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Little MP, Mai JZ, Fang M, Chernyavskiy P, Kennerley V, Cahoon EK, Cockburn MG, Kendall GM, Kimlin MG. Solar ultraviolet radiation exposure, and incidence of childhood acute lymphocytic leukaemia and non-Hodgkin lymphoma in a US population-based dataset. Br J Cancer 2024; 130:1441-1452. [PMID: 38424165 PMCID: PMC11059281 DOI: 10.1038/s41416-024-02629-3] [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: 10/04/2023] [Revised: 02/14/2024] [Accepted: 02/15/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Acute lymphocytic leukaemia (ALL) and non-Hodgkin lymphoma (NHL) are among the commonest types of childhood cancer. Some previous studies suggested that elevated ultraviolet radiation (UVR) exposures increase ALL risk; many more indicate NHL risk is reduced. METHODS We assessed age<20 ALL/NHL incidence in Surveillance, Epidemiology and End Results data using AVGLO-derived UVR irradiance/cumulative radiant exposure measures, using quasi-likelihood models accounting for underdispersion, adjusted for age, sex, racial/ethnic group and other county-level socioeconomic variables. RESULTS There were 30,349 cases of ALL and 8062 of NHL, with significant increasing trends of ALL with UVR irradiance (relative risk (RR) = 1.200/mW/cm2 (95% CI 1.060, 1.359, p = 0.0040)), but significant decreasing trends for NHL (RR = 0.646/mW/cm2 (95% CI 0.512, 0.816, p = 0.0002)). There was a borderline-significant increasing trend of ALL with UVR cumulative radiant exposure (RR = 1.444/MJ/cm2 (95% CI 0.949, 2.197, p = 0.0865)), and significant decreasing trends for NHL (RR = 0.284/MJ/cm2 (95% CI 0.166, 0.485, p < 0.0001)). ALL and NHL trend RR is substantially increased among those aged 0-3. All-age trend RRs are most extreme (increasing for ALL, decreasing for NHL) for Hispanics for both UVR measures. CONCLUSIONS Our more novel finding, of excess UVR-related ALL risk, is consistent with some previous studies, but is not clear-cut, and in need of replication.
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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, 20892-9778, USA.
- Faculty of Health and Life Sciences, Oxford Brookes University, Headington Campus, Oxford, OX3 0BP, UK.
| | - Jim Z Mai
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, MD, 20892-9778, USA
| | - Michelle Fang
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, MD, 20892-9778, USA
| | - Pavel Chernyavskiy
- Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, VA, 22908-0717, USA
| | - Victoria Kennerley
- Biostatistics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, MD, 20892-9778, USA
| | - Elizabeth K Cahoon
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, MD, 20892-9778, USA
| | - Myles G Cockburn
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Gerald M Kendall
- Cancer Epidemiology Unit, University of Oxford, Richard Doll Building, Old Road Campus, Headington, Oxford, OX3 7LF, UK
| | - Michael G Kimlin
- Institute of Evidence Based Medicine, Bond University, Robina, Gold Coast, QLD, 4226, Australia
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Gil JV, Ribera J, Llop M. Editorial: Pediatric acute lymphoblastic leukemia: what's next? Front Pediatr 2024; 11:1358139. [PMID: 38269288 PMCID: PMC10806147 DOI: 10.3389/fped.2023.1358139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 12/27/2023] [Indexed: 01/26/2024] Open
Affiliation(s)
- J. V. Gil
- Grupo de Investigación en Hematología y Hemoterapia, Instituto de Investigación Sanitaria la Fe, Valencia, Spain
| | - J. Ribera
- Acute Lymphoblastic Leukaemia Group, Josep Carreras Leukaemia Research Institute, Badalona, Spain
| | - M. Llop
- Unidad de Biología Molecular, Hospital Universitari I Politècnic la Fe, Valencia, Spain
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Kendall GM, Little MP, Wakeford R. A review of studies of childhood cancer and natural background radiation. Int J Radiat Biol 2021; 97:769-781. [PMID: 33395329 PMCID: PMC10686050 DOI: 10.1080/09553002.2020.1867926] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 12/16/2020] [Accepted: 12/17/2020] [Indexed: 12/22/2022]
Abstract
PURPOSE The projected existence and magnitude of carcinogenic effects of ionizing radiation at low doses and low-dose rates is perhaps the most important issue in radiation protection today. Studies of childhood cancer and natural background radiation have the potential to throw direct light on this question, into a dose range below a few tens of mSv. This paper describes the studies that have been undertaken and their context, discusses some problems that arise and summarizes the present position. CONCLUSIONS Many such studies have been undertaken, but most were too small to have a realistic chance of detecting the small effects expected from such low doses, based on risk projections from higher exposures. Case-control or cohort studies are to be preferred methodologically to ecological studies but can be prone to problems of registration/participation bias. Interview-based studies of the requisite size would be prohibitively expensive and would undoubtedly also run into problems of participation bias. Register-based studies can be very large and are free of participation bias. However, they need to estimate the radiation exposure of study subjects using models rather than individual measurements in the homes of those concerned. At present, no firm conclusions can be drawn from the studies that have been published to date. Further data and perhaps pooled studies offer a way forward.
