Cancer risks among studies of medical diagnostic radiation exposure in early life without quantitative estimates of dose.
Cancer risks among studies of medical diagnostic radiation exposure in early life without quantitative estimates of dose.
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DOI：
10.1016/j.scitotenv.2022.154723
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发表时间：
2022-08-01
影响因子：
9.8
通讯作者：
Kendall, Gerald M.
中科院分区：
文献类型：
--
作者：
Little, Mark P.;Wakeford, Richard;Bouffler, Simon D.;Abalo, Kossi;Hauptmann, Michael;Hamada, Nobuyuki;Kendall, Gerald M.
越来越多的证据表明，在低于几十毫西弗的急性剂量下或长期接受的剂量下，不同人群的癌症风险过高。也有证据表明，在子宫内或儿童时期受到辐射照射后，相对风险通常更高。我们回顾并总结了89项研究的证据，这些研究是在子宫或儿童时期医学诊断暴露后发生的癌症，其中没有直接的辐射剂量估计。在所有被研究的人群中，暴露于稀疏电离辐射（x射线）。几项关于子宫内暴露的早期研究显示，几种儿童癌症的风险适度，但在统计上具有显著意义。随着研究的日历期，比值比呈极显著（p<0.0005）负趋势，因此最近的研究倾向于表现出降低的超额风险。研究间无显著异质性（p < 0.05）。就产后暴露而言，白血病、脑癌和实体癌的风险明显过高，有迹象表明，不同癌症类型（p=0.07）和暴露类型（p=0.02）的风险存在差异，其中透视检查和计算机断层扫描与最高的超额风险相关。然而，除了一种暴露类型外，所有癌症终点和所有暴露类型的研究间异质性都非常显著（p<0.01），尽管在研究期间没有显著的风险趋势。总的来说，这一大量与子宫内医疗诊断辐射暴露有关的数据为儿童癌症的相关过度风险提供了支持。然而，出生后诊断暴露研究中明显的异质性，对汇总测量意义的隐含不确定性，以及明显的偏倚可能性，大大降低了我们观察到的儿童辐射成像与随后的癌症风险与辐射暴露因果关系之间关联的证据的强度。图1所示。子宫内暴露研究的元回归。限制最大似然（REML）拟合研究数据确定范围的历年中点的比值比或相对风险（<1950、1950 - 1959、1960-1969、1970-1979、1980-1989、1990+）。图中显示了(a)四个癌症终点分析（白血病，淋巴瘤，脑/中枢神经系统癌，其他癌症）和(b)任何癌症终点分析，用于每个子宫内暴露研究。红色虚线表示优势比/相对风险= 1。图2。产后暴露研究的荟萃回归。限制最大似然（REML）拟合研究数据确定范围的历年中点的比值比或相对风险（<1960年、1960 - 1969年、1970-1979年、1980-1989年、1990-1999年、2000+）。图中显示了(a)四个癌症终点分析（白血病、淋巴瘤、脑/中枢神经系统癌、其他癌症）和(b)每个产后暴露研究的任何癌症终点分析。红色虚线表示优势比/相对风险= 1。
There is accumulating evidence of excess risk of cancer in various populations exposed at acute doses below several tens of mSv or doses received over a protracted period. There is also evidence that relative risks are generally higher after radiation exposures in utero or in childhood. We reviewed and summarised evidence from 89 studies of cancer following medical diagnostic exposure in utero or in childhood, in which no direct estimates of radiation dose are available. In all of the populations studied exposure was to sparsely ionising radiation (X-rays). Several of the early studies of in utero exposure exhibit modest but statistically significant excess risks of several types of childhood cancer. There is a highly significant (p<0.0005) negative trend of odds ratio with calendar period of study, so that more recent studies tend to exhibit reduced excess risk. There is no significant inter-study heterogeneity (p>0.3). In relation to postnatal exposure there are significant excess risks of leukaemia, brain and solid cancers, with indications of variations in risk by cancer type (p=0.07) and type of exposure (p=0.02), with fluoroscopy and computed tomography scans associated with the highest excess risk. However, there is highly significant inter-study heterogeneity (p<0.01) for all cancer endpoints and all but one type of exposure, although no significant risk trend with calendar period of study. Overall, this large body of data relating to medical diagnostic radiation exposure in utero provides support for an associated excess risk of childhood cancer. However, the pronounced heterogeneity in studies of postnatal diagnostic exposure, the implied uncertainty as to the meaning of summary measures, and the distinct possibilities of bias, substantially reduce the strength of the evidence from the associations we observe between radiation imaging in childhood and the subsequent risk of cancer being causally related to radiation exposure. Figure 1. Meta-regression for studies of in utero exposure. Restricted maximum likelihood (REML) fits to odds ratio or relative risk by calendar year midpoint of study data ascertainment range (for <1950, 1950–1959, 1960–1969, 1970–1979, 1980–1989, 1990+). Plots are shown for (a) the four cancer endpoints analysis (leukaemia, lymphoma, brain/CNS cancer, other cancer) and (b) the any cancer endpoint analysis, for each in utero exposure study. Dashed red line is odds ratio/relative risk = 1. Figure 2. Meta-regression for studies of postnatal exposure. Restricted maximum likelihood (REML) fits to odds ratio or relative risk by calendar year midpoint of study data ascertainment range (for <1960, 1960–1969, 1970–1979, 1980–1989, 1990–1999, 2000+). Plots are shown for (a) the four cancer endpoints analysis (leukaemia, lymphoma, brain/CNS cancer, other cancer) and (b) the any cancer endpoint analysis, for each postnatal exposure study. Dashed red line is odds ratio/relative risk = 1.
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影响因子：
3.7
作者：
Duval, S;Tweedie, R
通讯作者：
Tweedie, R
影响因子：
7.7
作者：
Blettner, M;Sauerbrei, W;Friedenreich, C
通讯作者：
Friedenreich, C
影响因子：
1.5
作者：
Baaken, Dan;Hammer, Gael P.;Lorenz, Eva
通讯作者：
Lorenz, Eva
影响因子：
8.8
作者：
Bithell, J F;Stewart, A M
通讯作者：
Stewart, A M
DOI：
10.1016/0197-2456(86)90046-2
发表时间：
1986-09-01
期刊：
CONTROLLED CLINICAL TRIALS
影响因子：
--
作者：
DERSIMONIAN, R;LAIRD, N
通讯作者：
LAIRD, N