Radiation-Induced Undifferentiated Pleomorphic Sarcoma after Breast Conserving Therapy: Case Report / Sarcoma Pleomórfico de Mama Radioinduzido Pós-Tratamento Conservador de Câncer de Mama Inicial: Relato de Caso / Sarcoma Pleomórfico de Mama Radioinducido tras Tratamiento Conservador de Cáncer de Mama Inicial: Informe de Caso

Introduction: Breast sarcoma is a rare form of malignancy that arises from connective tissue, comprising less than 5% of all sarcomas. Undifferentiated pleomorphic sarcoma (UPS) of the breast is a rare and aggressive subtype of radiation-induced sarcoma that can occur in treated breast cancer patients. The diagnosis is challenging and often missed due to the low incidence, long latency period, unspecific imaging finding, and difficulties in clinical and histological detection. Case report: A 56-year-old woman was diagnosed with early-stage triple-negative breast cancer in 2013 and underwent breast-conserving therapy (BCT). After five years follow-up, she developed mastalgia and breast induration, and after mammography and ultrasound without suspicious lesions, a magnetic resonance imaging (MRI) was performed and showed a highly suggestive malignancy mass measuring 8.0 cm and invading the chest wall. The core biopsy revealed a spindle cells malignant tumor, negative for pan cytokeratin and most of immuno-histochemical markers, suggesting sarcoma, but requiring investigation of surgical specimen to exclude metaplastic carcinoma. She underwent Halsted radical mastectomy, full-thickness left anterior chest wall resection contemplating segments of the 4th and 5th ribs and reconstruction with synthetic mesh. The surgical specimen evidenced a UPS with clear margins. The patient had good postoperative recovery and remains in follow-up with the mastology team. Conclusion: This report shows that radiation-induced sarcomas of the breast can be difficult to diagnose, and how later treatment can demand a major surgery with higher morbidity. Prognosis may improve if detected early

Introdução: O sarcoma de mama é uma forma rara de câncer que surge do tecido conjuntivo, compreendendo menos de 5% de todos os sarcomas. O sarcoma pleomórfico indiferenciado (SPI) da mama é um subtipo raro e agressivo de sarcoma induzido por radiação que pode surgir em pacientes pós-tratamento conservador de câncer de mama. O diagnóstico é desafiador e, muitas vezes, tardio, em virtude da baixa incidência, longo período de latência, achados de imagem inespecíficos e dificuldades na detecção clínica e histológica. Relato do caso: Paciente do sexo feminino, 56 anos, foi diagnosticada com câncer de mama triplo-negativo estadiamento inicial em 2013 e submetida a tratamento conservador de câncer de mama. Após cinco anos de seguimento, evoluiu com mastalgia e endurecimento mamário e, após mamografia e ultrassonografia sem lesões suspeitas, foi realizada ressonância magnética que evidenciou massa altamente sugestiva de malignidade medindo 8,0 cm com invasão da parede torácica. O resultado da core biopsy revelou um tumor maligno de células fusiformes, negativo para pancitoqueratina e para a maioria dos marcadores imuno-histoquímicos, sugerindo sarcoma, mas exigindo estudo de peça cirúrgica para excluir carcinoma metaplásico. A paciente foi submetida à mastectomia radical de Halsted, ressecção da parede torácica anterior esquerda contemplando segmentos das 4ª e 5ª costelas e reconstrução com tela sintética. O laudo histopatológico da peça cirúrgica evidenciou SPI com margens livres. Evoluiu com boa recuperação pós-operatória, permanecendo em acompanhamento com a equipe de mastologia. Conclusão: O relato de caso ilustra como os sarcomas de mama induzidos por radiação podem ser de difícil diagnóstico e como o tratamento postergado pode exigir uma cirurgia de grande porte com maior morbidade. Estar ciente dessa condição pode melhorar o prognóstico do paciente

