Overview
Radiation exposures occur in controlled circumstances in both medical and occupational settings. We have prioritised research in three relevant populations of patients and medical occupationally exposed individuals: 1) cardiovascular disease (CVD) incidence from occupational radiation exposures (<500 mSv) in nuclear radiation workers; 2) establishing a cohort of medical radiation workers performing high-dose procedures, and 3) cancer and CVD risks following radiotherapy in pediatric and AYA cancer patients.
Theme Lead and Co-Lead: Prof Amy Berrington (ICR), Dr Richard Haylock (UKHSA)
Projects
- Project 1: Cardiovascular disease incidence following low-dose occupational radiation exposure
- Project 2. Exposure levels and health effects among vascular interventionists and nuclear medicine workers
- Project 3. Monitoring the late effects of radiotherapy innovations in paediatric cancer patients
Project Lead: Richard Haylock (UKHSA)
Project Team: Catherine Hinksman (UKHSA), Rosie Hillier (UKHSA), Marta Blangiardo (Imperial), Amy Berrington (ICR)
The National Registry for Radiation Workers (NRRW) is a long-term (50-year) follow-up study of 270,000 industrial radiation workers employed from the 1950s that provides direct evidence about the health risks of low-dose rate radiation exposure. Originally, it focused on estimating risks of cancer based on mortality and cancer registration data. However, in the last 10 years, it has provided the first good evidence of excess risk of circulatory disease mortality, in particular cardiovascular disease (CVD), at low exposure levels.
As for cancers, improving treatments for CVD over the past several decades have meant that the survival time for serious cardiovascular diseases has increased markedly to the extent that many people may die of other causes. As a result, analysis of just CVD mortality data misses the growing number of non-fatal cases. However, unlike for cancers, the UK has no equivalent registration scheme for CVD, which could be used to address this issue.
However, for many CVDs, such as a heart attack, a person is likely to attend a hospital for treatment (either inpatient or outpatient). As a result, hospital episode statistics (HES) data are generated, which can provide information about the illness and the treatment, which could be used in place of formal registration data in statistical analyses. It may also provide information about smoking, an important factor in estimating a person’s baseline rate of CVD.
This project aims to collect HES data for the NRRW retrospectively from the 1990s to the present day and prospectively into the future. These data will be used to identify instances of CVD, which will be analysed to provide the first estimates of CVD incidence risk in the NRRW cohort.
Project Lead: Richard Haylock (UKHSA)
Project Team: Lefteris Livieratos (KCL), Samantha Terry (KCL), Bijan Modarai (KCL)
Recently, concerns have been raised by several publications about radiation health effects among health care workers, such as vascular interventionalists and nuclear medicine workers. To date, there has been no long-term study of these workers similar to that of the industrial workers in the NRRW. When NRRW was set up in the 1970s, it did not include health care workers, as the perception at the time was that the monitoring of the workers' radiation exposure was not sufficiently good to justify their inclusion.
With an improved focus on occupational health and safety, we believe that this has now changed, and in this project, we aim to expand the NRRW to include individually monitored health care workers.
The focus of the work will be to evaluate the health of interventionalists (vascular and cardiology) and nuclear medicine workers in relation to the occupational radiation exposure, with particular attention to younger female operators.
Project Lead: Amy Berrington (ICR)
Project Team: Aislinn Macklin-Doherty (ICR/Royal Marsden Hospital), Imogen Sawyer (ICR funded PhD student), Christophe Badie (UKHSA), PhD student at ICR, Database Manager at ICR
Each year, approximately 2000 children are diagnosed with cancer in England, and they receive a range of treatments including radiotherapy, chemotherapy and immunotherapy. These treatments are continuously evolving with important changes in the last decades, including the introduction of proton therapy and increased use of multi-modal treatment with anthracyclines. With significant improvements in survival, there is a need to understand the long-term effects of these treatments, including the risk of developing a second radiation-related cancer. The impact of the variety of changes in radiotherapy and chemotherapy on long-term side-effects is not yet known, but the NHS national radiotherapy dataset and systemic anticancer dataset provide a unique opportunity to study this question using real-world data.
The National Radiotherapy Dataset (RTDS) was established in England in 2009 to collect consistent and comparable data from all providers of NHS-funded radiotherapy. It contains clinical information on the primary disease being treated, modality and intent of treatment, dose and fractionation. The Systemic Anticancer Dataset (SACT) includes all chemotherapy agents, number of cycles and doses and other treatments was established in 2012 and has been mandatory since 2014. These treatment datasets will be linked to the National Cancer Registration and Hospital Episode Statistics to provide comprehensive treatment and outcome information for all childhood cancer patients in England with an expected cohort of approximately 40,000 patients diagnosed since 2009. Analytical methods will include state-of-the-art causal inference and quantitative bias assessment methodology.
The findings will advance our understanding of the risk of subsequent cancers from modern radiotherapy treatment used for childhood cancer. These results can inform guidelines for surveillance or screening strategies for patients who received these treatments.
