiologic technologists performing general radiologic procedures declined during a 36-year period. However, consistently higher and more variable doses were associated with the performance of nuclear medicine procedures, particularly cardiac nuclear medicine and PET procedures. © RSNA, 2021 Online supplemental material is available for this article. See also the editorial by Mettler and Guiberteau in this issue.
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Affiliation(s)
- Daphnée Villoing
- From the Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, 9609 Medical Center Dr, Rockville, MD 20850 (D.V., D.B., A.R., M.S.L., C.L., C.M.K.); Hirosoft International, Eureka, Calif (D.L.P.); Division of Environmental Health Sciences, School of Public Health, University of Minnesota, Minneapolis, Minn (B.H.A.); Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, Colo (B.H.A.); and Landauer, Glenwood, Ill (M.S.)
| | - David Borrego
- From the Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, 9609 Medical Center Dr, Rockville, MD 20850 (D.V., D.B., A.R., M.S.L., C.L., C.M.K.); Hirosoft International, Eureka, Calif (D.L.P.); Division of Environmental Health Sciences, School of Public Health, University of Minnesota, Minneapolis, Minn (B.H.A.); Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, Colo (B.H.A.); and Landauer, Glenwood, Ill (M.S.)
| | - Dale L Preston
- From the Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, 9609 Medical Center Dr, Rockville, MD 20850 (D.V., D.B., A.R., M.S.L., C.L., C.M.K.); Hirosoft International, Eureka, Calif (D.L.P.); Division of Environmental Health Sciences, School of Public Health, University of Minnesota, Minneapolis, Minn (B.H.A.); Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, Colo (B.H.A.); and Landauer, Glenwood, Ill (M.S.)
| | - Bruce H Alexander
- From the Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, 9609 Medical Center Dr, Rockville, MD 20850 (D.V., D.B., A.R., M.S.L., C.L., C.M.K.); Hirosoft International, Eureka, Calif (D.L.P.); Division of Environmental Health Sciences, School of Public Health, University of Minnesota, Minneapolis, Minn (B.H.A.); Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, Colo (B.H.A.); and Landauer, Glenwood, Ill (M.S.)
| | - André Rose
- From the Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, 9609 Medical Center Dr, Rockville, MD 20850 (D.V., D.B., A.R., M.S.L., C.L., C.M.K.); Hirosoft International, Eureka, Calif (D.L.P.); Division of Environmental Health Sciences, School of Public Health, University of Minnesota, Minneapolis, Minn (B.H.A.); Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, Colo (B.H.A.); and Landauer, Glenwood, Ill (M.S.)
| | - Mark Salasky
- From the Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, 9609 Medical Center Dr, Rockville, MD 20850 (D.V., D.B., A.R., M.S.L., C.L., C.M.K.); Hirosoft International, Eureka, Calif (D.L.P.); Division of Environmental Health Sciences, School of Public Health, University of Minnesota, Minneapolis, Minn (B.H.A.); Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, Colo (B.H.A.); and Landauer, Glenwood, Ill (M.S.)
| | - Martha S Linet
- From the Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, 9609 Medical Center Dr, Rockville, MD 20850 (D.V., D.B., A.R., M.S.L., C.L., C.M.K.); Hirosoft International, Eureka, Calif (D.L.P.); Division of Environmental Health Sciences, School of Public Health, University of Minnesota, Minneapolis, Minn (B.H.A.); Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, Colo (B.H.A.); and Landauer, Glenwood, Ill (M.S.)
| | - Choonsik Lee
- From the Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, 9609 Medical Center Dr, Rockville, MD 20850 (D.V., D.B., A.R., M.S.L., C.L., C.M.K.); Hirosoft International, Eureka, Calif (D.L.P.); Division of Environmental Health Sciences, School of Public Health, University of Minnesota, Minneapolis, Minn (B.H.A.); Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, Colo (B.H.A.); and Landauer, Glenwood, Ill (M.S.)
| | - Cari M Kitahara
- From the Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, 9609 Medical Center Dr, Rockville, MD 20850 (D.V., D.B., A.R., M.S.L., C.L., C.M.K.); Hirosoft International, Eureka, Calif (D.L.P.); Division of Environmental Health Sciences, School of Public Health, University of Minnesota, Minneapolis, Minn (B.H.A.); Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, Colo (B.H.A.); and Landauer, Glenwood, Ill (M.S.)
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23
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Lee WJ, Ko S, Bang YJ, Choe SA, Choi Y, Preston DL. Occupational radiation exposure and cancer incidence in a cohort of diagnostic medical radiation workers in South Korea. Occup Environ Med 2021; 78:876-883. [PMID: 34039756 PMCID: PMC8606456 DOI: 10.1136/oemed-2021-107452] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 04/22/2021] [Accepted: 05/03/2021] [Indexed: 12/12/2022]
Abstract
Objectives We investigated the association between protracted low-dose ionising radiation and the risk of cancer in medical radiation workers, the largest group of workers with occupational radiation exposures. Methods Data of all South Korean diagnostic medical radiation workers enrolled at the National Dose Registry during 1996–2011 were merged with the death and cancer incidence data until 31 December 2017. SIRs, relative risks and excess relative risks (ERRs) for cancer were calculated to quantify the radiation dose–response relationship using Poisson regression models. Results A total of 3392 first primary cancer cases were identified among 93 920 diagnostic medical radiation workers. The mean cumulative badge dose in the cohort was 7.20 mSv. The ERRs for solid cancer with a 5-year lag and haematopoietic cancers with a 2-year lag for all workers were 0.15 per 100 mGy (95% CI −0.20 to 0.51) and 0.09 per 100 mGy (95% CI −2.02 to 2.20), respectively. The ERRs for cancers did not significantly vary by job title, different lag years or after excluding thyroid and lung cancers. Sensitivity analyses restricted to workers employed for at least 1 year, or who were employed in or after 1996, or who had exposure to a cumulative badge dose of 1 mSv or more showed similar results. Conclusions Occupational radiation doses were not significantly associated with cancer incidence among South Korean diagnostic medical radiation workers. However, cautious interpretation of ERRs is needed due to the limitations of short follow-up and low cumulative radiation doses.
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Affiliation(s)
- Won Jin Lee
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, South Korea
| | - Seulki Ko
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, South Korea
| | - Ye Jin Bang
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, South Korea
| | - Seung-Ah Choe
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, South Korea
| | - Yeongchull Choi
- Seoul Workers' Health Center, Ewha Womans University, Seoul, South Korea
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24
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Mohd Ridzwan SF, Bhoo-Pathy N, Wee LH, Isahak M. Beliefs, Facilitating Factors, and Barriers in Using Personal Dosimeter among Medical Radiation Workers in a Middle-Income Asian Setting. Ann Work Expo Health 2021; 65:940-954. [PMID: 34037205 DOI: 10.1093/annweh/wxab025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 02/22/2021] [Accepted: 03/23/2021] [Indexed: 11/14/2022] Open
Abstract
This qualitative study explores the medical radiation workers' (MRWs) beliefs with the support of the theory of planned behaviour's constructs regarding the use of personal dosimeters in order to identify the facilitating factors and barriers to practising good personal dose monitoring. The exploration was conducted through semi-structured face-to-face interviews with 63 MRWs from the public, private, and university hospitals. Belief statements from the informants were organized under the behavioural, normative, and control belief, as guided by the theory. A thematic analysis found that a majority of informants acknowledged the benefits of using dosimeters. However, several factors influenced the actual usage. The informants were hesitant to use the dosimeter as the loss of the device involved an expensive penalty. They also mentioned that delayed dosimeter supplies due to late budget approval in the hospitals and some other reasons had got them disconnected from the monitoring system. The workers' attitudes and social norms highly induced their dosimeter usage as well; some perceived themselves to be at low risk for high exposure to radiation, and forgetfulness was also mentioned as a reason for lack of adherence. Device physical factor influenced low dosimeter use too. This study highlighted some unique findings in Asian settings. A better understanding of the underlying reasons for the lack of dosimeter use will be useful in developing strategies to increase good practices in personal radiation monitoring.
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Affiliation(s)
- Siti Farizwana Mohd Ridzwan
- Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur, Malaysia.,Department of Radiology, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Cheras, Kuala Lumpur, Malaysia
| | - Nirmala Bhoo-Pathy
- Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur, Malaysia
| | - Lei Hum Wee
- Health Education Program, Centre for Community Health Studies (ReaCH), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur, Malaysia
| | - Marzuki Isahak
- Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur, Malaysia
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25
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Houghton SC, Hankinson SE. Cancer Progress and Priorities: Breast Cancer. Cancer Epidemiol Biomarkers Prev 2021; 30:822-844. [PMID: 33947744 DOI: 10.1158/1055-9965.epi-20-1193] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 10/13/2020] [Accepted: 02/19/2021] [Indexed: 12/24/2022] Open
Affiliation(s)
- Serena C Houghton
- Department of Biostatistics and Epidemiology, University of Massachusetts Amherst, Amherst, Massachusetts.
