Health Risks of Ionizing Radiation: - Clark University

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frequently or as intensively as it was in the early and middle part of the 20 th century. This section reviews studies of treatment of various diseases including tuberculosis, ankylosing spondylitis, and childhood skin conditions (hemangiomas and tinea capitis). Tuberculosis. Fluoroscopy, a form of x-ray examination, was frequently used in the past to both diagnosis and treat tuberculosis. Although exposures varied, this procedure resulted in average doses on the order of 1 Gy to the chest (lungs, breast, esophagus), and ~0.1 Gy to the bone marrow and stomach organs. Davis et al. (1989) looked at a cohort of Massachusetts fluoroscopy patients and found evidence for an increased risk of mortality from cancer of the breast (SMR 1.4) and esophagus (SMR 2.1). A largely overlapping cohort was revisited by Boice et al. (1991) to assess the risk of breast cancer in more detail. This study found a significant dose-response relationship that depended on age at exposure; the estimated relative risk for women exposed to 1 Gy at age 15 was 2.0; corresponding estimates for exposure at ages 20, 35 and 45 were 1.7, 1.2 and 1.1, respectively. Howe (1995) investigated the lung cancer risk associated with fluoroscopies administered in Canada. There was no evidence for such a risk in this cohort, and the estimated RR at 1 Gy was 1.00 (0.94-1.07), significantly lower than the estimate from the atomic bomb survivors of 1.60 (1.27-1.99). The fact that these observations differ markedly from atomic bomb survivor data has been explained as an effect of dose fractionation. Although cumulative doses averaged ~1 Gy, the fluoroscopic regimen included an average of 90 separate exposures received at a rate of two per month. Regarding breast cancer, Little and Boice (1999) showed that although Medical Exposures 25 the ERR estimate from the fluoroscopy group was roughly half that from the atomic bomb survivors, the absolute risks were essentially the same 13 . This implies that the induction of breast cancer by radiation is independent of the underlying breast cancer risk, which is much lower in Japan. Brenner (1999), however, observed that fluoroscopy radiation should be more biologically effective (damaging) than the atomic bomb radiation 14 . He concluded that the dose fractionation of the fluoroscopic treatment probably reduced the risk per dose. Ankylosing spondylitis. Ankylosing spondylitis is a chronic, progressive inflammation of the vertebrae. Over 14,000 patients in the UK, between 1935 and 1954, were treated for this disease with high doses of x-rays 15 . Weiss et al. (1994, 1995) studied the cancer mortality in this cohort through 1991 16 . The researchers found that there was increased risk of cancer mortality (RR 1.30, 1.24- 1.35), particularly non-CLL leukemia mortality (RR 3.11, 2.37-4.07), which peaked in the 1-5 years after first treatment. The dose-response relationship for cancer mortality was best described with an ERR of 0.28/Gy 17 (the atomic bomb survivors estimate is 0.47/Gy; Preston et al. 2003). Leukemia results were analyzed by Weiss et al. in a 1995 paper. The dose-response relationship for leukemia showed a maximum risk in the 0.01- 1.0 Gy dose range (RR 6.58, 2.22-15.98). This is likely to be a result of cell killing at higher doses- if cells that might otherwise develop into a cancer are killed then the risk per unit dose can be less 18 . Weiss et al. (1995) modeled leukemia mortality with a complicated linear-exponential model that allowed for this effect and also calculated total risk as the sum of the risks in different bone marrow regions. This compartmental component of the model took 13 The EAR estimates were 5.48/10,000 PY-Sv (0.90-10.43) for the fluoroscopy cohort and 4.95/10,000 PY-Sv (3.37- 6.71) for the atomic bomb survivors (Little and Boice 1999). 14 Fluoroscopic x-rays and gamma radiation from the atomic bombs are types of photons that have different energies. Fluoroscopic x-rays have a lower energy but a higher linear energy transfer, or LET. At low doses these photons are expected to be 1.6 to 1.9 times more damaging than the gamma radiation from the atomic bombs (Brenner 1999). 15 Weiss et al. (1994) report mean total body and bone marrow doses of 2.64 and 5.10 Gy. 16 An earlier analysis through 1982 was published by Darby et al. (1987). 17 Although an estimated ERR of 0.1/Gy (0.04-0.18; all cancers except leukemia) was derived with a simple linear model, the linear term in a linear-quadratic model was reported to be 0.28/Gy (0.07-0.48); this would be a more appropriate value to use when considering low doses. 18 It was estimated that the ERR at 1 Gy was reduced by 47% (17-79%) due to the effect of cell killing.