Introducción: El sarcoma de mama es una forma rara de cáncer que surge del tejido conectivo y comprende menos del 5% de todos los sarcomas. El sarcoma pleomórfico indiferenciado (SPI) de la mama es un subtipo raro y agresivo de sarcoma inducido por radiación que puede surgir en pacientes después de un tratamiento conservador del cáncer de mama. El diagnóstico es un desafío y, a menudo, se retrasa debido a la baja incidencia, el largo período de latencia, los hallazgos de imagen inespecíficos y las dificultades en la detección clínica e histológica. Informe del caso: Una paciente de 56 años fue diagnosticada de cáncer de mama triple negativo en estadio inicial en 2013 y se sometió a un tratamiento conservador para el cáncer de mama. A los cinco años de seguimiento desarrolló mastalgia y endurecimiento mamario, y tras mamografía y ecografía sin lesiones sospechosas, se realizó una resonancia magnética, que mostró una masa altamente sugestiva de malignidad de 8,0 cm. con invasión de la pared torácica. El estudio anatomopatológico de la lesión mostró un tumor de células fusiformes maligno, negativo para pancitoqueratina y para la mayoría de los marcadores inmuno-histoquímicos, lo que sugería sarcoma, pero requirió un estudio de la pieza quirúrgica para descartar un carcinoma metaplásico. La paciente fue intervenida de mastectomía radical de Halsted, resección de la pared torácica anterior izquierda cubriendo segmentos de las 4ª y 5ª costillas y reconstrucción con malla sintética. El informe histopatológico de la pieza quirúrgica mostró UPS, con márgenes libres. Evolucionó con buena recuperación postoperatoria, permaneciendo en seguimiento con el equipo de mastología. Conclusión: El relato de caso ilustra cómo los sarcomas de mama inducidos por radiación pueden ser difíciles de diagnosticar y cómo el tratamiento tardío puede requerir una cirugía mayor con mayor morbilidad. Ser consciente de esta condición puede mejorar el pronóstico del paciente.Palabras clave: sarcoma; neoplasias de la mama; neoplasias inducidas por radiación; neoplasias primarias secundarias; informes de casos

Evaluation of ionizing radiation as a risk factor for the incidence of breast cancer: long-term analysis after the cesium-137 accident in Goiânia, Brazil. An ecological study

ABSTRACT BACKGROUND: The largest radiological accident to occur in any urban area happened in Goiânia, Brazil, in 1987. OBJECTIVE: To evaluate the association between breast cancer incidence and ionizing radiation levels. DESIGN AND SETTING: Ecological study among residents of the city of Goiânia, Brazil. METHODS: The central region of Goiânia, with seven major sources of contamination from cesium-137, was defined as the study area. The addresses of women diagnosed with breast cancer were identified between 2001 and 2010. The data were geographically referenced and, using census data, the annual averages of crude incidence rates were estimated. The existence of clusters of new cases was ascertained by means of the Moran index. Correlations of radiometric measurements with the incidence were assessed using unconditional linear regression. RESULTS: A total of 4,105 new cases were identified, of which 2,233 were in the study area, and of these, 1,286 (57.59%) were georeferenced. The gross rates of total and referenced cases were 102.91 and 71.86/100,000 women, respectively. These were close to the average for Brazilian state capitals, which is 79.37/100,000 women. The cluster analysis showed slight correlations in three small sets of census tracts, but these were far from the sources of contamination. The scatter plot of points and the R2 value close to zero indicated that there was no association between the variables. CONCLUSION: This study reinforces the hypothesis that the ionizing radiation levels to which women living in Goiânia are now exposed to are not associated with the onset of new cases of breast cancer.

Radiation-induced angiosarcoma: case report / Angiossarcoma induzido por radiação: relato de caso

ABSTRACT Angiosarcoma of the breast accounts for less than 1% of breast tumors. This tumor may be primary or secondary to previous radiation therapy and it is also named "radiogenic angiosarcoma of the breast", which is still a rare entity with a poor prognosis. So far, there are only 307 cases reported about these tumors in the literature. We present a case of a 73-year-old woman with a prior history of breast-conserving treatment of right breast cancer, exhibiting mild pinkish skin changes in the ipsilateral breast. Her mammography was consistent with benign alterations (BI-RADS 2). On incisional biopsy specimens, hematoxylin-eosin showed atypical vascular lesion and suggested immunohistochemisty for diagnostic elucidation. Resection of the lesions was performed and histology showed radiogenic angiosarcoma. The patient underwent simple mastectomy. Immunohistochemistry was positive for antigens related to CD31 and CD34, and C-MYC oncogene amplification, confirming the diagnosis of angiosarcoma induced by breast irradiation. A delayed diagnosis is an important concern. Initial skin changes in radiogenic angiosarcoma are subtle, therefore, these alterations may be confused with other benign skin conditions such as telangiectasia. We highlight this case clinical aspects with the intention of alerting to the possibility of angiosarcoma of the breast in patients with a previous history of adjuvant radiation therapy for breast cancer treatment. Sixteen months after the surgery the patient remains asymptomatic.