| | - Susan E Hankinson
- Department of Biostatistics and Epidemiology, University of Massachusetts Amherst, Amherst, Massachusetts
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26
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Zupunski L, Yaumenenka A, Ryzhov A, Veyalkin I, Drozdovitch V, Masiuk S, Ivanova O, Kesminiene A, Pukkala E, Moiseev P, Prysyazhnyuk A, Schüz J, Ostroumova E. Breast cancer incidence in the regions of Belarus and Ukraine most contaminated by the Chernobyl accident: 1978 to 2016. Int J Cancer 2021; 148:1839-1849. [PMID: 33064313 PMCID: PMC9426215 DOI: 10.1002/ijc.33346] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 09/22/2020] [Accepted: 10/01/2020] [Indexed: 01/15/2023]
Abstract
Even 30 years after the accident, an association between breast cancer incidence and ionizing radiation exposure from Chernobyl fallout remains uncertain. We studied breast cancer incidence in the most contaminated regions of Belarus (Gomel and Mogilev) and Ukraine (Kyiv, Zhytomyr and Chernihiv) before (1978-1986) and after (1987-2016) the accident. Breast cancer cases and female population size data were received from the national cancer registries and the state departments of statistics. The study included 85 132 breast cancers with 150 million person-years at risk. We estimated annual rayon (district)-average absorbed doses to the breast from external and internal irradiation of the adult female population over the period of 1986-2016. We studied an association between rayon-average cumulative absorbed breast dose with 5-year lag, that is, excluding the exposure in 5 years prior to breast cancer diagnosis, and breast cancer incidence using negative binomial regression models. Mean (median) cumulative breast dose in 2016 was 12.3 (5.0) milligray (mGy) in Belarus and 5.7 (2.3) mGy in Ukraine, with the maximum dose of 55 mGy and 54 mGy, respectively. Breast cancer incidence rates statistically significantly increased with calendar year and attained age, and were higher in urban than in rural residents. Adjusting for time, age and urbanicity effects, we found no evidence of increasing incidence with rayon-average 5-year lagged cumulative breast dose. Owing to ecological study design limitations, a case-control study covering this area with individually reconstructed absorbed breast doses is needed testing for association between low-dose protracted radiation exposure and breast cancer risk after Chernobyl.
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Affiliation(s)
- Ljubica Zupunski
- Section of Environment and Radiation, International Agency for Research on Cancer, Lyon, France
| | - Alesia Yaumenenka
- Cancer Control Department, N.N. Alexandrov National Cancer Centre of Belarus, Minsk, Belarus
| | - Anton Ryzhov
- Faculty of Mechanics and Mathematics, Department of General Mathematics, Taras Shevchenko National University of Kyiv, Kyiv, Ukraine
- Department of Cancer Control with the National Cancer Registry of Ukraine, National Cancer Institute, Kyiv, Ukraine
| | - Ilya Veyalkin
- Epidemiology Laboratory, The Republican Research Centre for Radiation Medicine and Human Ecology, Gomel, Belarus
| | - Vladimir Drozdovitch
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, Maryland
| | - Sergii Masiuk
- Dosimetry and Radiation Hygiene Department, Health Physics and Epidemiology Institute, State Institution “National Research Center for Radiation Medicine of the National Academy of Medical Science of Ukraine”, Kyiv, Ukraine
| | - Olha Ivanova
- Dosimetry and Radiation Hygiene Department, Health Physics and Epidemiology Institute, State Institution “National Research Center for Radiation Medicine of the National Academy of Medical Science of Ukraine”, Kyiv, Ukraine
| | - Ausrele Kesminiene
- Section of Environment and Radiation, International Agency for Research on Cancer, Lyon, France
| | - Eero Pukkala
- Finnish Cancer Registry—Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Pavel Moiseev
- Cancer Control Department, N.N. Alexandrov National Cancer Centre of Belarus, Minsk, Belarus
| | - Anatoly Prysyazhnyuk
- Epidemiology Department, Health Physics and Epidemiology Institute, State Institution “National Research Center for Radiation Medicine of the National Academy of Medical Science of Ukraine”, Kyiv, Ukraine
| | - Joachim Schüz
- Section of Environment and Radiation, International Agency for Research on Cancer, Lyon, France
| | - Evgenia Ostroumova
- Section of Environment and Radiation, International Agency for Research on Cancer, Lyon, France
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27
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Apostoaei AI, Thomas BA, Hoffman FO, Kocher DC, Thiessen KM, Borrego D, Lee C, Simon SL, Zablotska LB. Fluoroscopy X-Ray Organ-Specific Dosimetry System (FLUXOR) for Estimation of Organ Doses and Their Uncertainties in the Canadian Fluoroscopy Cohort Study. Radiat Res 2021; 195:385-396. [PMID: 33544842 PMCID: PMC8133309 DOI: 10.1667/rade-20-00212.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 01/13/2021] [Indexed: 11/03/2022]
Abstract
As part of ongoing efforts to assess lifespan disease mortality and incidence in 63,715 patients from the Canadian Fluoroscopy Cohort Study (CFCS) who were treated for tuberculosis between 1930 and 1969, we developed a new FLUoroscopy X-ray ORgan-specific dosimetry system (FLUXOR) to estimate radiation doses to various organs and tissues. Approximately 45% of patients received medical procedures accompanied by fluoroscopy, including artificial pneumothorax (air in pleural cavity to collapse of lungs), pneumoperitoneum (air in peritoneal cavity), aspiration of fluid from pleural cavity and gastrointestinal series. In addition, patients received chest radiographs for purposes of diagnosis and monitoring of disease status. FLUXOR utilizes age-, sex- and body size-dependent dose coefficients for fluoroscopy and radiography exams, estimated using radiation transport simulations in up-to-date computational hybrid anthropomorphic phantoms. The phantoms include an updated heart model, and were adjusted to match the estimated mean height and body mass of tuberculosis patients in Canada during the relevant time period. Patient-specific data (machine settings, exposure duration, patient orientation) used during individual fluoroscopy or radiography exams were not recorded. Doses to patients were based on parameter values inferred from interviews with 91 physicians practicing at the time, historical literature, and estimated number of procedures from patient records. FLUXOR uses probability distributions to represent the uncertainty in the unknown true, average value of each dosimetry parameter. Uncertainties were shared across all patients within specific subgroups of the cohort, defined by age at treatment, sex, type of procedure, time period of exams and region (Nova Scotia or other provinces). Monte Carlo techniques were used to propagate uncertainties, by sampling alternative average values for each parameter. Alternative average doses per exam were estimated for patients in each subgroup, with the total average dose per individual determined by the number of exams received. This process was repeated to produce alternative cohort vectors of average organ doses per patient. This article presents estimates of doses to lungs, female breast, active bone marrow and heart wall. Means and 95% confidence intervals (CI) of average organ doses across all 63,715 patients were 320 (160, 560) mGy to lungs, 250 (120, 450) mGy to female breast, 190 (100, 340) mGy to heart wall and 92 (47, 160) mGy to active bone marrow. Approximately 60% of all patients had average doses to the four studied organs of less than 10 mGy, 10% received between 10 and 100 mGy, 25% between 100 and 1,000 mGy, and 5% above 1,000 mGy. Pneumothorax was the medical procedure that accounted for the largest contribution to cohort average doses. The major contributors to uncertainty in estimated doses per procedure for the four organs of interest are the uncertainties in exposure duration, tube voltage, tube output, and patient orientation relative to the X-ray tube, with the uncertainty in exposure duration being most often the dominant source. Uncertainty in patient orientation was important for doses to female breast, and, to a lesser degree, for doses to heart wall. The uncertainty in number of exams was an important contributor to uncertainty for ∼30% of patients. The estimated organ doses and their uncertainties will be used for analyses of incidence and mortality of cancer and non-cancer diseases. The CFCS cohort is an important addition to existing radio-epidemiological cohorts, given the moderate-to-high doses received fractionated over several years, the type of irradiation (external irradiation only), radiation type (X rays only), a balanced combination of both genders and inclusion of people of all ages.
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Affiliation(s)
| | - Brian A. Thomas
- Oak Ridge Center for Risk Analysis, Inc., Oak Ridge, Tennessee 37830
| | - F. Owen Hoffman
- Oak Ridge Center for Risk Analysis, Inc., Oak Ridge, Tennessee 37830
| | - David C. Kocher
- Oak Ridge Center for Risk Analysis, Inc., Oak Ridge, Tennessee 37830
| | | | - David Borrego
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland 20892-9778
| | - Choonsik Lee
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland 20892-9778
| | - Steven L. Simon
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland 20892-9778
| | - Lydia B. Zablotska
- Department of Epidemiology and Biostatistics, School of Medicine, University of California San Francisco, San Francisco, California 94143-1228
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28
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Brito-Marcelino A, Duarte-Tavares RJ, Marcelino KB, Silva-Neto JA. Breast cancer and occupational exposures: an integrative review of the literature. Rev Bras Med Trab 2021; 18:488-496. [PMID: 33688331 PMCID: PMC7934163 DOI: 10.47626/1679-4435-2020-595] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Occupational factors can lead to breast cancer, though the relationship between these variables is not well established. The objective of this study was to search the relevant literature for information on the association between breast cancer and exposure to occupational risk factors. For that purpose, electronic databases were searched using the following keywords: breast cancer and occupational exposures. A total of 40 articles published in the 10-year period from 2009 to 2019 were included in this review. Workers exposed to metals such as cadmium, chemical products, radiation and night work were more susceptible to breast cancer. The findings showed significant evidence to support an association between breast cancer and some chemical products, ionizing radiation and night work. However, most studies have difficulty establishing a causal relationship between these variables, pointing to the need for further investigation of these issues.
