Health Effects of Exposure to Low Levels of Ionizing Radiation BEIR V (1990) / Chapter Skim
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5 Radiogenic Cancer at Specific Sites
5 Radiogenic Cancer at Specific Sites
Pages 242-351
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From page 242... ...
Human Data The most extensive human data on the dose-incidence relationship come from studies of the Japanese atomic-bomb survivors and patients treated with x rays for ankylosing spondylitis. In the atomic-bomb survivors of the Life Span Study Cohort, a total of 202 deaths from leukemia were recorded for the period from 1950 to 1985, during which there were an estimated 2,185,335 person-years of follow-up.
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From page 243... ...
. Among 14,106 patients who were followed for up to 48 years after a single course of x-ray therapy for ankylosing spondylitis, 39 deaths from leukemia were recorded versus a total of 12.29 expected cases (ratio of observed to expected deaths, 3.17)
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From page 244... ...
0.5 1 1 1 1 1 1 1 1 _ 26 _ Leukemia T ~-0.7%/year, 18 ., 22 1 ~' 1 856 26 _ _ 942 :] 922 1950- 1955- 1959- 1963- 1967- 1971- 1975- 1979 1954 1958 1962 1966 1970 1974 1978 1982 INTERVAL OF FOLLOW-UP FIGURE 5-2 Relative risk of mortality from leukemia and all cancers other than leukemia in A-bomb survivors, 1950-1982, in relation to time after inadiation.
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From page 245... ...
Analyzed in relation to the average dose to the bone marrow, which was estimated to be 3.21 Gy, the excess relative risk amounted to O.98/Gy, or 0.45 additional cases of leukemia per 104 PYGy (Smirk. The smaller magnitude of the risk per Gy in patients with anlylosing spondylitis, compared with that in atomic-bomb survivors, may be ascribable to the younger average age of atomic-bomb survivors at the time of exposure and to the fact that they received instantaneous whole-bady irradiation, whereas in the patients with anlylosing spondylitis only a portion of the active marrow was irradiated and the dose was received in fractionated exposures that usually totaled more than 5 Gy within a given treatment field (Leafy.
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From page 246... ...
Linear ~, ., L l I i I l l l l l 0 2 4 6 8 10 12 14 16 18 AVERAGE BONE MARROW DOSE (Gy) FIGURE 5-3 Relative risk of acute leukemia and chronic myeloid leukemia in women treated with radiation for carcinoma of the uterine cervix, as influenced by the average dose to the bone marrow.
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From page 247... ...
For both the Life Span Study (LSS) and the Ankylosing Spondylitis
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From page 248... ...
+ 341(25 < T ~ 30~] if E > 20 Thy model is plotted as a function of attained age in Figure 5-4 and excess risk as a function of time after exposure for males is shown in Figure 5-5.
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From page 249... ...
were tested but these produced rather varied and unreliable risk estimates in extrapolations to this early, first 5-year period. Sources of data, other than that from A-bomb survivors, provide some guidance on this point.
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From page 250... ...
males at various ages of exposure. Leukemia Studies in Animals In mice, rats, dogs, swine, and other laboratory animals, a variety of lymphoid and myeloid leukemias have been induced by irradiation (UN77, UN86, NRC80~.
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From page 251... ...
Various models have been fitted to the observed dose-incidence data, all of which have included cell-killing terms to account for the diminution of the response at intermediate to high dose levels (UNTO. Although the data do not exclude a linear dose term in the low to intermediate dose range, all models also include higher power dose terms to account for the fact that the incidence per Gy of low-LET radiation increases with increasing dose at high dose rates in the intermediate dose range but is substantially reduced at low dose rates (UNDO.
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From page 252... ...
in male mice of different strains, in relation to dose and dose rate of whole body neutron-, x-, or y-irradiation. REM mice (U187~: acute neutron irradiation (curve 1~; acute y-irradiation (curve 2~; CBA mice (Mo82, Mo83a, Mo83b)
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From page 253... ...
Parallel Analyses of Breast Cancer Incidence and Mortality The Committee had available for analysis the original data from two mortality series and three incidence series. The mortality series were the
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From page 254... ...
