Utada Mai, Brenner Alina V, Preston Dale L, Cologne John B, Sakata Ritsu, Sugiyama Hiromi, Sadakane Atsuko, Grant Eric J, Cahoon Elizabeth K, Ozasa Kotaro, Mabuchi Kiyohiko
JNCI Cancer Spectr. 2018 Oct;2(4):pky081. doi: 10.1093/jncics/pky081. Epub 2019 Feb 8.
Ionizing radiation is known to be capable of causing cancer of many organs, but its relationship with uterine cancer has not been well characterized.
We studied incidence of uterine cancer during 1958-2009 among 62 534 female atomic bomb survivors. Using Poisson regression analysis, we fitted excess relative risk (ERR) models to uterine cancer rates adjusted for several lifestyle and reproductive factors. Person-years at risk were also adjusted for the probability of prior hysterectomy, because it could affect the subsequent risk of uterine cancer. We assessed the modifying effect of age and other factors on the radiation risk. For analysis of the modifying effect of age at radiation exposure around menarche, we compared the radiation risk for several exposure-age categories as well as using parametric models.
There were 224 uterine corpus cancers and 982 cervical cancers. We found a significant association between radiation dose and risk of corpus cancer (ERR per Gray [ERR/Gy] = 0.73, 95% confidence interval [CI] = 0.03 to 1.87) but not for cervical cancer (ERR/Gy = 0.00, 95% CI = -0.22 to 0.31). For corpus cancer, we found statistically significant heterogeneity in ERR/Gy by age ( = .001) with elevated risk for women exposed to radiation between ages 11 and 15 years (ERR/Gy = 4.10, 95% CI = 1.47 to 8.42) and no indication of a radiation effect for exposures before or after this exposure-age range.
The current data suggest that uterine corpus is especially sensitive to the carcinogenic effect of radiation exposure occurring during the mid-pubertal period preceding menarche. There is little evidence for a radiation effect on cervical cancer risk.
已知电离辐射能够引发多个器官的癌症，但它与子宫癌的关系尚未得到充分描述。
我们研究了1958年至2009年间62534名女性原子弹幸存者中子宫癌的发病率。使用泊松回归分析，我们将超额相对危险度（ERR）模型应用于经多种生活方式和生殖因素调整后的子宫癌发病率。由于既往子宫切除术的概率可能会影响后续患子宫癌的风险，因此对风险人年数也进行了调整。我们评估了年龄和其他因素对辐射风险的修正作用。为了分析初潮前后辐射暴露年龄的修正作用，我们比较了几个暴露年龄组的辐射风险，并使用了参数模型。
共发现224例子宫体癌和982例宫颈癌。我们发现辐射剂量与子宫体癌风险之间存在显著关联（每格雷的ERR [ERR/Gy] = 0.73，95%置信区间[CI] = 0.03至1.87），但与宫颈癌无关（ERR/Gy = 0.00，95% CI = -0.22至0.31）。对于子宫体癌，我们发现ERR/Gy在年龄方面存在统计学显著的异质性（P = 0.001），11至15岁接受辐射的女性风险升高（ERR/Gy = 4.10，95% CI = 1.47至8.42），且在此暴露年龄范围之前或之后的暴露没有辐射效应的迹象。
目前的数据表明，子宫体对初潮前青春期中期发生的辐射暴露致癌作用特别敏感。几乎没有证据表明辐射对宫颈癌风险有影响。