26 Medical Exposures localized exposures into account; some regions might have been exposed with doses in the cell killing range while others received more carcinogenic exposures. This type of model fit the data better than more conventional models and the linear term, which we are interested in because it applies directly to low doses, described an ERR of 12.37/Gy (2.25-52.07) for 10 years after first treatment. The risk declined with time so that the ERR was 5.18/Gy (0.81-23.63) 25 years after first treatment. Damber et al. (1995, 2002) studied the risks of x-ray treatment of spondylitis and related diseases in Sweden. The 1995 study found increased incidence of leukemia (SIR 1.18, 0.98-1.42; SMR 1.25, 0.99- 1.45); bone marrow doses were estimated to have been about 0.4 Gy. The 2002 study demonstrated an increased risk of thyroid cancer (SIR 1.60, 1.00- 2.42); thyroid doses were estimated to have been about 1 Gy. Hyperthyroidism. Hyperthyroid patients who were treated with iodine-131 have been studied in the US (Ron et al. 1998), the UK (Franklyn et al. 1999) and Sweden (Hall et al. 1992). This procedure involves very high thyroid doses (50-100 Gy); although this is intended to kill the thyroid there are significant risks of cancer developing in the remaining tissue. The SIR for thyroid cancer was estimated to be 3.25 (1.69-6.25) in the UK cohort, and SMRs of 3.94 (2.52-5.86) and 1.95 (1.01-3.41) were reported for the US and Sweden cohorts. Although the thyroid doses in these cohorts were high, the doses received by other parts of the body were relatively low 19 . Cancer sites with elevated mortality in the Swedish cohort included the digestive tract (SMR 1.14, 1.03-1.25) and the respiratory tract (SMR 1.26, 1.06-1.49). The US cohort exhibited increased mortality from lung cancer (SMR 1.1, 1.0- 1.2), kidney cancer (SMR 1.3, 1.0-1.6) and breast cancer (SMR 1.2, 1.1-1.3). The UK cohort showed increased incidence of cancer of the small intestine (SIR 4.81, 2.16-10.72). Radiotherapy for other non-cancer diseases. Inskip et al. (1990) found that patients treated for uterine bleeding with radiotherapy were at an elevated risk for cancer, specifically leukemia. This procedure, which was used mainly in the 1930s and 40s, involved either radium implants or x-rays and resulted in median bone marrow doses of 0.5 Gy (radium) and 2.5 Gy (x-rays). The SMR for cancer was 1.3 (1.2-1.4) and for leukemia was 2.0 (1.4-2.8). Leukemia risk was dependent on dose with an ERR of 1.9/Gy (0.8-3.2). In a larger cohort 20 Inskip et al. (1993) analyzed leukemia, lymphoma and multiple myeloma mortality. The mean bone marrow dose in this cohort was 1.2 Gy; non-CLL leukemia mortality was significantly elevated (SMR 1.7, 1.3-2.3) although a dose-response trend was not evident. X-rays were used to treat peptic ulcers at the University of Chicago between 1937 and 1965; doses from this procedure were very high (mean stomach dose 14.8 Gy). Carr et al. (2002) analyzed the cancer mortality patterns in 3,719 exposed patients. Observed increases in mortality included stomach cancer (RR 2.6, 1.33-5.09), lung cancer (RR 1.50, 1.08-2.08) and all cancers combined (RR 1.41, 1.18- 1.67). Leukemia risk was also elevated (RR 2.46, 0.75-8.01); the estimated mean bone marrow dose was 1.6 Gy. Analysis of dose-response was not very informative owing largely to a narrow distribution of relatively high doses. Radiotherapy for non-cancer disease in children. Hemangiomas of the skin are benign lesions that have been treated in infancy with xrays or radium 21 . Lindberg et al. (1995) investigated a cohort that had been treated at Sahlgrenska University Hospital in Gothenburg, Sweden. This study found significantly positive SIRs for all malignancies (1.21, 1.06-1.37), cancers of the central nervous system (1.85, 1.28-2.59), thyroid cancer (1.88, 1.05-3.09), and other endocrine gland cancers (2.58, 1.64-3.87). Lundell and Holm (1995) assessed the cancer risk in people who had been 19 In the Swedish cohort, for example, estimated doses to the stomach wall, small intestine, and bone marrow were 0.25, 0.14 and 0.06 Gy. 20 Inskip et al. (1990) studied 4,483 women treated in Massachussets. Inskip et al. (1993) studied 12,995 women treated in any of 17 hospitals in New England or New York State. 21 Although radium-226 is an alpha-emitter, it was used in these cases by placing it next to the hemangiomas, exposing the skin to beta particles and gamma radiation.
Page 1 and 2: Health Risks of Ionizing Radiation:
Page 3 and 4: Contents List of Tables ...........
Page 5 and 6: Contents iii Rocky Flats ..........
Page 7 and 8: Contents v APPENDIX A .............
Page 9 and 10: List of Figures Figure 1-1 Average
Page 11 and 12: We are indeed grateful to those who
Page 13 and 14: 2 Introduction 1.2 A brief history
Page 15 and 16: 4 Introduction Figure 1-2. The evol
Page 17 and 18: 6 Introduction Figure 1-5(a). Alpha
Page 19 and 20: 8 Introduction In epidemiological s
Page 21 and 22: 10 Introduction precision to detect
Page 23 and 24: 12 Introduction available informati
Page 25 and 26: 14 Background Radiation Figure 2-1.
Page 27 and 28: 16 Background Radiation Figure 2-3.
