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Kato T, Yamada K, Hongyo T. Area Dose-Response and Radiation Origin of Childhood Thyroid Cancer in Fukushima Based on Thyroid Dose in UNSCEAR 2020/2021: High 131I Exposure Comparable to Chernobyl. Cancers (Basel) 2023; 15:4583. [PMID: 37760552 PMCID: PMC10526940 DOI: 10.3390/cancers15184583] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 09/03/2023] [Accepted: 09/04/2023] [Indexed: 09/29/2023] Open
Abstract
The FMU and the United Nations Scientific Committee on the Effects of Atomic Radiation (UNSCEAR) concluded that the high incidence of thyroid cancer after the Fukushima nuclear accident was not the result of radiation exposure, but rather might have been overdiagnosis based on the low thyroid dose estimated in the UNSCEAR 2020/2021 report. In this study, the origin of increased PTC in Fukushima was examined based on the thyroid dose estimated by UNSCEAR. The dose-response relationship of the incidence rate per person-years (PY) was analyzed for four areas in Fukushima prefecture via regression analysis. The linear response of the annual incidence rates to thyroid dose in the first six years showed that the dominant origin of childhood thyroid cancer was radiation exposure. Excess absolute risk (EAR) proportionally increased with thyroid dose, with an EAR/104 PY Gy of 143 (95%CI: 122, 165) in the second TUE (p < 0.001), which is approximately 50-100 times higher than the EAR/104 PY Gy ≒ 2.3 observed after the Chernobyl accident. This suggests an underestimation of the thyroid dose by UNSCEAR of approximately 1/50~1/100 compared with the thyroid dose for Chernobyl. The increased childhood thyroid cancer in Fukushima was found to arise from radioactive iodine exposure, which was comparable to that in Chernobyl.
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Affiliation(s)
| | | | - Tadashi Hongyo
- Department of Radiation Biology, Health Sciences, Graduate School of Medicine, Osaka University, Osaka 565-0871, Japan;
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2
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Yasumura S, Ohira T, Ishikawa T, Shimura H, Sakai A, Maeda M, Miura I, Fujimori K, Ohto H, Kamiya K. Achievements and Current Status of the Fukushima Health Management Survey. J Epidemiol 2022; 32:S3-S10. [PMID: 36464298 PMCID: PMC9703928 DOI: 10.2188/jea.je20210390] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022] Open
Abstract
The Fukushima Health Management Survey (FHMS) was established in response to the Fukushima Daiichi Nuclear Power Plant accident on March 11, 2011. The primary objectives of the study are to monitor residents' long-term health and promote their future well-being, and to determine the health effects of long-term low-dose radiation exposure. This special issue summarizes the results and current status of the FHMS and discusses the challenges and future directions of the FHMS. The FHMS, a cohort study of all people who were residents in Fukushima Prefecture at the time of the accident, consists of a Basic Survey, Thyroid Ultrasound Examination, Comprehensive Health Check, Mental Health and Lifestyle Survey, and Pregnancy and Birth Survey. The radiation exposure was estimated based on the behavioral records examined using the Basic Survey. Although the response rate was low in the Basic Survey, the representativeness of the radiation exposure data was confirmed using additional surveys. There appears to be no relationship between the radiation exposure and risk of thyroid cancer, although more thyroid cancer cases were detected than initially expected. The ongoing Comprehensive Health Check and Mental Health and Lifestyle Survey have provided evidence of worsening physical and mental health status. The Pregnancy and Birth Survey showed rates of preterm delivery, low birth weight, and congenital abnormalities similar to the national average. Considering the above evidence, the Fukushima Prefectural Government decided to end the Pregnancy and Birth Survey at the end of March 2021, as recommended by the Prefectural Oversight Committee. The framework of the FHMS has not changed, but the FHMS needs to adapt according to the survey results and the changing needs of the eligible residents and municipalities.
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Affiliation(s)
- Seiji Yasumura
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima, Japan,Department of Public Health, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Tetsuya Ohira
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima, Japan,Department of Epidemiology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Tetsuo Ishikawa
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima, Japan,Department of Radiation Physics and Chemistry, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Hiroki Shimura
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima, Japan,Department of Laboratory Medicine, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Akira Sakai
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima, Japan,Department of Radiation Life Sciences, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Masaharu Maeda
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima, Japan,Department of Disaster Psychiatry, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Itaru Miura
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima, Japan,Department of Neuropsychiatry, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Keiya Fujimori
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima, Japan,Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Hitoshi Ohto
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima, Japan
| | - Kenji Kamiya
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima, Japan,Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
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3
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Tondel M, Nordquist T, Isaksson M, Rääf C, Wålinder R. Increased cancer risk in male hunters compared to the general male population in Northern Sweden after the Chernobyl Nuclear Power Plant accident? Environ Epidemiol 2021; 4:e084. [PMID: 33778348 PMCID: PMC7942827 DOI: 10.1097/ee9.0000000000000084] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Accepted: 01/15/2020] [Indexed: 11/25/2022] Open
Abstract
Male hunters in Swedish counties with high fallout of 137Cs after the Chernobyl Nuclear Power Plant (NPP) accident have higher radiation exposure due to higher consumption of game compared with the general population. Methods Cancer incidence in Sweden was studied in 9 counties with different 137Cs fallout after the Chernobyl NPP accident in 1986. In total, 9,267 cancer cases occurred in hunters and 138,909 cancer cases in non-hunters to 31 December 2015. Incidence rate ratios (IRR) with 95% confidence intervals (CI) were calculated using unexposed hunters, or non-hunters, as reference to study internal radiation exposure or hunter life style, respectively. Results Directly age standardized total cancer incidence showed an increasing trend in non-hunters. For hunters, the total cancer incidence was significantly lower up to 2001 when the total cancer incidence crossed over the weaker non-hunter trend and remained higher for the following 15 years. IRRs for total cancer in hunters versus non-hunters for each county did not show any clear exposure response pattern. IRRs for hunters versus non-hunters were higher regardless of rural/non-rural status with slightly higher risk estimates for the rural settings. The IRR for hunters was 1.06 (95% CI 1.04-1.08) 1986-2015, representing an excess of 531 cancer cases in hunters. Conclusion An increased total incidence of cancer was identified for male hunters compared with male non-hunters. No obvious association between cancer and 137Cs from the Chernobyl NPP accident could be identified, although the exposure classification was too crude to exclude such an association.
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Affiliation(s)
- Martin Tondel
- Department of Medical Sciences, Occupational and Environmental Medicine, Uppsala University, Sweden.,Occupational and Environmental Medicine, Uppsala University Hospital, Uppsala, Sweden
| | - Tobias Nordquist
- Occupational and Environmental Medicine, Uppsala University Hospital, Uppsala, Sweden
| | - Mats Isaksson
- Department of Radiation Physics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Christopher Rääf
- Medical Radiation Physics, Department of Translational Medicine, Lund University, Malmö, Sweden
| | - Robert Wålinder
- Department of Medical Sciences, Occupational and Environmental Medicine, Uppsala University, Sweden.,Occupational and Environmental Medicine, Uppsala University Hospital, Uppsala, Sweden
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Larsson M, Rudqvist N, Spetz J, Shubbar E, Parris TZ, Langen B, Helou K, Forssell-Aronsson E. Long-term transcriptomic and proteomic effects in Sprague Dawley rat thyroid and plasma after internal low dose 131I exposure. PLoS One 2021; 15:e0244098. [PMID: 33382739 PMCID: PMC7774980 DOI: 10.1371/journal.pone.0244098] [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: 05/25/2020] [Accepted: 12/03/2020] [Indexed: 02/08/2023] Open
Abstract
Background Radioiodide (131I) is commonly used to treat thyroid cancer and hyperthyroidis.131I released during nuclear accidents, have resulted in increased incidence of thyroid cancer in children. Therefore, a better understanding of underlying cellular mechanisms behind 131I exposure is of great clinical and radiation protection interest. The aim of this work was to study the long-term dose-related effects of 131I exposure in thyroid tissue and plasma in young rats and identify potential biomarkers. Materials and methods Male Sprague Dawley rats (5-week-old) were i.v. injected with 0.5, 5.0, 50 or 500 kBq 131I (Dthyroid ca 1–1000 mGy), and killed after nine months at which time the thyroid and blood samples were collected. Gene expression microarray analysis (thyroid samples) and LC-MS/MS analysis (thyroid and plasma samples) were performed to assess differential gene and protein expression profiles in treated and corresponding untreated control samples. Bioinformatics analyses were performed using the DAVID functional annotation tool and Ingenuity Pathway Analysis (IPA). The gene expression microarray data and LC-MS/MS data were validated using qRT-PCR and ELISA, respectively. Results Nine 131I exposure-related candidate biomarkers (transcripts: Afp and RT1-Bb, and proteins: ARF3, DLD, IKBKB, NONO, RAB6A, RPN2, and SLC25A5) were identified in thyroid tissue. Two dose-related protein candidate biomarkers were identified in thyroid (APRT and LDHA) and two in plasma (DSG4 and TGM3). Candidate biomarkers for thyroid function included the ACADL and SORBS2 (all activities), TPO and TG proteins (low activities). 131I exposure was shown to have a profound effect on metabolism, immune system, apoptosis and cell death. Furthermore, several signalling pathways essential for normal cellular function (actin cytoskeleton signalling, HGF signalling, NRF2-mediated oxidative stress, integrin signalling, calcium signalling) were also significantly regulated. Conclusion Exposure-related and dose-related effects on gene and protein expression generated few expression patterns useful as biomarkers for thyroid function and cancer.
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Affiliation(s)
- Malin Larsson
- Departments of Radiation Physics, Institute of Clinical Sciences, Sahlgrenska Cancer Center, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
- * E-mail:
| | - Nils Rudqvist
- Departments of Radiation Physics, Institute of Clinical Sciences, Sahlgrenska Cancer Center, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Johan Spetz
- Departments of Radiation Physics, Institute of Clinical Sciences, Sahlgrenska Cancer Center, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Emman Shubbar
- Departments of Radiation Physics, Institute of Clinical Sciences, Sahlgrenska Cancer Center, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Toshima Z. Parris
- Departments of Oncology, Institute of Clinical Sciences, Sahlgrenska Cancer Center, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Britta Langen
- Departments of Radiation Physics, Institute of Clinical Sciences, Sahlgrenska Cancer Center, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Khalil Helou
- Departments of Oncology, Institute of Clinical Sciences, Sahlgrenska Cancer Center, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Eva Forssell-Aronsson
- Departments of Radiation Physics, Institute of Clinical Sciences, Sahlgrenska Cancer Center, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
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Cléro E, Ostroumova E, Demoury C, Grosche B, Kesminiene A, Liutsko L, Motreff Y, Oughton D, Pirard P, Rogel A, Van Nieuwenhuyse A, Laurier D, Cardis E. Lessons learned from Chernobyl and Fukushima on thyroid cancer screening and recommendations in case of a future nuclear accident. ENVIRONMENT INTERNATIONAL 2021; 146:106230. [PMID: 33171378 DOI: 10.1016/j.envint.2020.106230] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 10/16/2020] [Accepted: 10/18/2020] [Indexed: 05/06/2023]
Abstract
Exposure of the thyroid gland to ionizing radiation at a young age is the main recognized risk factor for differentiated thyroid cancer. After the Chernobyl and Fukushima nuclear accidents, thyroid cancer screening was implemented mainly for children, leading to case over-diagnosis as seen in South Korea after the implementation of opportunistic screening (where subjects are recruited at healthcare sites). The aim of cancer screening is to reduce morbidity and mortality, but screening can also cause negative effects on health (with unnecessary treatment if over-diagnosis) and on quality of life. This paper from the SHAMISEN special issue (Nuclear Emergency Situations - Improvement of Medical And Health Surveillance) presents the principles of cancer screening, the lessons learned from thyroid cancer screening, as well as the knowledge on thyroid cancer incidence after exposure to iodine-131. The SHAMISEN Consortium recommends to envisage systematic health screening after a nuclear accident, only when appropriately justified, i.e. ensuring that screening will do more good than harm. Based on the experience of the Fukushima screening, the consortium does not recommend mass or population-based thyroid cancer screening, as the negative psychological and physical effects are likely to outweigh any possible benefit in affected populations; thyroid health monitoring should however be made available to persons who request it (regardless of whether they are at increased risk or not), accompanied with appropriate information and support.
