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Massera RT, Tomal A, Thomson RM. Multiscale Monte Carlo simulations for dosimetry in x-ray breast imaging: Part II - Microscopic scales. Med Phys 2024; 51:1117-1126. [PMID: 38146824 DOI: 10.1002/mp.16912] [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: 03/30/2023] [Revised: 08/09/2023] [Accepted: 09/23/2023] [Indexed: 12/27/2023] Open
Abstract
BACKGROUND Although the benefits of breast screening and early diagnosis are known for reducing breast cancer mortality rates, the effects and risks of low radiation doses to the cells in the breast are still ongoing topics of study. PURPOSE To study specific energy distributions (f ( z , D g ) $f(z,D_{g})$ ) in cytoplasm and nuclei of cells corresponding to glandular tissue for different x-ray breast imaging modalities. METHODS A cubic lattice (500 μm length side) containing 4064 spherical cells was irradiated with photons loaded from phase space files with varying glandular voxel doses (D g $D_{g}$ ). Specific energy distributions were scored for nucleus and cytoplasm compartments using the PENELOPE (v. 2018) + penEasy (v. 2020) Monte Carlo (MC) code. The phase space files, generated in part I of this work, were obtained from MC simulations in a voxelized anthropomorphic phantom corresponding to glandular voxels for different breast imaging modalities, including digital mammography (DM), digital breast tomosynthesis (DBT), contrast enhanced digital mammography (CEDM) and breast CT (BCT). RESULTS In general, the average specific energy in nuclei is higher than the respective glandular dose scored in the same region, by up to 10%. The specific energy distributions for nucleus and cytoplasm are directly related to the magnitude of the glandular dose in the voxel (D g $D_{g}$ ), with little dependence on the spatial location. For similarD g $D_{g}$ values,f ( z , D g ) $f(z,D_{g})$ for nuclei is different between DM/DBT and CEDM/BCT, indicating that distinct x-ray spectra play significant roles inf ( z , D g ) $f(z,D_{g})$ . In addition, this behavior is also present when the specific energy distribution (F g ( z ) $F_{g}(z)$ ) is considered taking into account the GDD in the breast. CONCLUSIONS Microdosimetry studies are complementary to the traditional macroscopic breast dosimetry based on the mean glandular dose (MGD). For the same MGD, the specific energy distribution in glandular tissue varies between breast imaging modalities, indicating that this effect could be considered for studying the risks of exposing the breast to ionizing radiation.
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Affiliation(s)
- Rodrigo T Massera
- Instituto de Física Gleb Wataghin, Universidade Estadual de Campinas (UNICAMP), Campinas, São Paulo, Brazil
- Carleton Laboratory for Radiotherapy Physics, Department of Physics, Carleton University, Ottawa, Ontario, Canada
| | - Alessandra Tomal
- Instituto de Física Gleb Wataghin, Universidade Estadual de Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Rowan M Thomson
- Carleton Laboratory for Radiotherapy Physics, Department of Physics, Carleton University, Ottawa, Ontario, Canada
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ALMisned G, Elshami W, Rabaa E, Kilic G, Ilik E, Sen Baykal D, Ene A, Tekin HO. Toward the strengthening of radioprotection during mammography examinations through transparent glass screens: A benchmarking between experimental and Monte Carlo simulation studies. Front Public Health 2023; 11:1171209. [PMID: 37064659 PMCID: PMC10102610 DOI: 10.3389/fpubh.2023.1171209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 03/07/2023] [Indexed: 04/03/2023] Open
Abstract
IntroductionA lead-acrylic protective screen is suggested to reduce radiation exposure to the unexposed breast during mammography. The presence of toxic lead in its structure may harm the tissues with which it comes in contact. This study aimed to design a CdO-rich quaternary tellurite glass screen (C40) and evaluate its efficiency compared to the Lead-Acrylic protective screen.MethodsA three-layer advanced heterogeneous breast phantom designed in MCNPX (version 2.7.0) general-purpose Monte Carlo code. Lead acrylic and C40 shielding screens were modeled in the MCNPX and installed between the right and left breast. The reliability of the absorption differences between the lead acrylic and C40 glass were assessed.Results and discussionThe results showed that C40 protective glass screen has much superior protection properties compared to the lead acrylic protective screen. The amount of total dose absorbed in the unexposed breast for C40 was found to be much less than that for lead-based acrylic. The protection provided by the C40 glass screen is 35–38% superior to that of the Lead-Acrylic screen. The C40 offer the opportunity to avoid the toxic Pb in the structure of Lead-Acrylic material and may be utilized for mammography to offer superior radioprotection to Lead-Acrylic and significantly lower the dose amount in the unexposed breast. It can be concluded that transparent glass screens may be utilized for radiation protection purposes in critical diagnostic radiology applications through mammography.
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Affiliation(s)
- Ghada ALMisned
- Department of Physics, College of Science, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Wiam Elshami
- Medical Diagnostic Imaging Department, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
| | - Elaf Rabaa
- Medical Diagnostic Imaging Department, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
| | - G. Kilic
- Department of Physics, Faculty of Science, Eskisehir Osmangazi University, Eskisehir, Türkiye
| | - E. Ilik
- Department of Physics, Faculty of Science, Eskisehir Osmangazi University, Eskisehir, Türkiye
| | - Duygu Sen Baykal
- Vocational School of Health Sciences, Medical Imaging Techniques, Istanbul Kent University, Istanbul, Türkiye
| | - Antoaneta Ene
- INPOLDE Research Center, Department of Chemistry, Physics and Environment, Faculty of Sciences and Environment, Dunarea de Jos University of Galati, Galati, Romania
- Antoaneta Ene
| | - H. O. Tekin
- Medical Diagnostic Imaging Department, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
- Computer Engineering Department, Faculty of Engineering and Natural Sciences, Istinye University, Istanbul, Türkiye
- *Correspondence: H. O. Tekin
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Analysis of precautions taken for protection from X-rays in a hospital in Gaziantep in the context of workplace health and safety. JOURNAL OF RADIATION RESEARCH AND APPLIED SCIENCES 2022. [DOI: 10.1016/j.jrras.2022.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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The risk of increasing tumor malignancy after PET diagnosis. CURRENT ISSUES IN PHARMACY AND MEDICAL SCIENCES 2022. [DOI: 10.2478/cipms-2022-0007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
This manuscript reviews evidences underlying the estimation of risk of malignancy enhancement of advanced aggressive cancers as a result of the gamma radiation emitted by tracers used in PET diagnostics. We conclude that among many cancers, such a phenomenon likely occurs, particularly in tumor cells with an aggressive biology in the advanced stages of their development, e.g. prostate cancer, melanoma and colorectal cancer. Moreover, we surmise based on gathered evidence that fluorine -18 (18F) labeled pharmaceuticals (18F-deoxyglucose and 18F-choline), commonly used in positron emission tomography (PET) can lead to malignancy enhancement of diagnosed cancer, manifesting as accelerated infiltration of the neighboring tissue, accelerated metastasis and/or radio- and chemotherapy resistance. In this review, some suggestions on future studies verifying this concept are also proposed. If our concerns are justified, it might be appropriate in the future to consider this assumption at the stage of deciding whether to undertake PET monitoring in some patients with advanced aggressive cancer.
