Cancer
Introduction
Man is always exposed to ionizing radiation. 82% of this exposure is from natural
background radiation whereas the remaining percentage comes from exposure to
manmade radiation.
The use of ionizing radiation can be traced back when xray was discovered by
Wilhelm Roentgen in 1895. Back then, people were unaware of the risks that radiation
poses over their lives. Xrays were used in the most ridiculous ways like shoe fitting and
headache treatments. During the early discovery of xrays, acute skin reactions were
already observed from those people working with xray generators. And by the year
1902, the first radiationinduced cancer was reported.
On the other hand, the radioactivity of thorium and a new radioactive element
which was called ‘radium’ was discovered by Marie and Pierre Curie in 1898. During the
same year, Paul Ulrich discovered the gamma ray. Radium, like xrays, was used in
absurd ways. It was used as an ingredient for chocolate, toothpaste, cosmetics, etc. It
was also thought to have healing properties and was used to treat different diseases
like rheumatism and impotence.
The first report linking xray with leukemia among physicians was published in
Radium Girls
1911. A few years later, the incident happened wherein hundreds of girls
were exposed to luminous paint containing radium. Amelia Maggia was the first person
to die from radiation poisoning in 1922. And during 1929, bone cancer is observed in
the radium paint workers. Lastly, the event which led many scientists into the
investigation of ionizing radiation as a carcinogen was the increase in number of people
with leukemia and other types of cancer following the bombing of Hiroshima and
Nagasaki in Japan.
How Can Radiation Cause Cancer?
Biological effects of radiation can be categorized into two, nonstochastic effects
and stochastic effects. Nonstochastic effects are those which severity varies with the
dose and is observable in acute (high dose) exposure. An example is radiation
poisoning. Stochastic effects, on the other hand, have an increasing probability of
occurring with chronic (low dose for a long time) exposure to radiation. There is no
threshold value in this effect. An example of a stochastic effect of exposure to radiation
is cancer.
Interaction of radiation with orbital electrons results in ionizations and excitations
inside the particle. Energy deposited in irradiated cells occurs in the form of ionized and
excited atoms or molecules distributed at random throughout the cells. It is the
ionizations which cause most of the chemical changes in the vicinity of the event. This
energy may be transferred through a chain of chemical reactions, finally producing
irreversible damage to critical molecules of biologic importance to the cell like the DNA.
However, energy that goes into producing excited molecules produces relatively few
chemical reactions and is eventually dissipated in the form of heat.
After the ionizing stage, this will cause ejection of electron from the outer shell of
the molecule leaving an unstable positive molecule. This will eventually undergo a
rapid chemical change which will cause cells to produce free radicals. These free
radicals are highly reactive chemicals that are responsible for the propagation of free
radical chain. These reactions are highly damaging to the DNA of the cell.
Normal cells become cancer cells due to the change and damage in their DNA
(deoxyribonucleic acid). A normal cell when damaged, usually either repairs itself or
dies. But a cancer cell, does not repair nor die, instead, it produces another damaged
cell. Cancer is a result of uncontrolled and abnormal growth and reproduction of these
cells.
Biological Effect of Ionizing Radiation VII Report
According to the Biological Effects of Ionizing Radiation (BEIR) VII Report, high
doses of radiation have the capacity to kill cells whereas low doses of radiation can
damage the DNA. In addition, the higher the radiation dose, the effect will manifest
faster and the probability of death is higher.
The BEIR VII report defined “lowlevel” radiation as a range from near zero to
100 millisieverts (mSv). This is 3040 times annual natural background exposure, 100
times the exposure from a CT, and 1000 times that of a chest xray film.
It is important to study the effect of lowlevel exposure because it has the
capacity to damage the genetic code of a cell and as a result, induce cancer. There are
several mechanisms in which genetic code damage can induce cancer: DNA damage
and deletions; single and double strand breaks; oxidative changes in nucleotide bases;
and damage to genes & chromosomes (BEIR VII,2006).
The BEIR VII Committee validated the LinearNon Threshold model proving that
there is no threshold dose below which no cellular damage can occur. The Committee
also found out that women have greater risk (~37.5% higher) to radiation related cancer
death compared with men. In addition, exposure to infants has 34 times the cancer
risk compared with that to adults. Female infants, moreover, have double the risk
compared to male infants. At low doses of radiation, the cancer risk is small, however
the risk will never be zero (BEIR VII, 2006).
RadiationInduced Cancer and Radiation Workers
People in workplaces that are exposed to ionizing radiation have been a topic of
research studies since the late 1950’s. So far, the studies made on this topic focus on
the occurrence of radiationinduced cancers and deaths in workplaces such as
hospitals, factories, laboratories, mining sites, etc (BEIR VII, 2006).