The patterns of breast cancer mortality or incidence, in the absence of radiation exposure, were first modeled for each of the populations from which the cohorts were drawn. These background rates were then either multiplied by a function of dose, age at exposure, and time since exposure (relative risk model)
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From page 255... ...
Since the relative risks for the two cohorts were not significantly different and because of the evidence against equal excess absolute risks in the incidence data, the Committee's preferred model for breast cancer mortality is a relative risk model in which the level of risk was determined from the combined LSS/non-Nova Scotia CAN-TB data. It should be noted that women in the LSS and NY-APM study received acute exposures whereas the women in both TB series received highly fractionated exposures, usually over several years.
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From page 256... ...
In fact there is no evidence of a significant excess risk for at least 10 years post exposure. The Committee's preferred risk model for breast cancer mortality is given in equation 4-5, reproduced below.
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From page 257... ...
] if E > 15, 257 1b illustrate the variation in excess risk with age-at-exposure and time in the preferred models, Figures 5-7 through 5-10 present risk estimates for specific ages-at-exposure by attained age and by time-since-exposure for breast cancer mortality.
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From page 258... ...
60 FIGURE 5-8 Excess breast cancer deaths due to low-LET radiation by attained age for U.S. females for exposure at various ages.
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~ 10 20 30 TIME AFTER EXPOSURE (Y) 40 FIGURE 5-10 Excess breast cancer deaths as a function of time after exposure to low-LET radiation for U.S.
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Q A En '13 1.25 > llJ G _ 1.00 30 45 ATTAINED AGE (y) Age at Exposure \ \ \ 60 FIGURE S-11 Excess relative risk of breast cancer incidence due to low-LET radiation by attained age for U.S.
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From page 261... ...
The time between irradiation and elevation of prolactin levels can be extended from a few days to as long as 12 months with little change in lag period from increased prolactin to appearance of tumors or in final tumor incidence. Life-span studies of irradiated rats have illustrated that there is a marked inverse relationship between radiation dose and the latency of mammary neoplasms (Sh80, Sh82, Sh86a)
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From page 262... ...
As noted above, of the recent analyses of breast cancer mortality among irradiated women, only the Canadian fluoroscope series (Mi89) , with the Nova Scotia series included, presented any evidence of a positive quadratic component in the dose-response relationship.
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From page 263... ...
When either irradiated or unirradiated rats are given estrogen, the mammary tumors are virtually all adenocarcinomas (Sham. The effect of total dose and dose rate of fission-spectrum neutrons on mammary cancer incidence has been investigated in BALB/c mice (Ultra.
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From page 264... ...
The fine structure of the dose response for the production of mammary tumors at low dose and dose rate requires further mechanistic analysis. Hormones and Breast Cancer The growth, development, and function of the normal mammary gland is dependent upon hormonal regulation (Cl79, He88, Ro79, Ru82, Sh86a)
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From page 265... ...
before age 35 is strongly protective, but breast cancer risk is detectably reduced by ovariectomy at as late as 45-50 years of age (Mama. In irradiated rats, even in the presence of high levels of prolactin plus glucocorticoid deficiency, ovariectomy reduces mammary cancer risk (C185c)
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From page 266... ...
There was a marked upswing in the age at menarche among Japanese women born between 1930 and 1940; this birth cohort reached the age of puberty during the severe food shortage during and after World War II (Ho83~. Thus, the incidence of radiogenic breast cancer in individuals in the various age cohorts of the Hiroshima-Nagasaki Life Span Study are being measured against a shifting background of breast cancer risk from other causes.
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From page 267... ...
Animal experiments and human studies indicate that the induction of breast cancer is hormonally mediated and that hormonal status plays a critical role in radiation carcinogenesis of the breast.
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From page 268... ...
(Da85) conducted a parallel analysis of the cancer mortality seen in patients with ankylosing spondylitis and Japanese atomic-bomb survivors who received a T65 dose of at least 100 red (1 Gy)
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From page 269... ...
In general, the number of excess deaths from all cancers other than leukemia was observed to increase proportional to the background cancer rate for attained age, with the result that the relative risks tended to remain constant for specific age cohorts, except for those who were 0-9 years old at the time of bombing. Lung cancer deaths deviated somewhat from this pattern because of a slightly decreasing trend with time.
