Health Risks of Ionizing Radiation: - Clark University

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treated at the Radiumhemmet in Stockholm, Sweden and found similar results. Specifically, this study found an increased cancer risk (SIR 1.11, 0.99-1.24) that was mainly attributable to breast cancer (SIR 1.24 0.98-1.34 22 ) and thyroid cancer (SIR 2.28, 1.33- 3.65) 23 . The dose-response trend for thyroid cancer showed an ERR of 4.9 (1.3-10.2); this is compatible with other studies (see appendix B). Karlsson et al. (1998) pooled the two Swedish skin hemangioma cohorts to assess the risks of intracranial (brain and central nervous system) tumors. Although the mean brain dose in the pooled cohort was 8 cGy, individual doses ranged as high as 11.5 Gy. The study found a significant risk (SIR 1.42, 1.13-1.75) and a significant dose-response relationship (ERR 2.2/Gy, 0.2-5.9). Risks associated with low doses (
28 Medical Exposures (2.1-28.7). This paper is discussed in greater detail in appendix B. 3.4 Radiotherapy for cancer Radiation is an important cancer therapy tool. Although the benefits of radiation therapy obviously outweigh the risks in many cases, researchers and doctors have long been concerned about the possibility of second cancers in cancer patients. Two types of potential risk factors converge in these patients; genetic or environmental predisposition to cancer, demonstrated by the first cancer, and the therapy, either chemotherapy or radiation. These factors make information about cancer patients a hard body of evidence to compare with other studies. The underlying genetic cancer risk can be accounted for, to some degree, by focusing exclusively on cancer patients and assessing the dose-response patterns or using cancer patients not treated with radiation as controls. Doses are typically very high, so we do not go into these studies in depth and only discuss a few representative papers. Little et al. (1999) provide a comprehensive review of the field in relation to atomic bomb survivor-based risk estimates 28 . Boice et al. (1987, 1988) have studied radiation treatment for cancer of the cervix using casecontrol methods. Doses to bone marrow were on the order of several Gy from this procedure. The 1987 paper focused on leukemia and found a marginally significant doubling of risk (RR 2.0, 90% CI 1.0- 4.2). The risk appeared to increase with dose up to about 4 Gy and the authors fit the data with a linear-exponential model with compartmentalized dose estimates (see Weiss et al. 1995, above). In this case the linear estimate of ERR was 0.88/Gy 29 . The 1988 paper focused on second cancers generally. Tissues close to the cervix received doses ranging as high as 200 Gy or more; cell killing is an obvious consideration in these cases. The incidence of cancers of the rectum, bladder, and genital organs was significantly increased. The thyroid received an average dose of 0.11 Gy and showed a nonsignificant twofold increase in cancer risk (RR 2.35, 0.6-8.7). Travis et al. (2000) examined men who had been treated for testicular cancer with radiation to see if they had an increased incidence of leukemia. The mean bone marrow dose in this cohort was 12.6 Gy. Patients who had been treated with radiation and not chemotherapy were found to have a threefold leukemia risk (RR 3.1, 0.7-22) compared to patients who had not received radiation or chemotherapy. Risk appeared to be significantly related to dose although the relationship was not quantified. Gilbert et al. (2003) investigated the lung cancer risk among Hodgkin’s disease patients. This study benefited from estimates of radiation dose for specific locations of the lung where cancer later developed. The authors were also able to control for chemotherapy treatments and smoking. There was a significant dose-response relationship in this cohort (ERR 0.15/Gy, 0.06-0.39) and even though most doses were above 30 Gy there was little evidence for departure from linearity, indicating similar doseresponse relationships for lower doses 30 . It was found that the interaction between chemotherapy and radiation was almost exactly additive while the interaction between radiotherapy and tobacco use seemed to be multiplicative. Hancock et al. (1993) found that women who were treated for Hodgkin’s disease had an increased risk of breast cancer incidence and mortality (incidence RR 4.1, 2.5-5.7); this risk was particularly evident in women who had been treated before the age of 15 (incidence RR 136, 34-371). Most tumors arose in tissues receiving ~44 Gy. These authors also found evidence for an increased incidence of thyroid disease in this cohort (thyroid cancer RR 15.6, 6.3-32.5; Hancock et al. 1991). 28 They found that in almost all cases the atomic bomb survivor-based risk estimates were higher. The authors speculated that cell sterilization from the scheduled high doses of the medical exposure were largely responsible for the difference. 29 This is substantially lower than the estimated ERR of 5.18/Gy (0.81-23.63) from the ankylosing spondylitis cohort (Weiss et al. 1995). 30 The lung cancer incidence pattern in the atomic bomb survivors showed a higher ERR of 0.95/Gy (0.60-1.36; Thompson et al. 1994). Doses among atomic bomb survivors were acute, single doses about 100 times lower than the fractionated doses in these Hodgkin’s disease patients.
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 and 36: 24 Medical Exposures with national
Page 37: 26 Medical Exposures localized expo
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
Page 87 and 88: 76 Radiation Workers Figure 6-5. A
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78 Radiation Workers Figure 6-8. To
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80 Radiation Workers Figure 6-10. A
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82 Radiation Workers Feed Material
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84 Radiation Workers by Beral et al
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86 Radiation Workers Figure 6-14. A
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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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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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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
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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
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Hashimoto’s thyroiditis, 185 Heal
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studies, 101-2 Medical exposure, 19
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(RERF), 43 Radiation Exposure Compe
Page 264:
Viruses, 118, 154, 193 West Germany
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