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Little MP, Wakeford R, Zablotska LB, Borrego D, Griffin KT, Allodji RS, de Vathaire F, Lee C, Brenner AV, Miller JS, Campbell D, Pearce MS, Sadetzki S, Doody MM, Holmberg E, Lundell M, French B, Adams MJ, Berrington de González A, Linet MS. Radiation exposure and leukaemia risk among cohorts of persons exposed to low and moderate doses of external ionising radiation in childhood. Br J Cancer 2023; 129:1152-1165. [PMID: 37596407 PMCID: PMC10539334 DOI: 10.1038/s41416-023-02387-8] [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: 12/21/2022] [Revised: 07/12/2023] [Accepted: 07/27/2023] [Indexed: 08/20/2023] Open
Abstract
BACKGROUND Many high-dose groups demonstrate increased leukaemia risks, with risk greatest following childhood exposure; risks at low/moderate doses are less clear. METHODS We conducted a pooled analysis of the major radiation-associated leukaemias (acute myeloid leukaemia (AML) with/without the inclusion of myelodysplastic syndrome (MDS), chronic myeloid leukaemia (CML), acute lymphoblastic leukaemia (ALL)) in ten childhood-exposed groups, including Japanese atomic bomb survivors, four therapeutically irradiated and five diagnostically exposed cohorts, a mixture of incidence and mortality data. Relative/absolute risk Poisson regression models were fitted. RESULTS Of 365 cases/deaths of leukaemias excluding chronic lymphocytic leukaemia, there were 272 AML/CML/ALL among 310,905 persons (7,641,362 person-years), with mean active bone marrow (ABM) dose of 0.11 Gy (range 0-5.95). We estimated significant (P < 0.005) linear excess relative risks/Gy (ERR/Gy) for: AML (n = 140) = 1.48 (95% CI 0.59-2.85), CML (n = 61) = 1.77 (95% CI 0.38-4.50), and ALL (n = 71) = 6.65 (95% CI 2.79-14.83). There is upward curvature in the dose response for ALL and AML over the full dose range, although at lower doses (<0.5 Gy) curvature for ALL is downwards. DISCUSSION We found increased ERR/Gy for all major types of radiation-associated leukaemia after childhood exposure to ABM doses that were predominantly (for 99%) <1 Gy, and consistent with our prior analysis focusing on <100 mGy.
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Affiliation(s)
- Mark P Little
- Radiation Epidemiology Branch, National Cancer Institute, 9609 Medical Center Drive, Bethesda, MD, 20892-9778, USA.
| | - Richard Wakeford
- Centre for Occupational and Environmental Health, Faculty of Biology, Medicine and Health, The University of Manchester, Ellen Wilkinson Building, Oxford Road, Manchester, M13 9PL, UK
| | - Lydia B Zablotska
- Department of Epidemiology & Biostatistics, School of Medicine, University of California, San Francisco, 550 16th Street, 2nd floor, San Francisco, CA, 94143, USA
| | - David Borrego
- Radiation Epidemiology Branch, National Cancer Institute, 9609 Medical Center Drive, Bethesda, MD, 20892-9778, USA
| | - Keith T Griffin
- Radiation Epidemiology Branch, National Cancer Institute, 9609 Medical Center Drive, Bethesda, MD, 20892-9778, USA
| | - Rodrigue S Allodji
- Equipe d'Epidémiologie des radiations, Unité 1018 INSERM, Bâtiment B2M, Institut Gustave Roussy, Villejuif, Cedex, 94805, France
| | - Florent de Vathaire
- Equipe d'Epidémiologie des radiations, Unité 1018 INSERM, Bâtiment B2M, Institut Gustave Roussy, Villejuif, Cedex, 94805, France
| | - Choonsik Lee
- Radiation Epidemiology Branch, National Cancer Institute, 9609 Medical Center Drive, Bethesda, MD, 20892-9778, USA
| | - Alina V Brenner
- Radiation Epidemiology Branch, National Cancer Institute, 9609 Medical Center Drive, Bethesda, MD, 20892-9778, USA
| | - Jeremy S Miller
- Information Management Services, Silver Spring, MD, 20904, USA
| | - David Campbell
- Information Management Services, Silver Spring, MD, 20904, USA
| | - Mark S Pearce
- Institute of Health and Society, Newcastle University, Sir James Spence Institute, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne, NE1 4LP, UK
- NIHR Health Protection Research Unit in chemical and radiation threats and hazards, Newcastle University, Newcastle upon Tyne, UK
| | - Siegal Sadetzki
- Israel Ministry of Health, Jerusalem, Israel
- Cancer & Radiation Epidemiology Unit, Gertner Institute for Epidemiology & Health Policy Research, Sheba Medical Center, Tel-Hashomer, Israel & Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
| | - Michele M Doody
- Radiation Epidemiology Branch, National Cancer Institute, 9609 Medical Center Drive, Bethesda, MD, 20892-9778, USA
| | - Erik Holmberg
- Department of Oncology, Sahlgrenska University Hospital, S-413-45, Göteborg, Sweden
| | - Marie Lundell
- Department of Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, S-17176, Stockholm, Sweden
| | - Benjamin French
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Michael Jacob Adams
- University of Rochester School of Medicine and Dentistry, 265 Crittenden Boulevard, CU 420644, Rochester, NY, 14642-0644, USA
| | - Amy Berrington de González
- Radiation Epidemiology Branch, National Cancer Institute, 9609 Medical Center Drive, Bethesda, MD, 20892-9778, USA
- Division of Genetics and Epidemiology, Institute of Cancer Research, London, UK
| | - Martha S Linet
- Radiation Epidemiology Branch, National Cancer Institute, 9609 Medical Center Drive, Bethesda, MD, 20892-9778, USA
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2
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Radiation and leukaemia: Which leukaemias and what doses? Blood Rev 2023; 58:101017. [PMID: 36220737 DOI: 10.1016/j.blre.2022.101017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 09/21/2022] [Accepted: 09/22/2022] [Indexed: 11/23/2022]
Abstract
The cause(s) of most cases of leukaemia is unknown. Save for several rare inherited disorders the most convincingly-identified causes of leukaemia are exposures to ionizing radiations, to some chemicals and to some anti-cancer drugs. Data implicating ionizing radiations as a cause of leukaemias come from several sources including persons exposed to the atomic bomb explosions in Japan, persons receiving radiation therapy for cancer and other disorders, persons occupationally exposed to radiation such as radiologists and nuclear facility workers, cigarette smokers, and others. Although ionizing radiations can be a cause of almost all types of leukaemias, some are especially sensitive to induction such as acute and chronic myeloid leukaemias (AML and CML) and acute lymphoblastic leukaemia (ALL). Whether chronic lymphocytic leukaemia can be caused by radiation exposure is controversial. The mechanism(s) by which ionizing radiations cause leukaemia differs for different leukaemia types. I discuss these issues and close with a hypothesis which might explain why haematopoietic stem cells are localized to the bone marrow.
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Drozdovitch V, Chizhov K, Chumak V, Bakhanova E, Trotsyuk N, Bondarenko P, Golovanov I, Kryuchkov V. Reliability of Questionnaire-Based Dose Reconstruction: Human Factor Uncertainties in the Radiation Dosimetry of Chernobyl Cleanup Workers. Radiat Res 2022; 198:172-180. [PMID: 35604875 PMCID: PMC9384793 DOI: 10.1667/rade-21-00207.1] [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: 10/22/2021] [Accepted: 05/10/2022] [Indexed: 11/03/2022]
Abstract
This original study aims to quantify the human factor uncertainties in radiation doses for Chernobyl cleanup workers that are associated with errors in direct or proxy personal interviews due to poor memory recall a long time after exposure. Two types of doses due to external irradiation during cleanup mission were calculated independently. First, a "reference" dose, that was calculated using the historical description of cleanup activities reported by 47 cleanup workers shortly after the completion of the cleanup mission. Second, a "current" dose that was calculated using information reported by 47 cleanup workers and respective 24 proxies (colleagues) nominated by cleanup workers during a personal interview conducted more recently, as part of this study, i.e., 25-30 years after their cleanup missions. The Jaccard similarity coefficient for reference and current doses was moderate: the arithmetic mean ± standard deviation was 0.29 ± 0.18 (median = 0.31) and 0.23 ± 0.18 (median = 0.22) for the cleanup worker's and proxy's interviews, respectively. The agreement between two doses was better if the cleanup worker was interviewed rather than his proxy: the median ratio of current to reference dose was 1.0 and 0.56 for cleanup workers and proxies, respectively. The present study has shown that human factor uncertainties lead to underestimation or overestimation of the "true" reference dose for most cleanup workers up to 3 times. In turn, the potential impact of these errors on radiation-related risk estimates should be assessed.
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Affiliation(s)
- Vladimir Drozdovitch
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, Maryland
| | - Konstantin Chizhov
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, Maryland
| | - Vadim Chumak
- National Research Centre for Radiation Medicine, Kyiv, Ukraine
| | - Elena Bakhanova
- National Research Centre for Radiation Medicine, Kyiv, Ukraine
| | | | | | - Ivan Golovanov
- State Research Center – Burnasyan Federal Medical Biophysical Center of Federal Medical Biological Agency, Moscow, Russia
| | - Victor Kryuchkov
- State Research Center – Burnasyan Federal Medical Biophysical Center of Federal Medical Biological Agency, Moscow, Russia
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Rühm W, Laurier D, Wakeford R. Cancer risk following low doses of ionising radiation - Current epidemiological evidence and implications for radiological protection. MUTATION RESEARCH. GENETIC TOXICOLOGY AND ENVIRONMENTAL MUTAGENESIS 2022; 873:503436. [PMID: 35094811 DOI: 10.1016/j.mrgentox.2021.503436] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 12/09/2021] [Accepted: 12/11/2021] [Indexed: 01/05/2023]
Abstract
Recent studies suggest that every year worldwide about a million patients might be exposed to doses of the order of 100 mGy of low-LET radiation, due to recurrent application of radioimaging procedures. This paper presents a synthesis of recent epidemiological evidence on radiation-related cancer risks from low-LET radiation doses of this magnitude. Evidence from pooled analyses and meta-analyses also involving epidemiological studies that, individually, do not find statistically significant radiation-related cancer risks is reviewed, and evidence from additional and more recent epidemiological studies of radiation exposures indicating excess cancer risks is also summarized. Cohorts discussed in the present paper include Japanese atomic bomb survivors, nuclear workers, patients exposed for medical purposes, and populations exposed environmentally to natural background radiation or radioactive contamination. Taken together, the overall evidence summarized here is based on studies including several million individuals, many of them followed-up for more than half a century. In summary, substantial evidence was found from epidemiological studies of exposed groups of humans that ionizing radiation causes cancer at acute and protracted doses above 100 mGy, and growing evidence for doses below 100 mGy. The significant radiation-related solid cancer risks observed at doses of several 100 mGy of protracted exposures (observed, for example, among nuclear workers) demonstrate that doses accumulated over many years at low dose rates do cause stochastic health effects. On this basis, it can be concluded that doses of the order of 100 mGy from recurrent application of medical imaging procedures involving ionizing radiation are of concern, from the viewpoint of radiological protection.
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Affiliation(s)
- W Rühm
- Helmholtz Center Munich German Research Center for Environmental Health, Neuherberg, Germany.
| | - D Laurier
- Institut de Radioprotection et de Sûreté Nucléaire (IRSN), Fontenay-aux-Roses, France
| | - R Wakeford
- Centre for Occupational and Environmental Health, The University of Manchester, Manchester, M13 9PL, UK
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Gu Y, Wang J, Wang Y, Xu C, Liu Y, Du L, Wang Q, Ji K, He N, Zhang M, Song H, Sun X, Wang J, Kitahara CM, de Gonzalez AB, Niu K, Liu Q. Low-dose ionizing radiation exposure and risk of leukemia: results from 1950-1995 Chinese medical X-ray workers cohort study and meta-analysis. JOURNAL OF THE NATIONAL CANCER CENTER 2022. [DOI: 10.1016/j.jncc.2022.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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6
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Non-Hodgkin lymphomas and ionizing radiation: case report and review of the literature. Ann Hematol 2021; 101:243-250. [PMID: 34881390 PMCID: PMC8742808 DOI: 10.1007/s00277-021-04729-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Accepted: 11/22/2021] [Indexed: 11/18/2022]
Abstract
Non-Hodgkin lymphoma (NHL) increased continuously since the last century in developed countries. While they are considered as disease in elder ages, a remarkable increasing incidence is also observed in German children and juveniles. The higher rates are interpreted by the changes in classification because diseases such as chronic lymphocytic leukaemia were also identified as NHL. Considerable rates of NHL were found in nuclear workers and liquidators of Chernobyl, i.e. in cases of low-dose chronical exposures. In Germany, we noticed three workers who developed NHL after decontamination of nuclear facilities. The bone marrow is generally considered as target organ for ionizing radiation, but NHL is obviously induced in the whole pool of lymphocytes. Therefore, the dosimetry in cases of typical occupational external and internal exposure must be revised. A high radiation sensitivity for NHL is a possible suspect and likely reason which may partly explain the continuous rise of the diseases in populations underlying the current increases of medical diagnostic exposure. NHL is also induced in children and juveniles with a history of diagnostic X-rays.
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Chizhov K, Drozdovitch V, Bragin Y, Mark NK, Szőke I, Golovanov I, Chumak V, Kryuchkov V. 3D simulations for evaluation of location factors in an urban environment: application of a novel methodology to calculate external exposure doses for evacuees from Pripyat. RADIATION AND ENVIRONMENTAL BIOPHYSICS 2021; 60:611-629. [PMID: 34537881 PMCID: PMC8637943 DOI: 10.1007/s00411-021-00940-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 08/21/2021] [Indexed: 06/13/2023]
Abstract
This article presents a methodology for assessing the radiation doses in an urban environment due to external irradiation from radionuclides deposited on the ground and other surfaces as well as from a passing radioactive cloud. The approach was developed and applied to assess individual doses of residents of the town of Pripyat who were evacuated shortly after the Chernobyl accident. Typically, the so-called location factor is defined as the ratio of the dose rate at a point of exposure and the dose rate at an undisturbed lawn far from any buildings. The present study used a new definition of the location factor as a regular four-dimensional grid of ratios of air kerma rates indoors and outdoors distributed in space and time. The location factors were calculated for two scenarios: outdoor and indoor values for typical apartments and buildings in Pripyat. Indoor location factors varied within two orders of magnitude depending on the floor of residence and place of staying inside the apartment. Values of the indoor location factor differed during the daytime and night by a factor of 30-40 depending on the behaviour of an individual within the apartment. Both, outdoor and indoor location factors decreased with decreasing distances between buildings. It was shown that during the first 4 days after the accident, air kerma rates in Pripyat were governed by the radionuclides deposited on the ground surface, and not by radionuclides in the cloud. Specifically, the contribution of the radioactive cloud to air kerma rate was maximal (i.e., 2.3%) on the morning of 28 April 1986. The methodology and results of this study are currently being used to reconstruct the radiation gonadal dose for the subjects of the American-Ukrainian study of parental irradiation in Chernobyl cleanup workers and evacuees for investigating germline mutations in their offspring.
