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. 2013 Mar;179(3):361-82.
doi: 10.1667/RR2892.1. Epub 2013 Feb 11.

The incidence of leukemia, lymphoma and multiple myeloma among atomic bomb survivors: 1950-2001

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The incidence of leukemia, lymphoma and multiple myeloma among atomic bomb survivors: 1950-2001

Wan-Ling Hsu et al. Radiat Res. 2013 Mar.

Abstract

A marked increase in leukemia risks was the first and most striking late effect of radiation exposure seen among the Hiroshima and Nagasaki atomic bomb survivors. This article presents analyses of radiation effects on leukemia, lymphoma and multiple myeloma incidence in the Life Span Study cohort of atomic bomb survivors updated 14 years since the last comprehensive report on these malignancies. These analyses make use of tumor- and leukemia-registry based incidence data on 113,011 cohort members with 3.6 million person-years of follow-up from late 1950 through the end of 2001. In addition to a detailed analysis of the excess risk for all leukemias other than chronic lymphocytic leukemia or adult T-cell leukemia (neither of which appear to be radiation-related), we present results for the major hematopoietic malignancy types: acute lymphoblastic leukemia, chronic lymphocytic leukemia, acute myeloid leukemia, chronic myeloid leukemia, adult T-cell leukemia, Hodgkin and non-Hodgkin lymphoma and multiple myeloma. Poisson regression methods were used to characterize the shape of the radiation dose-response relationship and, to the extent the data allowed, to investigate variation in the excess risks with gender, attained age, exposure age and time since exposure. In contrast to the previous report that focused on describing excess absolute rates, we considered both excess absolute rate (EAR) and excess relative risk (ERR) models and found that ERR models can often provide equivalent and sometimes more parsimonious descriptions of the excess risk than EAR models. The leukemia results indicated that there was a nonlinear dose response for leukemias other than chronic lymphocytic leukemia or adult T-cell leukemia, which varied markedly with time and age at exposure, with much of the evidence for this nonlinearity arising from the acute myeloid leukemia risks. Although the leukemia excess risks generally declined with attained age or time since exposure, there was evidence that the radiation-associated excess leukemia risks, especially for acute myeloid leukemia, had persisted throughout the follow-up period out to 55 years after the bombings. As in earlier analyses, there was a weak suggestion of a radiation dose response for non-Hodgkin lymphoma among men, with no indication of such an effect among women. There was no evidence of radiation-associated excess risks for either Hodgkin lymphoma or multiple myeloma.

