LOW DOSE RADIATION IN THE ETIOLOGY OF ACUTE MYELOGENOUS LEUKEMIA

自20世纪40年代S以来，急性髓系白血病的发病率和死亡率一直是 越来越多。暴露于医用x射线是最有可能导致 在这一增长中占最大比例。我们计划扩大 一项正在进行的基于人群的研究设计了这种假想的关联 以克服以往病例对照研究的严重局限性。 我们将包括450例30-69岁的洛杉矶县确诊的急性髓细胞白血病病例 在1987-1995年间，有450人单独匹配邻里对照。我们会 获得272个病例的个人访谈数据，所有450个对照，以及 代表受访者对628名受试者的访谈数据(案例和 控制)。我们还将从x光上的病历中提取信息 以及在诊断日期之前的10年内接触过药物。我们计划 开发改进的辐射剂量测量模型，考虑到 考试、进行的年份、设施的类型和重考率。比较 数据来源(例如，自我/代理；访谈/图表)将允许估计 错误率和错误分类的纠正。不确定性估计 将被纳入逻辑回归分析。 我们希望确定哪些程序(如果有的话)与过量有关 风险，以便采取适当的预防措施，防止不分青红皂白 使用。我们的初步发现和以前的病例对照研究的结果 提示AML的风险与多次重复的脊柱X光和胃肠道疾病有关 系列(带透视)。

Since the 1940's both the incidence and mortality rates for AML have been increasing. Exposure to medical x-rays is the factor most likely to account for the greatest proportion of this increase. We propose to expand an ongoing population-based study of this hypothesized association designed to overcome the serious limitations of previous case-control studies. We will include 450 Los Angeles County cases aged 30-69 with AML diagnosed from 1987-1995 and 450 individually matched neighborhood controls. We will obtain personal interview data for 272 cases, all 450 controls, and interview data from proxy respondents for 628 subjects (cases and controls). We will also abstract information from medical charts on x-ray and drug exposures during the 10 years prior to diagnosis date. We plan to develop improved radiation dosimetry models that consider type of examination, year performed, type of facility and retake rate. Comparisons of data sources (i.e. self/proxy; interview/chart) will allow estimation of error rates and correction for misclassification. Uncertainty estimates will be incorporated into logistic regression analyses. We hope to identify which procedures, if any, are associated with excess risk so that appropriate precautions can be taken against indiscriminate use. Our preliminary findings and those from previous case-control studies suggest that AML risk relates to multiple repeat spinal x-rays and GI series (with fluoroscopy).