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August 2, 1995, Vol 274, No. 5 >
ARTICLE | August 2, 1995

Breast Cancer Among Radiologic Technologists FREE

John D. Boice, Jr, ScD; Jack S. Mandel, PhD; Michele Morin Doody, MS
[+] Author Affiliations

Corresponding author: John D. Boice, Jr, ScD, Radiation Epidemiology Branch, National Cancer Institute, 6130 Executive Blvd, EPN/Room 408, Bethesda, MD 20892.


JAMA. 1995;274(5):394-401. doi:10.1001/jama.1995.03530050042030
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Article
References

Objective.  —To evaluate the risk of breast cancer among women occupationally exposed to ionizing radiation.

Design.  —Case-control study.

Participants.  —A health survey of 105 385 women radiologic technologists certified by the American Registry of Radiologic Technologists since 1926. Among 79016 respondents, 600 breast cancer cases were identified. Each of 528 eligible subjects with breast cancer was matched to five control subjects based on age, year of certification, and follow-up time.

Main Outcome Measures.  —Relative risk (RR) estimated as the relative odds ratio for breast cancer over categories of years worked as a radiologic technologist and according to personal and occupational exposure characteristics.

Results.  —Study subjects had been certified for a mean of 29 years; 63.8% of cases and 62.6% of controls worked as radiologic technologists for 10 years or more. Significant increased risks for breast cancer were associated with early age at menarche (for <11 years of age: RR=1.79; 95% confidence interval [Cl], 1.09 to 2.94), nulliparity (RR=1.36; 95% Cl, 1.04 to 1.78), first-degree relative with history of breast cancer (RR=2.07; 95% Cl, 1.56 to 2.74), prior breast biopsy (RR=1.53; 95% Cl, 1.17 to 2.00), alcohol consumption (for >14 alcoholic drinks per week: RR=2.12; 95% Cl, 1.06 to 4.27), thyroid cancer (RR=5.36; 95% Cl, 1.64 to 17.5), hyperthyroidism (RR=1.66; 95% Cl, 1.02 to 2.71), and residence in the northeastern United States (RR=1.66; 95% Cl, 1.19 to 2.30). Jobs involving radiotherapy, radioisotopes, or fluoroscopic equipment, however, were not linked to breast cancer risk, nor were personal exposures to fluoroscopy or multifilm procedures. Use of birth control pills, postmenopausal estrogens, or permanent hair dyes also were not risk factors. Based on dosimetry records for 35% of study subjects, cumulative exposures appeared low. Among women who worked more than 20 years, the RR for breast cancer was 1.13 (95% Cl, 0.79 to 1.64).

Conclusions.  —More than 50% of the reported breast cancers could be explained by established risk factors. Employment as a radiologic technologist, however, was not found to increase the risk of breast cancer. The contribution of prolonged exposure to relatively low doses of ionizing radiation to breast cancer risk was too small to be detectable at this time.(JAMA. 1995;274:394-401)