RESUMO Os angiossarcomas de mama representam menos de 1% dos tumores da mama e podem ser primários ou secundários à radioterapia prévia. Tais tumores são chamados de "angiossarcomas radiogênicos da mama" e representam uma entidade mais rara ainda e de prognóstico ruim. Atualmente, na literatura, são encontrados apenas 307 casos desses tumores. Relatamos o caso de uma mulher de 73 anos, com história prévia de tratamento conservador de câncer de mama direita, apresentando alteração rósea discreta em pele da mama homolateral. A mamografia demostrou resultado compatível com alterações benignas (BI-RADS 2). No material de biópsia incisional, a hematoxilina-eosina demonstrou lesão vascular atípica e sugeriu imuno-histoquímica para elucidação diagnóstica. A paciente foi submetida à ressecção de lesões, e a histologia demonstrou angiossarcoma radiogênico. Em seguida, mastectomia simples foi realizada. A imuno-histoquímica demonstrou positividade para os antígenos relacionados a CD31 e CD34, e a amplificação do oncogene C-MYC confirmou o diagnóstico de angiossarcoma induzido por radiação mamária. O atraso no diagnóstico constitui questão importante. Considerando que as alterações iniciais da pele do angiossarcoma radiogênico são sutis e podem ser confundidas com outras condições benignas da pele, como telangiectasias, neste relato destacamos os aspectos clínicos, no intuito de alertar sobre a possibilidade de angiossarcoma de mama em pacientes com história prévia de radioterapia adjuvante para tratamento de câncer de mama. A paciente permaneceu assintomática 16 meses após a cirurgia.

Manual de prevención del cáncer de piel inducido por la exposición prolongada a la radiación ultravioleta (RUV). Documento técnico / Manual of prevention of skin cancer induced by prolonged exposure to ultraviolet radiation (UVR). Technical document

El documento técnico contiene las medidas de prevención primaria dirigidas a la población en general, así como a las instituciones públicas y privadas que realicen actividades laborales, educativas, deportivas y recreacionales al aire libre y que implique un riesgo prolongado de exposición evitable a la radiación ultravioleta (RUV)

Radiation-Induced Uterine Carcinosarcoma after Concurrent Chemoradiotherapy for Cervical Squamous Cell Carcinoma

Abstract Objective To describe a case of radiation-induced uterine carcinosarcoma 6 years after a cervical squamous cell carcinoma treatment, which imposed some diagnostic and management challenges. Case Report A 57-year-old woman with a history of pelvic chemoradiotherapy ~ 6.5 years before the event described in this study, following an International Federation of Gynecology and Obstetrics (FIGO) stage IIB cervical cancer, presented with a cervical mass, involving the uterine cavity, the cervical canal and the upper two thirds of the vagina. The biopsy showed a poorly differentiated carcinoma, and a positron emission tomography (PET) scan excluded distant metastasis, although it was unable to define the origin of the tumor as either a new primary malignancy of the endometrium/cervix or as a cervical recurrence. Surgical staging procedure was performed, and the diagnosis was endometrial carcinosarcoma, FIGO stage IIB. The patient was not able to complete the adjuvant therapy, and the progression of the disease was remarkable. Conclusion The present case highlights one of the less common but more serious consequences of radiotherapy for cervical cancer, which has an increasing incidence in younger women, raising concerns about the long-termconsequences of its management.

Carcinoma basocelular. Un reto actual para el dermatólogo / Basal cell carcinoma. An actual challenge for the dermatologist