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29
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Patient Body Mass Index and Occupational Radiation Doses to Circulating Nurses During Coronary Angiography. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 26:48-52. [PMID: 33168435 DOI: 10.1016/j.carrev.2020.10.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 10/27/2020] [Accepted: 10/28/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Patient BMI is associated with radiation doses received by interventional cardiologists, yet the association between patient BMI and nurse radiation doses is unknown. This study evaluated the association between patient body mass index (BMI) and nurse radiation doses during coronary angiography. METHODS Nurse radiation doses were collected by real-time dosimeters during consecutive coronary angiography procedures and are reported as the personal dose equivalent (Hp10). Patient radiation doses were estimated using dose area product (DAP). Patient BMI was categorized in kg/m2 as <25.0, 25.0-29.9, 30.0-34.9, 35.0-39.9, and ≥40. Multiple regression analysis determined procedural factors independently association with nurse radiation doses. RESULTS In 643 consecutive coronary angiography procedures, patient radiation doses increased significantly across increasing patient BMI categories (p < 0.001). Compared to a patient BMI <25, a patient BMI ≥40 was associated with a 2.3-fold increase in DAP (p < 0.001). Significant differences were also observed in nurse radiation doses across patient BMI categories (p = 0.036). Compared to a patient BMI <25, a patient BMI ≥40 was associated with a 4.0-fold increase in nurse radiation dose (BMI < 25: 0.3 [0.1, 1.3] μSv; BMI ≥ 40: 1.2 [0.2, 2.9] μSv; p = 0.003). By multiple regression analysis, each 1-unit kg/m2 increase in patient BMI was associated with a 3.3% increase in nurse radiation dose (p = 0.002). CONCLUSIONS Patient BMI was significantly associated with nurse radiation doses during coronary angiography. These observations may have important implications on nurse radiation safety, especially in the setting of the ongoing obesity epidemic.
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The Risk of Cancer from CT Scans and Other Sources of Low-Dose Radiation: A Critical Appraisal of Methodologic Quality. Prehosp Disaster Med 2020; 35:3-16. [PMID: 32009606 DOI: 10.1017/s1049023x1900520x] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
INTRODUCTION Concern exists that radiation exposure from computerized tomography (CT) will cause thousands of malignancies. Other experts share the same perspective regarding the risk from additional sources of low-dose ionizing radiation, such as the releases from Three Mile Island (1979; Pennsylvania USA) and Fukushima (2011; Okuma, Fukushima Prefecture, Japan) nuclear power plant disasters. If this premise is false, the fear of cancer leading patients and physicians to avoid CT scans and disaster responders to initiate forced evacuations is unfounded. STUDY OBJECTIVE This investigation provides a quantitative evaluation of the methodologic quality of studies to determine the evidentiary strength supporting or refuting a causal relationship between low-dose radiation and cancer. It will assess the number of higher quality studies that support or question the role of low-dose radiation in oncogenesis. METHODS This investigation is a systematic, methodologic review of articles published from 1975-2017 examining cancer risk from external low-dose x-ray and gamma radiation, defined as less than 200 millisievert (mSv). Following the PRISMA guidelines, the authors performed a search of the PubMed, Cochrane, Scopus, and Web of Science databases. Methodologies of selected articles were scored using the Newcastle Ottawa Scale (NOS) and a tool identifying 11 lower quality indicators. Manuscript methodologies were ranked as higher quality if they scored no lower than seven out of nine on the NOS and contained no more than two lower quality indicators. Investigators then characterized articles as supporting or not supporting a causal relationship between low-dose radiation and cancer. RESULTS Investigators identified 4,382 articles for initial review. A total of 62 articles met all inclusion/exclusion criteria and were evaluated in this study. Quantitative evaluation of the manuscripts' methodologic strengths found 25 studies met higher quality criteria while 37 studies met lower quality criteria. Of the 25 studies with higher quality methods, 21 out of 25 did not support cancer induction by low-dose radiation (P = .0003). CONCLUSIONS A clear preponderance of articles with higher quality methods found no increased risk of cancer from low-dose radiation. The evidence suggests that exposure to multiple CT scans and other sources of low-dose radiation with a cumulative dose up to 100 mSv (approximately 10 scans), and possibly as high as 200 mSv (approximately 20 scans), does not increase cancer risk.
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Linet MS, Little MP, Kitahara CM, Cahoon EK, Doody MM, Simon SL, Alexander BH, Preston DL. Occupational radiation and haematopoietic malignancy mortality in the retrospective cohort study of US radiologic technologists, 1983-2012. Occup Environ Med 2020; 77:822-831. [PMID: 32967989 DOI: 10.1136/oemed-2019-106346] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 04/27/2020] [Accepted: 06/07/2020] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To evaluate cumulative occupational radiation dose response and haematopoietic malignancy mortality risks in the US radiologic technologist cohort. METHODS Among 110 297 radiologic technologists (83 655 women, 26 642 men) who completed a baseline questionnaire sometime during 1983-1998, a retrospective cohort study was undertaken to assess cumulative, low-to-moderate occupational radiation dose and haematopoietic malignancy mortality risks during 1983-2012. Cumulative bone marrow dose (mean 8.5 mGy, range 0-430 mGy) was estimated based on 921 134 badge monitoring measurements during 1960-1997, work histories and historical data; 35.4% of estimated doses were based on badge measurements. Poisson regression was used to estimate excess relative risk of haematopoietic cancers per 100 milligray (ERR/100 mGy) bone-marrow absorbed dose, adjusting for attained age, sex and birth year. RESULTS Deaths from baseline questionnaire completion through 2012 included 133 myeloid neoplasms, 381 lymphoid neoplasms and 155 leukaemias excluding chronic lymphocytic leukaemia (CLL). Based on a linear dose-response, no significant ERR/100 mGy occurred for acute myeloid leukaemia (ERR=0.0002, 95% CI <-0.02 to 0.24, p-trend>0.5, 85 cases) or leukaemia excluding CLL (ERR=0.05, 95% CI <-0.09 to 0.24, p-trend=0.21, 155 cases). No significant dose-response trends were observed overall for CLL (ERR<-0.023, 95% CI <-0.025 to 0.18, p-trend=0.45, 32 cases), non-Hodgkin lymphoma (ERR=0.03, 95% CI <-0.2 to 0.18, p-trend=0.4, 201 cases) or multiple myeloma (ERR=0.003, 95% CI -0.02 to 0.16, p-trend>0.5, 112 cases). Findings did not differ significantly by demographic factors, smoking or specific radiological procedures performed. CONCLUSION After follow-up averaging 22 years, there was little evidence of a relationship between occupational radiation exposure and myeloid or lymphoid haematopoietic neoplasms.
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Affiliation(s)
- Martha S Linet
- National Cancer Institute Division of Cancer Epidemiology and Genetics, Bethesda, Maryland, USA
| | - Mark P Little
- National Cancer Institute Division of Cancer Epidemiology and Genetics, Bethesda, Maryland, USA
| | - Cari M Kitahara
- National Cancer Institute Division of Cancer Epidemiology and Genetics, Bethesda, Maryland, USA
| | - Elizabeth K Cahoon
- National Cancer Institute Division of Cancer Epidemiology and Genetics, Bethesda, Maryland, USA
| | - Michele M Doody
- National Cancer Institute Division of Cancer Epidemiology and Genetics, Bethesda, Maryland, USA
| | - Steven L Simon
- National Cancer Institute Division of Cancer Epidemiology and Genetics, Bethesda, Maryland, USA
| | - Bruce H Alexander
- Division of Environmental Health Sciences, University of Minnesota, Minneapolis, Minnesota, USA
| | - Dale L Preston
- self-employed at Hirosoft International, Eureka, California, USA
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Chartier H, Fassier P, Leuraud K, Jacob S, Baudin C, Laurier D, Bernier MO. Occupational low-dose irradiation and cancer risk among medical radiation workers. Occup Med (Lond) 2020; 70:476-484. [DOI: 10.1093/occmed/kqaa130] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Abstract
Background
Medical workers are the largest group of workers occupationally exposed to low doses of ionizing radiation (IR) worldwide.
Aims
This review presents all the cohorts of medical workers exposed in the world and summarizes cancer risks associated with radiation exposure in this population.
Methods
Epidemiological studies on health professionals exposed to IR published from 1975 to 2019 were reviewed. Strength of evidence was assessed according to the modified Royal College of General Practitioners three-star system.
Results
Among the 16 epidemiological studies focusing on cancers from 11 cohorts among medical staff exposed to radiation, higher risks of cancer were observed for pre-1950 exposure and for medical workers who performed fluoroscopically guided interventional procedures or radionuclides procedures compared to those who did not. However, strength of evidence supporting the associations remains moderate as several methodological limits including the lack of dosimetry data, lifestyle factors and recent updates may obscure the link between medical occupational exposure and cancer occurrence.
