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1.
BMJ ; 368: m7, 2020 02 04.
Artigo em Inglês | MEDLINE | ID: mdl-32019742

RESUMO

OBJECTIVE: To assess whether an association exists between financial links to the indoor tanning industry and conclusions of indoor tanning literature. DESIGN: Systematic review. DATA SOURCES: PubMed, Embase, and Web of Science, up to 15 February 2019. STUDY SELECTION CRITERIA: Articles discussing indoor tanning and health were eligible for inclusion, with no article type restrictions (original research, systematic reviews, review articles, case reports, editorials, commentaries, and letters were all eligible). Basic science studies, articles describing only indoor tanning prevalence, non-English articles, and articles without full text available were excluded. RESULTS: 691 articles were included in analysis, including empiric articles (eg, original articles or systematic reviews) (357/691; 51.7%) and non-empiric articles letters (eg, commentaries, letters, or editorials) (334/691; 48.3%). Overall, 7.2% (50/691) of articles had financial links to the indoor tanning industry; 10.7% (74/691) articles favored indoor tanning, 3.9% (27/691) were neutral, and 85.4% (590/691) were critical of indoor tanning. Among the articles without industry funding, 4.4% (27/620) favored indoor tanning, 3.5% (22/620) were neutral, and 92.1% (571/620) were critical of indoor tanning. Among the articles with financial links to the indoor tanning industry, 78% (39/50) favored indoor tanning, 10% (5/50) were neutral, and 12% (6/50) were critical of indoor tanning. Support from the indoor tanning industry was significantly associated with favoring indoor tanning (risk ratio 14.3, 95% confidence interval 10.0 to 20.4). CONCLUSIONS: Although most articles in the indoor tanning literature are independent of industry funding, articles with financial links to the indoor tanning industry are more likely to favor indoor tanning. Public health practitioners and researchers need to be aware of and account for industry funding when interpreting the evidence related to indoor tanning. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42019123617.


Assuntos
Conflito de Interesses , Indústrias/economia , Neoplasias Induzidas por Radiação/epidemiologia , Neoplasias Cutâneas/epidemiologia , Banho de Sol/economia , Banho de Sol/estatística & dados numéricos , Raios Ultravioleta/efeitos adversos , Humanos , Neoplasias Induzidas por Radiação/economia , Apoio à Pesquisa como Assunto , Neoplasias Cutâneas/economia
4.
Int J Cancer ; 146(3): 635-645, 2020 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-30873589

RESUMO

Radiation effects on colorectal cancer rates, adjusted for smoking, alcohol intake and frequency of meat consumption and body mass index (BMI) by anatomical subsite (proximal colon, distal colon and rectum) were examined in a cohort of 105,444 atomic bomb survivors. Poisson regression methods were used to describe radiation-associated excess relative risks (ERR) and excess absolute rates (EAR) for the 1958-2009 period. There were 2,960 first primary colorectal cancers including 894 proximal, 871 distal and 1,046 rectal cancers. Smoking, alcohol intake and BMI were associated with subsite-specific cancer background rates. Significant linear dose-responses were found for total colon (sex-averaged ERR/Gy for 70 years old exposed at age 30 = 0.63, 95% confidence interval [CI]: 0.34; 0.98), proximal [ERR = 0.80, 95% CI: 0.32; 1.44] and distal colon cancers [ERR = 0.50, 95% CI: 0.04; 0.97], but not for rectal cancer [ERR = 0.023, 95% CI: -0.081; 0.13]. The ERRs for proximal and distal colon cancers were not significantly different (p = 0.41). The ERR decreased with attained age for total colon, but not for proximal colon cancer, and with calendar year for distal colon cancer. The ERRs and EARs did not vary by age at exposure, except for decreasing trend in EAR for proximal colon cancer. In conclusion, ionizing radiation is associated with increased risk of proximal and distal colon cancers. The ERR for proximal cancer persists over time, but that for distal colon cancer decreases. There continues to be no indication of radiation effects on rectal cancer incidence in this population.


Assuntos
/estatística & dados numéricos , Neoplasias do Colo/epidemiologia , Neoplasias Induzidas por Radiação/epidemiologia , Neoplasias Retais/epidemiologia , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Consumo de Bebidas Alcoólicas/efeitos adversos , Consumo de Bebidas Alcoólicas/epidemiologia , Índice de Massa Corporal , Criança , Pré-Escolar , Colo/efeitos da radiação , Neoplasias do Colo/etiologia , Relação Dose-Resposta à Radiação , Feminino , Seguimentos , Humanos , Incidência , Lactente , Recém-Nascido , Mucosa Intestinal/efeitos da radiação , Japão/epidemiologia , Masculino , Carne/efeitos adversos , Pessoa de Meia-Idade , Neoplasias Induzidas por Radiação/etiologia , Neoplasias Retais/etiologia , Reto/efeitos da radiação , Sistema de Registros/estatística & dados numéricos , Fatores de Risco , Fumar/efeitos adversos , Fumar/epidemiologia , Adulto Jovem
5.
Radiol Med ; 125(3): 296-305, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31845091