Page 29 and 30: 18 Background Radiation
Page 31 and 32: 20 Medical Exposures Fi
Page 33 and 34: 22 Medical Exposures
Page 35: 24 Medical Exposures with national
Page 39 and 40: 28 Medical Exposures (2.1-28.7). Th
Page 41 and 42: 30 Medical Exposures posed 2.69 tim
Page 43 and 44: 32 Medical Exposures with diagnosti
Page 45 and 46: 34 Medical Exposures Table 3-1. Stu
Page 55 and 56: 44 Atomic Bomb Survivors Figure 4-2
Page 57 and 58: 46 Atomic Bomb Survivors
Page 59 and 60: 48 Atomic Bomb Survivors approximat
Page 61 and 62: 50 Atomic Bomb Survivors (ALL), acu
Page 63 and 64: 52 Atomic Bomb Survivors of the 8 t
Page 69 and 70: 5 Nuclear Weapons Testing Over 500
Page 71 and 72: 60 Nuclear Weapons Testing by disti
Page 73 and 74: 62 Nuclear Weapons Testing Figure 5
Page 75 and 76: 64 Nuclear Weapons Testing near the
Page 77 and 78: 66 Nuclear Weapons Testing
Page 79 and 80: 68 Nuclear Weapons Testing
Page 81 and 82: 6 RADIATION WORKERS Introduction Th
Page 83 and 84: 72 Radiation Workers • 50 rem (0.
Page 85 and 86: 74 Radiation Workers work, reports
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76 Radiation Workers Figure 6-5. A
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78 Radiation Workers Figure 6-8. To
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Page 93 and 94:
82 Radiation Workers Feed Material
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84 Radiation Workers by Beral et al
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Page 99 and 100:
88 Radiation Workers Table 6-1. Leu
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90 Radiation Workers No
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92 Radiation Workers N
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94 Radiation Workers S
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96 Radiation Workers ERR estim
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98 Mayak Workers Table 1. Dose (Gy)
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100 Mayak Workers workers at the ra
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102 Mayak Workers
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104 Uranium Miners enrichment facil
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106 Uranium Miners Samet et al. (19
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108 Uranium Miners were selected 12
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Uranium Miners 111
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9 RADIATION EXPOSURE IN FLIGHT The
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DNA damage (a chemical change in DN
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10 PRECONCEPTION EXPOSURES Several
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of risk in the lowest dose groups,
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found elevated solid cancer risk wi
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preconception doses between 2.5 and
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Table 10-1. Preconception irradiati
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Preconception Exposures 127
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Tracheoesophageal fistula and conge
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cancer were both associated with th
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0.10-4.71) while respiratory system
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elationship was not significant for
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times higher than in less-contamina
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Nuclear Power Accidents 139
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Page 154 and 155:
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12 COMMUNITIES NEAR NUCLEAR FACILIT
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levels (this could not in itself be
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Figure 12-3. Native Americans from
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of leukemia was measured over a lar
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(RR 1.06; 1.00-1.11) and risks of s
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more that we can say about this app
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Communities Near Nuclear Facilities
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Page 172 and 173:
Page 174 and 175:
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54 observed vs. 46.1 expected death
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13 DISCUSSION Our intention in crea
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myeloid leukemia) was significantly
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0.1-3.5 WLM; this is roughly equiva
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adon (Lubin et al. 1997). These res
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Leukemia Leukemia, a general term t
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vical cancer. The doses to these pa
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England have found it convenient to
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Thyroid disease Thyroid cancer is a
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1986 through 1995. These workers sh
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dence of this disease includes elev
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Analysis of preconception exposure
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Paternal age, education, drinking O
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Gardner et al. 1990 Employed at Sel
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we consider this group of a few hun
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Leukemia risk (excluding CLL) among
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Glossary of Terms for Epidemiology
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Glossary 199 Beta radiation: Stream
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Dosimetry: Measurement or estimatio
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Glossary 203 Hypothyroidism: The cl
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Glossary 205 Metastasis: 1. Movemen
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Glossary 207 waves, ultra violet (U
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Glossary 209 Thyroid Disease: disea
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Bibliography ATSDR. Public Health A
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Bhatia S, Sklar C. Second cancers i
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Bibliography 215 Cavallo D, Tomao P
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Bibliography 217 Department of Ener
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Bibliography 219 Gardner MJ, Hall A
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Haldorsen T, Reitan JB, Tveten U. C
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Bibliography 223 Howe GR, Nair R, N
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of Mayak, A comparison of numerical
Page 238 and 239:
Bibliography 227 Laird NM. Thyroid
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control population. International J
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Bibliography 231 Neel JV, Schull WJ
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2003.160:381-407. Bibliography 233
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Bibliography 235 Saccomanno G, Auer
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Bibliography 237 analysis of cancer
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Bibliography 239 Tokarskaya ZB, Sco
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Journal of Epidemiology 1987.125(2)
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Actinium, 84 Acute lymphocytic leuk
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and Nevada Test Site, 60-61, 62 nuc
Page 258 and 259:
Hashimoto’s thyroiditis, 185 Heal
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studies, 101-2 Medical exposure, 19
Page 262 and 263:
(RERF), 43 Radiation Exposure Compe
Page 264:
Viruses, 118, 154, 193 West Germany
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