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Affiliation(s)
- Enora Cléro
- Health and Environment Division, Institute for Radiological Protection and Nuclear Safety (IRSN), Fontenay-aux-Roses, France.
| | - Evgenia Ostroumova
- International Agency for Research on Cancer (IARC), World Health Organization, Lyon, France
| | - Claire Demoury
- Risk and Health Impact Assessment Unit, Sciensano, Brussels, Belgium
| | - Bernd Grosche
- Federal Office for Radiation Protection (BfS), Munich, Germany
| | - Ausrele Kesminiene
- International Agency for Research on Cancer (IARC), World Health Organization, Lyon, France
| | - Liudmila Liutsko
- Institute for Global Health (ISGlobal), Barcelona, Spain; Pompeu Fabra University (UPF), Barcelona, Spain; Spanish Consortium for Research and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
| | | | - Deborah Oughton
- Norwegian University of Life Sciences (NMBU), Center for Environmental Radioactivity (CERAD), Aas, Norway
| | | | - Agnès Rogel
- Santé publique France, Saint-Maurice, France
| | - An Van Nieuwenhuyse
- Risk and Health Impact Assessment Unit, Sciensano, Brussels, Belgium; Centre for Environment and Health, Department of Public Health and Primary Care, Leuven, Belgium
| | - Dominique Laurier
- Health and Environment Division, Institute for Radiological Protection and Nuclear Safety (IRSN), Fontenay-aux-Roses, France
| | - Elisabeth Cardis
- Institute for Global Health (ISGlobal), Barcelona, Spain; Pompeu Fabra University (UPF), Barcelona, Spain; Spanish Consortium for Research and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
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Selmansberger M, Michna A, Braselmann H, Höfig I, Schorpp K, Weber P, Anastasov N, Zitzelsberger H, Hess J, Unger K. Transcriptome network of the papillary thyroid carcinoma radiation marker CLIP2. Radiat Oncol 2020; 15:182. [PMID: 32727620 PMCID: PMC7392692 DOI: 10.1186/s13014-020-01620-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 07/15/2020] [Indexed: 11/29/2022] Open
Abstract
Background We present a functional gene association network of the CLIP2 gene, generated by de-novo reconstruction from transcriptomic microarray data. CLIP2 was previously identified as a potential marker for radiation induced papillary thyroid carcinoma (PTC) of young patients in the aftermath of the Chernobyl reactor accident. Considering the rising thyroid cancer incidence rates in western societies, potentially related to medical radiation exposure, the functional characterization of CLIP2 is of relevance and contributes to the knowledge about radiation-induced thyroid malignancies. Methods We generated a transcriptomic mRNA expression data set from a CLIP2-perturbed thyroid cancer cell line (TPC-1) with induced CLIP2 mRNA overexpression and siRNA knockdown, respectively, followed by gene-association network reconstruction using the partial correlation-based approach GeneNet. Furthermore, we investigated different approaches for prioritizing differentially expressed genes for network reconstruction and compared the resulting networks with existing functional interaction networks from the Reactome, Biogrid and STRING databases. The derived CLIP2 interaction partners were validated on transcript and protein level. Results The best reconstructed network with regard to selection parameters contained a set of 20 genes in the 1st neighborhood of CLIP2 and suggests involvement of CLIP2 in the biological processes DNA repair/maintenance, chromosomal instability, promotion of proliferation and metastasis. Peptidylprolyl Isomerase Like 3 (PPIL3), previously identified as a potential direct interaction partner of CLIP2, was confirmed in this study by co-expression at the transcript and protein level. Conclusion In our study we present an optimized preselection approach for genes subjected to gene-association network reconstruction, which was applied to CLIP2 perturbation transcriptome data of a thyroid cancer cell culture model. Our data support the potential carcinogenic role of CLIP2 overexpression in radiation-induced PTC and further suggest potential interaction partners of the gene.
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Affiliation(s)
- Martin Selmansberger
- Research Unit Radiation Cytogenetics, Helmholtz Zentrum München, German Research Center for Environmental Health GmbH, 85764, Neuherberg, Germany
| | - Agata Michna
- Research Unit Radiation Cytogenetics, Helmholtz Zentrum München, German Research Center for Environmental Health GmbH, 85764, Neuherberg, Germany
| | - Herbert Braselmann
- Research Unit Radiation Cytogenetics, Helmholtz Zentrum München, German Research Center for Environmental Health GmbH, 85764, Neuherberg, Germany
| | - Ines Höfig
- Institute of Radiation Biology, Helmholtz Zentrum München, German Research Center for Environmental Health GmbH, 85764, Neuherberg, Germany
| | - Kenji Schorpp
- Institute for Molecular Toxicology and Pharmacology, Helmholtz Zentrum München, German Research Center for Environmental Health GmbH, 85764, Neuherberg, Germany
| | - Peter Weber
- Research Unit Radiation Cytogenetics, Helmholtz Zentrum München, German Research Center for Environmental Health GmbH, 85764, Neuherberg, Germany
| | - Natasa Anastasov
- Institute of Radiation Biology, Helmholtz Zentrum München, German Research Center for Environmental Health GmbH, 85764, Neuherberg, Germany
| | - Horst Zitzelsberger
- Research Unit Radiation Cytogenetics, Helmholtz Zentrum München, German Research Center for Environmental Health GmbH, 85764, Neuherberg, Germany.,Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany.,Clinical Cooperation Group 'Personalized Radiotherapy in Head and Neck Cancer', Helmholtz Zentrum München, German Research Center for Environmental Health GmbH, 85764, Neuherberg, Germany
| | - Julia Hess
- Research Unit Radiation Cytogenetics, Helmholtz Zentrum München, German Research Center for Environmental Health GmbH, 85764, Neuherberg, Germany.,Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany.,Clinical Cooperation Group 'Personalized Radiotherapy in Head and Neck Cancer', Helmholtz Zentrum München, German Research Center for Environmental Health GmbH, 85764, Neuherberg, Germany
| | - Kristian Unger
- Research Unit Radiation Cytogenetics, Helmholtz Zentrum München, German Research Center for Environmental Health GmbH, 85764, Neuherberg, Germany. .,Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany. .,Clinical Cooperation Group 'Personalized Radiotherapy in Head and Neck Cancer', Helmholtz Zentrum München, German Research Center for Environmental Health GmbH, 85764, Neuherberg, Germany.
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Takahashi H, Yasumura S, Takahashi K, Ohira T, Ohtsuru A, Midorikawa S, Suzuki S, Shimura H, Ishikawa T, Sakai A, Suzuki S, Yokoya S, Tanigawa K, Ohto H, Kamiya K. Nested matched case control study for the Japan Fukushima Health Management Survey's first full-scale (second-round) thyroid examination. Medicine (Baltimore) 2020; 99:e20440. [PMID: 32629628 PMCID: PMC7337421 DOI: 10.1097/md.0000000000020440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Since Fukushima nuclear accident in 2011, thyroid ultrasound examinations have been conducted. The first full-scale examination detected 71 thyroid-cancer cases. This study examined whether radiation exposure was associated with thyroid-cancer incidence.Subjects were participants in the baseline screening and newborns during the 2011 fiscal year. Under nested matched case-control study design, 10 controls per each case were selected by matching the age, sex, baseline screening results, and interval between examinations. With 3 dose levels of external radiation: 1.3 + mSv (upper), 0.8 to 1.3 (middle), and 0.0 to 0.8 (reference), we applied 2 logistic models adjusting for 3 participation-proportions (primary, secondary, and fine-needle aspiratory cytology), overweight, and the B-result of baseline screening (Model 1), and past medical history, family history of thyroid cancer, and frequencies of eating seafood and seaweed in addition to the parameters in Model 1 (Model 2). We examined each model in 3 ways: (a) excluding subjects with a missing radiation exposure dose; and substituting (b1) median or (b2) mean dose of the municipality with missing dose.Odds ratios (ORs) of middle-dose exposure were (a) 1.35 (0.46-3.94), (b1) 1.55 (0.61-3.96), and (b2) 1.23 (0.50-3.03) for Model 1, and (a) 1.18 (0.39-3.57), (b1) 1.31 (0.49-3.49), and (b2) 1.02 (0.40-2.59) for Model 2. For upper-dose exposure, similar results were obtained. Past medical history was significantly associated (odds ratio = 2.04-2.08) with both (b1) and (b2) in Model 2.No significant associations were obtained between the external radiation exposure and thyroid-cancer incidence.
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Affiliation(s)
- Hideto Takahashi
- National Institute of Public Health, Saitama
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University
| | - Seiji Yasumura
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University
- Department of Public Health, Fukushima Medical University School of Medicine, Fukushima
| | - Kunihiko Takahashi
- Department of Biostatistics M&D Data Science Center Tokyo Medical and Dental University
| | - Tetsuya Ohira
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University
- Department of Epidemiology
| | - Akira Ohtsuru
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University
- Department of Radiation Health Management
| | - Sanae Midorikawa
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University
- Department of Radiation Health Management
| | - Satoru Suzuki
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University
| | - Hiroki Shimura
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University
- Department of Laboratory Medicine
| | - Tetsuo Ishikawa
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University
- Department of Radiation Physics and Chemistry
| | - Akira Sakai
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University
- Department of Radiation Life Sciences
| | - Shinichi Suzuki
- Department of Thyroid and Endocrinology, Fukushima Medical University School of Medicine
| | - Susumu Yokoya
- Thyroid and Endocrine Center, Fukushima Medical University, Fukushima
| | - Koichi Tanigawa
- Fukushima Global Medical Science Center, Fukushima Medical University
| | - Hitoshi Ohto
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University
| | - Kenji Kamiya
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University
- Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
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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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9
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Leung KM, Shabat G, Lu P, Fields AC, Lukashenko A, Davids JS, Melnitchouk N. Trends in Solid Tumor Incidence in Ukraine 30 Years After Chernobyl. J Glob Oncol 2019; 5:1-10. [PMID: 31454285 PMCID: PMC6733202 DOI: 10.1200/jgo.19.00099] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
PURPOSE There is limited knowledge of the long-term health effects of the Chernobyl nuclear power plant accident that occurred more than 30 years ago in Ukraine. This study describes trends in the incidence of solid organ malignancy in Ukraine and the five regions most affected by the radioactive fallout. METHODS The National Cancer Registry of Ukraine was queried for age-standardized incidence rates (ASIRs) of solid organ malignancy in Ukraine and the regions of Kyiv, Chernihiv, Zhytomyr, Rivne, and Volyn covering the period of 1999 to 2016. Joinpoint analysis was used to calculate the average annual percentage of change. RESULTS The highest burdens of cancer incidence in Ukraine were seen in the lung, stomach, breast, and prostate. We observed significant increases in the ASIRs of colon (average annual percentage of change, 1.5 [95% CI, 1.3 to 1.7]), rectal (0.9 [95% CI, 0.6 to 1.2]), kidney (2.3 [95% CI, 1.8 to 2.9]), thyroid (4.2 [95% CI, 3.1 to 5.3]), breast (1 [95% CI, 0.6 to 1.4]), cervical (0.7 [95% CI, 0.3 to 1.2]), and prostate (3.9 [95% CI, 3.6 to 4.2]) cancers, with decreases in stomach (−2.4 [95% CI, −2.5 to −2.3]) and lung (−1.8 [95% CI, −2.1 to −1.5]) cancers. ASIRs in the affected regions were similar to nationwide rates, with the exception of those for Kyiv. CONCLUSION The incidence rates of many solid organ malignancies in Ukraine are rising. However, the rates of solid organ malignancy in the five regions most affected by fallout did not substantially differ from national patterns, with the exception of those for Kyiv. Ongoing monitoring of cancer incidence in Ukraine is necessary to understand how best to decrease disease burden nationwide and to elucidate the causes of regional variations in ASIRs, such as access to diagnostics and environmental exposures.
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Affiliation(s)
- Krystle M Leung
- Brigham and Women's Hospital, Boston, MA.,Harvard Medical School, Boston, MA
| | - Galyna Shabat
- National Cancer Institute, Kyiv, Ukraine.,University of Turin, Turin, Italy
| | - Pamela Lu
- Brigham and Women's Hospital, Boston, MA.,Harvard Medical School, Boston, MA
| | | | | | | | - Nelya Melnitchouk
- Brigham and Women's Hospital, Boston, MA.,Harvard Medical School, Boston, MA
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Assessing Individuals' Exposure to Environmental Conditions Using Residence-based Measures, Activity Location-based Measures, and Activity Path-based Measures. Epidemiology 2019; 30:166-176. [PMID: 30721163 DOI: 10.1097/ede.0000000000000940] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Many approaches are available to researchers who wish to measure individuals' exposure to environmental conditions. Different approaches may yield different estimates of associations with health outcomes. Taking adolescents' exposure to alcohol outlets as an example, we aimed to (1) compare exposure measures and (2) assess whether exposure measures were differentially associated with alcohol consumption. METHODS We tracked 231 adolescents 14-16 years of age from the San Francisco Bay Area for 4 weeks in 2015/2016 using global positioning systems (GPS). Participants were texted ecologic momentary assessment surveys six times per week, including assessment of alcohol consumption. We used GPS data to calculate exposure to alcohol outlets using three approach types: residence-based (e.g., within the home census tract), activity location-based (e.g., within buffer distances of frequently attended places), and activity path-based (e.g., average outlets per hour within buffer distances of GPS route lines). Spearman correlations compared exposure measures, and separate Tobit models assessed associations with the proportion of ecologic momentary assessment responses positive for alcohol consumption. RESULTS Measures were mostly strongly correlated within approach types (ρ ≥ 0.7), but weakly (ρ < 0.3) to moderately (0.3 ≤ ρ < 0.7) correlated between approach types. Associations with alcohol consumption were mostly inconsistent within and between approach types. Some of the residence-based measures (e.g., census tract: β = 8.3, 95% CI = 2.8, 13.8), none of the activity location-based approaches, and most of the activity path-based approaches (e.g., outlet-hours per hour, 100 m buffer: β = 8.3, 95% CI = 3.3, 13.3) were associated with alcohol consumption. CONCLUSIONS Methodologic decisions regarding measurement of exposure to environmental conditions may affect study results.
