Journal of Environmental Health Sciences (한국환경보건학회지)

Korean Society of Environmental Health (한국환경보건학회)
권호 표지
DOI QR코드

DOI QR Code

Epidemiology of Low-Dose Ionizing Radiation Exposure and Health Effects

저선량 방사선 노출과 건강 영향에 대한 역학적 고찰

  • Won Jin Lee (Department of Preventive Medicine, Korea University College of Medicine)
  • 이원진 (고려대학교 의과대학 예방의학교실)
  • Received : 2023.02.17
  • Accepted : 2023.02.22
  • Published : 2023.02.28
Download PDF
⟨ Previous Next ⟩

Abstract

Low-dose radiation exposure has received considerable attention because it reflects the general public's type and level of exposure. Still, controversy remains due to the relatively unclear results and uncertainty in risk estimation compared to high-dose radiation. However, recent epidemiological studies report direct evidence of health effects for various types of low-dose radiation exposure. In particular, international nuclear workers' studies, CT exposure studies, and children's cancer studies on natural radiation showed significantly increased cancer risk among the study populations despite their low-dose radiation exposure. These studies showed similar results even when the cumulative radiation dose was limited to an exposure group of less than 100 mGy, demonstrating that the observed excess risk was not affected by high exposure. A linear dose-response relationship between radiation exposure and cancer incidence has been observed, even at the low-dose interval. These recent epidemiological studies include relatively large populations, and findings are broadly consistent with previous studies on Japanese atomic bomb survivors. However, the health effects of low-dose radiation are assumed to be small compared to the risks that may arise from other lifestyle factors; therefore, the benefits of radiation use should be considered at the individual level through a balanced interpretation. Further low-dose radiation studies are essential to accurately determining the benefits and risks of radiation.