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Affiliation(s)
- Gerald M Kendall
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Headington, Oxford, UK
| | - Mark P Little
- Radiation Epidemiology Branch, National Cancer Institute, Bethesda, MD, USA
| | - Richard Wakeford
- Centre for Occupational and Environmental Health, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
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Mazzei-Abba A, Folly CL, Coste A, Wakeford R, Little MP, Raaschou-Nielsen O, Kendall G, Hémon D, Nikkilä A, Spix C, Auvinen A, Spycher BD. Epidemiological studies of natural sources of radiation and childhood cancer: current challenges and future perspectives. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2020; 40:R1-R23. [PMID: 31751953 PMCID: PMC10654695 DOI: 10.1088/1361-6498/ab5a38] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The empirical estimation of cancer risks in children associated with low-dose ionising radiation (<100 mSv) remains a challenge. The main reason is that the required combination of large sample sizes with accurate and comprehensive exposure assessment is difficult to achieve. An international scientific workshop, 'Childhood cancer and background radiation', organised by the Institute of Social and Preventive Medicine of the University of Bern, brought together researchers in this field to evaluate how epidemiological studies of background radiation and childhood cancer can best improve our understanding of the effects of low-dose ionising radiation. This review summarises and evaluates the findings of these studies with regard to their methodological differences, identifies key limitations and challenges, and proposes ways to move forward. Large childhood cancer registries, such as those in Great Britain, France and Germany, now permit the conducting of studies that should have sufficient statistical power to detect the effects predicted by standard risk models. Nevertheless, larger studies or pooled studies will be needed to investigate disease subgroups. The main challenge is to accurately assess children's individual exposure to radiation from natural sources and from other sources, as well as potentially confounding non-radiation exposures, in such large study populations. For this, the study groups should learn from each other to improve exposure estimation and develop new ways to validate exposure models with personal dosimetry.
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Affiliation(s)
- Antonella Mazzei-Abba
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
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Berlivet J, Hémon D, Cléro É, Ielsch G, Laurier D, Guissou S, Lacour B, Clavel J, Goujon S. Ecological association between residential natural background radiation exposure and the incidence rate of childhood central nervous system tumors in France, 2000-2012. JOURNAL OF ENVIRONMENTAL RADIOACTIVITY 2020; 211:106071. [PMID: 31600676 DOI: 10.1016/j.jenvrad.2019.106071] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 08/01/2019] [Accepted: 09/23/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND High-dose ionizing radiation is an established risk factor for childhood central nervous system tumors (CNST) but the role of low doses remains debated. In particular, there are few studies of natural background radiation (NBR, gamma radiation and radon) and childhood CNST, and their results are inconclusive. OBJECTIVES This study aimed to investigate the ecological association between NBR exposure and childhood CNST incidence in France, considering childhood CNST overall and by subgroups. METHODS Incidence data were provided by the French national registry of childhood cancers, which has high completeness. We included 5471 childhood CNST cases registered over the period 2000-2012, and their municipality of residence at diagnosis was recorded. Municipality NBR exposures were estimated by cokriging models, using NBR measurements and additional geographic data. The incidence rate ratio (IRR) per unit variation of exposure was estimated with Poisson regression models. NBR exposures were considered at the time of diagnosis, and cumulatively from birth to diagnosis. In an exploratory analysis, the total brain dose due to NBR was used. RESULTS Overall, there was no association between NBR exposure and childhood CNST incidence (IRR = 1.03 (0.98,1.09) per 50 nSv/h for gamma radiation, and IRR = 1.02 (0,96,1.07) per 100 Bq/m3 for radon). An association was suggested between pilocytic astrocytomas and gamma radiation (IRR = 1.12 (1.00,1.24) per 50 nSv/h) but not with radon (IRR = 1.07 (0.95,1.20) per 100 Bq/m3). Upward trends for this CNST subtype were also suggested with the cumulative exposures to gamma radiation and the total brain dose. NBR exposure was not associated with other CNST subgroups (ependymomas, embryonal tumors, and gliomas other than pilocytic astrocytomas). Adjustment for socio-demographic factors did not change the findings. CONCLUSIONS Our study was based on high quality incidence data, large numbers of CNST cases, and validated models of NBR exposure assessment. Results suggest an association between gamma radiation, as a component of NBR, and pilocytic astrocytomas incidence in France.