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11
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Rääf CL, Tondel M, Isaksson M. A model for estimating the total absorbed dose to the thyroid in Swedish inhabitants following the Chernobyl Nuclear Power Plant accident: implications for existing international estimates and future model applications. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2019; 39:522-547. [PMID: 30736018 DOI: 10.1088/1361-6498/ab0577] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The time-integrated absorbed dose to the thyroid gland in the years after a fallout event can indicate the potential excess number of thyroid cancers among young individuals after a radionuclide release. Typical mean values of the absorbed dose to the thyroid have been calculated previously using reported data on radioiodine obtained from air sampling and dairy milk surveys in Sweden after the Chernobyl fallout, not including the contribution from 134Cs and 137Cs. We have developed a model for Swedish conditions taking these additional dose contributions into account. Our estimate of the average time-integrated absorbed dose to the thyroid, D th,tot, during the first 5 years after fallout ranged from 0.5-4.1 mGy for infants and from 0.3-3.3 mGy for adults. The contribution to D th,tot from 131I through inhalation and milk consumption varied considerably among different regions of Sweden, ranging from 9%-79% in infants, and from 4%-58% in adults. The external irradiation and exposure from the ingestion of 134,137Cs in foodstuffs accounted for the remaining contributions to D th,tot (i.e. up to 96% for adults). These large variations can be explained by the highly diverse conditions in the regions studied, such as different degrees of fractionation between wet and dry deposition, different grazing restrictions on dairy cattle, and differences in 134,137Cs transfers through food resulting from differences in the local fallout. It is our conclusion that the main contribution to D th,tot from nuclear power plant fallout in areas subjected to predominantly wet deposition will be from external exposure from ground deposition, followed by internal exposure from contaminated food containing the long-lived fission product 137Cs and the neutron-activated fission product 134Cs. The contribution from 134,137Cs to the thyroid absorbed dose should thus be taken into account in future epidemiological studies.
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Affiliation(s)
- C L Rääf
- Medical Radiation Physics, Department of Translational Medicine (ITM), Lund University, Sweden
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12
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Vimercati L, De Maria L, Mansi F, Caputi A, Ferri GM, Luisi V, Lovreglio P, Cannone ESS, Lorusso P, Gatti MF, Massagli CRS, Triggiani V. Prevalence of Thyroid Diseases in an Occupationally Radiation Exposed Group: A Cross-Sectional Study in a University Hospital of Southern Italy. Endocr Metab Immune Disord Drug Targets 2018; 19:803-808. [PMID: 30387406 DOI: 10.2174/1871530318666181102114627] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 10/15/2018] [Accepted: 10/15/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND Thyroid diseases occur more frequently in people exposed to ionizing radiation, but the relationship between occupational exposure to ionizing radiation and thyroid pathologies still remains unclear. OBJECTIVE To evaluate the prevalence of thyroid diseases in healthcare workers exposed to low-level ionizing radiation compared with a control group working at the University Hospital of Bari, Southern Italy, and living in the same geographical area, characterized by mild iodine deficiency. METHODS We ran a cross-sectional study to investigate whether healthcare workers exposed to ionizing radiation had a higher prevalence of thyroid diseases. Four hundred and forty-four exposed healthcare workers (241 more exposed, or "A Category", and 203 less exposed, or "B Category") and 614 nonexposed healthcare workers were enrolled during a routine examination at the Occupational Health Unit. They were asked to fill in an anamnestic questionnaire and undergo a physical examination, serum determination of fT3, fT4 and TSH, anti-TPO ab and anti-TG ab and ultrasound neck scan. Thyroid nodules were submitted to fine needle aspiration biopsy when indicated. RESULTS The prevalence of thyroid diseases was statistically higher in the exposed workers compared to controls (40% vs 29%, adPR 1.65; IC95% 1.34-2.07). In particular, the thyroid nodularity prevalence in the exposed group was approximately twice as high as that in the controls (29% vs 13%; adPR 2.83; IC95% 2.12-3.8). No statistically significant association was found between exposure to ionizing radiation and other thyroid diseases. CONCLUSION In our study, mild ionizing radiation-exposed healthcare workers had a statistically higher prevalence of thyroid diseases than the control group. The results are likely due to a closer and more meticulous health surveillance programme carried out in the ionising radiation-exposed workers, allowing them to identify thyroid alterations earlier than non-exposed health staff.
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Affiliation(s)
- Luigi Vimercati
- Interdisciplinary Department of Medicine, Section of Occupational Medicine, University of Bari Aldo Moro, Bari, Italy
| | - Luigi De Maria
- Interdisciplinary Department of Medicine, Section of Occupational Medicine, University of Bari Aldo Moro, Bari, Italy
| | - Francesca Mansi
- Interdisciplinary Department of Medicine, Section of Occupational Medicine, University of Bari Aldo Moro, Bari, Italy
| | - Antonio Caputi
- Interdisciplinary Department of Medicine, Section of Occupational Medicine, University of Bari Aldo Moro, Bari, Italy
| | - Giovanni M Ferri
- Interdisciplinary Department of Medicine, Section of Occupational Medicine, University of Bari Aldo Moro, Bari, Italy
| | - Vito Luisi
- Interdisciplinary Department of Medicine, Section of Occupational Medicine, University of Bari Aldo Moro, Bari, Italy
| | - Piero Lovreglio
- Interdisciplinary Department of Medicine, Section of Occupational Medicine, University of Bari Aldo Moro, Bari, Italy
| | - Enza S S Cannone
- Interdisciplinary Department of Medicine, Section of Occupational Medicine, University of Bari Aldo Moro, Bari, Italy
| | - Pietro Lorusso
- Interdisciplinary Department of Medicine, Section of Occupational Medicine, University of Bari Aldo Moro, Bari, Italy
| | - Maria F Gatti
- Interdisciplinary Department of Medicine, Section of Occupational Medicine, University of Bari Aldo Moro, Bari, Italy
| | - Chiara R S Massagli
- Interdisciplinary Department of Medicine, Section of Occupational Medicine, University of Bari Aldo Moro, Bari, Italy
| | - Vincenzo Triggiani
- Interdisciplinary Department of Medicine, Section of Internal Medicine, Geriatrics, Endocrinology and Rare Diseases, University of Bari Aldo Moro, Bari, Italy
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Drozd VM, Branovan I, Shiglik N, Biko J, Reiners C. Thyroid Cancer Induction: Nitrates as Independent Risk Factors or Risk Modulators after Radiation Exposure, with a Focus on the Chernobyl Accident. Eur Thyroid J 2018; 7:67-74. [PMID: 29594057 PMCID: PMC5869559 DOI: 10.1159/000485971] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Revised: 12/01/2017] [Indexed: 12/31/2022] Open
Abstract
In recent decades, differentiated thyroid cancer (DTC) incidence has been increasing worldwide. The important contributions to this phenomenon of "overdiagnosis" driven by wider use of improved ultrasound systems are amply documented, notwithstanding the "real" carcinogenic effects of ionizing radiation, e.g., from the Chernobyl accident or health care interventions. Less well understood is the role of nitrates - as environmental pollutants, in diet, and in medication - in thyroid carcinogenesis. Increasing exposure to nitrates is associated with rising incidence of esophageal, stomach, bladder, and colon cancers. Recent data suggest that in agricultural areas with higher mean nitrate levels in groundwater, DTC risk is also elevated. Our work in Belarus after Chernobyl has shown that children in districts with high nitrate concentrations in drinking water had significantly higher thyroid cancer incidence after irradiation than did their counterparts in areas with lower nitrate concentrations. Notwithstanding thyroid shielding, increasing use of computed tomography and dental X-rays heightens radiation exposure of the salivary glands in the general population, especially in children and adolescents. When nitrate intake is increased, salivary gland irradiation may potentially result in carcinogenic elevations in plasma nitric oxide concentrations. In conclusion, excess nitrate intake seems to be an independent risk factor for DTC. Additionally, we hypothesize from our data that high nitrate levels modulate the carcinogenic effect of radiation on the thyroid. Cohort studies, case-control studies, or both, are needed to quantify the effects of nitrates on DTC risk in the presence or absence of radiation exposure, e.g., that associated with diagnostic or therapeutic health care interventions.
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Affiliation(s)
- Valentina M. Drozd
- The International Fund “Help for patients with radiation-induced thyroid cancer ‘Arnica’”, Minsk, Belarus
- Project Chernobyl, Brooklyn, New York, USA
- *Prof. Valentina M. Drozd, MD, PhD, The International Fund “Help for patients with radiation-induced thyroid cancer ‘Arnica’”, Zolotaya Gorka 11, 1, Minsk 220005 (Belarus), E-Mail
| | | | | | - Johannes Biko
- Clinic and Polyclinic of Nuclear Medicine, University of Würzburg, Würzburg, Germany
| | - Christoph Reiners
- The International Fund “Help for patients with radiation-induced thyroid cancer ‘Arnica’”, Minsk, Belarus
- Clinic and Polyclinic of Nuclear Medicine, University of Würzburg, Würzburg, Germany
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14
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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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15
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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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Abstract
After the Great East Japan Earthquake on March 11, 2011, the Tokyo Electric Power Company Fukushima Daiichi Nuclear Power Plant accident occurred. The Fukushima prefectural government decided to launch the Fukushima Health Management Survey; Fukushima Medical University was entrusted to design and implement the survey. The survey process and development is described from the standpoint of its background and aim. An overview of the basic survey and 4 detailed surveys is briefly provided. Issues related to the survey are discussed from the perspective of supporting the Fukushima residents.
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Affiliation(s)
| | - Masafumi Abe
- 1 Fukushima Medical University, Fukushima, Japan.,2 Fukushima Prefectural Government, Fukushima, Japan
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17
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Sholl LM, Barletta JA, Hornick JL. Radiation-associated neoplasia: clinical, pathological and genomic correlates. Histopathology 2017; 70:70-80. [PMID: 27960236 DOI: 10.1111/his.13069] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 08/26/2016] [Indexed: 01/21/2023]
Abstract
Ionizing radiation is an established risk factor for the development of benign and malignant tumours. The epidemiology of radiation-associated neoplasia has been studied over the decades in diverse populations, including Japanese atomic bomb survivors, exposed communities following the Chernobyl nuclear power plant disaster, and paediatric and adult populations receiving therapeutic irradiation. Radiation has been associated with an increased risk of neoplasia throughout the human body, with some sites showing a markedly increased relative risk of developing tumours (thyroid; soft tissues), depending on patient age and the context of exposure. Although the mechanisms of cellular injury and repair resulting from ionizing radiation are well described, the genomics of radiation-induced tumours are still relatively poorly understood, with some exceptions, such as RET rearrangement in thyroid carcinomas following iodine-131 exposure and MYC amplification in cutaneous angiosarcoma following chest wall irradiation for breast cancer. This review will provide a general overview of the epidemiology, molecular mechanism, pathology and genomics of radiation-associated neoplasia in humans.
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Affiliation(s)
- Lynette M Sholl
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Justine A Barletta
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Jason L Hornick
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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18
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Kaiser JC, Meckbach R, Eidemüller M, Selmansberger M, Unger K, Shpak V, Blettner M, Zitzelsberger H, Jacob P. Integration of a radiation biomarker into modeling of thyroid carcinogenesis and post-Chernobyl risk assessment. Carcinogenesis 2016; 37:1152-1160. [PMID: 27729373 PMCID: PMC5137265 DOI: 10.1093/carcin/bgw102] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Revised: 09/20/2016] [Accepted: 10/10/2016] [Indexed: 01/18/2023] Open
Abstract
Strong evidence for the statistical association between radiation exposure and disease has been produced for thyroid cancer by epidemiological studies after the Chernobyl accident. However, limitations of the epidemiological approach in order to explore health risks especially at low doses of radiation appear obvious. Statistical fluctuations due to small case numbers dominate the uncertainty of risk estimates. Molecular radiation markers have been searched extensively to separate radiation-induced cancer cases from sporadic cases. The overexpression of the CLIP2 gene is the most promising of these markers. It was found in the majority of papillary thyroid cancers (PTCs) from young patients included in the Chernobyl tissue bank. Motivated by the CLIP2 findings we propose a mechanistic model which describes PTC development as a sequence of rate-limiting events in two distinct paths of CLIP2-associated and multistage carcinogenesis. It integrates molecular measurements of the dichotomous CLIP2 marker from 141 patients into the epidemiological risk analysis for about 13 000 subjects from the Ukrainian-American cohort which were exposed below age 19 years and were put under enhanced medical surveillance since 1998. For the first time, a radiation risk has been estimated solely from marker measurements. Cross checking with epidemiological estimates and model validation suggests that CLIP2 is a marker of high precision. CLIP2 leaves an imprint in the epidemiological incidence data which is typical for a driver gene. With the mechanistic model, we explore the impact of radiation on the molecular landscape of PTC. The model constitutes a unique interface between molecular biology and radiation epidemiology.
