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Association of ionizing radiation dose from common medical diagnostic procedures and lymphoma risk in the Epilymph case-control study
Open accessAbstract
Medical diagnostic X-rays are an important source of ionizing radiation (IR) exposure in the general population; however, it is unclear if the resulting low patient doses increase lymphoma risk. We examined the association between lifetime medical diagnostic X-ray dose and lymphoma risk, taking into account potential confounding factors, including medical history. The international Epilymph study (conducted in the Czech-Republic, France, Germany, Ireland, Italy, and Spain) collected self-reported information on common diagnostic X-ray procedures from 2,362 lymphoma cases and 2,465 frequency-matched (age, sex, country) controls. Individual lifetime cumulative bone marrow (BM) dose was estimated using time period-based dose estimates for different procedures and body parts. The association between categories of BM dose and lymphoma risk was examined using unconditional logistic regression models adjusting for matching factors, socioeconomic variables, and the presence of underlying medical conditions (atopic, autoimmune, infectious diseases, osteoarthritis, having had a sick childhood, and family history of lymphoma) as potential confounders of the association. Cumulative BM dose was low (median 2.25 mGy) and was not positively associated with lymphoma risk. Odds ratios (ORs) were consistently less than 1.0 in all dose categories compared to the reference category (less than 1 mGy). Results were similar after adjustment for potential confounding factors, when using different exposure scenarios, and in analyses by lymphoma subtype and by type of control (hospital-, population-based). Overall no increased risk of lymphoma was observed. The reduced ORs may be related to unmeasured confounding or other sources of systematic bias.We found little evidence that chronic medical conditions confound lymphoma risk and medical radiation associations.
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These analyses support a low likelihood for confounding by indication for leukemia, though confounding by indication may be more important for lymphoma.
“These analyses support a low likelihood for confounding by indication for leukemia, though it may be more important for lymphoma, as patients are more likely to have immune deficiencies and may be at higher risk of infectious diseases35.”
From Risk of hematological malignancies from CT radiation exposure in children, adolescents and young adults (2023) · cites this paper as [35]
The Introduction identifies confounding by clinical indication as a potential concern for lymphoma and says lymphoma patients are more likely to have immune deficiencies or infectious diseases. The paper does not assess whether such confounding is unlikely for leukemia or compare its importance between leukemia and lymphoma. Its Discussion reports little evidence that the measured chronic conditions confounded the lymphoma association, while acknowledging limitations. (LLM, conf=0.86)
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Metadata
- Authors
- Pasqual, E., Turner, M. C., Gracia-Lavedan, E., Casabonne, D., Benavente, Y., Chef, I. T., Maynadié, M., Cocco, P., Staines, A., Foretova, L., Nieters, A., Boffetta, P., Brennan, P., Cardis, E., & de Sanjose, S.
- Affiliations
- Universitat Pompeu Fabra (ES)
- University of Ottawa (CA)
- Institut d'Investigació Biomédica de Bellvitge (ES)
- Inserm (FR)
- University of Cagliari (IT)
- Dublin City University (IE)
- University Medical Center Freiburg (DE)
- Tisch Cancer Institute (US)
- Centre international de recherche sur le cancer (FR)
- Corresponding author
- Pasqual, Elisa
- ORCID
- Venue
- PLOS ONE
- Publisher
- Public Library of Science (PLoS)
- Published
- 2020-07-10
- Volume
- 15
- Issue
- 7
- Pages
- e0235658
- ISSN
- 1932-6203 (ISSN-L)
- PMC
- PMC7351167
- OpenAlex
- W3041484967
- Cited by
- 8
- References
- 44
- Citations by year
- 2024: 2 · 2023: 2 · 2022: 2 · 2020: 2
- FWCI
- 0.73
- Type
- journal article
- Language
- en
- Update notices
- correction (2020-12-01)
- Open access
- gold
- doi.org
- Licence
- Locations
- PLoS ONE (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Repositori digital de la UPF (Universitat Pompeu Fabra) (publishedVersion, cc-by)
- HAL (submittedVersion, other-oa)
- Dipòsit Digital de la Universitat de Barcelona (Universitat de Barcelona) (submittedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Lenus, The Irish Health Repository (Dr Steevens Hospital Library) (submittedVersion)
- Funders
- Fifth Framework Programme (QLK4CT200000422)
- Fondation de France (1999 0084 71)
- Bundesamt für Strahlenschutz (StSch4261 stSch4420)
- Instituto de Salud Carlos III (FIS 040091, PI14/01219)
- Agència de Gestió d’Ajuts Universitaris i de Recerca (2017SGR1085)
- Consejo de Seguridad Nuclear
- Departament de Salut, Generalitat de Catalunya (slt002/16/00232)
- Ministry of heath (MMCI, 00209805)
- Ministerio de Ciencia, Innovación y Universidades (RYC 2017 01892)
- Topics
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Radiation Dose and Imaging
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Effects of Radiation Exposure
- Physical Sciences › Physics and Astronomy › Radiation › Radioactivity and Radon Measurements
- Keywords
- ionizing radiation, diagnostic X-rays, lymphoma risk, low-dose radiation exposure, unmeasured confounding, lymphoma subtypes
- MeSH terms
- Radiation Exposure, Adult, Aged, Bone Marrow, Female, Humans, Lymphoma, Male, Middle Aged, Radiation Dosage, Radiation, Ionizing, Risk Factors, Logistic Models, Odds Ratio, Case-Control Studies
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