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Affiliation(s)
- Justine Berlivet
- Inserm, UMR 1153 Epidemiology and Biostatistics Sorbonne Paris Cité Research Center (CRESS), Epidémiologie des Cancers de l'enfant et de l'adolescent Team (EPICEA), Villejuif, F-94807, France; Paris Descartes University, Sorbonne Paris Cité, France.
| | - Denis Hémon
- Inserm, UMR 1153 Epidemiology and Biostatistics Sorbonne Paris Cité Research Center (CRESS), Epidémiologie des Cancers de l'enfant et de l'adolescent Team (EPICEA), Villejuif, F-94807, France; Paris Descartes University, Sorbonne Paris Cité, France
| | - Énora Cléro
- Institut de Radioprotection et de Sûreté Nucléaire, IRSN, PSE-SANTE/SESANE, Fontenay aux Roses, F-92262, France
| | - Géraldine Ielsch
- Institut de Radioprotection et de Sûreté Nucléaire, IRSN, PSE-ENV/SEREN, Fontenay aux Roses, F-92262, France
| | - Dominique Laurier
- Institut de Radioprotection et de Sûreté Nucléaire, IRSN, PSE-SANTE/SESANE, Fontenay aux Roses, F-92262, France
| | - Sandra Guissou
- Inserm, UMR 1153 Epidemiology and Biostatistics Sorbonne Paris Cité Research Center (CRESS), Epidémiologie des Cancers de l'enfant et de l'adolescent Team (EPICEA), Villejuif, F-94807, France; Paris Descartes University, Sorbonne Paris Cité, France; CHU Nancy, French National Registry of Childhood Solid Tumors (RNTSE), Faculté de Médecine, Vandoeuvre-lès-Nancy, F-54500, France
| | - Brigitte Lacour
- Inserm, UMR 1153 Epidemiology and Biostatistics Sorbonne Paris Cité Research Center (CRESS), Epidémiologie des Cancers de l'enfant et de l'adolescent Team (EPICEA), Villejuif, F-94807, France; Paris Descartes University, Sorbonne Paris Cité, France; CHU Nancy, French National Registry of Childhood Solid Tumors (RNTSE), Faculté de Médecine, Vandoeuvre-lès-Nancy, F-54500, France
| | - Jacqueline Clavel
- Inserm, UMR 1153 Epidemiology and Biostatistics Sorbonne Paris Cité Research Center (CRESS), Epidémiologie des Cancers de l'enfant et de l'adolescent Team (EPICEA), Villejuif, F-94807, France; Paris Descartes University, Sorbonne Paris Cité, France; French National Registry of Childhood Hematological Malignancies (RNHE), Villejuif, F-94807, France
| | - Stéphanie Goujon
- Inserm, UMR 1153 Epidemiology and Biostatistics Sorbonne Paris Cité Research Center (CRESS), Epidémiologie des Cancers de l'enfant et de l'adolescent Team (EPICEA), Villejuif, F-94807, France; Paris Descartes University, Sorbonne Paris Cité, France; French National Registry of Childhood Hematological Malignancies (RNHE), Villejuif, F-94807, France
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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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7
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Kendall GM, Chernyavskiy P, Appleton JD, Miles JCH, Wakeford R, Athanson M, Vincent TJ, McColl NP, Little MP. Modelling the bimodal distribution of indoor gamma-ray dose-rates in Great Britain. RADIATION AND ENVIRONMENTAL BIOPHYSICS 2018; 57:321-347. [PMID: 30132159 DOI: 10.1007/s00411-018-0752-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 08/04/2018] [Indexed: 06/08/2023]
Abstract
Gamma radiation from naturally occurring sources (including directly ionizing cosmic-rays) is a major component of background radiation. An understanding of the magnitude and variation of doses from these sources is important, and the ability to predict them is required for epidemiological studies. In the present paper, indoor measurements of naturally occurring gamma-rays at representative locations in Great Britain are summarized. It is shown that, although the individual measurement data appear unimodal, the distribution of gamma-ray dose-rates when averaged over relatively small areas, which probably better represents the underlying distribution with inter-house variation reduced, appears bimodal. The dose-rate distributions predicted by three empirical and geostatistical models are also bimodal and compatible with the distributions of the areally averaged dose-rates. The distribution of indoor gamma-ray dose-rates in the UK is compared with those in other countries, which also tend to appear bimodal (or possibly multimodal). The variation of indoor gamma-ray dose-rates with geology, socio-economic status of the area, building type, and period of construction are explored. The factors affecting indoor dose-rates from background gamma radiation are complex and frequently intertwined, but geology, period of construction, and socio-economic status are influential; the first is potentially most influential, perhaps, because it can be used as a general proxy for local building materials. Various statistical models are tested for predicting indoor gamma-ray dose-rates at unmeasured locations. Significant improvements over previous modelling are reported. The dose-rate estimates generated by these models reflect the imputed underlying distribution of dose-rates and provide acceptable predictions at geographical locations without measurements.
