Cancer risks among studies of medical diagnostic radiation exposure in early life without quantitative estimates of dose

Little, Mark P.; Wakeford, Richard; Bouffler, Simon; Abalo, Kossi; Hauptmann, Michael; Hamada, Nobuyuki; Kendall, G M

doi:10.1016/j.scitotenv.2022.154723

Cited by 21 publications

(7 citation statements)

References 125 publications

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“…The association between cancer in childhood and a prior radiographic examination of the abdomen of the pregnant mother identified by case-control studies such as those of Stewart et al ( Bithell and Stewart 1975 ; Stewart et al 1956 ) and many others ( Wakeford 2008 ) (see Little et al ( Little et al 2021b , submitted)) provides epidemiological evidence that externally delivered doses of ionising radiation of the order of 0.005–0.030 Gy of X-rays increase the risk of cancer ( United Nations Scientific Committee on the Effects of Atomic Radiation (UNSCEAR) 2008 ). This level of dose is somewhat lower than the lowest doses producing significantly increased risks of cancer in all other epidemiological studies, apart from the natural background radiation studies that we discuss below ( United Nations Scientific Committee on the Effects of Atomic Radiation (UNSCEAR) 2008 ).…”

Section: Discussionmentioning

confidence: 99%

“…As well as the medical diagnostic studies without assessed doses (which are reviewed in a separate paper ( Little et al 2021b , submitted)), there is information in a large number of studies of various exposed groups in which individual dose estimates are available ( Tables 2 , 3 , Supplementary Table S7 ). One of the more intriguing findings of the meta-analysis are the indications of difference for certain endpoints in the magnitude of relative risk for exposures in utero and in the postnatal period ( Tables 6 , 7 ).…”

Section: Discussionmentioning

confidence: 99%

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Review of the risk of cancer following low and moderate doses of sparsely ionising radiation received in early life in groups with individually estimated doses

Little

Wakeford

Bouffler³

et al. 2022

Environment International

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Review of the risk of cancer following low and moderate doses of sparsely ionising radiation received in early life in groups with individually estimated doses

Little

Wakeford

Bouffler³

et al. 2022

Environment International

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“…For leukemia, the shape of the dose response curve differs among subtypes: e.g., upward curvature for acute myeloid leukemia (AML), linear for acute lymphoid leukemia (ALL) and chronic myeloid leukemia (CML) in the LSS (286), and the pooled analysis has shown a linear dose response relationship for AML and ALL (287). Increased radiation risks below 100 mSv or below 50 mSv have recently been observed for several types of cancer after in utero or childhood exposures (287)(288)(289)(290)(291)(292). If such knowledge becomes more available for various types of cancer at low dose and low dose rate and for various ages at exposure, then the risk may be directly estimated, without relying on an LNT dose response relationship and DDREF/ LDEF/DREF.…”

Section: Radiation Effect Classificationmentioning

confidence: 99%

Noncancer Effects of Ionizing Radiation Exposure on the Eye, the Circulatory System and beyond: Developments made since the 2011 ICRP Statement on Tissue Reactions