RESUMO

The advances in technology have led to a growing trend in population exposure to radiation emerging from the invention of high-dose procedures. It is, for example, estimated that annually 1.2% of cancers are induced by radiological scans in Norway. This study aims to investigate and discuss the frequency and dose trends of radiological examinations in Europe. European Commission (EC) launched projects to gain information for medical exposures in 2004 and 2011. In this study, the European Commission Radiation Protection (RP) reports No. 154 and 180 have been reviewed. The RP 154 countries' data were extracted from both reports, and the average variation trend of the number of examinations and effective doses were studied. According to the results, plain radiography and fluoroscopy witnessed a reduction in the frequency and effective dose per examination. Nevertheless, European collective dose encountered an average increase of 23%, which resulted from a growing tendency for implementation of high-dose procedures such as CT scans and interventional examinations. It is worth noting that most of the CT procedures have undergone an increase in effective dose per examination. Although demand and dose per examination in some radiological procedures (such as intravenous urography (IVU) have been reduced, population collective dose is still rising due to the increasing demand for CT scan procedures. Even though the individual risks are not considerable, it can, in a large scale, threaten the health of the people at the present time. Due to this fact, better justification should be addressed so as to reduce population exposure.


Assuntos
Exposição à Radiação/estatística & dados numéricos , Radiografia Intervencionista/tendências , Radiografia/tendências , Tomografia Computadorizada por Raios X/tendências , Europa (Continente)/epidemiologia , Fluoroscopia/estatística & dados numéricos , Fluoroscopia/tendências , Humanos , Neoplasias Induzidas por Radiação/epidemiologia , Noruega/epidemiologia , Doses de Radiação , Proteção Radiológica , Radiografia/estatística & dados numéricos , Radiografia Intervencionista/estatística & dados numéricos , Radiologia/tendências , Tomografia Computadorizada por Raios X/estatística & dados numéricos
6.
Br J Radiol ; 93(1105): 20180677, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31674803

RESUMO

OBJECTIVES: Our aim was to compare cancer incidence in a cohort exposed in childhood (1950-63) to a therapeutic dose of radiation in the North of Portugal and followed-up until the end of 2012, with the incidence rates for the same age and sex in the general population. METHODS: A population-based North Region cancer registry (RORENO) was used to assess which members of the cohort developed cancer. The association between radiation exposure and overall and specific cancer sites was evaluated using standardised incidence ratios (SIR). RESULTS: Over the full follow-up period, 3357 individuals of the 5356 original tinea capitis (TC) cohort (63%) were retrieved in the RORENO, and 399 new cancer cases were identified, representing an increased risk of 49% when compared with the general population (SIR = 1.49; 95% CI: 1.35-1.64). The risk was slightly higher in males than in females (SIR = 1.65; 95% CI: 1.43-1.89 vs SIR = 1.35; CI = 1.17-1.55). The risk was slightly higher in the individuals exposed to a higher radiation dose (SIR = 1.78; 95% CI: 1.22-2.51 for ≥630 R vs SIR = 1.46; 95% CI: 1.31-1.62 for 325-475 R). In females, there was an excess cancer risk in all cancers with the higher radiation dose (SIR = 2.00; 95% CI: 1.21-3.13 for ≥630 R vs SIR = 1.30; 95% CI: 1.11-1.51 for 325-475 R) which was not observed in males, and for combined dose categories significantly raised SIRs for thyroid and head and neck cancer, suggesting a possible higher radiosensitivity of females. An increased risk was also observed for some cancers located far from the irradiated area. CONCLUSIONS: The results suggest an association between radiation exposure and later increased cancer risk for cancers located near the radiation exposed area, mainly thyroid, and head and neck cancers. Further studies are necessary to disentangle possible non-radiation causes for distant cancers increased risk. ADVANCES IN KNOWLEDGE: This paper shows a possible association between childhood X-ray epilation and increased risk of cancer which was not previously investigated in the Portuguese TC cohort.