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Affiliation(s)
- G M Kendall
- Cancer Epidemiology Unit, NDPH, University of Oxford, Richard Doll Building, Old Road Campus, Headington, Oxford, OX3 7LF, UK.
| | - P Chernyavskiy
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, DHHS, NIH, Bethesda, MD, 20892-9778, USA
- Department of Mathematics and Statistics, Ross Hall 331, University of Wyoming, Laramie, WY, 82071-3036, USA
| | - J D Appleton
- British Geological Survey, Kingsley Dunham Centre, Nicker Hill, Keyworth, Nottingham, NG12 5GG, UK
| | - J C H Miles
- , Nobles Close, Grove, Oxfordshire, OX12 0NR, UK
| | - R Wakeford
- Centre for Occupational and Environmental Health, Institute of Population Health, The University of Manchester, Ellen Wilkinson Building, Oxford Road, Manchester, M13 9PL, UK
| | - M Athanson
- Bodleian Library, University of Oxford, Broad Street, Oxford, OX1 3BG, UK
| | - T J Vincent
- Childhood Cancer Research Group, University of Oxford, New Richards Building, Old Road, Oxford, UK
| | - N P McColl
- Centre for Radiation, Chemical and Environmental Hazards, Public Health England, Chilton, Didcot Oxon, OX11 0RQ, UK
| | - M P Little
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, DHHS, NIH, Bethesda, MD, 20892-9778, USA
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Nikkilä A, Kendall G, Raitanen J, Spycher B, Lohi O, Auvinen A. Effects of incomplete residential histories on studies of environmental exposure with application to childhood leukaemia and background radiation. ENVIRONMENTAL RESEARCH 2018; 166:466-472. [PMID: 29945121 DOI: 10.1016/j.envres.2018.06.035] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 06/13/2018] [Accepted: 06/16/2018] [Indexed: 06/08/2023]
Abstract
When evaluating environmental exposures, residential exposures are often most relevant. In most countries, it is impossible to establish full residential histories. In recent publications, childhood leukaemia and background radiation have been studied with and without full residential histories. This paper investigates the consequences of lacking such full data. Data from a nationwide Finnish Case-Control study of Childhood Leukaemia and gamma rays were analysed. This included 1093 children diagnosed with leukaemia in Finland in 1990-2011. Each case was matched by gender and year of birth to three controls. Full residential histories were available. The dose estimates were based on outdoor background radiation measurements. The indoor dose rates were obtained with a dwelling type specific conversion coefficient and the individual time-weighted mean red bone marrow dose rates were calculated using age-specific indoor occupancy and the age and gender of the child. Radiation from Chernobyl fallout was included and a 2-year latency period assumed. The median separation between successive dwellings was 3.4 km and median difference in red bone marrow dose 2.9 nSv/h. The Pearson correlation between the indoor red bone marrow dose rates of successive dwellings was 0.62 (95% CI 0.60, 0.64). The odds ratio for a 10 nSv/h increase in dose rate with full residential histories was 1.01 (95% CI 0.97, 1.05). Similar odds ratios were calculated with dose rates based on only the first dwelling (1.02, 95% CI 0.99, 1.05) and only the last dwelling (1.00, 95% CI 0.98, 1.03) and for subjects who had lived only in a single dwelling (1.05, 95% CI 0.98, 1.10). Knowledge of full residential histories would always be the option of choice. However, due to the strong correlation between exposure estimates in successive dwellings and the uncertainty about the most relevant exposure period, estimation of overall exposure level from a single address is also informative. Error in dose estimation is likely to cause some degree of classical measurement error resulting in bias towards the null.