Keywords

References

  1. United Nations Scientific Committee on the Effects of Atomic Radiation (UNSCEAR). Sources, Effects and Risks of Ionizing Radiation. UNSCEAR 2012 Report: Report to the General Assembly Scientific Annexes A and B. New York: United Nations; 2015.
  2. International Agency for Research on Cancer (IARC). Radiation: IARC Monographs on the Evaluation of Carcinogenic Risks to Humans Volume 100D. Lyon: IARC; 2012.
  3. Ministry of the Environment Government of Japan. BOOKLET to Provide Basic Information Regarding Health Effects of Radiation. Available: https://www.env.go.jp/en/chemi/rhm/basic-info/ [accessed 22 February 2023].
  4. Moon EK, Ha WH, Seo S, Jin YW, Jeong KH, Yoon HJ, et al. Estimates of radiation doses and cancer risk from food intake in Korea. J Korean Med Sci. 2016; 31(1): 9-12. https://doi.org/10.3346/jkms.2016.31.1.9
  5. Berrington A, Darby SC, Weiss HA, Doll R. 100 years of observation on British radiologists: mortality from cancer and other causes 1897-1997. Br J Radiol. 2001; 74(882): 507-519. https://doi.org/10.1259/bjr.74.882.740507
  6. Little MP, Zhang W, van Dusen R, Hamada N, Bugden M, Cao M, et al. Low-dose radiotherapy for COVID-19 pneumonia and cancer: summary of a recent symposium and future perspectives. Int J Radiat Biol. 2023; 99(2): 357-371. https://doi.org/10.1080/09553002.2022.2074165
  7. Brenner DJ, Doll R, Goodhead DT, Hall EJ, Land CE, Little JB, et al. Cancer risks attributable to low doses of ionizing radiation: assessing what we really know. Proc Natl Acad Sci U S A. 2003; 100(24): 13761-13766. https://doi.org/10.1073/pnas.2235592100
  8. Ruhm W, Woloschak GE, Shore RE, Azizova TV, Grosche B, Niwa O, et al. Dose and dose-rate effects of ionizing radiation: a discussion in the light of radiological protection. Radiat Environ Biophys. 2015; 54(4): 379-401. https://doi.org/10.1007/s00411-015-0613-6
  9. National Research Council (NRC). Health Risks from Exposure to Low Levels of Ionizing Radiation: BEIR VII, Phase 2. Washington, D.C.: National Academies Press; 2006.
  10. Richardson DB, Cardis E, Daniels RD, Gillies M, O'Hagan JA, Hamra GB, et al. Risk of cancer from occupational exposure to ionising radiation: retrospective cohort study of workers in France, the United Kingdom, and the United States (INWORKS). BMJ. 2015; 351: h5359.
  11. Leuraud K, Richardson DB, Cardis E, Daniels RD, Gillies M, O'Hagan JA, et al. Ionising radiation and risk of death from leukaemia and lymphoma in radiation-monitored workers (INWORKS): an international cohort study. Lancet Haematol. 2015; 2(7): e276-e281. https://doi.org/10.1016/S2352-3026(15)00094-0
  12. Haylock RGE, Gillies M, Hunter N, Zhang W, Phillipson M. Cancer mortality and incidence following external occupational radiation exposure: an update of the 3rd analysis of the UK national registry for radiation workers. Br J Cancer. 2018; 119(5): 631-637. https://doi.org/10.1038/s41416-018-0184-9
  13. Pearce MS, Salotti JA, Little MP, McHugh K, Lee C, Kim KP, et al. Radiation exposure from CT scans in childhood and subsequent risk of leukaemia and brain tumours: a retrospective cohort study. Lancet. 2012; 380(9840): 499-505. https://doi.org/10.1016/S0140-6736(12)60815-0
  14. Berrington de Gonzalez A, Pasqual E, Veiga L. Epidemiological studies of CT scans and cancer risk: the state of the science. Br J Radiol. 2021; 94(1126): 20210471.
  15. Foucault A, Ancelet S, Dreuil S, Caer-Lorho S, Ducou Le Pointe H, Brisse H, et al. Childhood cancer risks estimates following CT scans: an update of the French CT cohort study. Eur Radiol. 2022; 32(8): 5491-5498. https://doi.org/10.1007/s00330-022-08602-z
  16. Grant EJ, Brenner A, Sugiyama H, Sakata R, Sadakane A, Utada M, et al. Solid cancer incidence among the life span study of atomic bomb survivors: 1958-2009. Radiat Res. 2017; 187(5): 513-537. https://doi.org/10.1667/RR14492.1
  17. Cologne J, Kim J, Sugiyama H, French B, Cullings HM, Preston DL, et al. Effect of heterogeneity in background incidence on inference about the solid-cancer radiation dose response in atomic bomb survivors. Radiat Res. 2019; 192(4): 388-398. https://doi.org/10.1667/RR15127.1
  18. Cologne J, Preston DL, Grant EJ, Cullings HM, Ozasa K. Effect of follow-up period on minimal-significant dose in the atomic-bomb survivor studies. Radiat Environ Biophys. 2018; 57(1): 83-88. https://doi.org/10.1007/s00411-017-0720-7
