Effect of Heterogeneity in Background Incidence on Inference about the Solid-Cancer Radiation Dose Response in Atomic Bomb Survivors

Epidemiological data have provided limited and inconsistent evidence on the relationship between radiation exposure and lymphoid neoplasms. We classified 553 lymphoid neoplasm cases diagnosed between 1950 and 1994 in the Life Span Study (LSS) cohort of atomic bomb survivors into WHO subtypes. Mature B-cell neoplasms represented 58%, mature T-cell and NK-cell neoplasms 20%; precursor cell neoplasms, 5%, and Hodgkin lymphoma, 3%; with the remaining 15% classified as non-Hodgkin lymphoid neoplasms or lymphoid neoplasms, not otherwise specified. We used Poisson regression methods to assess the relationship between radiation exposure and the more common subtypes. As in earlier reports, a significant dose response for non-Hodgkin lymphoid neoplasms as a group was seen for males but not females. However, subtype analyses showed that radiation dose was strongly associated with increased precursor cell neoplasms rates, with an estimated excess relative risk per Gy of 16 (95% Confidence interval: 7.0, >533) at age 50. The current data based primarily of tissue-based diagnoses suggest that the association between radiation dose and lymphoid neoplasms as a group is largely driven by the radiation effect on precursor cell neoplasms while presenting no evidence of a radiation dose response for major categories of mature cell neoplasms, either B- or T-/NK-cell, or more specific disease entities (diffuse large B-cell lymphoma, plasma cell myeloma, adult T-cell leukemia/lymphoma) or Hodgkin lymphoma.

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Risk of Myelodysplastic Syndromes in People Exposed to Ionizing Radiation: A Retrospective Cohort Study of Nagasaki Atomic Bomb Survivors

Journal of Clinical Oncology ◽

10.1200/jco.2010.31.3080 ◽

2011 ◽

Vol 29 (4) ◽

pp. 428-434 ◽

Cited By ~ 74

Author(s):

Masako Iwanaga ◽

Wan-Ling Hsu ◽

Midori Soda ◽

Yumi Takasaki ◽

Masayuki Tawara ◽

...

Keyword(s):

Cohort Study ◽

Radiation Dose ◽

Ionizing Radiation ◽

Dose Response ◽

Myelodysplastic Syndromes ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Radiation Effects ◽

Atomic Bomb ◽

Atomic Bomb Survivors

Purpose The risk of myelodysplastic syndromes (MDS) has not been fully investigated among people exposed to ionizing radiation. We investigate MDS risk and radiation dose-response in Japanese atomic bomb survivors. Patients and Methods We conducted a retrospective cohort study by using two databases of Nagasaki atomic bomb survivors: 64,026 people with known exposure distance in the database of Nagasaki University Atomic-Bomb Disease Institute (ABDI) and 22,245 people with estimated radiation dose in the Radiation Effects Research Foundation Life Span Study (LSS). Patients with MDS diagnosed from 1985 to 2004 were identified by record linkage between the cohorts and the Nagasaki Prefecture Cancer Registry. Cox and Poisson regression models were used to estimate relationships between exposure distance or dose and MDS risk. Results There were 151 patients with MDS in the ABDI cohort and 47 patients with MDS in the LSS cohort. MDS rate increased inversely with exposure distance, with an excess relative risk (ERR) decay per km of 1.2 (95% CI, 0.4 to 3.0; P < .001) for ABDI. MDS risk also showed a significant linear response to exposure dose level (P < .001) with an ERR per Gy of 4.3 (95% CI, 1.6 to 9.5; P < .001). After adjustment for sex, attained age, and birth year, the MDS risk was significantly greater in those exposed when young. Conclusion A significant linear radiation dose-response for MDS exists in atomic bomb survivors 40 to 60 years after radiation exposure. Clinicians should perform careful long-term follow-up of irradiated people to detect MDS as early as possible.

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Postoperative Cataract Cases among Atomic Bomb Survivors: Radiation Dose Response and Threshold

Radiation Research ◽

10.1667/rr0928.1 ◽

2007 ◽

Vol 168 (4) ◽

pp. 404-408 ◽

Cited By ~ 123

Author(s):

Kazuo Neriishi ◽

Eiji Nakashima ◽

Atsushi Minamoto ◽

Saeko Fujiwara ◽

Masazumi Akahoshi ◽

...

Keyword(s):

Radiation Dose ◽

Dose Response ◽

Atomic Bomb ◽

Atomic Bomb Survivors

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Risk of cancer associated with low-dose radiation exposure: comparison of results between the INWORKS nuclear workers study and the A-bomb survivors study

Radiation and Environmental Biophysics ◽

10.1007/s00411-020-00890-7 ◽

2021 ◽

Vol 60 (1) ◽

pp. 23-39

Author(s):

Klervi Leuraud ◽

David B. Richardson ◽

Elisabeth Cardis ◽

Robert D. Daniels ◽

Michael Gillies ◽

...

Keyword(s):

Low Dose ◽

Atomic Bomb ◽

Absolute Risk ◽

Joint Analysis ◽

Solid Cancer ◽

Atomic Bomb Survivors ◽

Nuclear Workers ◽

Long Term Follow Up ◽

Primary Basis ◽

Risk Of Cancer

AbstractThe Life Span Study (LSS) of Japanese atomic bomb survivors has served as the primary basis for estimates of radiation-related disease risks that inform radiation protection standards. The long-term follow-up of radiation-monitored nuclear workers provides estimates of radiation-cancer associations that complement findings from the LSS. Here, a comparison of radiation-cancer mortality risk estimates derived from the LSS and INWORKS, a large international nuclear worker study, is presented. Restrictions were made, so that the two study populations were similar with respect to ages and periods of exposure, leading to selection of 45,625 A-bomb survivors and 259,350 nuclear workers. For solid cancer, excess relative rates (ERR) per gray (Gy) were 0.28 (90% CI 0.18; 0.38) in the LSS, and 0.29 (90% CI 0.07; 0.53) in INWORKS. A joint analysis of the data allowed for a formal assessment of heterogeneity of the ERR per Gy across the two studies (P = 0.909), with minimal evidence of curvature or of a modifying effect of attained age, age at exposure, or sex in either study. There was evidence in both cohorts of modification of the excess absolute risk (EAR) of solid cancer by attained age, with a trend of increasing EAR per Gy with attained age. For leukemia, under a simple linear model, the ERR per Gy was 2.75 (90% CI 1.73; 4.21) in the LSS and 3.15 (90% CI 1.12; 5.72) in INWORKS, with evidence of curvature in the association across the range of dose observed in the LSS but not in INWORKS; the EAR per Gy was 3.54 (90% CI 2.30; 5.05) in the LSS and 2.03 (90% CI 0.36; 4.07) in INWORKS. These findings from different study populations may help understanding of radiation risks, with INWORKS contributing information derived from cohorts of workers with protracted low dose-rate exposures.

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