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From page 270... ...
Because dose estimates for individuals are not available for this cohort, it was not possible to analyze the follow-up results in terms of various dose-response models. Cervical Cancer Patients In a multicenter international study of 182,040 women treated for cancer of the uterine cervix, the relative risk of lung cancer was observed to be increased after radiation therapy (Bosh.
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From page 271... ...
When the BEIR IV model was used to project lifetime risks of lung cancer from lifetime exposures to radon progeny, an overall value of 350 excess lung cancer deaths/106 person-WLM was obtained. Annex 4G provides an analytical description of the risk model developed by the BEIR IV Committee and summary tables of their risk estimates for lifetime exposure to radon progeny.
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From page 272... ...
, respectively, whereas the corresponding relative risks for cigarette smokers were 2.4, 2.-4, and 3.6. Neither a multiplicative nor an additive interaction for lung cancer mortality could be distinguished clearly.
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From page 273... ...
Moveover, those exposed as children are still too young to provide reliabile information on lung cancer mortality. The Committee's preferred risk model for respiratory cancer mortality is given in Equation 4-4 which is reproduced below.
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From page 274... ...
FIGURE 5-14 Relative risk of lung cancer in U.S. males by attained age at various ages due to low-LET radiation exposure.
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From page 275... ...
Studies in Laboratory Animals The studies of populations described above are invaluable in providing information on the response of the lungs to certain kinds of exposure to ionizing radiation. However, except for radon progeny, there are no human data available on lung cancer due to internally deposited radionuclides.
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From page 276... ...
(1989) reported on the effectiveness of various radiation exposure modalities (radon-daughter inhalation, fission-neutron irradiation, or gamma irradiation)
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From page 277... ...
The use of laboratory animals has made it possible to study the impact of various modifying factors on the resulting lung cancer incidence, thereby broadening the knowledge obtained from human epidemiology studies. Factors discussed in this regard in the BEIR IV report include the effects of cumulative exposure, exposure rate, unattached fraction of radon progeny, disequilibrium of radon progeny, and concomitant exposure to cigarette smoke.
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From page 278... ...
Data suggesting greater than additive interactions between radiation and smoking are equivocal and are largely restricted to the effects of chronic exposure to radon progeny, which are of uncertain relevance to the effects of brief exposure to low-LET irradiation. Studies in laboratory animals have provided much of what is known about the influence of various modifying factors on the long-term biological effects of chronic beta or chronic alpha irradiation on the respiratory tract.
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From page 279... ...
The endings from the Japanese atomic-bomb survivors and the University of Chicago ulcer patients appear, at first, to be in marked contrast to the results of the investigation of second primary tumors among more than 82,000 women who underwent treatment for cervical cancer (Bomb. In the radiation-treated patient series of this study, an excess of 60 stomach cancers was predicted on the basis of risk estimates for radiation-induced stomach cancers prevalent in the literature at that time.
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From page 280... ...
The existing data, although not sufficient to define the dose-incidence relationship precisely, are consistent with observations on atomic-bomb survivors, in whom the relative risk of mortality from stomach cancer is estimated to approximate 1.19 per Gy. The Committee's risk model for cancer of the digestive system is based on the mortality of A-bomb survivors in the Life Span Study (LSS)
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From page 281... ...
Even earlier, however, an increased incidence of thyroid cancer had been reported among persons exposed to therapeutic x rays as infants (DuS0, Si55) and among individuals on the Marshall Islands who were exposed to radioactive fallout (Co80, Comb.
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From page 282... ...
3. Radiogenic cancer of the thyroid is frequently preceded or accompanied by benign thyroid nodules; the frequency of hypothyroidism and simple goiter also is increased in those exposed to large doses of radiation when young.
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From page 283... ...
Risk of Human Thyroid Cancer from External Radiation The incidence of thyroid cancer was evaluated in two groups of patients who were exposed to low-LET radiations for benign conditions: children in the Israel Tinea Capitis Study (Ro84a) (10,834 irradiated subjects of ages 0-15 years when exposed and 16,226 nonirradiated subjects for comparison)
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From page 284... ...