RESUMEN El carcinoma basocelular es un tumor maligno de origen epitelial, su crecimiento es lento y rara vez metastiza. Este puede producir destrucción local y comprometer extensas áreas de tejido, cartílago y hueso. Existen variantes clínicas e histológicas y constituye el cáncer más frecuente en humanos y su incidencia está en aumento. Se realizó una revisión para exponer los aspectos esenciales sobre factores predisponentes, formas clínicas y diagnóstico, así como las opciones terapéuticas en esta entidad. Se desarrolló una búsqueda en la Biblioteca Virtual de Infomed y Google. Fueron revisados veinticinco trabajos científicos sin limitación de año y país, de los cuales quince pertenecen a los últimos 5 años. El carcinoma basocelular se considera de origen multifactorial, el carcinógeno más importante es la luz ultravioleta. La forma clínica más frecuente es la variedad nodular y la distribución es en cara y cuello. La elección del tratamiento dependerá del tamaño de la lesión, la localización, la edad y estado general del paciente. A pesar de tener baja malignidad y mortalidad, puede ocasionar destrucción y deformidad y repercutir en la vida de los pacientes. El dominio de los factores de riesgo, los elementos para el diagnóstico precoz y las opciones terapéuticas son indispensable para elegir la conducta adecuada frente a la enfermedad y promover cambios en el estilo de vida, que favorezcan la prevención y disminuyan la morbilidad por esta causa (AU).

ABSTRACT Basal cell Carcinoma (BCC) is an epidermal malignant tumor, it has a slow growth and seldom metastases. It can produce local destruction and compromise big tissue areas, cartilage and bone. There are clinical and histological presentations. It is one of the most common cancer in humans and its incidence is increasing. This project’s goal is to expose the essential aspects about the predisposal factors, clinic presentations and diagnoses as well as this disorder’s therapeutic options.This study was made from different bibliographical revisions. The research was developed on Infomed Database and Google. Twenty five Scientific studies were researched without country and/or timeline limit, from whom fifteen belongs to the last 5 years. BCC is considered to have a multifactorial origin, whose most important carcinogen is the ultraviolet light. The most frequent clinical presentation is the nodular and the most common distribution is face and neck. The treatment choice depends on the tumor size, its distribution and the patient’s age and current state. Although it is a low malignancy and low-death rate neoplasia, it can cause tissue destruction and affect patient’s social life. The management of the risk factors, the elements for the early diagnosis and the therapeutic options are indispensable to choose the adequate behavior for the disorder and promote life style changes that favor the prevention and lower the morbidity rate (AU).

Patient Radiation Dose in Neurointerventional Radiologic Procedure: A Tertiary Care Experience / 신경중재치료의학

PURPOSE: Neurointerventional radiology procedures often require a long time to perform. Patient radiation dose is an important issue due to the hazards of ionizing radiation. The objective of this study was to measure the peak skin dose (PSD) and effective dose to estimate the deterministic and stochastic effects of a therapeutic interventional neuroradiologic procedure. MATERIALS AND METHODS: The cumulative dose (CD) and dose area product (DAP) were automatically recorded by a fluoroscopic machine and collected prospectively between April and November 2015. The study included 54 patients who underwent therapeutic neurointerventional radiology procedures. The CD of each patient was used to estimate the peak skin dose and the DAP was also calculated to estimate the effective dose. RESULTS: The average estimated peak skin dose was 1,009.68 mGy. Two patients received radiation doses of more than 2 Gy, which is the threshold that may cause skin complications and radiation-induced cataract. The average effective dose was 35.32 mSv. The majority of patients in this study (85.2%) who underwent therapeutic neurointerventional radiologic procedures received effective doses greater than 20 mSv. CONCLUSION: Not all therapeutic neurointerventional radiology procedures are safe from deterministic complications. A small number of patients received doses above the threshold for skin complications and radiation induced cataract. In terms of stochastic complications, most neurointerventional radiology procedures in this study were quite safe in terms of radiation-induced cancer.

Riscos e benefícios do rastreamento mamográfico no Brasil / Risks and benefits of breast cancer screening in Brazil