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Affiliation(s)
- Konstantin Chizhov
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS 9609 Medical Center Drive, Room 7E548 MSC 9778, Bethesda, MD, 20892-9778, USA
| | - Vladimir Drozdovitch
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS 9609 Medical Center Drive, Room 7E548 MSC 9778, Bethesda, MD, 20892-9778, USA.
| | - Yuri Bragin
- State Research Center, Burnasyan Federal Medical Biophysical Center of Federal Medical Biological Agency, Moscow, Russia
| | | | | | - Ivan Golovanov
- State Research Center, Burnasyan Federal Medical Biophysical Center of Federal Medical Biological Agency, Moscow, Russia
| | - Vadim Chumak
- National Research Centre for Radiation Medicine, Kyiv, Ukraine
| | - Victor Kryuchkov
- State Research Center, Burnasyan Federal Medical Biophysical Center of Federal Medical Biological Agency, Moscow, Russia
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8
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Chumak V, Bakhanova E, Kryuchkov V, Golovanov I, Chizhov K, Bazyka D, Gudzenko N, Trotsuk N, Mabuchi K, Hatch M, Cahoon EK, Little MP, Kukhta T, de Gonzalez AB, Chanock SJ, Drozdovitch V. Estimation of radiation gonadal doses for the American-Ukrainian trio study of parental irradiation in Chornobyl cleanup workers and evacuees and germline mutations in their offspring. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2021; 41:10.1088/1361-6498/abf0f4. [PMID: 33752181 PMCID: PMC9426296 DOI: 10.1088/1361-6498/abf0f4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 03/22/2021] [Indexed: 06/12/2023]
Abstract
Radiation doses of parents exposed from the Chornobyl accident as cleanup workers or evacuees were estimated in the National Cancer Institute-National Research Center for Radiation Medicine trio (i.e. father, mother, offspring) study aimed at investigating the radiation effects on germlinede novomutations in children as well as other outcomes. Paternal (testes) and maternal (ovaries) gonadal doses were calculated along with associated uncertainty distributions for the following exposure pathways: (a) external irradiation during the cleanup mission, (b) external irradiation during residence in Pripyat, and (c) external irradiation and (d) ingestion of radiocesium isotopes, such as134Cs and137Cs, during residence in settlements other than Pripyat. Gonadal doses were reconstructed for 298 trios for the periods from the time of the accident on 26 April 1986 to two time points before the child's date of birth (DOB): 51 (DOB-51) and 38 (DOB-38) weeks. The two doses, DOB-51 and DOB-38 were equal (within 1 mGy) in most instances, except for 35 fathers where the conception of the child occurred within 3 months of exposure or during exposure. The arithmetic mean of gonadal DOB-38 doses was 227 mGy (median: 11 mGy, range 0-4080 mGy) and 8.5 mGy (median: 1.0 mGy, range 0-550 mGy) for fathers and mothers, respectively. Gonadal doses varied considerably depending on the exposure pathway, the highest gonadal DOB-38 doses being received during the cleanup mission (mean doses of 376 and 34 mGy, median of 144 and 7.4 mGy for fathers and mothers, respectively), followed by exposure during residence in Pripyat (7.7 and 13 mGy for mean, 7.2 and 6.2 mGy for median doses) and during residence in other settlements (2.0 and 2.1 mGy for mean, 0.91 and 0.81 mGy for median doses). Monte Carlo simulations were used to estimate the parental gonadal doses and associated uncertainties. The geometric standard deviations (GSDs) in the individual parental stochastic doses due to external irradiation during the cleanup mission varied from 1.2 to 4.7 (mean of 1.8), while during residence in Pripyat they varied from 1.4 to 2.8 (mean of 1.8), while the mean GSD in doses received during residence in settlements other than Pripyat was 1.3 and 1.4 for external irradiation and ingestion of radiocesium isotopes, respectively.
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Affiliation(s)
- Vadim Chumak
- National Research Centre for Radiation Medicine, Kyiv, Ukraine
| | - Elena Bakhanova
- National Research Centre for Radiation Medicine, Kyiv, Ukraine
| | - Victor Kryuchkov
- Burnasyan Federal Medical and Biophysical Centre, Moscow, Russia
| | - Ivan Golovanov
- Burnasyan Federal Medical and Biophysical Centre, Moscow, Russia
| | - Konstantin Chizhov
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, 9609 Medical Center Drive, Room 7E548 MSC 9778, Bethesda, MD 20892-9778, United States of America
| | - Dimitry Bazyka
- National Research Centre for Radiation Medicine, Kyiv, Ukraine
| | | | - Natalia Trotsuk
- National Research Centre for Radiation Medicine, Kyiv, Ukraine
| | - Kiyohiko Mabuchi
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, 9609 Medical Center Drive, Room 7E548 MSC 9778, Bethesda, MD 20892-9778, United States of America
| | - Maureen Hatch
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, 9609 Medical Center Drive, Room 7E548 MSC 9778, Bethesda, MD 20892-9778, United States of America
| | - Elizabeth K Cahoon
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, 9609 Medical Center Drive, Room 7E548 MSC 9778, Bethesda, MD 20892-9778, United States of America
| | - Mark P Little
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, 9609 Medical Center Drive, Room 7E548 MSC 9778, Bethesda, MD 20892-9778, United States of America
| | - Tatiana Kukhta
- United Institute of Informatics Problems, Minsk, Belarus
| | - Amy Berrington de Gonzalez
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, 9609 Medical Center Drive, Room 7E548 MSC 9778, Bethesda, MD 20892-9778, United States of America
| | - Stephen J Chanock
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, 9609 Medical Center Drive, Room 7E548 MSC 9778, Bethesda, MD 20892-9778, United States of America
| | - Vladimir Drozdovitch
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, 9609 Medical Center Drive, Room 7E548 MSC 9778, Bethesda, MD 20892-9778, United States of America
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9
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Little MP, Wakeford R, Zablotska LB, Borrego D, Griffin KT, Allodji RS, de Vathaire F, Lee C, Brenner AV, Miller JS, Campbell D, Sadetzki S, Doody MM, Holmberg E, Lundell M, Adams MJ, French B, Linet MS, Berrington de Gonzalez A. Lymphoma and multiple myeloma in cohorts of persons exposed to ionising radiation at a young age. Leukemia 2021; 35:2906-2916. [PMID: 34050261 PMCID: PMC8484030 DOI: 10.1038/s41375-021-01284-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 04/19/2021] [Accepted: 05/04/2021] [Indexed: 02/06/2023]
Abstract
There is limited evidence that non-leukaemic lymphoid malignancies are radiogenic. As radiation-related cancer risks are generally higher after childhood exposure, we analysed pooled lymphoid neoplasm data in nine cohorts first exposed to external radiation aged <21 years using active bone marrow (ABM) and, where available, lymphoid system doses, and harmonised outcome classification. Relative and absolute risk models were fitted. Years of entry spanned 1916-1981. At the end of follow-up (mean 42.1 years) there were 593 lymphoma (422 non-Hodgkin (NHL), 107 Hodgkin (HL), 64 uncertain subtype), 66 chronic lymphocytic leukaemia (CLL) and 122 multiple myeloma (MM) deaths and incident cases among 143,136 persons, with mean ABM dose 0.14 Gy (range 0-5.95 Gy) and mean age at first exposure 6.93 years. Excess relative risk (ERR) was not significantly increased for lymphoma (ERR/Gy = -0.001; 95% CI: -0.255, 0.279), HL (ERR/Gy = -0.113; 95% CI: -0.669, 0.709), NHL + CLL (ERR/Gy = 0.099; 95% CI: -0.149, 0.433), NHL (ERR/Gy = 0.068; 95% CI: -0.253, 0.421), CLL (ERR/Gy = 0.320; 95% CI: -0.678, 1.712), or MM (ERR/Gy = 0.149; 95% CI: -0.513, 1.063) (all p-trend > 0.4). In six cohorts with estimates of lymphatic tissue dose, borderline significant increased risks (p-trend = 0.02-0.07) were observed for NHL + CLL, NHL, and CLL. Further pooled epidemiological studies are needed with longer follow-up, central outcome review by expert hematopathologists, and assessment of radiation doses to lymphoid tissues.
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Affiliation(s)
- Mark P Little
- Radiation Epidemiology Branch, National Cancer Institute, Bethesda, MD, USA.
| | - Richard Wakeford
- Centre for Occupational and Environmental Health, Institute of Population Health, The University of Manchester, Manchester, UK
| | - Lydia B Zablotska
- Department of Epidemiology & Biostatistics, School of Medicine, University of California, San Francisco, CA, USA
| | - David Borrego
- Radiation Epidemiology Branch, National Cancer Institute, Bethesda, MD, USA
| | - Keith T Griffin
- Radiation Epidemiology Branch, National Cancer Institute, Bethesda, MD, USA
| | - Rodrigue S Allodji
- Equipe d'Epidémiologie des radiations, Unité 1018 INSERM, Bâtiment B2M, Institut Gustave Roussy, Villejuif Cedex, France
| | - Florent de Vathaire
- Equipe d'Epidémiologie des radiations, Unité 1018 INSERM, Bâtiment B2M, Institut Gustave Roussy, Villejuif Cedex, France
| | - Choonsik Lee
- Radiation Epidemiology Branch, National Cancer Institute, Bethesda, MD, USA
| | - Alina V Brenner
- Radiation Effects Research Foundation, Hiroshima City, Japan
| | | | | | - Siegal Sadetzki
- Israel Ministry of Health, Jerusalem, Israel
- Cancer & Radiation Epidemiology Unit, Gertner Institute for Epidemiology & Health Policy Research, Sheba Medical Center, Tel-Hashomer, Israel & Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
| | - Michele M Doody
- Radiation Epidemiology Branch, National Cancer Institute, Bethesda, MD, USA
| | - Erik Holmberg
- Department of Oncology, Sahlgrenska University Hospital, Göteborg, Sweden
| | - Marie Lundell
- Department of Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Michael Jacob Adams
- University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Benjamin French
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Martha S Linet
- Radiation Epidemiology Branch, National Cancer Institute, Bethesda, MD, USA
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10
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Smailyte G, Kaceniene A, Steponaviciene R, Kesminiene A. Lithuanian cohort of Chernobyl cleanup workers: Cancer incidence follow-up 1986-2012. Cancer Epidemiol 2021; 74:102015. [PMID: 34455236 DOI: 10.1016/j.canep.2021.102015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 07/24/2021] [Accepted: 08/17/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Cancer risks following radiation exposure in adulthood after Chernobyl are less studied compared to those after exposure in childhood. We aimed to evaluate cancer risk in the Lithuanian cohort of Chernobyl cleanup workers 26 years after their exposure in Chernobyl. METHODS Study population (6707 men) was followed for cancer incidence upon return from Chernobyl till the end of 2012 by linkage procedure with the Lithuanian Cancer Registry and for migration and death - with Central Population Registry. The site-specific cancer risk in the cohort was estimated by calculating the standardised incidence ratio (SIR) with 95 % confidence interval (CI). RESULTS A total of 596 cancer cases was observed in the cohort, against 584 expected (SIR 1.02; 95 % CI 0.94, 1.11). Only incidence of mouth and pharynx cancers was increased compared to the expected (SIR 1.41; 95 % CI 1.07, 1.86). Nevertheless, an increased risk of thyroid cancer was observed among cleanup workers who were younger than 30 years when entering the Chernobyl zone (SIR 2.90; 95 % CI 1.09, 7.72), whose radiation dose was above 100 milisievert (mSv) (SIR 3.13; 95 % CI 1.30, 7.52) and who had shorter duration of stay (SIR 2.30; 95 % CI 1.03, 5.13). CONCLUSIONS Our findings are consistent with those observed in other cohorts of workers, namely, the increased risk of cancer sites related to behavioural factors. The increased risk of thyroid cancer among cleanup workers who were younger than 30 years when entering Chernobyl and whose radiation dose was above 100 mSv cannot exclude the association with the radiation exposure in Chernobyl.
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Affiliation(s)
- Giedre Smailyte
- Laboratory of Cancer Epidemiology, National Cancer Institute, P. Baublio 3B, LT-08406, Vilnius, Lithuania; Institute of Health Sciences, Faculty of Medicine, Vilnius University, M.K. Ciurlionio. 21, LT-03101, Vilnius, Lithuania
| | - Auguste Kaceniene
- Laboratory of Cancer Epidemiology, National Cancer Institute, P. Baublio 3B, LT-08406, Vilnius, Lithuania
| | - Rita Steponaviciene
- External Beam Radiotherapy Department, National Cancer Institute, Santariskių 1, LT-08660, Vilnius, Lithuania
| | - Ausrele Kesminiene
- Environmental and Lifestyle Epidemiology Branch, International Agency for Research on Cancer, 150 Cours Albert Thomas, 69372, Lyon Cedex 08, France.
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11
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Spatola GJ, Ostrander EA, Mousseau TA. The effects of ionizing radiation on domestic dogs: a review of the atomic bomb testing era. Biol Rev Camb Philos Soc 2021; 96:1799-1815. [PMID: 33987930 PMCID: PMC8429057 DOI: 10.1111/brv.12723] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 04/11/2021] [Accepted: 04/13/2021] [Indexed: 12/25/2022]
Abstract
Dogs were frequently employed as laboratory subjects during the era of atomic bomb testing (1950–1980), particularly in studies used to generate predictive data regarding the expected effects of accidental human occupational exposure to radiation. The bulk of these studies were only partly reported in the primary literature, despite providing vital information regarding the effects of radiation exposure on a model mammalian species. Herein we review this literature and summarize the biological effects in relation to the isotopes used and the method of radionuclide exposure. Overall, these studies demonstrate the wide range of developmental and physiological effects of exposure to radiation and radionuclides in a mid‐sized mammal.