Dose-Response Relationships and Their Modification A highly significantly elevated risk of thyroid cancer following radiation exposure during childhood was demonstrated in both the Israeli and Rochester cohorts (Table 5-3~. Moreover, there was no evidence of significant nonlinearity in the shape of the dose-response function in either cohort.
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From page 285... ...
The thyroid cancer background rates among unirradiated females in both cohorts were about 3 times those among unirradiated males. Age at exposure: In the Israeli study, age at irradiation ranged from less than 1 year to 15 years, which allowed a limited assessment of the effect of age at exposure on cancer incidence.
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From page 286... ...
Recommended model: The choice of a model to be used in projecting thyroid cancer risks is difficult, because both available studies are limited to childhood exposures, and the levels of risk, as well as the latency distributions, in the two studies are inconsistent. Model choice is further complicated by the fact that thyroid cancer incidence rates are highly dependent on both the method of ascertainment and the criteria for surgery and hence confirmation of diagnoses used in a given study area.
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From page 287... ...
Estimates of the relative effectiveness per unit of radiation dose from i3iI varied from 1/lSth to 1/2 of that from external x-irradiation in the older experimental literature (Du80, NCRP85~. The effects of internally deposited radioiodides have been investigated in three categories of human subjects: patients who received relatively large therapeutic doses of i3iI (Do74, Ho84a, Ho84b, Ho80a)
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From page 288... ...
was not statistically significant. After a mean follow-up of 8 years, the thyroid cancer incidence ratio of 21,714 i3iI-treated patients to 11,732 surgically treated patients was 2.6, and was not significant (Doom.
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From page 289... ...
The thyroid status of the Marshall Islanders 27 years after exposure is summarized in Able 5-4. Although the dose estimation is open to question, the prevalence of hypothyroidism, thyroid nodules and proven thyroid cancer all appears to increase with dose (Comb.
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From page 290... ...
As suggested by the control data in Able 4-9, previous analyses had assumed a prevalence of non-radiation-related thyroid nodules of 6-7% (Comb. In the current analysis, the prevalence of spontaneous thyroid nodules was taken to be 2.45%, which was the mean prevalence of residents of the two southernmost atolls, which were far from the path of fallout (Hawk.
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From page 291... ...
. Although there was no increase in thyroid cancer incidence in the presumably exposed populations, there was a suggestive 20-30% greater prevalence of all thyroid abnormalities in exposed versus unexposed children.
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From page 292... ...
292 I_ $ o _' au ._ An: a' V)
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From page 293... ...
The 24 month thyroid cancer risk per 0.01 Gy for both i3iI and x rays in the 0.80-0.90 Gy range was 1.9 X 10-4 which is similar to the estimated human life time risk from x rays (Legal. In contrast, the slopes of the dose-response relationship for adenoma and total tumor had upward curvature, and appeared to rise more rapidly in the x-ray-treated groups.
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From page 294... ...
The SHE calculated in this way is the risk of development of thyroid cancer during the rest of an individual's life. If a thyroid cancer mortality risk is desired, the SRE is multiplied by L, the lethality factor, assumed to be 1/10.
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From page 295... ...
. The Acute Phase The first step in radiogenic thyroid cancer induction is initiation, that is, the formation of one or more heritable precancerous changes in one to many thyroid cells (Cl86b, Dumb.
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From page 296... ...
Higher doses of x rays (greater than 15-20 Gy) result in widespread evidence of epithelial cell damage (Do67)
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From page 297... ...
Summary Thyroid cancer is well established as a late consequence of exposure to ionizing radiation from both external and internal sources in humans and experimental animals. The histopatholoy of radiogenic thyroid cancer indicates that it appears to arise exclusively from the follicular epithelium.
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From page 298... ...
, thyroid cancer as males. Hence, relative-risk estimates do not differ significantly by sex.
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From page 299... ...
Esophageal cancer was not included in a recent case control analysis of these data (Bomb. Stronger evidence in support of the relationship between esophageal cancer and exposure to ionizing radiation is provided by the analysis of the updated mortality experience of the cohort of patients with ankylosing spondylitis (Damp.