As evidências sobre a redução da mortalidade geral com o rastreamento mamográfico são inconclusivas e até hoje nenhum estudo publicado abrangeu todos os danos reconhecidamente associados ao rastreamento para a avaliação do balanço entre riscos e benefícios dessa intervenção. Adicionalmente, os benéficos e riscos do rastreamento variam entre os estados brasileiros, mas essas diferenças nunca foram estudadas. O objetivo do estudo foi estimar os riscos e benefícios do rastreamento mamográfico no Brasil, em termos de óbitos evitados e causados pelo mesmo. Foram construídas 196 tábuas de vida para estimativas de benefícios e 13.440 para estimativas de danos do rastreamento no Brasil e para as 27 Unidades da Federação, para 5 diferentes protocolos de rastreamento mamográfico, com base em dados nacionais de 2012 a 2015. O risco cumulativo de morte por câncer de mama em cada coorte e a redução absoluta na mortalidade com o rastreamento foram calculados. Foram também estimados os danos associados ao rastreamento, incluindo número de falso-positivos, excesso de biópsias, números de casos de sobrediagnóstico e so0bretratamento e mortes por: câncer de mama radioinduzido; por suicídio e cardiovascular associadas ao sobrediagnóstico; mortalidade cirúrgica; síndrome de Stewart-Treves e doença cardiovascular, câncer de pulmão, câncer de esôfago, tromboembolismo pulmonar e sarcoma de mama radioinduzidos pelo sobretratamento com radioterapia adjuvante. A análise de sensibilidade incluiu três cenários diferentes para cada protocolo de rastreamento, além de outras simulações adicionais. No cenário mais provável, a redução do risco absoluto de morte por câncer de mama com o rastreamento bienal de 50 a 69 anos no Brasil foi de 0,23% e, considerando os danos do rastreamento, o benefício líquido foi de 21,2 mortes evitadas por 10 mil convidadas para o rastreamento. O benefício absoluto do rastreamento e o benefício líquido do rastreamento na UF com pior resultado, chegam a ser três vezes e meia menores do que naquela com melhor resultado. O rastreamento anual de 40 a 49 anos provocou 1,2 óbitos por 10 mil convidadas para o rastreamento e, mesmo no cenário mais favorável para a eficácia, a diferença entre óbitos potencialmente evitados e causados foi de 1,48 por 10 mil convidadas, considerando os danos mais prováveis. Nessa faixa etária, a maior causa de óbitos foi a indução de câncer de mama radioinduzido pelas mamografias (70% do total), seguidas pelas doenças cardiovasculares associadas à radioterapia adjuvante (16%), as quais foram a principal causa na faixa de 50 a 69 anos (70% do total), seguidas pelo câncer de pulmão radioinduzido (13%). Os benefícios do rastreamento mamográfico são menores no Brasil ­ e especialmente nas regiões Norte e Nordeste - do que em países europeus. Para reduzir os danos do rastreamento mamográfico no Brasil, e assegurar que o balanço entre riscos e benefícios seja provavelmente favorável, as principais medidas que devem ser adotadas são incentivos para adesão às diretrizes oficiais de faixa etária e população-alvo; a instituição de decisão informada e compartilhada antes da solicitação de rastreamento; implementação de programas nacionais de qualidade em mamografia e de qualidade em radioterapia, além da cessação do tabagismo em pacientes que se submetem à radioterapia adjuvante

Osteosarcoma primario de mama en una paciente con antecedentes de tratamiento radioterápico loco-regional por carcinoma in situ mamario / Primary breast osteosarcoma in a patient with a history of locoregional radiotherapy treatment for breast carcinoma in situ

RESUMEN El cáncer de mama es el tumor más prevalente a nivel mundial entre las mujeres. A pesar de que la supervivencia global alcanza cifras cercanas al 90%, sigue suponiendo un importante problema sanitario y económico para la población. Los sarcomas primarios de mama suponen menos del 1% de estas neoplasias, pero sus tasas de recidiva y mortalidad son elevadas. Dado que no existen pruebas de imagen específicas para el diagnóstico, la confirmación de dicha entidad supone un reto a nivel histopatológico. El tratamiento del osteosarcoma de mama es principalmente quirúrgico, con la extirpación de la tumoración con márgenes adecuados, que será trascendental para el pronóstico de las pacientes. No se ha demostrado que sea necesaria una disección axilar, ni un tratamiento adyuvante estándar de quimioterapia ni radioterapia, salvo casos indicados. Presentamos el caso de una paciente postmenopaúsica que tras haber desarrollado un carcinoma ductal in situ de mama tratado de forma satisfactoria, desarrolla dos años posterior a la finalización del tratamiento radioterápico, y en la misma localización del tumor inicial, un osteosarcoma primario de mama de rápido crecimiento atribuible al efecto de la radioterapia administrada.

