| Ionizing Radiation and Chronic Lymphocytic Leukemia David B. Richardson,1 Steve Wing,1 Jane Schroeder,1 Inge Schmitz-Feuerhake,2 and Wolfgang Hoffmann3 1Department of Epidemiology, School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA; 2Department of Physics (retired), University of Bremen, Germany; 3Institute for Community Medicine, Division of Health Care Epidemiology and Community Health, Ernst-Moritz-Arndt-University Greifswald, Greifswald, Germany Abstract
The U.S. government recently implemented rules for awarding compensation to individuals with cancer who were exposed to ionizing radiation while working in the nuclear weapons complex. Under these rules, chronic lymphocytic leukemia (CLL) is considered to be a nonradiogenic form of cancer. In other words, workers who develop CLL automatically have their compensation claim rejected because the compensation rules hold that the risk of radiation-induced CLL is zero. In this article we review molecular, clinical, and epidemiologic evidence regarding the radiogenicity of CLL. We note that current understanding of radiation-induced tumorigenesis and the etiology of lymphatic neoplasia provides a strong mechanistic basis for expecting that ionizing radiation exposure increases CLL risk. The clinical characteristics of CLL, including prolonged latency and morbidity periods and a low case fatality rate, make it relatively difficult to evaluate associations between ionizing radiation and CLL risk via epidemiologic methods. The epidemiologic evidence of association between external exposure to ionizing radiation and CLL is weak. However, epidemiologic findings are consistent with a hypothesis of elevated CLL mortality risk after a latency and morbidity period that spans several decades. Our findings in this review suggest that there is not a persuasive basis for the conclusion that CLL is a nonradiogenic form of cancer. Key words: chronic lymphocytic leukemia, compensation, ionizing radiation, radiogenicity. Environ Health Perspect 113: 1-5 (2005) . doi:10.1289/ehp.7433 available via http://dx.doi.org/ [Online 21 October 2004]
Address correspondence to D. Richardson, Department of Epidemiology, School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-8050 USA. Telephone: (919) 966-2675. Fax: (919) 966-6650. E-mail: david_richardson@unc.edu The authors declare they have no competing financial interests. Received 20 July 2004 ; accepted 21 October 2004.
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