Nonmelanoma skin cancer in relation to ionizing radiation exposure among U.S. radiologic technologists

Ionizing radiation (IR) is an established cause of nonmelanoma skin cancer, but there is uncertainty about the risk associated with chronic occupational exposure to IR and how it is influenced by ultraviolet radiation (UVR) exposure. We studied 1,355 incident cases with basal cell carcinoma (BCC) and 270 with squamous cell carcinoma (SCC) of the skin in a cohort of 65,304 U.S. white radiologic technologists who responded to the baseline questionnaire survey in 1983–1989 and the follow‐up survey in 1994–1998. Cox's proportional‐hazards model was used to estimate relative risks of BCC and SCC associated with surrogate measures of occupational exposure to IR and residential UVR exposure during childhood and adulthood, adjusted for potential confounders including pigmentation characteristics. Relative risks of BCC, but not of SCC, were elevated among technologists who first worked during the 1950s (RR = 1.42; 95% CI = 1.12–1.80), 1940s (RR = 2.04; 95% CI = 1.44–2.88) and before 1940 (RR = 2.16; 95% CI = 1.14–4.09), when IR exposures were high, compared to those who first worked after 1960 (p for trend < 0.01). The effect of year first worked on BCC risk was not modified by UVR exposure, but was significantly stronger among individuals with lighter compared to darker eye and hair color (p = 0.013 and 0.027, respectively). This study provides some evidence that chronic occupational exposure to IR at low to moderate levels can increase the risk of BCC, and that this risk may be modified by pigmentation characteristics. © 2005 Wiley‐Liss, Inc.

[1]  M. Hauptmann,et al.  Mortality from diseases of the circulatory system in radiologic technologists in the United States. , 2003, American journal of epidemiology.

[2]  Ian Jackson,et al.  Variants of the melanocyte–stimulating hormone receptor gene are associated with red hair and fair skin in humans , 1995, Nature Genetics.

[3]  D. English,et al.  Pigmentary and cutaneous risk factors for non‐melanocytic skin cancer—A case‐control study , 1991, International journal of cancer.

[4]  Icrp.  1990 Recommendations of the International Commission on Radiological Protection , 1991 .

[5]  G. Matanoski,et al.  The current mortality rates of radiologists and other physician specialists: specific causes of death. , 1975, American journal of epidemiology.

[6]  B. Modan,et al.  Radiation-induced skin carcinomas of the head and neck. , 1991, Radiation research.

[7]  M. Hauptmann,et al.  Cancer incidence in the U.S. radiologic technologists health study, 1983–1998 , 2003 .

[8]  I. Jackson,et al.  Pleiotropic effects of the melanocortin 1 receptor (MC1R) gene on human pigmentation. , 2000, Human molecular genetics.

[9]  R. Stern,et al.  Risk of subsequent basal cell carcinoma and squamous cell carcinoma of the skin among patients with prior skin cancer. Skin Cancer Prevention Study Group. , 1992, JAMA.

[10]  O. Glasser,et al.  Radiation exposure survey of personnel at the Cleveland Clinic Foundation. , 1953, Radiology.

[11]  N. Robinson.  Solar radiation , 2020, Advanced Remote Sensing.

[12]  R. Shore,et al.  Risk of extrathyroid tumors following radiation treatment in infancy for thymic enlargement. , 1985, Radiation research.

[13]  W. Willett,et al.  Risk factors for basal cell carcinoma in a prospective cohort of women. , 1990, Annals of epidemiology.

[14]  R. Doll,et al.  Mortality from cancer and all causes among British radiologists. , 1981, The British journal of radiology.

[15]  Kiyohiko Mabuchi,et al.  Skin tumor risk among atomic-bomb survivors in Japan , 1998, Cancer Causes & Control.

[16]  T. H. Nguyen,et al.  Nonmelanoma skin cancer , 2002, Current treatment options in oncology.

[17]  D. Cowie,et al.  A Survey of Radiation Protection In Hospitals , 1941 .