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Hooshmand S, Reed WM, Suleiman ME, Brennan PC. A review of screening mammography: The benefits and radiation risks put into perspective. J Med Imaging Radiat Sci 2021; 53:147-158. [PMID: 34969620 DOI: 10.1016/j.jmir.2021.12.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 12/01/2021] [Accepted: 12/01/2021] [Indexed: 12/28/2022]
Abstract
INTRODUCTION/BACKGROUND In medical imaging a benefit to risk analysis is required when justifying or implementing diagnostic procedures. Screening mammography is no exception and in particular concerns around the use of radiation to help diagnose cancer must be addressed. METHODS The Medline database and various established reports on breast screening and radiological protection were utilised to explore this review. RESULTS/DISCUSSION The benefit of screening is well argued; the ability to detect and treat breast cancer has led to a 91% 5-year survival rate and 497 deaths prevented from breast cancer amongst 100,000 screened women. Subsequently, screening guidelines by various countries recommend annual, biennial or triennial screening from ages somewhere between 40-74 years. Whilst the literature presents different perspectives on screening younger and older women, the current evidence of benefit for screening women <40 and ≥75 years is currently not strong. The radiation dose and associated risk delivered to each woman for a single examination is dependent upon age, breast density and breast thickness, however the average mean glandular dose is around 2.5-3 mGy, and this would result in 65 induced cancers and 8 deaths per 100,000 women over a screening lifetime from 40-74 years. This results in a ratio of lives saved to deaths from induced cancer of 62:1. CONCLUSION Therefore, compared to the potential mortality reduction achievable with screening mammography, the risk is small.
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Affiliation(s)
- Sahand Hooshmand
- Faculty of Medicine and Health, The Discipline of Medical Imaging Sciences, The University of Sydney, Susan Wakil Health Building (D18), Sydney, NSW 2050, Australia.
| | - Warren M Reed
- Faculty of Medicine and Health, The Discipline of Medical Imaging Sciences, The University of Sydney, Susan Wakil Health Building (D18), Sydney, NSW 2050, Australia
| | - Mo'ayyad E Suleiman
- Faculty of Medicine and Health, The Discipline of Medical Imaging Sciences, The University of Sydney, Susan Wakil Health Building (D18), Sydney, NSW 2050, Australia
| | - Patrick C Brennan
- Faculty of Medicine and Health, The Discipline of Medical Imaging Sciences, The University of Sydney, Susan Wakil Health Building (D18), Sydney, NSW 2050, Australia
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Pereira L, Ferreira MT, Lima AGF, Salata C, Ferreira-Machado SC, Lima I, Morandi V, Magalhães LAG. Biological effects induced by doses of mammographic screening. Phys Med 2021; 87:90-98. [PMID: 34130221 DOI: 10.1016/j.ejmp.2021.06.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 05/31/2021] [Accepted: 06/04/2021] [Indexed: 10/21/2022] Open
Abstract
PURPOSE Mammography is the diagnostic imaging practice used in screening to detect early lesions suspected of malignancy. It uses a low energy X-ray beam in which a low dose in the order of 2-3 mGy is delivered to patient breast cells. However, it has been speculated that it could lead to significant cell damage, when compared to conventional X-ray. We investigated the biological effects of low doses, with mean glandular doses (MGDs) of 2.5 mGy and 2.5 + 2.5 mGy, on mammary cells in vitro. METHODS We used the non-tumorigenic cell line (MCF-10A) and two tumor cells lines (MCF-7 and MDA-MB-231). Colony formation, apoptosis, and double-strand DNA breaks (DSBs) were quantified. RESULTS The selected MGD regimens did not alter the formation of colonies by any of the cell lines. MCF-7 cells exhibited a markedly increase in apoptosis, 24 h after the single-dose protocol; MCF-10A cells underwent apoptosis only after 72 h, with both irradiation regimens, while MDA-MB-231 cells (highly invasive and metastatic) were not susceptible to apoptosis. The detection of γH2AX histone in the nuclei of irradiated cells showed that the double-dose resulted in increase of DSBs, especially in tumor cell lines. CONCLUSIONS Although the health benefits of early breast screening remain indisputable, our future perspective is to better understand the biological basis for the effects of low dose radiation on breast cells and to investigate if and under what conditions there would be a risky situation in repeated mammography screening, in both asymptomatic and symptomatic women.
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Affiliation(s)
- Leslie Pereira
- Department of Medical Physics, Institute of Radiation Protection and Dosimetry (IRD), Av. Salvador Allende, 3773, Barra da Tijuca, Rio de Janeiro, RJ CEP 22783-127, Brazil; Nuclear Engineering Department (DNC), Federal University of Rio de Janeiro (UFRJ), sala 206, Centro de Tecnologia, Av. Horácio Macedo, 2030, Bloco G, Fundão, Rio de Janeiro, RJ CEP 21941-941, Brazil.
| | - Marcella T Ferreira
- Department of Cell Biology, University of the State of Rio de Janeiro (UERJ), Pavilhão Haroldo Lisboa da Cunha, LabAngio, Rua São Francisco Xavier, 524, Maracanã, Rio de Janeiro, RJ CEP 20550-900, Brazil
| | - Antonio Gilcler F Lima
- Department of Cell Biology, University of the State of Rio de Janeiro (UERJ), Pavilhão Haroldo Lisboa da Cunha, LabAngio, Rua São Francisco Xavier, 524, Maracanã, Rio de Janeiro, RJ CEP 20550-900, Brazil
| | - Camila Salata
- CGMI/DRS, Brazilian National Nuclear Energy Comission (CNEN), Rua General Severiano, 90, Botafogo, Rio de Janeiro, RJ CEP 22290-901, Brazil.
| | - Samara C Ferreira-Machado
- Department of Radiological Sciences (LCR), State University of Rio de Janeiro (UERJ), Pavilhão Haroldo Lisboa da Cunha, Rua São Francisco Xavier, 524, Maracanã, Rio de Janeiro, RJ CEP 20550-900, Brazil; Department of General Biology, Federal Fluminense University, Niterói, RJ CEP 21045-900, Brazil
| | - I Lima
- Nuclear Engineering Department (DNC), Federal University of Rio de Janeiro (UFRJ), sala 206, Centro de Tecnologia, Av. Horácio Macedo, 2030, Bloco G, Fundão, Rio de Janeiro, RJ CEP 21941-941, Brazil.
| | - Verônica Morandi
- Department of Cell Biology, University of the State of Rio de Janeiro (UERJ), Pavilhão Haroldo Lisboa da Cunha, LabAngio, Rua São Francisco Xavier, 524, Maracanã, Rio de Janeiro, RJ CEP 20550-900, Brazil.
| | - Luís A G Magalhães
- Department of Radiological Sciences (LCR), State University of Rio de Janeiro (UERJ), Pavilhão Haroldo Lisboa da Cunha, Rua São Francisco Xavier, 524, Maracanã, Rio de Janeiro, RJ CEP 20550-900, Brazil
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Niroshani HS, Jeyasugiththan J, Senanayake G, Negishi T. Establishment of regional diagnostic reference levels for digital mammography in Western Province of Sri Lanka. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2021; 41:79-96. [PMID: 33271512 DOI: 10.1088/1361-6498/abd075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 12/03/2020] [Indexed: 06/12/2023]
Abstract
The radiation dose to the breasts should be kept to a minimum as breast tissues are highly sensitive to radiation. In mammography, the mean glandular dose (MGD) is used to specify the patient dose. In this study, data on the MGD during diagnostic mammographic examinations was collected using the database from six digital mammography facilities available in the Western Province in Sri Lanka. Examinations involving breast pathology, breast implants, or compressed breast thicknesses (CBT) outside the range of 20-110 mm were excluded in this study. The mean MGD per breast was 3.50 mGy, with a mean CBT of 57 mm. The mean MGD per facility varies from 1.58 to 2.27 mGy, with overall 75th and 95th percentiles of 2.15 and 2.82 mGy, respectively. The 75th and 95th percentile MGD per image, for the average CBT of 57 ± 12 mm, were 2.00 and 2.65 mGy respectively. The 75th percentile value of the MGD is suggested for the Western Province and it depends on the specific CBT.
