Radiation exposure and leukaemia risk among cohorts of persons exposed to low and moderate doses of external ionising radiation in childhood

Mark P. Little*, Richard Wakeford, Lydia B. Zablotska, David Borrego, Keith T. Griffin, Rodrigue S. Allodji, Florent de Vathaire, Choonsik Lee, Alina V. Brenner, Jeremy S. Miller, David Campbell, Mark S. Pearce, Siegal Sadetzki, Michele M. Doody, Erik Holmberg, Marie Lundell, Benjamin French, Michael Jacob Adams, Amy Berrington de González, Martha S. Linet

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Background: Many high-dose groups demonstrate increased leukaemia risks, with risk greatest following childhood exposure; risks at low/moderate doses are less clear. Methods: We conducted a pooled analysis of the major radiation-associated leukaemias (acute myeloid leukaemia (AML) with/without the inclusion of myelodysplastic syndrome (MDS), chronic myeloid leukaemia (CML), acute lymphoblastic leukaemia (ALL)) in ten childhood-exposed groups, including Japanese atomic bomb survivors, four therapeutically irradiated and five diagnostically exposed cohorts, a mixture of incidence and mortality data. Relative/absolute risk Poisson regression models were fitted. Results: Of 365 cases/deaths of leukaemias excluding chronic lymphocytic leukaemia, there were 272 AML/CML/ALL among 310,905 persons (7,641,362 person-years), with mean active bone marrow (ABM) dose of 0.11 Gy (range 0–5.95). We estimated significant (P < 0.005) linear excess relative risks/Gy (ERR/Gy) for: AML (n = 140) = 1.48 (95% CI 0.59–2.85), CML (n = 61) = 1.77 (95% CI 0.38–4.50), and ALL (n = 71) = 6.65 (95% CI 2.79–14.83). There is upward curvature in the dose response for ALL and AML over the full dose range, although at lower doses (<0.5 Gy) curvature for ALL is downwards. Discussion: We found increased ERR/Gy for all major types of radiation-associated leukaemia after childhood exposure to ABM doses that were predominantly (for 99%) <1 Gy, and consistent with our prior analysis focusing on <100 mGy.

Original languageEnglish
Pages (from-to)1152-1165
Number of pages14
JournalBritish Journal of Cancer
Issue number7
StatePublished - 19 Oct 2023


FundersFunder number
National Institutes of Health
U.S. Department of EnergyDE-HS0000031
National Cancer InstituteR01CA197422
National Academy of Sciences
Division of Cancer Epidemiology and Genetics, National Cancer InstituteINtramural Research Program, Intramural Research Program
Ministry of Health, Labour and Welfare


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