Relationship between radiation exposure and risk of second primary cancers among atomic bomb survivors.
Relationship between radiation exposure and risk of second primary cancers among atomic bomb survivors.
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DOI：
10.1158/0008-5472.can-10-0276
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发表时间：
2010-09-15
期刊：
影响因子：
11.2
通讯作者：
Kopecky KJ
中科院分区：
文献类型：
--
作者：
Li CI;Nishi N;McDougall JA;Semmens EO;Sugiyama H;Soda M;Sakata R;Hayashi M;Kasagi F;Suyama A;Mabuchi K;Davis S;Kodama K;Kopecky KJ
辐射暴露与许多类型的癌症风险有关，但对其对多种原发性癌症风险的影响知之甚少。利用2002年77752名日本原子弹幸存者的随访数据，我们确定了14048名被诊断为第一原发性癌症的参与者，其中1088人被诊断为第二原发性癌症。使用泊松回归量化了辐射暴露与第一和第二原发癌症风险之间的关系。辐射暴露与第一和第二原发性实体瘤的风险(每Gray的超额相对风险（ERR) = 0.65, 95%可信区间（CI）： 0.57-0.74, ERR/Gy=0.56, 95% CI: 0.33-0.80）和第一和第二原发性白血病的风险（ERR/Gy=2.65, 95% CI: 1.78-3.78, ERR/Gy=3.65, 95% CI: 0.96-10.70）之间存在类似的线性剂量反应关系。与第一次实体癌相比，第二次实体癌的背景发病率更高，直到男性70岁和女性80岁左右（p<0.0001），但与辐射相关的ERRs在第一和第二原发性实体癌之间没有差异（p=0.70）。辐射剂量与对辐射敏感的实体瘤的风险关系最为密切，包括第二原发性肺癌、结肠癌、女性乳腺癌、甲状腺癌和膀胱癌。辐射暴露导致第二原发癌症的相对风险与第一原发癌症同样高。辐射是一种强致癌物，被诊断为第一原发性癌症的大量暴露者应仔细筛查第二原发性癌症，特别是对辐射敏感的癌症。
Radiation exposure is related to risk of numerous types of cancer, but relatively little is known about its impact on risk of multiple primary cancers. Using follow-up data through 2002 from 77,752 Japanese atomic bomb survivors, we identified 14,048 participants diagnosed with a first primary cancer, of whom 1,088 were diagnosed with a second primary cancer. Relationships between radiation exposure and risks of first and second primary cancers were quantified using Poisson regression. There was a similar linear dose-response relationship between radiation exposure and risks of both first and second primary solid tumors [excess relative risk (ERR) per Gray = 0.65, 95% confidence interval (CI): 0.57–0.74 and ERR/Gy=0.56, 95% CI: 0.33–0.80, respectively] and risk of both first and second primary leukemias (ERR/Gy=2.65, 95% CI: 1.78–3.78 and ERR/Gy=3.65, 95% CI: 0.96–10.70, respectively). Background incidence rates were higher for second solid cancers, compared to first solid cancers, until about age 70 years for men and 80 years for women (p<0.0001), but radiation-related ERRs did not differ between first and second primary solid cancers (p=0.70). Radiation dose was most strongly related to risk of solid tumors that are radiation sensitive including second primary lung, colon, female breast, thyroid, and bladder cancers. Radiation exposure confers equally high relative risks of second primary cancers as first primary cancers. Radiation is a potent carcinogen and those with substantial exposures who are diagnosed with a first primary cancer should be carefully screened for second primary cancers, particularly for cancers that are radiation sensitive.