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From page 300... ...
In 2,068 women treated with irradiation of the ovaries for excessive menstrual bleeding, an excess of mortality from cancer of the small intestine was observed; that is, there were 3 observed deaths, compared with only 0.4 expected deaths (Smog. Similarly, in an international study of 82,616 women treated with radiation for carcinoma of the uterine cervix, a twofold excess of cancer of the small intestine was observed; that is, there were 21 observed versus 9.5 expected cases (Bomb.
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From page 301... ...
In 14,106 patients who were treated with x rays to the spine for ankylosing spondylitis during 1935-1954 and who were followed until 1985, a total of 47 deaths from colon cancer were observed, versus 36.11 expected (relative risk, 1.30) (Damp; however, the relative risk in this population
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From page 302... ...
. As yet, however, there is no evidence of such an excess in patients treated with radiation for ankylosing spondylitis (Damp.
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From page 303... ...
Summary The data imply that the risks of cancer of the colon and cancer of the rectum can be increased by intensive irradiation in humans and laboratory animals; however, the shapes of the dose-incidence curves and the risks per unit dose are highly uncertain. In the Japanese A-bomb survivors, the dose-dependent excess of colon cancers corresponds to a relative risk of 1.85/Gy, or 0.81 fatal cases per 104 PYGy, and was not evident until more than 15 years after irradiation.
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From page 304... ...
In 14,106 patients who received a single treatment course of x rays for ankylosing spondylitis and were followed through 1982, a total of 6 liver cancers were absented more than 5 years after exposure, with 2 cases between 5 and 25 years and the other 4 cases more than 25 years after exposure; the observation of the 6 liver cancers was not significantly
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From page 305... ...
The BEIR IV report briefly discussed the prolonged retention of actinide radionuclides in the livers of Chinese hamsters, deer mice, grasshopper mice, and beagle dogs, compared with the shorter retention half-times seen in laboratory mice and rats (NRC88~. Prolonged retention times increase the radiation doses received by the liver and increase the carcinogenic effects observed in some species.
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From page 306... ...
SKELETON Human Data Low-LET Irradiation Among 14,106 persons given a single treatment course of x rays for ankylosing spondylitis, four bone cancers were observed at times greater than 5 years after exposure (ratio of observed to expected bone cancers, 4/1.36) , corresponding to a relative risk of 2.95 (n < 0.05)
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From page 307... ...
Therefore, other approaches, including studies of the effects of internally deposited alpha emitters in human populations or studies of the comparative carcinogenic effects of alpha irradiation and beta irradiation in laboratory animals, are required. High-LET Irradiai'on With internally deposited 224Ra, 226Ra or 228Ra, the main long-term biological effect has been observed to be the induction of bone cancer, primarily osteosarcoma (NRC80, NRC88, UN86, Va86)
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From page 308... ...
Most of the currently available data on the long-term biological effects of low-LET irradiation in laboratory animals have been derived from chronic beta irradiation by internally deposited beta-emitting radionuclides such as 32p, 45Ca, and 90Sr (Go86a)
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From page 309... ...
(Ra83) , using a log-normal dose-response model, reported that the relative effectiveness of these two chronic exposure modalities was of about equal potency when the average skeletal dose rate was about 0.1 Gy/day, but that the relative effectiveness of 90Sr at lower dose rates decreased in comparison with that of 226Ra, eventually reaching a point at which 90Sr was only 1/30 as effective as 226 Ra.
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From page 310... ...
Parallel studies with 226Ra in beagles dogs have demonstrated chronic beta irradiation from 90Sr to be less effective than chronic alpha irradiation from 226Ra, by a factor of up to 25, the carcinogenic effectiveness of chronic beta irradiation being greatly reduced at low doses and low dose rates. BRAIN AND NERVOUS SYSTEM Radiation has been observed to increase the incidence of tumors of the nervous system in humans and laboratory animals.
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From page 311... ...
has been observed in a series of 14,106 patients treated with spinal irradiation for ankylosing spondylitis and followed for up to 48 years after treatment (Damp; if the
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From page 312... ...
