Overview of epidemiologic studies of radiation and cancer risk based on medical series

Epidemiologic studies of individuals exposed to ionizing radiation for medical reasons have made important contributions to understanding of the relationship between such radiation and subsequent cancer risk. In this paper the strengths and limitations of medical studies are considered and their future potential usefulness is discussed. Studies may be broadly classified into two types, namely, those of individuals exposed for therapeutic purposes such as the study of ankylosing spondylytics and those of individuals exposed for diagnostic or examination purposes such as those of tuberculosis patients routinely examined by chest fluoroscopy. In general, studies of therapeutic exposures tend to involve high doses of radiation given at high dose rates and in a relatively small number of fractions, whereas studies of diagnostic exposures tend to involve relatively low doses, low dose rates and many fractions. However, these generalizations are not always true: for example, in the fluoroscopy studies some patients received doses to organs such as breast and lung which were substantially higher than those experienced in the atomic bomb survivors study and in a study of Israeli children treated with radiation for tinea capitis the average thyroid dose was reported to be low, and only about 0.09 gray. These studies illustrate one of the most important advantages of medical series, namely the variety of such studies in terms of the characteristics of the radiation involved (linear energy transfer characteristics, dose range, dose rate, and fractionation), the organs exposed and hence potentially at risk, and the characteristics of those exposed to such radiation