Estimation of Breast Doses and Breast Cancer Risk Associated with Repeated Fluoroscopic Chest Examinations of Women with Tuberculosis

Boice, John D.; Rosenstein, Marvin; Trout, E. Dale

doi:10.2307/3574828

Cited by 61 publications

(37 citation statements)

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“…Dosimetry considerations could change this conclusion slightly (e.g., the relative biological effectiveness of low-energy x rays vs. gamma rays; possible inaccuracies in estimated fluoroscopy doses). Nevertheless, both fluoroscopy studies clearly demonstrate that fractionated doses, mostly on the order of 10 mGy per fraction (Sherman et al 1978;Boice et al 1978), increase breast cancer risk.…”

Section: Risk Estimates In Low-dose Studiesmentioning

confidence: 97%

Low-Dose Radiation Epidemiology Studies: Status and Issues

Shore

2009

Health Physics

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Although the Japanese atomic bomb study and radiotherapy studies have clearly documented cancer risks from high-dose radiation exposures, radiation risk assessment groups have long recognized that protracted or low exposures to low-linear energy transfer radiations are key radiation protection concerns because these are far more common than high-exposure scenarios. Epidemiologic studies of human populations with low-dose or low dose-rate exposures are one approach to addressing those concerns. A number of large studies of radiation workers (Chernobyl clean-up workers, U.S. and Chinese radiological technologists, and the 15-country worker study) or of persons exposed to environmental radiation at moderate to low levels (residents near Techa River, Semipalatinsk, Chernobyl, or nuclear facilities) have been conducted. A variety of studies of medical radiation exposures (multiple-fluoroscopy, diagnostic (131)I, scatter radiation doses from radiotherapy, etc.) also are of interest. Key results from these studies are summarized and compared with risk estimates from the Japanese atomic bomb study. Ideally, one would like the low-dose and low dose-rate studies to guide radiation risk estimation regarding the shape of the dose-response curve, DDREF (dose and dose-rate effectiveness factor), and risk at low doses. However, the degree to which low-dose studies can do so is subject to various limitations, especially those pertaining to dosimetric uncertainties and limited statistical power. The identification of individuals who are particularly susceptible to radiation cancer induction also is of high interest in terms of occupational and medical radiation protection. Several examples of studies of radiation-related cancer susceptibility are discussed, but none thus far have clearly identified radiation-susceptible genotypes.

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Section: Risk Estimates In Low-dose Studiesmentioning

confidence: 97%

Low-Dose Radiation Epidemiology Studies: Status and Issues

Shore

2009

Health Physics

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“…Typically this procedure was repeated, with the aid of a fluoroscopic examination, 2-3 times per month for over 2 years, and up to 5 years for patients with advanced disease. The radiation dose absorbed by several organs adjacent to the lung and exposed during the fluoroscopic procedures was estimated [17,18]. This dosimetry method accounted for the number of fluoroscopies, calendar year of exposure, sex, age at treatment (<18, ≥18 years of age), and phantom studies of organ-specific doses using contemporary machine exposure settings to the extent possible.…”

Section: Dosimetrymentioning

confidence: 99%

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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“…A single spinal X-ray was estimated to give approximately 0.3 rads of exposure to the female breast 13 and fluoroscopic examinations in conjunction with pneumotherapy for tuberculosis yielded about 1.5 rads per examination to the breast. 24 If we assume that these estimates are roughly applicable, respectively, to the chest X-rays and radiographic examinations reported in this study, then a man with two chest X-rays per year for 30 years would receive 18 rads (probably a high estimate), and persons with six radiographic examinations (the mean number in men with three or more) would receive about nine rads. Doses of these orders of magnitude have been associated with small increases in risk of breast cancer in women of all ages exposed to atomic bombs 1 (RRs of 0.96, 1.24, and 1.38 in those exposed to < 10, 10-19, and 20-49 rads, respectively), but not in those exposed to similar doses in the Canadian fluoroscopy study.…”

Section: Discussionmentioning

confidence: 99%

Ionizing radiation and breast cancer in men (United States)

Thomas

Rosenblatt

Jimenez

et al. 1994

Cancer Causes Control

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The purposes of this study were to determine whether exposure of the vestigial male breast to ionizing radiation is associated with an increase in risk of breast cancer and, if so, to determine whether the apparent effects on risk in men are similar to those reported for women. A population-based case-control study of breast cancer in men was conducted in 10 geographic areas of the United States. Information on possible prior exposure to ionizing radiation, and on other potential risk factors for breast cancer, was obtained from personal interviews of 227 cases and 300 controls who were recruited from October 1983 to September 1986. Evidence from this study that ionizing radiation can cause breast cancer in men includes: a modest trend of increasing risk with frequency of chest X-rays; an increase in risk in men with three or more radiographic examinations, especially if received prior to 1963; and an increase in risk in men who received X-ray treatments to the chest and adjacent body areas. Risk was increased only from 20 to 35 years after initial exposure from either radiographic examinations or X-ray treatments, and declined after three to four decades since last exposure, suggesting a wave of increased risk of finite duration following exposure. The doses of radiation received could not be estimated precisely, but those from diagnostic procedures were likely similar to those received by prepubertal females in prior studies, and the results of those and the present investigation are compatible. The carcinogenic effects of ionizing radiation may be similar in the male and prepubertal female breast.

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Estimation of Breast Doses and Breast Cancer Risk Associated with Repeated Fluoroscopic Chest Examinations of Women with Tuberculosis

Cited by 61 publications

References 0 publications

Low-Dose Radiation Epidemiology Studies: Status and Issues

Low-Dose Radiation Epidemiology Studies: Status and Issues

Circulatory disease mortality in the Massachusetts tuberculosis fluoroscopy cohort study

Ionizing radiation and breast cancer in men (United States)

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