Breast Cancer

The BEIR VII committee’s recommended model for breast cancer is the EAR model developed by Preston and colleagues (2002a), who found it possible to use a common model to describe data from female atomic bomb survivors, two cohorts of Massachusetts tuberculosis fluoroscopy patients, and the Rochester infant thymus irradiation cohort. Preston and colleagues (2002a) also analyzed data from additional cohorts: the New York acute postpartum mastitis cohort (Shore and others 1986), the Swedish benign breast disease cohort (Mattsson and others 1993), and two Swedish skin hemangioma cohorts exposed in infancy (Lundell and Holm 1996). These cohorts all exhibited patterns that were not compatible with the models noted in the previous paragraph and adopted by the committee. The reader should consult Preston and colleagues (2002a) for details on the differences, but they include lower risks for the skin hemangioma cohorts (possibly due to the lower dose rates at which they were exposed) and different age at exposure and attained age patterns for the New York postpartum mastitis and Swedish benign breast disease cohorts (possibly due to the existence of breast disease in these cohorts). The reasons for these differences are not understood, but remind us that our understanding of radiation risks is incomplete and that models used to describe radiation risks are likely to be oversimplifications.

Another study that was not used in the BEIR VII committee’s breast cancer model is the Canadian tuberculosis fluoroscopy cohort, where breast cancer mortality has been evaluated. Howe and McLaughlin (1996) conducted combined analyses of this cohort and female atomic bomb survivors, and found it possible to describe both cohorts with common models, although it was necessary to exclude Nova Scotia women, who had risks (both ERR and EAR) that were much higher than non-Nova Scotia women. This study is also discussed in Chapter 10.

Thyroid Cancer

The committee’s model for thyroid cancer risks was based on analyses of data from five studies of persons exposed under age 15 (Ron and others 1995a), as described earlier in this chapter. Although the pooled analyses did not include all studies addressing thyroid cancer risks from external radiation exposure, it included those considered most informative by the authors, who reviewed published studies of thyroid cancer and external radiation. Specifically, the analyses included cohort studies with at least 1000 irradiated subjects who had individual estimates of radiation dose to the thyroid and case-control studies with at least 20 thyroid cancer cases and adequate dose information.

Shore and Xue (1999) summarized data from several studies of thyroid cancer risks in persons exposed in childhood that were not included in the analyses by Ron and colleagues and found that the combined estimate of the ERR/Gy from these studies was similar to that obtained by Ron and colleagues. Shore and Xue also summarized data from studies involving adult exposure and confirmed the finding from A-bomb survivors that risks are much lower (and possibly nonexistent) among persons exposed as adults.

Site-Specific Solid Cancers Other Than Breast and Thyroid

Most medical exposure results in nonuniform doses to various organs of the body; thus, only site-specific estimates can be compared. As noted earlier, not all studies involving medical exposure have adequate dosimetry or sample sizes to obtain informative quantitative risk estimates. Furthermore, doses are often at a level where cell killing is likely to have reduced the risk per gray. Table 12-11 summarizes risk estimates for selected sites from six medically exposed cohorts where doses for individuals were estimated. The studies included are those of women treated for cervical cancer (Boice and others 1988), women treated for uterine bleeding with intrauterine radium capsules (Inskip and others 1990a) or X-irradiation (Darby and others 1994), ankylosing spondylitis patients (Weiss and others 1994), people treated for peptic ulcer (Carr and others 2002), and tuberculosis fluoroscopy patients (Howe 1995). The table is limited to sites for which (1) the BEIR VII committee provides lifetime risk estimates, (2) the investigators present estimates of the ERR/Gy (usually based on regression analyses), (3) the mean dose to the organ of interest is less than 4 Gy, and (4) the estimate is based on at least 30 cases. Further information on these studies is given in Chapter 7.

Also shown in Table 12-11 are BEIR VII sex-specific estimates of the ERR/Gy based on incidence data from the LSS cohort and taken from Table 12-2. Because the ankylosing spondylitis and peptic ulcer patients were predominantly male (sex-specific estimates were not presented), Table 12-11 compares estimates from these studies with those of male LSS cohort members. The estimates from medical studies can be considered an average over the exposure and attained ages of the study cohorts; in all cases, exposure occurred in adulthood. The LSS estimates are for exposure at age 30 or older at attained age 60, ages that seem likely to be reasonably appropriate for comparison with the medical studies.

In most cases, estimates from the medical studies are similar to those from the LSS cohort, especially if one considers statistical uncertainties reflected in the confidence intervals. The studies with mean organ doses exceeding 2 Gy (stomach cancer in ankylosing spondylitis patients and colon cancer in the U.K. uterine bleeding study) included many subjects with considerably higher doses, and this might have affected results. The colon cancer estimate based on women in the United Kingdom given X-ray therapy for uterine bleeding (Darby and others 1994) is lower than that for LSS females, but the two estimates are not significantly different. The estimate for women treated in the United States for this

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