Effect of radiation exposure on survival after first solid cancer diagnosis in A-bomb survivors

• Published in: Cancer Epidemiology Vol. 83; p. 102341
• Main Authors: Sposto, Richard, Sugiyama, Hiromi, Tsuruyama, Tatsuaki, Brenner, Alina V.
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 01.04.2023; Elsevier BV; Elsevier Limited; Elsevier
• Subjects: 60 APPLIED LIFE SCIENCES; A-bomb radiation; Atomic Bomb Survivors; Atomic bombs; Cancer; Classification; Death; Diagnosis; Dosimetry; Epidemiology; Estimates; Humans; Hypotheses; Incidence; Japan; Japan - epidemiology; Life span; Medical diagnosis; Mortality; Neoplasms, Radiation-Induced; Neoplasms, Radiation-Induced - etiology; Nuclear weapons; Post-diagnosis survival; Radiation; Radiation Exposure; RADIATION, THERMAL, AND OTHER ENVIRON. POLLUTANT EFFECTS ON LIVING ORGS. AND BIOL. MAT; Regression analysis; Risk; Survival; Japan; Post-diagnosis survival; A-bomb radiation; Cancer
• ISSN: 1877-7821; 1877-783X; 1877-783X
• DOI: 10.1016/j.canep.2023.102341

Comparison of the estimated effect of atomic bomb radiation exposure on solid cancer incidence and solid cancer mortality in the RERF Life Span Study (LSS) reveals a difference in the magnitude and shape of the excess relative risk dose response. A possible contributing factor to this difference is pre-diagnosis radiation effect on post-diagnosis survival. Pre-diagnosis radiation exposure theoretically could influence post-diagnosis survival by affecting the genetic makeup and possibly aggressiveness of cancer, or by compromising tolerance for aggressive treatment for cancer. We analyze the radiation effect on post-diagnosis survival in 20,463 LSS subjects diagnosed with first-primary solid cancer between 1958 and 2009 with particular attention to whether death was caused by the first-primary cancer, other cancer, or non-cancer diseases. From multivariable Cox regression analysis of cause-specific survival, the excess hazard at 1 Gy (EH1Gy) for death from the first primary cancer was not significantly different from zero – p = 0.23, EH1Gy = 0.038 (95 % CI: −0.023, 0.104). Death from other cancer and death from non-cancer diseases both were significantly associated with radiation dose: other cancer EH1Gy = 0.38 (95 % CI: 0.24, 0.53); non-cancer EH1Gy = 0.24 (95 % CI: 0.13, 0.36), both p < 0.001. There is no detectable large effect of pre-diagnosis radiation exposure on post-diagnosis death from the first primary cancer in A-bomb survivors. A direct effect of pre-diagnosis radiation exposure on cancer prognosis is ruled out as an explanation for the difference in incidence and mortality dose response in A-bomb survivors. •Analysis of survival of 20,000 + atomic bomb survivors diagnosed with solid cancer.•A-bomb radiation exposure prior to a cancer diagnosis does not influence survival from the primary diagnosed cancer.•A-bomb radiation exposure prior to cancer diagnosis does influence survival for non-primary cancer death causes.•Radiation influence on solid cancer prognosis does not contribute to the difference in mortality and incidence dose response.