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Affiliation(s)
- Jan Christian Kaiser
- *To whom correspondence should be addressed. Tel: +49 8931874028; Fax: +49 31873363
| | | | - Markus Eidemüller
- Institute of Radiation Protection, Helmholtz Zentrum München, 85764 Oberschleißheim, Germany
- Boris-Blacher-Str. 14, 80939 München, Germany
- Helmholtz Zentrum München, Research Unit Radiation Cytogenetics, 85764 Neuherberg, Germany
- National Academy of Medical Sciences of the Ukraine, Institute of Endocrinology and Metabolism, 254114 Kyiv, Ukraine
- Johannes Gutenberg Universität, Institut für Medizinische Biometrie Epidemiologie und Informatik, 55131 Mainz, Germany and
- RADRISK, 83727 Schliersee, Germany
| | - Martin Selmansberger
- Helmholtz Zentrum München, Research Unit Radiation Cytogenetics, 85764 Neuherberg, Germany
| | - Kristian Unger
- Helmholtz Zentrum München, Research Unit Radiation Cytogenetics, 85764 Neuherberg, Germany
| | - Viktor Shpak
- National Academy of Medical Sciences of the Ukraine, Institute of Endocrinology and Metabolism, 254114 Kyiv, Ukraine
| | - Maria Blettner
- Johannes Gutenberg Universität, Institut für Medizinische Biometrie Epidemiologie und Informatik, 55131 Mainz, Germany and
| | - Horst Zitzelsberger
- Helmholtz Zentrum München, Research Unit Radiation Cytogenetics, 85764 Neuherberg, Germany
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Bazyka DA, Prysyazhnyuk AY, Fuzik MM, Fedorenko ZP. Thyroid Cancer and the Chornobyl Accident in Ukraine: Experience With the Implementation of a Follow-Up Programme. RADIATION PROTECTION DOSIMETRY 2016; 171:32-40. [PMID: 27521208 DOI: 10.1093/rpd/ncw224] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Thyroid cancer incidence, its annual variation pattern and influence of gender and age at exposure were analyzed in population groups of Ukraine exposed to ionizing radiation by the Chornobyl accident. Significant radiation risks are demonstrated in the recovery operation workers and evacuees from Prypiat town and the exclusion zone. The radiation-induced excess of thyroid cancer is confirmed among people exposed as children and adolescents and subjects who had relatively high average thyroid radiation doses. Some excess is observed in population groups exposed as adults. In the female age group of 40-49 at the moment of the accident the age-specific thyroid cancer incidence rates were significantly higher in 'high exposure' regions versus 'low exposure' ones for all the years of follow-up since 1989 until 2012. The available Ukrainian data suggest that wider survey of population with application of thyroid ultrasound examination improves the early detection of cancer and only marginally leads to bias of the completeness of registration of this disease because of 'screening effect'.
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Affiliation(s)
- Dimitry A Bazyka
- State Institution 'National Research Center for Radiation Medicine, National Academy of Medical Sciences of Ukraine' 53, Melnykov str., Kyiv 04050, Ukraine
| | - Anatoly Ye Prysyazhnyuk
- State Institution 'National Research Center for Radiation Medicine, National Academy of Medical Sciences of Ukraine' 53, Melnykov str., Kyiv 04050, Ukraine
| | - Mykola M Fuzik
- State Institution 'National Research Center for Radiation Medicine, National Academy of Medical Sciences of Ukraine' 53, Melnykov str., Kyiv 04050, Ukraine
| | - Zoya P Fedorenko
- National Cancer Institute, 33/43 Lomonosov str., Kyiv 03022, Ukraine
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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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Ohira T, Takahashi H, Yasumura S, Ohtsuru A, Midorikawa S, Suzuki S, Fukushima T, Shimura H, Ishikawa T, Sakai A, Yamashita S, Tanigawa K, Ohto H, Abe M, Suzuki S. Comparison of childhood thyroid cancer prevalence among 3 areas based on external radiation dose after the Fukushima Daiichi nuclear power plant accident: The Fukushima health management survey. Medicine (Baltimore) 2016; 95:e4472. [PMID: 27583855 PMCID: PMC5008539 DOI: 10.1097/md.0000000000004472] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 06/18/2016] [Accepted: 07/11/2016] [Indexed: 11/26/2022] Open
Abstract
The 2011 Great East Japan Earthquake led to a subsequent nuclear accident at the Fukushima Daiichi Nuclear Power Plant. In its wake, we sought to examine the association between external radiation dose and thyroid cancer in Fukushima Prefecture. We applied a cross-sectional study design with 300,476 participants aged 18 years and younger who underwent thyroid examinations between October 2011 and June 2015. Areas within Fukushima Prefecture were divided into three groups based on individual external doses (≥1% of 5 mSv, <99% of 1 mSv/y, and the other). The odds ratios (ORs) and 95% confidence intervals of thyroid cancer for all areas, with the lowest dose area as reference, were calculated using logistic regression models adjusted for age and sex. Furthermore, the ORs of thyroid cancer for individual external doses of 1 mSv or more and 2 mSv or more, with the external dose less than 1 mSv as reference, were calculated. Prevalence of thyroid cancer for the location groups were 48/100,000 for the highest dose area, 36/100,000 for the middle dose area, and 41/100,000 for the lowest dose area. Compared with the lowest dose area, age-, and sex-adjusted ORs (95% confidence intervals) for the highest-dose and middle-dose areas were 1.49 (0.36-6.23) and 1.00 (0.67-1.50), respectively. The duration between accident and thyroid examination was not associated with thyroid cancer prevalence. There were no significant associations between individual external doses and prevalence of thyroid cancer. External radiation dose was not associated with thyroid cancer prevalence among Fukushima children within the first 4 years after the nuclear accident.
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Affiliation(s)
- Tetsuya Ohira
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University
- Department of Epidemiology
| | - Hideto Takahashi
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University
| | - Seiji Yasumura
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University
- Department of Public Health
| | - Akira Ohtsuru
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University
- Department of Radiation Health Management
| | - Sanae Midorikawa
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University
- Department of Radiation Health Management
| | - Satoru Suzuki
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University
- Department of Thyroid and Endocrinology
| | - Toshihiko Fukushima
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University
- Department of Thyroid and Endocrinology
| | - Hiroki Shimura
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University
- Department of Laboratory Medicine
| | - Tetsuo Ishikawa
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University
- Department of Radiation Physics and Chemistry
| | - Akira Sakai
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University
- Department of Radiation Life Sciences, Fukushima Medical University School of Medicine, Fukushima
| | - Shunichi Yamashita
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University
- Atomic Bomb Disease Institute, Nagasaki University, Nagasaki, Japan
| | - Koichi Tanigawa
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University
| | - Hitoshi Ohto
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University
| | - Masafumi Abe
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University
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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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23
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Bible KC, Ryder M. Evolving molecularly targeted therapies for advanced-stage thyroid cancers. Nat Rev Clin Oncol 2016; 13:403-16. [PMID: 26925962 DOI: 10.1038/nrclinonc.2016.19] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Increased understanding of disease-specific molecular targets of therapy has led to the regulatory approval of two drugs (vandetanib and cabozantinib) for the treatment of medullary thyroid cancer (MTC), and two agents (sorafenib and lenvatinib) for the treatment of radioactive- iodine refractory differentiated thyroid cancer (DTC) in both the USA and in the EU. The effects of these and other therapies on overall survival and quality of life among patients with thyroid cancer, however, remain to be more-clearly defined. When applied early in the disease course, intensive multimodality therapy seems to improve the survival outcomes of patients with anaplastic thyroid cancer (ATC), but salvage therapies for ATC are of uncertain benefit. Additional innovative, rationally designed therapeutic strategies are under active development both for patients with DTC and for patients with ATC, with multiple phase II and phase III randomized clinical trials currently ongoing. Continued effort is being made to identify further signalling pathways with potential therapeutic relevance in thyroid cancers, as well as to elaborate on the complex interactions between signalling pathways, with the intention of translating these discoveries into effective and personalized therapies. Herein, we summarize the progress made in molecular medicine for advanced-stage thyroid cancers of different histotypes, analyse how these developments have altered - and might further refine - patient care, and identify open questions for future research.
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Affiliation(s)
- Keith C Bible
- Division of Medical Oncology, Department of Oncology, and Endocrine Malignancies Disease Oriented Group, Mayo Clinic Cancer Center, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905, USA
| | - Mabel Ryder
- Division of Medical Oncology, Department of Oncology, and Endocrine Malignancies Disease Oriented Group, Mayo Clinic Cancer Center, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905, USA.,Division of Endocrinology, Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905, USA
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24
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Seong KM, Seo S, Lee D, Kim MJ, Lee SS, Park S, Jin YW. Is the Linear No-Threshold Dose-Response Paradigm Still Necessary for the Assessment of Health Effects of Low Dose Radiation? J Korean Med Sci 2016; 31 Suppl 1:S10-23. [PMID: 26908982 PMCID: PMC4756336 DOI: 10.3346/jkms.2016.31.s1.s10] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Accepted: 09/17/2015] [Indexed: 12/17/2022] Open
Abstract
Inevitable human exposure to ionizing radiation from man-made sources has been increased with the proceeding of human civilization and consequently public concerns focus on the possible risk to human health. Moreover, Fukushima nuclear power plant accidents after the 2011 East-Japan earthquake and tsunami has brought the great fear and anxiety for the exposure of radiation at low levels, even much lower levels similar to natural background. Health effects of low dose radiation less than 100 mSv have been debated whether they are beneficial or detrimental because sample sizes were not large enough to allow epidemiological detection of excess effects and there was lack of consistency among the available experimental data. We have reviewed an extensive literature on the low dose radiation effects in both radiation biology and epidemiology, and highlighted some of the controversies therein. This article could provide a reasonable view of utilizing radiation for human life and responding to the public questions about radiation risk. In addition, it suggests the necessity of integrated studies of radiobiology and epidemiology at the national level in order to collect more systematic and profound information about health effects of low dose radiation.
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Affiliation(s)
- Ki Moon Seong
- Laboratory of Radiation Exposure & Therapeutics, National Radiation Emergency Medical Center, Korea Institute of Radiological & Medical Sciences, Seoul, Korea
| | - Songwon Seo
- Laboratory of Radiation Exposure & Therapeutics, National Radiation Emergency Medical Center, Korea Institute of Radiological & Medical Sciences, Seoul, Korea
| | - Dalnim Lee
- Laboratory of Radiation Exposure & Therapeutics, National Radiation Emergency Medical Center, Korea Institute of Radiological & Medical Sciences, Seoul, Korea
| | - Min-Jeong Kim
- Laboratory of Radiation Exposure & Therapeutics, National Radiation Emergency Medical Center, Korea Institute of Radiological & Medical Sciences, Seoul, Korea
| | - Seung-Sook Lee
- Laboratory of Radiation Exposure & Therapeutics, National Radiation Emergency Medical Center, Korea Institute of Radiological & Medical Sciences, Seoul, Korea
| | - Sunhoo Park
- Laboratory of Radiation Exposure & Therapeutics, National Radiation Emergency Medical Center, Korea Institute of Radiological & Medical Sciences, Seoul, Korea
| | - Young Woo Jin
- Laboratory of Radiation Exposure & Therapeutics, National Radiation Emergency Medical Center, Korea Institute of Radiological & Medical Sciences, Seoul, Korea
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25
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Masiuk SV, Shklyar SV, Kukush AG, Carroll RJ, Kovgan LN, Likhtarov IA. Estimation of radiation risk in presence of classical additive and Berkson multiplicative errors in exposure doses. Biostatistics 2016; 17:422-36. [PMID: 26795191 DOI: 10.1093/biostatistics/kxv052] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Accepted: 12/02/2015] [Indexed: 11/14/2022] Open
Abstract
In this paper, the influence of measurement errors in exposure doses in a regression model with binary response is studied. Recently, it has been recognized that uncertainty in exposure dose is characterized by errors of two types: classical additive errors and Berkson multiplicative errors. The combination of classical additive and Berkson multiplicative errors has not been considered in the literature previously. In a simulation study based on data from radio-epidemiological research of thyroid cancer in Ukraine caused by the Chornobyl accident, it is shown that ignoring measurement errors in doses leads to overestimation of background prevalence and underestimation of excess relative risk. In the work, several methods to reduce these biases are proposed. They are new regression calibration, an additive version of efficient SIMEX, and novel corrected score methods.