REFERENCES

1 +
Boice JD Jr, Preston D, Davis FG, Monson RR.  Frequent chest x-ray fluoroscopy and breast cancer incidence among tuberculosis patients in Massachusetts. Radiat Res . 1991;;125:214-222.
2 +
Boice JD Jr, Mandel JS, Doody MM, Yoder RC, McGowan R.  A health survey of radiologic technologists. Cancer . 1992;;69:586-598.
3 +
London SS, Colditz GA, Stampfer MJ, Willet WC, Rosner BA, Speizer FE.  Prospective study of relative weight, height, and risk for breast cancer. JAMA . 1989;;262:2853-2858.
4 +
Kelsey JL.  Breast cancer epidemiology: summary and future directions. Epidemiol Rev . 1993;; 15:256-263.
5 +
Kereiakes JG, Rosenstein M. Handbook of Radiation Doses in Nuclear Medicine and Diagnostic X-ray . Boca Raton, Fla: CRC Press; 1980;.
6 +
Lubin JH.  A computer program for the analysis of matched case-control studies. Comput Biomed Res . 1981;;14:138-143.
7 +
Wang J-X, Inskip PD, Boice JD Jr, et al.  Cancer incidence among medical diagnostic x-ray workers in China, 1950 to 1985. Int J Cancer . 1990;;45:889-895.
8 +
Stebbings JH, Lucas HF, Stehney AF.  Mortality from cancers of major sites in female radium dial workers. Am J Ind Med . 1984;;5:435-459.
9 +
Baverstock KF, Papworth DG.  The UK radium luminiser survey.  In: Taylor DM, Mays CW, Gerber GB, Thomas RG, eds. Risks From Radium and Thorotrast . London, England: British Institute of Radiology; 1989;:72-76. BIR Report 21.
10 +
Kendall GM, Muirhead CR, MacGibbon BH, et al.  Mortality and occupational exposure to radiation: first analysis of the National Registry for Radiation Workers. BMJ . 1992;;304:220-225.
11 +
Gilbert ES, Cragle DL, Wiggs LD.  Updated analysis of combined mortality data on workers at the Hanford site, Oak Ridge National Laboratory, and Rocky Flats Weapons Plant. Radiat Res . 1993;; 136:408-421.
12 +
MacKenzie I.  Breast cancer following multiple fluoroscopies. Br J Cancer . 1965;;19:1-8.
13 +
Miller AB, Howe GR, Sherman GJ, et al.  Mortality from breast cancer after irradiation during fluoroscopic examinations in patients being treated for tuberculosis. N Engl J Med . 1989;;321:1285-1289.
14 +
Wanebo CK, Johnson KG, Sato K, et al.  Breast cancer after exposure to the atomic bombings of Hiroshima and Nagasaki. N Engl J Med . 1968;;279: 667-671.
15 +
15. Tokunaga M, Land CE, Tokuoka S, Nishimori I, Soda M, Akiba S.  Incidence of female breast cancer among atomic bomb survivors, 1950-1985. Radiat Res . 1994;;138:209-223.
16 +
Shore RE, Hildreth N, Woodward E, Dvoretsky P, Hempelmann L, Pasternack B.  Breast cancer among women given x-ray therapy for acute postpartum mastitis. J Natl Cancer Inst . 1986;;77:689-696.
17 +
Mattsson A, Rudén B-I, Hall P, Wiling N, Rutqvist LE.  Radiation-induced breast cancer: long-term follow-up of radiation therapy for benign breast disease. J Natl Cancer Inst . 1993;;85:1679-1685.
18 +
Boice JD Jr, Harvey EB, Blettner M, Stovall M, Flannery JT.  Cancer in the contralateral breast after radiotherapy for breast cancer. N Engl J Med . 1992;;326:781-785.
19 +
Hancock SL, Tucker MA, Hoppe RT.  Breast cancer after treatment of Hodgkin's disease. J Natl Cancer Inst . 1993;;85:25-31.
20 +
Hidreth NG, Shore RE, Dvoretsky PM.  The risk of breast cancer after irradiation of the thymus in infancy. N Engl J Med . 1989;;321:1281-1284.
21 +
