Association Between Radiation Exposure and Family History of Cancer: Analysis of an Online Risk Assessment Tool

Abstract

<h3>Purpose/Objective(s)</h3> Radiation exposure (RE) is recognized to contribute to risk of cancer, particularly leukemias and thyroid/ breast cancers (TC, BC), which may take years to manifest clinically. RE may include occupational hazards, accidents, and medical procedures. Risk of cancer after RE is multifactorial and impacted by RE dose, biologic factors, heredity, younger age, and female sex. This study examines the relationship between FH of TC, leukemia, or BC and individual behaviors demonstrating precautions to reduce RE. <h3>Materials/Methods</h3> The OncoLink Reduce My Risk tool was created in 2009 to provide users personalized cancer risk data based on demographics, risk factors, risk-associated behaviors, and FH. This free tool is accessible at www.oncolink.org. IRB-exempt data analysis involved a convenience sample of all survey responses. Differences between respondents with vs without radiation exposure were analyzed using chi-square test. <h3>Results</h3> Among 28,001 total respondents, 682 (2.44%), 1,573 (5.62%), and 6,849 (28.35%) reported FH of TC, leukemia, and BC, respectively. Of those, 475 (69.65%), 1,072 (68.15%), and 4,907 (71.65%) were female, and the median age was 24 (IQR 19-34), 26 (IQR 19-37), and 27 (IQR 20-38), respectively. Those with FH of these cancers were significantly more likely to report rural residence. For respondents with FH TC vs those without, occupational RE was significantly more common (p = 0.01) while RE through a radiation accident was slightly more common (0% vs 0.44%, p = 0.08). For respondents with FH leukemia vs those without, REs (occupational or accidental) were slightly more common (1.27% vs 1.04%, 0.51% vs 0.42%, p = NS). FH BC did not impact RE. For the total cohort, those who reported RE from an accident were significantly more likely to be non-White (p = 0.02), possess a sub-high school education (p < 0.01), and report a household income below $45,000 (p<0.01). Occupational RE was not associated with income or education, although it was significantly more common in non-White individuals (p < 0.01). <h3>Conclusion</h3> Respondents who demonstrated FH of radiation-associated cancers did not achieve lower RE as a risk mitigation measure, and in some cases had higher incidence of RE than those without FH. The incidence of RE events was significantly more common in populations of lower SES. These findings identify RE as an under-recognized social determinant of health and highlight the importance of patient counseling and structural assistance to reduce cancer incidence through targeted preventive interventions.