Conclusions
Excess risk of cancer is suspected for high and former exposures. The more highly exposed professions, i.e. interventional physicians and nuclear medicine workers, should be monitored carefully. Collaborative projects aiming to increase the quantity and quality of information of the studied populations would be a key point
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Affiliation(s)
- H Chartier
- PSE-SANTE/SESANE/LEPID, Institute for Radiological Protection and Nuclear Safety (IRSN), Fontenay-aux-Roses, France
- Percy Hospital, Radiological Protection Service of the Armed Forces (SPRA), Clamart, France
| | - P Fassier
- PSE-SANTE/SESANE/LEPID, Institute for Radiological Protection and Nuclear Safety (IRSN), Fontenay-aux-Roses, France
| | - K Leuraud
- PSE-SANTE/SESANE/LEPID, Institute for Radiological Protection and Nuclear Safety (IRSN), Fontenay-aux-Roses, France
| | - S Jacob
- PSE-SANTE/SESANE/LEPID, Institute for Radiological Protection and Nuclear Safety (IRSN), Fontenay-aux-Roses, France
| | - C Baudin
- PSE-SANTE/SESANE/LEPID, Institute for Radiological Protection and Nuclear Safety (IRSN), Fontenay-aux-Roses, France
| | - D Laurier
- PSE-SANTE/SESANE/LEPID, Institute for Radiological Protection and Nuclear Safety (IRSN), Fontenay-aux-Roses, France
| | - M-O Bernier
- PSE-SANTE/SESANE/LEPID, Institute for Radiological Protection and Nuclear Safety (IRSN), Fontenay-aux-Roses, France
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Kitahara CM, Preston DL, Sosa JA, Berrington de Gonzalez A. Association of Radioactive Iodine, Antithyroid Drug, and Surgical Treatments With Solid Cancer Mortality in Patients With Hyperthyroidism. JAMA Netw Open 2020; 3:e209660. [PMID: 32701159 PMCID: PMC7378755 DOI: 10.1001/jamanetworkopen.2020.9660] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE The long-term health effects of radioactive iodine (RAI) and antithyroid drug (ATD) treatments compared with surgery for hyperthyroidism remain uncertain. OBJECTIVE To compare solid cancer mortality rates associated with RAI and ATD treatments vs surgical management for hyperthyroidism. DESIGN, SETTING, AND PARTICIPANTS This multicenter cohort study assessed patients treated for hyperthyroidism from January 1, 1946, to December 31, 1964, with follow-up through December 31, 2014. Data analysis was performed from August 1, 2019, to April 23, 2020. EXPOSURES Management with RAI, ATDs, surgical intervention, or combinations of these treatments. MAIN OUTCOMES AND MEASURES Comparisons of solid cancer mortality rates in each treatment group with expected rates from the general population were assessed using standardized mortality ratios (SMRs), and internal comparisons were assessed using hazard ratios (HRs) adjusted for age, sex, and underlying diagnosis (Graves disease or toxic nodular goiter). RESULTS Of 31 363 patients (24 894 [79.4%] female; mean [SD] age, 46.9 [14.8] years) included in the study, 28 523 (90.9%) had Graves disease. The median follow-up time was 26.0 years (interquartile range, 12.3-41.9 years). Important differences in patient characteristics existed across treatment groups at study entry. Notably, the drug-only group (3.6% of the cohort) included a higher proportion of patients with prior cancers (7.3% vs 1.9%-4.0%), contributing to an elevated SMR for solid cancer mortality. After excluding prior cancers, solid cancer SMRs were not elevated in any of the treatment groups (SMR for surgery only, 0.82 [95% CI, 0.66-1.00]; SMR for drugs only, 0.90 [95% CI, 0.74-1.09]; SMR for drugs and surgery, 0.88 [95% CI, 0.84-0.94]; SMR for RAI only, 0.90 [95% CI, 0.84-0.96]; SMR for surgery and RAI, 0.66 [95% CI, 0.52-0.85]; SMR for drugs and RAI, 0.94 [95% CI, 0.89-1.00]; and SMR for drugs, surgery, and RAI, 0.85 [95% CI, 0.75-0.96]), and no significant HRs for solid cancer death were observed across treatment groups. Among RAI-treated patients, HRs for solid cancer mortality increased significantly across levels of total administered activity (1.08 per 370 MBq; 95% CI, 1.03-1.13 per 370 MBq); this association was stronger among patients treated with only RAI (HR, 1.19 per 370 MBq; 95% CI, 1.09-1.30 per 370 MBq). CONCLUSIONS AND RELEVANCE After controlling for known sources of confounding, the study found no significant differences in the risk of solid cancer mortality by treatment group. However, among RAI-treated patients, a modest positive association was observed between total administered activity and solid cancer mortality, providing further evidence in support of a dose-dependent association between RAI and solid cancer mortality.
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Affiliation(s)
- Cari M. Kitahara
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | | | - Julie Ann Sosa
- Department of Surgery, University of California, San Francisco
| | - Amy Berrington de Gonzalez
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
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Hauptmann M, Daniels RD, Cardis E, Cullings HM, Kendall G, Laurier D, Linet MS, Little MP, Lubin JH, Preston DL, Richardson DB, Stram DO, Thierry-Chef I, Schubauer-Berigan MK, Gilbert ES, Berrington de Gonzalez A. Epidemiological Studies of Low-Dose Ionizing Radiation and Cancer: Summary Bias Assessment and Meta-Analysis. J Natl Cancer Inst Monogr 2020; 2020:188-200. [PMID: 32657347 PMCID: PMC8454205 DOI: 10.1093/jncimonographs/lgaa010] [Citation(s) in RCA: 89] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 03/26/2020] [Indexed: 07/27/2023] Open
Abstract
BACKGROUND Ionizing radiation is an established carcinogen, but risks from low-dose exposures are controversial. Since the Biological Effects of Ionizing Radiation VII review of the epidemiological data in 2006, many subsequent publications have reported excess cancer risks from low-dose exposures. Our aim was to systematically review these studies to assess the magnitude of the risk and whether the positive findings could be explained by biases. METHODS Eligible studies had mean cumulative doses of less than 100 mGy, individualized dose estimates, risk estimates, and confidence intervals (CI) for the dose-response and were published in 2006-2017. We summarized the evidence for bias (dose error, confounding, outcome ascertainment) and its likely direction for each study. We tested whether the median excess relative risk (ERR) per unit dose equals zero and assessed the impact of excluding positive studies with potential bias away from the null. We performed a meta-analysis to quantify the ERR and assess consistency across studies for all solid cancers and leukemia. RESULTS Of the 26 eligible studies, 8 concerned environmental, 4 medical, and 14 occupational exposure. For solid cancers, 16 of 22 studies reported positive ERRs per unit dose, and we rejected the hypothesis that the median ERR equals zero (P = .03). After exclusion of 4 positive studies with potential positive bias, 12 of 18 studies reported positive ERRs per unit dose (P = .12). For leukemia, 17 of 20 studies were positive, and we rejected the hypothesis that the median ERR per unit dose equals zero (P = .001), also after exclusion of 5 positive studies with potential positive bias (P = .02). For adulthood exposure, the meta-ERR at 100 mGy was 0.029 (95% CI = 0.011 to 0.047) for solid cancers and 0.16 (95% CI = 0.07 to 0.25) for leukemia. For childhood exposure, the meta-ERR at 100 mGy for leukemia was 2.84 (95% CI = 0.37 to 5.32); there were only two eligible studies of all solid cancers. CONCLUSIONS Our systematic assessments in this monograph showed that these new epidemiological studies are characterized by several limitations, but only a few positive studies were potentially biased away from the null. After exclusion of these studies, the majority of studies still reported positive risk estimates. We therefore conclude that these new epidemiological studies directly support excess cancer risks from low-dose ionizing radiation. Furthermore, the magnitude of the cancer risks from these low-dose radiation exposures was statistically compatible with the radiation dose-related cancer risks of the atomic bomb survivors.
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Affiliation(s)
- Michael Hauptmann
- Correspondence to: Michael Hauptmann, Institute of Biostatistics and Registry Research, Brandenburg Medical School Theodor Fontane. Fehrbelliner Straße 38, 16816 Neuruppin, Germany (e-mail: )
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Daniels RD, Kendall GM, Thierry-Chef I, Linet MS, Cullings HM. Strengths and Weaknesses of Dosimetry Used in Studies of Low-Dose Radiation Exposure and Cancer. J Natl Cancer Inst Monogr 2020; 2020:114-132. [PMID: 32657346 PMCID: PMC7667397 DOI: 10.1093/jncimonographs/lgaa001] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 01/07/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND A monograph systematically evaluating recent evidence on the dose-response relationship between low-dose ionizing radiation exposure and cancer risk required a critical appraisal of dosimetry methods in 26 potentially informative studies. METHODS The relevant literature included studies published in 2006-2017. Studies comprised case-control and cohort designs examining populations predominantly exposed to sparsely ionizing radiation, mostly from external sources, resulting in average doses of no more than 100 mGy. At least two dosimetrists reviewed each study and appraised the strengths and weaknesses of the dosimetry systems used, including assessment of sources and effects of dose estimation error. An overarching concern was whether dose error might cause the spurious appearance of a dose-response where none was present. RESULTS The review included 8 environmental, 4 medical, and 14 occupational studies that varied in properties relative to evaluation criteria. Treatment of dose estimation error also varied among studies, although few conducted a comprehensive evaluation. Six studies appeared to have known or suspected biases in dose estimates. The potential for these biases to cause a spurious dose-response association was constrained to three case-control studies that relied extensively on information gathered in interviews conducted after case ascertainment. CONCLUSIONS The potential for spurious dose-response associations from dose information appeared limited to case-control studies vulnerable to recall errors that may be differential by case status. Otherwise, risk estimates appeared reasonably free of a substantial bias from dose estimation error. Future studies would benefit from a comprehensive evaluation of dose estimation errors, including methods accounting for their potential effects on dose-response associations.
