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Cancer Epidemiology, Biomarkers & Prevention
Cancer Epidemiology, Biomarkers & Prevention
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Research Article

Gastrointestinal Cancer Survival and Radiation Exposure among Atomic Bomb Survivors: The Life Span Study

Brandie Bockwoldt, Hiromi Sugiyama, Kevin Tsai, Parveen Bhatti, Alina V. Brenner, Audrey Hu, Kathleen F. Kerr, Eric Morenz, Benjamin French and Amanda I. Phipps
Brandie Bockwoldt
1Department of Epidemiology, University of Washington, Seattle, Washington.
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Hiromi Sugiyama
2Department of Epidemiology, Radiation Effects Research Foundation, Hiroshima and Nagasaki, Japan.
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Kevin Tsai
1Department of Epidemiology, University of Washington, Seattle, Washington.
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Parveen Bhatti
3Cancer Control Research, British Columbia Cancer Research Centre, Vancouver, British Columbia, Canada.
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Alina V. Brenner
2Department of Epidemiology, Radiation Effects Research Foundation, Hiroshima and Nagasaki, Japan.
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Audrey Hu
1Department of Epidemiology, University of Washington, Seattle, Washington.
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Kathleen F. Kerr
4Department of Biostatistics, University of Washington, Seattle, Washington.
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Eric Morenz
4Department of Biostatistics, University of Washington, Seattle, Washington.
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Benjamin French
5Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee.
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Amanda I. Phipps
1Department of Epidemiology, University of Washington, Seattle, Washington.
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  • For correspondence: aiphipps@uw.edu
DOI: 10.1158/1055-9965.EPI-20-1239
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Abstract

Background: Radiation exposure is an established risk factor for the development of several forms of cancer, including gastrointestinal cancers. However, few studies have investigated the relationship between prediagnostic radiation exposure and survival after cancer diagnosis.

Methods: Participants in the Life Span Study (LSS) of atomic bomb survivors who were diagnosed with a first primary invasive stomach, colon, or rectal cancer between 1958 and 2009 were followed for mortality during 1958–2014. Cox regression models were used to calculate HRs and 95% confidence intervals (CI) for associations of radiation dose from atomic bomb exposure with survival (cancer-specific and overall) after cancer diagnosis. Analyses were adjusted for city of primary exposure, sex, age at diagnosis, and year of diagnosis.

Results: We identified 7,728 eligible patients with cancer for analysis. We observed no statistically significant associations between radiation dose and cancer-specific survival among LSS participants with a gastrointestinal cancer. Higher radiation doses (≥1 Gy) were suggestively, but not significantly, associated with modestly poorer cancer-specific survival for colon cancer only (HR, 1.38; 95% CI, 0.90–2.12), and were associated with poorer overall survival regardless of cancer site.

Conclusion: Although radiation exposure is associated with increased risk of gastrointestinal cancer incidence and mortality, study results are inconclusive about an association between prediagnostic radiation exposure and survival after gastrointestinal cancer diagnosis.

Impact: Radiation exposure from the atomic bomb before gastrointestinal cancer diagnosis was not associated with cancer survival, but should be evaluated in relation to survival for other cancer types.

Footnotes

  • Note: Supplementary data for this article are available at Cancer Epidemiology, Biomarkers & Prevention Online (http://cebp.aacrjournals.org/).

  • Cancer Epidemiol Biomarkers Prev 2020;XX:XX–XX

  • Received August 21, 2020.
  • Revision received October 16, 2020.
  • Accepted November 11, 2020.
  • Published first November 16, 2020.
  • ©2020 American Association for Cancer Research.

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This OnlineFirst version was published on December 11, 2020
doi: 10.1158/1055-9965.EPI-20-1239

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Gastrointestinal Cancer Survival and Radiation Exposure among Atomic Bomb Survivors: The Life Span Study
Brandie Bockwoldt, Hiromi Sugiyama, Kevin Tsai, Parveen Bhatti, Alina V. Brenner, Audrey Hu, Kathleen F. Kerr, Eric Morenz, Benjamin French and Amanda I. Phipps
Cancer Epidemiol Biomarkers Prev December 11 2020 DOI: 10.1158/1055-9965.EPI-20-1239

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Gastrointestinal Cancer Survival and Radiation Exposure among Atomic Bomb Survivors: The Life Span Study
Brandie Bockwoldt, Hiromi Sugiyama, Kevin Tsai, Parveen Bhatti, Alina V. Brenner, Audrey Hu, Kathleen F. Kerr, Eric Morenz, Benjamin French and Amanda I. Phipps
Cancer Epidemiol Biomarkers Prev December 11 2020 DOI: 10.1158/1055-9965.EPI-20-1239
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