Hoffman DA, Lonstein JE, Morin MM, Visscher W, Harris BSH III, Boice JD Jr.  Breast cancer in women with scoliosis exposed to multiple diagnostic x-rays. J Natl Cancer Inst . 1989;;81:1307-1312.
22 +
Li F, Corkery J, Vawter G, Fine W, Sallan SE.  Breast carcinoma after cancer therapy in childhood. Cancer . 1983;;51:521-523.
23 +
Fürst CJ, Lundell M, Holm L-E.  Cancer incidence after radiotherapy for skin hemangioma: a retrospective cohort study in Sweden. J Natl Cancer Inst . 1988;;80:1387-1392.
24 +
Weiss HA, Darby SC, Doll R.  Cancer mortality following x-ray treatment for ankylosing spondylitis. Int J Cancer . 1994;;59:327-338.
25 +
McLaughlin JR, Kreiger N, Sloan MP, Benson LN, Hilditch S, Clarke EA.  An historical cohort study of cardiac catheterization during childhood and the risk of cancer. Int J Epidemiol . 1993;;22: 584-589.
26 +
Boice JD Jr, Blettner M, Kleinerman RA, et al.  Radiation dose and breast cancer risk in patients treated for cancer of the cervix. Int J Cancer . 1989;; 44:7-16.
27 +
Holm L-E, Hall P, Wiklund K, et al.  Cancer risk after iodine-131 therapy for hyperthyroidism. J Natl Cancer Inst . 1991;;83:1072-1077.
28 +
United Nations Scientific Committee on the Effects of Atomic Radiation. Sources and Effects of Ionizing Radiation . New York, NY: United Nations; 1994;. Publication E.94.IX.11.
29 +
Lucas JN, Awa A, Straume T, et al.  Rapid translocation frequency analysis in humans decades after exposure to ionizing radiation. Int J Radiat Biol . 1992;;62:53-63.
30 +
Straume T, Lucas JN, Tucker JD, Bigbee WL, Langlois RG.  Biodosimetry for a radiation worker using multiple assays. Health Phys . 1992;;62:122-130.
31 +
Kelsey JL, Horn-Ross PL.  Breast cancer: magnitude of the problem and descriptive epidemiology. Epidemiol Rev . 1993;;15:7-16.
32 +
Malone KE, Darling JR, Weiss NS.  Oral contraceptives in relation to breast cancer. Epidemiol Rev . 1993;;15:80-97.
33 +
White E, Malone KE, Weiss NS, Daling JR.  Breast cancer among young U.S. women in relation to oral contraceptive use. J Natl Cancer Inst . 1994;; 86:505-514.
34 +
Brinton LA, Schairer C.  Estrogen replacement therapy and breast cancer risk. Epidemiol. Rev . 1993;;15:66-79.
35 +
Colditz GA, Stampfer MJ, Willet WC, et al.  Type of postmenopausal hormone use and risk of breast cancer: 12-year follow-up from the Nurses' Health Study. Cancer Causes Control . 1992;;3:433-439.
36 +
Green A, Willett WC, Colditz GA, et al.  Use of permanent hair dyes and risk of breast cancer. J Natl Cancer Inst . 1987;;79:253-257.
37 +
Palmer JR, Rosenberg L.  Cigarette smoking and the risk of breast cancer. Epidemiol Rev . 1993;; 15:145-156.
38 +
Rosenberg L, Metzger LS, Palmer JR.  Alcohol consumption and risk of breast cancer: a review of the epidemiologic evidence. Epidemiol Rev . 1993;; 15:133-144.
39 +
Harvey EB, Brinton LA.  Second cancer following cancer of the breast in Connecticut, 1935-82. Natl Cancer Inst Mongr . 1985;;68:99-112.
40 +
Hunter DJ, Willett WC.  Diet, body size, and breast cancer. Epidemiol Rev . 1993;;15:110-132.
41 +
Bruzzi P, Green SB, Byar DP, et al.  Estimating the population attributable risk for multiple risk factors using case-control data. Am J Epidemiol . 1985;;122:904-914.
42 +
Savitsky K, Bar-Shira A, Gilad S, et al.  A single ataxia telangiectasia gene with a product similar to Pl-3 kinase. Science . 1995;;268:1749-1753.