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Affiliation(s)
- Robert D Daniels
- Division of Science Integration, National Institute for Occupational Safety and Health, Cincinnati, OH
| | - Gerald M Kendall
- Cancer Epidemiology Unit, NDPH, University of Oxford, Oxford, UK
| | - Isabelle Thierry-Chef
- Barcelona Institute for Global Health, Barcelona, Catalonia, Spain
- Universitat Pompeu Fabra, Barcelona, Catalonia, Spain
- CIBER Epidemiología y Salud Pública, Madrid, Spain
| | - Martha S Linet
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD
| | - Harry M Cullings
- Department of Statistics, Radiation Effects Research Foundation, Hiroshima, Japan
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Linet MS, Schubauer-Berigan MK, Berrington de González A. Outcome Assessment in Epidemiological Studies of Low-Dose Radiation Exposure and Cancer Risks: Sources, Level of Ascertainment, and Misclassification. J Natl Cancer Inst Monogr 2020; 2020:154-175. [PMID: 32657350 PMCID: PMC8454197 DOI: 10.1093/jncimonographs/lgaa007] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 02/18/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Outcome assessment problems and errors that could lead to biased risk estimates in low-dose radiation epidemiological studies of cancer risks have not been systematically evaluated. METHODS Incidence or mortality risks for all cancers or all solid cancers combined and for leukemia were examined in 26 studies published in 2006-2017 involving low-dose (mean dose ≤100 mGy) radiation from environmental, medical, or occupational sources. We evaluated the impact of loss to follow-up, under- or overascertainment, outcome misclassification, and changing classifications occurring similarly or differentially across radiation dose levels. RESULTS Loss to follow-up was not reported in 62% of studies, but when reported it was generally small. Only one study critically evaluated the completeness of the sources of vital status. Underascertainment of cancers ("false negatives") was a potential shortcoming for cohorts that could not be linked with high-quality population-based registries, particularly during early years of exposure in five studies, in two lacking complete residential history, and in one with substantial emigration. False positives may have occurred as a result of cancer ascertainment from self- or next-of-kin report in three studies or from enhanced medical surveillance of exposed patients that could lead to detection bias (eg, reporting precancer lesions as physician-diagnosed cancer) in one study. Most pediatric but few adult leukemia studies used expert hematopathology review or current classifications. Only a few studies recoded solid cancers to the latest International Classification of Diseases or International Classification of Diseases for Oncology codes. These outcome assessment shortcomings were generally nondifferential in relation to radiation exposure level except possibly in four studies. CONCLUSION The majority of studies lacked information to enable comprehensive evaluation of all major sources of outcome assessment errors, although reported data suggested that the outcome assessment limitations generally had little effect on risk or biased estimates towards the null except possibly in four studies.
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Affiliation(s)
- Martha S Linet
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Rockville, MD
| | - Mary K Schubauer-Berigan
- Monographs Programme, Evidence Synthesis and Classification Section, International Agency for Research on Cancer, Lyon, France
| | - Amy Berrington de González
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Rockville, MD
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Schubauer-Berigan MK, Berrington de Gonzalez A, Cardis E, Laurier D, Lubin JH, Hauptmann M, Richardson DB. Evaluation of Confounding and Selection Bias in Epidemiological Studies of Populations Exposed to Low-Dose, High-Energy Photon Radiation. J Natl Cancer Inst Monogr 2020; 2020:133-153. [PMID: 32657349 PMCID: PMC7355263 DOI: 10.1093/jncimonographs/lgaa008] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Low-dose, penetrating photon radiation exposure is ubiquitous, yet our understanding of cancer risk at low doses and dose rates derives mainly from high-dose studies. Although a large number of low-dose cancer studies have been recently published, concern exists about the potential for confounding to distort findings. The aim of this study was to describe and assess the likely impact of confounding and selection bias within the context of a systematic review. METHODS We summarized confounding control methods for 26 studies published from 2006 to 2017 by exposure setting (environmental, medical, or occupational) and identified confounders of potential concern. We used information from these and related studies to assess evidence for confounding and selection bias. For factors in which direct or indirect evidence of confounding was lacking for certain studies, we used a theoretical adjustment to determine whether uncontrolled confounding was likely to have affected the results. RESULTS For medical studies of childhood cancers, confounding by indication (CBI) was the main concern. Lifestyle-related factors were of primary concern for environmental and medical studies of adult cancers and for occupational studies. For occupational studies, other workplace exposures and healthy worker survivor bias were additionally of interest. For most of these factors, however, review of the direct and indirect evidence suggested that confounding was minimal. One study showed evidence of selection bias, and three occupational studies did not adjust for lifestyle or healthy worker survivor bias correlates. Theoretical adjustment for three factors (smoking and asbestos in occupational studies and CBI in childhood cancer studies) demonstrated that these were unlikely to explain positive study findings due to the rarity of exposure (eg, CBI) or the relatively weak association with the outcome (eg, smoking or asbestos and all cancers). CONCLUSION Confounding and selection bias are unlikely to explain the findings from most low-dose radiation epidemiology studies.
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Affiliation(s)
- Mary K Schubauer-Berigan
- Evidence Synthesis and Classification Section, International Agency for Research on Cancer, Lyon, France
| | | | - Elisabeth Cardis
- Radiation Programme, Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Dominique Laurier
- Institut de Radioprotection et de Sûreté Nucléaire (IRSN), Fontenay-aux-Roses, France
| | - Jay H Lubin
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD
| | - Michael Hauptmann
- Division of Epidemiology and Biostatistics, Netherlands Cancer Institute, Amsterdam, The Netherlands (MH); Brandenburg Medical School, Institute of Biostatistics and Registry Research, Neuruppin, Germany
| | - David B Richardson
- Department of Epidemiology, University of North Carolina, School of Public Health, Chapel Hill, NC, USA
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Gilbert ES, Little MP, Preston DL, Stram DO. Issues in Interpreting Epidemiologic Studies of Populations Exposed to Low-Dose, High-Energy Photon Radiation. J Natl Cancer Inst Monogr 2020; 2020:176-187. [PMID: 32657345 PMCID: PMC7355296 DOI: 10.1093/jncimonographs/lgaa004] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 01/02/2020] [Indexed: 01/19/2023] Open
Abstract
This article addresses issues relevant to interpreting findings from 26 epidemiologic studies of persons exposed to low-dose radiation. We review the extensive data from both epidemiologic studies of persons exposed at moderate or high doses and from radiobiology that together have firmly established radiation as carcinogenic. We then discuss the use of the linear relative risk model that has been used to describe data from both low- and moderate- or high-dose studies. We consider the effects of dose measurement errors; these can reduce statistical power and lead to underestimation of risks but are very unlikely to bring about a spurious dose response. We estimate statistical power for the low-dose studies under the assumption that true risks of radiation-related cancers are those expected from studies of Japanese atomic bomb survivors. Finally, we discuss the interpretation of confidence intervals and statistical tests and the applicability of the Bradford Hill principles for a causal relationship.
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Affiliation(s)
- Ethel S Gilbert
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Mark P Little
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | | | - Daniel O Stram
- Department of Preventive Medicine, School of Medicine, University of Southern California, Los Angeles, CA, USA
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Berrington de Gonzalez A, Daniels RD, Cardis E, Cullings HM, Gilbert E, Hauptmann M, Kendall G, Laurier D, Linet MS, Little MP, Lubin JH, Preston DL, Richardson DB, Stram D, Thierry-Chef I, Schubauer-Berigan MK. Epidemiological Studies of Low-Dose Ionizing Radiation and Cancer: Rationale and Framework for the Monograph and Overview of Eligible Studies. J Natl Cancer Inst Monogr 2020; 2020:97-113. [PMID: 32657348 PMCID: PMC7610154 DOI: 10.1093/jncimonographs/lgaa009] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 03/13/2020] [Indexed: 12/21/2022] Open
Abstract
Whether low-dose ionizing radiation can cause cancer is a critical and long-debated question in radiation protection. Since the Biological Effects of Ionizing Radiation report by the National Academies in 2006, new publications from large, well-powered epidemiological studies of low doses have reported positive dose-response relationships. It has been suggested, however, that biases could explain these findings. We conducted a systematic review of epidemiological studies with mean doses less than 100 mGy published 2006-2017. We required individualized doses and dose-response estimates with confidence intervals. We identified 26 eligible studies (eight environmental, four medical, and 14 occupational), including 91 000 solid cancers and 13 000 leukemias. Mean doses ranged from 0.1 to 82 mGy. The excess relative risk at 100 mGy was positive for 16 of 22 solid cancer studies and 17 of 20 leukemia studies. The aim of this monograph was to systematically review the potential biases in these studies (including dose uncertainty, confounding, and outcome misclassification) and to assess whether the subset of minimally biased studies provides evidence for cancer risks from low-dose radiation. Here, we describe the framework for the systematic bias review and provide an overview of the eligible studies.
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Affiliation(s)
| | - Robert D Daniels
- National Institute for Occupational Safety and Health, Cincinnati, OH, USA
| | - Elisabeth Cardis
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Catalonia, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Catalonia, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | | | - Ethel Gilbert
- Division of Cancer Epidemiology & Genetics, Radiation Epidemiology Branch, Bethesda, MD, USA
| | - Michael Hauptmann
- Department of Epidemiology and Biostatistics, Netherlands Cancer Institute, Amsterdam, the Netherlands
- Brandenburg Medical School Theodor Fontane, Institute of Biostatistics and Registry Research, Neuruppin, Germany
| | | | | | - Martha S Linet
- Division of Cancer Epidemiology & Genetics, Radiation Epidemiology Branch, Bethesda, MD, USA
| | - Mark P Little
- Division of Cancer Epidemiology & Genetics, Radiation Epidemiology Branch, Bethesda, MD, USA
| | - Jay H Lubin
- Division of Cancer Epidemiology & Genetics, Radiation Epidemiology Branch, Bethesda, MD, USA
| | | | | | - Daniel Stram
- University of Southern California, Los Angeles, CA
| | - Isabelle Thierry-Chef
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Catalonia, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Catalonia, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
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Vanderstraeten J, Baselet B, Buset J, Ben Said N, de Ville de Goyet C, Many MC, Gérard AC, Derradji H. Modulation of VEGF Expression and Oxidative Stress Response by Iodine Deficiency in Irradiated Cancerous and Non-Cancerous Breast Cells. Int J Mol Sci 2020; 21:ijms21113963. [PMID: 32486504 PMCID: PMC7312479 DOI: 10.3390/ijms21113963] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 05/23/2020] [Accepted: 05/28/2020] [Indexed: 12/21/2022] Open
Abstract
Breast cancer remains a major concern and its physiopathology is influenced by iodine deficiency (ID) and radiation exposure. Since radiation and ID can separately induce oxidative stress (OS) and microvascular responses in breast, their combination could additively increase these responses. Therefore, ID was induced in MCF7 and MCF12A breast cell lines by medium change. Cells were then X-irradiated with doses of 0.05, 0.1, or 3 Gy. In MCF12A cells, both ID and radiation (0.1 and 3 Gy) increased OS and vascular endothelial growth factor (VEGF) expression, with an additive effect when the highest dose was combined with ID. However, in MCF7 cells no additive effect was observed. VEGF mRNA up-regulation was reactive oxygen species (ROS)-dependent, involving radiation-induced mitochondrial ROS. Results on total VEGF mRNA hold true for the pro-angiogenic isoform VEGF165 mRNA, but the treatments did not modulate the anti-angiogenic isoform VEGF165b. Radiation-induced antioxidant response was differentially regulated upon ID in both cell lines. Thus, radiation response is modulated according to iodine status and cell type and can lead to additive effects on ROS and VEGF. As these are often involved in cancer initiation and progression, we believe that iodine status should be taken into account in radiation prevention policies.
