Re: Comment to "Relationship between exposure to ionizing radiation and mesothelioma risk: A systematic review of the scientific literature and meta-analysis": Cancer Med. 2022 Feb;11(3):778-789. doi: 10.1002/cam4.4436. Epub 2022 Jan 14: Cancer Med. 2022 Feb;11(3):778-789. doi: 10.1002/cam4.4436. Epub 2022 Jan 14

Our plain-English summary of Re: Comment to "Relationship between exposure to ionizing radiation and mesothelioma risk: A systematic review of the scientific literature and meta-analysis": Cancer Med. 2022 Feb;11(3):778-789. doi:10.1002/cam4.4436. Epub 2022 Jan 14: Cancer Med. 2022 Feb;11(3):778-789. doi:10.1002/cam4.4436. Epub 2022 Jan 14, by G. Visci, C. Zunarelli, P. Boffetta, et al (Cancer Medicine, 2022).

The study

• Authors: G. Visci, C. Zunarelli, P. Boffetta, F. Violante
• Journal: Cancer Medicine
• Published: 2022;11(24):5035-5036
• Type of article: Letter, Comment
• Read it: PubMed · Publisher · Free full text

In plain English

This letter to the editor updated the authors' own 2022 systematic review and meta-analysis of ionizing radiation and mesothelioma risk. The authors added a study by Mumma and coworkers of 253,632 United States workers monitored for external radiation and followed from 1969 through 2011. As the letter describes it, that study reported 421 mesothelioma deaths and a standardized mortality ratio (SMR) of 6.10 (95% CI 5.53 to 6.71). The excess was seen among shipyard workers (SMR 9.97; 95% CI 8.50 to 11.63) and nuclear power plant workers (SMR 5.55; 95% CI 4.88 to 6.29). It was not seen among industrial radiographers who had not worked at a nuclear power plant or shipyard (SMR 1.15; 95% CI 0.53 to 2.19). With this sixth cohort added, the authors' pooled relative risk was 4.43 (95% CI 2.77 to 7.09), compared with 3.57 (95% CI 2.16 to 5.89) originally. The authors concluded that their earlier finding of increased mesothelioma risk in these workers was unchanged. However, because the excess in the new cohort was confined to workers with possible concomitant asbestos exposure, they suggested caution in attributing it to ionizing radiation.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Letter to the editor reporting an updated meta-analysis (the authors' earlier systematic review and meta-analysis repeated with one additional cohort study added)
• Who was studied: The added cohort, from a separate study by Mumma and coworkers, was 253,632 United States workers routinely monitored for external radiation. These were 30,724 industrial radiographers at shipyards, 142,583 nuclear power plant workers, and 83,441 industrial radiographers who had not worked at a nuclear power plant or shipyard. They were followed from 1969 through 2011. This cohort became the sixth in the authors' pooled analysis.
• Exposure: Occupational ionizing radiation; in the added cohort the mean cumulative lung dose was 28.6 mGy. Shipyard and nuclear power plant workers had concomitant potential asbestos exposure (no fiber type stated).
• Main results:
  • In the added cohort (as reported by Mumma and coworkers), 421 mesothelioma deaths were observed among all 253,632 workers. The overall SMR was 6.10 (95% CI 5.53 to 6.71).
  • In the added cohort, mesothelioma mortality was increased among shipyard workers (SMR 9.97; 95% CI 8.50 to 11.63) and nuclear power plant workers (SMR 5.55; 95% CI 4.88 to 6.29).
  • In the added cohort, mesothelioma mortality was not increased among industrial radiographers who had not worked at a nuclear power plant or shipyard (SMR 1.15; 95% CI 0.53 to 2.19).
  • The authors' updated meta-analysis including the sixth cohort gave a pooled relative risk of 4.43 (95% CI 2.77 to 7.09). Their original meta-analysis had given a pooled relative risk of 3.57 (95% CI 2.16 to 5.89).
• The authors' conclusion: The authors concluded that adding the sixth cohort did not change their previous conclusion that workers exposed to ionizing radiation experienced an increased risk of mesothelioma. They also said the pattern in the new cohort suggests caution in attributing the excess risk to occupational ionizing radiation.
• Limitations the authors state:
  • In the added cohort, the increased risk was restricted to workers with concomitant potential asbestos exposure (nuclear power plant and shipyard workers). It was not seen in radiation-exposed workers without asbestos exposure, which the authors said suggests caution in attributing the excess mesothelioma risk to ionizing radiation.

Topics

Medical terms in this study, explained in our Lexicon: Mesothelioma, Systematic Review, Meta-Analysis.

Related studies

• Relationship between exposure to ionizing radiation and mesothelioma risk: A systematic review of the scientific literature and meta-analysis — G. Visci, E. Rizzello, et al. (2022)
• Ionizing radiation: a risk factor for mesothelioma — J.E. Goodman, M.A. Nascarella, et al. (2009)
• A nested case-control study of lung cancer risk and ionizing radiation exposure at the portsmouth naval shipyard — J.H. Yiin, S.R. Silver, et al. (2007)
• The association between occupational asbestos exposure with the risk of incidence and mortality from prostate cancer: a systematic review and meta-analysis — A. Godono, M. Clari, et al. (2022)
• Risk of mesothelioma after cessation of asbestos exposure: a systematic review and meta-regression — P. Boffetta, F. Donato, et al. (2019)
• Risk of Mortality from Respiratory Malignant and Non-Malignant Diseases among Talc Miners and Millers: A Systematic Review and Meta-Analysis — C. Ciocan, A. Godono, et al. (2022)

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