Summary Radiation has been observed to increase the incidence of nervous system tumors in human populations and laboratory animals. The tumors include malignant as well as benign growths of the brain, meninges, and
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From page 313... ...
of patients with ankylosing spondylitis offer little additional support for the presumed relationship between ovarian cancer and exposure to ionizing radiation. The overall mortality risk among patients 5 years or more after radiotherapy is slightly below the expectation based on the experience of the national population (i.e., 5 observed versus 5.37 expected deaths)
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From page 314... ...
In a study of the occurrence of second primary tumors among 182,040 women treated for cervical cancer (Bo85) , an overall deficit in the number of cancers of the uterine corpus was observed among patients who received radiotherapy, in comparison with the expectated number based on general population rates.
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From page 315... ...
(Da85) specifically addressed the question of radiation-induced testicular cancer in a study involving a parallel analysis of cancer mortality among the Japanese A-bomb survivors and patients with ankylosing spondylitis in the United Kingdom who had been given x-ray therapy.
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From page 316... ...
In the most recent Life Span Study cohort report (Sh88) , prostate cancer mortality in the years 1950-85 showed no significant increase with increasing dose.
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From page 317... ...
In the most recent follow-up on cancer mortality, to January 1, 1983, covering 11,772 men with ankylosing spondylitis given a single course of x ray treatment during the period 1935-1954 (152,979 person-years at risk) , there were 21 observed versus 18.15 expected prostate cancers (ratio of observed to expected cases, 1.16)
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From page 318... ...
Japanese A-Bomb Surnvors The Radiation Effects Research Foundation (RERF) Life Span Study Report 10 on cancer mortality among A-bomb survivors in Hiroshima and Nagasaki (1950-1982)
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From page 319... ...
occurred primarily among those who died from bladder cancer ~ = 0.003~; for those who died from kidney cancer, the positive radiation dose response was slight (p = 0.3~. An analysis of radiation-related cancer mortality during 1950-1985 according to the new DS86 dosimetry systems has recently been made on data from 75,991 Hiroshima and Nagasaki survivors, a subgroup of the RERF Life Span Study cohort designated the DS86 subcohort (Sh87, Sheaf.
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From page 320... ...
The effects of smoking and radiation exposure were independent; controlling for smoking did not appreciably alter the radiation risk estimates. Overall bladder cancer risks were greater in the U.S.
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From page 321... ...
registry areas and those exposed when they were <55 years of age had the greatest radiogenic kidney cancer risks (Bomb. Finally, a relative risk of 2.9 was found for cancers of the renal pelvis (23 cases)
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From page 322... ...
A total of 17% of 130 patients with HPT at the Henry Ford Hospital had a history of radiation exposure at a mean age of 16 years, whereas only 3% of 4~) 0 ambulatory eucalcemic patients had been irradiated (p < 0.025)
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From page 323... ...
In one experiment, a cumulative total of 12 parathyroid tumors were noted among 80 rats of each sex that were exposed to 250kVp x rays at 5 Gy when they were 100 days of age; no tumors occurred in 160 unirradiated controls. Ten animals of each sex in the irradiated and control groups were necropsied every 3 months for 24 months after exposure, so the cumulative reported incidence of 8% parathyroid tumors is an underestimate of the true 24-month (or life span)
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From page 324... ...
In the latest report from the Life Span Study cohort of Japanese A-bomb survivors, Shimizu et al.
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From page 325... ...
imply that the skin has a higher susceptibility to radiation carcinogenesis than has generally been suspected. Perhaps the most extensive study of radiation-induced skin cancer is an investigation of 2,226 persons who were treated in childhood with epilating doses of 100 kVp x rays to the scalp for tinea capitis and who have since been followed for an average of more than 25 years (Sh84a, Ha83b)
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From page 326... ...
Radiation carcinogenesis in the skin has been studied experimentally in several species of laboratory animals (UNTO. In the rat, a variety of different types of skin tumors occur in response to irradiation, including tumors of hair follicles; in total numbers, the tumors induced by a given dose in the rat exceed those induced by the same dose in the mouse, a species in which the tumors are composed predominantly of squamous cell carcinomas (Bump.
