Comment on “Dose-responses from multi-model inference for the non-cancer disease mortality of atomic bomb survivors” (Radiat. Environ. Biophys (2012) 51:165–178) by Schöllnberger et al.

Little, Mark P.; Azizova, Tamara V.; Bazyka, Dimitry; Bouffler, Simon; Cardis, Elisabeth; Chekin, S.Yu.; Chumak, Vadim; Cucinotta, Francis A.; Vathaire, Florent de; Hall, Per; Harrison, John; Hildebrandt, Guido; Ivanov, V. P.; Кащеев, В. В.; Klymenko, Sergiy; Olivier, Laurent; Ozasa, Kotaro; Tapio, Soile; Tzoulaki, Ioanna; Vandoolaeghe, Wendy; Wakeford, Richard; Zablotska, Lydia B.; Zhang, Wei; Lipshultz, Steven E.

doi:10.1007/s00411-012-0453-6

Cited by 12 publications

(11 citation statements)

References 10 publications

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“…For the detrimental health outcomes of heart diseases and stroke there is, however, no healthy survivor selection effect. This has recently been confirmed by Schöllnberger et al (23) following the comments of Little et al (22). Shimizu et al (21) found an ERR of 0.14 (95% CI, 0.06–0.23) for heart disease and an ERR of 0.09 (95% CI, 0.01–0.17) for stroke based on the LNT model.…”

Section: Cardiovascular Disease Risk Related To Low Doses Of Ionizmentioning

confidence: 54%

Cardiovascular diseases related to ionizing radiation: The risk of low-dose exposure (Review)

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Rombouts

Benotmane

et al. 2016

International Journal of Molecular Medicine

118

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Traditionally, non-cancer diseases are not considered as health risks following exposure to low doses of ionizing radiation. Indeed, non-cancer diseases are classified as deterministic tissue reactions, which are characterized by a threshold dose. It is judged that below an absorbed dose of 100 mGy, no clinically relevant tissue damage occurs, forming the basis for the current radiation protection system concerning non-cancer effects. Recent epidemiological findings point, however, to an excess risk of non-cancer diseases following exposure to lower doses of ionizing radiation than was previously thought. The evidence is the most sound for cardiovascular disease (CVD) and cataract. Due to limited statistical power, the dose-risk relationship is undetermined below 0.5 Gy; however, if this relationship proves to be without a threshold, it may have considerable impact on current low-dose health risk estimates. In this review, we describe the CVD risk related to low doses of ionizing radiation, the clinical manifestation and the pathology of radiation-induced CVD, as well as the importance of the endothelium models in CVD research as a way forward to complement the epidemiological data with the underlying biological and molecular mechanisms.

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Section: Cardiovascular Disease Risk Related To Low Doses Of Ionizmentioning

confidence: 54%

Cardiovascular diseases related to ionizing radiation: The risk of low-dose exposure (Review)

Baselet

Rombouts

Benotmane

et al. 2016

International Journal of Molecular Medicine

118

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“…Schollnberger et al [52], analyzing somewhat older Japanese atomic bomb survivor data, concluded that for CeVD and cardiovascular disease, risk estimates are compatible with no risk below threshold doses of 0.62 and 2.19 Gy respectively. However, this analysis is controversial [53]. The analysis of Table 5 suggests that a threshold of the order of 0.5 Gy is marginally inconsistent with the pattern of radiogenic excess risk observed in the Massachusetts tuberculosis fluoroscopy sub-cohort.…”

Section: Discussionmentioning

confidence: 95%

Circulatory disease mortality in the Massachusetts tuberculosis fluoroscopy cohort study

