Radiation-induced cancer: a modern view

Abstract

Diagnostic medical radiation has been the most rapidly increasing component of population background radiation exposure in Western countries over the past decade. This trend is set to increase as CT scanning is readily available with burgeoning use in everyday clinical practice. Consequently, the issue of cancer induction from the doses received during diagnostic medical exposures is highly relevant. In this review we explain current understanding of potential cancer induction at low doses of sparsely ionising radiation. For cancers that may be induced at low doses, a mechanistic description of radiation-induced cancer is discussed, which, in combination with extrapolation of data based on population cohort studies, provides the basis of the currently accepted linear no-threshold model. We explore the assumptions made in deriving risk estimates, the controversies surrounding the linear no-threshold model and the potential future challenges facing clinicians and policy-makers with regards to diagnostic medical radiation and cancer risk, most notably the uncertainties regarding deriving risk estimates from epidemiological data at low doses.

Figure 1

Schematic representation of different possible extrapolations of measured risks to lower doses. The data points schematically indicate results at the lowest doses for which convincing post-natal, epidemiological cancer dose–response data are available. The curves are extrapolations down to still lower doses, based on in utero data, surrogate in vivo human end point data, mechanistic biophysical models, animal experiments, in vitro experiments and/or computer simulations. Adapted from Brenner et al [35].