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Affiliation(s)
- Gabriella J Spatola
- Department of Biological Sciences, University of South Carolina, Columbia, SC, 29208, U.S.A.,Graduate Partnerships Program, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, 20892, U.S.A
| | - Elaine A Ostrander
- Cancer Genetics and Comparative Genomics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, 20892, U.S.A
| | - Timothy A Mousseau
- Department of Biological Sciences, University of South Carolina, Columbia, SC, 29208, U.S.A.,SURA/LASSO/NASA, ISS Utilization and Life Sciences Division, Kennedy Space Center, Cape Canaveral, FL, 32899, U.S.A
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12
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Cwikel J, Sheiner E, Sergienko R, Slusky D, Quastel M. Hospitalizations Among Chernobyl-Exposed Immigrants to the Negev of Israel, 1992-2017: A Historical Follow-Up Study. J Immigr Minor Health 2021; 24:469-480. [PMID: 33974176 DOI: 10.1007/s10903-021-01202-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2021] [Indexed: 11/26/2022]
Abstract
On April 26th, 1986 the nuclear reactor at Chernobyl, Ukraine exploded, causing the worst radiation disaster in history. The aim was to estimate hospitalization rates among exposed civilians who later immigrated to Israel. We conducted a historical follow-up study, among persons exposed to Chernobyl (n = 1128) using linked hospitalization records from Soroka University Medical Center (SUMC), compared with immigrants from other areas of the Former Soviet Union (FSU) (n = 11,574), immigrants not from FSU (n = 11,742) and native-born Israelis (n = 8351), matched on age and gender (N = 32,795). Hospitalizations for specific ICD-10 coded diagnostic groups were analyzed by exposure and comparison groups by gender and age at accident. In addition, the rate of hospitalization, and the duration of hospital days and the number of hospitalizations for these selected diagnostic groups was also calculated. Hospitalizations for specific ICD-10 coded diagnostic groups and for any hospitalization in these diagnostic groups in general were analyzed by exposure and comparison groups and by covariates (gender and age at accident). The rate of any hospitalization for the selected diagnostic groups was elevated in the low exposure Chernobyl group (51.1%), which was significantly higher than the immigrant (41.6%) and the Israel-born comparison group (35.1%) (p < .01) but did not differ from either the high exposure group (46.9%) or the FSU comparison group (46.4%), according to the post-hoc tests. The total number of hospitalizations in the low exposure Chernobyl group (2.35) differed from the immigrant (1.73) and Israel comparison group (1.26) (p < .01) but did not differ from the FSU comparison group (1.73) or the high exposure group (2.10). Low exposure women showed higher rates of circulatory hospitalizations (33.8%) compared to immigrants (22.8%) and Israeli born (16.5%), while high exposure women (27.5%) only differed from Israelis (p < .01). Neither exposure group differed from FSU immigrant women on the rate of circulatory hospitalizations. Post-hoc tests showed that among women in the low exposure group, there was a significant difference in rate of hospitalizations for neoplasms (28.6%) compared to the three comparison groups; FSU (18.6%), immigrants (15.7%) and Israel (13.1) (p < .01). Those among the low exposure group who were over the age of 20 at the time of the accident showed the higher rates of circulatory (51.2%) and neoplasm hospitalizations (33.3%), compared to the other immigrant groups (p < .01). When controlling for both age at accident and gender, hospitalizations for neoplasms were higher among Chernobyl-exposed populations (RR = 1.65, RR = 1.77 for high and low-exposure groups, respectively) compared to other FSU immigrants (RR = 1.31) other immigrants (RR = 1.11) and Israeli born (RR = 1.0) after controlling for gender and age at accident. High RRs attributable to Chernobyl exposure were also found for circulatory diseases compared to other immigrants and Israeli born (RRs = 1.50, 1.47 for high and low exposure compared to 1.11. and 1.0, other immigrants and Israeli born, respectively). Endocrine problems and disorders of the eye also showed elevated RR compared to the immigrant comparison groups. Respiratory and mental disorders did not show any consistent association with Chernobyl exposure. The findings support unique Chernobyl morbidity associations only in some diagnostic groups, particularly for low exposure women. General immigration effects on hospitalizations compared to the Israeli born population were found on all diagnostic groups. There is a need to improve the services and medical follow-up for these Chernobyl exposed groups in specific diagnostic groups.
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Affiliation(s)
- Julie Cwikel
- Chilewich Family Chair in Studies in Social Integration, Spitzer Department of Social Work, & BGU Center for Women's Health Studies and Promotion, POB 653, 84105, Beer Sheva, Israel.
| | - Eyal Sheiner
- OB-GYN (Women's B Ward), Soroka University Medical Center, Beer Sheva, Israel
| | - Ruslan Sergienko
- Department of Epidemiology, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | | | - Michael Quastel
- Nuclear Medicine, Soroka University Medical Center (retired), Beer Sheva, Israel
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13
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Abstract
Patients with chronic lymphocytic leukemia can be divided into three categories: those who are minimally affected by the problem, often never requiring therapy; those that initially follow an indolent course but subsequently progress and require therapy; and those that from the point of diagnosis exhibit an aggressive disease necessitating treatment. Likewise, such patients pass through three phases: development of the disease, diagnosis, and need for therapy. Finally, the leukemic clones of all patients appear to require continuous input from the exterior, most often through membrane receptors, to allow them to survive and grow. This review is presented according to the temporal course that the disease follows, focusing on those external influences from the tissue microenvironment (TME) that support the time lines as well as those internal influences that are inherited or develop as genetic and epigenetic changes occurring over the time line. Regarding the former, special emphasis is placed on the input provided via the B-cell receptor for antigen and the C-X-C-motif chemokine receptor-4 and the therapeutic agents that block these inputs. Regarding the latter, prominence is laid upon inherited susceptibility genes and the genetic and epigenetic abnormalities that lead to the developmental and progression of the disease.
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Affiliation(s)
- Nicholas Chiorazzi
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York 11030, USA
| | - Shih-Shih Chen
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York 11030, USA
| | - Kanti R. Rai
- The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York 11549, USA
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14
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Harbron RW, Pasqual E. Ionising radiation as a risk factor for lymphoma: a review. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2020; 40:R151-R185. [PMID: 33017815 DOI: 10.1088/1361-6498/abbe37] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 10/05/2020] [Indexed: 06/11/2023]
Abstract
The ability of ionising radiation to induce lymphoma is unclear. Here, we present a narrative review of epidemiological evidence of the risk of lymphoma, including chronic lymphocytic leukaemia (CLL) and multiple myeloma (MM), among various exposed populations including atomic bombing survivors, industrial and medical radiation workers, and individuals exposed for medical purposes. Overall, there is a suggestion of a positive dose-dependent association between radiation exposure and lymphoma. The magnitude of this association is highly imprecise, however, with wide confidence intervals frequently including zero risk. External comparisons tend to show similar incidence and mortality rates to the general population. Currently, there is insufficient information on the impact of age at exposure, high versus low linear energy transfer radiation, external versus internal or acute versus chronic exposures. Associations are stronger for males than females, and stronger for non-Hodgkin lymphoma and MM than for Hodgkin lymphoma, while the risk of radiation-induced CLL may be non-existent. This broad grouping of diverse diseases could potentially obscure stronger associations for certain subtypes, each with a different cell of origin. Additionally, the classification of malignancies as leukaemia or lymphoma may result in similar diseases being analysed separately, while distinct diseases are analysed in the same category. Uncertainty in cell of origin means the appropriate organ for dose response analysis is unclear. Further uncertainties arise from potential confounding or bias due to infectious causes and immunosuppression. The potential interaction between radiation and other risk factors is unknown. Combined, these uncertainties make lymphoma perhaps the most challenging malignancy to study in radiation epidemiology.
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Affiliation(s)
- Richard W Harbron
- Population Health Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
- NIHR Health Protection Research Unit in Chemical and Radiation Threats and Hazards, Newcastle University, United Kingdom
- Barcelona Institute for Global Health, (ISGlobal), Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Elisa Pasqual
- Barcelona Institute for Global Health, (ISGlobal), Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
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15
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Linet MS, Little MP, Kitahara CM, Cahoon EK, Doody MM, Simon SL, Alexander BH, Preston DL. Occupational radiation and haematopoietic malignancy mortality in the retrospective cohort study of US radiologic technologists, 1983-2012. Occup Environ Med 2020; 77:822-831. [PMID: 32967989 DOI: 10.1136/oemed-2019-106346] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 04/27/2020] [Accepted: 06/07/2020] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To evaluate cumulative occupational radiation dose response and haematopoietic malignancy mortality risks in the US radiologic technologist cohort. METHODS Among 110 297 radiologic technologists (83 655 women, 26 642 men) who completed a baseline questionnaire sometime during 1983-1998, a retrospective cohort study was undertaken to assess cumulative, low-to-moderate occupational radiation dose and haematopoietic malignancy mortality risks during 1983-2012. Cumulative bone marrow dose (mean 8.5 mGy, range 0-430 mGy) was estimated based on 921 134 badge monitoring measurements during 1960-1997, work histories and historical data; 35.4% of estimated doses were based on badge measurements. Poisson regression was used to estimate excess relative risk of haematopoietic cancers per 100 milligray (ERR/100 mGy) bone-marrow absorbed dose, adjusting for attained age, sex and birth year. RESULTS Deaths from baseline questionnaire completion through 2012 included 133 myeloid neoplasms, 381 lymphoid neoplasms and 155 leukaemias excluding chronic lymphocytic leukaemia (CLL). Based on a linear dose-response, no significant ERR/100 mGy occurred for acute myeloid leukaemia (ERR=0.0002, 95% CI <-0.02 to 0.24, p-trend>0.5, 85 cases) or leukaemia excluding CLL (ERR=0.05, 95% CI <-0.09 to 0.24, p-trend=0.21, 155 cases). No significant dose-response trends were observed overall for CLL (ERR<-0.023, 95% CI <-0.025 to 0.18, p-trend=0.45, 32 cases), non-Hodgkin lymphoma (ERR=0.03, 95% CI <-0.2 to 0.18, p-trend=0.4, 201 cases) or multiple myeloma (ERR=0.003, 95% CI -0.02 to 0.16, p-trend>0.5, 112 cases). Findings did not differ significantly by demographic factors, smoking or specific radiological procedures performed. CONCLUSION After follow-up averaging 22 years, there was little evidence of a relationship between occupational radiation exposure and myeloid or lymphoid haematopoietic neoplasms.
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Affiliation(s)
- Martha S Linet
- National Cancer Institute Division of Cancer Epidemiology and Genetics, Bethesda, Maryland, USA
| | - Mark P Little
- National Cancer Institute Division of Cancer Epidemiology and Genetics, Bethesda, Maryland, USA
| | - Cari M Kitahara
- National Cancer Institute Division of Cancer Epidemiology and Genetics, Bethesda, Maryland, USA
| | - Elizabeth K Cahoon
- National Cancer Institute Division of Cancer Epidemiology and Genetics, Bethesda, Maryland, USA
| | - Michele M Doody
- National Cancer Institute Division of Cancer Epidemiology and Genetics, Bethesda, Maryland, USA
| | - Steven L Simon
- National Cancer Institute Division of Cancer Epidemiology and Genetics, Bethesda, Maryland, USA
| | - Bruce H Alexander
- Division of Environmental Health Sciences, University of Minnesota, Minneapolis, Minnesota, USA
| | - Dale L Preston
- self-employed at Hirosoft International, Eureka, California, USA
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16
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Pasqual E, Turner MC, Gracia-Lavedan E, Casabonne D, Benavente Y, Chef IT, Maynadié M, Cocco P, Staines A, Foretova L, Nieters A, Boffetta P, Brennan P, Cardis E, de Sanjose S. Association of ionizing radiation dose from common medical diagnostic procedures and lymphoma risk in the Epilymph case-control study. PLoS One 2020; 15:e0235658. [PMID: 32649712 PMCID: PMC7351167 DOI: 10.1371/journal.pone.0235658] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 06/21/2020] [Indexed: 11/19/2022] Open
Abstract
Medical diagnostic X-rays are an important source of ionizing radiation (IR) exposure in the general population; however, it is unclear if the resulting low patient doses increase lymphoma risk. We examined the association between lifetime medical diagnostic X-ray dose and lymphoma risk, taking into account potential confounding factors, including medical history. The international Epilymph study (conducted in the Czech-Republic, France, Germany, Ireland, Italy, and Spain) collected self-reported information on common diagnostic X-ray procedures from 2,362 lymphoma cases and 2,465 frequency-matched (age, sex, country) controls. Individual lifetime cumulative bone marrow (BM) dose was estimated using time period-based dose estimates for different procedures and body parts. The association between categories of BM dose and lymphoma risk was examined using unconditional logistic regression models adjusting for matching factors, socioeconomic variables, and the presence of underlying medical conditions (atopic, autoimmune, infectious diseases, osteoarthritis, having had a sick childhood, and family history of lymphoma) as potential confounders of the association. Cumulative BM dose was low (median 2.25 mGy) and was not positively associated with lymphoma risk. Odds ratios (ORs) were consistently less than 1.0 in all dose categories compared to the reference category (less than 1 mGy). Results were similar after adjustment for potential confounding factors, when using different exposure scenarios, and in analyses by lymphoma subtype and by type of control (hospital-, population-based). Overall no increased risk of lymphoma was observed. The reduced ORs may be related to unmeasured confounding or other sources of systematic bias.We found little evidence that chronic medical conditions confound lymphoma risk and medical radiation associations.