[18]  Bruce K. Armstrong,et al.  Sun exposure and non-melanocytic skin cancer , 1994, Cancer Causes & Control.

[19]  D Spiegelman,et al.  Risk factors for basal cell carcinoma of the skin in men: results from the health professionals follow-up study. , 1999, American journal of epidemiology.

[20]  B. Li,et al.  CANCER INCIDENCE AND RISK ESTIMATION AMONG MEDICAL X-RAY WORKERS IN CHINA, 1950–1995 , 2002, Health physics.

[21]  B. Armstrong,et al.  The epidemiology of UV induced skin cancer. , 2001, Journal of photochemistry and photobiology. B, Biology.

[22]  C. A. Willis,et al.  History of the medical uses of radiation: regulatory and voluntary standards of protection. , 1995, Health physics.

[23]  J. Lubin,et al.  Mortality among United States radiologic technologists, 1926-90 , 2004, Cancer Causes & Control.

[24]  Risk of Subsequent Basal Cell Carcinoma and Squamous Cell Carcinoma of the Skin Among Patients With Prior Skin Cancer , 1992 .

[25]  岩崎 民子.  SOURCES AND EFFECTS OF IONIZING RADIATION : United Nations Scientific Committee on the Effects of Atomic Radiation UNSCEAR 2000 Report to the General Assembly, with Scientific Annexes , 2002 .

[26]  D. Preston,et al.  Cancer incidence in atomic bomb survivors. Part II: Solid tumors, 1958-1987. , 1994, Radiation research.

[27]  R. Shore.  Radiation-induced skin cancer in humans. , 2001, Medical and pediatric oncology.

[28]  W. Willett,et al.  Vitamin and carotenoid intake and risk of squamous cell carcinoma of the skin , 2003, International journal of cancer.

[29]  M. Hauptmann,et al.  Estimating Historical Radiation Doses to a Cohort of U.S. Radiologic Technologists , 2006, Radiation research.

[30]  F. Speizer,et al.  A prospective study of incident squamous cell carcinoma of the skin in the nurses' health study. , 1995, Journal of the National Cancer Institute.

[31]  J. Lubin,et al.  Breast cancer mortality among female radiologic technologists in the United States. , 2002, Journal of the National Cancer Institute.

[32]  J. Hermans,et al.  Radiation‐induced skin cancer and radiodermatitis of the head and neck , 1987, Cancer.

[33]  E L Korn,et al.  Time-to-event analysis of longitudinal follow-up of a survey: choice of the time-scale. , 1997, American journal of epidemiology.

[34]  B. Pasternack,et al.  Skin Cancer after X-Ray Treatment for Scalp Ringworm , 2002, Radiation research.

[35]  Fuller Jw.  Maine's experience with a state-operated personnel monitoring program for radiation workers. , 1966 .

[36]  M. Hauptmann,et al.  Risk of melanoma among radiologic technologists in the United States , 2003, International journal of cancer.

[37]  J. Y. BUCHANAN,et al.  Solar Radiation , 1901, Nature.

[38]  A. Schneider,et al.  Radiation‐Induced Tumors of the Head and Neck Following Childhood Irradiation: PROSPECTIVE STUDIES , 1985, Medicine.

[39]  R. Fry.  Radiation protection guidelines for the skin. , 1990, International journal of radiation biology.

[40]  J. Lubin,et al.  Cancer and other causes of mortality among radiologic technologists in the United States , 2003, International journal of cancer.

[41]  M. Karagas,et al.  Therapeutic ionizing radiation and the incidence of basal cell carcinoma and squamous cell carcinoma. The New Hampshire Skin Cancer Study Group. , 2000, Archives of dermatology.

[42]  J. Fuller.  Maine's experience with a state-operated personnel monitoring program for radiation workers. , 1966, Radiological health data and reports.

[43]  M. Doody,et al.  A health survey of radiologic technologists , 1992, Cancer.