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Affiliation(s)
- S V Masiuk
- State Institution "National Research Center for Radiation Medicine of the National Academy of Medical Sciences of Ukraine", Melnykova str., 53, Kyiv, 04050, Ukraine; Ukrainian Radiation Protection Institute, Melnykova str., 53, Kyiv, 04050, Ukraine
| | - S V Shklyar
- Taras Shevchenko National University of Kyiv, Volodymyrska Str. 64, Kyiv 01601, Ukraine
| | - A G Kukush
- Taras Shevchenko National University of Kyiv, Volodymyrska Str. 64, Kyiv 01601, Ukraine
| | - R J Carroll
- Texas A&M University, College Station, TX 77843, USA
| | - L N Kovgan
- State Institution "National Research Center for Radiation Medicine of the National Academy of Medical Sciences of Ukraine", Melnykova str., 53, Kyiv, 04050, Ukraine; Ukrainian Radiation Protection Institute, Melnykova str., 53, Kyiv, 04050, Ukraine
| | - I A Likhtarov
- State Institution "National Research Center for Radiation Medicine of the National Academy of Medical Sciences of Ukraine", Melnykova str., 53, Kyiv, 04050, Ukraine; Ukrainian Radiation Protection Institute, Melnykova str., 53, Kyiv, 04050, Ukraine
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26
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Michel R, Daraoui A, Gorny M, Jakob D, Sachse R, Romantschuk LD, Alfimov V, Synal HA. Retrospective dosimetry of Iodine-131 exposures using Iodine-129 and Caesium-137 inventories in soils--A critical evaluation of the consequences of the Chernobyl accident in parts of Northern Ukraine. JOURNAL OF ENVIRONMENTAL RADIOACTIVITY 2015; 150:20-35. [PMID: 26254721 DOI: 10.1016/j.jenvrad.2015.07.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2015] [Revised: 07/20/2015] [Accepted: 07/22/2015] [Indexed: 06/04/2023]
Abstract
The radiation exposure of thyroid glands due to (131)I as a consequence of the Chernobyl accident was investigated retrospectively based on (129)I and (137)Cs inventories in soils in Northern Ukraine. To this end, soil samples from 60 settlements were investigated for (129)I, (127)I, and (137)Cs by AMS, ICP-MS and gamma-spectrometry, respectively. Sampling was performed between 2004 und 2007. In those parts of Northern Ukraine investigated here the (129)I and (137)Cs inventories are well correlated, the variability of the individual (129)I/(137)Cs ratios being, however, high. Both the (129)I and (137)Cs inventories in the individual 5 samples for each settlement allowed estimating the uncertainties of the inventories due to the variability of the radionuclide deposition and consequently of the retrospective dosimetry. Thyroid equivalent doses were calculated from the (129)I and the (137)Cs inventories using aggregated dose coefficients for 5-year old and 10-year-old children as well as for adults. The highest thyroid equivalent doses (calculated from (129)I inventories) were calculated for Wladimirowka with 30 Gy for 5-years-old children and 7 Gy for adults. In 35 settlements of contamination zone II the geometric mean of the thyroid equivalent doses was 2.0 Gy for 5-years-old children with a geometric standard deviation (GSD) of 3.0. For adults the geometric mean was 0.47 Gy also with a GSD of 3.0. In more than 25 settlements of contamination zone III the geometric means were 0.82 Gy for 5-years old children with a GSD of 1.8 and 0.21 Gy for adults (GSD 1.8). For 45 settlements, the results of the retrospective dosimetry could be compared with thyroid equivalent doses calculated using time-integrated (131)I activities of thyroids which were measured in 1986. Thus, a critical evaluation of the results was possible which demonstrated the general feasibility of the method, but also the associated uncertainties and limitations.
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Affiliation(s)
- R Michel
- Institut für Radiooekologie und Strahlenschutz (IRS), Leibniz Universität Hannover, Herrenhaeuser Str. 2, D-30419 Hannover, Germany.
| | - A Daraoui
- Institut für Radiooekologie und Strahlenschutz (IRS), Leibniz Universität Hannover, Herrenhaeuser Str. 2, D-30419 Hannover, Germany
| | - M Gorny
- Institut für Radiooekologie und Strahlenschutz (IRS), Leibniz Universität Hannover, Herrenhaeuser Str. 2, D-30419 Hannover, Germany
| | - D Jakob
- Institut für Radiooekologie und Strahlenschutz (IRS), Leibniz Universität Hannover, Herrenhaeuser Str. 2, D-30419 Hannover, Germany
| | - R Sachse
- Institut für Radiooekologie und Strahlenschutz (IRS), Leibniz Universität Hannover, Herrenhaeuser Str. 2, D-30419 Hannover, Germany
| | - L D Romantschuk
- State University of Agriculture and Ecology, Stari Bulvar 7, Zhitomir 262 001, Ukraine
| | - V Alfimov
- Laboratory of Ion Beam Physics, ETH-Zurich, Otto-Stern-Weg 5, CH-8093 Zurich, Switzerland
| | - H-A Synal
- Laboratory of Ion Beam Physics, ETH-Zurich, Otto-Stern-Weg 5, CH-8093 Zurich, Switzerland
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27
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Drozd VM, Saenko VA, Brenner AV, Drozdovitch V, Pashkevich VI, Kudelsky AV, Demidchik YE, Branovan I, Shiglik N, Rogounovitch TI, Yamashita S, Biko J, Reiners C. Major Factors Affecting Incidence of Childhood Thyroid Cancer in Belarus after the Chernobyl Accident: Do Nitrates in Drinking Water Play a Role? PLoS One 2015; 10:e0137226. [PMID: 26397978 PMCID: PMC4580601 DOI: 10.1371/journal.pone.0137226] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 08/14/2015] [Indexed: 11/21/2022] Open
Abstract
One of the major health consequences of the Chernobyl Nuclear Power Plant accident in 1986 was a dramatic increase in incidence of thyroid cancer among those who were aged less than 18 years at the time of the accident. This increase has been directly linked in several analytic epidemiological studies to iodine-131 (131I) thyroid doses received from the accident. However, there remains limited understanding of factors that modify the 131I-related risk. Focusing on post-Chernobyl pediatric thyroid cancer in Belarus, we reviewed evidence of the effects of radiation, thyroid screening, and iodine deficiency on regional differences in incidence rates of thyroid cancer. We also reviewed current evidence on content of nitrate in groundwater and thyroid cancer risk drawing attention to high levels of nitrates in open well water in several contaminated regions of Belarus, i.e. Gomel and Brest, related to the usage of nitrogen fertilizers. In this hypothesis generating study, based on ecological data and biological plausibility, we suggest that nitrate pollution may modify the radiation-related risk of thyroid cancer contributing to regional differences in rates of pediatric thyroid cancer in Belarus. Analytic epidemiological studies designed to evaluate joint effect of nitrate content in groundwater and radiation present a promising avenue of research and may provide useful insights into etiology of thyroid cancer.
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Affiliation(s)
- Valentina M. Drozd
- The International fund “Help for patients with radiation-induced thyroid cancer “Arnica”, Minsk, Belarus
- Department of Endocrinology, Belarusian Medical Academy for Postgraduate Education, Minsk, Belarus
| | - Vladimir A. Saenko
- Department of Radiation Molecular Epidemiology, Atomic Bomb Disease Institute, Nagasaki University, Sakamoto, Nagasaki, Japan
| | - Alina V. Brenner
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, United States Department of Health and Human Services, Bethesda, Maryland, United States of America
| | - Vladimir Drozdovitch
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, United States Department of Health and Human Services, Bethesda, Maryland, United States of America
| | - Vasilii I. Pashkevich
- Laboratory of Hydrogeology and Hydroecology, Institute for Nature Management of the National Academy of Sciences, Minsk, Belarus
| | - Anatoliy V. Kudelsky
- Laboratory of Hydrogeology and Hydroecology, Institute for Nature Management of the National Academy of Sciences, Minsk, Belarus
| | - Yuri E. Demidchik
- Department of Oncology, Belarusian Medical Academy for Postgraduate Education, Minsk, Belarus
| | - Igor Branovan
- Project Chernobyl, Brooklyn, New York, United States of America
| | - Nikolay Shiglik
- Project Chernobyl, Brooklyn, New York, United States of America
| | - Tatiana I. Rogounovitch
- Department of Global Health, Medicine and Welfare, Atomic Bomb Disease Institute, Nagasaki University, Sakamoto, Nagasaki, Japan
| | - Shunichi Yamashita
- Department of Radiation Molecular Epidemiology, Atomic Bomb Disease Institute, Nagasaki University, Sakamoto, Nagasaki, Japan
- Department of Radiation Medical Sciences, Atomic Bomb Disease Institute, Nagasaki University, Sakamoto, Nagasaki, Japan
| | - Johannes Biko
- The International fund “Help for patients with radiation-induced thyroid cancer “Arnica”, Minsk, Belarus
- Clinic and Polyclinic of Nuclear Medicine, University of Wuerzburg, Wuerzburg, Germany
| | - Christoph Reiners
- The International fund “Help for patients with radiation-induced thyroid cancer “Arnica”, Minsk, Belarus
- Clinic and Polyclinic of Nuclear Medicine, University of Wuerzburg, Wuerzburg, Germany
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28
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Selmansberger M, Kaiser JC, Hess J, Güthlin D, Likhtarev I, Shpak V, Tronko M, Brenner A, Abend M, Blettner M, Unger K, Jacob P, Zitzelsberger H. Dose-dependent expression of CLIP2 in post-Chernobyl papillary thyroid carcinomas. Carcinogenesis 2015; 36:748-56. [PMID: 25957251 PMCID: PMC4496450 DOI: 10.1093/carcin/bgv043] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2015] [Accepted: 03/25/2015] [Indexed: 11/24/2022] Open
Abstract
This study showed a clear dose-response relationship for the CLIP2 radiation marker in post-Chernobyl papillary thyroid carcinoma cohorts for young patients and hints to different molecular mechanisms in tumors induced at low doses compared to moderate/high doses. A previous study on papillary thyroid carcinomas (PTC) in young patients who were exposed to 131iodine from the Chernobyl fallout revealed an exclusive gain of chromosomal band 7q11.23 in exposed cases compared to an age-matched control cohort. CLIP2, a gene located within band 7q11.23 was shown to be differentially expressed between exposed and non-exposed cases at messenger RNA and protein level. Therefore, a standardized procedure for CLIP2 typing of PTCs has been developed in a follow-up study. Here we used CLIP2 typing data on 117 post-Chernobyl PTCs from two cohorts of exposed patients with individual dose estimates and 24 non-exposed controls to investigate a possible quantitative dose-response relationship of the CLIP2 marker. The ‘Genrisk-T’ cohort consisted of 45 PTCs and the ‘UkrAm’ cohort of 72 PTCs. Both cohorts differed in mean dose (0.59 Gy Genrisk-T, 1.2 Gy UkrAm) and mean age at exposure (AaE) (2 years Genrisk-T, 8 years UkrAm), whilst the median latency (16 years Genrisk-T, 18 years UkrAm) was comparable. We analyzed the association between the binary CLIP2 typing and continuous thyroid dose with logistic regression. A clear positive dose-response relationship was found for young PTC cases [age at operation (AaO) < 20 years, AaE < 5 years]. In the elder age group a higher proportion of sporadic tumors is assumed due to a negligible dose response, suggesting different molecular mechanisms in sporadic and radiation-induced cases. This is further supported by the association of elder patients (AaO > 20 years) with positivity for BRAF V600E mutation.
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Affiliation(s)
| | - Jan Christian Kaiser
- Institute of Radiation Protection, Helmholtz Zentrum München, German Research Center for Environmental Health GmbH, 85674 Neuherberg, Germany,
| | - Julia Hess
- Research Unit Radiation Cytogenetics and
| | - Denise Güthlin
- Institute of Radiation Protection, Helmholtz Zentrum München, German Research Center for Environmental Health GmbH, 85674 Neuherberg, Germany
| | - I Likhtarev
- Radiation Protection Institute, Ukrainian Academy of Technological Sciences, 04050 Kyiv, Ukraine
| | - Victor Shpak
- Institute of Endocrinology and Metabolism, National Academy of Medical Sciences of the Ukraine, 254114 Kyiv, Ukraine
| | - Mykola Tronko
- Institute of Endocrinology and Metabolism, National Academy of Medical Sciences of the Ukraine, 254114 Kyiv, Ukraine
| | - Alina Brenner
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, NCI, Bethesda, MD 20892, USA
| | - Michael Abend
- Bundeswehr Institute of Radiobiology, 80937 Munich, Germany and
| | - Maria Blettner
- Institut für Medizinische Biometrie, Epidemiologie und Informatik (IMBEI), Johannes Gutenberg Universität, 55131 Mainz, Germany
| | | | - Peter Jacob
- Institute of Radiation Protection, Helmholtz Zentrum München, German Research Center for Environmental Health GmbH, 85674 Neuherberg, Germany
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Walsh L, Zhang W, Shore RE, Auvinen A, Laurier D, Wakeford R, Jacob P, Gent N, Anspaugh LR, Schüz J, Kesminiene A, van Deventer E, Tritscher A, del Rosarion Pérez M. A framework for estimating radiation-related cancer risks in Japan from the 2011 Fukushima nuclear accident. Radiat Res 2014; 182:556-72. [PMID: 25251702 DOI: 10.1667/rr13779.1] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
We present here a methodology for health risk assessment adopted by the World Health Organization that provides a framework for estimating risks from the Fukushima nuclear accident after the March 11, 2011 Japanese major earthquake and tsunami. Substantial attention has been given to the possible health risks associated with human exposure to radiation from damaged reactors at the Fukushima Daiichi nuclear power station. Cumulative doses were estimated and applied for each post-accident year of life, based on a reference level of exposure during the first year after the earthquake. A lifetime cumulative dose of twice the first year dose was estimated for the primary radionuclide contaminants ((134)Cs and (137)Cs) and are based on Chernobyl data, relative abundances of cesium isotopes, and cleanup efforts. Risks for particularly radiosensitive cancer sites (leukemia, thyroid and breast cancer), as well as the combined risk for all solid cancers were considered. The male and female cumulative risks of cancer incidence attributed to radiation doses from the accident, for those exposed at various ages, were estimated in terms of the lifetime attributable risk (LAR). Calculations of LAR were based on recent Japanese population statistics for cancer incidence and current radiation risk models from the Life Span Study of Japanese A-bomb survivors. Cancer risks over an initial period of 15 years after first exposure were also considered. LAR results were also given as a percentage of the lifetime baseline risk (i.e., the cancer risk in the absence of radiation exposure from the accident). The LAR results were based on either a reference first year dose (10 mGy) or a reference lifetime dose (20 mGy) so that risk assessment may be applied for relocated and non-relocated members of the public, as well as for adult male emergency workers. The results show that the major contribution to LAR from the reference lifetime dose comes from the first year dose. For a dose of 10 mGy in the first year and continuing exposure, the lifetime radiation-related cancer risks based on lifetime dose (which are highest for children under 5 years of age at initial exposure), are small, and much smaller than the lifetime baseline cancer risks. For example, after initial exposure at age 1 year, the lifetime excess radiation risk and baseline risk of all solid cancers in females were estimated to be 0.7 · 10(-2) and 29.0 · 10(-2), respectively. The 15 year risks based on the lifetime reference dose are very small. However, for initial exposure in childhood, the 15 year risks based on the lifetime reference dose are up to 33 and 88% as large as the 15 year baseline risks for leukemia and thyroid cancer, respectively. The results may be scaled to particular dose estimates after consideration of caveats. One caveat is related to the lack of epidemiological evidence defining risks at low doses, because the predicted risks come from cancer risk models fitted to a wide dose range (0-4 Gy), which assume that the solid cancer and leukemia lifetime risks for doses less than about 0.5 Gy and 0.2 Gy, respectively, are proportional to organ/tissue doses: this is unlikely to seriously underestimate risks, but may overestimate risks. This WHO-HRA framework may be used to update the risk estimates, when new population health statistics data, dosimetry information and radiation risk models become available.