et al. 2015

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High-dose ionizing radiation is associated with circulatory disease. Risks from lower-dose fractionated exposures, such as from diagnostic radiation procedures, remain unclear. In this study we aimed to ascertain the relationship between fractionated low-to-medium dose radiation exposure and circulatory disease mortality in a cohort of 13,568 tuberculosis patients in Massachusetts, some with fluoroscopy screenings, between 1916 and 1961 and follow-up until the end of 2002. Analysis of mortality was in relation to cumulative thyroid (cerebrovascular) or lung (all other circulatory disease) radiation dose via Poisson regression. Over the full dose range, there was no overall radiation-related excess risk of death from circulatory disease (n = 3221; excess relative risk/Gy -0.023; 95 % CI -0.067, 0.028; p = 0.3574). Risk was somewhat elevated in hypertensive heart disease (n = 89; excess relative risk/Gy 0.357; 95 % CI -0.043, 1.030, p = 0.0907) and slightly decreased in ischemic heart dis-ease (n = 1950; excess relative risk/Gy -0.077; 95 % CI -0.130, -0.012; p = 0.0211). However, under 0.5 Gy, there was a borderline significant increasing trend for all circulatory disease (excess relative risk/Gy 0.345; 95 % CI -0.032, 0.764; p = 0.0743) and for ischemic heart disease (excess relative risk/Gy 0.465; 95 % CI, -0.032, 1.034, p = 0.0682). Pneumolobectomy increased radiation-associated risk (excess relative risk/Gy 0.252; 95 % CI 0.024, 0.579). Fractionation of dose did not modify excess risk. In summary, we found no evidence of radiation-associated excess circulatory death risk overall, but there are indications of excess circulatory death risk at lower doses (<0.5 Gy). Although consistent with other radiation-exposed groups, the indications of higher risk at lower doses are unusual and should be confirmed against other data.

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“…Although not explicitly Bayesian, MMI is somewhat related to Bayesian model-averaging and similar Bayesian techniques (Wang et al 2012); these Bayesian methods have the advantage of assessing the parameter uncertainty distribution more thoroughly; it may be judged that the method of Schöllnberger et al does not adequately assess the uncertainties in model parameters, which Bayesian techniques can better address (Wang et al 2012). Moreover, it is doubtful that models incorporating thresholds as employed by Schöllnberger et al (Schöllnberger et al 2012) should be fitted to the Japanese atomic bomb survivor Life Span Study (LSS) cohort’s circulatory disease endpoints or any other data of this sort, as discussed elsewhere (Little et al 2013a). There are other aspects of the analysis of Schöllnberger et al (Schöllnberger et al 2012) that are also controversial (Little et al 2013a; Schöllnberger et al 2013).…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, it is doubtful that models incorporating thresholds as employed by Schöllnberger et al (Schöllnberger et al 2012) should be fitted to the Japanese atomic bomb survivor Life Span Study (LSS) cohort’s circulatory disease endpoints or any other data of this sort, as discussed elsewhere (Little et al 2013a). There are other aspects of the analysis of Schöllnberger et al (Schöllnberger et al 2012) that are also controversial (Little et al 2013a; Schöllnberger et al 2013). …”

Section: Discussionmentioning

confidence: 99%

A review of non-cancer effects, especially circulatory and ocular diseases

Little

2013

Radiat Environ Biophys

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105

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There is a well-established association between high doses (> 5 Gy) of ionizing radiation exposure and damage to the heart and coronary arteries, although only recently have studies with high quality individual dosimetry been conducted that would enable quantification of this risk adjusting for concomitant chemotherapy. The association between lower dose exposures and late occurring circulatory disease has only recently begun to emerge in the Japanese atomic bomb survivors and in various occupationally-exposed cohorts, and is still controversial. Excess relative risks per unit dose in moderate and low dose epidemiological studies are somewhat variable, possibly a result of confounding and effect modification by well known (but unobserved) risk factors. Radiation doses of 1 Gy or more are associated with increased risk of posterior subcapsular cataract. Accumulating evidence from the Japanese atomic bomb survivors, Chernobyl liquidators, US astronauts and various other exposed groups suggest that cortical cataracts may also be associated with ionizing radiation, although there is little evidence that nuclear cataracts are radiogenic. The dose response appears to be linear, although modest thresholds (of no more than about 0.6 Gy) cannot be ruled out. A variety of other non-malignant effects have been observed after moderate/low dose exposure in various groups, in particular respiratory and digestive disease and central nervous system (and in particular neuro-cognitive) damage. However, because these are generally only observed in isolated groups, or because the evidence is excessively heterogeneous, these associations must be treated with caution.

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Comment on “Dose-responses from multi-model inference for the non-cancer disease mortality of atomic bomb survivors” (Radiat. Environ. Biophys (2012) 51:165–178) by Schöllnberger et al.

Cited by 12 publications

References 10 publications

Cardiovascular diseases related to ionizing radiation: The risk of low-dose exposure (Review)

Cardiovascular diseases related to ionizing radiation: The risk of low-dose exposure (Review)

Circulatory disease mortality in the Massachusetts tuberculosis fluoroscopy cohort study

A review of non-cancer effects, especially circulatory and ocular diseases

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