Figures

Tables

Interactive Graphics

Video

Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Boice JD Jr, Preston D, Davis FG, Monson RR.  Frequent chest x-ray fluoroscopy and breast cancer incidence among tuberculosis patients in Massachusetts. Radiat Res . 1991;;125:214-222.
2 +
Boice JD Jr, Mandel JS, Doody MM, Yoder RC, McGowan R.  A health survey of radiologic technologists. Cancer . 1992;;69:586-598.
3 +
London SS, Colditz GA, Stampfer MJ, Willet WC, Rosner BA, Speizer FE.  Prospective study of relative weight, height, and risk for breast cancer. JAMA . 1989;;262:2853-2858.
4 +
Kelsey JL.  Breast cancer epidemiology: summary and future directions. Epidemiol Rev . 1993;; 15:256-263.
5 +
Kereiakes JG, Rosenstein M. Handbook of Radiation Doses in Nuclear Medicine and Diagnostic X-ray . Boca Raton, Fla: CRC Press; 1980;.
6 +
Lubin JH.  A computer program for the analysis of matched case-control studies. Comput Biomed Res . 1981;;14:138-143.
7 +
Wang J-X, Inskip PD, Boice JD Jr, et al.  Cancer incidence among medical diagnostic x-ray workers in China, 1950 to 1985. Int J Cancer . 1990;;45:889-895.
8 +
Stebbings JH, Lucas HF, Stehney AF.  Mortality from cancers of major sites in female radium dial workers. Am J Ind Med . 1984;;5:435-459.
9 +
Baverstock KF, Papworth DG.  The UK radium luminiser survey.  In: Taylor DM, Mays CW, Gerber GB, Thomas RG, eds. Risks From Radium and Thorotrast . London, England: British Institute of Radiology; 1989;:72-76. BIR Report 21.
10 +
Kendall GM, Muirhead CR, MacGibbon BH, et al.  Mortality and occupational exposure to radiation: first analysis of the National Registry for Radiation Workers. BMJ . 1992;;304:220-225.
11 +
Gilbert ES, Cragle DL, Wiggs LD.  Updated analysis of combined mortality data on workers at the Hanford site, Oak Ridge National Laboratory, and Rocky Flats Weapons Plant. Radiat Res . 1993;; 136:408-421.
12 +
MacKenzie I.  Breast cancer following multiple fluoroscopies. Br J Cancer . 1965;;19:1-8.
13 +
Miller AB, Howe GR, Sherman GJ, et al.  Mortality from breast cancer after irradiation during fluoroscopic examinations in patients being treated for tuberculosis. N Engl J Med . 1989;;321:1285-1289.
14 +
Wanebo CK, Johnson KG, Sato K, et al.  Breast cancer after exposure to the atomic bombings of Hiroshima and Nagasaki. N Engl J Med . 1968;;279: 667-671.
15 +
15. Tokunaga M, Land CE, Tokuoka S, Nishimori I, Soda M, Akiba S.  Incidence of female breast cancer among atomic bomb survivors, 1950-1985. Radiat Res . 1994;;138:209-223.
16 +
Shore RE, Hildreth N, Woodward E, Dvoretsky P, Hempelmann L, Pasternack B.  Breast cancer among women given x-ray therapy for acute postpartum mastitis. J Natl Cancer Inst . 1986;;77:689-696.
17 +
Mattsson A, Rudén B-I, Hall P, Wiling N, Rutqvist LE.  Radiation-induced breast cancer: long-term follow-up of radiation therapy for benign breast disease. J Natl Cancer Inst . 1993;;85:1679-1685.
18 +
Boice JD Jr, Harvey EB, Blettner M, Stovall M, Flannery JT.  Cancer in the contralateral breast after radiotherapy for breast cancer. N Engl J Med . 1992;;326:781-785.
19 +
Hancock SL, Tucker MA, Hoppe RT.  Breast cancer after treatment of Hodgkin's disease. J Natl Cancer Inst . 1993;;85:25-31.
20 +
Hidreth NG, Shore RE, Dvoretsky PM.  The risk of breast cancer after irradiation of the thymus in infancy. N Engl J Med . 1989;;321:1281-1284.
21 +
