What can epidemiology tell us about risks at low doses?

Puskin, J. S. What Can Epidemiology Tell Us about Risks at Low Doses? Radiat. Res. 169, 122-124 (2008). Limitations on statistical power preclude direct detection and quantification of radiogenic cancer risks at very low (environmental) levels of low-LET radiation through epidemiological studies. Given this limitation and our incomplete understanding of cellular processes leading to radiation carcinogenesis, an "effective threshold" in the dose range of interest for radiation protection cannot yet be ruled out. Ongoing epidemiological studies of chronically exposed individuals receiving very low daily doses of radiation can be used, however, together with radiobiological data, to critically test whether such a threshold is plausible.     

Epidemiological studies on radiation carcinogenesis in human populations following acute exposure: nuclear explosions and medical radiation.

The present review provides an understanding of our current knowledge of the carcinogenic effect of low-dose radiation in man, and surveys the epidemiological studies of human populations exposed to nuclear explosions and medical radiation. Discussion centers on the contributions of quantitative epidemiology to present knowledge, the reliability of the dose-incidence data, and those relevant epidemiological studies that provide the most useful information for risk estimation of cancer induction in man. Reference is made to dose-incidence relationships from laboratory animal experiments where they may obtain, for problems and difficulties in extrapolation from data obtained at high doses to low doses, and from animal data to the human situation. The paper describes the methods of application of such epidemiological data for estimation of excess risk of radiation-induced cancer in exposed human populations and discusses the strengths and limitations of epidemiology in guiding radiation protection philosophy and public health policy.     

UV and pigmentation: molecular mechanisms and social controversies

Ultraviolet radiation (UVR) is an essential risk factor for the development of premalignant skin lesions as well as of melanoma and non-melanoma skin cancer. UVR exerts many effects on the skin, including tanning, carcinogenesis, immunomodulation, and production of vitamin D. Vitamin D (vit D) is important in the maintenance of healthy bones as well as other purported beneficial effects, amongst which is the potential for reducing risk of malignancy--though oral supplementation is fully capable of maintaining systemic levels. The known medical harm from UV exposure relates primarily to cancer of the skin--the most common organ in man to be affected by cancer. In this review, we summarize the knowledge about the ultraviolet (UV) response in regards to inflammation, immunosuppression, carcinogenesis and the tanning response. We also discuss vit D and UV, as well as public health implications of tanning behavior and commercial interests related to the promotion of UV exposure. As the most ubiquitous human carcinogen, UVR exposure represents both a challenge and enormous opportunity in the realm of skin cancer prevention.     

Cancer incidence and mortality after low-dose radiation exposure: epidemiological aspects

Current recommendations for limiting exposure to ionizing radiation are based on the linear-no-threshold (LNT) model for radiation carcinogenesis under which every dose, no matter how low, carries with it some cancer risk. In this review, epidemiological evidences are discussed that the LNT hypothesis is incorrect at low doses. A large set of data was accumulated that showed that cancer risk after ordinarily encountered radiation exposure (natural background radiation, medical X-rays, etc.) is much lower than projections based on the LNT model. The discovery of the low-level radiation hormesis (stimulating effect) implies a non-linear dose-response curve in the low-dose region. The further studies in this field will provide new insights about the mechanisms of radiation carcinogenesis.     

Should we affraid of induced cancer in group of patients after radical radiotherapy of prostate cancer?

Radiotherapy is one of the basic methods of radical treatment of prostate cancer. Because of that getting to know all factors of post-radiation complications, and in consequence the possibility to limit them, is one of the challenges of contemporary radiotherapy.One of the potential complications associated with radiation treatment is radiation-induced cancer. Despite a whole range of epidemiological analyses there is still lacking a fully credible model that would allow one to estimate the magnitude of risk of inducing such cancers. The last decades have seen the entry into clinical practice of technologically advanced methods of radiation therapy, such as the 3DCRT and IMRT. As the previous epidemiological analyses refer mainly to older radiation techniques, there is still a lack of credible data estimating the risk of inducing secondary cancers for new techniques, and in particular IMRT. It should be emphasized that IMRT allows one to escalate the dose, which may contribute to the improvement of radiotherapy effectiveness. From this there follows a new problem to be solved in future, i.e. how the escalation of the dose may influence the magnitude of risk of radiation carcinogenesis.The problem of carcinogenesis may concern the group of younger patients for whom long survival is very likely, and the competitive edge of RT relative to surgery, in particular in the aspect of late complications, has to be thoroughly justified.     

