Données épidémiologiques sur le cancer du sein radio-induit

Abstract

Background Female breast cancer is the most frequent cancer, both in incidence and mortality. It is well known that exposure to ionizing radiation increases the risk, but some questions remain concerning low dose and low-dose rate effects and cofactors. These potential effects have to be taken into account to carry out adequate risk assessment on medically exposed populations. A literature review is proposed on this issue. Methods A Medline research was undertaken. Keywords used were ionizing radiation, breast cancer and epidemiology. More studies were added through references included in the first list of articles. The focus was placed on studies including quantitative dose–effect relationship analyses. Results A latency of five to 10 to 13 years is observed in the appearance of risk. The risk diminishes with age at exposure. A diminution with age at risk is also suspected. The excess relative risk per gray varies between 0.3 and 1.5 for an age at first exposure of 25 years. The study of Hiroshima and Nagasaki survivors shows that risk is increased even if doses are restricted to below 0.5 Gy. Above high doses (20 Gy), the risk no longer increases. This can be interpreted as a cell-killing effect. The excess subsists if doses are fractionated, but a diminution of the effect is suspected. Conclusion The effects of exposure to levels of doses used for medical diagnostic are very difficult to study in the general population by epidemiological methods. Only studies conducted on very young children could achieve enough power, because of their high radiosensitivity. Available information on the effects of doses above 0.5 Gy allows extrapolation on maximal effects. Models deduced from existing cohorts can be used to assess risk, with their limits due to associated uncertainties. Preston et al. proposed an excess absolute-risk model, which makes estimates from the more comprehensive cohorts compatible. This model has been retained by the 2006 committee “Biological effects of ionizing radiation” (report VII).