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Affiliation(s)
- H S Niroshani
- Department of Nuclear Science, University of Colombo, Colombo, Sri Lanka
- Department of Radiography & Radiotherapy, General Sir John Kotelawala Defence University, Werahera, Sri Lanka
- Department of Radiological Sciences, Graduate school of Human Health Sciences, Tokyo Metropolitan University, Tokyo, Japan
| | | | - G Senanayake
- Department of Clinical Sciences, Faculty of Medicine, General Sir John Kotelawala Defence University, Werahera, Sri Lanka
| | - Toru Negishi
- Department of Radiological Sciences, Graduate school of Human Health Sciences, Tokyo Metropolitan University, Tokyo, Japan
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Abstract
The International Commission on Radiological Protection (ICRP) developed effective dose as a quantity related to risk for occupational and public exposure. There was a need for a similar dose quantity linked to risk for making everyday decisions relating to medical procedures. Coefficients were developed to enable the calculation of doses to organs and tissues, and effective doses for procedures in nuclear medicine and radiology during the 1980s and 1990s. Effective dose has provided a valuable tool that is now used in the establishment of guidelines for patient referral and justification of procedures, choice of appropriate imaging techniques, and providing dose data on potential exposure of volunteers for research studies, all of which require the benefits from the procedure to be weighed against the risks. However, the approximations made in the derivation of effective dose are often forgotten, and the uncertainties in calculations of risks are discussed. An ICRP report on protection dose quantities has been prepared that provides more information on the application of effective dose, and concludes that effective dose can be used as an approximate measure of possible risk. A discussion of the way in which it should be used is given here, with applications for which it is considered suitable. Approaches to the evaluation of risk and methods for conveying information on risk are also discussed.
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Affiliation(s)
- C.J. Martin
- Department of Clinical Physics and Bioengineering,
University of Glasgow, Gartnavel Royal Hospital, Glasgow G12 0XH, UK
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Koo BY, Lee KS. Reduction of scattered radiation dose by X-ray shielding during mammography. Radiat Phys Chem Oxf Engl 1993 2020. [DOI: 10.1016/j.radphyschem.2020.109111] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Maqsudur Rashid A, Ramalingam L, Al-Jawadi A, Moustaid-Moussa N, Moussa H. Low dose radiation, inflammation, cancer and chemoprevention. Int J Radiat Biol 2018; 95:506-515. [DOI: 10.1080/09553002.2018.1484194] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Al Maqsudur Rashid
- Department of Mechanical Engineering, Texas Tech University, Lubbock, TX, USA
| | - Latha Ramalingam
- Department of Nutritional Sciences, Texas Tech University, Lubbock, TX, USA
- Obesity Research Cluster, Texas Tech University, Lubbock, TX, USA
| | - Arwa Al-Jawadi
- Department of Nutritional Sciences, Texas Tech University, Lubbock, TX, USA
- Obesity Research Cluster, Texas Tech University, Lubbock, TX, USA
| | - Naima Moustaid-Moussa
- Department of Nutritional Sciences, Texas Tech University, Lubbock, TX, USA
- Obesity Research Cluster, Texas Tech University, Lubbock, TX, USA
| | - Hanna Moussa
- Department of Mechanical Engineering, Texas Tech University, Lubbock, TX, USA
- Obesity Research Cluster, Texas Tech University, Lubbock, TX, USA
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Miura S, Shintaku Y, Ishiuchi H, Parque V, Miyashita T. Enhanced Frequency Difference of Tumor inside Vibrated Tissue by a Compression Cylinder. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2018; 2018:380-383. [PMID: 30440415 DOI: 10.1109/embc.2018.8512437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Breast cancer diagnosis has been mostly accomplished by imaging technologies. These methods have the great advantages of detecting the presence and location of breast cancer. However, it's difficult to distinguish between a benign and malignant tumor in a deep position because both tumor types look similar. In this paper, we vibrated the tissue including tumor from skin with a compression cylinder to analyze the frequency difference for distinguishing the tissue type. Before distinguishing a benign and malignant tumor, it's necessary to validate to distinguish between normal tissue and tumor. The objective is to validate the feasibility of using a compression cylinder that emphasizes the differences in frequency between normal tissue and tumor. In two experiments, we measured the displacement on the surface of a breast phantom vibrated by an impulse hammer. We compared the frequency difference with and without a cylinder. We also studied the frequency changes in the relationship between tumor and cylinder position. We found a 5.0 Hz difference in compliance between normal tissue and the simulated tumor using a compression cylinder. The difference in frequency correlated negatively with distance from the simulated tumor to a compression cylinder. We concluded that a compression cylinder would enhance the frequency difference between normal tissue and a simulated tumor with appropriate configuration.
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Depuydt J, Viaene T, Blondeel P, Roche N, Van den Broecke R, Thierens H, Vral A. DNA double strand breaks induced by low dose mammography X-rays in breast tissue: A pilot study. Oncol Lett 2018; 16:3394-3400. [PMID: 30127940 DOI: 10.3892/ol.2018.9024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 04/26/2018] [Indexed: 12/18/2022] Open
Abstract
Breast tissue is very sensitive to ionizing radiation due to the presence of reproductive hormones, including estrogen. In the present pilot study, the efficiency of mammography X-rays to induce DNA double strand breaks (DSB) in mammary epithelial cells was investigated. For this, freshly resected healthy breast tissue was irradiated with 30 kV mammography X-rays in the dose range 0-500 mGy (2, 4, 10, 20, 40, 100 and 500 mGy). Breast specimens were also irradiated with identical doses of 60Co γ-rays as a radiation quality standard. With the γH2AX-foci assay, the number of DNA DSB induced by radiation were quantified in the mammary epithelial cells present in breast tissue. Results indicated that foci induced by 30 kV X-rays and γ-rays followed a biphasic linear dose-response. For 30 kV X-rays, the slope in the low dose region (0-20 mGy) was 8.71 times steeper compared with the slope in the higher dose region (20-500 mGy). Furthermore, compared with γ-rays, 30 kV X-rays were also more effective in inducing γH2AX-foci. This resulted in a relative biological effectiveness (RBE) value of 1.82 in the low dose range. In the higher dose range, an RBE close to 1 was obtained. In conclusion, the results indicated the existence of a low dose hypersensitive response for DSB induction in the dose range representative for mammography screening, which is probably caused by the bystander effect. This could affect the radiation risk calculations for women participating in mammography screening.
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Affiliation(s)
- Julie Depuydt
- Department of Basic Medical Sciences, University of Ghent, 9000 Ghent, Belgium
| | - Tanguy Viaene
- Department of Basic Medical Sciences, University of Ghent, 9000 Ghent, Belgium
| | | | - Nathalie Roche
- Plastic Surgery, Ghent University Hospital, 9000 Ghent, Belgium
| | | | - Hubert Thierens
- Department of Basic Medical Sciences, University of Ghent, 9000 Ghent, Belgium
| | - Anne Vral
- Department of Basic Medical Sciences, University of Ghent, 9000 Ghent, Belgium
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Suleiman ME, Brennan PC, Ekpo E, Kench P, McEntee MF. Integrating mammographic breast density in glandular dose calculation. Br J Radiol 2018; 91:20180032. [PMID: 29400552 PMCID: PMC6190790 DOI: 10.1259/bjr.20180032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2018] [Revised: 01/30/2018] [Accepted: 01/31/2018] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVE This work proposes the use of mammographic breast density (MBD) to estimate actual glandular dose (AGD), and assesses how AGD compares to mean glandular dose (MGD) estimated using Dance et al method. METHODS A retrospective sample of anonymised mammograms (52,405) was retrieved from a central database. Technical parameters and patient characteristics were exported from the Digital Imaging and Communication in Medicine (DICOM) header using third party software. LIBRA (Laboratory for Individualized Breast Radiodensity Assessment) software package (University of Pennsylvania, Philadelphia, USA) was used to estimate MBDs for each mammogram included in the data set. MGD was estimated using Dance et al method, while AGD was calculated by replacing Dance et al standard glandularities with LIBRA estimated MBDs. A linear regression analysis was used to assess the association between MGD and AGD, and a Bland-Altman analysis was performed to assess their mean difference. RESULTS The final data set included 31,097 mammograms from 7728 females. MGD, AGD, and MBD medians were 1.53 , 1.62 mGy and 8% respectively. When stratified per breast thickness ranges, median MBDs were lower than Dance's standard glandularities. There was a strong positive correlation (R2 = 0.987, p < 0.0001) between MGD and AGD although the Bland-Altman analysis revealed a small statistically significant bias of 0.087 mGy between MGD and AGD (p < 0.001). CONCLUSION AGD estimated from MBD is highly correlated to MGD from Dance method, albeit the Dance method underestimates dose at smaller CBTs. Advances in knowledge: Our work should provide a stepping-stone towards an individualised dose estimation using automated clinical measures of MBD.