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Affiliation(s)
- Atte Nikkilä
- Faculty of Medicine and Biosciences, University of Tampere, Tampere, Finland.
| | - Gerald Kendall
- Cancer Epidemiology Unit, NDPH, University of Oxford, Old Road Campus, Oxford OX3 7LF, UK
| | - Jani Raitanen
- Faculty of Social Sciences, University of Tampere, Tampere, Finland; UKK Institute, Tampere, Finland
| | - Ben Spycher
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
| | - Olli Lohi
- Tampere Center for Child Health Research, University of Tampere and Tampere University Hospital, Tampere, Finland
| | - Anssi Auvinen
- Faculty of Social Sciences, University of Tampere, Tampere, Finland; Radiation and Nuclear Safety Authority, Helsinki, Finland
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9
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Draper GJ, Bithell JF, Bunch KJ, Kendall GM, Murphy MFG, Stiller CA. Childhood cancer research in Oxford II: The Childhood Cancer Research Group. Br J Cancer 2018; 119:763-770. [PMID: 30131553 PMCID: PMC6173767 DOI: 10.1038/s41416-018-0181-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 05/26/2018] [Accepted: 06/20/2018] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND We summarise the work of the Childhood Cancer Research Group, particularly in relation to the UK National Registry of Childhood Tumours (NRCT). METHODS The Group was responsible for setting up and maintaining the NRCT. This registry was based on notifications from regional cancer registries, specialist children's tumour registries, paediatric oncologists and clinical trials organisers. For a large sample of cases, data on controls matched by date and place of birth were also collected. RESULTS Significant achievements of the Group include: studies of aetiology and of genetic epidemiology; proposals for, and participation in, international comparative studies of these diseases and on a classification system specifically for childhood cancer; the initial development of, and major contributions to, follow-up studies of the health of long-term survivors; the enhancement of cancer registration records by the addition of clinical data and of birth records. The Group made substantial contributions to the UK government's Committee on Medical Aspects of Radiation in the Environment. CONCLUSION An important part of the ethos of the Group was to work in collaboration with many other organisations and individuals, both nationally and internationally: many of the Group's achievements described here were the result of such collaborations.
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Affiliation(s)
- Gerald J Draper
- Department of Statistics, University of Oxford, 24-29 St Giles, Oxford, OX1 3LB, UK.