Assuntos
Neoplasias Induzidas por Radiação/epidemiologia , Tinha do Couro Cabeludo/radioterapia , Criança , Pré-Escolar , Feminino , Humanos , Incidência , Lactente , Masculino , Portugal/epidemiologia , Sistema de Registros , Fatores de Risco
7.
Medicine (Baltimore) ; 98(37): e17165, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31517868

RESUMO

A thyroid cancer ultrasonography screening for all residents 18 years old or younger living in the Fukushima prefecture started in October 2011 to investigate the possible effect of the radiological contamination after the Fukushima Daiichi Nuclear Power Plant accidents as of March 12 to 15, 2011. Thyroid cancer in 184 cases was reported by February 2017. The question arises to which extent those cancer cases are a biological consequence of the radiation exposure or an artefactual result of the intense screening of a large population.Experiences with the Chernobyl accident suggest that the external dose may be considered a valid surrogate for the internal dose of the thyroid gland. We, therefore, calculated the average external effective dose-rate (µSv/h) for the 59 municipalities of the Fukushima prefecture based on published data of air and soil radiation. We further determined the municipality-specific absolute numbers of thyroid cancers found by each of the two screening rounds in the corresponding municipality-specific exposed person-time observed. A possible association between the radiation exposure and the thyroid cancer detection rate was analyzed with Poisson regression assuming Poisson distributed thyroid cancer cases in the exposed person-time observed per municipality.The target populations consisted of 367,674 and 381,286 children and adolescents for the 1st and the 2nd screening rounds, respectively. In the 1st screening, 300,476 persons participated and 270,489 in the 2nd round. From October 2011 to March 2016, a total of 184 cancer cases were found in 1,079,786 person-years counted from the onset of the exposure to the corresponding examination periods in the municipalities. A significant association between the external effective dose-rate and the thyroid cancer detection rate exists: detection rate ratio (DRR) per µSv/h 1.065 (1.013, 1.119). Restricting the analysis to the 53 municipalities that received less than 2 µSv/h, and which represent 176 of the total 184 cancer cases, the association appears to be considerably stronger: DRR per µSv/h 1.555 (1.096, 2.206).The average radiation dose-rates in the 59 municipalities of the Fukushima prefecture in June 2011 and the corresponding thyroid cancer detection rates in the period October 2011 to March 2016 show statistically significant relationships.


Assuntos
Acidente Nuclear de Fukushima , Neoplasias Induzidas por Radiação/epidemiologia , Doses de Radiação , Neoplasias da Glândula Tireoide/epidemiologia , Adolescente , Criança , Pré-Escolar , Relação Dose-Resposta à Radiação , Detecção Precoce de Câncer , Geografia Médica , Humanos , Incidência , Lactente , Recém-Nascido , Japão/epidemiologia , Modelos Estatísticos , Neoplasias Induzidas por Radiação/diagnóstico por imagem , Prevalência , Exposição à Radiação/efeitos adversos , Glândula Tireoide/diagnóstico por imagem , Glândula Tireoide/efeitos da radiação , Neoplasias da Glândula Tireoide/diagnóstico por imagem , Ultrassonografia
8.
J Bone Joint Surg Am ; 101(15): 1375-1380, 2019 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-31393428

RESUMO

BACKGROUND: The utilization of medical imaging continues to rise, including routine use in major trauma centers. The aims of this study were to estimate the amount of radiation exposure from radiographic imaging and the associated fatal carcinogenesis risk among patients treated for polytrauma at 1 institution. METHODS: Included were patients who were admitted to our institution with an Injury Severity Score (ISS) of ≥16 during the period of January 2007 to December 2016. Records of patients were reviewed to assess exposures to radiation (excluding fluoroscopy) in the 12 months following injury. The risk of developing a fatal cancer of any type was modeled using patient age and sex, on the basis of the International Commission on Radiological Protection (ICRP) recommendations. Estimates of cancer risk were based on the exposure received and then imported into previously developed models. RESULTS: Overall, 2,394 patients, with a mean ISS of 28.66 (range, 17 to 66), were included in our analysis. The mean total radiation dose received was 30.45 mSv and the median dose was 18.46 mSv. One hundred and fifteen patients (4.8% of the cohort) received ≥100 mSv of radiation. The total patient group had a 3.56% mean risk of fatal carcinogenesis of any type that related solely to medical exposure of radiation as a result of their injuries. In their lifetime, 85 patients would be expected to develop cancer as a result of medical imaging that they had undergone in the year following their accident. The ISS and the body region of injury contributing to the ISS were predictive of the level of radiation exposure. CONCLUSIONS: Those involved in trauma care can use the ISS and body region to predict radiation exposure and the risk of fatal carcinogenesis of any type. We found that, for injuries to the limb and pelvis, the greater the severity of injury, the greater the radiation exposure and fatal carcinogenesis risk. However, this study does not provide an actuarial analysis. It is unknown how many patients in the study went on to develop cancer. LEVEL OF EVIDENCE: Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.