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Affiliation(s)
- Moayyad E Suleiman
- Medical Radiation Sciences, The University of Sydney, Faculty of Health Sciences. Cumberland Campus, Lidcombe, NSW, Australia
| | - Patrick C Brennan
- Medical Radiation Sciences, The University of Sydney, Faculty of Health Sciences. Cumberland Campus, Lidcombe, NSW, Australia
| | - Ernest Ekpo
- Medical Radiation Sciences, The University of Sydney, Faculty of Health Sciences. Cumberland Campus, Lidcombe, NSW, Australia
| | - Peter Kench
- Medical Radiation Sciences, The University of Sydney, Faculty of Health Sciences. Cumberland Campus, Lidcombe, NSW, Australia
| | - Mark F McEntee
- Medical Radiation Sciences, The University of Sydney, Faculty of Health Sciences. Cumberland Campus, Lidcombe, NSW, Australia
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Gray JM, Rasanayagam S, Engel C, Rizzo J. State of the evidence 2017: an update on the connection between breast cancer and the environment. Environ Health 2017; 16:94. [PMID: 28865460 PMCID: PMC5581466 DOI: 10.1186/s12940-017-0287-4] [Citation(s) in RCA: 109] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 07/17/2017] [Indexed: 05/23/2023]
Abstract
BACKGROUND In this review, we examine the continually expanding and increasingly compelling data linking radiation and various chemicals in our environment to the current high incidence of breast cancer. Singly and in combination, these toxicants may have contributed significantly to the increasing rates of breast cancer observed over the past several decades. Exposures early in development from gestation through adolescence and early adulthood are particularly of concern as they re-shape the program of genetic, epigenetic and physiological processes in the developing mammary system, leading to an increased risk for developing breast cancer. In the 8 years since we last published a comprehensive review of the relevant literature, hundreds of new papers have appeared supporting this link, and in this update, the evidence on this topic is more extensive and of better quality than that previously available. CONCLUSION Increasing evidence from epidemiological studies, as well as a better understanding of mechanisms linking toxicants with development of breast cancer, all reinforce the conclusion that exposures to these substances - many of which are found in common, everyday products and byproducts - may lead to increased risk of developing breast cancer. Moving forward, attention to methodological limitations, especially in relevant epidemiological and animal models, will need to be addressed to allow clearer and more direct connections to be evaluated.
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Affiliation(s)
- Janet M. Gray
- Department of Psychology and Program in Science, Technology, and Society, Vassar College, 124 Raymond Avenue, Poughkeepsie, NY 12604-0246 USA
| | - Sharima Rasanayagam
- Breast Cancer Prevention Partners, 1388 Sutter St., Suite 400, San Francisco, CA 94109-5400 USA
| | - Connie Engel
- Breast Cancer Prevention Partners, 1388 Sutter St., Suite 400, San Francisco, CA 94109-5400 USA
| | - Jeanne Rizzo
- Breast Cancer Prevention Partners, 1388 Sutter St., Suite 400, San Francisco, CA 94109-5400 USA
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Chadwick KH. Towards a new dose and dose-rate effectiveness factor (DDREF)? Some comments. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2017; 37:422-433. [PMID: 28488593 DOI: 10.1088/1361-6498/aa6722] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The aim of this article is to offer a broader, mechanism-based, analytical tool than that used by (Rühm et al 2016 Ann. ICRP 45 262-79) for the interpretation of cancer induction relationships. The article explains the limitations of this broader analytical tool and the implications of its use in view of the publications by Leuraud et al 2015 (Lancet Haematol. 2 e276-81) and Richardson et al 2015 (Br. Med. J. 351 h5359). The publication by Rühm et al 2016 (Ann. ICRP 45 262-79), which is clearly work in progress, reviews the current status of the dose and dose-rate effectiveness factor (DDREF) as recommended by the ICRP. It also considers the issues which might influence a reassessment of both the value of the DDREF as well as its application in radiological protection. In this article, the problem is approached from a different perspective and starts by commenting on the limited scientific data used by Rühm et al 2016 (Ann. ICRP 45 262-79) to develop their analysis which ultimately leads them to use a linear-quadratic dose effect relationship to fit solid cancer mortality data from the Japanese life span study of atomic bomb survivors. The approach taken here includes more data on the induction of DNA double strand breaks and, using experimental data taken from the literature, directly relates the breaks to cell killing, chromosomal aberrations and somatic mutations. The relationships are expanded to describe the induction of cancer as arising from radiation induced cytological damage coupled to cell killing since the cancer mutated cell has to survive to express its malignant nature. Equations are derived for the induction of cancer after both acute and chronic exposure to sparsely ionising radiation. The equations are fitted to the induction of cancer in mice to illustrate a dose effect relationship over the total dose range. The 'DDREF' derived from the two equations varies with dose and the DDREF concept is called into question. Although the equation for acute exposure can be used to analyse atomic bomb survivor data, the fitting is dominated by the quadratic dose component. Thus, little useful information can be derived about the linear dose component which is important for the derivation of low dose rate risk. The ICRP are advised to derive the risk at low dose rates from epidemiological studies of, for example, worker populations, together with information from cellular radiation biological research.
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Warren LM, Dance DR, Young KC. Radiation risk of breast screening in England with digital mammography. Br J Radiol 2016; 89:20150897. [PMID: 27585843 PMCID: PMC5124825 DOI: 10.1259/bjr.20150897] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Revised: 08/25/2016] [Accepted: 09/01/2016] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To estimate the risks and benefits of breast screening in terms of number of deaths due to radiation-induced cancers and the number of lives saved owing to modern screening in the National Health Service Breast Screening Programme (NHSBSP) in England. METHODS Radiation risk model, patient dose data and data from national screening statistics were used to estimate the number of deaths due to radiation-induced breast cancers in the NHSBSP in England. Dose and dose effectiveness factors (DDREFs) equal to one and two were assumed. The breast cancer mortality reduction in the invited population due to screening and the percentage of females diagnosed with symptomatic breast cancer, who die from breast cancer, were collated from the literature. The number of lives saved owing to screening was calculated. RESULTS Assuming, a total of 1,770,436 females between the ages of 50-70 years were screened each year, and a breast cancer mortality reduction of 20% due to screening in the invited population, the number of screen-detected cancers were 14,872 annually, resulting in 1071 lives saved. Conversely, for the same mortality reduction, the number of radiation-induced cancers was 36 and 18 for DDREFs of 1 and 2, respectively. This resulted in seven and three deaths due to radiation-induced cancers annually for DDREFs of 1 and 2, respectively. The ratios of lives saved owing to screening to radiation-induced cancers were 30 : 1 and 60 : 1 for DDREFs of 1 and 2. The ratios of lives saved owing to screening to deaths due to radiation-induced cancers were 156 : 1 and 312 : 1 for DDREFs of 1 and 2. For the 1.8% of the screening population with very thick breasts, the latter ratios decrease to 94 : 1 and 187 : 1 for DDREFs of 1 and 2. CONCLUSION The breast cancer mortality reduction due to screening greatly outweighs the risk of death due to radiation-induced cancers. Advances in knowledge: Estimation of the radiation risk for modern breast screening in England using digital mammography.