| | - John F Bithell
- Department of Statistics, University of Oxford, 24-29 St Giles, Oxford, OX1 3LB, UK
| | - Kathryn J Bunch
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Oxford, OX3 7LF, UK
| | - Gerald M Kendall
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Oxford, OX3 7LF, UK
| | - Michael F G Murphy
- Nuffield Department of Women's and Reproductive Health, University of Oxford, John Radcliffe Hospital, Oxford, OX3 9DU, UK
| | - Charles A Stiller
- National Cancer Registration and Analysis Service, Public Health England, Chancellor Court, Oxford Business Park South, Oxford, OX4 2GX, UK
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10
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Amoon AT, Oksuzyan S, Crespi CM, Arah OA, Cockburn M, Vergara X, Kheifets L. Residential mobility and childhood leukemia. ENVIRONMENTAL RESEARCH 2018; 164:459-466. [PMID: 29574256 PMCID: PMC7491916 DOI: 10.1016/j.envres.2018.03.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/25/2017] [Revised: 03/08/2018] [Accepted: 03/10/2018] [Indexed: 05/29/2023]
Abstract
AIMS Studies of environmental exposures and childhood leukemia studies do not usually account for residential mobility. Yet, in addition to being a potential risk factor, mobility can induce selection bias, confounding, or measurement error in such studies. Using data collected for California Powerline Study (CAPS), we attempt to disentangle the effect of mobility. METHODS We analyzed data from a population-based case-control study of childhood leukemia using cases who were born in California and diagnosed between 1988 and 2008 and birth certificate controls. We used stratified logistic regression, case-only analysis, and propensity-score adjustments to assess predictors of residential mobility between birth and diagnosis, and account for potential confounding due to residential mobility. RESULTS Children who moved tended to be older, lived in housing other than single-family homes, had younger mothers and fewer siblings, and were of lower socioeconomic status. Odds ratios for leukemia among non-movers living <50 meters (m) from a 200+ kilovolt line (OR: 1.62; 95% CI: 0.72-3.65) and for calculated fields ≥ 0.4 microTesla (OR: 1.71; 95% CI: 0.65-4.52) were slightly higher than previously reported overall results. Adjustments for propensity scores based on all variables predictive of mobility, including dwelling type, increased odds ratios for leukemia to 2.61 (95% CI: 1.76-3.86) for living < 50 m from a 200 + kilovolt line and to 1.98 (1.11-3.52) for calculated fields. Individual or propensity-score adjustments for all variables, except dwelling type, did not materially change the estimates of power line exposures on childhood leukemia. CONCLUSION The residential mobility of childhood leukemia cases varied by several sociodemographic characteristics, but not by the distance to the nearest power line or calculated magnetic fields. Mobility appears to be an unlikely explanation for the associations observed between power lines exposure and childhood leukemia.
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Affiliation(s)
- A T Amoon
- Department of Epidemiology, University of California Los Angeles Fielding School of Public Health, 650 Charles E. Young Drive South, Los Angeles, CA 90095-1772, USA.
| | - S Oksuzyan
- Division of HIV and STD Programs, Los Angeles County Department of Public Health, 600 S Commonwealth Ave, Los Angeles, CA 90005, USA
| | - C M Crespi
- Department of Biostatistics, University of California Los Angeles Fielding School of Public Health, 650 Charles E. Young Drive South, Los Angeles, CA 90095-1772, USA
| | - O A Arah
- Department of Epidemiology, University of California Los Angeles Fielding School of Public Health, 650 Charles E. Young Drive South, Los Angeles, CA 90095-1772, USA
| | - M Cockburn
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA, 90089, USA
| | - X Vergara
- Department of Epidemiology, University of California Los Angeles Fielding School of Public Health, 650 Charles E. Young Drive South, Los Angeles, CA 90095-1772, USA; Energy & Environment Sector, Electric Power Research Institute, 3420 Hillview Avenue, Palo Alto, CA 94304, USA
| | - L Kheifets
- Department of Epidemiology, University of California Los Angeles Fielding School of Public Health, 650 Charles E. Young Drive South, Los Angeles, CA 90095-1772, USA
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Kheifets L, Swanson J, Yuan Y, Kusters C, Vergara X. Comparative analyses of studies of childhood leukemia and magnetic fields, radon and gamma radiation. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2017; 37:459-491. [PMID: 28586320 DOI: 10.1088/1361-6498/aa5fc7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
In this paper we compare the findings of epidemiologic studies of childhood leukemia that examined at least two of ELF magnetic fields and/or distance to power lines, and exposure to radon and gamma radiation or distance to nuclear plants. Many of the methodologic aspects are common to studies of non-ionising (i.e. ELF-MF) and ionising radiation. A systematic search and review of studies with more than one exposure under study identified 33 key and 35 supplementary papers from ten countries that have been included in this review. Examining studies that have looked at several radiation exposures, and comparing similarities and differences for the different types of radiation, through the use of directed acyclic graphs, we evaluate to what extent bias, confounding and other methodological issues might be operating in these studies. We found some indication of bias, although results are not clear cut. There is little evidence that confounding has had a substantial influence on results. Influence of the residential mobility on the study conduct and interpretation is complex and can manifest as a selection bias, confounding, increased measurement error or could also be a potential risk factor. Other factors associated with distance to power lines and to nuclear power plants should be investigated. A more complete and consistent reporting of results in the future studies will allow for a more informative comparison across studies and integration of results.