Assuntos
Traumatismo Múltiplo/diagnóstico por imagem , Neoplasias Induzidas por Radiação/epidemiologia , Exposição à Radiação/efeitos adversos , Radiografia/efeitos adversos , Tomografia Computadorizada por Raios X/efeitos adversos , Adolescente , Adulto , Fatores Etários , Idoso , Carcinogênese/efeitos da radiação , Estudos de Coortes , Bases de Dados Factuais , Diagnóstico por Imagem/efeitos adversos , Diagnóstico por Imagem/métodos , Feminino , Humanos , Incidência , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Traumatismo Múltiplo/terapia , Análise Multivariada , Neoplasias Induzidas por Radiação/patologia , Doses de Radiação , Estudos Retrospectivos , Fatores Sexuais , Fatores de Tempo , Centros de Traumatologia , Adulto Jovem
9.
Radiat Res ; 192(3): 299-310, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31291162

RESUMO

The Life Span Study (LSS) of atomic bomb survivors has consistently demonstrated significant excess radiation-related risks of liver cancer since the first cancer incidence report. Here, we present updated information on radiation risks of liver, biliary tract and pancreatic cancers based on 11 additional years of follow-up since the last report, from 1958 to 2009. The current analyses used improved individual radiation doses and accounted for the effects of alcohol consumption, smoking and body mass index. The study participants included 105,444 LSS participants with known individual radiation dose and no known history of cancer at the start of follow-up. Cases were the first primary incident cancers of the liver (including intrahepatic bile duct), biliary tract (gallbladder and other and unspecified parts of biliary tract) or pancreas identified through linkage with population-based cancer registries in Hiroshima and Nagasaki. Poisson regression methods were used to estimate excess relative risks (ERRs) and excess absolute risks (EARs) associated with DS02R1 doses for liver (liver and biliary tract cancers) or pancreas (pancreatic cancer). We identified 2,016 incident liver cancer cases during the follow-up period. Radiation dose was significantly associated with liver cancer risk (ERR per Gy: 0.53, 95% CI: 0.23 to 0.89; EAR per 10,000 person-year Gy: 5.32, 95% CI: 2.49 to 8.51). There was no evidence for curvature in the radiation dose response (P=0.344). ERRs by age-at-exposure categories were significantly increased among those who were exposed at 0-9, 10-19 and 20-29 years, but not significantly increased after age 30 years, although there was no statistical evidence of heterogeneity in these ERRs (P = 0.378). The radiation ERRs were not affected by adjustment for smoking, alcohol consumption or body mass index. As in previously reported studies, radiation dose was not associated with risk of biliary tract cancer (ERR per Gy: -0.02, 95% CI: -0.25 to 0.30). Radiation dose was associated with a nonsignificant increase in pancreatic cancer risk (ERR per Gy: 0.38, 95% CI: <0 to 0.83). The increased risk was statistically significant among women (ERR per Gy: 0.70, 95% CI: 0.12 to 1.45), but not among men.


Assuntos
Neoplasias Induzidas por Radiação/epidemiologia , Armas Nucleares , Sobreviventes/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Consumo de Bebidas Alcoólicas/epidemiologia , Neoplasias do Sistema Biliar/epidemiologia , Neoplasias do Sistema Biliar/etiologia , Índice de Massa Corporal , Feminino , Humanos , Japão/epidemiologia , Neoplasias Hepáticas/epidemiologia , Neoplasias Hepáticas/etiologia , Masculino , Pessoa de Meia-Idade , Neoplasias Induzidas por Radiação/etiologia , Neoplasias Pancreáticas/epidemiologia , Neoplasias Pancreáticas/etiologia , Risco , Fumar/epidemiologia , Adulto Jovem
10.
Urology ; 133: 40-45, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31255539

RESUMO

OBJECTIVE: To model the risk of radiation-induced malignancy from computed tomography urography (CTU) in evaluation of gross hematuria and contrast this with the benefits of urinary tract cancer detection when compared to renal ultrasound. METHODS: A PUBMED-based literature search was performed to identify model inputs. Estimates of radiation-induced malignancy rates were obtained from the Biological Effects of Ionizing Radiation VII report with dose extrapolation using the linear no-threshold model. RESULTS: Male gender and age over 50 years were associated with a relative risk of upper tract malignancy of 2.04 and 2.95, respectively. The risk of upper tract malignancy missed by renal ultrasound ranged from 0.055% in females under 50 to 0.51% in males over 50. Risk of CTU-induced malignancy with associated loss of life expectancy ranged from 0.25% and 0.027 years in females under 50 to 0.08% and 0.0054 years in males over 50. For CTU to be superior to renal ultrasound, an undiagnosed upper tract malignancy would have to carry a loss of life expectancy of 49.2 years in females under 50, 13.4 years in males under 50, 2.6 years in females over 50, and 1.1 years in males over 50. CONCLUSION: In low-risk patients, CTU for evaluation of gross hematuria may carry a significant risk of radiation-induced secondary malignancy relative to the diagnostic benefit offered over renal ultrasound.


