Boice J D, Morin M M, Glass A G, Friedman G D, Stovall M, Hoover R N, Fraumeni J F
Epidemiology and Biostatistics Program, National Cancer Institute, Bethesda, MD 20852.
JAMA. 1991 Mar 13;265(10):1290-4.
Exposure to diagnostic x-rays and the risk of leukemia, non-Hodgkin's lymphoma (NHL), and multiple myeloma were studied within two prepaid health plans. Adult patients with leukemia (n = 565), NHL (n = 318), and multiple myeloma (n = 208) were matched to controls (n = 1390), and over 25,000 x-ray procedures were abstracted from medical records. Dose response was evaluated by assigning each x-ray procedure a score based on estimated bone marrow dose. X-ray exposure was not associated with chronic lymphocytic leukemia, one of the few malignant conditions never linked to radiation (relative risk [RR], 0.66). For all other forms of leukemia combined (n = 358), there was a slight elevation in risk (RR, 1.17) but no evidence of a dose-response relationship when x-ray procedures near the time of diagnosis were excluded. Similarly, patients with NHL were exposed to diagnostic x-ray procedures more often than controls (RR, 1.32), but the RR fell to 0.99 when the exposure to diagnostic x-ray procedures within 2 years of diagnosis was ignored. For multiple myeloma, overall risk was not significantly high (RR, 1.14), but there was consistent evidence of increasing risk with increasing numbers of diagnostic x-ray procedures. These data suggest that persons with leukemia and NHL undergo x-ray procedures frequently just prior to diagnosis for conditions related to the development or natural history of their disease. There was little evidence that diagnostic x-ray procedures were causally associated with leukemia or NHL. The risk for multiple myeloma, however, was increased among those patients who were frequently exposed to x-rays.
在两个预付健康计划中研究了诊断性X射线照射与白血病、非霍奇金淋巴瘤（NHL）和多发性骨髓瘤风险之间的关系。将成年白血病患者（n = 565）、NHL患者（n = 318）和多发性骨髓瘤患者（n = 208）与对照组（n = 1390）进行匹配，并从医疗记录中提取了超过25000次X射线检查程序。通过根据估计的骨髓剂量为每次X射线检查程序分配一个分数来评估剂量反应。X射线照射与慢性淋巴细胞白血病无关，慢性淋巴细胞白血病是少数从未与辐射相关联的恶性疾病之一（相对风险[RR]，0.66）。对于所有其他合并的白血病形式（n = 358），风险略有升高（RR，1.17），但排除诊断时附近的X射线检查程序后，没有剂量反应关系的证据。同样，NHL患者比对照组更频繁地接受诊断性X射线检查程序（RR，1.32），但忽略诊断后2年内的诊断性X射线检查程序暴露时，RR降至0.99。对于多发性骨髓瘤，总体风险没有显著升高（RR，1.14），但有一致的证据表明，随着诊断性X射线检查程序数量的增加，风险也在增加。这些数据表明，白血病和NHL患者在诊断前经常因与其疾病发展或自然史相关的病症而接受X射线检查程序。几乎没有证据表明诊断性X射线检查程序与白血病或NHL有因果关系。然而，在那些经常接受X射线照射的患者中，多发性骨髓瘤的风险增加了。
