Non-melanoma skin cancer in relation to ionizing and ultraviolet radiation among radiologic technologists in the United States

Ionizing and ultraviolet (UV) radiations are known to increase the risk of non-melanoma skin cancer. However, the effect of chronic or protracted exposure to ionizing radiation and the modifying effect of UV exposure on skin cancer risk are not well defined. We evaluated risk of basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) of the skin among radiologic technologists in the United States. A total of 1,355 incident cases with BCC and 270 with SCC were ascertained in 65,304 white technologists between the baseline questionnaire survey in 1983-1989 and the follow-up survey in 1994-1998. Analysis by Cox's proportional hazard model, stratified by birth cohort and adjusted for potential confounders including pigmentation characteristics (skin complexion, eye and hair color) and estimated index of residential UV exposure, indicated significantly increased relative risks for BCC, but not for SCC, among early technologists who likely had high radiation exposure. Relative risks of BCC were 1.42 (95% CI: 1.12-1.79), 2.04 (95% CI: 1.44-2.88), and 2.17 (95% CI: 1.14-4.10) among those who first worked in the 1950s, 1940s, and before 1940, respectively (p for trend: <0.01), compared with technologists who first worked after 1960. The effects of ionizing radiation on BCC were not significantly modified by UV exposure (p for effect modification: 0.31), but they were modified by eye and hair color (p=0.01 and 0.03), with light eye or hair color conferring a higher radiation-related risk. In contrast, relative risks of both BCC and SCC significantly increased with increasing residential UV exposure index, and no modifying effects of pigmentation characteristics were observed. This study provides evidence of increased BCC risk associated with chronic, occupational exposure to a low-to-moderate level of ionizing radiation, which may be modified by pigmentation characteristics