  19. Ivanov VK, Karpenko SV, Kashcheev VV, Lovachev SS, Kashcheeva PV, Shchukina NV, et al. Relationship between follow-up periods and the low-dose ranges with statistically significant radiationinduced risk of all solid cancers in the Russian cohort of Chernobyl emergency workers. Radiat Environ Biophys. 2020; 59(3): 415-421. https://doi.org/10.1007/s00411-020-00850-1
  20. Davis FG, Yu KL, Preston D, Epifanova S, Degteva M, Akleyev AV. Solid cancer incidence in the Techa river incidence cohort: 1956-2007. Radiat Res. 2015; 184(1): 56-65. https://doi.org/10.1667/RR14023.1
  21. Kendall GM, Little MP, Wakeford R. A review of studies of childhood cancer and natural background radiation. Int J Radiat Biol. 2021; 97(6): 769-781. https://doi.org/10.1080/09553002.2020.1867926
  22. Little MP, Wakeford R, Borrego D, French B, Zablotska LB, Adams MJ, et al. Leukaemia and myeloid malignancy among people exposed to low doses (<100 mSv) of ionising radiation during childhood: a pooled analysis of nine historical cohort studies. Lancet Haematol. 2018; 5(8): e346-e358. https://doi.org/10.1016/S2352-3018(18)30146-2
  23. Lubin JH, Adams MJ, Shore R, Holmberg E, Schneider AB, Hawkins MM, et al. Thyroid cancer following childhood low-dose radiation exposure: a pooled analysis of nine cohorts. J Clin Endocrinol Metab. 2017; 102(7): 2575-2583. https://doi.org/10.1210/jc.2016-3529
  24. Berrington de Gonzalez A, Salotti JA, McHugh K, Little MP, Harbron RW, Lee C, et al. Relationship between paediatric CT scans and subsequent risk of leukaemia and brain tumours: assessment of the impact of underlying conditions. Br J Cancer. 2016; 114(4): 388-394. https://doi.org/10.1038/bjc.2015.415
  25. Gilbert ES, Little MP, Preston DL, Stram DO. Issues in interpreting epidemiologic studies of populations exposed to low-dose, high-energy photon radiation. J Natl Cancer Inst Monogr. 2020; 2020(56): 176-187. https://doi.org/10.1093/jncimonographs/lgaa004
  26. National Academies of Sciences, Engineering, and Medicine (NAS). Triangulation in Environmental Epidemiology for EPA Human Health Assessments: Proceedings of a Workshop. Washington, D.C.: National Academies Press; 2022.
  27. Lee WJ. Radiation Epidemiology. Seoul: KU PRESS; 2022.
  28. Berrington de Gonzalez A, Daniels RD, Cardis E, Cullings HM, Gilbert E, Hauptmann M, et al. Epidemiological studies of low-dose ionizing radiation and cancer: rationale and framework for the monograph and overview of eligible studies. J Natl Cancer Inst Monogr. 2020; 2020(56): 97-113. https://doi.org/10.1093/jncimonographs/lgaa009
  29. National Council on Radiation Protection and Measurements (NCRP). Implications of Recent Epidemiologic Studies for the Linear-nonthreshold Model and Radiation Protection. Bethesda: National Council on Radiation Protection and Measurements; 2018.
  30. Perko T. Radiation risk perception: a discrepancy between the experts and the general population. J Environ Radioact. 2014; 133: 86- 91. https://doi.org/10.1016/j.jenvrad.2013.04.005
  31. World Health Organization (WHO). Communicating Radiation Risks in Paediatric Imaging: Information to Support Healthcare Discussions about Benefit and Risk. Geneva: WHO Press; 2016.
  32. Kudo S, Nishide A, Furuta H, Ishizawa N, Saigusa S. A risk comparison between lifestyle, socioeconomic status, and radiation: a cohort study of cancer mortality among Japanese nuclear workers (J-EPISODE). Health Phys. 2022; 122(4): 469-479. https://doi.org/10.1097/HP.0000000000001525
  33. Boice JD, Jr. Ionizing radiation. In: Schottenfeld D, Fraumeni JF. editors. Cancer Epidemiology and Prevention, 3rd ed. Oxford: Oxford University Press; 2006. p.259-293.
  34. International Commission on Radiological Protection (ICRP). The 2007 recommendations of the International Commission on Radiological Protection. ICRP publication 103. Ann ICRP. 2007; 37(2-4): 1-332.
  35. International Commission on Radiological Protection (ICRP). Recommendations of the International Commission on Radiological Protection. Oxford: International Commission on Radiological Protection; 1966.
  36. National Academies of Sciences, Engineering, and Medicine (NAS). Leveraging Advances in Modern Science to Revitalize Low-Dose Radiation Research in the United States. Washington, D.C.: National Academies Press; 2022.