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Affiliation(s)
- Elisa Pasqual
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Michelle C. Turner
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- McLaughlin Centre for Population Health Risk Assessment, University of Ottawa, Ottawa, Canada
| | - Esther Gracia-Lavedan
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Delphine Casabonne
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Unit of Infections and Cancer, Cancer Epidemiology Research Programme, IDIBELL, Catalan Institute of Oncology, Barcelona, Spain
| | - Yolanda Benavente
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Unit of Infections and Cancer, Cancer Epidemiology Research Programme, IDIBELL, Catalan Institute of Oncology, Barcelona, Spain
| | - Isabelle Thierry Chef
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Marc Maynadié
- Registre des Hémopathies Malignes de Côte d’Or INSERM U 1231, Université de Bourgogne Franche-Comté et CHU Dijon-Bourgogne, Dijon, France
| | - Pierluigi Cocco
- Department of Public Health, Clinical and Molecular Medicine, Occupational Health Section, University of Cagliari, Cagliari, Italy
| | - Anthony Staines
- School of Nursing and Human Science, Dublin City University, Glasnevin, Dublin, Ireland
| | - Lenka Foretova
- Cancer Epidemiology and Genetics, Masaryk Memorial Cancer Institute and MF MU, Brno, Czech Republic
| | - Alexandra Nieters
- Centre of Chronic Immunodeficiency, Molecular Epidemiology, University Medical Center Freiburg, Freiburg, Germany
| | - Paolo Boffetta
- Tisch Cancer Institute and Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Paul Brennan
- IARC, International Agency for Research on Cancer, Lyon, France
| | - Elisabeth Cardis
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Silvia de Sanjose
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Unit of Infections and Cancer, Cancer Epidemiology Research Programme, IDIBELL, Catalan Institute of Oncology, Barcelona, Spain
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17
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Hauptmann M, Daniels RD, Cardis E, Cullings HM, Kendall G, Laurier D, Linet MS, Little MP, Lubin JH, Preston DL, Richardson DB, Stram DO, Thierry-Chef I, Schubauer-Berigan MK, Gilbert ES, Berrington de Gonzalez A. Epidemiological Studies of Low-Dose Ionizing Radiation and Cancer: Summary Bias Assessment and Meta-Analysis. J Natl Cancer Inst Monogr 2020; 2020:188-200. [PMID: 32657347 PMCID: PMC8454205 DOI: 10.1093/jncimonographs/lgaa010] [Citation(s) in RCA: 89] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 03/26/2020] [Indexed: 07/27/2023] Open
Abstract
BACKGROUND Ionizing radiation is an established carcinogen, but risks from low-dose exposures are controversial. Since the Biological Effects of Ionizing Radiation VII review of the epidemiological data in 2006, many subsequent publications have reported excess cancer risks from low-dose exposures. Our aim was to systematically review these studies to assess the magnitude of the risk and whether the positive findings could be explained by biases. METHODS Eligible studies had mean cumulative doses of less than 100 mGy, individualized dose estimates, risk estimates, and confidence intervals (CI) for the dose-response and were published in 2006-2017. We summarized the evidence for bias (dose error, confounding, outcome ascertainment) and its likely direction for each study. We tested whether the median excess relative risk (ERR) per unit dose equals zero and assessed the impact of excluding positive studies with potential bias away from the null. We performed a meta-analysis to quantify the ERR and assess consistency across studies for all solid cancers and leukemia. RESULTS Of the 26 eligible studies, 8 concerned environmental, 4 medical, and 14 occupational exposure. For solid cancers, 16 of 22 studies reported positive ERRs per unit dose, and we rejected the hypothesis that the median ERR equals zero (P = .03). After exclusion of 4 positive studies with potential positive bias, 12 of 18 studies reported positive ERRs per unit dose (P = .12). For leukemia, 17 of 20 studies were positive, and we rejected the hypothesis that the median ERR per unit dose equals zero (P = .001), also after exclusion of 5 positive studies with potential positive bias (P = .02). For adulthood exposure, the meta-ERR at 100 mGy was 0.029 (95% CI = 0.011 to 0.047) for solid cancers and 0.16 (95% CI = 0.07 to 0.25) for leukemia. For childhood exposure, the meta-ERR at 100 mGy for leukemia was 2.84 (95% CI = 0.37 to 5.32); there were only two eligible studies of all solid cancers. CONCLUSIONS Our systematic assessments in this monograph showed that these new epidemiological studies are characterized by several limitations, but only a few positive studies were potentially biased away from the null. After exclusion of these studies, the majority of studies still reported positive risk estimates. We therefore conclude that these new epidemiological studies directly support excess cancer risks from low-dose ionizing radiation. Furthermore, the magnitude of the cancer risks from these low-dose radiation exposures was statistically compatible with the radiation dose-related cancer risks of the atomic bomb survivors.
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Affiliation(s)
- Michael Hauptmann
- Correspondence to: Michael Hauptmann, Institute of Biostatistics and Registry Research, Brandenburg Medical School Theodor Fontane. Fehrbelliner Straße 38, 16816 Neuruppin, Germany (e-mail: )
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18
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Daniels RD, Kendall GM, Thierry-Chef I, Linet MS, Cullings HM. Strengths and Weaknesses of Dosimetry Used in Studies of Low-Dose Radiation Exposure and Cancer. J Natl Cancer Inst Monogr 2020; 2020:114-132. [PMID: 32657346 PMCID: PMC7667397 DOI: 10.1093/jncimonographs/lgaa001] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 01/07/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND A monograph systematically evaluating recent evidence on the dose-response relationship between low-dose ionizing radiation exposure and cancer risk required a critical appraisal of dosimetry methods in 26 potentially informative studies. METHODS The relevant literature included studies published in 2006-2017. Studies comprised case-control and cohort designs examining populations predominantly exposed to sparsely ionizing radiation, mostly from external sources, resulting in average doses of no more than 100 mGy. At least two dosimetrists reviewed each study and appraised the strengths and weaknesses of the dosimetry systems used, including assessment of sources and effects of dose estimation error. An overarching concern was whether dose error might cause the spurious appearance of a dose-response where none was present. RESULTS The review included 8 environmental, 4 medical, and 14 occupational studies that varied in properties relative to evaluation criteria. Treatment of dose estimation error also varied among studies, although few conducted a comprehensive evaluation. Six studies appeared to have known or suspected biases in dose estimates. The potential for these biases to cause a spurious dose-response association was constrained to three case-control studies that relied extensively on information gathered in interviews conducted after case ascertainment. CONCLUSIONS The potential for spurious dose-response associations from dose information appeared limited to case-control studies vulnerable to recall errors that may be differential by case status. Otherwise, risk estimates appeared reasonably free of a substantial bias from dose estimation error. Future studies would benefit from a comprehensive evaluation of dose estimation errors, including methods accounting for their potential effects on dose-response associations.
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Affiliation(s)
- Robert D Daniels
- Division of Science Integration, National Institute for Occupational Safety and Health, Cincinnati, OH
| | - Gerald M Kendall
- Cancer Epidemiology Unit, NDPH, University of Oxford, Oxford, UK
| | - Isabelle Thierry-Chef
- Barcelona Institute for Global Health, Barcelona, Catalonia, Spain
- Universitat Pompeu Fabra, Barcelona, Catalonia, Spain
- CIBER Epidemiología y Salud Pública, Madrid, Spain
| | - Martha S Linet
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD
| | - Harry M Cullings
- Department of Statistics, Radiation Effects Research Foundation, Hiroshima, Japan
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19
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Linet MS, Schubauer-Berigan MK, Berrington de González A. Outcome Assessment in Epidemiological Studies of Low-Dose Radiation Exposure and Cancer Risks: Sources, Level of Ascertainment, and Misclassification. J Natl Cancer Inst Monogr 2020; 2020:154-175. [PMID: 32657350 PMCID: PMC8454197 DOI: 10.1093/jncimonographs/lgaa007] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 02/18/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Outcome assessment problems and errors that could lead to biased risk estimates in low-dose radiation epidemiological studies of cancer risks have not been systematically evaluated. METHODS Incidence or mortality risks for all cancers or all solid cancers combined and for leukemia were examined in 26 studies published in 2006-2017 involving low-dose (mean dose ≤100 mGy) radiation from environmental, medical, or occupational sources. We evaluated the impact of loss to follow-up, under- or overascertainment, outcome misclassification, and changing classifications occurring similarly or differentially across radiation dose levels. RESULTS Loss to follow-up was not reported in 62% of studies, but when reported it was generally small. Only one study critically evaluated the completeness of the sources of vital status. Underascertainment of cancers ("false negatives") was a potential shortcoming for cohorts that could not be linked with high-quality population-based registries, particularly during early years of exposure in five studies, in two lacking complete residential history, and in one with substantial emigration. False positives may have occurred as a result of cancer ascertainment from self- or next-of-kin report in three studies or from enhanced medical surveillance of exposed patients that could lead to detection bias (eg, reporting precancer lesions as physician-diagnosed cancer) in one study. Most pediatric but few adult leukemia studies used expert hematopathology review or current classifications. Only a few studies recoded solid cancers to the latest International Classification of Diseases or International Classification of Diseases for Oncology codes. These outcome assessment shortcomings were generally nondifferential in relation to radiation exposure level except possibly in four studies. CONCLUSION The majority of studies lacked information to enable comprehensive evaluation of all major sources of outcome assessment errors, although reported data suggested that the outcome assessment limitations generally had little effect on risk or biased estimates towards the null except possibly in four studies.
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Affiliation(s)
- Martha S Linet
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Rockville, MD
| | - Mary K Schubauer-Berigan
- Monographs Programme, Evidence Synthesis and Classification Section, International Agency for Research on Cancer, Lyon, France
| | - Amy Berrington de González
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Rockville, MD
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Schubauer-Berigan MK, Berrington de Gonzalez A, Cardis E, Laurier D, Lubin JH, Hauptmann M, Richardson DB. Evaluation of Confounding and Selection Bias in Epidemiological Studies of Populations Exposed to Low-Dose, High-Energy Photon Radiation. J Natl Cancer Inst Monogr 2020; 2020:133-153. [PMID: 32657349 PMCID: PMC7355263 DOI: 10.1093/jncimonographs/lgaa008] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Low-dose, penetrating photon radiation exposure is ubiquitous, yet our understanding of cancer risk at low doses and dose rates derives mainly from high-dose studies. Although a large number of low-dose cancer studies have been recently published, concern exists about the potential for confounding to distort findings. The aim of this study was to describe and assess the likely impact of confounding and selection bias within the context of a systematic review. METHODS We summarized confounding control methods for 26 studies published from 2006 to 2017 by exposure setting (environmental, medical, or occupational) and identified confounders of potential concern. We used information from these and related studies to assess evidence for confounding and selection bias. For factors in which direct or indirect evidence of confounding was lacking for certain studies, we used a theoretical adjustment to determine whether uncontrolled confounding was likely to have affected the results. RESULTS For medical studies of childhood cancers, confounding by indication (CBI) was the main concern. Lifestyle-related factors were of primary concern for environmental and medical studies of adult cancers and for occupational studies. For occupational studies, other workplace exposures and healthy worker survivor bias were additionally of interest. For most of these factors, however, review of the direct and indirect evidence suggested that confounding was minimal. One study showed evidence of selection bias, and three occupational studies did not adjust for lifestyle or healthy worker survivor bias correlates. Theoretical adjustment for three factors (smoking and asbestos in occupational studies and CBI in childhood cancer studies) demonstrated that these were unlikely to explain positive study findings due to the rarity of exposure (eg, CBI) or the relatively weak association with the outcome (eg, smoking or asbestos and all cancers). CONCLUSION Confounding and selection bias are unlikely to explain the findings from most low-dose radiation epidemiology studies.
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Affiliation(s)
- Mary K Schubauer-Berigan
- Evidence Synthesis and Classification Section, International Agency for Research on Cancer, Lyon, France
| | | | - Elisabeth Cardis
- Radiation Programme, Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Dominique Laurier
- Institut de Radioprotection et de Sûreté Nucléaire (IRSN), Fontenay-aux-Roses, France
| | - Jay H Lubin
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD
| | - Michael Hauptmann
- Division of Epidemiology and Biostatistics, Netherlands Cancer Institute, Amsterdam, The Netherlands (MH); Brandenburg Medical School, Institute of Biostatistics and Registry Research, Neuruppin, Germany
| | - David B Richardson
- Department of Epidemiology, University of North Carolina, School of Public Health, Chapel Hill, NC, USA
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21
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Gilbert ES, Little MP, Preston DL, Stram DO. Issues in Interpreting Epidemiologic Studies of Populations Exposed to Low-Dose, High-Energy Photon Radiation. J Natl Cancer Inst Monogr 2020; 2020:176-187. [PMID: 32657345 PMCID: PMC7355296 DOI: 10.1093/jncimonographs/lgaa004] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 01/02/2020] [Indexed: 01/19/2023] Open
Abstract
This article addresses issues relevant to interpreting findings from 26 epidemiologic studies of persons exposed to low-dose radiation. We review the extensive data from both epidemiologic studies of persons exposed at moderate or high doses and from radiobiology that together have firmly established radiation as carcinogenic. We then discuss the use of the linear relative risk model that has been used to describe data from both low- and moderate- or high-dose studies. We consider the effects of dose measurement errors; these can reduce statistical power and lead to underestimation of risks but are very unlikely to bring about a spurious dose response. We estimate statistical power for the low-dose studies under the assumption that true risks of radiation-related cancers are those expected from studies of Japanese atomic bomb survivors. Finally, we discuss the interpretation of confidence intervals and statistical tests and the applicability of the Bradford Hill principles for a causal relationship.
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Affiliation(s)
- Ethel S Gilbert
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Mark P Little
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | | | - Daniel O Stram
- Department of Preventive Medicine, School of Medicine, University of Southern California, Los Angeles, CA, USA
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22
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Berrington de Gonzalez A, Daniels RD, Cardis E, Cullings HM, Gilbert E, Hauptmann M, Kendall G, Laurier D, Linet MS, Little MP, Lubin JH, Preston DL, Richardson DB, Stram D, Thierry-Chef I, Schubauer-Berigan MK. Epidemiological Studies of Low-Dose Ionizing Radiation and Cancer: Rationale and Framework for the Monograph and Overview of Eligible Studies. J Natl Cancer Inst Monogr 2020; 2020:97-113. [PMID: 32657348 PMCID: PMC7610154 DOI: 10.1093/jncimonographs/lgaa009] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 03/13/2020] [Indexed: 12/21/2022] Open
Abstract
Whether low-dose ionizing radiation can cause cancer is a critical and long-debated question in radiation protection. Since the Biological Effects of Ionizing Radiation report by the National Academies in 2006, new publications from large, well-powered epidemiological studies of low doses have reported positive dose-response relationships. It has been suggested, however, that biases could explain these findings. We conducted a systematic review of epidemiological studies with mean doses less than 100 mGy published 2006-2017. We required individualized doses and dose-response estimates with confidence intervals. We identified 26 eligible studies (eight environmental, four medical, and 14 occupational), including 91 000 solid cancers and 13 000 leukemias. Mean doses ranged from 0.1 to 82 mGy. The excess relative risk at 100 mGy was positive for 16 of 22 solid cancer studies and 17 of 20 leukemia studies. The aim of this monograph was to systematically review the potential biases in these studies (including dose uncertainty, confounding, and outcome misclassification) and to assess whether the subset of minimally biased studies provides evidence for cancer risks from low-dose radiation. Here, we describe the framework for the systematic bias review and provide an overview of the eligible studies.