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Affiliation(s)
- Lucy M Warren
- National Coordinating Centre for the Physics of Mammography, Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK
| | - David R Dance
- National Coordinating Centre for the Physics of Mammography, Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK
- Department of Physics, University of Surrey, Guildford, UK
| | - Kenneth C Young
- National Coordinating Centre for the Physics of Mammography, Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK
- Department of Physics, University of Surrey, Guildford, UK
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Baert A, Depuydt J, Van Maerken T, Poppe B, Malfait F, Storm K, van den Ende J, Van Damme T, De Nobele S, Perletti G, De Leeneer K, Claes KBM, Vral A. Increased chromosomal radiosensitivity in asymptomatic carriers of a heterozygous BRCA1 mutation. Breast Cancer Res 2016; 18:52. [PMID: 27184744 PMCID: PMC4869288 DOI: 10.1186/s13058-016-0709-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 04/23/2016] [Indexed: 01/08/2023] Open
Abstract
Background Breast cancer risk increases drastically in individuals carrying a germline BRCA1 mutation. The exposure to ionizing radiation for diagnostic or therapeutic purposes of BRCA1 mutation carriers is counterintuitive, since BRCA1 is active in the DNA damage response pathway. The aim of this study was to investigate whether healthy BRCA1 mutations carriers demonstrate an increased radiosensitivity compared with healthy individuals. Methods We defined a novel radiosensitivity indicator (RIND) based on two endpoints measured by the G2 micronucleus assay, reflecting defects in DNA repair and G2 arrest capacity after exposure to doses of 2 or 4 Gy. We investigated if a correlation between the RIND score and nonsense-mediated decay (NMD) could be established. Results We found significantly increased radiosensitivity in the cohort of healthy BRCA1 mutation carriers compared with healthy controls. In addition, our analysis showed a significantly different distribution over the RIND scores (p = 0.034, Fisher’s exact test) for healthy BRCA1 mutation carriers compared with non-carriers: 72 % of mutation carriers showed a radiosensitive phenotype (RIND score 1–4), whereas 72 % of the healthy volunteers showed no radiosensitivity (RIND score 0). Furthermore, 28 % of BRCA1 mutation carriers had a RIND score of 3 or 4 (not observed in control subjects). The radiosensitive phenotype was similar for relatives within several families, but not for unrelated individuals carrying the same mutation. The median RIND score was higher in patients with a mutation leading to a premature termination codon (PTC) located in the central part of the gene than in patients with a germline mutation in the 5′ end of the gene. Conclusions We show that BRCA1 mutations are associated with a radiosensitive phenotype related to a compromised DNA repair and G2 arrest capacity after exposure to either 2 or 4 Gy. Our study confirms that haploinsufficiency is the mechanism involved in radiosensitivity in patients with a PTC allele, but it suggests that further research is needed to evaluate alternative mechanisms for mutations not subjected to NMD. Electronic supplementary material The online version of this article (doi:10.1186/s13058-016-0709-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Annelot Baert
- Department of Basic Medical Sciences, Ghent University, Ghent, Belgium
| | - Julie Depuydt
- Department of Basic Medical Sciences, Ghent University, Ghent, Belgium
| | - Tom Van Maerken
- Center for Medical Genetics, Ghent University Hospital, Ghent, Belgium
| | - Bruce Poppe
- Center for Medical Genetics, Ghent University Hospital, Ghent, Belgium
| | - Fransiska Malfait
- Center for Medical Genetics, Ghent University Hospital, Ghent, Belgium
| | - Katrien Storm
- Department of Medical Genetics, University of Antwerp/University Hospital of Antwerp, Antwerp, Belgium
| | - Jenneke van den Ende
- Department of Medical Genetics, University of Antwerp/University Hospital of Antwerp, Antwerp, Belgium
| | - Tim Van Damme
- Center for Medical Genetics, Ghent University Hospital, Ghent, Belgium
| | - Sylvia De Nobele
- Center for Medical Genetics, Ghent University Hospital, Ghent, Belgium
| | - Gianpaolo Perletti
- Department of Basic Medical Sciences, Ghent University, Ghent, Belgium.,Biomedical Research Division, Department of Theoretical and Applied Sciences, University of Insubria, Busto Arsizio, Italy
| | - Kim De Leeneer
- Center for Medical Genetics, Ghent University Hospital, Ghent, Belgium
| | | | - Anne Vral
- Department of Basic Medical Sciences, Ghent University, Ghent, Belgium.
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Armaroli P, Villain P, Suonio E, Almonte M, Anttila A, Atkin WS, Dean PB, de Koning HJ, Dillner L, Herrero R, Kuipers EJ, Lansdorp-Vogelaar I, Minozzi S, Paci E, Regula J, Törnberg S, Segnan N. European Code against Cancer, 4th Edition: Cancer screening. Cancer Epidemiol 2015; 39 Suppl 1:S139-52. [PMID: 26596722 DOI: 10.1016/j.canep.2015.10.021] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Revised: 10/09/2015] [Accepted: 10/14/2015] [Indexed: 12/23/2022]
Abstract
In order to update the previous version of the European Code against Cancer and formulate evidence-based recommendations, a systematic search of the literature was performed according to the methodology agreed by the Code Working Groups. Based on the review, the 4th edition of the European Code against Cancer recommends: "Take part in organized cancer screening programmes for: Bowel cancer (men and women); Breast cancer (women); Cervical cancer (women)." Organized screening programs are preferable because they provide better conditions to ensure that the Guidelines for Quality Assurance in Screening are followed in order to achieve the greatest benefit with the least harm. Screening is recommended only for those cancers where a demonstrated life-saving effect substantially outweighs the potential harm of examining very large numbers of people who may otherwise never have, or suffer from, these cancers, and when an adequate quality of the screening is achieved. EU citizens are recommended to participate in cancer screening each time an invitation from the national or regional screening program is received and after having read the information materials provided and carefully considered the potential benefits and harms of screening. Screening programs in the European Union vary with respect to the age groups invited and to the interval between invitations, depending on each country's cancer burden, local resources, and the type of screening test used For colorectal cancer, most programs in the EU invite men and women starting at the age of 50-60 years, and from then on every 2 years if the screening test is the guaiac-based fecal occult blood test or fecal immunochemical test, or every 10 years or more if the screening test is flexible sigmoidoscopy or total colonoscopy. Most programs continue sending invitations to screening up to the age of 70-75 years. For breast cancer, most programs in the EU invite women starting at the age of 50 years, and not before the age of 40 years, and from then on every 2 years until the age of 70-75 years. For cervical cancer, if cytology (Pap) testing is used for screening, most programs in the EU invite women starting at the age of 25-30 years and from then on every 3 or 5 years. If human papillomavirus testing is used for screening, most women are invited starting at the age of 35 years (usually not before age 30 years) and from then on every 5 years or more. Irrespective of the test used, women continue participating in screening until the age of 60 or 65 years, and continue beyond this age unless the most recent test results are normal.