Assuntos
Hematúria/diagnóstico por imagem , Rim/diagnóstico por imagem , Neoplasias Induzidas por Radiação/epidemiologia , Neoplasias Induzidas por Radiação/etiologia , Tomografia Computadorizada por Raios X , Urografia/efeitos adversos , Urografia/métodos , Neoplasias Urológicas/diagnóstico por imagem , Feminino , Hematúria/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Medição de Risco , Ultrassonografia/efeitos adversos
11.
Regul Toxicol Pharmacol ; 107: 104418, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31278959

RESUMO

BACKGROUND: It is agreed that high level radon exposure is harmful to humans. However, some published literature suggests that low levels of radon show no adverse effects or may even be protective. Claims made using traditional methods of analysis on observational data often fail to replicate. Here, we use a simple, alternative data-analytic strategy for examining effects of low-level indoor radon exposure on lung cancer mortality. One objective will be to demonstrate that local population characteristics can alter expected effects. METHODS: Observational data on indoor radon exposure levels and lung cancer mortality for 2881 U.S. counties were obtained from federal and state governmental agencies. A new "statistical thinking" step-by-step analysis strategy called Local Control (LC) allows us to perform analyses of observational data that are more objective and "fair" than regression-like methods. LC analytical strategy makes as few and as realistic assumptions as possible. As a result, key LC inferences are nonparametric, and estimates of potentially heterogeneous treatment effect-sizes are robust. RESULTS: Our LC analyses suggest that lung cancer mortality usually tends to decrease as background radon exposure increases. Local rank correlation (LRC) effect-sizes are shown to be predictable from confounding local characteristics like percentage of residents over 65, percentage of residents who currently smoke and percentage of obese residents. CONCLUSIONS: At low indoor radon exposure levels, reverse (negative) LRCs between radon exposure level and lung cancer mortality predominate. The strengths of these associations vary with local demographics.


Assuntos
Poluentes Radioativos do Ar/análise , Poluição do Ar em Ambientes Fechados/análise , Neoplasias Pulmonares/epidemiologia , Neoplasias Induzidas por Radiação/epidemiologia , Radônio/análise , Exposição Ambiental , Humanos , Obesidade/epidemiologia , Fumar/epidemiologia , Estados Unidos/epidemiologia
12.
Radiat Res ; 192(4): 388-398, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31355713

RESUMO

A recent analysis of solid cancer incidence in the Life Span Study of atomic bomb survivors (Hiroshima and Nagasaki, Japan) found evidence of a nonlinear, upwardly curving radiation dose response among males but not among females. Further analysis of this new and unexpected finding was necessary. We used two approaches to investigate this finding. In one approach, we excluded individual cancer sites or groups of sites from all solid cancers. In the other approach, we used joint analysis to allow for heterogeneity in background-rate parameters across groups of cancers with dissimilar trends in background rates. Exclusion of a few sites led to the disappearance of curvature among males in the remaining collection of solid cancers; some of these influential sites have unique features in their background age-specific incidence that are not captured by a background-rate model fit to all solid cancers combined. Exclusion of a few sites also led to an appearance of curvature among females. Misspecification of background rates can cause bias in inference about the shape of the dose response, so heterogeneity of background rates might explain at least part of the all solid cancer dose-response difference in curvature between males and females. We conclude that analysis based on all solid cancers as a single outcome is not the optimal method to assess radiation risk for solid cancer in the Life Span Study; joint analysis with suitable choices of cancer groups might be preferable by allowing for background-rate heterogeneity across sites while providing greater power to assess radiation risk than analyses of individual sites.


Assuntos
Radiação de Fundo/efeitos adversos , Neoplasias Induzidas por Radiação/etiologia , Armas Nucleares , Adulto , Idoso , Idoso de 80 Anos ou mais , Relação Dose-Resposta à Radiação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Modelos Estatísticos , Neoplasias Induzidas por Radiação/epidemiologia , Medição de Risco , Sobreviventes
13.
Radiat Res ; 192(3): 331-344, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31356146