Cancer incidence and mortality after low-dosage radiation exposure: Epidemiological aspects

Current recommendations for limiting exposure to ionizing radiation are based on the linear no-threshold (LNT) model for radiation carcinogenesis under which every dose, no matter how low, bears some cancer risk. In this review, epidemiological evidence is discussed that the LNT hypothesis is incorrect at low doses. A large set of data was accumulated that show that cancer risk after ordinarily encountered radiation exposure (natural background radiation, medical X-rays, etc.) is much lower than estimates based on the LNT model. The discovery of low-level radiation hormesis (stimulating effect) implies a non-linear dose-response curve in the low-dosage region. Further studies in this field will provide new insights into the mechanisms of radiation carcinogenesis.     

Roles of stem cells in tissue turnover and radiation carcinogenesis

Radiation research has its foundation on the target and hit theories, which assume that the initial stochastic deposition of energy on a sensitive target in a cell determines the final biological outcome. This assumption is rather static in nature but forms the foundation of the linear no-threshold (LNT) model of radiation carcinogenesis. The stochastic treatment of radiation carcinogenesis by the LNT model enables easy calculation of radiation risk, and this has made the LNT model an indispensable tool for radiation protection. However, the LNT model sometimes fails to explain some of the biological and epidemiological data, and this suggests the need for insight into the mechanisms of radiation carcinogenesis. Recent studies have identified unique characteristics of the tissue stem cells and their roles in tissue turnover. In the present report, some important issues of radiation protection such as the risk of low-dose-rate exposures and in utero exposures are discussed in light of the recent advances of stem cell biology.     

Environmental pollutants and skin cancer

We are increasingly exposed to environmental pollution. Pollutants can be inhaled, ingested or come into contact with the skin depending on the form in which they occur. On metabolization, activation, or accumulation, pollutants can become extremely toxic for the vital organs and this is often related to a strong genotoxic effect. Since the skin acts as a barrier between the organism and the environment, it is frequently directly exposed to pollution. It is very often degraded by polluting agents and acts as an inlet toward other tissues. Numerous studies in man recognize and demonstrate the carcinogenic power of certain pollutants in the digestive and respiratory tracts. The "pollutants" that react most specifically with the skin are: ultraviolet radiation, polycyclic aromatic hydrocarbons (e.g., benzo[a]pyrene), volatile organic compounds (e.g., benzene), heavy metals, and ozone. Ultraviolet radiation, a "physical" pollutant, has been described as being the factor responsible for most skin cancers in man. The genotoxicity of UV light is well documented (type of lesion or mutation, etc.) and its carcinogenic effect is clearly demonstratedin vivo in man. A few epidemiological studies describe the carcinogenicity of certain pollutants such as arsenic or lead on the skin. However, most of the evidence for the role of pollutants in skin cancers comes fromin vivo animal studies or fromin vitro studies (e.g., PAHs). In this report, different studies are presented to illustrate the research strategies developed to investigate the mechanism of action of "chemical" pollutants and their potential role in human skin pathology. All the study models and the associated techniques of investigation are tools for a better understanding and thus more efficient prevention of the deleterious effects caused by the environment. This revised version was published online in August 2006 with corrections to the Cover Date.     

X-ray and UV-radiation sensitivity of circulating lymphocytes in multiple epidermal cancer in relation to previous radiation exposure

The cellular sensitivity to X rays (200 kV, 16 mA) and UV radiation (254 nm) was examined in lymphocytes from three groups of patients with multiple epidermal malignant tumors, selected by their clinical history of carcinogenesis. Eight patients previously exposed to low energy ionizing radiation (less than or equal to 12 kV) had an increased cellular sensitivity to UV radiation as well as X rays compared with 24 age and sex matched controls. This indicates the existence of a cellular cross-sensitivity to UV radiation and ionizing radiation not previously established for human cells. In contrast six patients previously exposed to high energy ionizing radiation (between 25 and 170 kV) had normal cellular response to both UV radiation and X rays, indicating a different biologic effect of low and high energy ionizing radiation. In the third group of patients, previously exposed to therapeutic UV radiation/excess sunlight, the lymphocytes had a normal response to X rays, but an increased sensitivity to UV radiation. The possibility of evaluating the individual risk at radiation exposure is suggested.     