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Affiliation(s)
- Paola Armaroli
- CPO Piemonte, AOU Città della Salute e della Scienza di Torino, via S. Francesco da Paola 31, 10123 Turin, Italy
| | - Patricia Villain
- International Agency for Research on Cancer (IARC), 150 Cours Albert Thomas, 69372 Lyon Cedex 08, France
| | - Eero Suonio
- International Agency for Research on Cancer (IARC), 150 Cours Albert Thomas, 69372 Lyon Cedex 08, France
| | - Maribel Almonte
- International Agency for Research on Cancer (IARC), 150 Cours Albert Thomas, 69372 Lyon Cedex 08, France
| | - Ahti Anttila
- Mass Screening Registry, Finnish Cancer Registry, Unioninkatu 22, 00130 Helsinki, Finland
| | - Wendy S Atkin
- Department of Surgery and Cancer, Imperial College London, St. Mary's Campus, Norfolk Place, London W2 1NY, United Kingdom
| | - Peter B Dean
- International Agency for Research on Cancer (IARC), 150 Cours Albert Thomas, 69372 Lyon Cedex 08, France
| | - Harry J de Koning
- Departments of Public Health, Erasmus MC University Medical Centre, PO Box 2040, 3000CA Rotterdam, The Netherlands
| | - Lena Dillner
- Department of Infectious Disease, Karolinska University Hospital, S-17176 Stockholm, Sweden
| | - Rolando Herrero
- International Agency for Research on Cancer (IARC), 150 Cours Albert Thomas, 69372 Lyon Cedex 08, France
| | - Ernst J Kuipers
- Department of Gastroenterology & Hepatology, Erasmus MC University Medical Centre, PO Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Iris Lansdorp-Vogelaar
- Departments of Public Health, Erasmus MC University Medical Centre, PO Box 2040, 3000CA Rotterdam, The Netherlands
| | - Silvia Minozzi
- CPO Piemonte, AOU Città della Salute e della Scienza di Torino, via S. Francesco da Paola 31, 10123 Turin, Italy
| | - Eugenio Paci
- ISPO-Cancer Prevention and Research Institute, Occupational and Environmental Epidemiology Unit, Ponte Nuovo - Padiglione Mario Fiori, Via delle Oblate 2, 50141 Florence, Italy
| | - Jaroslaw Regula
- Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Department of Gastroenterology, 02-781 Warsaw, Poland
| | - Sven Törnberg
- Department of Cancer Screening, Stockholm Regional Cancer Centre, PO Box 6909, S-102 39 Stockholm, Sweden
| | - Nereo Segnan
- CPO Piemonte, AOU Città della Salute e della Scienza di Torino, via S. Francesco da Paola 31, 10123 Turin, Italy.
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Albada A, van Dulmen S, Dijkstra H, Wieffer I, Witkamp A, Ausems MGEM. Counselees' Expressed Level of Understanding of the Risk Estimate and Surveillance Recommendation are Not Associated with Breast Cancer Surveillance Adherence. J Genet Couns 2015; 25:279-89. [PMID: 26321750 PMCID: PMC4799246 DOI: 10.1007/s10897-015-9869-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2014] [Accepted: 07/23/2015] [Indexed: 11/16/2022]
Abstract
We studied counselees’ expressed understanding of the risk estimate and surveillance recommendation in the final consultation for breast cancer genetic counseling in relation with their risk perception, worry and cancer surveillance adherence 1 year post-counseling. Consecutive counselees were included from 2008 to 2010. Counselees with an indication for diagnostic DNA-testing for themselves or a breast cancer affected relative were requested to complete online questionnaires before and after counseling and one year after counseling (N = 152–124). Self-reported surveillance was compared to surveillance recommendations. Consultations were videotaped. Counselees’ reactions to the risks and recommendations were coded. Statements about the risk perception and surveillance intentions of breast cancer unaffected counselees were transcribed. Associations with outcomes were explored. Almost all breast cancer unaffected counselees (>90 %) reacted to their risk estimate with an utterance indicating understanding and this reaction was not significantly associated with their post-visit risk perception alignment. Over one-third (38.6 %) overestimated their risk post-counseling. Few counselees (5.8 %) expressed surveillance intentions. One year after counseling, about three-quarters (74.0 %) of the breast cancer unaffected counselees had adhered to the surveillance recommendation. Almost one-quarter (23.3 %) had performed more mammograms/MRI scans than recommended, which was associated with prior mammography uptake (n = 47; X2 = 5.2; p = .02). Counselees’ post-counseling overestimation of their risk, high levels of worry and high surveillance uptake were not reflected in their reactions to the counselor’s information during the final visit.
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Affiliation(s)
- Akke Albada
- Department of Medical Genetics, University Medical Centre Utrecht, Utrecht, The Netherlands.
| | - Sandra van Dulmen
- NIVEL (Netherlands Institute for Health Services Research, Utrecht, The Netherlands.,Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, The Netherlands.,Department of Health Sciences, Buskerud and Vestfold University College, Drammen, Norway
| | - Henrietta Dijkstra
- NIVEL (Netherlands Institute for Health Services Research, Utrecht, The Netherlands
| | - Ivette Wieffer
- Department of Medical Genetics, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Arjen Witkamp
- Department of Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Margreet G E M Ausems
- Department of Medical Genetics, University Medical Centre Utrecht, Utrecht, The Netherlands
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Hauge IHR, Pedersen K, Olerud HM, Hole EO, Hofvind S. The risk of radiation-induced breast cancers due to biennial mammographic screening in women aged 50-69 years is minimal. Acta Radiol 2014; 55:1174-9. [PMID: 24311702 DOI: 10.1177/0284185113514051] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The main aim of mammographic screening is to reduce the mortality from breast cancer. However, use of ionizing radiation is considered a potential harm due to the possible risk of inducing cancer in healthy women. PURPOSE To estimate the potential number of radiation-induced breast cancers, radiation-induced breast cancer deaths, and lives saved due to implementation of organized mammographic screening as performed in Norway. MATERIAL AND METHODS We used a previously published excess absolute risk model which assumes a linear no-threshold dose-response. The estimates were calculated for 100,000 women aged 50-69 years, a screening interval of 2 years, and with an assumed follow-up until the age of 85 or 105 years. Radiation doses of 0.7, 2.5, and 5.7 mGy per screening examination, a latency time of 5 or 10 years, and a dose and dose-rate effectiveness factor (DDREF) of 1 or 2 were applied. RESULTS The total lifetime risk of radiation-induced breast cancers per 100,000 women was 10 (95% CI: 4-25) if the women were followed from the ages of 50 to 85 years, for a dose of 2.5 mGy, a latency time of 10 years, and a DDREF of 1. For the same parameter values the number of radiation-induced breast cancer death was 1 (95% CI: 0-2). The assumed number of lives saved is approximately 350. CONCLUSION The risk of radiation-induced breast cancer and breast cancer death due to mammographic screening is minimal. Women should not be discouraged from attending screening due to fear of radiation-induced breast cancer death.
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Affiliation(s)
- Ingrid Helen Ryste Hauge
- Norwegian Radiation Protection Authority, Østerås, Norway
- Department of Physics, University of Oslo, Oslo, Norway
- Oslo and Akershus University College of Applied Sciences, Faculty of Health Sciences, Department of Radiography and Dental Technology, Oslo, Norway
| | | | - Hilde Merete Olerud
- Norwegian Radiation Protection Authority, Østerås, Norway
- Department of Physics, University of Oslo, Oslo, Norway
| | | | - Solveig Hofvind
- Oslo and Akershus University College of Applied Sciences, Faculty of Health Sciences, Department of Radiography and Dental Technology, Oslo, Norway
- Cancer Registry of Norway, Oslo, Norway
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21
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Belkić D, Belkić K. Proof-of-the-Concept Study on Mathematically Optimized Magnetic Resonance Spectroscopy for Breast Cancer Diagnostics. Technol Cancer Res Treat 2014; 14:277-97. [DOI: 10.1177/1533034614547446] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Accepted: 06/25/2014] [Indexed: 12/22/2022] Open
Abstract
Magnetic resonance (MR)-based modalities aid breast cancer detection without exposure to ionizing radiation. Magnetic resonance imaging is very sensitive but costly and insufficiently specific. Molecular imaging through magnetic resonance spectroscopy (MRS) can provide information about key metabolites. Here, the measured/encoded time signals cannot be interpreted directly, necessitating mathematics for mapping to the more manageable frequency domain. Conventional applications of MRS are hampered by data analysis via the fast Fourier transform (FFT) and postprocessing by fitting techniques. Most in vivo MRS studies on breast cancer rely upon estimations of total choline (tCHO). These have yielded only incremental improvements in diagnostic accuracy. In vitro studies reveal richer metabolic information for identifying breast cancer, particularly in closely overlapping components of tCHO. Among these are phosphocholine (PC), a marker of malignant transformation of the breast. The FFT cannot assess these congested spectral components. This can be done by the fast Padé transform (FPT), a high-resolution, quantification-equipped method, which we presently apply to noisy MRS time signals consistent with those encoded in breast cancer. The FPT unequivocally and robustly extracted the concentrations of all physical metabolites, including PC. In sharp contrast, the FFT produced a rough envelope spectrum with a few distorted peaks and key metabolites absent altogether. As such, the FFT has poor resolution for these typical MRS time signals from breast cancer. Hence, based on Fourier-estimated envelope spectra, tCHO estimates are unreliable. Using even truncated time signals, the FPT clearly distinguishes noise from true metabolites whose concentrations are accurately extracted. The high resolution of the FPT translates directly into shortened examination time of the patient. These capabilities strongly suggest that by applying the FPT to time signals encoded in vivo from the breast, MRS will, at last, fulfill its potential to become a clinically reliable, cost-effective method for breast cancer detection, including screening/surveillance.