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Affiliation(s)
| | - Robert D Daniels
- National Institute for Occupational Safety and Health, Cincinnati, OH, USA
| | - Elisabeth Cardis
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Catalonia, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Catalonia, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | | | - Ethel Gilbert
- Division of Cancer Epidemiology & Genetics, Radiation Epidemiology Branch, Bethesda, MD, USA
| | - Michael Hauptmann
- Department of Epidemiology and Biostatistics, Netherlands Cancer Institute, Amsterdam, the Netherlands
- Brandenburg Medical School Theodor Fontane, Institute of Biostatistics and Registry Research, Neuruppin, Germany
| | | | | | - Martha S Linet
- Division of Cancer Epidemiology & Genetics, Radiation Epidemiology Branch, Bethesda, MD, USA
| | - Mark P Little
- Division of Cancer Epidemiology & Genetics, Radiation Epidemiology Branch, Bethesda, MD, USA
| | - Jay H Lubin
- Division of Cancer Epidemiology & Genetics, Radiation Epidemiology Branch, Bethesda, MD, USA
| | | | | | - Daniel Stram
- University of Southern California, Los Angeles, CA
| | - Isabelle Thierry-Chef
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Catalonia, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Catalonia, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
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23
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Satta G, Loi M, Becker N, Benavente Y, De Sanjose S, Foretova L, Staines A, Maynadie M, Nieters A, Meloni F, Pilia I, Campagna M, Pau M, Zablotska LB, Cocco P. Occupational exposure to ionizing radiation and risk of lymphoma subtypes: results of the Epilymph European case-control study. Environ Health 2020; 19:43. [PMID: 32334593 PMCID: PMC7183712 DOI: 10.1186/s12940-020-00596-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 04/07/2020] [Indexed: 05/27/2023]
Abstract
BACKGROUND Evidence linking risk of lymphoma and B-cell lymphoma subtypes to ionizing radiation is inconclusive, particularly at low exposure levels. METHODS We investigated risk of lymphoma (all subtypes), B-cell lymphomas, and its major subtypes, associated with low-level occupational exposure to ionizing radiation, in 2346 lymphoma cases and 2463 controls, who participated in the multicenter EpiLymph case-control study. We developed a job-exposure matrix to estimate exposure to ionizing radiation, distinguishing between internal and external radiation, and we applied it to the lifetime occupational history of study subjects, We calculated the Odds Ratio (OR) and its 95% confidence interval (95% CI) for lymphoma (all subtypes combined), B-cell lymphoma, and its major subtypes using unconditional, polytomous logistic regression adjusting for age, gender, and education. RESULTS We did not observe an association between exposure metrics of external and internal radiation and risk of lymphoma (all subtypes), nor with B-cell lymphoma, or its major subtypes, at the levels regularly experienced in occupational settings. An elevated risk of diffuse large B cell lymphoma was observed among the most likely exposed study subjects with relatively higher exposure intensity, which would be worth further investigation. CONCLUSIONS Further investigation is warranted on risk of B cell lymphoma subtypes associated with low-level occupational exposure to external ionizing radiation, and to clarify whether lymphoma should be included among the cancer outcomes related to ionizing radiation.
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Affiliation(s)
- Giannina Satta
- Department of Medical Sciences and Public Health, University of Cagliari, SS554, km 4.500, 09042, Monserrato (Cagliari), Italy
| | - Matteo Loi
- Department of Medical Sciences and Public Health, University of Cagliari, SS554, km 4.500, 09042, Monserrato (Cagliari), Italy
| | | | | | | | - Lenka Foretova
- Department of Cancer Epidemiology and Genetics, Masaryk Memorial Cancer Institute and MF MU, Brno, Czech Republic
| | | | | | | | - Federico Meloni
- Department of Medical Sciences and Public Health, University of Cagliari, SS554, km 4.500, 09042, Monserrato (Cagliari), Italy
| | - Ilaria Pilia
- Department of Medical Sciences and Public Health, University of Cagliari, SS554, km 4.500, 09042, Monserrato (Cagliari), Italy
| | - Marcello Campagna
- Department of Medical Sciences and Public Health, University of Cagliari, SS554, km 4.500, 09042, Monserrato (Cagliari), Italy
| | - Marco Pau
- Department of Medical Sciences and Public Health, University of Cagliari, SS554, km 4.500, 09042, Monserrato (Cagliari), Italy
| | - Lydia B Zablotska
- Department of Epidemiology and Biostatistics, School of Medicine, University of California-San Francisco, San Francisco, CA, USA
| | - Pierluigi Cocco
- Department of Medical Sciences and Public Health, University of Cagliari, SS554, km 4.500, 09042, Monserrato (Cagliari), Italy.
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da Costa Dantas R, Navoni JA, de Alencar FLS, da Costa Xavier LA, do Amaral VS. Natural radioactivity in Brazil: a systematic review. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2020; 27:143-157. [PMID: 31832968 DOI: 10.1007/s11356-019-06962-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 11/04/2019] [Indexed: 06/10/2023]
Abstract
Natural radioactivity is a public health concern worldwide. Its deleterious effects are largely associated with emitting ionizing particles which generate innumerable toxicological consequences to human being. The present study aimed to describe the research state of the art on natural radioactivity in Brazil through a systematic review limited to articles published in the twenty-first century in the PubMed, SciELO, Lilacs, and Google Scholar databases. A total of 55 research articles were considered for this purpose. Based on the collected sample types, the radiation analysis in most of the scientific reports was performed on solid samples (soil/sediment/rocks), followed by water and air. In fact, most of the available information came from geological studies. A wide range of concentrations and a variety of radionuclides have been assessed, with radium being the most cited. Most of the studies described radiation levels above the international guidelines, and consider the Brazilian territory as a high natural background radiation region (HNBR). In comparison with other HNBR areas, the scientific information about the related risks to human health is still scarce. There is uncertainty about the real impact of natural radioactivity on human health, as there is a lack of scientific information for most of the country about this issue. The analysis and comparison of the available information highlights the potential risks linked to natural radioactivity and the need to incorporate suitable environmental management policies about this issue.
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Affiliation(s)
- Richelly da Costa Dantas
- Rede Nordeste de Biotecnologia (RENORBIO), Universidade Federal do Rio Grande do Norte, Natal, RN, Brazil
| | - Julio Alejandro Navoni
- Programa de Pós-graduação em Desenvolvimento e Meio Ambiente (PRODEMA), Universidade Federal do Rio Grande do Norte, Natal, RN, Brazil
- Instituto Federal do Rio Grande do Norte (IFRN), Programa de Pós-graduação em Uso Sustentavel de Recursos Naturais (PPgUSRN), Natal, RN, Brazil
| | - Feliphe Lacerda Souza de Alencar
- Programa de Pós-graduação em Desenvolvimento e Meio Ambiente (PRODEMA), Universidade Federal do Rio Grande do Norte, Natal, RN, Brazil
- Departamento de Biologia Celular e Genética, Laboratório de Genética Toxicológica, Universidade Federal do Rio Grande do Norte, Sen. Salgado Filho, Lagoa Nova Natal, RN, CEP 59078-970, Brazil
| | - Luíza Araújo da Costa Xavier
- Departamento de Biologia Celular e Genética, Laboratório de Genética Toxicológica, Universidade Federal do Rio Grande do Norte, Sen. Salgado Filho, Lagoa Nova Natal, RN, CEP 59078-970, Brazil
- Programa de Pós-graduação em Bioquímica, Universidade Federal do Rio Grande do Norte, Natal, RN, Brazil
| | - Viviane Souza do Amaral
- Rede Nordeste de Biotecnologia (RENORBIO), Universidade Federal do Rio Grande do Norte, Natal, RN, Brazil.
- Programa de Pós-graduação em Desenvolvimento e Meio Ambiente (PRODEMA), Universidade Federal do Rio Grande do Norte, Natal, RN, Brazil.
- Departamento de Biologia Celular e Genética, Laboratório de Genética Toxicológica, Universidade Federal do Rio Grande do Norte, Sen. Salgado Filho, Lagoa Nova Natal, RN, CEP 59078-970, Brazil.
- Programa de Pós-graduação em Bioquímica, Universidade Federal do Rio Grande do Norte, Natal, RN, Brazil.
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Drozdovitch V, Kryuchkov V, Bakhanova E, Golovanov I, Bazyka D, Gudzenko N, Trotsyuk N, Hatch M, Cahoon EK, Mabuchi K, Bouville A, Chumak V. Estimation of Radiation Doses for a Case-control Study of Thyroid Cancer Among Ukrainian Chernobyl Cleanup Workers. HEALTH PHYSICS 2020; 118:18-35. [PMID: 31764419 PMCID: PMC6880802 DOI: 10.1097/hp.0000000000001120] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
Thyroid doses were estimated for 607 subjects of a case-control study of thyroid cancer nested in the cohort of 150,813 male Ukrainian cleanup workers who were exposed to radiation as a result of the 1986 Chernobyl nuclear power plant accident. Individual thyroid doses due to external irradiation, inhalation of I and short-lived radioiodine and radiotellurium isotopes (I, I, I, Te, and Te) during the cleanup mission, and intake of I during residence in contaminated settlements were calculated for all study subjects, along with associated uncertainty distributions. The average thyroid dose due to all exposure pathways combined was estimated to be 199 mGy (median: 47 mGy; range: 0.15 mGy to 9.0 Gy), with averages of 140 mGy (median: 20 mGy; range: 0.015 mGy to 3.6 Gy) from external irradiation during the cleanup mission, 44 mGy (median: 12 mGy; range: ~0 mGy to 1.7 Gy) due to I inhalation, 42 mGy (median: 7.3 mGy; range: 0.001 mGy to 3.4 Gy) due to I intake during residence, and 11 mGy (median: 1.6 mGy; range: ~0 mGy to 0.38 Gy) due to inhalation of short-lived radionuclides. Internal exposure of the thyroid gland to I contributed more than 50% of the total thyroid dose in 45% of the study subjects. The uncertainties in the individual stochastic doses were characterized by a mean geometric standard deviation of 2.0, 1.8, 2.0, and 2.6 for external irradiation, inhalation of I, inhalation of short-lived radionuclides, and residential exposure, respectively. The models used for dose calculations were validated against instrument measurements done shortly after the accident. Results of the validation showed that thyroid doses could be estimated retrospectively for Chernobyl cleanup workers two to three decades after the accident with a reasonable degree of reliability.
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Affiliation(s)
- Vladimir Drozdovitch
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, 9609 Medical Center Drive, Bethesda, MD 20892, USA
| | - Victor Kryuchkov
- Burnasyan Federal Medical and Biophysical Centre, 46 Zhivopisnaya Street, Moscow, 123182, Russia
| | - Elena Bakhanova
- National Research Centre for Radiation Medicine, 53 Melnikova Street, Kyiv, 04050, Ukraine
| | - Ivan Golovanov
- Burnasyan Federal Medical and Biophysical Centre, 46 Zhivopisnaya Street, Moscow, 123182, Russia
| | - Dimitry Bazyka
- National Research Centre for Radiation Medicine, 53 Melnikova Street, Kyiv, 04050, Ukraine
| | - Natalia Gudzenko
- National Research Centre for Radiation Medicine, 53 Melnikova Street, Kyiv, 04050, Ukraine
| | - Natalia Trotsyuk
- National Research Centre for Radiation Medicine, 53 Melnikova Street, Kyiv, 04050, Ukraine
| | - Maureen Hatch
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, 9609 Medical Center Drive, Bethesda, MD 20892, USA
| | - Elizabeth K. Cahoon
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, 9609 Medical Center Drive, Bethesda, MD 20892, USA
| | - Kiyohiko Mabuchi
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, 9609 Medical Center Drive, Bethesda, MD 20892, USA
| | - André Bouville
- U. S. National Cancer Institute, Bethesda, MD, USA (retired)
| | - Vadim Chumak
- National Research Centre for Radiation Medicine, 53 Melnikova Street, Kyiv, 04050, Ukraine
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Ernst T, Rinke J, Hagen J, Dmytrenko I, Hochhaus A, Dyagil I. Molecular-defined clonal evolution in patients with chronic myeloid leukemia who were exposed to ionizing radiation following the Chernobyl nuclear disaster. Leukemia 2019; 34:645-650. [PMID: 31836850 DOI: 10.1038/s41375-019-0679-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 11/01/2019] [Accepted: 11/29/2019] [Indexed: 02/03/2023]
Affiliation(s)
- Thomas Ernst
- Abteilung Hämatologie und Internistische Onkologie, Klinik für Innere Medizin II, Universitätsklinikum Jena, Jena, Germany.
| | - Jenny Rinke
- Abteilung Hämatologie und Internistische Onkologie, Klinik für Innere Medizin II, Universitätsklinikum Jena, Jena, Germany
| | - Julia Hagen
- Abteilung Hämatologie und Internistische Onkologie, Klinik für Innere Medizin II, Universitätsklinikum Jena, Jena, Germany
| | - Iryna Dmytrenko
- Department of Hematology and Transplantology, National Research Center for Radiation Medicine of the National Academy of Medical Sciences of Ukraine, Kyiv, Ukraine
| | - Andreas Hochhaus
- Abteilung Hämatologie und Internistische Onkologie, Klinik für Innere Medizin II, Universitätsklinikum Jena, Jena, Germany
| | - Iryna Dyagil
- Department of Hematology and Transplantology, National Research Center for Radiation Medicine of the National Academy of Medical Sciences of Ukraine, Kyiv, Ukraine
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Jakathamani S, Annalakshmi O, Menon S, Kadam SY, Jose M, Venkatraman B. Ceramic resistors as optically stimulated luminescent retrospective dosimeters. Radiat Phys Chem Oxf Engl 1993 2019. [DOI: 10.1016/j.radphyschem.2019.108436] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Cancers after Chornobyl: From Epidemiology to Molecular Quantification. Cancers (Basel) 2019; 11:cancers11091291. [PMID: 31480731 PMCID: PMC6770927 DOI: 10.3390/cancers11091291] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 07/18/2019] [Accepted: 08/03/2019] [Indexed: 11/17/2022] Open
Abstract
An overview and new data are presented from cancer studies of the most exposed groups of the population after the Chornobyl accident, performed at the National Research Center for Radiation Medicine (NRCRM). Incidence rates of solid cancers were analyzed for the 1990-2016 period in cleanup workers, evacuees, and the general population from the contaminated areas. In male cleanup workers, the significant increase in rates was demonstrated for cancers in total, leukemia, lymphoma, and thyroid cancer, as well as breast cancer rates were increased in females. Significantly elevated thyroid cancer incidence was identified in the male cleanup workers cohort (150,813) in 1986-2012 with an overall standardized incidence ratio (SIR) of 3.35 (95% CI: 2.91-3.80). A slight decrease in incidence rates was registered starting at 25 years after exposure. In total, 32 of 57 deaths in a group of cleanup workers with confirmed acute radiation syndrome (ARS) or not confirmed ARS (ARS NC) were due to blood malignancies or cancer. Molecular studies in cohort members included gene expression and polymorphism, FISH, relative telomere length, immunophenotype, micronuclei test, histone H2AX, and TORCH infections. Analysis of chronic lymphocytic leukemia (CLL) cases from the cohort showed more frequent mutations in telomere maintenance pathway genes as compared with unexposed CLL patients.