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Figures

Figure 1
Figure 1. Summaries of the risk of leukemia other than CLL or ATL in the LSS
Plot (a) shows age-specific baseline (zero dose) rates in Hiroshima for men (black-colored curves) and women (gray-colored curves) for LSS cohort members born in 1895 (dash-dot; age at exposure 50), 1915 (dash; age at exposure 30), and 1935 (solid; age at exposure 10). Plot (b) illustrates the radiation dose response based on the ERR model with risks standardized to attained age 70 for a person exposed at age 30 (born in 1915). The solid black-colored curve illustrates the fitted linear-quadratic dose response. The points are based on a nonparametric dose response model while the middle dashed gray-colored curve is a smoothed version of the dose category-specific estimates from the non-parametric fit. The upper and lower dashed gray-colored curves are plus and minus one standard error from the smoothed fit. Plots (c) and (d) illustrate the temporal pattern and age-at-exposure effects for our preferred ERR model. The fitted ERR did not depend on either sex or city. Plots (e) and (f) present the temporal pattern and age-at-exposure effects for Hiroshima males based on the preferred EAR model. The points in (c)–(f) are non-parametric estimates for exposure at age 10.
Figure 2
Figure 2. LSS Acute Myeloid Leukemia risk summary plots
Plot (a) shows age-specific rates Hiroshima baseline (zero dose) for men (black-colored curves) and women (gray-colored curves) for LSS cohort members born in 1895 (dash-dot; age at exposure 50), 1915 (dash; age at exposure 30), and 1935 (solid; age at exposure 10). Plots (b) illustrate the radiation dose response based for the preferred ERR model with risks standardized to attained age 70 for a person exposed at age 30 (born in 1915). The solid black-colored curve illustrates the fitted pure quadratic dose response. The points are based on a nonparametric dose response model while the middle dashed gray-colored curve is a smoothed-version of the dose category-specific estimates from the non-parametric fit. The upper and lower dashed gray-colored curves are plus and minus one standard error from the smoothed fit. Plots (c) and (d) illustrate the temporal pattern and age-at-exposure effects for our preferred ERR model. Plots (e) and (f) present the temporal pattern and age-at-exposure effects for Hiroshima males based on the preferred EAR model. Black-colored curves are shown for ages at exposure of 10 (solid), 30 (dash), and 50 years (dash-dot); the gray-colored lines are the EAR temporal patterns using the model specified in previous report (4). For the ERR and EAR models shown here, the excess risks did not depend on either sex or city.
Figure 3
Figure 3. LSS Acute Lymphoblastic Leukemia risk summary plots
Plot (a) shows age-specific Hiroshima baseline rate for LSS cohort members. Plot (b) illustrates the radiation dose response based on the ERR model with gender average risks standardized to attained age 70. The solid black-colored curve illustrates the fitted linear dose response. The points are based on a nonparametric dose response model while the middle dashed gray-colored curve is a smoothed-version of the dose category-specific estimates from the non-parametric fit. The upper and lower dashed gray-colored curves are plus and minus one standard error from the smoothed fit. Plots (c) and (d) exhibit the temporal patterns for men (black) and for women (gray) in either city based on the preferred ERR model. Plots (e) and (f) present the temporal pattern for males (black) and females (gray) based on the preferred EAR model. In plots (d) and (f), different line patterns are shown for ages at exposure of 10 (solid line), 30 (dash line) and 50 (dash-dot line).
Figure 4
Figure 4. LSS Chronic Myeloid Leukemia risk summary plots
Plot (a) shows age-specific Hiroshima baseline rate for LSS cohort members for men (black) and women (gray). Plot (b) illustrates the radiation dose response based on the ERR model with gender average risks standardized to time since exposure 25 and attained age 55. The solid black-colored curve illustrates the fitted linear dose response. The points are based on a nonparametric dose response model while the middle dashed gray-colored curve is a smoothed version of the dose category-specific estimates from the non-parametric fit. The upper and lower dashed gray-colored curves are plus and minus one standard error from the smoothed fit. Plots (c) and (d) illustrate the temporal pattern and age-at-exposure effects for our preferred ERR model. Curves are shown for ages at exposure 10 (solid curve), 30 (dash curve), and 50 (dash-dot curve) in Hiroshima. The ERR does not depend on gender. Plots (e) and (f) present the temporal pattern and age-at-exposure effects by gender based on the preferred EAR model in Hiroshima. Curves are shown for age at exposure 10 (solid curve), 30 (dash curve), and 50 (dash-dot curve) with black and gray lines for men and for women.
Figure 5
Figure 5. LSS Adult T-cell Leukemia risk summary plots
The plot shows age-specific Nagasaki baseline rates (zero dose) for LSS cohort members born in 1895 (dash-dot curve), 1915 (dash curve), and 1935 (solid curve). There is no significant dose response.
Figure 6
Figure 6. LSS Non-Hodgkin Lymphoma risk summary plots
Plot (a) shows age-specific Hiroshima baseline rates for LSS cohort members. Curves are shown for birth cohorts 1935 (solid curve), 1915 (dash curve), and 1895 (dash-dot curve) model with black and gray lines for men and for women, respectively. Plot (b) illustrates the radiation dose response based on the EAR model with black and gray lines for men and for women, respectively. Plot (c) illustrates the ERR temporal pattern for men. The solid curve shows the predicted ERR based on our preferred ERR model, and the dotted curve is the ERR derived from our preferred EAR model. Plot (d) presents the EAR temporal pattern for men. The dotted curve shows the predicted EAR based on our preferred EAR model, and the solid curve is the EAR derived from our preferred ERR model.
Figure 7
Figure 7. LSS Hodgkin Lymphoma
The plot shows age-specific baseline rates (zero dose) for LSS cohort members born in 1895 (dash-dot curve), 1915 (dot curve), and 1935 (solid curve). The black-colored lines are for men and the gray-colored lines are for women. There is no significant dose response.
Figure 8
Figure 8. LSS Multiple Myeloma summary plots
Plot (a) shows age-specific baseline rate (zero dose) for LSS cohort members born in 1895 (dash-dot curve), 1915 (dash curve), and 1935 (solid curve). Plot (b) shows the baseline rate by birth year at attained age 70.

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References

    1. Dunlap CE. Effects of radiation on normal cells. III. Effects of radiation on the blood and the hematopoietic tisues, including the spleen, the thymus, and the lymph nodes. Arch Path. 1942;3:562–608.
    1. Henshaw PS, Hawkins JW. Incidence of leukemia in physicians. J Natl Cancer Inst. 1944;4:339–46.
    1. Folley JH, Borges W, Yamasaki T. Incidence of leukemia in survivors of the atomic bomb in Hiroshima and Nagasaki, Japan. American Journal of Medicine. 1952;13:311–21. - PubMed
    1. Preston DL, Kusumi S, Tomonaga M, Izumi S, Ron E, Kuramoto A, et al. Cancer incidence in atomic bomb survivors. Part III. Leukemia, lymphoma and multiple myeloma, 1950–1987. Radiat Res. 1994;137(2 Suppl):S68–S97. - PubMed
    1. Pierce DA, Shimizu Y, Preston DL, Vaeth M, Mabuchi K. Studies of the mortality of atomic bomb survivors. Report 12, Part I. Cancer: 1950–1990. Radiat Res. 1996;146(1):1–27. - PubMed

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