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Affiliation(s)
- Dževad Belkić
- Department of Oncology-Pathology, Karolinska Institute, Stockholm, Sweden
| | - Karen Belkić
- Department of Oncology-Pathology, Karolinska Institute, Stockholm, Sweden
- School of Community and Global Health, Claremont Graduate University, Claremont, CA, USA
- Institute for Prevention Research, Keck School of Medicine, University of Southern California, Alhambra, CA, USA
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Tieu MT, Cigsar C, Ahmed S, Ng A, Diller L, Millar BA, Crystal P, Hodgson DC. Breast cancer detection among young survivors of pediatric Hodgkin lymphoma with screening magnetic resonance imaging. Cancer 2014; 120:2507-13. [PMID: 24888639 PMCID: PMC4283737 DOI: 10.1002/cncr.28747] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Revised: 02/05/2014] [Accepted: 02/05/2014] [Indexed: 02/05/2023]
Abstract
BACKGROUND Female survivors of pediatric Hodgkin lymphoma (HL) who have received chest radiotherapy are at increased risk of breast cancer. Guidelines for early breast cancer screening among these survivors are based on little data regarding clinical outcomes. This study reports outcomes of breast cancer screening with MRI and mammography (MMG) after childhood HL. METHODS We evaluated the results of breast MRI and MMG screening among 96 female survivors of childhood HL treated with chest radiotherapy. Outcomes measured included imaging sensitivity and specificity, breast cancer characteristics, and incidence of additional imaging and breast biopsy. RESULTS Median age at first screening was 30 years, and the median number of MRI screening rounds was 3. Ten breast cancers were detected in 9 women at a median age of 39 years (range, 24-43 years). Half were invasive and half were preinvasive. The median size of invasive tumors was 8 mm (range, 3-15 mm), and none had lymph node involvement. Sensitivity and specificity of the screening modalities were as follows: for MRI alone, 80% and 93.5%, respectively; MMG alone, 70% and 95%, respectively; both modalities combined, 100% and 88.6%, respectively. All invasive tumors were detected by MRI. Additional investigations were required in 52 patients, (54%), and 26 patients (27%) required breast biopsy, with 10 patients requiring more than 1 biopsy. CONCLUSIONS Screening including breast MRI with MMG has high sensitivity and specificity in pediatric HL survivors, with breast cancers detected at an early stage, although it is associated with a substantial rate of additional investigations. Cancer 2014;120:2507–2513. © 2014 The Authors. Cancer published by Wiley Periodicals, Inc. on behalf of American Cancer Society. Screening female survivors of pediatric Hodgkin Lymphoma for breast cancer with MRI and mammography detected tumors at an earlier stage than prior studies of mammography alone, although a substantial proportion of women required additional tests for benign imaging findings. The 5-year cumulative incidence of invasive or preinvasive tumors after initiating screening was 10.8%.
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Affiliation(s)
- Minh Thi Tieu
- Radiation Medicine Program, Princess Margaret Hospital, and the Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
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May FE. Novel drugs that target the estrogen-related receptor alpha: their therapeutic potential in breast cancer. Cancer Manag Res 2014; 6:225-52. [PMID: 24904222 PMCID: PMC4041375 DOI: 10.2147/cmar.s35024] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
THE INCIDENCE OF BREAST CANCER CONTINUES TO RISE 1.7 million women were diagnosed with and 521,000 women died from breast cancer in 2012. This review considers first current treatment options: surgery; radiotherapy; and systemic endocrine, anti-biological, and cytotoxic therapies. Clinical management includes prevention, early detection by screening, treatment with curative intent, management of chronic disease, and palliative control of advanced breast cancer. Next, the potential of novel drugs that target DNA repair, growth factor dependence, intracellular and intercellular signal transduction, and cell cycle are considered. Estrogen-related receptor alpha has attracted attention as a therapeutic target in triple-negative breast cancers with de novo resistance to, and in breast cancers with acquired resistance to, endocrine therapies such as antiestrogens and aromatase inhibitors. Estrogen-related receptor alpha is an orphan receptor and transcription factor. Its activity is regulated by coregulator proteins and posttranslational modification. It is an energy sensor that controls adaptation to energy demand and may facilitate glycolytic metabolism and mitochondrial oxidative respiration in breast cancer cells. Estrogen-related receptor alpha increases breast cancer cell migration, proliferation, and tumor development. It is expressed at high levels in estrogen receptor-negative tumors, and is proposed to activate estrogen-responsive genes in endocrine-resistant tumors. The structures and functions of the ligand-binding domains of estrogen receptor alpha and estrogen-related receptor alpha, their ability to bind estrogens, phytoestrogens, and synthetic ligands, and the effects of ligand agonists, antagonists, and inverse agonists on biological activity, are evaluated. Synthetic ligands of estrogen-related receptor alpha have activity in preclinical models of metabolic disorders, diabetes, osteoporosis, and oncology. The clinical settings in which these novel drugs might have utility in the management of advanced breast cancer, and biomarkers for stratification of patients likely to benefit, are discussed. Finally, the potential side effects of the novel drugs on metabolism, osteoporosis, osteo-metastasis, and cachexia are considered.
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Affiliation(s)
- Felicity Eb May
- Northern Institute for Cancer Research and Department of Pathology, Faculty of Medical Sciences, University of Newcastle upon Tyne, Newcastle upon Tyne, UK
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Impact of the digitalisation of mammography on performance parameters and breast dose in the Flemish Breast Cancer Screening Programme. Eur Radiol 2014; 24:1808-19. [PMID: 24816932 DOI: 10.1007/s00330-014-3169-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Revised: 03/05/2014] [Accepted: 03/27/2014] [Indexed: 10/25/2022]
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Affiliation(s)
- Francesco Sardanelli
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milan, Italy.