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Affiliation(s)
- Jessica Vanderstraeten
- Pole of Morphology, Institut de Recherche Expérimentale et Clinique (IREC), Université catholique de Louvain (UCL), 1200 Brussels, Belgium; (N.B.S.); (C.d.V.d.G.); (M.-C.M.)
- Correspondence:
| | - Bjorn Baselet
- Radiobiology Unit, Belgian Nuclear Research Centre (SCK•CEN), 2400 Mol, Belgium; (B.B.); (J.B.); (H.D.)
| | - Jasmine Buset
- Radiobiology Unit, Belgian Nuclear Research Centre (SCK•CEN), 2400 Mol, Belgium; (B.B.); (J.B.); (H.D.)
| | - Naziha Ben Said
- Pole of Morphology, Institut de Recherche Expérimentale et Clinique (IREC), Université catholique de Louvain (UCL), 1200 Brussels, Belgium; (N.B.S.); (C.d.V.d.G.); (M.-C.M.)
| | - Christine de Ville de Goyet
- Pole of Morphology, Institut de Recherche Expérimentale et Clinique (IREC), Université catholique de Louvain (UCL), 1200 Brussels, Belgium; (N.B.S.); (C.d.V.d.G.); (M.-C.M.)
| | - Marie-Christine Many
- Pole of Morphology, Institut de Recherche Expérimentale et Clinique (IREC), Université catholique de Louvain (UCL), 1200 Brussels, Belgium; (N.B.S.); (C.d.V.d.G.); (M.-C.M.)
| | - Anne-Catherine Gérard
- Service d’Endocrino-Diabétologie, Centre Hospitalier Régional (CHR) Mons-Hainaut, 7000 Mons, Belgium;
| | - Hanane Derradji
- Radiobiology Unit, Belgian Nuclear Research Centre (SCK•CEN), 2400 Mol, Belgium; (B.B.); (J.B.); (H.D.)
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Anglada T, Repullés J, Espinal A, LaBarge MA, Stampfer MR, Genescà A, Martín M. Delayed γH2AX foci disappearance in mammary epithelial cells from aged women reveals an age-associated DNA repair defect. Aging (Albany NY) 2020; 11:1510-1523. [PMID: 30875333 PMCID: PMC6428106 DOI: 10.18632/aging.101849] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Accepted: 03/09/2019] [Indexed: 01/15/2023]
Abstract
Aging is a degenerative process in which genome instability plays a crucial role. To gain insight into the link between organismal aging and DNA repair capacity, we analyzed DNA double-strand break (DSB) resolution efficiency in human mammary epithelial cells from 12 healthy donors of young and old ages. The frequency of DSBs was measured by quantifying the number of γH2AX foci before and after 1Gy of γ-rays and it was higher in cells from aged donors (ADs) at all times analyzed. At 24 hours after irradiation, ADs retained a significantly higher frequency of residual DSBs than young donors (YDs), which had already reached values close to basal levels. The kinetics of DSB induction and disappearance showed that cells from ADs and YDs repair DSBs with similar speed, although analysis of early times after irradiation indicate that a repair defect may lie within the firing of the DNA repair machinery in AD cells. Indeed, using a mathematical model we calculated a constant factor of delay affecting aged human epithelial cells repair kinetics. This defect manifests with the accumulation of DSBs that might eventually undergo illegitimate repair, thus posing a relevant threat to the maintenance of genome integrity in older individuals.
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Affiliation(s)
- Teresa Anglada
- Department of Cell Biology, Physiology and Immunology, Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain
| | - Joan Repullés
- Department of Cell Biology, Physiology and Immunology, Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain.,Microscopy Platform, Biomedical Research Institute Sant Pau (IIB-Sant Pau), Barcelona, 08041, Spain
| | - Anna Espinal
- Servei d'Estadística Aplicada, Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain
| | - Mark A LaBarge
- Department of Population Sciences, and Center for Cancer and Aging, Beckman Research Institute at City of Hope, Duarte, CA, 91010, USA.,Biological Systems and Engineering Division, Lawrence Berkeley National Laboratory, Berkeley, CA 94720, USA
| | - Martha R Stampfer
- Biological Systems and Engineering Division, Lawrence Berkeley National Laboratory, Berkeley, CA 94720, USA
| | - Anna Genescà
- Department of Cell Biology, Physiology and Immunology, Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain
| | - Marta Martín
- Department of Cell Biology, Physiology and Immunology, Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain
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Martinez Marignac V, Mondragon L, Gloria O, Cervantes L, Cantero F, Favant J. Preclinical study of genuine essiac formula: A cancer treatment eight-herbs' tea minimizes DNA insult of X-rays. CLINICAL CANCER INVESTIGATION JOURNAL 2020. [DOI: 10.4103/ccij.ccij_73_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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43
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Kitahara CM, Berrington de Gonzalez A, Bouville A, Brill AB, Doody MM, Melo DR, Simon SL, Sosa JA, Tulchinsky M, Villoing D, Preston DL. Association of Radioactive Iodine Treatment With Cancer Mortality in Patients With Hyperthyroidism. JAMA Intern Med 2019; 179:1034-1042. [PMID: 31260066 PMCID: PMC6604114 DOI: 10.1001/jamainternmed.2019.0981] [Citation(s) in RCA: 102] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
IMPORTANCE Radioactive iodine (RAI) has been used extensively to treat hyperthyroidism since the 1940s. Although widely considered a safe and effective therapy, RAI has been associated with elevated risks of total and site-specific cancer death among patients with hyperthyroidism. OBJECTIVE To determine whether greater organ- or tissue-absorbed doses from RAI treatment are associated with overall and site-specific cancer mortality in patients with hyperthyroidism. DESIGN, SETTING, AND PARTICIPANTS This cohort study is a 24-year extension of the multicenter Cooperative Thyrotoxicosis Therapy Follow-up Study, which has followed up US and UK patients diagnosed and treated for hyperthyroidism for nearly 7 decades, beginning in 1946. Patients were traced using records from the National Death Index, Social Security Administration, and other resources. After exclusions, 18 805 patients who were treated with RAI and had no history of cancer at the time of the first treatment were eligible for the current analysis. Excess relative risks (ERRs) per 100-mGy dose to the organ or tissue were calculated using multivariable-adjusted linear dose-response models and were converted to relative risks (RR = 1 + ERR). The current analyses were conducted from April 28, 2017, to January 30, 2019. EXPOSURES Mean total administered activity of sodium iodide I 131 was 375 MBq for patients with Graves disease and 653 MBq for patients with toxic nodular goiter. Mean organ or tissue dose estimates ranged from 20 to 99 mGy (colon or rectum, ovary, uterus, prostate, bladder, and brain/central nervous system), to 100 to 400 mGy (pancreas, kidney, liver, stomach, female breast, lung, oral mucosa, and marrow), to 1.6 Gy (esophagus), and to 130 Gy (thyroid gland). MAIN OUTCOMES AND MEASURES Site-specific and all solid-cancer mortality. RESULTS A total of 18 805 patients were included in the study cohort, and the mean (SD) entry age was 49 (14) years. Most patients were women (14 671 [78.0%]), and most had a Graves disease diagnosis (17 615 [93.7%]). Statistically significant positive associations were observed for all solid cancer mortality (n = 1984; RR at 100-mGy dose to the stomach = 1.06; 95% CI, 1.02-1.10; P = .002), including female breast cancer (n = 291; RR at 100-mGy dose to the breast = 1.12; 95% CI, 1.003-1.32; P = .04) and all other solid cancers combined (n = 1693; RR at 100-mGy dose to the stomach = 1.05; 95% CI, 1.01-1.10; P = .01). The 100-mGy dose to the stomach and breast corresponded to a mean (SD) administered activity of 243 (35) MBq and 266 (58) MBq in patients with Graves disease. For every 1000 patients with hyperthyroidism receiving typical doses to the stomach (150 to 250 mGy), an estimated lifetime excess of 19 (95% CI, 3-40) to 32 (95% CI, 5-66) solid cancer deaths could occur. CONCLUSIONS AND RELEVANCE In RAI-treated patients with hyperthyroidism, greater organ-absorbed doses appeared to be modestly positively associated with risk of death from solid cancer, including breast cancer. Additional studies are needed of the risks and advantages of all major treatment options available to patients with hyperthyroidism.