According to the USA’s National Research Council (2006), these studies are
helpful in estimating the result of ionizing radiation in terms of its low doses and dose
rates. However, with that being said, the council found uncertainties in estimation of
these effects. And since these studies were only done only on a particular age bracket,
it would be hard to apply the results of these studies in multiple age brackets, i.e. entire
population. Although these studies are not useful for realtime applications, the results
give a comparison to the estimation of cancer risks of atomic bomb survivors.
On a study by Richardson et al. in 2015, it was suggested that radioactive
exposures of high dose rate can affect a person similarly as that of low dose rate would.
This is because the results of the experiment done in this study shows that the relative
rate of cancer in nuclear industry workers is directly proportional to the exposure of said
workers to ionizing radiation in their workplace. This is also known as a linear
nothreshold (LNT) doseresponse relationship and is accepted by the United States as
an examples for estimating radiation risks (U.S.NRC, 2014).
In the industry of uranium mining, safety measures and procedures are being
followed by many countries in order to assure that workers with higher levels of
radiation exposure have their health protected and secured. To keep the workers’ levels
of exposure to a minimum, the ICRP recommends that radiation workers should be
limited to an annual level of 20 mSv over the period of 5 years. Moreover, some
countries provide their workers programs of education, training, and engineering design
in order to reduce any possible amount of radiation exposure that could increase cancer
risks.
RadiationInduced Cancer and Patients
The use of ionizing radiation in many imaging techniques today contributes to the
increased exposure of patients to radiation. In the United States during the 1980s, the
average dose people receive is 3.6 mSv per year. Only 0.54 mSv from this annual dose
came from medical radiation. However, in a study done in 2006, medical radiation alone
contributed 3 mSv to the annual dose. The annual dose per capita was increased into
6.2 mSv.
Due to this, many authors predicted thousands of radiationinduced cancer and
cancer deaths attributed to computed tomography (CT) in the future years. In 2007,
Brenner and Hall reported that at most 2% of all cancers that will occur in U.S.A. will be
caused by studies about CT. On the other hand, in 2009, de González et al. reported
that 29 000 additional cancers and 14 500 cancer deaths yearly will be caused by CT
examinations (Hendee & O’Connor, 2012). These predictions are being sensationalized
by the media and the public are seemingly buying it because many people are being
hesitant to undergo imaging procedures which uses ionizing radiation because of these
predictions.
On the other hand, the American Association of Physicist in Medicine stated in a
position paper published in 2011 that cancer risks from medical imaging procedures
with shortperiod effective doses of 50 mSv and 100 mSv respectively for single and
multiple procedures may be considered nonexistent. (AAPM, 2011)
In contrast with the stand of AAPM, according to Hendee & O’Connor, a recently
published cohort study by Pearce et al. demonstrated an increase in leukemia and brain
cancer to children under 15 who underwent multiple CT scans, with an excess absolute
risk of 0.83 excess case of leukemia and 0.32 excess case of brain cancer in 10000
children receiving 10 mGy from a CT scan. This result, according to Brenner & Hall,
shows clearly that it would not be correct to claim that the risk from CT is “too low to be
detectable and may be nonexistent” (AAPM). However, this study does not show the
complete picture in relation with adult CT because the study was applicable only for
pediatric CT. 90% of scans are performed in adults and they have much lower risk of
getting cancer from radation exposure due to CT. Thus, the benefits from clinically
justified CT scans still outweigh the risks. (Brenner & Hall, 2012)
RadiationInduced Cancer and Public
Aside from patients and workers, the general public’s risk of having
radiationinduced cancer is also a primary concern.
