Research Paper on Association Between Leukemia and Chronic External Exposure to Ionizing Radiation

Introduction

The research question posed in the present study is of vital public health significance because it provides an in-depth understanding of the association between leukemia and chronic external exposure to ionizing radiation (Metz-Flamant, Samson, Caer-Lorho, Acker, & Laurier, 2012). Understanding this association is useful in efforts to protect the workers from exposure to the ionizing radiations.

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Local Significance/Global Impact of the Study

This study is not only of local importance but also of global significance. It is worth noting that countries across the world are starting to embrace nuclear energy. For instance, World Nuclear Organization (2018) has reported that nearly 30 countries are considering, planning or starting nuclear power alternatives with an addition of 20 states also considering the same in the next few years. Consequently, it is necessary to understand the risks, such as cancer risks, posed by ionizing radiations that can emanate from nuclear plants. Understanding the association between ionizing radiation and cancer is helpful in establishing mitigation strategies.

Does the Study Fill an Important Gap, In Your Opinion? Why or Why Not?

I believe that the study fills an essential gap in the literature. This is because unlike in the past studies, compared to a previous research carried out by Telle-Lamberton et al. (2007), the current investigation had a 20% larger cohort and a longer follow-up duration (an additional 10 years), thus improving on the sample size limitation and shorter follow-up period limitations of past studies. Also, Metz-Flamant et al. (2012) improved on the previous studies by utilizing more robust approaches of quantifying dose-response relationship.

Critique of The Methodology and What I Would Have Done Differently

In the current study, the researcher's utilized cohort longitudinal study to examine the association between exposure to ionizing radiation and cancer. The researchers chose a longitudinal study to address the purpose of their research because this methodology is useful in the evaluation of the association between risk factors and the development of disease over an extended time (Caruana, Roman, Hernandez-Sanchez, & Solli, 2015). Also, a cohort study was chosen because of it enables researchers to follow groups of people for a prolonged time with the aim of investigating the causes of a specific disease, thus allowing the investigators to establish the association between risk factors and outcomes (Ahn, 2016). Even though I would have utilized a cohort longitudinal study too, I would have incorporated a comparison or a control group of individuals not working in nuclear plants. This is useful in establishing cause-effect relationships.

Interpretation of the Results

Prolonged exposure to ionizing radiations is linked to increased risk of all types of cancers, except chronic lymphatic leukemia. The risk of developing cancer also increases with exposure to higher doses of ionizing radiations. I agree with the author's interpretation of the findings because they are based on results obtained from robust statistical analysis techniques. Additionally, the researchers interpreted their findings considering the findings of past studies.

The Social Change Impact of the Findings

These findings have crucial social change impacts. For instance, based on these findings, it is vital to protect the workers from harmful exposure to ionizing radiations with the aim of reducing their risk of developing cancers. Protecting workers from ionizing radiations can be achieved by ensuring that all workers have access to protective clothing to curb against radiations (Canadian Nuclear Safety Commission, 2016). Also, there is a need to lower the current radiation protection limit of 20 mSv per year with the aim of reducing the prevalence of cancer in workers working in high-risk environments.

Modifiability/Actionability of the Outcomes of the Study

I believe the outcomes of this study are actionable and modifiable because of several reasons. First, the outcomes of the research are transferable to real-world settings or working environments because they are relevant to the day-to-day running of industries or plants which release ionizing radiations. Also, the study has been conducted using robust research methodologies hence the outcomes can be trusted.

What Would You Propose as A Reasonable Action From The Findings, And Why?

I propose that the current the current radiation protection limit of 20 mSv per year should be lowered with the aim of reducing cancer-related deaths arising from exposure to ionizing radiations. Secondly, I propose that there needs to be frequent health check on the workers to establish the levels of ionizing radiation exposure and appropriate action taken to combat any further increase. Lastly, I propose that industries should provide their workers with protective clothing to cushion them from ionizing radiation.

How Might the Precautionary Principle Apply to this Study?

The precautionary principle states that when an activity is likely to have negative impacts on the environment or the health of individuals, preventive measures should be put in place if causal associations have not been fully established scientifically. Because there exist conflicting results regarding the causal relationship between chronic ionizing radiation and leukemia, there should be a regulation about the levels or limits of exposure of workers to the radiations. Where possible, radiation should be limited below the level at which no adverse effect has been found or reported.