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Wu Y, Hoffman FO, Apostoaei AI, Kwon D, Thomas BA, Glass R, Zablotska LB. Methods to account for uncertainties in exposure assessment in studies of environmental exposures. Environ Health 2019; 18:31. [PMID: 30961632 PMCID: PMC6454753 DOI: 10.1186/s12940-019-0468-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 03/20/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND Accurate exposure estimation in environmental epidemiological studies is crucial for health risk assessment. Failure to account for uncertainties in exposure estimation could lead to biased results in exposure-response analyses. Assessment of the effects of uncertainties in exposure estimation on risk estimates received a lot of attention in radiation epidemiology and in several studies of diet and air pollution. The objective of this narrative review is to examine the commonly used statistical approaches to account for exposure estimation errors in risk analyses and to suggest how each could be applied in environmental epidemiological studies. MAIN TEXT We review two main error types in estimating exposures in epidemiological studies: shared and unshared errors and their subtypes. We describe the four main statistical approaches to adjust for exposure estimation uncertainties (regression calibration, simulation-extrapolation, Monte Carlo maximum likelihood and Bayesian model averaging) along with examples to give readers better understanding of their advantages and limitations. We also explain the advantages of using a 2-dimensional Monte-Carlo (2DMC) simulation method to quantify the effect of uncertainties in exposure estimates using full-likelihood methods. For exposures that are estimated independently between subjects and are more likely to introduce unshared errors, regression calibration and SIMEX methods are able to adequately account for exposure uncertainties in risk analyses. When an uncalibrated measuring device is used or estimation parameters with uncertain mean values are applied to a group of people, shared errors could potentially be large. In this case, Monte Carlo maximum likelihood and Bayesian model averaging methods based on estimates of exposure from the 2DMC simulations would work well. The majority of reviewed studies show relatively moderate changes (within 100%) in risk estimates after accounting for uncertainties in exposure estimates, except for the two studies which doubled/tripled naïve estimates. CONCLUSIONS In this paper, we demonstrate various statistical methods to account for uncertain exposure estimates in risk analyses. The differences in the results of various adjustment methods could be due to various error structures in datasets and whether or not a proper statistical method was applied. Epidemiological studies of environmental exposures should include exposure-response analyses accounting for uncertainties in exposure estimates.
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Affiliation(s)
- You Wu
- Department of Epidemiology and Biostatistics, University of California, San Francisco, 550 16th Street, 2nd floor, Box 0560, San Francisco, CA 94143 USA
- Center for Design and Analysis, Amgen, Inc., 1 Amgen Center Dr., Thousand Oaks, CA 91320 USA
| | - F. Owen Hoffman
- Oak Ridge Center for Risk Analysis, Inc., 102 Donner Drive, Oak Ridge, TN USA
| | - A. Iulian Apostoaei
- Oak Ridge Center for Risk Analysis, Inc., 102 Donner Drive, Oak Ridge, TN USA
| | - Deukwoo Kwon
- Sylvester Comprehensive Cancer Center, University of Miami, 1475 NW 12th Avenue, Miami, FL USA
| | - Brian A. Thomas
- Oak Ridge Center for Risk Analysis, Inc., 102 Donner Drive, Oak Ridge, TN USA
| | - Racquel Glass
- Department of Epidemiology and Biostatistics, University of California, San Francisco, 550 16th Street, 2nd floor, Box 0560, San Francisco, CA 94143 USA
| | - Lydia B. Zablotska
- Department of Epidemiology and Biostatistics, University of California, San Francisco, 550 16th Street, 2nd floor, Box 0560, San Francisco, CA 94143 USA
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Kitamura H, Okubo T, Kodama K. EPIDEMIOLOGICAL STUDY OF HEALTH EFFECTS IN FUKUSHIMA NUCLEAR EMERGENCY WORKERS-STUDY DESIGN AND PROGRESS REPORT. RADIATION PROTECTION DOSIMETRY 2018; 182:40-48. [PMID: 30137628 DOI: 10.1093/rpd/ncy136] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Between 14 March and 16 December 2011, the radiation dose limit for emergency work was tentatively raised from an effective dose of 100-250 mSv by the Japanese Government after the Fukushima Daiichi Nuclear Power Plant (FDNPP) accident. The objective of this study is to clarify the long-term health effects of radiation on the emergency workers involved during that period, based on a detailed evaluation of the radiation exposures and long-term monitoring. The potential subjects of the study are the approximately 20 000 workers who were engaged in emergency operations at FDNPP during the period described above. During the first phase of this project, the first 5 years from 2014, we plan to set up a research scheme and establish a cohort. To date, the establishment of the scheme for general health examinations is nearly complete. As of 31 January 2017, 5419 emergency workers (27.4% of the subjects) have agreed to participate in the study. We will continue our efforts to recruit additional potential subjects during the first phase to maximize the size of the cohort.
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Affiliation(s)
- Hiroko Kitamura
- Radiation Effects Research Foundation, 5-2 Hijiyama Park, Minami-ku, Hiroshima, Japan
| | - Toshiteru Okubo
- Radiation Effects Research Foundation, 5-2 Hijiyama Park, Minami-ku, Hiroshima, Japan
| | - Kazunori Kodama
- Radiation Effects Research Foundation, 5-2 Hijiyama Park, Minami-ku, Hiroshima, Japan
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Haematological analysis of Japanese macaques (Macaca fuscata) in the area affected by the Fukushima Daiichi Nuclear Power Plant accident. Sci Rep 2018; 8:16748. [PMID: 30425289 PMCID: PMC6233195 DOI: 10.1038/s41598-018-35104-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 10/28/2018] [Indexed: 12/25/2022] Open
Abstract
Several populations of wild Japanese macaques (Macaca fuscata) inhabit the area around Fukushima Daiichi Nuclear Power Plant (FNPP). To measure and control the size of these populations, macaques are captured annually. Between May 2013 and December 2014, we performed a haematological analysis of Japanese macaques captured within a 40-km radius of FNPP, the location of a nuclear disaster two years post-accident. The dose-rate of radiocaesium was estimated using the ERICA Tool. The median internal dose-rate was 7.6 μGy/day (ranging from 1.8 to 219 μGy/day) and the external dose-rate was 13.9 μGy/day (ranging from 6.7 to 35.1 μGy/day). We performed multiple regression analyses to estimate the dose-rate effects on haematological values in peripheral blood and bone marrow. The white blood cell and platelet counts showed an inverse correlation with the internal dose-rate in mature macaques. Furthermore, the myeloid cell, megakaryocyte, and haematopoietic cell counts were inversely correlated and the occupancy of adipose tissue was positively correlated with internal dose-rate in femoral bone marrow of mature macaques. These relationships suggest that persistent whole body exposure to low-dose-rate radiation affects haematopoiesis in Japanese macaques.
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Karabulutoglu M, Finnon R, Imaoka T, Friedl AA, Badie C. Influence of diet and metabolism on hematopoietic stem cells and leukemia development following ionizing radiation exposure. Int J Radiat Biol 2018; 95:452-479. [PMID: 29932783 DOI: 10.1080/09553002.2018.1490042] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE The review aims to discuss the prominence of dietary and metabolic regulators in maintaining hematopoietic stem cell (HSC) function, long-term self-renewal, and differentiation. RESULTS Most adult stem cells are preserved in a quiescent, nonmotile state in vivo which acts as a "protective state" for stem cells to reduce endogenous stress provoked by DNA replication and cellular respiration as well as exogenous environmental stress. The dynamic balance between quiescence, self-renewal and differentiation is critical for supporting a functional blood system throughout life of an organism. Stress-conditions, for example ionizing radiation exposure can trigger the blood forming HSCs to proliferate and migrate through extramedullary tissues to expand the number of HSCs and increase hematopoiesis. In addition, a wealth of investigation validated that deregulation of this balance plays a critical pathogenic role in various different hematopoietic diseases including the leukemia development. CONCLUSION The review summarizes the current knowledge on how alterations in dietary and metabolic factors could alter the risk of leukemia development following ionizing radiation exposure by inhibiting or even reversing the leukemic progression. Understanding the influence of diet, metabolism, and epigenetics on radiation-induced leukemogenesis may lead to the development of practical interventions to reduce the risk in exposed populations.
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Affiliation(s)
- Melis Karabulutoglu
- a Cancer Mechanisms and Biomarkers group, Biological Effects Department, Centre for Radiation, Chemical and Environmental Hazards , Public Health England , Didcot , UK.,b CRUK & MRC Oxford Institute for Radiation Oncology, Department of Oncology , University of Oxford , Oxford , UK
| | - Rosemary Finnon
- a Cancer Mechanisms and Biomarkers group, Biological Effects Department, Centre for Radiation, Chemical and Environmental Hazards , Public Health England , Didcot , UK
| | - Tatsuhiko Imaoka
- c Department of Radiation Effects Research, National Institute of Radiological Sciences , National Institutes for Quantum and Radiological Science and Technology , Chiba , Japan
| | - Anna A Friedl
- d Department of Radiation Oncology , University Hospital, LMU Munich , Munich , Germany
| | - Christophe Badie
- a Cancer Mechanisms and Biomarkers group, Biological Effects Department, Centre for Radiation, Chemical and Environmental Hazards , Public Health England , Didcot , UK
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Bazyka D, Prysyazhnyuk A, Gudzenko N, Dyagil I, Belyi D, Chumak V, Buzunov V. Epidemiology of Late Health Effects in Ukrainian Chornobyl Cleanup Workers. HEALTH PHYSICS 2018; 115:161-169. [PMID: 29787442 DOI: 10.1097/hp.0000000000000868] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
This article summarizes the results of 30 y of follow-up of cancer and noncancer effects in Ukrainian cleanup workers after the Chornobyl accident. The number of power plant employees and first responders with acute radiation syndrome under follow-up by the National Research Center for Radiation Medicine decreased from 179 in 1986-1991 to 105 in 2011-2015. Cancers and leukemia (19) and cardiovascular diseases (21) were the main causes of deaths among acute radiation syndrome survivors (54) during the postaccident period. Increased radiation risks of leukemia in the Ukrainian cohort of 110,645 cleanup workers exposed to low doses are comparable to those among survivors of the atomic bomb explosions in Japan in 1945. Additionally, an excess of chronic lymphocytic leukemia was demonstrated in the cleanup workers cohort for 26 y after the exposure. A significant excess of multiple myeloma incidence [standardized incidence rate (SIR) 1.61 %, 95% confidence interval (CI) 1.01-2.21], thyroid cancer (SIR 4.18, 95% CI 3.76-4.59), female breast cancer (SIR 1.57 CI 1.40-1.73), and all cancers combined (SIR 1.07; 95% CI 1.05-1.09) was registered. High prevalence was demonstrated for cardio- and cerebrovascular diseases and mental health changes. However, the reasons for the increases require further investigation. To monitor other possible late effects of radiation exposure in Chornobyl cleanup workers, analytical cohort and case-control studies need to include cardiovascular pathology, specifically types of potentially radiogenic cancers using a molecular epidemiology approach. Possible effects for further study include increased rates of thyroid, breast, and lung cancers and multiple myeloma; reduction of radiation risks of leukemia to population levels; and increased morbidity and mortality of cleanup workers from cardio- and cerebrovascular pathology.
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Affiliation(s)
- Dimitry Bazyka
- 1National Research Center for Radiation Medicine, 53 Melnikov Str., Kyiv 04050 Ukraine
| | | | | | | | | | | | - Volodymyr Buzunov
- National Research Center for Radiation Medicine, 53 Melnikov Str., Kyiv 04050 Ukraine
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Ojha J, Dyagil I, Finch SC, Reiss RF, de Smith AJ, Gonseth S, Zhou M, Hansen HM, Sherborne AL, Nakamura J, Bracci PM, Gudzenko N, Hatch M, Babkina N, Little MP, Chumak VV, Walsh KM, Bazyka D, Wiemels JL, Zablotska LB. Genomic characterization of chronic lymphocytic leukemia (CLL) in radiation-exposed Chornobyl cleanup workers. Environ Health 2018; 17:43. [PMID: 29720177 PMCID: PMC5930419 DOI: 10.1186/s12940-018-0387-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 04/20/2018] [Indexed: 05/29/2023]
Abstract
BACKGROUND Chronic lymphocytic leukemia (CLL) was the predominant leukemia in a recent study of Chornobyl cleanup workers from Ukraine exposed to radiation (UR-CLL). Radiation risks of CLL significantly increased with increasing bone marrow radiation doses. Current analysis aimed to clarify whether the increased risks were due to radiation or to genetic mutations in the Ukrainian population. METHODS A detailed characterization of the genomic landscape was performed in a unique sample of 16 UR-CLL patients and age- and sex-matched unexposed general population Ukrainian-CLL (UN-CLL) and Western-CLL (W-CLL) patients (n = 28 and 100, respectively). RESULTS Mutations in telomere-maintenance pathway genes POT1 and ATM were more frequent in UR-CLL compared to UN-CLL and W-CLL (both p < 0.05). No significant enrichment in copy-number abnormalities at del13q14, del11q, del17p or trisomy12 was identified in UR-CLL compared to other groups. Type of work performed in the Chornobyl zone, age at exposure and at diagnosis, calendar time, and Rai stage were significant predictors of total genetic lesions (all p < 0.05). Tumor telomere length was significantly longer in UR-CLL than in UN-CLL (p = 0.009) and was associated with the POT1 mutation and survival. CONCLUSIONS No significant enrichment in copy-number abnormalities at CLL-associated genes was identified in UR-CLL compared to other groups. The novel associations between radiation exposure, telomere maintenance and CLL prognosis identified in this unique case series provide suggestive, though limited data and merit further investigation.