According to Physicians for Social Responsibility, there is no safe amount of
radiation because any amount increases the risk of having cancer. Even if the cancer
risk of being exposed to a low dose of radiation is very low, there is still a 0.1% that the
person exposed could get cancer. Therefore, the impact of lowdose radiation even in
very small amounts is very significant in a largescale basis i.e. the community. (Psr.org,
2015)
According to the International Atomic Energy Agency, long term exposure to
radon, a naturallyoccurring radioactive gas derived from the decay of uranium that is
present in rocks and soil, the major contributor to the annual effective dose of most
people, and responsible for approximately 40% (1.15 mSv) of the estimated global
annual average individual effective dose from all sources of radiation which is
approximately 3.0 mSv increase the risk of lung cancer. An estimate of around 3% to
13% of all lung cancer cases are associated with indoor Radon exposure which
corresponds to about 170,000 fatal lung cancer worldwide per year. (IAEA, 2015)
Another being looked upon is the effect of the electromagnetic fields emitted by
mobile phones. According to the World Health Organization, the electromagnetic fields
emitted by mobile phones are possible to be carcinogenic based on the study
conducted by the International Agency for Research found no risk of glioma or
meningioma associated with the use of mobile phones in the span of 10 years but there
are some indications of increased risk for the people who reported the highest 10% total
hours of usage. (Who.int, 2015)
The risk of having cancer is different for different people. The risk is dependent in
the amount of radiation exposure, the number of exposures over time, and your age at
exposure. People in the lower age bracket are more vulnerable of having cancer. (UW
Health, 2015)
According to The Centers for Disease Control and Prevention, there is a possible
increase in risk of having cancer later in life of people who experienced radiation
exposure before birth. (Emergency.cdc.gov, 2015)
Another crucial topic for radiationinduced cancer affecting the general public is
the aftermath of the atomic bombings in Hiroshima and Nagasaki. According to The
Center for Nuclear Studies Columbia University long term effects suffered by the atomic
bomb survivors are increase in the number of people with leukemia, a risk of having
leukemia of about 46%, risk of having other kinds of cancer of about 10.7%. (Project &
Project, 2012)
Solid cancer incidence among atomic bomb survivors
A report on radiation effects on the incidence of solid cancers (cancers other than
leukemia and other hematopoietic malignancies) among members of the Life Span
Study (LSS) cohort of Hiroshima and Nagasaki atomic bomb survivors (Preston et al,
2007) had determined that among the 105,427 members of the LSS cohort included in
their study, who were alive and not known to have had cancer prior to 1958, 17,448 of
them were diagnosed with first primary solid cancers (including nonmelanoma skin
cancer) from 1958–1998. The most prevalent cancer in the cohort, accounting for more
than 25% of all cases was stomach cancer. Lung (10%), liver (9%), colon (9%), rectum
(5%), female breast (6%), and cervix (5%) cancers were the other commonly cancers
occurred in this period. In this cohort, 54% of all cancers happened among women.
Cancer of the gallbladder, nonmelanoma skin, brain and nervous system, and thyroid
were mostly more common (60%) among women. On the other hand, the breast and
thyroid cancers had the lowest mean age at diagnosis while cancers of the gallbladder,
pancreas, lung, nonmelanoma skin, prostate and bladder had mean ages over 70
years.
It was estimated that at the age 70, after exposure at age 30, solid cancer rates
increase by about 35% per Gy for men and 58% per Gy for women. For all solid
cancers as a group, 853 of 17,448 cohort members with incident solid cancers were
estimated to be associated with atomic bomb radiation exposure. The excess relative
risk (ERR per Gy) for this cohort decreases by about 17% per decade increase in age at
exposure after allowing for attained age effects, while the ERR decreased in proportion
to attained age to the power 1.65 after allowing for age at exposure. Although the
decline in the ERR with attained age, the increase in excess absolute rates throughout
their study period provided further evidence that radiationassociated increases in
cancer rates continue throughout life regardless of age at exposure. For all solid
cancers as a group, women had somewhat higher excess absolute rates than men, but
this difference disappears when the analysis was restricted to nongenderspecific
cancers.
In most sites, oral cavity, esophagus, stomach, colon, liver, lung, nonmelanoma
skin, breast, ovary, bladder, nervous system and thyroid significant radiationassociated
increases in risk were seen. While there was no indication of a statistically considerable
dose response for cancers of the pancreas, prostate and kidney, the excess relative
risks for these sites were also coherent with that for all solid cancers as a group.
Dose–response estimates for cancers of the rectum, gallbladder and uterus were not
statistically appreciable. The risks for these sites may be lower than those for all solid
cancers combined as suggested.
However, emerging evidence from their data showed that exposure as a child
may increase risks of cancer of the body of the uterus. Prominent risks were seen for all
of the five broadly classified histological groups considered, including squamous cell
carcinoma, adenocarcinoma, other epithelial cancers, sarcomas and other
nonepithelial cancers. Although their data was limited, there was a significant
radiationassociated increase in the risk of cancer occurring in adolescence and young
adulthood.
Conclusion
Ionizing radiation proves to be of great importance to mankind. It is of great use
in the field of medicine as a non invasive medical imaging technique, and is also used in
treating cancer patients. It is also used as the source of energy in many countries of the
world. However, when not used properly, ionizing radiation proves to be detrimental to
human health and the environment. Ionizing radiation is one of the proven carcinogens
in human beings. Evidences that radiation indeed cause cancer can be found on studies
involving people who were exposed to high doses of radiation such as the victims of
bombing in Japan, people working with xrays, and miners that are exposed to alpha
radiation.
Radiationinduced cancer is not a myth. The risk of obtaining it is real. Thus,
proper safety measures must be observed when working around with ionizing radiation.
Every exposure to ionizing radiation must be justified and the benefits from it must
always outweigh the risks.
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