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Affiliation(s)
- L Walsh
- a BfS - Federal Office for Radiation Protection, Radiation Protection and Health, Neuherberg, Germany
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30
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Goyal N, Camacho F, Mangano J, Goldenberg D. Evaluating for a geospatial relationship between radon levels and thyroid cancer in Pennsylvania. Laryngoscope 2014; 125:E45-9. [PMID: 25043810 DOI: 10.1002/lary.24815] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2013] [Revised: 04/08/2014] [Accepted: 06/04/2014] [Indexed: 11/10/2022]
Abstract
OBJECTIVES/HYPOTHESIS To determine whether there is an association between radon levels and the rise in incidence of thyroid cancer in Pennsylvania. STUDY DESIGN Epidemiological study of the state of Pennsylvania. METHODS We used information from the Pennsylvania Cancer Registry and the Pennsylvania Department of Energy. From the registry, information regarding thyroid incidence by county and zip code was recorded. Information regarding radon levels per county was recorded from the state. Poisson regression models were fit predicting county-level thyroid incidence and change as a function of radon/lagged radon levels. To account for measurement error in the radon levels, a Bayesian Model extending the Poisson models was fit. Geospatial clustering analysis was also performed. RESULTS No association was noted between cumulative radon levels and thyroid incidence. In the Poisson modeling, no significant association was noted between county radon level and thyroid cancer incidence (P = .23). Looking for a lag between the radon level and its effect, no significant effect was seen with a lag of 0 to 6 years between exposure and effect (P = .063 to P = .59). The Bayesian models also failed to show a statistically significant association. A cluster of high thyroid cancer incidence was found in western Pennsylvania. CONCLUSIONS Through a variety of models, no association was elicited between annual radon levels recorded in Pennsylvania and the rising incidence of thyroid cancer. However, a cluster of thyroid cancer incidence was found in western Pennsylvania. Further studies may be helpful in looking for other exposures or associations.
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Affiliation(s)
- Neerav Goyal
- Pennsylvania State University-Milton S. Hershey Medical Center, Hershey, Pennsylvania, U.S.A.; Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, Hershey, Pennsylvania, U.S.A
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Jacob P, Kaiser JC, Ulanovsky A. Ultrasonography survey and thyroid cancer in the Fukushima Prefecture. RADIATION AND ENVIRONMENTAL BIOPHYSICS 2014; 53:391-401. [PMID: 24398917 PMCID: PMC4713929 DOI: 10.1007/s00411-014-0528-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Accepted: 12/14/2013] [Indexed: 05/18/2023]
Abstract
Thyroid cancer is one of the major health concerns after the accident in the Fukushima Dai-ichi nuclear power station (NPS). Currently, ultrasonography surveys are being performed for persons residing in the Fukushima Prefecture at the time of the accident with an age of up to 18 years. Here, the expected thyroid cancer prevalence in the Fukushima Prefecture is assessed based on an ultrasonography survey of Ukrainians, who were exposed at an age of up to 18 years to (131)I released during the Chernobyl NPS accident, and on differences in equipment and study protocol in the two surveys. Radiation risk of thyroid cancer incidence among survivors of the atomic bombings of Hiroshima and Nagasaki and preliminary estimates of thyroid dose due to the Fukushima accident were used for the prediction of baseline and radiation-related thyroid cancer risks. We estimate a prevalence of thyroid cancer of 0.027 % (95 % CI 0.010 %; 0.050 %) for the first screening campaign in the Fukushima Prefecture. Compared with the incidence rate in Japan in 2007, the ultrasonography survey is predicted to increase baseline thyroid cancer incidence by a factor of 7.4 (95 % CI 0.95; 17.3). Under the condition of continued screening, thyroid cancer during the first fifty years after the accident is predicted to be detected for about 2 % of the screened population. The prediction of radiation-related thyroid cancer in the most exposed fraction (a few ten thousand persons) of the screened population of the Fukushima Prefecture has a large uncertainty with the best estimates of the average risk of 0.1-0.3 %, depending on average dose.
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Affiliation(s)
- Peter Jacob
- Department of Radiation Sciences, Institute of Radiation Protection, Helmholtz Zentrum München-German Research Center for Environmental Health, Ingolstädter Landstraße 1, 85764, Neuherberg, Germany,
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Jacob P, Kaiser JC, Ulanovsky A. Ultrasonography survey and thyroid cancer in the Fukushima Prefecture. RADIATION AND ENVIRONMENTAL BIOPHYSICS 2014; 53:391-401. [PMID: 24398917 PMCID: PMC3996282 DOI: 10.1007/s00411-013-0508-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Accepted: 12/14/2013] [Indexed: 05/23/2023]
Abstract
Thyroid cancer is one of the major health concerns after the accident in the Fukushima Dai-ichi nuclear power station (NPS). Currently, ultrasonography surveys are being performed for persons residing in the Fukushima Prefecture at the time of the accident with an age of up to 18 years. Here, the expected thyroid cancer prevalence in the Fukushima Prefecture is assessed based on an ultrasonography survey of Ukrainians, who were exposed at an age of up to 18 years to (131)I released during the Chernobyl NPS accident, and on differences in equipment and study protocol in the two surveys. Radiation risk of thyroid cancer incidence among survivors of the atomic bombings of Hiroshima and Nagasaki and preliminary estimates of thyroid dose due to the Fukushima accident were used for the prediction of baseline and radiation-related thyroid cancer risks. We estimate a prevalence of thyroid cancer of 0.027 % (95 % CI 0.010 %; 0.050 %) for the first screening campaign in the Fukushima Prefecture. Compared with the incidence rate in Japan in 2007, the ultrasonography survey is predicted to increase baseline thyroid cancer incidence by a factor of 7.4 (95 % CI 0.95; 17.3). Under the condition of continued screening, thyroid cancer during the first fifty years after the accident is predicted to be detected for about 2 % of the screened population. The prediction of radiation-related thyroid cancer in the most exposed fraction (a few ten thousand persons) of the screened population of the Fukushima Prefecture has a large uncertainty with the best estimates of the average risk of 0.1-0.3 %, depending on average dose.
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Affiliation(s)
- Peter Jacob
- Department of Radiation Sciences, Institute of Radiation Protection, Helmholtz Zentrum München-German Research Center for Environmental Health, Ingolstädter Landstraße 1, 85764, Neuherberg, Germany,
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Abstract
Everyone is exposed to natural and manmade ionizing radiation that can originate from sources in the environment and in medical and occupational settings. There is notable variation, however, among individuals and across populations in the types of sources of radiation and in the frequency, level, and duration of exposure. Adverse health effects associated with radiation exposure have been known for decades, and ionizing radiation exposure has been linked with a broad range of different types of cancer and benign neoplasms as well as birth defects, reproductive effects, and diseases of the circulatory, hematologic, and neurologic systems. Our present understanding of radiation-related health risks derives primarily from multidisciplinary health risk (epidemiologic) studies that provide the key information on radiation-associated health outcomes, quantify radiation-related disease risks, and enhance understanding of mechanisms of radiation-related disease pathogenesis. Such information is central to quantifying risks in relation to benefits; addressing public concerns, including societal and clinical needs in relation to radiation exposure; and providing the database needed for establishing recommendations for radiation protection. Because of the importance of determining risks compared to benefits for all situations where exposure to ionizing radiation might result, it is useful for planning new health risks studies to categorize exposed populations according to the sources and types of radiation. This paper describes a wide range of populations exposed to radiation and the motivation and key methodological criteria that drive the rationale and priority of studying such populations. Also, discussed are alternative methods for evaluating radiation-related health risks in these populations, with a major focus on epidemiologic approaches. This paper concludes with a short summary of major highlights from radiation epidemiologic research and important unanswered questions.Introduction of Exposed Populations (Video 1:29, http://links.lww.com/HP/A22).
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Affiliation(s)
- Steven L Simon
- *Division of Cancer Epidemiology and Genetics, National CancerInstitute, National Institutes of Health, 6120 Executive Blvd, Bethesda, MD
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Yamashita S. Tenth Warren K. Sinclair keynote address-the Fukushima nuclear power plant accident and comprehensive health risk management. HEALTH PHYSICS 2014; 106:166-180. [PMID: 24378490 DOI: 10.1097/hp.0000000000000007] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Just two years have passed since the Tokyo Electric Power Company-Fukushima Daiichi Nuclear Power Plant (NPP) accident, a multidimensional disaster that combined to destroy the local infrastructure on which the safety system depended and gave a serious impact to the world. Countermeasures including evacuation, sheltering, and control of the food chain were implemented in a timely manner by the Japanese government. However, there is a clear need for improvement, especially in the areas of nuclear safety and protection and also in the management of the radiation health risk during and even after the accident. To date there have been no acute radiation injuries. The radiation-related physical health consequences to the general public, including evacuees, are likely to be much lower than those arising from the Chernobyl nuclear reactor accident, because the radiation fallout and the subsequent environmental contamination were much more limited. However, the social, psychological, and economic impacts of the Fukushima NPP accident are expected to be considerable. Currently, continued monitoring and characterization of the levels of radioactivity in the environment and foods in Fukushima are vital for obtaining informed consent to the decisions on living in the areas already radiocontaminated and returning back to the evacuated areas once re-entry is permitted; it is also important to perform a realistic assessment of the radiation doses on the basis of measurements. We are currently implementing the official plans of the Fukushima Health Management Survey, which includes a basic survey for the estimation of the external doses that were received during the first 4 mo after the accident and four more detailed surveys (thyroid ultrasound examination, comprehensive health check-up, mental health and life-style survey, and survey of pregnant women and nursing mothers), with the aim to take care of the health of all of the residents of the Fukushima Prefecture for a long time. Introduction of the Sinclair Lecture (Video 2:01, http://links.lww.com/HP/A24).
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Affiliation(s)
- Shunichi Yamashita
- *Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, 1 Hiragaoka, Fukushima 960-1295, Japan and Atomic Bomb Disease Institute, Nagasaki University, 1-12-4 Sakamoto, Nagasaki 852-8523, Japan
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Huda W, Spampinato MV, Tipnis SV, Magill D. Computation of thyroid doses and carcinogenic radiation risks to patients undergoing neck CT examinations. RADIATION PROTECTION DOSIMETRY 2013; 156:436-444. [PMID: 23579263 DOI: 10.1093/rpd/nct090] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The aim of the study was to investigate how differences in patient anatomy and CT technical factors in neck CT impact on thyroid doses and the corresponding carcinogenic risks. The CTDIvol and dose-length product used in 11 consecutive neck CT studies, as well as data on automatic exposure control (AEC) tube current variation(s) from the image DICOM header, were recorded. For each CT image that included the thyroid, the mass equivalent water cylinder was estimated based on the patient cross-sectional area and average relative attenuation coefficient (Hounsfield unit, HU). Patient thyroid doses were estimated by accounting for radiation intensity at the location of the patient's thyroid, patient size and the scan length. Thyroid doses were used to estimate thyroid cancer risks as a function of patient demographics using risk factors in BEIR VII. The length of the thyroid glands ranged from 21 to 54 mm with an average length of 42 ± 12 mm. Water cylinder diameters corresponding to the central slice through the patient thyroid ranged from 18 to 32 cm with a mean of 25 ± 5 cm. The average CTDIvol (32-cm phantom) used to perform these scans was 26 ± 6 mGy, but the use of an AEC increased the tube current by an average of 44 % at the thyroid mid-point. Thyroid doses ranged from 29 to 80 mGy, with an average of 55 ± 19 mGy. A 20-y-old female receiving the highest thyroid dose of 80 mGy would have a thyroid cancer risk of nearly 0.1 %, but radiation risks decreased very rapidly with increasing patient age. The key factors that affect thyroid doses in neck CT examinations are the radiation intensity at the thyroid location and the size of the patient. The corresponding patient thyroid cancer risk is markedly influenced by patient sex and age.