Hoffman DA, Lonstein JE, Morin MM, Visscher W, Harris BSH III, Boice JD Jr.  Breast cancer in women with scoliosis exposed to multiple diagnostic x-rays. J Natl Cancer Inst . 1989;;81:1307-1312.
22 +
Li F, Corkery J, Vawter G, Fine W, Sallan SE.  Breast carcinoma after cancer therapy in childhood. Cancer . 1983;;51:521-523.
23 +
Fürst CJ, Lundell M, Holm L-E.  Cancer incidence after radiotherapy for skin hemangioma: a retrospective cohort study in Sweden. J Natl Cancer Inst . 1988;;80:1387-1392.
24 +
Weiss HA, Darby SC, Doll R.  Cancer mortality following x-ray treatment for ankylosing spondylitis. Int J Cancer . 1994;;59:327-338.
25 +
McLaughlin JR, Kreiger N, Sloan MP, Benson LN, Hilditch S, Clarke EA.  An historical cohort study of cardiac catheterization during childhood and the risk of cancer. Int J Epidemiol . 1993;;22: 584-589.
26 +
Boice JD Jr, Blettner M, Kleinerman RA, et al.  Radiation dose and breast cancer risk in patients treated for cancer of the cervix. Int J Cancer . 1989;; 44:7-16.
27 +
Holm L-E, Hall P, Wiklund K, et al.  Cancer risk after iodine-131 therapy for hyperthyroidism. J Natl Cancer Inst . 1991;;83:1072-1077.
28 +
United Nations Scientific Committee on the Effects of Atomic Radiation. Sources and Effects of Ionizing Radiation . New York, NY: United Nations; 1994;. Publication E.94.IX.11.
29 +
Lucas JN, Awa A, Straume T, et al.  Rapid translocation frequency analysis in humans decades after exposure to ionizing radiation. Int J Radiat Biol . 1992;;62:53-63.
30 +
Straume T, Lucas JN, Tucker JD, Bigbee WL, Langlois RG.  Biodosimetry for a radiation worker using multiple assays. Health Phys . 1992;;62:122-130.
31 +
Kelsey JL, Horn-Ross PL.  Breast cancer: magnitude of the problem and descriptive epidemiology. Epidemiol Rev . 1993;;15:7-16.
32 +
Malone KE, Darling JR, Weiss NS.  Oral contraceptives in relation to breast cancer. Epidemiol Rev . 1993;;15:80-97.
33 +
White E, Malone KE, Weiss NS, Daling JR.  Breast cancer among young U.S. women in relation to oral contraceptive use. J Natl Cancer Inst . 1994;; 86:505-514.
34 +
Brinton LA, Schairer C.  Estrogen replacement therapy and breast cancer risk. Epidemiol. Rev . 1993;;15:66-79.
35 +
Colditz GA, Stampfer MJ, Willet WC, et al.  Type of postmenopausal hormone use and risk of breast cancer: 12-year follow-up from the Nurses' Health Study. Cancer Causes Control . 1992;;3:433-439.
36 +
Green A, Willett WC, Colditz GA, et al.  Use of permanent hair dyes and risk of breast cancer. J Natl Cancer Inst . 1987;;79:253-257.
37 +
Palmer JR, Rosenberg L.  Cigarette smoking and the risk of breast cancer. Epidemiol Rev . 1993;; 15:145-156.
38 +
Rosenberg L, Metzger LS, Palmer JR.  Alcohol consumption and risk of breast cancer: a review of the epidemiologic evidence. Epidemiol Rev . 1993;; 15:133-144.
39 +
Harvey EB, Brinton LA.  Second cancer following cancer of the breast in Connecticut, 1935-82. Natl Cancer Inst Mongr . 1985;;68:99-112.
40 +
Hunter DJ, Willett WC.  Diet, body size, and breast cancer. Epidemiol Rev . 1993;;15:110-132.
41 +
Bruzzi P, Green SB, Byar DP, et al.  Estimating the population attributable risk for multiple risk factors using case-control data. Am J Epidemiol . 1985;;122:904-914.
42 +
Savitsky K, Bar-Shira A, Gilad S, et al.  A single ataxia telangiectasia gene with a product similar to Pl-3 kinase. Science . 1995;;268:1749-1753.

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