Recent Studies

The findings of the study revealed that exposure to chronic ionizing radiation increases the risk of developing leukemia, except for chronic lymphatic leukemia, by 8% per 10 mSv (Metz-Flamant et al., 2012). Also, exposure to higher doses of ionizing radiation, such as 20 mSv per annum, further increased the risk of contracting leukemia (Metz-Flamant et al., 2012). These findings have been supported by more recent studies. For instance, a study conducted by Leuraud et al. (2015) aimed at quantifying the associations between prolonged low-dose radiation exposures and multiple myelonoma, lymphoma, and leukemia mortality among adults monitored for radiation in the US, UK, and France established that there is protracted exposure to low-dose radiation is strongly and positively linked to leukemia. Specifically, exposure to low doses of radiation throughout two years resulted in an excess relative risk of leukemia mortality by 296 per Gy. Also, Radivoyevitch, Sachs, Gale, Smith, and Hill (2016) found a significant relationship between ionizing radiation and chronic lymphocytic leukemia.

Additionally, like in Metz-Flamant et al. (2012), Leuraud et al. (2015) found no statistically significant association between prolonged exposure to low-dose ionizing radiation and chronic lymphatic leukemia. However, chronic myeloid leukemia mortality increased with extended exposure to ionizing radiation (Leuraud et al., 2015). However, Metz-Flamant et al.'s (2012) study results are not supported by Richardson et al.'s (2015) findings. Even though Richardson et al. (2015) found a positive correlation between exposure to radiation and all cancers, the researchers reported that the risk of mortality from leukemia did not increase with increased exposure to radiation. Similarly, unlike Metz-Flamant et al.'s (2012) study, Schubauer-Berigan, Daniels, Bertke, Tseng, and Richardson (2015) found no association between external ionizing radiation and leukemia.

How Other Studies Affect My Assessment of The Significance and Interpretation Of This Study

The findings of other studies, especially those which have established a cause-effect relationship between exposure to ionizing radiation and cancer, reinforces my evaluation of the significance of the study. I believe that because the findings have been supported by more recent studies, the results of this study are valid, and its practical implications should be adopted.

References

Ahn, C. (2016). Chapter 19 - Biostatistics Used for Clinical Investigation of Coronary Artery Disease. In W. S. Aronow & J. A. McClung (Eds.), Translational Research in Coronary Artery Disease (pp. 215-221). Boston: Academic Press.

Canadian Nuclear Safety Commission (2016). Protecting workers. Retrieved from https://nuclearsafety.gc.ca/eng/resources/radiation/introduction-to-radiation/protecting-workers.cfm

Caruana, E. J., Roman, M., Hernandez-Sanchez, J., & Solli, P. (2015). Longitudinal studies. Journal of Thoracic Disease, 7(11), E537-E540. https://doi.org/10.3978/j.issn.2072-1439.2015.10.63

Leuraud, K., Richardson, D. B., Cardis, E., Daniels, R. D., Gillies, M., O'Hagan, J. A., ... Kesminiene, A. (2015). Ionising radiation and risk of death from leukaemia and lymphoma in radiation-monitored workers (INWORKS): an international cohort study. The Lancet Haematology, 2(7), e276-e281.

Metz-Flamant, C., Samson, E., Caer-Lorho, S., Acker, A., & Laurier, D. (2012). Leukemia risk associated with chronic external exposure to ionizing radiation in a French cohort of nuclear workers. Radiation Research, 178(5), 489-498.

Radivoyevitch, T., Sachs, R. K., Gale, R. P., Smith, M. R., & Hill, B. T. (2016). Ionizing radiation exposures in treatments of solid neoplasms are not associated with subsequent increased risks of chronic lymphocytic leukemia. Leukemia Research, 43, 9-12.

Richardson, D. B., Cardis, E., Daniels, R. D., Gillies, M., O'Hagan, J. A., Hamra, G. B., ... Kesminiene, A. (2015). Risk of cancer from occupational exposure to ionising radiation: retrospective cohort study of workers in France, the United Kingdom, and the United States (INWORKS). BMJ, 351, h5359.

Schubauer-Berigan, M. K., Daniels, R. D., Bertke, S. J., Tseng, C.-Y., & Richardson, D. B. (2015). Cancer Mortality through 2005 among a Pooled Cohort of U.S. Nuclear Workers Exposed to External Ionizing Radiation. Radiation Research, 183(6), 620-631.

Telle-Lamberton, M., Samson, E., Caer, S., Bergot, D., Bard, D., Bermann, F., ... Metz-Flamant, C. (2007). External radiation exposure and mortality in a cohort of French nuclear workers. Occupational and Environmental Medicine. Retrieved from https://oem.bmj.com/content/early/2007/05/23/oem.2007.032631.short

World Nuclear Organization (2018). Emerging world nuclear countries. Retrieved from http://www.world-nuclear.org/information-library/country-profiles/others/emerging-nuclear-energy-countries.aspx