Hamada

2023

Radiation Research

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For radiation protection purposes, noncancer effects with a threshold-type dose-response relationship have been classified as tissue reactions (formerly called nonstochastic or deterministic effects), and equivalent dose limits aim to prevent occurrence of such tissue reactions. Accumulating evidence demonstrates increased risks for several late occurring noncancer effects at doses and dose rates much lower than previously considered. In 2011, the International Commission on Radiological Protection (ICRP) issued a statement on tissue reactions to recommend a threshold of 0.5 Gy to the lens of the eye for cataracts and to the heart and brain for diseases of the circulatory system (DCS), independent of dose rate. Literature published thereafter continues to provide updated knowledge. Increased risks for cataracts below 0.5 Gy have been reported in several cohorts (e.g., including in those receiving protracted or chronic exposures). A dose threshold for cataracts is less evident with longer follow-up, with limited evidence available for risk of cataract removal surgery. There is emerging evidence for risk of normal-tension glaucoma and diabetic retinopathy, but the long-held tenet that the lens represents among the most radiosensitive tissues in the eye and in the body seems to remain unchanged. For DCS, increased risks have been reported in various cohorts, but the existence or otherwise of a dose threshold is unclear. The level of risk is less uncertain at lower dose and lower dose rate, with the possibility that risk per unit dose is greater at lower doses and dose rates. Target organs and tissues for DCS are also unknown, but may include heart, large blood vessels and kidneys. Identification of potential factors (e.g., sex, age, lifestyle factors, coexposures, comorbidities, genetics and epigenetics) that may modify radiation risk of cataracts and DCS would be important. Other noncancer effects on the radar include neurological effects (e.g., Parkinsonŉs disease and dementia) of which elevated risk has increasingly been reported. These late occurring noncancer effects tend to deviate from the definition of tissue reactions, necessitating more scientific developments to reconsider the radiation effect classification system and risk management. This paper gives an overview of historical developments made in ICRP prior to the 2011 statement and an update on relevant developments made since the 2011 ICRP statement.

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“…Moderate and high doses of ionising radiation are well established causes of most types of cancer 1,2 . There is emerging evidence, particularly for leukaemia and thyroid cancer, of risk at low dose (<100 mGy) low-linear energy transfer (LET) radiation [3][4][5][6] . For most other cancer endpoints it is necessary to assess risks via extrapolation from groups exposed at moderate and high levels of dose.…”

Section: Introductionmentioning

confidence: 99%

A generalisation of the method of regression calibration and comparison with the Bayesian 2-dimensional Monte Carlo method

Little,

Hamada,

Zablotska

2023

Preprint

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For many cancer sites it is necessary to assess risks from low-dose exposures via extrapolation from groups exposed at moderate and high levels of dose. Measurement error can substantially alter the shape of this relationship and hence the derived population risk estimates. Even in studies with direct measurement of low-dose exposures measurement error could be substantial in relation to the size of the dose estimates and thereby distort population risk estimates. Recently, much attention has been devoted to the issue of shared errors, common in many datasets, and particularly important in occupational settings. In this paper we test a Bayesian model averaging method, the so-called Bayesian two-dimensional Monte Carlo (2DMC) method, that has been fairly recently proposed against a very newly proposed modification of the regression calibration method, which is particularly suited to studies in which there is a substantial amount of shared error, and in which there may also be curvature in the true dose response. We also compared both methods against standard regression calibration and Monte Carlo maximum likelihood. The Bayesian 2DMC method performs poorly, with coverage probabilities both for the linear and quadratic dose coefficients that are under 5%, particularly when the magnitudes of classical and Berkson error are both moderate to large (20%-50%). The method also produces substantially biased (by a factor of 10) estimates of both the linear and quadratic coefficients, with the linear coefficient overestimated and the quadratic coefficient underestimated. By comparison the extended regression calibration method yields coverage probabilities that are too low when shared and unshared Berkson errors are both large (50%), although otherwise it performs well, and coverage is generally better than the Bayesian 2DMC and all other methods. The bias of the predicted relative risk at a variety of doses is generally smallest for extended regression calibration, and largest for the Bayesian 2DMC method (apart from unadjusted regression), with standard regression calibration and Monte Carlo maximum likelihood exhibiting bias in predicted relative risk generally somewhat intermediate between the other two methods.

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Cancer risks among studies of medical diagnostic radiation exposure in early life without quantitative estimates of dose

Cited by 21 publications

References 125 publications

Review of the risk of cancer following low and moderate doses of sparsely ionising radiation received in early life in groups with individually estimated doses

Review of the risk of cancer following low and moderate doses of sparsely ionising radiation received in early life in groups with individually estimated doses

Noncancer Effects of Ionizing Radiation Exposure on the Eye, the Circulatory System and beyond: Developments made since the 2011 ICRP Statement on Tissue Reactions

A generalisation of the method of regression calibration and comparison with the Bayesian 2-dimensional Monte Carlo method

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