ABSTRACT Breast cancer is the most prevalent tumor worldwide among women. Despite the fact that overall survival reaches figures close to 90%, it continues to be an important health and economic problem for the population. Primary breast sarcomas account for less than 1% of these neoplasms but their rates of recurrence and mortality are high. Given that there are no specific imaging tests for diagnosis, confirmation of this entity is a challenge at the histopathological level. The treatment of the OSM is mainly surgical with the removal of the tumor with adequate margins, which will be transcendental for the prognosis of the patients. It has not been demonstrated that an axillary dissection is required, nor a standard adjuvant treatment of chemotherapy or radiotherapy, unless indicated. We present the case of a postmenopausal patient who, after having developed a ductal carcinoma in situ of the breast (DCIS) successfully treated, developed two years after the end of the radiotherapy treatment, and in the same location of the initial tumor, an osteosarcoma primary breast of rapid growth attributable to the effect of radiotherapy administered.

Increased risk of thyroid cancer in female residents nearby nuclear power plants in Korea: was it due to detection bias?

BACKGROUND: The Korea Radiation Effect & Epidemiology Cohort METHODS: Using the KREEC-R raw data, we calculated age standardized rates (ASRs) of female thyroid cancer and re-analyzed the results of survey on the use of medical services. We also marked the administrative districts of residents who received the Radiation Health Research Institute (RHRI) health examinations and those in which thyroid cancer case occurred as per the Chonnam National University Research Institute of Medical Sciences (RIMS) final report on maps where the locations of NPPs and 5 km-radii around them were also indicated. And we compared the incidence rates of Radiation-induced cancer measured between the first period when RHRI health examinations were not yet implemented, and the second period when the RHRI health examinations were implemented. RESULTS: The ASR for the far-distance group, which comprised residents living in areas outside the 30 km radius of the NPPs, increased rapidly after 2000; however, that of the exposed group, which comprised residents living within a 5 km radius of the NPPs, started to increase rapidly even before 1995. The frequencies of the use of medical services were significantly higher in the intermediate proximate group, which comprised residents living within a 5–30 km radius of the NPPs, than in the exposed group in women. In case of female thyroid cancer, the second period ASR was higher than the first period ASR, but in case of female liver cancer and female stomach cancer no significant difference were observed between the periods. On map, many administrative districts of residents who received RHRI health examinations and most administrative districts in which thyroid cancer case occurred on RIMS final report were outside 5 km-radii around NPPs. CONCLUSIONS: We could not find any evidence supporting the assertion that detection bias influenced the increased risks of female thyroid cancer observed in the exposed group of the KREEC-R study, as opposed to the control group.

Lymphangioma secondary to irradiation after mastectomy

Abstract Lymphangioma is a rare benign disease of the lymphatic vessels. Typically, they are primary conditions but may be acquired secondarily, such as those caused by irradiation during radiotherapy for the treatment of breast cancer. The local lymphatic obstruction provoked by irradiation causes the appearance of asymptomatic hyaline vesicles on the irradiated skin. The present report describes a 78-year-old female patient, who initially presented hyaline vesicles that progressed into multiple papules with serous exudation of a yellowish and odorless secretion on the area of chronic radiodermitis in right breast. Despite the rarity of the case, we emphasize the importance of knowledge regarding dermatological disease for early diagnosis and proper medical conduct.

Tomografia computadorizada e risco de neoplasias / Computed tomography and risk of neoplasias

Contexto: Milhões de pessoas são atendidas nas emergências de todo o mundo e bilhões de dólares são gastos nos sistemas de saúde com exames, muitas vezes desnecessários. Dentre estes, o uso da tomografia computadorizada apresenta um crescimento importante nas últimas décadas, gerando preocupação com relação a riscos relacionados à exposição à radiação e custos. Vários autores têm alertado sobre o aumento de neoplasias cerebrais e leucemia principalmente em crianças e as evidências são crescentes, relacionando esse fato à exposição à radiação. Objetivo: Identificar as evidências sobre risco de desenvolvimento de neoplasias relacionados à radiação ionizante com o uso da tomografia computadorizada. Métodos: Revisão narrativa com busca sistematizada, incluindo estudos sobre a relação entre exposição à radiação por meio da tomografia computadorizada e desenvolvimento de neoplasias. Resultados: As doses associadas à tomografia estão entre as maiores na radiologia diagnóstica. Há evidências nos estudos epidemiológicos de que a dose correspondente a um exame tomográfico resulta em aumento do risco de neoplasias. Há estimativas, baseadas em modelos matemáticos, de que esse risco seja em torno de 5%. Nas crianças, estudos mostram associação de tomografia com aumento da incidência de leucemia e tumores cerebrais. Conclusões: Há indução de tumores cerebrais e leucemias em crianças expostas a tomografias. Exames radiológicos, como quaisquer exames, só devem ser pedidos na certeza de que poderão modificar a conduta e beneficiar o paciente. Protocolos clínicos com base nas melhores evidências científicas devem nortear a tomada de decisão.

