Peterson L E, Dreyer Z E, Plon S E, Smith J L, Weinberg A D, McCarthy P L
Department of Medicine, Baylor College of Medicine, Houston, Texas, USA.
Stem Cells. 1997;15 Suppl 2:211-30. doi: 10.1002/stem.5530150730.
Within the last decade, a substantial amount of attention has been devoted to etiological research on the association between exposure to fallout radionuclides from the Chernobyl accident and radiation-induced late effects (cancer) among children. A majority of the studies completed to date have been of the descriptive type, which only correlate average population exposure with average rate of cancer incidence as a function of calendar period. Since individual dosimetry is not performed in descriptive studies, it is unclear whether exposure precedes the development of cancer and a final decision cannot be made regarding the association between radiation exposure and cancer. This paper reviews the background epidemiology and outlines an analytical study design that is needed to clarify the unclear association between Chernobyl fallout exposure and childhood cancer. We discuss the essential elements of an analytical case-control design such as genetic predisposition, vital statistics, sample size and power determinations, ascertainment of cases and controls, and phenomenological dose modeling to establish individual doses. Examples such as cytogenetic biodosimetry, medical radiation dosimetry, and cytogenetic characterization of leukemia to minimize exposure and diagnostic misclassification are provided. We recommend the analytical methods described in this paper for studying the role of Chernobyl radionuclides and development of childhood cancer.
在过去十年中，大量关注集中于切尔诺贝利事故中沉降放射性核素暴露与儿童辐射诱发晚期效应（癌症）之间关联的病因学研究。迄今为止完成的大多数研究属于描述性研究，仅将人群平均暴露量与作为日历时间函数的癌症平均发病率相关联。由于描述性研究中未进行个体剂量测定，因此尚不清楚暴露是否先于癌症发生，并且无法就辐射暴露与癌症之间的关联做出最终决定。本文回顾了背景流行病学，并概述了一种分析性研究设计，该设计对于阐明切尔诺贝利沉降物暴露与儿童癌症之间不明确的关联是必要的。我们讨论了分析性病例对照设计的基本要素，如遗传易感性、生命统计、样本量和效能测定、病例和对照的确定，以及用于确定个体剂量的现象学剂量建模。还提供了一些示例，如细胞遗传学生物剂量测定、医学辐射剂量测定以及白血病的细胞遗传学特征分析，以尽量减少暴露和诊断错误分类。我们推荐本文所述的分析方法用于研究切尔诺贝利放射性核素的作用以及儿童癌症的发生。