RESUMO

As a follow-up to the comprehensive work on solid cancer incidence in the Life Span Study (LSS) cohort of atomic bomb survivors between 1958 and 1998, we report here on updated radiation risk estimates for upper digestive tract cancers. In this study, we added 11 years of follow-up (1958-2009), used improved radiation dose estimates, considered effects of smoking and alcohol consumption and performed dose-response analyses by anatomical sub-site. In examining 52 years'worth of data, we ascertained the occurrence of 394 oral cavity/pharyngeal cancers, 486 esophageal cancers and 5,661 stomach cancers among 105,444 subjects. The radiation risk for oral cavity/pharyngeal cancer, other than salivary gland, was elevated but not significantly so. In contrast, salivary gland cancer exhibited a strong linear dose response with excess relative risk (ERR) of 2.54 per Gy [95% confidence interval (CI): 0.69 to 6.1]. Radiation risk decreased considerably with increasing age at time of exposure (-66% per decade, 95% CI: -88% to -32%). The dose response for esophageal cancer was statistically significant under a simple linear, linear-quadratic and quadratic model. Both linear-quadratic and quadratic models described the data better than a simple linear model and, of the two, the quadratic model showed a marginally better fit based on the Akaike Information Criteria. Sex difference in linear ERRs was not statistically significant; however, when the dose-response shape was allowed to vary by sex, statistically significant curvature was found among males, with no evidence of quadratic departure from linearity among females. The risk for stomach cancer increased significantly with dose and there was little evidence for quadratic departure from linearity among either males or females. The sex-averaged ERR at age 70 was 0.33 per Gy (95% CI: 0.20 to 0.47). The ERR decreased significantly (-1.93 power of attained age, 95% CI: -2.94 to -0.82) with increasing attained age, but not with age at exposure, and was higher in females than males (P = 0.02). Our results are largely consistent with the results of prior LSS analyses. Salivary gland, esophageal and stomach cancers continue to show significant increases in risk with radiation dose. Adjustment for lifestyle factors had almost no impact on the radiation effect estimates. Further follow-up of the LSS cohort is important to clarify the nature of radiation effects for upper digestive tract cancers, especially for oral cavity/pharyngeal and esophageal cancers, for which detailed investigation for dose-response shape could not be conducted due to the small number of cases.


Assuntos
Neoplasias Gastrointestinais/epidemiologia , Neoplasias Induzidas por Radiação/epidemiologia , Armas Nucleares , Sobreviventes/estatística & dados numéricos , Trato Gastrointestinal Superior/efeitos da radiação , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Neoplasias Gastrointestinais/etiologia , Humanos , Japão/epidemiologia , Masculino , Pessoa de Meia-Idade , Neoplasias Induzidas por Radiação/etiologia
14.
Pediatr Blood Cancer ; 66(11): e27938, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31347793

RESUMO

The therapies used to treat Ewing sarcoma are associated with a risk of second malignant neoplasm (SMN). We conducted a systematic review to pool available evidence on the risks, types, and outcomes after SMN. We obtained 52 articles that met inclusion criteria. Cumulative incidence rates of SMN ranged from 0.9 to 8.4% and 10.1 to 20.5% at 5 and 30 years after initial diagnosis. Of the 327 reported SMNs, 63.6% were solid tumors, although acute myeloid leukemia /myelodysplastic syndrome was the single most commonly diagnosed SMN, with generally poor outcomes. Patients treated for Ewing sarcoma are at substantial risk of SMN, with a broad range of reported secondary cancers.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Neoplasias Ósseas , Neoplasias Induzidas por Radiação/etiologia , Segunda Neoplasia Primária/etiologia , Radioterapia/efeitos adversos , Sarcoma de Ewing , Fatores Etários , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias Ósseas/tratamento farmacológico , Neoplasias Ósseas/radioterapia , Neoplasias Ósseas/cirurgia , Carcinoma/epidemiologia , Carcinoma/etiologia , Carcinoma/terapia , Humanos , Incidência , Leucemia Mieloide/epidemiologia , Leucemia Mieloide/etiologia , Leucemia Mieloide/terapia , Linfoma/epidemiologia , Linfoma/etiologia , Linfoma/terapia , Melanoma/epidemiologia , Melanoma/etiologia , Melanoma/terapia , Neoplasias Induzidas por Radiação/epidemiologia , Neoplasias Induzidas por Radiação/terapia , Segunda Neoplasia Primária/epidemiologia , Segunda Neoplasia Primária/terapia , Risco , Sarcoma/epidemiologia , Sarcoma/etiologia , Sarcoma/terapia , Sarcoma de Ewing/tratamento farmacológico , Sarcoma de Ewing/radioterapia , Sarcoma de Ewing/cirurgia , Fatores de Tempo , Resultado do Tratamento
16.
Int J Radiat Oncol Biol Phys ; 105(2): 275-284, 2019 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-31201893