Prevalence of photoprotection and its associated factors in risk group for skin cancer in Teresina, Piauí

Abstract: Background: The incidence of skin cancer has increased worldwide, particularly melanoma rates, which had a mean development of 2.6 % a year in the last 10 years. The agreement on the relation between long-term or chronic exposure to the sun and the emergence of these neoplasias has made several workers who perform activities exposed to solar radiation to form a risk group for the development of skin cancer, community health agents included. OBJECTIVES: To analyze the prevalence of sunscreen-use-related factors to skin cancer in a labor risk group. METHODOLOGY: Cross-sectional study with community health agents selected through simple random sampling. After collecting data using semi-structured interviews, a descriptive analysis was performed for the qualitative variables, bivariate analysis was employed for checking the association between sunscreen use and sociodemographic, occupational and knowledge about skin variables, and multivariate analysis was conducted to check independent variables associated to sunscreen use. A 5% significance level was used. Results: Of 261 health gents selected, 243 were able to participate in the study. The prevalence rate of sunscreen use was 34.2% (95% CI: 28.2-40.2). Factors associated with sunscreen use were female sex, advanced age, use of sunscreen in situations when the skin got burnt, knowledge of the negative effects of the sun on the skin and skin cancer history. Conclusions: The prevalence found reveals that there is a need for implementing educational strategies in health services regarding photoprotection.

Radiation exposure and thyroid cancer: a review

ABSTRACT The association between radiation exposure and the occurrence of thyroid cancer has been well documented, and the two main risk factors for the development of a thyroid cancer are the radiation dose delivered to the thyroid gland and the age at exposure. The risk increases after exposure to a mean dose of more than 0.05-0.1 Gy (50-100mGy). The risk is more important during childhood and decreases with increased age at exposure, being low in adults. After exposure, the minimum latency period before the appearance of thyroid cancers is 5 to 10 years. Papillary carcinoma (PTC) is the most frequent form of thyroid carcinoma diagnosed after radiation exposure, with a higher prevalence of the solid subtype in young children with a short latency period and of the classical subtype in cases with a longer latency period after exposure. Molecular alterations, including intra-chromosomal rearrangements, are frequently found. Among them, RET/PTC rearrangements are the most frequent. Current research is directed on the mechanism of genetic alterations induced by radiation and on a molecular signature that can identify the origin of thyroid carcinoma after a known or suspected exposure to radiation.

Radiation-related neoplasms, circulatory diseases, and cataracts among radiological technologists

Background: In response to the need for diagnosis and treatment, medical radiation has been increasingly used worldwide. This study investigated the medical utilization of radiation-related diseases among radiological technologists [RTs] and factors that influence such diseases

Materials and Methods: Data were collected from the Taiwan National Health Insurance Research Database. A panel study was conducted with a sample of 3,432 RTs obtained in 2007 and followed up until 2011. Logistic regression applying generalized estimating equations was used for investigating the relationship between RTs and radiation-related diseases

Results: Among the RTs, the annual medical utilization rate of hospitalization for radiation-related neoplasms was 1.17%o-4.43%0, that for circulatory diseases was 4.68%o-11.50%o, and the annual medical utilization rate of outpatient visits for cataracts was 2.91%o-7.38%0. After sex, age, hospital accreditation level, and hospital ownership were controlled, the odds of hospitalization for neoplasms and circulatory diseases among the RTs were nonsignificantly higher than those of pharmacists, and the odds of outpatient visits for cataracts among the RTs were nonsignificantly lower than those of pharmacists

Conclusion: No sufficient evidence exists to substantiate the argument that the exposure of RTs to current doses of radiation could increase the risk of neoplasms, circulatory diseases, and cataracts. Considering the increased use of radiation treatment in current medical facilities, all speculation on occupational radiation-induced diseases must be further investigated and verified

Residential radon and lung cancer: a cohort study in Galicia, Spain / Radón residencial y cáncer de pulmón: un estudio de cohorte en Galicia, España / Radônio residencial e câncer de pulmão: um estudo de coorte na Galícia, Espanha

