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Article
March 13, 1991

Diagnostic X-ray Procedures and Risk of Leukemia, Lymphoma, and Multiple Myeloma

Author Affiliations

From the Epidemiology and Biostatistics Program, Division of Cancer Etiology, National Cancer Institute, Bethesda, Md (Drs Boice, Hoover, and Fraumeni and Ms Morin); the Kaiser Permanente Medical Care Program, Portland, Ore (Dr Glass); the Kaiser Permanente Medical Care Program, Oakland, Calif (Dr Friedman); and the M. D. Anderson Cancer Center, Houston, Tex (Ms Stovall).

From the Epidemiology and Biostatistics Program, Division of Cancer Etiology, National Cancer Institute, Bethesda, Md (Drs Boice, Hoover, and Fraumeni and Ms Morin); the Kaiser Permanente Medical Care Program, Portland, Ore (Dr Glass); the Kaiser Permanente Medical Care Program, Oakland, Calif (Dr Friedman); and the M. D. Anderson Cancer Center, Houston, Tex (Ms Stovall).

JAMA. 1991;265(10):1290-1294. doi:10.1001/jama.1991.03460100092031
Abstract

Exposure to diagnostic x-rays and the risk of leukemia, non-Hodgkin's lymphoma (NHL), and multiple myeloma were studied within two prepaid health plans. Adult patients with leukemia (n = 565), NHL (n = 318), and multiple myeloma (n = 208) were matched to controls (n = 1390), and over 25 000 x-ray procedures were abstracted from medical records. Dose response was evaluated by assigning each x-ray procedure a score based on estimated bone marrow dose. X-ray exposure was not associated with chronic lymphocytic leukemia, one of the few malignant conditions never linked to radiation (relative risk [RR], 0.66). For all other forms of leukemia combined (n = 358), there was a slight elevation in risk (RR, 1.17) but no evidence of a dose-response relationship when x-ray procedures near the time of diagnosis were excluded. Similarly, patients with NHL were exposed to diagnostic x-ray procedures more often than controls (RR, 1.32), but the RR fell to 0.99 when the exposure to diagnostic x-ray procedures within 2 years of diagnosis was ignored. For multiple myeloma, overall risk was not significantly high (RR, 1.14), but there was consistent evidence of increasing risk with increasing numbers of diagnostic x-ray procedures. These data suggest that persons with leukemia and NHL undergo x-ray procedures frequently just prior to diagnosis for conditions related to the development or natural history of their disease. There was little evidence that diagnostic x-ray procedures were causally associated with leukemia or NHL. The risk for multiple myeloma, however, was increased among those patients who were frequently exposed to x-rays.

(JAMA. 1991;265:1290-1294)

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