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Affiliation(s)
- Walter Huda
- Department of Radiology and Radiological Science, MUSC, 96 Jonathan Lucas Street, MSC 323, Charleston, SC 29425-3230, USA
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Walsh L, Schneider U. A method for determining weights for excess relative risk and excess absolute risk when applied in the calculation of lifetime risk of cancer from radiation exposure. RADIATION AND ENVIRONMENTAL BIOPHYSICS 2013; 52:135-145. [PMID: 23180110 DOI: 10.1007/s00411-012-0441-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2012] [Accepted: 10/27/2012] [Indexed: 05/18/2023]
Abstract
Radiation-related risks of cancer can be transported from one population to another population at risk, for the purpose of calculating lifetime risks from radiation exposure. Transfer via excess relative risks (ERR) or excess absolute risks (EAR) or a mixture of both (i.e., from the life span study (LSS) of Japanese atomic bomb survivors) has been done in the past based on qualitative weighting. Consequently, the values of the weights applied and the method of application of the weights (i.e., as additive or geometric weighted means) have varied both between reports produced at different times by the same regulatory body and also between reports produced at similar times by different regulatory bodies. Since the gender and age patterns are often markedly different between EAR and ERR models, it is useful to have an evidence-based method for determining the relative goodness of fit of such models to the data. This paper identifies a method, using Akaike model weights, which could aid expert judgment and be applied to help to achieve consistency of approach and quantitative evidence-based results in future health risk assessments. The results of applying this method to recent LSS cancer incidence models are that the relative EAR weighting by cancer solid cancer site, on a scale of 0-1, is zero for breast and colon, 0.02 for all solid, 0.03 for lung, 0.08 for liver, 0.15 for thyroid, 0.18 for bladder and 0.93 for stomach. The EAR weighting for female breast cancer increases from 0 to 0.3, if a generally observed change in the trend between female age-specific breast cancer incidence rates and attained age, associated with menopause, is accounted for in the EAR model. Application of this method to preferred models from a study of multi-model inference from many models fitted to the LSS leukemia mortality data, results in an EAR weighting of 0. From these results it can be seen that lifetime risk transfer is most highly weighted by EAR only for stomach cancer. However, the generalization and interpretation of radiation effect estimates based on the LSS cancer data, when projected to other populations, are particularly uncertain if considerable differences exist between site-specific baseline rates in the LSS and the other populations of interest. Definitive conclusions, regarding the appropriate method for transporting cancer risks, are limited by a lack of knowledge in several areas including unknown factors and uncertainties in biological mechanisms and genetic and environmental risk factors for carcinogenesis; uncertainties in radiation dosimetry; and insufficient statistical power and/or incomplete follow-up in data from radio-epidemiological studies.
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Affiliation(s)
- Linda Walsh
- Federal Office for Radiation Protection, Department of Radiation Protection and Health, Ingolstädter Landstr. 1, 85764 Oberschleissheim, Germany.
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Ivanov VK, Kashcheev VV, Chekin SY, Maksioutov MA, Tumanov KA, Vlasov OK, Shchukina NV, Tsyb AF. Radiation-epidemiological studies of thyroid cancer incidence in Russia after the Chernobyl accident (estimation of radiation risks, 1991-2008 follow-up period). RADIATION PROTECTION DOSIMETRY 2012; 151:489-499. [PMID: 22416255 DOI: 10.1093/rpd/ncs019] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
This study presents an analysis of the thyroid cancer incidence in the population of the most contaminated territories of Bryansk, Kaluga, Oryol and Tula oblasts affected by the Chernobyl accident. The follow-up period is 1991-2008, and the cohort size is 309 130 people. For that period 978 thyroid cancer cases were detected. The excess relative risk per 1 Gy (ERR/Gy) is found to be statistically significant for children and adolescents (0-17 y of age) at the time of the Chernobyl accident (ERR/Gy=3.22; 95 % confidence interval (1.56; 5.81). In boys, the ERR/Gy was higher than in girls -6.54 and 2.24, respectively. A statistically significant decrease in ERR/Gy with time since exposure, by a factor of 0.37 per 10 y, was observed for the whole cohort and for boys separately, but not for girls. No radiation risks of a thyroid cancer among people of 18 y of age at exposure and older were found.
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Affiliation(s)
- V K Ivanov
- Federal State Institution Medical Radiological Research Center of the Russian Ministry of Health and Social Development, 4 Korolyov Str., Obninsk, Kaluga Region 249036, Russia.
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Yasumura S, Hosoya M, Yamashita S, Kamiya K, Abe M, Akashi M, Kodama K, Ozasa K. Study protocol for the Fukushima Health Management Survey. J Epidemiol 2012; 22:375-83. [PMID: 22955043 PMCID: PMC3798631 DOI: 10.2188/jea.je20120105] [Citation(s) in RCA: 279] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2012] [Accepted: 07/22/2012] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The accidents that occurred at the Fukushima Daiichi Nuclear Power Plant after the Great East Japan Earthquake on 11 March 2011 have resulted in long-term, ongoing anxiety among the residents of Fukushima, Japan. Soon after the disaster, Fukushima Prefecture launched the Fukushima Health Management Survey to investigate long-term low-dose radiation exposure caused by the accident. Fukushima Medical University took the lead in planning and implementing this survey. The primary purposes of this survey are to monitor the long-term health of residents, promote their future well-being, and confirm whether long-term low-dose radiation exposure has health effects. This report describes the rationale and implementation of the Fukushima Health Management Survey. METHODS This cohort study enrolled all people living in Fukushima Prefecture after the earthquake and comprises a basic survey and 4 detailed surveys. The basic survey is to estimate levels of external radiation exposure among all 2.05 million residents. It should be noted that internal radiation levels were estimated by Fukushima Prefecture using whole-body counters. The detailed surveys comprise a thyroid ultrasound examination for all Fukushima children aged 18 years or younger, a comprehensive health check for all residents from the evacuation zones, an assessment of mental health and lifestyles of all residents from the evacuation zones, and recording of all pregnancies and births among all women in the prefecture who were pregnant on 11 March. All data have been entered into a database and will be used to support the residents and analyze the health effects of radiation. CONCLUSIONS The low response rate (<30%) to the basic survey complicates the estimation of health effects. There have been no cases of malignancy to date among 38 114 children who received thyroid ultrasound examinations. The importance of mental health care was revealed by the mental health and lifestyle survey and the pregnancy and birth survey. This long-term large-scale epidemiologic study is expected to provide valuable data in the investigation of the health effects of low-dose radiation and disaster-related stress.
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Affiliation(s)
- Seiji Yasumura
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima, Japan.
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Mozdarani H. Biological complexities in radiation carcinogenesis and cancer radiotherapy: impact of new biological paradigms. Genes (Basel) 2012; 3:90-114. [PMID: 24704845 PMCID: PMC3899963 DOI: 10.3390/genes3010090] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2011] [Revised: 01/07/2012] [Accepted: 01/13/2012] [Indexed: 12/31/2022] Open
Abstract
Although radiation carcinogenesis has been shown both experimentally and epidemiologically, the use of ionizing radiation is also one of the major modalities in cancer treatment. Various known cellular and molecular events are involved in carcinogenesis. Apart from the known phenomena, there could be implications for carcinogenesis and cancer prevention due to other biological processes such as the bystander effect, the abscopal effect, intrinsic radiosensitivity and radioadaptation. Bystander effects have consequences for mutation initiated cancer paradigms of radiation carcinogenesis, which provide the mechanistic justification for low-dose risk estimates. The abscopal effect is potentially important for tumor control and is mediated through cytokines and/or the immune system (mainly cell-mediated immunity). It results from loss of growth and stimulatory and/or immunosuppressive factors from the tumor. Intrinsic radiosensitivity is a feature of some cancer prone chromosomal breakage syndromes such as ataxia telangectiasia. Radiosensitivity is manifested as higher chromosomal aberrations and DNA repair impairment is now known as a good biomarker for breast cancer screening and prediction of prognosis. However, it is not yet known whether this effect is good or bad for those receiving radiation or radiomimetic agents for treatment. Radiation hormesis is another major concern for carcinogenesis. This process which protects cells from higher doses of radiation or radio mimic chemicals, may lead to the escape of cells from mitotic death or apoptosis and put cells with a lower amount of damage into the process of cancer induction. Therefore, any of these biological phenomena could have impact on another process giving rise to genome instability of cells which are not in the field of radiation but still receiving a lower amount of radiation. For prevention of radiation induced carcinogenesis or risk assessment as well as for successful radiation therapy, all these phenomena should be taken into account.
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Affiliation(s)
- Hossein Mozdarani
- Department of Medical Genetics, Faculty of Medical Sciences, Tarbiat Modares University, Tehran P.O. Box 14115-111, Iran.
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Brenner AV, Tronko MD, Hatch M, Bogdanova TI, Oliynik VA, Lubin JH, Zablotska LB, Tereschenko VP, McConnell RJ, Zamotaeva GA, O'Kane P, Bouville AC, Chaykovskaya LV, Greenebaum E, Paster IP, Shpak VM, Ron E. I-131 dose response for incident thyroid cancers in Ukraine related to the Chornobyl accident. ENVIRONMENTAL HEALTH PERSPECTIVES 2011; 119:933-9. [PMID: 21406336 PMCID: PMC3222994 DOI: 10.1289/ehp.1002674] [Citation(s) in RCA: 141] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2010] [Accepted: 03/14/2011] [Indexed: 05/19/2023]
Abstract
BACKGROUND Current knowledge about Chornobyl-related thyroid cancer risks comes from ecological studies based on grouped doses, case-control studies, and studies of prevalent cancers. OBJECTIVE To address this limitation, we evaluated the dose-response relationship for incident thyroid cancers using measurement-based individual iodine-131 (I-131) thyroid dose estimates in a prospective analytic cohort study. METHODS The cohort consists of individuals < 18 years of age on 26 April 1986 who resided in three contaminated oblasts (states) of Ukraine and underwent up to four thyroid screening examinations between 1998 and 2007 (n = 12,514). Thyroid doses of I-131 were estimated based on individual radioactivity measurements taken within 2 months after the accident, environmental transport models, and interview data. Excess radiation risks were estimated using Poisson regression models. RESULTS Sixty-five incident thyroid cancers were diagnosed during the second through fourth screenings and 73,004 person-years (PY) of observation. The dose-response relationship was consistent with linearity on relative and absolute scales, although the excess relative risk (ERR) model described data better than did the excess absolute risk (EAR) model. The ERR per gray was 1.91 [95% confidence interval (CI), 0.43-6.34], and the EAR per 10⁴ PY/Gy was 2.21 (95% CI, 0.04-5.78). The ERR per gray varied significantly by oblast of residence but not by time since exposure, use of iodine prophylaxis, iodine status, sex, age, or tumor size. CONCLUSIONS I-131-related thyroid cancer risks persisted for two decades after exposure, with no evidence of decrease during the observation period. The radiation risks, although smaller, are compatible with those of retrospective and ecological post-Chornobyl studies.
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Affiliation(s)
- Alina V Brenner
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland 20892-7238, USA.
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Reiners C. Clinical experiences with radiation induced thyroid cancer after chernobyl. Genes (Basel) 2011; 2:374-83. [PMID: 24710197 PMCID: PMC3924813 DOI: 10.3390/genes2020374] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2011] [Revised: 05/24/2011] [Accepted: 05/30/2011] [Indexed: 11/16/2022] Open
Abstract
The risk of developing thyroid cancer increases considerably after exposure to external or internal radiation, especially in children below the age of 10. After the Chernobyl reactor accident, the yearly incidence of childhood thyroid cancer in Belarus increased to approximately 40 per 1.000.000 in girls and to roughly 20 per 1.000.000 in boys compared to approximately 0.5 cases per 1.000.000 prior to the accident. Typically, young children with thyroid cancer after radiation exposure present in ≈95% of the cases as papillary cancers, in ≈50% as invasive tumors growing outside the thyroid capsule, in ≈65% with lymph node metastases and in ≈15% with distant metastases. A joint Belarusian-German project starting in April 1993 that combined treatment with surgery and radioiodine was organized in 237 selected children from Belarus who were exposed to the Chernobyl fallout and had advanced stages of thyroid cancer. The study group included 141 girls and 96 boys. Their median age at the time of the accident was 1.7 years; whereas the median age at the time of diagnosis was 12.4 years. With the exception of two cases with follicular histology, the majority of the patients had been diagnosed with papillary thyroid cancers. In 63%, the tumor had grown outside the thyroid capsule and invaded the tissue of the neck (pT4). Nearly all of the selected cases (96%) showed-up with lymph node metastases (pN1) and 43% of the patients with distant metastases mainly to the lungs (pM1). In 58% of the children, complete remissions of thyroid cancer could be achieved until December 31st 2010 and in 34% of the children, stable partial remissions; in the remaining 8% of the patients, partial remissions were observed. The risk of radiation-induced thyroid cancer increased considerably in children and adolescents who were affected by the Chernobyl reactor accident. In spite of the fact, that thyroid cancers in young children seem to behave more aggressively than in older patients, the results of combined treatment with thyroidectomy, radioiodine therapy and thyroid hormone replacement are excellent.