TGF-β Targets the Wnt Pathway Components,APC and β-catenin,as Mv1Lu Cells Undergo Cell Cycle Arrest

Mammalian cells exhibit complex cellular responses to DNA damage, including cell cycle arrest, DNA repair and apoptosis. Defects in any one of these responses can result in carcinogenesis. Absence of the chromatin remodeling complex Swi/Snf is found in many instances of cancer, and we have investigated its role in the UV damage response. The human carcinoma cell line SW13 is deficient in Swi/Snf and is very sensitive to UV radiation. In contrast, SW13 cells with ectopic Brg1 expression regain active Swi/Snf and become significantly more resistant to UV radiation. Sensitivity to UV light correlates well with dramatic UV induced apoptosis in SW13 cells, but not in SW13 cells expressing Brg1. We show that SW13 cells synchronized at the G1/S border progress into S phase after UV irradiation, and this checkpoint deficiency is corrected after Brg1 expression is restored. Interestingly, Brg1 expression in SW13 cells restores expression of two DNA damage responsive genes, Gadd45a and p21. Furthermore, Gadd45a induction and p21 degradation were observed in the Brg1-expressing SW13 cells after UV irradiation. Our findings demonstrate that Swi/Snf protects cells against deleterious consequences of UV induced DNA damage. These results also indicate that Swi/Snf may play a role in replication checkpoint activation after UV damage via regulation of the two PCNA-binding proteins Gadd45a and p21.     

Electromagnetic-field exposure and cancer

Electromagnetic fields are a ubiquitous part of man's environment. Natural sources of energy have been present, and possibly have contributed to the processes of the evolution of living forms. In very recent time, however, exploitation of the properties of the electromagnetic spectrum, has added variables in intensity, frequency, modulation frequency, and alterations in contributions of electrical and magnetic components. Biological impact has been little studied and poorly defined. Animal carcinogenesis studies and human epidemiological data indicate that exposure to nonionizing radiation can play a role in cancer causation. Numerous effects at the physiological and biochemical level have been reported; many are of such a nature that a relationship to the causation of neoplastic transformation can rationally be hypothesized. Many bioeffects of electromagnetic fields can be adequately and economically explained in terms of heat effects alone. However, observations of frequency-, pulse form or modulation-, and intensity-specificity as well as effects opposite to that known for temperature-rise, imply direct interaction of radiant energy with biomolecules. The possibility of such direct interaction has been shown in quantum mechanical models.     

Cell phones and cancer: what is the evidence for a connection?

There have been allegations in the media and in the courts that cell phones and other types of hand-held transceivers are a cause of cancer. There have also been numerous public objections to the siting of TV, radio and cell phone transmission facilities because of a fear of cancer induction. A recent publication in Radiation Research by Repacholi et al. (147, 631-640, 1997) which suggests that exposure to radiofrequency (RF) radiation may increase lymphoma incidence in mice has contributed to this controversy. The goal of this review is to provide biomedical researchers a brief overview of the existing RF radiation-cancer studies. This article begins with a brief review of the physics and technology of cell phones. It then reviews the existing epidemiological studies of RF radiation, identifying gaps in our knowledge. Finally, the review discusses the cytogenetics literature on RF radiation and the whole-animal RF-radiation carcinogenesis studies. The epidemiological evidence for an association between RF radiation and cancer is found to be weak and inconsistent, the laboratory studies generally do not suggest that cell phone RF radiation has genotoxic or epigenetic activity, and a cell phone RF radiation-cancer connection is found to be physically implausible. Overall, the existing evidence for a causal relationship between RF radiation from cell phones and cancer is found to be weak to nonexistent.     

Cell division transforms mutagenic lesions into deletion-recombinagenic lesions in yeast cells.