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Affiliation(s)
- Leeka Kheifets
- University of California Los Angeles, United States of America
| | - John Swanson
- National Grid, 1-3 Strand, London, United Kingdom
| | - Yingzhe Yuan
- University of California Los Angeles, United States of America
| | - Cynthia Kusters
- University of California Los Angeles, United States of America
| | - Ximena Vergara
- University of California Los Angeles, United States of America
- Electric Power Research Institute, Palo Alto, CA, United States of America
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Demoury C, Marquant F, Ielsch G, Goujon S, Debayle C, Faure L, Coste A, Laurent O, Guillevic J, Laurier D, Hémon D, Clavel J. Residential Exposure to Natural Background Radiation and Risk of Childhood Acute Leukemia in France, 1990-2009. ENVIRONMENTAL HEALTH PERSPECTIVES 2017; 125:714-720. [PMID: 27483500 PMCID: PMC5381982 DOI: 10.1289/ehp296] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 06/20/2016] [Accepted: 07/11/2016] [Indexed: 05/22/2023]
Abstract
BACKGROUND Exposures to high-dose ionizing radiation and high-dose rate ionizing radiation are established risk factors for childhood acute leukemia (AL). The risk of AL following exposure to lower doses due to natural background radiation (NBR) has yet to be conclusively determined. METHODS AL cases diagnosed over 1990-2009 (9,056 cases) were identified and their municipality of residence at diagnosis collected by the National Registry of Childhood Cancers. The Geocap study, which included the 2,763 cases in 2002-2007 and 30,000 population controls, was used for complementary analyses. NBR exposures were modeled on a fine scale (36,326 municipalities) based on measurement campaigns and geological data. The power to detect an association between AL and dose to the red bone marrow (RBM) fitting UNSCEAR (United Nations Scientific Committee on the Effects of Atomic Radiation) predictions was 92%, 45% and 99% for exposure to natural gamma radiation, radon and total radiation, respectively. RESULTS AL risk, irrespective of subtype and age group, was not associated with the exposure of municipalities to radon or gamma radiation in terms of yearly exposure at age reached, cumulative exposure or RBM dose. There was no confounding effect of census-based socio-demographic indicators, or environmental factors (road traffic, high voltage power lines, vicinity of nuclear plants) related to AL in the Geocap study. CONCLUSIONS Our findings do not support the hypothesis that residential exposure to NBR increases the risk of AL, despite the large size of the study, fine scale exposure estimates and wide range of exposures over France. However, our results at the time of diagnosis do not rule out a slight association with gamma radiation at the time of birth, which would be more in line with the recent findings in the UK and Switzerland.
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Affiliation(s)
- Claire Demoury
- INSERM, Université Paris-Descartes, Université Sorbonne-Paris-Cité, CRESS-EPICEA Epidémiologie des cancers de l’enfant et de l’adolescent, Paris, France
| | - Fabienne Marquant
- INSERM, Université Paris-Descartes, Université Sorbonne-Paris-Cité, CRESS-EPICEA Epidémiologie des cancers de l’enfant et de l’adolescent, Paris, France
| | - Géraldine Ielsch
- Institut de Radioprotection et de Sûreté Nucléaire (IRSN), Bureau d’étude et d’expertise du radon et de la modélisation (PRP-DGE/SEDRAN/BERAM), Fontenay aux Roses, France
| | - Stéphanie Goujon
- INSERM, Université Paris-Descartes, Université Sorbonne-Paris-Cité, CRESS-EPICEA Epidémiologie des cancers de l’enfant et de l’adolescent, Paris, France
- French National Registry of Childhood Hematological Malignancies, Villejuif, France
| | - Christophe Debayle
- IRSN, Laboratoire de surveillance atmosphérique et d’alerte (PRP-ENV/SESURE/LS2A), Le Vésinet, France
| | - Laure Faure
- INSERM, Université Paris-Descartes, Université Sorbonne-Paris-Cité, CRESS-EPICEA Epidémiologie des cancers de l’enfant et de l’adolescent, Paris, France
- French National Registry of Childhood Hematological Malignancies, Villejuif, France
