LOW DOSE RADIATION IN THE ETIOLOGY OF ACUTE MYELOGENOUS LEUKEMIA

自20世纪40年代以来，AML的发病率和死亡率均已降低， 增加。 暴露于医用X射线是最有可能导致 占这一增长的最大比例。 我们建议扩大 一项正在进行的基于人群的研究， 以克服以往病例对照研究的严重局限性。 我们将纳入450例年龄在30-69岁之间的洛杉矶县AML确诊病例 从1987年到1995年，450个单独匹配的邻居控制。 我们将 获得272例病例的个人访谈数据，所有450例对照， 628名受试者的代理受访者访谈数据（病例和 对照）。 我们还将从x光的医疗图表中提取信息 和诊断日期前10年内的药物暴露。 我们计划 开发改进的辐射剂量测定模型， 检查、执行年份、设施类型和重考率。 比较 数据源（即自我/代理;访谈/图表）将允许估计 错误率和错误分类的校正。 不确定性估计 将纳入逻辑回归分析。 我们希望确定哪些程序，如果有的话，与过度有关 风险，以便采取适当的预防措施， 使用. 我们的初步研究结果和以前的病例对照研究结果 提示AML风险与多次重复脊柱X线检查和GI 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).