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Affiliation(s)
- Cari M Kitahara
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Amy Berrington de Gonzalez
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Andre Bouville
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Aaron B Brill
- Department of Radiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Michele M Doody
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | | | - Steven L Simon
- Epidemiology and Biostatistics Program, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Julie A Sosa
- Department of Surgery, University of California, San Francisco, San Francisco
| | - Mark Tulchinsky
- Department of Radiology, Milton S. Hershey Medical Center, Pennsylvania State University, Hershey
| | - Daphnée Villoing
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
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Boice JD, Held KD, Shore RE. Radiation epidemiology and health effects following low-level radiation exposure. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2019; 39:S14-S27. [PMID: 31272090 DOI: 10.1088/1361-6498/ab2f3d] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Radiation epidemiology is the study of human disease following radiation exposure to populations. Epidemiologic studies of radiation-exposed populations have been conducted for nearly 100 years, starting with the radium dial painters in the 1920s and most recently with large-scale studies of radiation workers. As radiation epidemiology has become increasingly sophisticated it is used for setting radiation protection standards as well as to guide the compensation programmes in place for nuclear weapons workers, nuclear weapons test participants, and other occupationally exposed workers in the United States and elsewhere. It is known with high assurance that radiation effects at levels above 100-150 mGy can be detected as evidenced in multiple population studies conducted around the world. The challenge for radiation epidemiology is evaluating the effects at low doses, below about 100 mGy of low-linear energy transfer radiation, and assessing the risks following low dose-rate exposures over years. The weakness of radiation epidemiology in directly studying low dose and low dose-rate exposures is that the signal, i.e. the excess numbers of cancers associated with low-level radiation exposure, is so very small that it cannot be seen against the very high background occurrence of cancer in the population, i.e. a lifetime risk of incidence reaching up to about 38% (i.e. 1 in 3 persons will develop a cancer in their lifetime). Thus, extrapolation models are used for the management of risk at low doses and low dose rates, but having adequate information from low dose and low dose-rate studies would be highly desirable. An overview of recently conducted radiation epidemiologic studies which evaluate risk following low-level radiation exposures is presented. Future improvements in risk assessment for radiation protection may come from increasingly informative epidemiologic studies, combined with mechanistic radiobiologic understanding of adverse outcome pathways, with both incorporated into biologically based models.
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Affiliation(s)
- J D Boice
- National Council on Radiation Protection and Measurements, Bethesda, Maryland, United States of America. Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
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45
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Sritharan J, MacLeod JS, Dakouo M, Qadri M, McLeod CB, Peter A, Demers PA. Breast cancer risk by occupation and industry in women and men: Results from the Occupational Disease Surveillance System (ODSS). Am J Ind Med 2019; 62:205-211. [PMID: 30648268 DOI: 10.1002/ajim.22942] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND The recently established Occupational Disease Surveillance System (ODSS) was used to examine breast cancer risk in women and men by occupation and industry. METHODS Ontario workers in the ODSS cohort (1983-2016) were followed up for breast cancer diagnosis through the Ontario Cancer Registry. Cox-proportional hazard models were used to calculate age-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs). RESULTS A total of 17 865 and 492 cases were identified in working women (W) and men (M), respectively. Elevated risks were observed in management (W: HR = 1.54, 95% CI = 1.40-1.70; M: HR = 2.79, 95% CI = 1.44-5.39), administrative/clerical (W: HR = 1.16, 95% CI = 1.11-1.21; M: HR = 1.45, 95% CI = 1.06-1.99), and teaching (W: HR = 1.54, 95% CI = 1.44-1.63; M: HR = 3.00, 95% CI = 1.49-6.03). Other elevated risks were observed in nursing/health, social sciences, and janitor/cleaning services for both genders. CONCLUSIONS Common occupational associations in both genders warrant investigation into job-related risk factors, such as sedentary behavior, shift work, ionizing radiation, and chemical exposures.
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Affiliation(s)
- Jeavana Sritharan
- Occupational Cancer Research Centre; Cancer Care Ontario; Ontario Canada
| | - Jill S. MacLeod
- Occupational Cancer Research Centre; Cancer Care Ontario; Ontario Canada
| | - Mamadou Dakouo
- Occupational Cancer Research Centre; Cancer Care Ontario; Ontario Canada
| | - Maria Qadri
- Occupational Cancer Research Centre; Cancer Care Ontario; Ontario Canada
| | - Chris B. McLeod
- School of Population and Public Health; University of British Columbia; British Columbia Canada
- Institute for Work & Health; Ontario Canada
| | - Alice Peter
- Population Health and Prevention; Cancer Care Ontario; Ontario Canada
| | - Paul A. Demers
- Occupational Cancer Research Centre; Cancer Care Ontario; Ontario Canada
- Dalla Lana School of Public Health; University of Toronto; Ontario Canada
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46
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Shore RE, Beck HL, Boice JD, Caffrey EA, Davis S, Grogan HA, Mettler FA, Preston RJ, Till JE, Wakeford R, Walsh L, Dauer LT. Recent Epidemiologic Studies and the Linear No-Threshold Model For Radiation Protection-Considerations Regarding NCRP Commentary 27. HEALTH PHYSICS 2019; 116:235-246. [PMID: 30585971 DOI: 10.1097/hp.0000000000001015] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
National Council on Radiation Protection and Measurements Commentary 27 examines recent epidemiologic data primarily from low-dose or low dose-rate studies of low linear-energy-transfer radiation and cancer to assess whether they support the linear no-threshold model as used in radiation protection. The commentary provides a critical review of low-dose or low dose-rate studies, most published within the last 10 y, that are applicable to current occupational, environmental, and medical radiation exposures. The strengths and weaknesses of the epidemiologic methods, dosimetry assessments, and statistical modeling of 29 epidemiologic studies of total solid cancer, leukemia, breast cancer, and thyroid cancer, as well as heritable effects and a few nonmalignant conditions, were evaluated. An appraisal of the degree to which the low-dose or low dose-rate studies supported a linear no-threshold model for radiation protection or on the contrary, demonstrated sufficient evidence that the linear no-threshold model is inappropriate for the purposes of radiation protection was also included. The review found that many, though not all, studies of solid cancer supported the continued use of the linear no-threshold model in radiation protection. Evaluations of the principal studies of leukemia and low-dose or low dose-rate radiation exposure also lent support for the linear no-threshold model as used in protection. Ischemic heart disease, a major type of cardiovascular disease, was examined briefly, but the results of recent studies were considered too weak or inconsistent to allow firm conclusions regarding support of the linear no-threshold model. It is acknowledged that the possible risks from very low doses of low linear-energy-transfer radiation are small and uncertain and that it may never be possible to prove or disprove the validity of the linear no-threshold assumption by epidemiologic means. Nonetheless, the preponderance of recent epidemiologic data on solid cancer is supportive of the continued use of the linear no-threshold model for the purposes of radiation protection. This conclusion is in accord with judgments by other national and international scientific committees, based on somewhat older data. Currently, no alternative dose-response relationship appears more pragmatic or prudent for radiation protection purposes than the linear no-threshold model.
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Affiliation(s)
- Roy E Shore
- New York University School of Medicine, New York, NY, and Radiation Effects Research Foundation, Hiroshima, Japan (retired)
| | | | - John D Boice
- National Council on Radiation Protection and Measurements, Bethesda, MD, and Vanderbilt University, Nashville, TN
| | | | - Scott Davis
- Fred Hutchinson Cancer Research Center, Seattle, WA
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47
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Little MP, Kitahara CM, Cahoon EK, Bernier MO, Velazquez-Kronen R, Doody MM, Borrego D, Miller JS, Alexander BH, Simon SL, Preston DL, Hamada N, Linet MS, Meyer C. Occupational radiation exposure and risk of cataract incidence in a cohort of US radiologic technologists. Eur J Epidemiol 2018; 33:1179-1191. [PMID: 30151727 PMCID: PMC10645574 DOI: 10.1007/s10654-018-0435-3] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Accepted: 08/18/2018] [Indexed: 12/13/2022]
Abstract
It has long been known that relatively high-dose ionising radiation exposure (> 1 Gy) can induce cataract, but there has been no evidence that this occurs at low doses (< 100 mGy). To assess low-dose risk, participants from the US Radiologic Technologists Study, a large, prospective cohort, were followed from date of mailed questionnaire survey completed during 1994-1998 to the earliest of self-reported diagnosis of cataract/cataract surgery, cancer other than non-melanoma skin, or date of last survey (up to end 2014). Cox proportional hazards models with age as timescale were used, adjusted for a priori selected cataract risk factors (diabetes, body mass index, smoking history, race, sex, birth year, cumulative UVB radiant exposure). 12,336 out of 67,246 eligible technologists reported a history of diagnosis of cataract during 832,479 person years of follow-up, and 5509 from 67,709 eligible technologists reported undergoing cataract surgery with 888,420 person years of follow-up. The mean cumulative estimated 5-year lagged eye-lens absorbed dose from occupational radiation exposures was 55.7 mGy (interquartile range 23.6-69.0 mGy). Five-year lagged occupational radiation exposure was strongly associated with self-reported cataract, with an excess hazard ratio/mGy of 0.69 × 10-3 (95% CI 0.27 × 10-3 to 1.16 × 10-3, p < 0.001). Cataract risk remained statistically significant (p = 0.030) when analysis was restricted to < 100 mGy cumulative occupational radiation exposure to the eye lens. A non-significantly increased excess hazard ratio/mGy of 0.34 × 10-3 (95% CI - 0.19 × 10-3 to 0.97 × 10-3, p = 0.221) was observed for cataract surgery. Our results suggest that there is excess risk for cataract associated with radiation exposure from low-dose and low dose-rate occupational exposures.