RESUMO

PURPOSE: To estimate the effect of radiation therapy (RT) on nonbreast second malignant neoplasms (SMNs) in young women survivors of stage I-IIIA breast cancer. METHODS AND MATERIALS: Women aged 20 to 44 years who received a diagnosis of stage I-IIIA breast cancer (1988-2008) were identified in the Surveillance, Epidemiology, and End Results 9 registries. Bootstrapping approach and competing-risk proportional hazards models were used to evaluate the effect of RT on nonbreast SMN risk. The analysis was repeated in racial subgroups. Radiotolerance score analysis of normal airway epithelium was performed using Gene Expression Omnibus (GEO) data sets. RESULTS: Within records of 30,003 women with primary breast cancer, 20,516 eligible patients were identified, including 2,183 African Americans (AAs) and 16,009 Caucasians. The 25-year cumulative incidences of SMN were 5.2% and 3.6% (RT vs no-RT) for AAs, with 12.8-year and 17.4-year (RT vs no-RT) median follow-up (hazard ratio [HR] = 1.81; 95% bootstrapping confidence interval [BCI], 1.02-2.50; P < .05), respectively, and 6.4% and 5.9% (RT vs no-RT) for Caucasians with 14.3-year and 18.1-year (RT vs no-RT) median follow-up (HR = 1.10; 95% BCI, 0.61-1.40; P > .05), respectively. The largest portion of excess RT-related SMN risk was lung cancer (AA: HR = 2.08, 95% BCI, 1.02-5.39, P < .05; Caucasian: HR = 1.50, 95% BCI, 0.84-5.38, P > .05). Subpopulation Treatment Effect Pattern Plot (STEPP) analysis revealed higher post-RT nonbreast SMN risk in those 20 to 44 years of age, with larger HRs for RT in AAs. Radiotolerance score (RTS) of normal airway epithelium from young AA women was significantly lower than that from young Caucasian women (P = .038). CONCLUSIONS: With a projected 25-year follow-up, RT is associated with elevated risk of nonbreast SMNs, particularly second lung cancer, in young women survivors of stage I-IIIA breast cancer. Nonbreast SMNs associated with RT are higher in AA women than Caucasian women.


Assuntos
Afro-Americanos , Neoplasias da Mama/radioterapia , Carcinoma Ductal de Mama/radioterapia , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Neoplasias Induzidas por Radiação , Segunda Neoplasia Primária/etiologia , Adulto , Afro-Americanos/estatística & dados numéricos , Fatores Etários , Neoplasias da Mama/patologia , Sobreviventes de Câncer , Carcinoma Ductal de Mama/patologia , Feminino , Seguimentos , Expressão Gênica , Humanos , Incidência , Neoplasias Pulmonares/epidemiologia , Neoplasias Pulmonares/etiologia , Neoplasias Induzidas por Radiação/epidemiologia , Segunda Neoplasia Primária/epidemiologia , Modelos de Riscos Proporcionais , Tolerância a Radiação/genética , Programa de SEER , Estatísticas não Paramétricas , Estados Unidos/epidemiologia , Adulto Jovem
17.
Occup Environ Med ; 76(8): 511-518, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31167952

RESUMO

OBJECTIVES: Uranium miners in Príbram, Czech Republic were exposed to low and moderate levels of radon gas and other hazards. It is unknown whether these hazards increase the risk of mortality or cancer incidence when compared with the general Czech population. METHODS: A cohort of 16 434 male underground miners employed underground for at least 1 year between 1946 and 1976, and alive and residing in the Czech Republic in 1977, were followed for mortality and cancer incidence through 1992. We compared observed deaths and cancer incidence to expectation based on Czech rates. Standardised mortality ratios (SMRs), standardised incidence ratios (SIRs) and causal mortality ratios were calculated. RESULTS: Underground workers in the Príbram mines had higher rates of death than expected due to all causes (SMR=1.23, 95% CI 1.20 to 1.27), all cancers (SMR=1.52, 95% CI 1.44 to 1.60), lung cancer (SMR=2.12, 95% CI 1.96 to 2.28) and extrathoracic cancer (SMR=1.41, 95% CI 1.15 to 1.77). Similar excess was observed in cancer incidence analyses, with the addition of stomach cancer (SIR=1.37, 95% CI 1.11 to 1.63), liver cancer (SIR=1.70, 95% CI 1.16 to 2.25) and rectal cancer (SIR=1.41, 95% CI 1.16 to 1.66). The SIR was elevated for all leukaemias (SIR=1.51, 95% CI 1.08 to 2.07) and for lymphatic and haematopoietic cancers combined (SIR=1.31, 95% CI 1.05 to 1.61), but results for specific subtypes were imprecise. Deaths due to hazardous mining conditions resulted in 0.33 person-years of life lost per miner. CONCLUSIONS: Occupational exposure to the Príbram mines resulted in excess cancers at several sites, including sites previously linked to radon and uranium exposure. Incidence analyses showed relative excess of several additional cancer subtypes.


