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13.
Second cancers following radiation treatment for cervical cancer an international collaboration among cancer registries
Boice, John D., Jr. ...
The numbers of second cancer among 182,040women treated for cervical cancer that were reported to 15 cancerregistries in 8 countries were compared to the numbers expected had the same risk prevailed ...as in the general population. A small 9% excess of second cancers (5,146 observed vs. 4,736 expected) occurred1 or more years after treatment. Large radiation doses experienced by 82,616 women did not dramatically alter their risk of developing a second cancer; at most, about 162 of 3,324 second cancers (=5%) could be attributed to radiation. The relative risk (RR=1.1) for developing cancer in organs closeto the cervix that had received high radiation exposures-most notably, the bladder, rectum, uterine corpus, ovary, small intestine, bone, and connective tissue- and for developing multiple myeloma increased with time since treatment. No similar increase was seen for 99,424 women not treated with radiation. Only a slight excess of acute and nonlymphocytic leukemia was found among irradiated women (RR=1.3), and substantially fewer cases were observed than expected on the basis of current radiation risk estimates. The small risk of leukemia may be associated with low doses of radiation absorved by the bone marrow outside the pelvis, inasmuch as the marrow in the pelvis may have been destroyed or rendered inactive by very large radiotherapy exposures. There was little evidence of a radiation effect for cancers of the stomach, colon, liver, and gallbladder, for melanoma and other skin cancers, or for chronic lymphocytic leukemia despite substantial exposures. An excess of thyroid cancer possibly was related to the low dose received by this organ.Ovarian damage caused by radiation may have been responsible for a low breast cancer risk (RR=0.7), which was evident even among postmenopausal women. (Abstract trunacted at 2000 characters)
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