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Affiliation(s)
- Christoph Reiners
- Department of Nuclear Medicine, University of Würzburg, Oberdürrbacherstr.6, D-97082 Würzburg, Germany.
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Huda W, Magill D, Spampinato MV. Technical Note: Estimating absorbed doses to the thyroid in CT. Med Phys 2011; 38:3108-13. [DOI: 10.1118/1.3592022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Gain of chromosome band 7q11 in papillary thyroid carcinomas of young patients is associated with exposure to low-dose irradiation. Proc Natl Acad Sci U S A 2011; 108:9595-600. [PMID: 21606360 DOI: 10.1073/pnas.1017137108] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The main consequence of the Chernobyl accident has been an increase in papillary thyroid carcinomas (PTCs) in those exposed to radioactive fallout as young children. Our aim was to identify genomic alterations that are associated with exposure to radiation. We used array comparative genomic hybridization to analyze a main (n = 52) and a validation cohort (n = 28) of PTC from patients aged <25 y at operation and matched for age at diagnosis and residency. Both cohorts consisted of patients exposed and not exposed to radioiodine fallout. The study showed association of a gain on chromosome 7 (7q11.22-11.23) with exposure (false discovery rate = 0.035). Thirty-nine percent of the exposed group showed the alteration; however, it was not found in a single case from the unexposed group. This was confirmed in the validation set. Because only a subgroup of cases in the exposed groups showed gain of 7q11.22-11.23, it is likely that different molecular subgroups and routes of radiation-induced carcinogenesis exist. The candidate gene CLIP2 was specifically overexpressed in the exposed cases. In addition, the expression of the genes PMS2L11, PMS2L3, and STAG3L3 correlated with gain of 7q11.22-11.23. An enrichment of Gene Ontology terms "DNA repair" (PMS2L3, PMS2L5), "response to DNA damage stimulus" (BAZ1B, PMS2L3, PMS2L5, RFC2), and "cell-cell adhesion" (CLDN3, CLDN4) was found. This study, using matched exposed and unexposed cohorts, provides insights into the radiation-related carcinogenesis of young-onset PTC and, with the exposure-specific gain of 7q11 and overexpression of the CLIP2 gene, radiation-specific molecular markers.
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Cardis E, Hatch M. The Chernobyl accident--an epidemiological perspective. Clin Oncol (R Coll Radiol) 2011; 23:251-60. [PMID: 21396807 PMCID: PMC3107017 DOI: 10.1016/j.clon.2011.01.510] [Citation(s) in RCA: 126] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2011] [Accepted: 01/28/2011] [Indexed: 01/28/2023]
Abstract
Twenty-five years have passed since radioactive releases from the Chernobyl nuclear accident led to the exposure of millions of people in Europe. Studies of affected populations have provided important new data on the links between radiation and cancer-particularly the risk of thyroid tumours from exposure to iodine isotopes-that are important not only for a fuller scientific understanding of radiation effects, but also for radiation protection. It is now well documented that children and adolescents exposed to radioiodines from Chernobyl fallout have a sizeable dose-related increase in thyroid cancer, with the risk greatest in those youngest at exposure and with a suggestion that deficiency in stable iodine may increase the risk. Data on thyroid cancer risks to other age groups are somewhat less definitive. In addition, there have been reported increases in incidence and mortality from non-thyroid cancers and non-cancer end points. Although some studies are difficult to interpret because of methodological limitations, recent investigations of Chernobyl clean-up workers ('liquidators') have provided evidence of increased risks of leukaemia and other haematological malignancies and of cataracts, and suggestions of an increase in the risk of cardiovascular diseases, following low doses and low dose rates of radiation. Further careful follow-up of these populations, including the establishment and long-term support of life-span study cohorts, could provide additional important information for the quantification of radiation risks and the protection of persons exposed to low doses of radiation.
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Affiliation(s)
- E Cardis
- Centre for Research in Environmental Epidemiology, Hospital del Mar Research Institute, CIBER Epidemiologia y Salud Pública, Barcelona, Spain.
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DNA Copy Number Alterations in Radiation-induced Thyroid Cancer. Clin Oncol (R Coll Radiol) 2011; 23:289-96. [DOI: 10.1016/j.clon.2011.01.154] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2010] [Accepted: 01/12/2011] [Indexed: 12/28/2022]
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Fuzik M, Prysyazhnyuk A, Shibata Y, Romanenko A, Fedorenko Z, Gulak L, Goroh Y, Gudzenko N, Trotsyuk N, Khukhrianska O, Saenko V, Yamashita S. Thyroid cancer incidence in Ukraine: trends with reference to the Chernobyl accident. RADIATION AND ENVIRONMENTAL BIOPHYSICS 2011; 50:47-55. [PMID: 21063719 DOI: 10.1007/s00411-010-0340-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2010] [Accepted: 10/23/2010] [Indexed: 05/06/2023]
Abstract
For the first time, a comparative analysis of thyroid cancer incidence in Ukraine after the Chernobyl accident was done in a cohort that is almost as large as the general population. On the basis of thyroid doses from radioactive iodine in individuals aged 1-18 years at the time of accident, geographic regions of Ukraine with low and high average accumulated thyroid doses were established and designated "low-exposure" and "high-exposure" territories, respectively. A significant difference of thyroid cancer incidence rates as a function of time between the two territories was found. That is, the increase in the incidence was higher in high-exposure regions than in low-exposure regions. The incidence rates varied substantially among the different attained age-groups, especially in the youngest one (up to 19 years old). The analysis that was adjusted for screening and technological effects also indicated that in the high-exposure regions, thyroid cancer incidence rates at the age of diagnosis of 5-9, 10-14 and 15-19 years were significantly higher in those born in 1982-1986 compared to those born in 1987-1991, while in the low-exposure regions, no significant difference was observed. The observed probable excess of radiation-induced thyroid cancer cases in adults exposed to radioactive iodine from the Chernobyl accident, especially in females, may be due to the high power of the present study. However, it should be noted that our investigation was not essentially free from ecological biases.
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Affiliation(s)
- M Fuzik
- Atomic Bomb Disease Institute, Nagasaki University Graduate School of Biomedical Sciences, 1-12-4 Sakamoto, Nagasaki, 852-8523, Japan.
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Kukush A, Shklyar S, Masiuk S, Likhtarov I, Kovgan L, Carroll RJ, Bouville A. Methods for estimation of radiation risk in epidemiological studies accounting for classical and Berkson errors in doses. Int J Biostat 2011; 7:15. [PMID: 21423564 PMCID: PMC3058406 DOI: 10.2202/1557-4679.1281] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
With a binary response Y, the dose-response model under consideration is logistic in flavor with pr(Y=1 | D) = R (1+R)(-1), R = λ(0) + EAR D, where λ(0) is the baseline incidence rate and EAR is the excess absolute risk per gray. The calculated thyroid dose of a person i is expressed as Dimes=fiQi(mes)/Mi(mes). Here, Qi(mes) is the measured content of radioiodine in the thyroid gland of person i at time t(mes), Mi(mes) is the estimate of the thyroid mass, and f(i) is the normalizing multiplier. The Q(i) and M(i) are measured with multiplicative errors Vi(Q) and ViM, so that Qi(mes)=Qi(tr)Vi(Q) (this is classical measurement error model) and Mi(tr)=Mi(mes)Vi(M) (this is Berkson measurement error model). Here, Qi(tr) is the true content of radioactivity in the thyroid gland, and Mi(tr) is the true value of the thyroid mass. The error in f(i) is much smaller than the errors in ( Qi(mes), Mi(mes)) and ignored in the analysis. By means of Parametric Full Maximum Likelihood and Regression Calibration (under the assumption that the data set of true doses has lognormal distribution), Nonparametric Full Maximum Likelihood, Nonparametric Regression Calibration, and by properly tuned SIMEX method we study the influence of measurement errors in thyroid dose on the estimates of λ(0) and EAR. The simulation study is presented based on a real sample from the epidemiological studies. The doses were reconstructed in the framework of the Ukrainian-American project on the investigation of Post-Chernobyl thyroid cancers in Ukraine, and the underlying subpolulation was artificially enlarged in order to increase the statistical power. The true risk parameters were given by the values to earlier epidemiological studies, and then the binary response was simulated according to the dose-response model.
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de Vathaire F, Drozdovitch V, Brindel P, Rachedi F, Boissin JL, Sebbag J, Shan L, Bost-Bezeaud F, Petitdidier P, Paoaafaite J, Teuri J, Iltis J, Bouville A, Cardis E, Hill C, Doyon F. Thyroid cancer following nuclear tests in French Polynesia. Br J Cancer 2010; 103:1115-21. [PMID: 20808313 PMCID: PMC2965871 DOI: 10.1038/sj.bjc.6605862] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2010] [Revised: 07/27/2010] [Accepted: 08/03/2010] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Between 1966 and 1974, France conducted 41 atmospheric nuclear tests in Polynesia, but their potential health effects have not previously been investigated. METHODS In a case-control study, we compared the radiation exposure of almost all the French Polynesians diagnosed with differentiated thyroid carcinoma between 1981 and 2003 (n=229) to the exposure of 373 French Polynesian control individuals without cancer from the general population. Radiation exposures were estimated using measurements after the nuclear tests, age at time of each test, residential and dietary information. RESULTS The average thyroid dose before 15 years of age was about 1.8 mGy, and 5% of the cases and 3% of the controls received a dose above 10 mGy. Despite this low level of dose, and after adjusting for ethnic group, level of education, body surface area, family history of thyroid cancer and number of pregnancies for women, we observed an increasing risk (P=0.04) of thyroid cancer with increasing thyroid dose received before age of 15 years, which remained after excluding non-aggressive differentiated thyroid micro-carcinomas. This increase of risk per unit of thyroid radiation dose was higher (P=0.03) in women who later experienced four or more pregnancies than among other women. CONCLUSION The risk estimate is low, but is based on limited exposure data. The release of information on exposure, currently classified, would greatly improve the reliability of the risk estimation.
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Affiliation(s)
- F de Vathaire
- Radiation Epidemiology Group, U1018 INSERM, Institut Gustave Roussy, 39 rue Camille Desmoulins, Inserm, Villejuif F-94800, France.
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Bhandari S, Cheung NKV, Kushner BH, Kramer K, Modak S, Larson SM, Yeh S, Heller G, Sklar CA. Hypothyroidism after 131I-monoclonal antibody treatment of neuroblastoma. Pediatr Blood Cancer 2010; 55:76-80. [PMID: 20213847 DOI: 10.1002/pbc.22452] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND To determine the prevalence of and risk factors for primary hypothyroidism following treatment with a radiolabeled monoclonal antibody ((131)I-3F8) in children with neuroblastoma. PROCEDURE In the current study, we assessed thyroid function in 51 neuroblastoma patients who survived for > or =3 months after treatment with (131)I-3F8 (a murine IgG3 monoclonal antibody that reacts with the ganglioside GD2) at 4 mCi/kg/day x 5 days (total 20 mCi/kg). Prior therapy in all subjects included dose-intensive chemotherapy; 13 subjects also received external beam radiation to the neck. Oral iodide and liothyronine sodium (T3) were administered for protection of the thyroid gland. RESULTS Thirty-two of 51 subjects (63%) developed hormonal evidence of primary hypothyroidism. The median time to hypothyroidism after treatment with (131)I-3F8 was 6.4 months. The probability of developing hypothyroidism was 56% at 2 years following treatment with (131)I-3F8. There was evidence for an association between thyroidal uptake of (131)I and development of hypothyroidism (hazard ratio 1.83, 95% confidence interval 0.91-3.30; P = 0.09). CONCLUSIONS We conclude that hormonal evidence of primary hypothyroidism developed in a majority of subjects treated with (131)I-3F8, despite pretreatment with oral iodide plus liothyronine sodium. Alternative strategies for thyroid gland protection are needed.
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Affiliation(s)
- Sonal Bhandari
- Department of Pediatrics, New York Presbyterian-Weill Cornell Medical College, New York, New York, USA
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Konrad R, Bezchlibnyk-Butler K, Wodoslawsky MD. Allocation of aid for health institutions in Ukraine: implications from a case study of Chornobyl (Chernobyl) area hospitals. INTERNATIONAL JOURNAL OF HEALTH SERVICES 2009; 39:623-41. [PMID: 19927406 DOI: 10.2190/hs.39.4.b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Over the past two decades, numerous non-governmental organizations have sought to improve the health status of populations struggling with the lingering effects of the Chornobyl (Chernobyl) nuclear disaster. Political and economic features of Ukraine's government produced a health system unable to provide services required by its population. To compensate somewhat for these shortcomings, Ukraine's health institutions rely on foreign donations. However, to effectively target foreign aid efforts, a more thorough understanding of the administration of health institutions in Ukraine is needed. This study investigates the organizational structures, care delivery, and legislative and financial regulations in the country's health system and their implications for patient care. Through an exhaustive study of four representative health institutions across Ukraine, the authors identify how donor organizations can achieve their aid objectives and work within the country's health infrastructure.
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Affiliation(s)
- Renata Konrad
- Department of Management, Worcester Polytechnic Institute, Worcester, MA 01609, USA.
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