Epidemiology data for low-linear energy transfer radiation

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Epidemiological studies of the health effects of low levels of ionizing radiation, in particular the incidence and mortality from various forms of cancer, have been carried out in different population groups exposed to such radiation. These have included survivors of the atomic bombings of Hiroshima and Nagasaki in 1945, workers at nuclear reactors, and medical patients treated with X-rays.

Contents

Life span studies of atomic bomb survivors

Figure 1. From Preston et al.: Solid cancer dose-response function average over gender for attained age 70 after exposure at age 30. The solid straight-line is the linear slope estimate; the points are dose-category-specific ERR estimates; the dashed curve is a smoothed estimate that is derived from the points; and the dotted curves indicate upper and lower one-stand-error bounds on the smoothed estimate. HHPS Figure 4-4.jpg
Figure 1. From Preston et al.: Solid cancer dose-response function average over gender for attained age 70 after exposure at age 30. The solid straight-line is the linear slope estimate; the points are dose-category-specific ERR estimates; the dashed curve is a smoothed estimate that is derived from the points; and the dotted curves indicate upper and lower one-stand-error bounds on the smoothed estimate.

Survivors of the atomic bomb explosions at Hiroshima and Nagasaki, Japan have been the subjects of a Life Span Study (LSS), which has provided valuable epidemiological data.

The LSS population went through several changes:

However, some 44,000 individuals were censured or excluded from the LSS project, so there remained about 86,000 people who were followed through the study. There is a gap in knowledge of the earliest cancer that developed in the first few years after the war, which impacts the assessment of leukemia to an important extent and for solid cancers to a minor extent. Table 1 shows summary statistics of the number of persons and deaths for different dose groups. These comparisons show that the doses that were received by the LSS population overlap strongly with the doses that are of concern to NASA Exploration mission (i.e., 50 to 2,000 milliSieverts (mSv)).

Table 1. Number of persons, Cancer Deaths, and Non-cancer Deaths for Different Dose Groups in the Life Span Study [2]
DS86 Weighted Colon Dose, mSv
Total0-5050-100100-200200-500500-1,0001,000-2,000>2,000
No. Subjects86,57237,45831,6505,7326,3323,2991,613488
Cancer Deaths9,3353,8333,27766876343827482
Non-cancer Deaths31,88113,83211,6332,1632,4231,161506163

Figure 1 shows the dose response for the excess relative risk (ERR) for all solid cancers from Preston et al. [1] Tables 2 and 3 show several summary parameters for tissue-specific cancer mortality risks for females and males, respectively, including estimates of ERR, excess absolute risk (EAR), and percentage attributable risks. Cancer incidence risks from low-LET radiation are about 60% higher than cancer mortality risks. [3]

Table 2. From Preston et al.: [1] Tissue-specific Cancer Mortality Risk Summary Statistics (i.e., ERR, EAR, and Attributable Risks) for Females and Males, RespectivelyLSS Female Site-specific Summary Mortality Rate Estimates: Solid Cancers 1950-1997
Site/SystemDeaths
(>0.005Sv)
ERR/Sva
(90% CI)
EAR/104PYb -Svc
(90%CI)
Attributable
risk (%)d
All solid cancer4,884 (2,948)0.63 (0.49; 0.79)13.5 (7.4; 16.3)9.2 (7.4; 11.0)
Oral cavity42 (25)-0.20 (<-0.3; 0.75)-0.04 (<-0.3; 0.14)-4.1 (<-6; 14)
Digestive System
Esophagus67 (44)1.7 (0.46; 3.8)0.51 (0.15; 0.92)22 (6.6; 42)
Stomach1,312 (786)0.65 (0.40; 0.95)3.3 (2.1; 4.7)8.8 (5.5; 12)
Colon272 (786)0.49 (0.11; 1.1)0.68 (0.76; 1.3)9.0 (4.3; 17)
Rectum198 (127)0.75 (0.16; 1.6)0.69 (0.16; 1.3)11.3 (2.6; 22)
Liver514 (291)0.35 (0.07; 0.72)0.85 (0.18; 1.6)6.2 (1.3; 12)
Gallbladder236 (149)0.16 (-0.17; 0.67)0.18 (-0.21; 0.71)2.6 (-2.9; 10)
Pancreas244 (135)-0.01 (-0.28; 0.45)-0.01 (-0.35; 0.52)-0.2 (-5.0; 7.6)
Respiratory System
Lung548 (348)1.1 (0.678; 1.6)2.5 (1.6; 3.5)16 (10; 22)
Female breast272; (173)0.79 (0.29; 1.5)1.6 (1.2; 2.2)24 (18; 32)
Uterus518 (323)0.17 (-0.10; 0.52)0.44 (-0.27; 1.3)2.7 (-1.6; 7.9)
Ovary136 (85)0.94 (0.07; 2.0)0.63 (0.23; 1.2)15 (5.3; 28)
Urinary System
Bladder67 (43)1.2 (0.10; 3.1)0.33 (0.02; 0.74)16 (0.9; 36)
Kidney31 (21)0.97 (<-0.3; 3.8)0.14 (<-0.1; 0.42)14 (<-3; 42)
Brain/CNSd17 (10)0.51 (<-0.3; 3.9)0.04 (<-0.02; 0.2)11 (<0.05; 57)
aERR/SV for age at exposure 30 in an age-constant linear ERR model; bExcess absolute risk per 10,000 persons per year; cAverage EAR computed from ERR model; dAttributable risk among survivors whose estimated dose is at least 0.005 Sv; CNS – central nervous system.
Table 3. From Preston et al.: [1] Tissue-specific Cancer Mortality Risk Summary Statistics 9 i.e., ERR, EAR, and Attributable Risks) for MalesLSS Male Site-specific Summary Mortality Rate Estimates: Solid Cancers 1950-1997
Site/SystemDeaths
(>0.005Sv)
ERR/Sva
(90% CI)
EAR/104PYb -Svc
(90%CI)
Attributable
risk (%)d
All solid cancer4,451 (2,554)0.37 (0.26; 0.49).6 (9.4; 16.2)6.6 (4.9; 8.4)
Oral cavity68 (37)-0.20 (<-0.3; 0.45)-0.12 (<-0.3; 0.25)-5.2 (<-6; 11)
Digestive System
Esophagus224 (130)0.61 (0.15; 1.2)1.1 (0.28; 2.0)11.1 (2.8; 21)
Stomach1,555 (899)0.20 (0.04; 0.39)2.1 (0.43; 4.0)3.2 (0.07; 6.2)
Colon206 (122)0.54 (0.13; 1.2)1.1 (0.64; 1.9)12 (6.9; 21)
Rectum172 (96)-0.25 (<-0.3; 0.15)-0.41 (<-0.4; 0.22)-5.4 (<-6; 3.1)
Liver722 (408)0.59 (0.11; 0.68)2.4 (1.2; 4.0)8.4 (4.2; 14)
Gallbladder92 (52)0.89 (0.22; 1.9)0.63 (0.17; 1.2)17 (4.5; 33)
Pancreas163 (103)-0.11 (<-0.3; 0.44)-0.15 (<-0.4; 0.58)--1.9 (<-6; 7.5)
Respiratory System
Lung716 (406)0.48 (0.23; 0.78)2.7 (1.4; 4.1)9.7 (4.9; 15)
Urinary System
Bladder82 (56)1.1 (0.2; 2.5)0.7 (0.1; 1.4)17 (3.3; 34)
Kidney36 (18)-0.02 (<-0.3; 1.1)-0.01 (-0.1; 0.28)-0.4 (<-5; 22)
Brain/CNSd14 (9)5.3 (1.4; 16)0.35 (0.13; 0.59)62 (23; 100)
aERR/SV for age at exposure 30 in an age-constant linear ERR model; bExcess absolute risk per 10,000 persons per year; cAverage EAR computed from ERR model; dAttributable risk among survivors whose estimated dose is at least 0.005 Sv; CNS – central nervous system.