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Affiliation(s)
- Juhi Ojha
- School of Medicine, University of California, San Francisco, San Francisco, CA USA
| | - Iryna Dyagil
- National Research Center for Radiation Medicine, Kyiv, Ukraine
| | - Stuart C. Finch
- Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ USA
| | - Robert F. Reiss
- Department of Pathology and Cell Biology, and Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY USA
| | - Adam J. de Smith
- School of Medicine, University of California, San Francisco, San Francisco, CA USA
| | - Semira Gonseth
- School of Public Health, University of California, Berkeley, Berkeley, CA USA
| | - Mi Zhou
- School of Medicine, University of California, San Francisco, San Francisco, CA USA
| | - Helen M. Hansen
- School of Medicine, University of California, San Francisco, San Francisco, CA USA
| | - Amy L. Sherborne
- School of Medicine, University of California, San Francisco, San Francisco, CA USA
| | - Jean Nakamura
- School of Medicine, University of California, San Francisco, San Francisco, CA USA
| | - Paige M. Bracci
- School of Medicine, University of California, San Francisco, San Francisco, CA USA
| | | | - Maureen Hatch
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, MD USA
| | | | - Mark P. Little
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, MD USA
| | - Vadim V. Chumak
- National Research Center for Radiation Medicine, Kyiv, Ukraine
| | - Kyle M. Walsh
- School of Medicine, University of California, San Francisco, San Francisco, CA USA
| | - Dimitry Bazyka
- National Research Center for Radiation Medicine, Kyiv, Ukraine
| | - Joseph L. Wiemels
- School of Medicine, University of California, San Francisco, San Francisco, CA USA
| | - Lydia B. Zablotska
- School of Medicine, University of California, San Francisco, San Francisco, CA USA
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Chumak VV, Klymenko SV, Zitzelsberger H, Wilke C, Rybchenko LA, Bakhanova EV. Doses of Ukrainian female clean-up workers with diagnosed breast cancer. RADIATION AND ENVIRONMENTAL BIOPHYSICS 2018; 57:163-168. [PMID: 29550923 DOI: 10.1007/s00411-018-0738-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 02/26/2018] [Indexed: 06/08/2023]
Abstract
The Chernobyl reactor accident in 1986 has caused significant exposure to ionizing radiation of the Ukrainian population, in particular clean-up workers and evacuees from the exclusion zones. A study aiming at the discovery of radiation markers of the breast cancer was conducted from 2008 to 2015 within a collaborative project by HZM, LMU, and NRCRM. In this study, post-Chernobyl breast cancer cases both in radiation-exposed female patients diagnosed at age less than 60 from 1992 to 2014 and in non-exposed controls matched for residency, tumor type, age at diagnosis, TNM classification as well as tumor grading were investigated for molecular changes with special emphasis to copy number alterations and miRNA profiles. Cancer registry and clinical archive data were used to identify 435 breast cancer patients among female clean-up workers and 14 among evacuees from highly contaminated territories as candidates for the study. Of these, 129 breast cancer patients fit study inclusion criteria and were traced for individual reconstruction of the target organ (breast) doses. The doses were estimated for 71 exposed cases (clean-up workers and evacuees from which biomaterial was available for molecular studies and who agreed to participate in a dosimetric interview) by the use of the well-established RADRUE method, which was adjusted specifically for the assessment of breast doses. The results of 58 female clean-up workers showed a large inter-individual variability of doses in a range of about five orders of magnitude: from 0.03 to 929 mGy, with median of 5.8 mGy. The study provides the first quantitative estimate of exposures received by female clean-up workers, which represent a limited but very important group of population affected by the Chernobyl accident. The doses of 13 women evacuated after the accident who did not take part in the clean-up activities (from 4 to 45 mGy with median of 19 mGy) are in line with the previous estimates for the evacuees from Pripyat and the 30-km zone.
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Affiliation(s)
- Vadim V Chumak
- National Research Center for Radiation Medicine, National Academy of Medical Sciences of Ukraine, Kyiv, Ukraine.
| | - Sergiy V Klymenko
- National Research Center for Radiation Medicine, National Academy of Medical Sciences of Ukraine, Kyiv, Ukraine
| | - Horst Zitzelsberger
- Research Unit Radiation Cytogenetics, Deutsches Forschungszentrum fuer Gesundheit und Umwelt, Helmholtz Zentrum Muenchen, Neuherberg, Germany
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Christina Wilke
- Research Unit Radiation Cytogenetics, Deutsches Forschungszentrum fuer Gesundheit und Umwelt, Helmholtz Zentrum Muenchen, Neuherberg, Germany
| | - Lyudmila A Rybchenko
- National Research Center for Radiation Medicine, National Academy of Medical Sciences of Ukraine, Kyiv, Ukraine
| | - Elena V Bakhanova
- National Research Center for Radiation Medicine, National Academy of Medical Sciences of Ukraine, Kyiv, Ukraine
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Szatmári T, Persa E, Kis E, Benedek A, Hargitai R, Sáfrány G, Lumniczky K. Extracellular vesicles mediate low dose ionizing radiation-induced immune and inflammatory responses in the blood. Int J Radiat Biol 2018. [PMID: 29533121 DOI: 10.1080/09553002.2018.1450533] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE Radiation-induced bystander effects (RIBE) imply the involvement of complex signaling mechanisms, which can be mediated by extracellular vesicles (EVs). Using an in vivo model, we investigated EV-transmitted RIBE in blood plasma and radiation effects on plasma EV miRNA profiles. MATERIALS AND METHODS C57Bl/6 mice were total-body irradiated with 0.1 and 2 Gy, bone marrow-derived EVs were isolated, and injected systemically into naive, 'bystander' animals. Proteome profiler antibody array membranes were used to detect alterations in plasma, both in directly irradiated and bystander mice. MiRNA profile of plasma EVs was determined by PCR array. RESULTS M-CSF and pentraxin-3 levels were increased in the blood of directly irradiated and bystander mice both after low and high dose irradiations, CXCL16 and lipocalin-2 increased after 2 Gy in directly irradiated and bystander mice, CCL5 and CCL11 changed in bystander mice only. Substantial overlap was found in the cellular pathways regulated by those miRNAs whose level were altered in EVs isolated from the plasma of mice irradiated with 0.1 and 2 Gy. Several of these pathways have already been associated with bystander responses. CONCLUSION Low and high dose effects overlapped both in EV-mediated alterations in signaling pathways leading to RIBE and in their systemic manifestations.
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Affiliation(s)
- Tünde Szatmári
- a Department of Radiation Medicine, Division of Radiobiology and Radiohygiene , National Public Health Institute , Budapest , Hungary
| | - Eszter Persa
- a Department of Radiation Medicine, Division of Radiobiology and Radiohygiene , National Public Health Institute , Budapest , Hungary
| | - Enikő Kis
- a Department of Radiation Medicine, Division of Radiobiology and Radiohygiene , National Public Health Institute , Budapest , Hungary
| | - Anett Benedek
- a Department of Radiation Medicine, Division of Radiobiology and Radiohygiene , National Public Health Institute , Budapest , Hungary
| | - Rita Hargitai
- a Department of Radiation Medicine, Division of Radiobiology and Radiohygiene , National Public Health Institute , Budapest , Hungary
| | - Géza Sáfrány
- a Department of Radiation Medicine, Division of Radiobiology and Radiohygiene , National Public Health Institute , Budapest , Hungary
| | - Katalin Lumniczky
- a Department of Radiation Medicine, Division of Radiobiology and Radiohygiene , National Public Health Institute , Budapest , Hungary
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Seo S, Lee D, Seong KM, Park S, Kim SG, Won JU, Jin YW. Radiation-related occupational cancer and its recognition criteria in South Korea. Ann Occup Environ Med 2018; 30:9. [PMID: 29435340 PMCID: PMC5797363 DOI: 10.1186/s40557-018-0219-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Accepted: 01/17/2018] [Indexed: 12/15/2022] Open
Abstract
Ionizing radiation is a well-known carcinogen, and is listed as one carcinogenic agent of occupational cancer. Given the increase in the number of workers exposed to radiation, as well as the increase in concern regarding occupational cancer, the number of radiation-related occupational cancer claims is expected to increase. Unlike exposure assessment of other carcinogenic agents in the workplace, such as asbestos and benzene, radiation exposure is usually assessed on an individual basis with personal dosimeters, which makes it feasible to assess whether a worker’s cancer occurrence is associated with their individual exposure. However, given the absence of a threshold dose for cancer initiation, it remains difficult to identify radiation exposure as the root cause of occupational cancer. Moreover, the association between cancer and radiation exposure in the workplace has not been clearly established due to a lack of scientific evidence. Therefore, criteria for the recognition of radiation-related occupational cancer should be carefully reviewed and updated with new scientific evidence and social consensus. The current criteria in Korea are valid in terms of eligible radiogenic cancer sites, adequate latent period, assessment of radiation exposure, and probability of causation. However, reducing uncertainty with respect to the determination of causation between exposure and cancer and developing more specific criteria that considers mixed exposure to radiation and other carcinogenic agents remains an important open question.
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Affiliation(s)
- Songwon Seo
- 1National Radiation Emergency Medical Center, Korea Institute of Radiological & Medical Sciences, 75, Nowon-ro, Nowon-gu, Seoul, 01812 Republic of Korea.,2Department of Preventive Medicine, Korea University College of Medicine, Seoul, Korea
| | - Dalnim Lee
- 1National Radiation Emergency Medical Center, Korea Institute of Radiological & Medical Sciences, 75, Nowon-ro, Nowon-gu, Seoul, 01812 Republic of Korea
| | - Ki Moon Seong
- 1National Radiation Emergency Medical Center, Korea Institute of Radiological & Medical Sciences, 75, Nowon-ro, Nowon-gu, Seoul, 01812 Republic of Korea
| | - Sunhoo Park
- 1National Radiation Emergency Medical Center, Korea Institute of Radiological & Medical Sciences, 75, Nowon-ro, Nowon-gu, Seoul, 01812 Republic of Korea
| | - Soo-Geun Kim
- 3Department of Occupational Medicine, Sungkyunkwan University, School of Medicine, Seoul, Korea
| | - Jong-Uk Won
- 4The Institute for Occupational Health, Yonsei University College of Medicine, Seoul, Korea
| | - Young Woo Jin
- 1National Radiation Emergency Medical Center, Korea Institute of Radiological & Medical Sciences, 75, Nowon-ro, Nowon-gu, Seoul, 01812 Republic of Korea
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Samet JM, Berrington de González A, Dauer LT, Hatch M, Kosti O, Mettler FA, Satyamitra MM. Gilbert W. Beebe Symposium on 30 Years after the Chernobyl Accident: Current and Future Studies on Radiation Health Effects. Radiat Res 2017; 189:5-18. [PMID: 29136393 DOI: 10.1667/rr14791.1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
This commentary summarizes the presentations and discussions from the 2016 Gilbert W. Beebe symposium "30 years after the Chernobyl accident: Current and future studies on radiation health effects." The symposium was hosted by the National Academies of Sciences, Engineering, and Medicine (the National Academies). The symposium focused on the health consequences of the Chernobyl accident, looking retrospectively at what has been learned and prospectively at potential future discoveries using emerging 21st Century research methodologies.
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Affiliation(s)
- Jonathan M Samet
- a Keck School of Medicine, University of Southern California, Los Angeles, California
| | | | | | | | - Ourania Kosti
- d National Academies of Sciences, Engineering, and Medicine, Washington, DC
| | - Fred A Mettler
- e University of New Mexico School of Medicine, Albuquerque, New Mexico
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Hatch M, Cardis E. Somatic health effects of Chernobyl: 30 years on. Eur J Epidemiol 2017; 32:1047-1054. [PMID: 28929329 DOI: 10.1007/s10654-017-0303-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 08/23/2017] [Indexed: 01/01/2023]
Abstract
2016 marked the 30th anniversary of the Chernobyl Nuclear Power Plant accident. We and others wrote reviews for the 25th anniversary. Since then, additional papers have appeared and it seems timely to highlight lessons learned. To present, not a systematic review, but a commentary drawing attention to notable findings. We include not only recent reports and updates on previous results, but key findings from prior Chernobyl studies. The dose-dependent increase in Papillary Thyroid Cancer (PTC) following childhood I-131 exposure in Ukraine and Belarus has now been shown to persist for decades. Studies of post-Chernobyl PTCs have produced novel information on chromosomal rearrangements and gene fusions, critical to understanding molecular mechanisms. Studies of clean-up workers/liquidators suggest dose-related increases of thyroid cancer and hematological malignancies in adults. They also report increases in cardiovascular and cerebrovascular disease. If confirmed, these would have significant public health and radiation protection implications. The lens opacities following low to moderate doses found earlier are also a concern, particularly among interventional radiologists who may receive substantial lens doses. Finally, there is some, inconsistent, evidence for genetic effects among offspring of exposed persons. Further efforts, including improved dosimetry, collection of information on other risk factors, and continued follow-up/monitoring of established cohorts, could contribute importantly to further understand effects of low doses and dose-rates of radiation, particularly in young people, and ensure that appropriate public health and radiation protection systems are in place. This will require multinational collaborations and long-term funding.
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Affiliation(s)
- Maureen Hatch
- Radiation Epidemiology Branch, National Cancer Institute, Bethesda, MD, 20892-9778, USA
| | - Elisabeth Cardis
- Radiation Programme, Barcelona Institute for Global Health (ISGlobal), Campus Mar, Barcelona Biomedical Research Park (PRBB), Dr Aiguader 88, 08003, Barcelona, Spain. .,Universitat Pompeu Fabra (UPF), Barcelona, Spain. .,CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.
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Oancea SC, Rundquist BC, Simon I, Swartz S, Zheng Y, Zhou X, Sens MA, Schwartz GG. County level incidence rates of chronic lymphocytic leukemia are associated with residential radon levels. Future Oncol 2017; 13:1873-1881. [PMID: 28835109 PMCID: PMC5618932 DOI: 10.2217/fon-2017-0165] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Aim: We previously reported that incidence rates for chronic lymphocytic leukemia (CLL) among US states are significantly correlated with levels of residential radon (RR). Because these correlations could be influenced by confounding and/or misclassification among large geographic units, we reinvestigated them using smaller geographic units that better reflect exposure and disease at the individual level. Methods: We examined the relationships between CLL and RR per county in 478 counties with publicly-available data. Results: After adjustment for ultraviolet radiation, a possible risk factor for CLL, county rates for CLL and RR were significantly correlated among males and females both together and separately (p < 0.0001). Conclusion: CLL is significantly associated with RR at the county level.