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Affiliation(s)
- Mark P Little
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, Department of Health and Human Services, National Cancer Institute, National Institutes of Health, 9609 Medical Center Drive, Bethesda, MD, 20892-9778, USA.
| | - Cari M Kitahara
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, Department of Health and Human Services, National Cancer Institute, National Institutes of Health, 9609 Medical Center Drive, Bethesda, MD, 20892-9778, USA
| | - Elizabeth K Cahoon
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, Department of Health and Human Services, National Cancer Institute, National Institutes of Health, 9609 Medical Center Drive, Bethesda, MD, 20892-9778, USA
| | - Marie-Odile Bernier
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, Department of Health and Human Services, National Cancer Institute, National Institutes of Health, 9609 Medical Center Drive, Bethesda, MD, 20892-9778, USA
- Laboratory of Epidemiology, Institut de Radioprotection et de Sûreté Nucléaire, Fontenay aux Roses, France
| | - Raquel Velazquez-Kronen
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, Department of Health and Human Services, National Cancer Institute, National Institutes of Health, 9609 Medical Center Drive, Bethesda, MD, 20892-9778, USA
| | - Michele M Doody
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, Department of Health and Human Services, National Cancer Institute, National Institutes of Health, 9609 Medical Center Drive, Bethesda, MD, 20892-9778, USA
| | - David Borrego
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, Department of Health and Human Services, National Cancer Institute, National Institutes of Health, 9609 Medical Center Drive, Bethesda, MD, 20892-9778, USA
| | - Jeremy S Miller
- Information Management Services, Silver Spring, MD, 20904, USA
| | - Bruce H Alexander
- Division of Environmental Health Sciences, School of Public Health, University of Minnesota, Minneapolis, MN, 55409, USA
| | - Steven L Simon
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, Department of Health and Human Services, National Cancer Institute, National Institutes of Health, 9609 Medical Center Drive, Bethesda, MD, 20892-9778, USA
| | | | - Nobuyuki Hamada
- Radiation Safety Research Center, Nuclear Technology Research Laboratory, Central Research Institute of Electric Power Industry (CRIEPI), 2-11-1 Iwado-kita, Komae, Tokyo, 201-8511, Japan
| | - Martha S Linet
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, Department of Health and Human Services, National Cancer Institute, National Institutes of Health, 9609 Medical Center Drive, Bethesda, MD, 20892-9778, USA
| | - Craig Meyer
- Division of Environmental Health Sciences, School of Public Health, University of Minnesota, Minneapolis, MN, 55409, USA
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48
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Little MP, Tatalovich Z, Linet MS, Fang M, Kendall GM, Kimlin MG. Improving Assessment of Lifetime Solar Ultraviolet Radiation Exposure in Epidemiologic Studies: Comparison of Ultraviolet Exposure Assessment Methods in a Nationwide U.S. Occupational Cohort. Photochem Photobiol 2018; 94:1297-1307. [PMID: 29896764 DOI: 10.1111/php.12964] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 06/10/2018] [Indexed: 01/19/2023]
Abstract
Solar ultraviolet radiation is the primary risk factor for skin cancers and sun-related eye disorders. Estimates of individual ambient ultraviolet irradiance derived from ground-based solar measurements and from satellite measurements have rarely been compared. Using self-reported residential history from 67 189 persons in a nationwide occupational US radiologic technologists' cohort, we estimated ambient solar irradiance using data from ground-based meters and noontime satellite measurements. The mean distance moved from city of longest residence in childhood increased from 137.6 km at ages 13-19 to 870.3 km at ages ≥65, with corresponding increases in absolute latitude difference moved. At ages 20/40/60/80, the Pearson/Spearman correlation coefficients of ground-based and satellite-derived potential solar ultraviolet exposure, using irradiance and cumulative radiant exposure metrics, were high (=0.87-0.92). There was also moderate correlation (Pearson/Spearman correlation coefficients = 0.51-0.60) between irradiance at birth and at last-known address, for ground-based and satellite data. Satellite-based lifetime estimates of ultraviolet radiation were generally 14-15% lower than ground-based estimates, albeit with substantial uncertainties, possibly because ground-based estimates incorporate fluctuations in cloud and ozone, which are incompletely incorporated in the single noontime satellite-overpass ultraviolet value. If confirmed elsewhere, the findings suggest that ground-based estimates may improve exposure assessment accuracy and potentially provide new insights into ultraviolet radiation-disease relationships in epidemiologic studies.
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Affiliation(s)
- Mark P Little
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, MD
| | - Zaria Tatalovich
- Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, NIH, DHHS, Bethesda, MD
| | - Martha S Linet
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, MD
| | - Michelle Fang
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, MD
| | | | - Michael G Kimlin
- NHMRC Centre for Research Excellence in Sun and Health, University of the Sunshine Coast, Maroochydore, Qld, Australia
- Cancer Council Queensland, Qld, Australia
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Brenner AV, Preston DL, Sakata R, Sugiyama H, Berrington A, French B, Utada M, Cahoon EK, Sadakane A, Ozasa K, Grant EJ, Mabuchi K. Incidence of Breast Cancer in the Life Span Study of Atomic Bomb Survivors: 1958-2009. Radiat Res 2018; 190:433-444. [PMID: 30044713 PMCID: PMC10284068 DOI: 10.1667/rr15015.1] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
The importance of reproductive history in breast tissue development and etiology of sporadic breast cancer in females is well established. However, there is limited evidence of factors, other than age, that modify risk of radiation-related breast cancer. In this study, we evaluated breast cancer incidence in the Life Span Study cohort of atomic bomb survivors, adding 11 years of follow-up and incorporating reproductive history data. We used Poisson regression models to describe radiation risks and modifying effects of age and reproductive factors. Among 62,534 females, we identified 1,470 breast cancers between 1958 and 2009. Of 397 new cases diagnosed since 1998, 75% were exposed before age 20. We found a strong linear dose response with excess relative risk (ERR) of 1.12 per Gy [95% confidence interval (CI): 0.73 to 1.59] for females at age 70 after exposure at age 30. The ERR decreased with increasing attained age ( P = 0.007) while excess absolute rate (EAR) increased with attained age up to age 70 ( P < 0.001). Age at menarche was a strong modifier of the radiation effect: for a given dose, both the ERR and EAR decreased with increasing age at menarche ( P = 0.007 and P < 0.001). Also, independently, age-at-exposure effects on ERR and EAR differed before and after menarche ( P = 0.043 and P = 0.015, respectively, relative to log-linear trends), with highest risks for exposures around menarche. Despite the small number of male breast cancers (n = 10), the data continue to suggest a dose response (ERR per Gy = 5.7; 95% CI: 0.3 to 30.8; P = 0.018). Persistently increased risk of female breast cancer after radiation exposure and its modification pattern suggests heightened breast sensitivity during puberty.
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Affiliation(s)
- Alina V. Brenner
- Radiation Effects Research Foundation, Hiroshima and Nagasaki, Japan
| | | | - Ritsu Sakata
- Radiation Effects Research Foundation, Hiroshima and Nagasaki, Japan
| | - Hiromi Sugiyama
- Radiation Effects Research Foundation, Hiroshima and Nagasaki, Japan
| | - Amy Berrington
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland, U.S.A
| | - Benjamin French
- Radiation Effects Research Foundation, Hiroshima and Nagasaki, Japan
| | - Mai Utada
- Radiation Effects Research Foundation, Hiroshima and Nagasaki, Japan
| | - Elizabeth K. Cahoon
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland, U.S.A
| | - Atsuko Sadakane
- Radiation Effects Research Foundation, Hiroshima and Nagasaki, Japan
| | - Kotaro Ozasa
- Radiation Effects Research Foundation, Hiroshima and Nagasaki, Japan
| | - Eric J. Grant
- Radiation Effects Research Foundation, Hiroshima and Nagasaki, Japan
| | - Kiyohiko Mabuchi
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland, U.S.A
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Doss M. Are We Approaching the End of the Linear No-Threshold Era? J Nucl Med 2018; 59:1786-1793. [PMID: 30262515 DOI: 10.2967/jnumed.118.217182] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 09/24/2018] [Indexed: 12/12/2022] Open
Abstract
The linear no-threshold (LNT) model for radiation-induced cancer was adopted by national and international advisory bodies in the 1950s and has guided radiation protection policies worldwide since then. The resulting strict regulations have increased the compliance costs for the various uses of radiation, including nuclear medicine. The concerns about low levels of radiation due to the absence of a threshold have also resulted in adverse consequences. Justification of the LNT model was based on the concept that low levels of radiation increase mutations and that increased mutations imply increased cancers. This concept may not be valid. Low-dose radiation boosts defenses such as antioxidants and DNA repair enzymes. The boosted defenses would reduce the endogenous DNA damage that would have occurred in the subsequent period, and so the result would be reduced DNA damage and mutations. Whereas mutations are necessary for causing cancer, they are not sufficient since the immune system eliminates cancer cells or keeps them under control. The immune system plays an extremely important role in preventing cancer, as indicated by the substantially increased cancer risk in immune-suppressed patients. Hence, since low-dose radiation enhances the immune system, it would reduce cancers, resulting in a phenomenon known as radiation hormesis. There is considerable evidence for radiation hormesis and against the LNT model, including studies of atomic bomb survivors, background radiation, environmental radiation, cancer patients, medical radiation, and occupational exposures. Though Commentary 27 published by the National Council on Radiation Protection and Measurements concluded that recent epidemiologic studies broadly support the LNT model, a critical examination of the studies has shown that they do not. Another deficiency of Commentary 27 is that it did not consider the vast available evidence for radiation hormesis. Other advisory body reports that have supported the LNT model have similar deficiencies. Advisory bodies are urged to critically evaluate the evidence supporting both sides and arrive at an objective conclusion on the validity of the LNT model. Considering the strength of the evidence against the LNT model and the weakness of the evidence for it, the present analysis indicates that advisory bodies would be compelled to reject the LNT model. Hence, we may be approaching the end of the LNT model era.
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Affiliation(s)
- Mohan Doss
- Diagnostic Imaging, Fox Chase Cancer Center, Philadelphia, Pennsylvania
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