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Morgan WF, Bair WJ. Issues in Low Dose Radiation Biology: The Controversy Continues. A Perspective. Radiat Res 2013; 179:501-10. [DOI: 10.1667/rr3306.1] [Citation(s) in RCA: 102] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Hugtenburg RP. Monte Carlo modelling of acute and late effects in radiation therapy. Appl Radiat Isot 2012; 70:1113-7. [DOI: 10.1016/j.apradiso.2011.11.038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2011] [Accepted: 11/13/2011] [Indexed: 11/17/2022]
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Colin C, Devic C, Noël A, Rabilloud M, Zabot MT, Pinet-Isaac S, Giraud S, Riche B, Valette PJ, Rodriguez-Lafrasse C, Foray N. DNA double-strand breaks induced by mammographic screening procedures in human mammary epithelial cells. Int J Radiat Biol 2011; 87:1103-12. [PMID: 21797809 DOI: 10.3109/09553002.2011.608410] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To assess in vitro mammographic radiation-induced DNA damage in mammary epithelial cells from 30 patients with low (LR) or high (HR) family risk of breast cancer. MATERIALS AND METHODS Spontaneous and radiation-induced DNA double-strand breaks (DSB) were quantified by using immunofluorescence of the phosphorylated H2AX histone (γH2AX) in different conditions of mammography irradiation (2, 4, 2 + 2 mGy). RESULTS HR patients showed significantly more spontaneous γH2AX foci than LR patients (p = 0.014). A significant dose-effect was observed, with an exacerbation in HR patients (p = 0.01). The dose repetition (2 + 2 mGy) provided more induced and more unrepaired DSB than 2 mGy and 4 mGy, and was exacerbated in HR (p = 0.006). CONCLUSIONS This study highlights the existence of DSB induced by mammography and revealed by γH2AX assay with two major radiobiological effects occurring: A low-dose effect, and a LOw and Repeated Dose (LORD) effect. All these effects were exacerbated in HR patients. These findings may lead us to re-evaluate the number of views performed in screening using a single view (oblique) in women whose mammographic benefit has not properly been proved such as HR patients.
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Affiliation(s)
- Catherine Colin
- Hospices Civils de Lyon, Service de Radiologie, Centre Hospitalier Lyon Sud, Pierre-Bénite, France.
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Biologie des radiations : avancées majeures et perspectives pour la radiothérapie. Cancer Radiother 2011; 15:348-54. [DOI: 10.1016/j.canrad.2011.05.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2010] [Revised: 05/05/2011] [Accepted: 05/10/2011] [Indexed: 11/22/2022]
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Multicenter surveillance of women at high genetic breast cancer risk using mammography, ultrasonography, and contrast-enhanced magnetic resonance imaging (the high breast cancer risk italian 1 study): final results. Invest Radiol 2011; 46:94-105. [PMID: 21139507 DOI: 10.1097/rli.0b013e3181f3fcdf] [Citation(s) in RCA: 231] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVES : To prospectively compare clinical breast examination, mammography, ultrasonography, and contrast-enhanced magnetic resonance imaging (MRI) in a multicenter surveillance of high-risk women. MATERIALS AND METHODS : We enrolled asymptomatic women aged ≥ 25: BRCA mutation carriers; first-degree relatives of BRCA mutation carriers, and women with strong family history of breast/ovarian cancer, including those with previous personal breast cancer. RESULTS : A total of 18 centers enrolled 501 women and performed 1592 rounds (3.2 rounds/woman). Forty-nine screen-detected and 3 interval cancers were diagnosed: 44 invasive, 8 ductal carcinoma in situ; only 4 pT2 stage; 32 G3 grade. Of 39 patients explored for nodal status, 28 (72%) were negative. Incidence per year-woman resulted 3.3% overall, 2.1% <50, and 5.4% ≥ 50 years (P < 0.001), 4.3% in women with previous personal breast cancer and 2.5% in those without (P = 0.045). MRI was more sensitive (91%) than clinical breast examination (18%), mammography (50%), ultrasonography (52%), or mammography plus ultrasonography (63%) (P < 0.001). Specificity ranged 96% to 99%, positive predictive value 53% to 71%, positive likelihood ratio 24 to 52 (P not significant). MRI showed significantly better negative predictive value (99.6) and negative likelihood ratio (0.09) than those of the other modalities. At receiver operating characteristic analysis, the area under the curve of MRI (0.97) was significantly higher than that of mammography (0.83) or ultrasonography (0.82) and not significantly increased when MRI was combined with mammography and/or ultrasonography. Of 52 cancers, 16 (31%) were diagnosed only by MRI, 8 of 21 (38%) in women <50, and 8 of 31 (26%) in women ≥ 50 years of age. CONCLUSION : MRI largely outperformed mammography, ultrasonography, and their combination for screening high-risk women below and over 50.
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Leenhouts HP, Chadwick KH. Dose-effect relationships, epidemiological analysis and the derivation of low dose risk. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2011; 31:95-105. [PMID: 21346287 DOI: 10.1088/0952-4746/31/1/006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
This paper expands on our recent comments in a letter to this journal about the analysis of epidemiological studies and the determination of low dose RBE of low LET radiation (Chadwick and Leenhouts 2009 J. Radiol. Prot. 29 445-7). Using the assumption that radiation induced cancer arises from a somatic mutation (Chadwick and Leenhouts 2011 J. Radiol. Prot. 31 41-8) a model equation is derived to describe cancer induction as a function of dose. The model is described briefly, evidence is provided in support of it, and it is applied to a set of experimental animal data. The results are compared with a linear fit to the data as has often been done in epidemiological studies. The article presents arguments to support several related messages which are relevant to epidemiological analysis, the derivation of low dose risk and the weighting factor of sparsely ionising radiations. The messages are: (a) cancer incidence following acute exposure should, in principle, be fitted to a linear-quadratic curve with cell killing using all the data available; (b) the acute data are dominated by the quadratic component of dose; (c) the linear fit of any acute data will essentially be dependent on the quadratic component and will be unrelated to the effectiveness of the radiation at low doses; consequently, (d) the method used by ICRP to derive low dose risk from the atomic bomb survivor data means that it is unrelated to the effectiveness of the hard gamma radiation at low radiation doses; (e) the low dose risk value should, therefore, not be used as if it were representative for hard gamma rays to argue for an increased weighting factor for tritium and soft x-rays even though there are mechanistic reasons to expect this; (f) epidemiological studies of chronically exposed populations supported by appropriate cellular radiobiological studies have the best chance of revealing different RBE values for different sparsely ionising radiations.
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Affiliation(s)
- Martin J Yaffe
- Imaging Research Program, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Ave, Room S6-57, Toronto, ON, Canada M4N 3M5.
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Stop Breast Cancer Now! Imagining Imaging Pathways Toward Search, Destroy, Cure, and Watchful Waiting of Premetastasis Breast Cancer. Breast Cancer 2010. [DOI: 10.1007/978-1-84996-314-5_10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Martin CJ, Sutton DG, West CM, Wright EG. The radiobiology/radiation protection interface in healthcare. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2009; 29:A1-A20. [PMID: 19454808 DOI: 10.1088/0952-4746/29/2a/s01] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
The current knowledge of radiation effects is reviewed and implications for its application in healthcare considered. The 21st L H Gray conference gathered leading experts in radiobiology, radiation epidemiology, radiation effect modelling, and the application of radiation in medicine to provide an overview of the subject. The latest radiobiology research in non-targeted effects such as genomic instability and the bystander effect challenge the old models, but the implications for health effects on humans are uncertain. Adaptive responses to external stresses, of which radiation is one, have been demonstrated in cells and animal models, but it is not known how these might modify human dose-effect relationships. Epidemiological evidence from the Japanese A-bomb survivors provides strong evidence that there is a linear relationship between the excess risk of cancer and organ dose that extends from about 50 mSv up to 2.5 Sv, and results from pooled data for multiple epidemiological studies indicate that risks extend down to doses of 20 mSv. Thus linear extrapolation of the A-bomb dose-effect data provides an appropriate basis for radiological protection standards at the present time. Risks from higher dose diagnostic procedures fall within the range in which health effects can be demonstrated. There is therefore reason for concern about the rise in the number of computed tomography (CT) scans performed in many countries, and in particular the use of CT for screening of asymptomatic individuals. New radiotherapy techniques allow high dose radiation fields to be conformed more effectively to target volumes, and reduce doses to critical organs, but they tend to give a higher and more uniform dose to the whole body which may increase the risk of second cancer. It is important that radiation protection practitioners keep abreast of developments in understanding of radiation effects and advise the medical community about the implications of fundamental research when planning medical applications for the future.
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Affiliation(s)
- C J Martin
- Department of Clinical Physics and Bio-engineering, Gartnavel Royal Hospital, Glasgow, UK
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