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Affiliation(s)
- S Cristina Oancea
- Department of Population Health, School of Medicine & Health Sciences, University of North Dakota, Grand Forks, ND 58202, USA
| | - Bradley C Rundquist
- Department of Geography & Geographic Information Science, University of North Dakota, College of Arts & Sciences, Grand Forks, ND 58202, USA
| | - Isaac Simon
- Department of Earth System Science & Policy, University of North Dakota, John D. Odegard School of Aerospace Sciences, Grand Forks, ND, 58202, USA
| | - Sami Swartz
- Department of Geography & Geographic Information Science, University of North Dakota, College of Arts & Sciences, Grand Forks, ND 58202, USA
| | - Yun Zheng
- Department of Pathology, University of North Dakota, School of Medicine & Health Sciences, Grand Forks, ND 58202, USA
| | - Xudong Zhou
- Department of Pathology, University of North Dakota, School of Medicine & Health Sciences, Grand Forks, ND 58202, USA
| | - Mary Ann Sens
- Department of Pathology, University of North Dakota, School of Medicine & Health Sciences, Grand Forks, ND 58202, USA
| | - Gary G Schwartz
- Department of Population Health, School of Medicine & Health Sciences, University of North Dakota, Grand Forks, ND 58202, USA
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Bazyka D, Finch SC, Ilienko IM, Lyaskivska O, Dyagil I, Trotsiuk N, Gudzenko N, Chumak VV, Walsh KM, Wiemels J, Little MP, Zablotska L. Buccal mucosa micronuclei counts in relation to exposure to low dose-rate radiation from the Chornobyl nuclear accident and other medical and occupational radiation exposures. Environ Health 2017; 16:70. [PMID: 28645274 PMCID: PMC5481966 DOI: 10.1186/s12940-017-0273-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
BACKGROUND Ionizing radiation is a well-known carcinogen. Chromosome aberrations, and in particular micronuclei represent an early biological predictor of cancer risk. There are well-documented associations of micronuclei with ionizing radiation dose in some radiation-exposed groups, although not all. That associations are not seen in all radiation-exposed groups may be because cells with micronuclei will not generally pass through mitosis, so that radiation-induced micronuclei decay, generally within a few years after exposure. METHODS Buccal samples from a group of 111 male workers in Ukraine exposed to ionizing radiation during the cleanup activities at the Chornobyl nuclear power plant were studied. Samples were taken between 12 and 18 years after their last radiation exposure from the Chornobyl cleanup. The frequency of binucleated micronuclei was analyzed in relation to estimated bone marrow dose from the cleanup activities along with a number of environmental/occupational risk factors using Poisson regression adjusted for overdispersion. RESULTS Among the 105 persons without a previous cancer diagnosis, the mean Chornobyl-related dose was 59.5 mSv (range 0-748.4 mSv). There was a borderline significant increase in micronuclei frequency among those reporting work as an industrial radiographer compared with all others, with a relative risk of 6.19 (95% CI 0.90, 31.08, 2-sided p = 0.0729), although this was based on a single person. There was a borderline significant positive radiation dose response for micronuclei frequency with increase in micronuclei per 1000 scored cells per Gy of 3.03 (95% CI -0.78, 7.65, 2-sided p = 0.1170), and a borderline significant reduction of excess relative MN prevalence with increasing time since last exposure (p = 0.0949). There was a significant (p = 0.0388) reduction in MN prevalence associated with bone X-ray exposure, but no significant trend (p = 0.3845) of MN prevalence with numbers of bone X-ray procedures. CONCLUSIONS There are indications of increasing trends of micronuclei prevalence with Chornobyl-cleanup-associated dose, and indications of reduction in radiation-associated excess prevalence of micronuclei with time after exposure. There are also indications of substantially increased micronuclei associated with work as an industrial radiographer. This analysis adds to the understanding of the long-term effects of low-dose radiation exposures on relevant cellular structures and methods appropriate for long-term radiation biodosimetry.
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Affiliation(s)
- D. Bazyka
- National Research Center for Radiation Medicine, 53 Melnikov Street, Kyiv, 04050 Ukraine
| | - S. C. Finch
- Rutgers-Robert Wood Johnson Medical School, 5635, 675 Hoes Lane W, Piscataway Township, New Brunswick, NJ 08854 USA
| | - I. M. Ilienko
- National Research Center for Radiation Medicine, 53 Melnikov Street, Kyiv, 04050 Ukraine
| | - O. Lyaskivska
- National Research Center for Radiation Medicine, 53 Melnikov Street, Kyiv, 04050 Ukraine
| | - I. Dyagil
- National Research Center for Radiation Medicine, 53 Melnikov Street, Kyiv, 04050 Ukraine
| | - N. Trotsiuk
- National Research Center for Radiation Medicine, 53 Melnikov Street, Kyiv, 04050 Ukraine
| | - N. Gudzenko
- National Research Center for Radiation Medicine, 53 Melnikov Street, Kyiv, 04050 Ukraine
| | - V. V. Chumak
- National Research Center for Radiation Medicine, 53 Melnikov Street, Kyiv, 04050 Ukraine
| | - K. M. Walsh
- UCSF Box 0520, Division of Neuroepidemiology, Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, 505 Parnassus Avenue, San Francisco, CA 94143-0520 USA
| | - J. Wiemels
- Box 0520, Laboratory of Molecular Epidemiology, University of California San Francisco Comprehensive Cancer Center, 1450 3rd Street, San Francisco, CA 94158 USA
| | - M. P. Little
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Radiation Epidemiology Branch, Room 7E546, 9609 Medical Center Drive, Bethesda, MD 20892-9778 USA
| | - L.B. Zablotska
- Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, 3333 California St, San Francisco, CA 94118 USA
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Boice JD. The linear nonthreshold (LNT) model as used in radiation protection: an NCRP update. Int J Radiat Biol 2017; 93:1079-1092. [DOI: 10.1080/09553002.2017.1328750] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- John D. Boice
- National Council on Radiation Protection and Measurements, Bethesda, MD, USA
- Department of Medicine, Division of Epidemiology, Vanderbilt University, Nashville, TN, USA
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43
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Finch SC, Dyagil I, Reiss RF, Gudzenko N, Babkina N, Lyubarets T, Bebeshko V, Romanenko A, Chumak VV, Bouville A, Hatch M, Little MP, Bazyka D, Zablotska LB. Clinical characteristics of chronic lymphocytic leukemia occurring in chornobyl cleanup workers. Hematol Oncol 2017; 35:215-224. [PMID: 26806761 PMCID: PMC5531054 DOI: 10.1002/hon.2278] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 11/23/2015] [Accepted: 12/04/2015] [Indexed: 11/06/2022]
Abstract
The recently demonstrated radiation-induction of chronic lymphocytic leukemia (CLL) raises the question as to whether the amount of radiation exposure influences any of the clinical characteristics of the disease. We evaluated the relationship between bone marrow radiation doses and clinical characteristics and survival of 79 CLL cases diagnosed during 1986-2006 in a cohort of 110 645 male workers who participated in the cleanup work of the Chornobyl nuclear accident in Ukraine in 1986. All diagnoses were confirmed by an independent International Hematology Panel. Patients were followed up to the date of death or end of follow-up on 31 October 2010. The median age at diagnosis was 57 years. Median bone marrow dose was 22.6 milligray (mGy) and was not associated with time between exposure and clinical diagnosis of CLL (latent period), age, peripheral blood lymphocyte count or clinical stage of disease in univariate and multivariate analyses. Latent period was significantly shorter among those older at first exposure, smokers and those with higher frequency of visits to the doctor prior to diagnosis. A significant increase in the risk of death with increasing radiation dose was observed (p = 0.03, hazard ratio = 2.38, 95% confidence interval: 1.11,5.08 comparing those with doses ≥22 mGy to doses <22 mGy). After adjustment for radiation dose, survival of CLL cases was significantly shorter among those with younger age at first exposure, higher peripheral blood lymphocyte count, more advanced clinical stage of disease and older age at diagnosis (all p < 0.05). This is the first study to examine association between bone marrow radiation doses from the Chornobyl accident and clinical manifestations of the CLL in Chornobyl cleanup workers. The current study provides new evidence on the association of radiation dose and younger age at first radiation exposure at Chornobyl with shorter survival after diagnosis. Future studies are necessary with more cases in order to improve the statistical power of these analyses and to determine their significance. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Stuart C. Finch
- Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Irina Dyagil
- National Research Center for Radiation Medicine, Kyiv, Ukraine
| | - Robert F. Reiss
- Department of Pathology and Cell Biology, and Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | | | | | | | | | | | - Vadim V. Chumak
- National Research Center for Radiation Medicine, Kyiv, Ukraine
| | - Andre Bouville
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, USA
| | - Maureen Hatch
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, USA
| | - Mark P. Little
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, USA
| | - Dimitry Bazyka
- National Research Center for Radiation Medicine, Kyiv, Ukraine
| | - Lydia B. Zablotska
- Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, San Francisco, CA, USA
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Chronic diseases and mortality among immigrants to Israel from areas contaminated by the Chernobyl disaster: a follow-up study. Int J Public Health 2017; 62:463-469. [PMID: 28130563 DOI: 10.1007/s00038-017-0941-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2016] [Revised: 12/17/2016] [Accepted: 12/29/2016] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVES To examine six chronic diseases and all-cause mortality among immigrants to Israel from areas contaminated by the Chernobyl accident. METHODS The medical data were obtained from the two largest HMOs in Israel. In the assessment of chronic diseases, individuals were divided into three groups: less exposed (n = 480), more exposed (n = 359), and liquidators (n = 45) and in the mortality analysis, into two groups: less exposed (n = 792) and more exposed (n = 590). RESULTS Compared to the less exposed, adults from the more exposed group had increased odds of respiratory disorders (OR = 2.34, 95% CI 1.21, 4.54) and elevated odds, with borderline significance, of ischemic heart disease (OR = 2.01, 95% CI 0.97, 4.20). In addition, the liquidators had increased odds of hypertension compared to the less exposed (OR = 2.64, 95% CI 1.24, 5.64). The Cox proportional-hazards model indicated no difference in the ratio of all-cause mortality between the exposed groups during the follow up period. CONCLUSIONS Our study, conducted approximately two decades after the accident, suggests that exposure to radionuclides may be associated with increased odds of respiratory disorders and hypertension.
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45
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Jargin SV. Debate on the Chernobyl Disaster: Response to Alison Rosamund Katz. INTERNATIONAL JOURNAL OF HEALTH SERVICES 2016; 47:150-159. [PMID: 27956579 DOI: 10.1177/0020731416679343] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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46
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Kreuzer M, Sobotzki C, Fenske N, Marsh JW, Schnelzer M. Leukaemia mortality and low-dose ionising radiation in the WISMUT uranium miner cohort (1946–2013). Occup Environ Med 2016; 74:252-258. [DOI: 10.1136/oemed-2016-103795] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Revised: 09/08/2016] [Accepted: 10/08/2016] [Indexed: 12/30/2022]
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47
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Drozdovitch V, Chumak V, Kesminiene A, Ostroumova E, Bouville A. Doses for post-Chernobyl epidemiological studies: are they reliable? JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2016; 36:R36-R73. [PMID: 27355439 PMCID: PMC9426290 DOI: 10.1088/0952-4746/36/3/r36] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
On 26 April 2016, thirty years will have elapsed since the occurrence of the Chernobyl accident, which has so far been the most severe in the history of the nuclear reactor industry. Numerous epidemiological studies were conducted to evaluate the possible health consequences of the accident. Since the credibility of the association between the radiation exposure and health outcome is highly dependent on the adequacy of the dosimetric quantities used in these studies, this paper makes an effort to overview the methods used to estimate individual doses and the associated uncertainties in the main analytical epidemiological studies (i.e. cohort or case-control) related to the Chernobyl accident. Based on the thorough analysis and comparison with other radiation studies, the authors conclude that individual doses for the Chernobyl analytical epidemiological studies have been calculated with a relatively high degree of reliability and well-characterized uncertainties, and that they compare favorably with many other non-Chernobyl studies. The major strengths of the Chernobyl studies are: (1) they are grounded on a large number of measurements, either performed on humans or made in the environment; and (2) extensive effort has been invested to evaluate the uncertainties associated with the dose estimates. Nevertheless, gaps in the methodology are identified and suggestions for the possible improvement of the current dose estimates are made.
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Affiliation(s)
- Vladimir Drozdovitch
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Vadim Chumak
- National Research Centre for Radiation Medicine, Kyiv, Ukraine
| | | | | | - André Bouville
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
- Retired
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48
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Weiland N, Steiner DM, Grosche B. [Effects on health of the Chernobyl accident: 30 years on]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2016; 59:1171-7. [PMID: 27481124 DOI: 10.1007/s00103-016-2415-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This paper reflects the current state of research into the short- and long-term effects on health in the former Soviet Union and Europe of the nuclear accident in Chernobyl. It discusses the latest results of epidemiological studies and presents future research perspectives.
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Affiliation(s)
- N Weiland
- Bundesamt für Strahlenschutz, Ingolstädter Landstraße 1, 85764, Neuherberg, Deutschland
| | - Dr M Steiner
- Bundesamt für Strahlenschutz, Ingolstädter Landstraße 1, 85764, Neuherberg, Deutschland
| | - B Grosche
- Bundesamt für Strahlenschutz, Ingolstädter Landstraße 1, 85764, Neuherberg, Deutschland.
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Bazyka D, Gudzenko N, Dyagil I, Goroh E, Polyschuk O, Trotsuk N, Babkina N, Romanenko A. Chronic Lymphocytic Leukemia in Chornobyl Cleanup Workers. HEALTH PHYSICS 2016; 111:186-191. [PMID: 27356063 DOI: 10.1097/hp.0000000000000440] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
This paper describes the chronic lymphocytic leukemia (CLL) incidence in a cohort of 110,645 (enlarged later to 152,520) male Ukrainian cleanup workers of the Chornobyl (Chernobyl) accident who were exposed to a range of radiation doses over the 1986-1990 time period. The standardized incidence rates are presented for a 27-y period after the exposure. For 2007-2012 period, the authors have identified the incident CLL cases in an enlarged cohort of 152,520 persons by linkage of the cohort file with the Ukrainian National Cancer Registry (NCRU). CLL data for the previous period (1987-2006) were identified in a frame of the Ukrainian-American leukemia study in the original cohort of 110,645 male clean-up workers. A significant CLL incidence excess was shown for the entire study period 1987-2012, with more prominent levels for the earliest years (1987-1996) when the standardized incidence rate (SIR) value was estimated to be 3.61 with 95% confidence interval from 2.32 to 4.91. In 2007-2012, the CLL incidence decreased substantially but still exceeded the national level although not significantly. In parallel, the several studies were performed at the National Research Center for Radiation Medicine (NRCRM) to explore if any clinical and cytogenetic features of CLL existed in the clean-up workers. The clinical study included 80 exposed and 70 unexposed CLL cases. Among the major clinical differences of the CLL course in the clean-up workers were a shorter period of white blood cells (WBC) doubling (10.7 vs. 18.0; p<0.001), frequent infectious episodes, lymphoadenopathy and hepatosplenomegaly (37 vs. 16), higher expression for CD38, and lower expression for ZAP-70 antigen.
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Affiliation(s)
- Dimitry Bazyka
- *National Research Center for Radiation Medicine, Ukraine (RCRM); †National Cancer Registry of Ukraine (NCRU)
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Zablotska LB. 30 years After the Chernobyl Nuclear Accident: Time for Reflection and Re-evaluation of Current Disaster Preparedness Plans. J Urban Health 2016; 93:407-13. [PMID: 27130482 PMCID: PMC4899336 DOI: 10.1007/s11524-016-0053-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
It has been 30 years since the worst accident in the history of the nuclear era occurred at the Chernobyl power plant in Ukraine close to densely populated urban areas. To date, epidemiological studies reported increased long-term risks of leukemia, cardiovascular diseases, and cataracts among cleanup workers and of thyroid cancer and non-malignant diseases in those exposed as children and adolescents. Mental health effects were the most significant public health consequence of the accident in the three most contaminated countries of Ukraine, Belarus, and the Russian Federation. Timely and clear communication with affected populations emerged as one of the main lessons in the aftermath of the Chernobyl nuclear accident.
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