Assuntos
Mineradores , Neoplasias Induzidas por Radiação/epidemiologia , Neoplasias Induzidas por Radiação/mortalidade , Exposição Ocupacional/efeitos adversos , Adulto , Idoso , Causas de Morte , Estudos de Coortes , República Tcheca/epidemiologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Radônio/efeitos adversos , Urânio/efeitos adversos
18.
Life Sci Space Res (Amst) ; 21: 73-82, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31101157

RESUMO

The European Space Agency (ESA) is currently expanding its efforts in identifying requirements and promoting research towards optimizing radiation protection of astronauts. Space agencies use common limits for tissue (deterministic) effects on the International Space Station. However, the agencies have in place different career radiation exposure limits (for stochastic effects) for astronauts in low-Earth orbit missions. Moreover, no specific limits for interplanetary missions are issued. Harmonization of risk models and dose limits for exploratory-class missions are now operational priorities, in view of the short-term plans for international exploratory-class human missions. The purpose of this paper is to report on the activity of the ESA Topical Team on space radiation research, whose task was to identify the most pertinent research requirements for improved space radiation protection and to develop a European space radiation risk model, to contribute to the efforts to reach international consensus on dose limits for deep space. The Topical Team recommended ESA to promote the development of a space radiation risk model based on European-specific expertise in: transport codes, radiobiological modelling, risk assessment, and uncertainty analysis. The model should provide cancer and non-cancer radiation risks for crews implementing exploratory missions. ESA should then support the International Commission on Radiological Protection to harmonize international models and dose limits in deep space, and guarantee continuous support in Europe for accelerator-based research configured to improve the models and develop risk mitigation strategies.


Assuntos
Radiação Cósmica/efeitos adversos , Neoplasias Induzidas por Radiação/epidemiologia , Lesões por Radiação/epidemiologia , Proteção Radiológica/normas , Projetos de Pesquisa , Medição de Risco/métodos , Astronautas , Europa (Continente)/epidemiologia , Humanos , Incidência , Doses de Radiação , Radiobiologia , Voo Espacial
19.
Health Phys ; 117(1): 13-19, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31136363

RESUMO

The excess relative risk of mortality for all cancers excluding leukemia among nuclear workers was reanalyzed by taking the annual dose as the dose rate into consideration using publicly available epidemiological data from the Hanford site dedicated to the cohort study of nuclear workers in the United States, the United Kingdom, and Canada (Three Countries Study). Values of the dose rate (cut points) were chosen at 2 mSv y intervals from 2 to 40 mSv y, and risk estimates were made for 32,988 workers, considering doses accumulated below the cut point and above the cut point to have different effects. Although the procedure to extract the study population and the methodology used for analysis basically followed those in the Three Countries Study, additional examinations were also carried out for different risk models, lag periods, and impacts of adjusting the monitoring period to find the effect of the dose rate. As a result, no statistically significant difference in dose rate was found among the excess relative risks under different calculation conditions.


Assuntos
Neoplasias Induzidas por Radiação/mortalidade , Doenças Profissionais/mortalidade , Exposição Ocupacional/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Canadá/epidemiologia , Estudos de Coortes , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Neoplasias Induzidas por Radiação/epidemiologia , Doenças Profissionais/epidemiologia , Exposição Ocupacional/análise , Doses de Radiação , Risco , Taxa de Sobrevida , Reino Unido/epidemiologia , Estados Unidos/epidemiologia , Adulto Jovem
20.
Urology ; 130: 48-53, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31026476

RESUMO

OBJECTIVE: To model the risk of secondary malignancy and associated mortality due to ionizing radiation from the evaluation and management of nephrolithiasis. METHODS: A PUBMED-based literature search was performed to identify model inputs, specifically annual incidence of nephrolithiasis sub-stratified by age and gender and radiation exposure associated with nephrolithiasis episodes. Estimates of age and gender specific radiation-induced malignancy and mortality rates were obtained from the BEIR VII Phase 2 report with dose extrapolation using the linear no-threshold model. RESULTS: Incidence of new diagnoses of nephrolithiasis ranged from 42/100,000 in males 20-30 years old to 248/100,000 in males 60-70 years old. Radiation exposure per nephrolithiasis episode was 37.3 mSv over a 2-year period. Data regarding average stone episodes per patient with nephrolithiasis was limited and conservatively estimated at 1.5. Modeled lifetime attributable risk of secondary malignancy and subsequent mortality in individual stone patients ranged from 0.096% and 0.085%, respectively, in males over the age of 70 to 0.59% and 0.39% in females 20-30 years old. In the USA, overall incidence of secondary malignancy and associated mortality related to nephrolithiasis management was calculated to be 862.7 and 545.3 cases/year, respectively. CONCLUSION: This model suggests that ionizing radiation from the management of nephrolithiasis carries a small but significant risk of causing secondary malignancy. This knowledge must be considered when using modalities that involve radiation in the diagnosis and therapeutic management of nephrolithiasis.


Assuntos
Cálculos Renais/radioterapia , Neoplasias Induzidas por Radiação/epidemiologia , Segunda Neoplasia Primária/epidemiologia , Adulto , Idoso , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Modelos Estatísticos , Radioterapia/efeitos adversos , Medição de Risco , Adulto Jovem
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