| | - Astrid Coste
- INSERM, Université Paris-Descartes, Université Sorbonne-Paris-Cité, CRESS-EPICEA Epidémiologie des cancers de l’enfant et de l’adolescent, Paris, France
| | - Olivier Laurent
- IRSN, Laboratoire d’épidémiologie des rayonnements ionisants (PRP-HOM/SRBE/LEPID), Fontenay aux Roses, France
| | - Jérôme Guillevic
- Institut de Radioprotection et de Sûreté Nucléaire (IRSN), Bureau d’étude et d’expertise du radon et de la modélisation (PRP-DGE/SEDRAN/BERAM), Fontenay aux Roses, France
| | - Dominique Laurier
- IRSN, Laboratoire d’épidémiologie des rayonnements ionisants (PRP-HOM/SRBE/LEPID), Fontenay aux Roses, France
| | - Denis Hémon
- INSERM, Université Paris-Descartes, Université Sorbonne-Paris-Cité, CRESS-EPICEA Epidémiologie des cancers de l’enfant et de l’adolescent, Paris, France
| | - Jacqueline Clavel
- INSERM, Université Paris-Descartes, Université Sorbonne-Paris-Cité, CRESS-EPICEA Epidémiologie des cancers de l’enfant et de l’adolescent, Paris, France
- French National Registry of Childhood Hematological Malignancies, Villejuif, France
- Address correspondence to J. Clavel, CRESS–INSERM U1153, 16 Avenue Paul Vaillant-Couturier, F-94807 Villejuif Cedex, France. Telephone: 33 (01) 45 59 50 38.
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Kendall GM, Miles JCH, Rees D, Wakeford R, Bunch KJ, Vincent TJ, Little MP. Variation with socioeconomic status of indoor radon levels in Great Britain: The less affluent have less radon. JOURNAL OF ENVIRONMENTAL RADIOACTIVITY 2016; 164:84-90. [PMID: 27442258 DOI: 10.1016/j.jenvrad.2016.07.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 05/27/2016] [Accepted: 07/01/2016] [Indexed: 06/06/2023]
Abstract
We demonstrate a strong correlation between domestic radon levels and socio-economic status (SES) in Great Britain, so that radon levels in homes of people with lower SES are, on average, only about two thirds of those of the more affluent. This trend is apparent using small area measures of SES and also using individual social classes. The reasons for these differences are not known with certainty, but may be connected with greater underpressure in warmer and better-sealed dwellings. There is also a variation of indoor radon levels with the design of the house (detached, terraced, etc.). In part this is probably an effect of SES, but it appears to have other causes as well. Data from other countries are also reviewed, and broadly similar effects seen in the United States for SES, and in other European countries for detached vs other types of housing. Because of correlations with smoking, this tendency for the lower SES groups to experience lower radon levels may underlie the negative association between radon levels and lung cancer rates in a well-known ecological study based on US Counties. Those conducting epidemiological studies of radon should be alert for this effect and control adequately for SES.
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Affiliation(s)
- Gerald M Kendall
- Cancer Epidemiology Unit, University of Oxford, Richard Doll Building, Old Road Campus, Headington, Oxford, OX3 7LF, UK.
| | - Jon C H Miles
- Centre for Radiation, Chemical and Environmental Hazards, Public Health England, Chilton, Didcot, Oxon, OX11 0RQ, UK
| | - David Rees
- Centre for Radiation, Chemical and Environmental Hazards, Public Health England, Chilton, Didcot, Oxon, OX11 0RQ, UK
| | - Richard Wakeford
- Centre for Occupational and Environmental Health, Institute of Population Health, The University of Manchester, Ellen Wilkinson Building, Oxford Road, Manchester, M13 9PL, UK
| | - Kathryn J Bunch
- National Perinatal Epidemiology Unit, University of Oxford, Richard Doll Building, Old Road Campus, Headington, Oxford, OX3 7LF, UK
| | - Tim J Vincent
- Formerly Childhood Cancer Research Group, University of Oxford, New Richards Building, Old Road 12 Campus, Headington, Oxford, OX3 7LF, UK
| | - Mark P Little
- Radiation Epidemiology Branch, National Cancer Institute, DHHS, NIH, Division of Cancer Epidemiology and Genetics, Bethesda, MD, 20892-9778, USA
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