© 2001 by Oxford University Press
Journal of the National Cancer Institute, Vol. 93, No. 13, 1021-1027,
July 4, 2001
© 2001 Oxford University Press
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Cancer Mortality After Nasopharyngeal Radium Irradiation in The Netherlands: a Cohort Study
Affiliations of authors: C. M. Ronckers, P. G. Verduijn, Department of Ear-Nose and Throat Medicine, Reinaert Kliniek, Maastricht, The Netherlands; C. E. Land (Radiation Epidemiology Branch), R. B. Hayes (Occupational Epidemiology Branch), Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD; M. Stovall, Department of Radiation Physics, The University of Texas M. D. Anderson Cancer Center, Houston; F. E. van Leeuwen, Department of Epidemiology, The Netherlands Cancer Institute, Amsterdam.
Correspondence to: Cécile M. Ronckers, Department of Epidemiology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands (e-mail: cmronckers{at}worldmail.nl).
Background: Nasopharyngeal radium irradiation (NRI) was used widely from 1940 through 1970 to treat otitis serosa in children and barotrauma in airmen and submariners. We assessed whether NRI-exposed individuals were at higher risk for cancer-related deaths than were nonexposed individuals. Methods: We conducted a retrospective cohort study of all-cause and cancer-related mortality in 5358 NRI-exposed subjects and in 5265 frequency-matched nonexposed subjects, who as children were treated at nine ear, nose, and throat clinics in The Netherlands from 1945 through 1981. We recorded personal and medical data from original patient medical records and assessed vital status through follow-up at municipal population registries. Risk of mortality was evaluated by standardized mortality ratios (SMRs). All statistical tests were two-sided. Results: The average radiation doses were 275, 10.9, 1.8, and 1.5 cGy for the nasopharynx, pituitary, brain, and thyroid, respectively. The median follow-up was 31.6 years. Three hundred two NRI-exposed subjects had died, with 269.2 deaths expected (SMR = 1.1; 95% confidence interval [CI] = 1.0 to 1.3); among nonexposed subjects, 315 died, with 283.5 deaths expected (SMR = 1.1; 95% CI = 0.99 to 1.2). Cancer-related deaths of 96 exposed subjects (SMR = 1.2; 95% CI = 0.95 to 1.4) and 87 nonexposed subjects (SMR = 1.0; 95% CI = 0.8 to 1.3) were documented. There were no excess deaths from cancers of the head and neck area among exposed subjects. However, there were excess deaths from cancers of lymphoproliferative and hematopoietic origin (SMR = 1.9; 95% CI = 1.1 to 3.0), mainly from non-Hodgkin's lymphoma (SMR = 2.6; 95% CI = 1.0 to 5.3). We found no evidence that breast cancer deaths were less than expected (SMR = 1.7; 95% CI = 0.9 to 2.8) in contrast to an earlier study. Conclusions: Our findings do not indicate an increased cancer mortality risk in a population exposed to NRI in childhood. More prolonged follow-up of this and other NRI cohorts is recommended.
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