Cell proliferation has been recognized as an important factor in human and experimental carcinogenesis. Point mutations as well as larger chromosomal rearrangements are involved in the initiation of cancer. In this paper we compared the relative potencies of radiation and chemical carcinogens for inducing point mutations vs. deletions in cell cycle arrested with dividing cells of Saccharomyces cerevisiae. Point mutation substrates and deletion (DEL) recombination substrates were constructed with the genes CDC28 and TUB2 that are required for cell cycle progression through G1 and G2, respectively. The carcinogens ionizing radiation, UV, MMS, EMS and 4-NQO induced point mutations in G1 and in G2 arrested as well as in dividing cells. UV, MMS, EMS and 4-NQO caused very weak if any increases in DEL recombination in G1 or G2 arrested cells, but large increases in dividing cells. When cells treated with carcinogen either in G1 or G2 were allowed to progress through the cell cycle, a time-dependent increase in DEL recombination was seen. Ionizing radiation and the site-specific endonuclease I-SceI, which both directly create double-strand breaks, induced DEL recombination in G1 as well as in G2 arrested cells. In conclusion, UV-, MMS-, EMS- and 4-NQO-induced DNA damage was converted during DNA replication to a lesion capable of inducing DEL recombination which is probably a DNA strand break. Thus, cell proliferation is not necessary to turn DNA alkylation or UV damage into a mutagenic lesion but to convert the damage into a lesion that induces DNA deletions. These results are discussed with respect to mechanisms of carcinogenesis.     

Quantitative risk in radiation protection standards

Summary Although the overall aim of radiobiology is to understand the biological effects of radiation, it also has the implied practical purpose of developing rational measures for the control of radiation exposure in man. The emphasis in this presentation is to show that the enormous effort expended over the years to develop quantitative dose-effect relations relationships in biochemical and cellular systems, animals and human beings, now seems to be paying off. The pieces appear to be falling into place, and a framework is evolving to utilize these data. Specifically, quantitative risk assessments will be discussed in terms of the cellular, animal and human data on which they are based; their use in the development of radiation protection standards; and their present and potential impact and meaning in relation to the quantity dose equivalent and its special unit, the rem. Recent neutron carcinogenesis data in man are evaluated.Invited paper, presented at the 14th Annual Meeting of European Society of Radiation Biology, Jülich, Germany, October 8–14, 1978     

Aspects of psoralen phototumorigenesis with emphasis on the possible role of tumour promotion

8-Methoxypsoralen in combination with UVA radiation (PUVA) is carcinogenic in mice and probably so in man. PUVA is genotoxic and so has tumour initiation potential. Some evidence suggests that PUVA has other biological effects which may be equated with tumour promotion. Thus, the use of a two-stage model, similar to that of chemical carcinogenesis, may be a useful experimental approach for the further understanding of PUVA carcinogenesis.     

Beneficial effects of solar UV‐B radiation on soybean yield mediated by reduced insect herbivory under field conditions

Ultraviolet‐B radiation (UV‐B: 280–315 nm) has damaging effects on cellular components and macromolecules. In plants, natural levels of UV‐B can reduce leaf area expansion and growth, which can lead to reduced productivity and yield. UV‐B can also have important effects on herbivorous insects. Owing to the successful implementation of the Montreal Protocol, current models predict that clear‐sky levels of UV‐B radiation will decline during this century in response to ozone recovery. However, because of climate change and changes in land use practices, future trends in UV doses are difficult to predict. In the experiments reported here, we used an exclusion approach to study the effects of solar UV‐B radiation on soybean crops, which are extensively grown in many areas of the world that may be affected by future variations in UV‐B radiation. In a first experiment, performed under normal management practices (which included chemical pest control), we found that natural levels of UV‐B radiation reduced soybean yield. In a second experiment, where no pesticides were applied, we found that solar UV‐B significantly reduced insect herbivory and, surprisingly, caused a concomitant increase in crop yield. Our data support the idea that UV‐B effects on agroecosystems are the result of complex interactions involving multiple trophic levels. A better understanding of the mechanisms that mediate the anti‐herbivore effect of UV‐B radiation may be used to design crop varieties with improved adaptation to the cropping systems that are likely to prevail in the coming decades in response to agricultural intensification.     

