Multiple diagnostic x-rays for spine deformities and risk of breast cancer
Multiple diagnostic x-rays for spine deformities and risk of breast cancer
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DOI：
10.1158/1055-9965.epi-07-2628
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发表时间：
2008-03-01
影响因子：
3.8
通讯作者：
Land, Charles E.
中科院分区：
文献类型：
--
作者：
Ronckers, Cecile M.;Doody, Michele M.;Land, Charles E.
背景：电离辐射是公认的人类乳腺癌致癌物。在年轻时通过x线摄影监测脊柱曲度异常的妇女是适合调查辐射相关风险及其通过修改因素变化的暴露人群。在这一历史性队列中，95%的日剂量增量（当暴露于乳房时）低于2.4 cGy，平均为1.1 cGy。方法：对美国14个儿科骨科中心1912年至1965年间诊断为脊柱弯曲的3010名妇女进行回顾性队列研究，这些妇女于1992年通过电话访谈或邮件调查完成了一份调查问卷，在调整了确定的乳腺癌危险因素后，通过乳房辐射剂量（平均12 cGy）研究乳腺癌的风险。结果：78例浸润性乳腺癌的118,905女性年随访（中位35.5年）中，观察到临界显著的辐射剂量反应（过量相对风险/Gy = 2.86; P = 0.058；单尾P = 0.029）。对于有一级或二级亲属有乳腺癌家族史的妇女，剂量反应明显更大（P = 0.03）（超额相对危险度/Gy = 8.37； 95%可信区间，1.50-28.16）。辐射相关风险在生殖发育阶段没有显著差异。结论：假设与辐射相关的DNA损伤的修复最多需要几个小时，我们的数据反对存在1至3cgy量级的辐射暴露导致乳腺癌的低剂量阈值。乳腺癌家族史可能增强致癌辐射效应的可能性需要其他研究的证实。
Background: Ionizing radiation is a well-established human mammary carcinogen. Women historically monitored by radiography at young ages for abnormal spinal curvature are an exposed population suitable for investigating radiation-related risk and its variation by modifying factors. In this historic cohort, 95% of daily dose increments (when exposure to the breast occurred) were under 2.4 cGy, with mean 1.1 cGy.Methods: A retrospective cohort of 3,010 women, diagnosed with spinal curvature between 1912 and 1965 in 14 U.S. pediatric orthopedic centers and who completed a questionnaire by telephone interview or mail survey in 1992, were studied for risk of breast cancer by radiation dose to the breast (mean, 12 cGy) after adjustment for established breast cancer risk factors.Results: A borderline-significant radiation dose response (excess relative risk/Gy = 2.86; P = 0.058; one-tailed P = 0.029) was observed during 118,905 woman-years of follow-up (median, 35.5 years) based on 78 cases of invasive breast cancer. The dose response was significantly greater (P = 0.03) for women who reported a family history of breast cancer in first- or second-degree relatives (excess relative risk/Gy = 8.37; 95% confidence interval, 1.50-28.16). Radiation-related risk did not vary significantly by stage of reproductive development at exposure.Conclusions: Assuming that repair of radiation-related DNA damage requires at most a few hours, our data argue against existence of a low-dose threshold on the order of 1 to 3 cGy for radiation exposure contributing to breast carcinogenesis. The possibility that a family history of breast cancer may have enhanced a carcinogenic radiation effect requires confirmation in other studies.