Malignant Neoplasms after Radiation Therapy for Peptic Ulcer

Abstract

Most information on radiation-related cancer risk comes from the Life Span Study (LSS) of the Japanese atomic bomb survivors. Stomach cancer mortality rates are much higher in Japan than in the U.S., making the applicability of LSS findings to the U.S. population uncertain. A unique cohort of U.S. patients who were irradiated for peptic ulcer to control gastric secretion provides a different perspective on risk. Cancer mortality data were analyzed and relative risks estimated for 3719 subjects treated by radiotherapy (mean stomach dose 14.8 Gy) and/or by surgery and medication during the period 1936-1965 and followed through 1997 (average 25 years). Compared to the U.S. rates, stomach cancer mortality was significantly increased for irradiated and nonirradiated patients (observed/expected = 3.20 and 1.52, respectively). We observed strong evidence of exposure-related excess mortality from cancer of the stomach (RR 2.6, 95% CI 1.3, 5.1), pancreas (RR 2.7, 95% CI 1.5, 5.1), and lung (RR 1.5, 95% CI 1.1, 2.1), with commensurate radiation dose responses in analyses that included nonexposed patients. However, the dose responses for these cancers were not significant when restricted to exposed patients. Our excess relative risk per gray estimate of 0.20 at doses <or=10 Gy (95% CI 0, 0.73) is consistent with the estimate of 0.24 (95% CI 0.10, 0.40) obtained from the LSS study with the linear model.

The cancer epidemiology of radiation

“…The stomach cancer mortality ERR coefficient of 0.20/Sv (95% CI: 0, 0.73) obtained by Carr et al (2002) from a study of US patients irradiated for peptic ulcer to control gastric secretion is compatible with the estimate of 0.24/Sv (95% CI: 0.10, 0.40) derived from the LSS. This finding is of particular interest given the 10-fold greater background rate of stomach cancer in Japan, and suggests a multiplicative interaction of risks.…”

Radiotherapy for benign disease; assessing the risk of radiation-induced cancer following exposure to intermediate dose radiation

“…This was also observed in a study of individuals irradiated for peptic ulcers, a treatment which is no longer in use. 79 In a reanalysis of this cohort, there was confirmation of a statistically significant (p , 0.05) excess risk for all cancers and lung cancer, with a borderline increase in risk for stomach cancer (p 5 0.07) and leukaemia (p 5 0.06). For all tumour types, age at exposure is inversely related to RR.…”

Radon and other natural radionuclides in drinking water and risk of stomach cancer: A case-cohort study in Finland

“…External gamma radiation has been shown to induce stomach cancer among atomic bomb survivors as well as patients receiving radiotherapy for gastric ulcer, benign breast disease or cervical cancer. 2,10 Also, workers at the Mayak nuclear facility, who were exposed to both plutonium and external gamma radiation, have an excess risk of stomach cancer. 2 Increased risk of stomach cancer has also been reported following internal exposure to high linear energy transfer (LET) radiation resulting from administration of radium or thoron for medical purposes.…”