Abstract
Medical diagnostic X-rays are an important source of ionizing radiation (IR) exposure in the general population; however, it is unclear if the resulting low patient doses increase lymphoma risk. We examined the association between lifetime medical diagnostic X-ray dose and lymphoma risk, taking into account potential confounding factors, including medical history. The international Epilymph study (conducted in the Czech-Republic, France, Germany, Ireland, Italy, and Spain) collected self-reported information on common diagnostic X-ray procedures from 2,362 lymphoma cases and 2,465 frequency-matched (age, sex, country) controls. Individual lifetime cumulative bone marrow (BM) dose was estimated using time period-based dose estimates for different procedures and body parts. The association between categories of BM dose and lymphoma risk was examined using unconditional logistic regression models adjusting for matching factors, socioeconomic variables, and the presence of underlying medical conditions (atopic, autoimmune, infectious diseases, osteoarthritis, having had a sick childhood, and family history of lymphoma) as potential confounders of the association. Cumulative BM dose was low (median 2.25 mGy) and was not positively associated with lymphoma risk. Odds ratios (ORs) were consistently less than 1.0 in all dose categories compared to the reference category (less than 1 mGy). Results were similar after adjustment for potential confounding factors, when using different exposure scenarios, and in analyses by lymphoma subtype and by type of control (hospital-, population-based). Overall no increased risk of lymphoma was observed. The reduced ORs may be related to unmeasured confounding or other sources of systematic bias.We found little evidence that chronic medical conditions confound lymphoma risk and medical radiation associations.
Highlights
The use of ionizing radiation (IR) in medicine has significantly improved patient care
Lymphoid cells originate in the bone marrow (BM), a radiosensitive organ; at present, it is unclear whether IR increases the risk of lymphoma risk, at low doses [4,5,6,7]
ERR: Excessive Relative Risk; RR: Relative risk; IRR: Incidence Rate Ratio; CI: Confidence Interval; SIR: Standardized Incidence Ratio; n.e: not estimable. aIn recent atomic bomb survivor studies, the doses are expressed as “weighted doses”, in Gy, rather than equivalent doses in Sv, using a weighting factor of 10 for neutrons, whatever their energy. bColon dose in atomic bomb survivors reports is usually used for solid cancer risk estimation. cDose estimated in Sv because the study focused on high energy photon exposure; for comparison purposes 1 Gy of absorbed dose is approximately equal to 1 Sv of equivalent dose. dHighest category corresponds to 110 WLM or more; lowest category to less than 3 WLM
Summary
The use of ionizing radiation (IR) in medicine has significantly improved patient care. It has resulted in a large increase in IR exposure to the general population [1,2,3], raising concerns in the public health and radiological protection communities. Lymphomas are mainly classified into Hodgkin Lymphomas (HL) and Non Hodgkin Lymphomas (NHL), and are initiated by a mutation in a lymphoid stem cell. Lymphoid cells originate in the bone marrow (BM), a radiosensitive organ; at present, it is unclear whether IR increases the risk of lymphoma risk, at low doses [4,5,6,7]
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