Analysis of a Hormesis Effect in the Leukemia-Caused Mortality Among Atomic Bomb Survivors

Yakovlev and Polig (1996) developed a mechanistically motivated stochastic model of radiation carcinogenesis allowing for cell death. The key feature of the model is that it allows for radiation-induced cell killing to compete with the process of tumor promotion. This model describes and explains a wide range of experimental findings documented in the radiobiological literature, including the inverse dose-rate effect and radiation hormesis. The model has successfully been applied to various sets of experimental and epidemiological data to gain quantitative insight into the processes of tumorigenesis induced by radiation and chemical carcinogens. In this paper, we discuss the most recent application of the Yakovlev-Polig model to the analysis of epidemiological data on the mortality caused by radiation-induced leukemia (all types) among the atomic bomb survivors (Hiroshima and Nagasaki). Nonparametric estimates of the hazard function for leukemia latency time were obtained for three different dose groups identified in the Hiroshima cohort. The behavior of these estimates suggests the presence of the hormesis-type effect in relation to leukemia-caused mortality. A parsimonious version of the mechanistic model yields parametric estimates that are in good agreement with their nonparametric counterparts. Using the parametric model, we corroborated the presence of a moderate hormesis effect in the Hiroshima data. However, we have been unable to uncover the same effect with the Nagasaki cohort of the atomic bomb survivors.     

Low-dose ionizing radiation: induction of differential intracellular signalling possibly affecting intercellular communication

Given the complexity of the carcinogenic process and the lack of any mechanistic understanding of how ionizing radiation at low-level exposures affects the multistage, multimechanism processes of carcinogenesis, it is imperative that concepts and paradigms be reexamined when extrapolating from high dose to low dose. Any health effect directly linked to low-dose radiation exposure must have molecular/biochemical and biological bases. On the other hand, demonstrating some molecular/biochemical or cellular effect, using surrogate systems for the human being, does not necessarily imply a corresponding health effect. Given the general acceptance of an extrapolated LNT model, our current understanding of carcinogenesis cries out for a resolution of a real problem. How can a low-level acute, or even a chronic, exposure of ionizing radiation bring about all the different mechanisms (mutagenic, cytotoxic, and epigenetic) and genotypic/phenotypic changes needed to convert normal cells to an invasive, malignant cell, given all the protective, repair, and suppressive systems known to exist in the human body? Until recently, the prevailing paradigm that ionizing radiation brings about cancer primarily by DNA damage and its conversion to gene and chromosomal mutations, drove our interpretation of radiation carcinogenesis. Today, our knowledge includes the facts both that epigenetic events play a major role in carcinogenesis and that low-dose radiation can also induce epigenetic events in and between cells in tissues. This challenges any simple extrapolation of the LNT model. Although a recent delineation of “hallmarks” of the cancer process has helped to focus on how ionizing radiation might contribute to the induction of cancers, several other hallmarks, previously ignored—namely, the stem cells in tissues as targets for carcinogenesis and the role of cell–cell communication processes in modulating the radiation effects on the target cell—must be considered, particularly for the adaptive response, bystander effects, and genomic instability phenomena.     

Multistage models and the incidence of cancer in the cohort of atomic bomb survivors

The analyses in this paper show that a number of biologically based models describe cancer incidence among the A-bomb survivors equally well. However, these different models can predict very different temporal patterns of risk after irradiation. No evidence was found to support the previous claim of Pierce and Mendelsohn that excess cancer risks for the solid tumors depend only upon attained age and not on age at exposure or time since exposure. Although the A-bomb survivor cohort is the largest epidemiological data set for the study of radiation and cancer, it is not large enough to discriminate among various possible carcinogenic mechanisms. Unfortunately for hypothesis generation, the data appear to be consistent with a number of different mechanistic interpretations of the role of radiation in carcinogenesis.     

MiR-21 plays an important role in radiation induced carcinogenesis in BALB/c mice by directly targeting the tumor suppressor gene Big-h3

Dysregulation of certain microRNAs (miRNAs) in cancer can promote tumorigenesis, metastasis and invasion. However, the functions and targets of only a few mammalian miRNAs are known. In particular, the miRNAs that participates in radiation induced carcinogenesis and the miRNAs that target the tumor suppressor gene Big-h3 remain undefined. Here in this study, using a radiation induced thymic lymphoma model in BALB/c mice, we found that the tumor suppressor gene Big-h3 is down-regulated and miR-21 is up-regulated in radiation induced thymic lymphoma tissue samples. We also found inverse correlations between Big-h3 protein and miR-21 expression level among different tissue samples. Furthermore, our data indicated that miR-21 could directly target Big-h3 in a 3'UTR dependent manner. Finally, we found that miR-21 could be induced by TGFβ, and miR-21 has both positive and negative effects in regulating TGFβ signaling. We conclude that miR-21 participates in radiation induced carcinogenesis and it regulates TGFβ signaling.