Other human studies

The BEIR VII Report [2] contains an extensive review of data sets from human populations, including nuclear reactor workers and patients who were treated with radiation. The recent report from Cardis et al. [4] describes a meta-analysis for reactor workers from several countries. A meta-analysis at specific cancer sites, including breast, lung, and leukemia, has also been performed. [2] These studies require adjustments for photon energy, dose-rate, and country of origin as well as adjustments made in single population studies. Table 4 shows the results that are derived from Preston et al. [5] for a meta-analysis of breast cancer risks in eight populations, including the atomic-bomb survivors. The median ERR varies by slightly more than a factor of two, but confidence levels significantly overlap. Adjustments for photon energy or dose-rate and fractionation have not been made. These types of analysis lend confidence to risk assessments as well as showing the limitations of such data sets.

Of special interest to NASA is the dependence on age at exposure of low-LET cancer risk projections. The BEIR VII report prefers models that show less than a 25% reduction in risk over the range from 35 to 55 years, while NCRP Report No. 132 [6] shows about a two-fold reduction over this range.

Table 4. Results from Meta-analysis of Breast Cancer from Eight Population Groups, Including the Life Span Study of Atomic Bomb Survivors and Several Medical Patient Groups Exposed to X Rays, as described in Preston et al. [5] Summary of Parameter Estimates for the Final Pooled ERR Model
CohortReference age for
the ERR/Gy estimate
ERR/GyaPercentage change
per decade increase
in age at exposure
Exponent of
attained age
Background
SIRb
LSSattained age 502.10
(1.6; 2.8)
Not includedb-2.0
(-2.8; -1.1)
1.01
(0.9; 1.1)
TBOattained age 500.74
(0.4; 1.2)
Not included-2.0
(-2.8; -1.1)
0.96
(0.7; 1.2)
TBXattained age 500.74
(0.4; 1.2)
Not included-2.0
(-2.8; -1.1)
0.73
(0.6; 0.9)
THYattained age 500.74
(0.4; 1.2)
Not included-2.0
(-2.8; -1.1)
1.05
(0.7; 1.5)
BBDage at exposure 251.9
(1.3; 2.8)
-60%
(-71%; -44%)
Not includedc0.98
(0.8; 1.2)
APMall ages0.56
(0.3; 0.9)
Not includedNot included1.45
(1.1; 1.8)
HMGall ages0.34
(0.1; 0.7)
Not includedNot included1.07
(0.8; 1.3)
HMSall ages0.34
(0.1; 0.7)
Not includedNot included1.05
(0.9; 1.2)
a C.I.'s within parentheses; bSIR = standardized incidence ratio; c"Not included" means that the risk is assumed not to vary with age at exposure (attained age).

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PD-icon.svg This article incorporates public domain material from Human Health and Performance Risks of Space Exploration Missions (PDF). National Aeronautics and Space Administration. (NASA SP-2009-3405, pp. 132-134).