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From page 327... ...
Although the data do not suffice to define the dose-incidence relationship precisely, the cumulative 30-year excess of basal cell carcinomas in fair-skinned persons treated with x rays to the scalp for tinea capitis in childhood has been observed to increase over a 25-year period with dose in a manner consistent with linearity, corresponding to 7.1 x 10-6 excess cases/cm2 Person Gy in areas of skin not exposed to sunlight and 3.3 x 10-5 excess cases/cm2 Person Gy in areas of skin exposed to sunlight as well as x rays. LYMPHOMA AND MULTIPLE MYELOMA An increase in the frequency of some forms of lymphoma has been associated with irradiation in humans and laboratory animals (UNTO.
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From page 328... ...
, the data from A-bomb survivors, as well as from other populations, imply that for multiple myeloma the minimal latent period is appreciably longer, the relative risk smaller, and the age distribution later than for leukemia. Although mortality from multiple myeloma has been observed to be
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From page 329... ...
, notwithstanding a previous suggestion to the contrary (Anew. Patients treated with radiation for ankylosing spondylitis, however, continue to show increased mortality from the disease (ratio of observed to expected mortality 16/7.14 = 2.24)
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From page 330... ...
Neither the excess for the pharynx nor that for the larynx was significant at p ~ 0.05. Similarly, Darby and colleagues later found no significant excess in deaths from cancer of the pharynx or larynx in ankylosing spondylitis patients and in Japanese A-bomb survivors (Damp.
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From page 331... ...
SALIVARY GLANDS The incidence of salivary gland tumors has been observed to be increased in patients treated with irradiation for diseases of the head and neck, in Japanese A-bomb survivors, and in persons exposed to diagnostic x radiation. The therapeutically irradiated populations fall primarily into three groups: (1)
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From page 333... ...
In patients treated for tinea capitis, the excess was evident at an estimated average dose of only 0.4 Gy, indicating that the susceptibility of the salivary gland to radiation carcinogenesis is relatively high. PANCREAS Cancer of the pancreas is the fourth leading type of fatal cancer in the United States (Yo81)
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From page 334... ...
Pp. 263-276 in Late Biological Effects of Ionizing Radiation, Vol.
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From page 335... ...
Katon. Ionizing radiation and lung cancer: A review including prelimina~y results from a case-control study among a-bomb survivors.
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From page 336... ...
1985. Lactation and breast cancer Evidence for a negative association in premenopausal women.
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From page 337... ...
1979. Animal models of breast cancer.
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From page 338... ...
1985. A parallel analysis of cancer mortality among atomic bomb survivors and patients with ankylosing spondylitis.
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From page 339... ...
1987. Single inhalation exposure to 9°SrCl2 in the beagle dog: Late biological effects.
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From page 340... ...
1983. Secular trends in the distributions of the breast cancer risk factors menarche, first birth, menopause and weight- in Hiroshima and Nagasaki, Japan.
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From page 341... ...
1989. Breast cancer after multiple chest fluoroscopies: Second follow-up of Massachusetts women with tuberculosis.
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From page 342... ...
1980. Breast cancer risk from low-dose exposures to ionizing radiation: Results of parallel analysis of three exposed populations of women.
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From page 343... ...
1965. Breast cancer following multiple fluoroscopies.
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From page 344... ...
1989. Breast cancer mortality following irradiation in a cohort of Canadian tuberculosis patients.
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From page 345... ...
1983. "Hormonal" risk factors, "breast tissue age" and the age-incidence of breast cancer.
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From page 346... ...
1982. Radiation ex posure and thyroid cancer incidence among Hiroshima and Nagasaki residents.
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From page 347... ...
Breast Cancer Res.
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From page 348... ...
1986. Breast cancer among women given x-ray therapy for acute postpartum mastitis.
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From page 349... ...
1987. Incidence of female breast cancer among atomic bomb su~vivors, Hiroshima and Nagasaki, 1950-1980.
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From page 350... ...
1968. Breast cancer after exposure to the atomic bombings of Hiroshima and Nagasaki.
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From page 351... ...
1988. Risk factors for breast cancer in Chinese women in Shaghai.
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