Case-control studies show an association between residential radon and lung cancer. The aim of this paper is to investigate this association through a cohort study. We designed an ambispective cohort study using the Galician radon map, Spain, with controls drawn from a previous case-control study. Subjects were recruited between 2002 and 2009. The data were cross-checked to ascertain lung cancer incidence and then analysed using a Cox regression model. A total of 2,127 subjects participated; 24 lung cancer cases were identified; 76.6% of subjects were drawn from the radon map. The adjusted hazard ratio was 1.2 (95%CI: 0.5-2.8) for the category of subjects exposed to 50Bq/m3 or more. This risk rose when subjects from the case-control study were analyzed separately. In conclusion, we did not observe any statistically significant association between residential radon exposure and lung cancer; however, it appears that with a sample of greater median age (such as participants from the case-control study), the risk of lung cancer would have been higher.

Los estudios de casos y controles muestran una asociación entre el radón residencial y el cáncer de pulmón. El objetivo del artículo fue investigar esa asociación a través de un estudio de cohorte. Proyectamos un estudio de cohorte ambispectivo, utilizando el mapa de radón de Galicia, España, con los controles obtenidos de un estudio anterior de casos y controles. Los individuos fueron reclutados entre 2002 y 2009. Los datos fueron verificados para confirmar la incidencia de cáncer de pulmón y después analizados con un modelo de regresión de Cox. Participaron un total de 2.127 individuos; se identificaron 24 casos de cáncer de pulmón; un 76,6% de los individuos fueron obtenidos a través del mapa de radón. El hazard ratio ajustado era 1,2 (IC95%: 0,5-2,8) para la categoría de individuos expuestos a 50Bq/m3 o más. El riesgo aumentó cuando los individuos del estudio de casos y controles fueron analizados separadamente. En conclusión, no se observó una asociación estadísticamente significativa entre exposición al radón residencial y cáncer de pulmón; sin embargo, parece que con una muestra con una media de edad más elevada (tales como los participantes del estudio de casos y controles), el riesgo de cáncer de pulmón habría sido más alto.

Estudos de casos e controles mostram uma associação entre radônio residencial e câncer de pulmão. O artigo teve como objetivo investigar essa associação através de um estudo de coorte. Projetamos um estudo ambispectivo coorte, utilizando o mapa de radônio da Galícia, Espanha, com os controles obtidos de um estudo anterior de casos e controles. Os indivíduos foram recrutados entre 2002 e 2009. Os dados foram verificados para confirmar a incidência de câncer de pulmão e depois analisados com um modelo de regressão de Cox. Participaram um total de 2.127 indivíduos; foram identificados 24 casos de câncer de pulmão; 76,6% dos indivíduos foram obtidos através do mapa de radônio. O hazard ratio ajustado era 1,2 (IC95%: 0,5-2,8) para a categoria de indivíduos expostos a 50Bq/m3 ou mais. O risco aumentou quando os indivíduos do estudo de casos e controles foram analisados separadamente. Em conclusão, não foi observada associação estatisticamente significativa entre exposição ao radônio residencial e câncer de pulmão; entretanto, parece que com uma amostra com mediana de idade mais elevada (tais como os participantes do estudo de casos e controles), o risco de câncer de pulmão teria sido mais alto.

Is radioactive iodine- 131 treatment related to the occurrence of non-synchronous second primary malignancy in patients with differentiated thyroid cancer?

Objective Much controversy relates to the risk of non-synchronous second primary malignancies (NSSPM) after radioactive iodine treatment (RAI-131) in differentiated thyroid cancer (DTC) patients. This study evaluated the relationship between RAI-131 and NSSPM in DTC survivors with long-term follow-up. Materials and methods Retrospective analysis of 413 DTC cases was performed; 252 received RAI-131 and 161 were treated with thyroidectomy alone. Exclusion criteria were: prior or synchronous non-thyroidal malignancies (within the first year), familial syndromes associated to multiple neoplasms, ionizing radiation exposure or second tumors with unknown histopathology. Results During a mean follow-up of 11.0 ± 7.5 years, 17 (4.1%) patients developed solid NSSPM. Patients with NSSPM were older than those without (p = 0.02). RAI-131 and I-131 cumulative activity were similar in patients with and without NSSPM (p = 0.18 and p = 0.78, respectively). Incidence of NSSPM was 5.2% in patients with RAI-131 treatment and 2.5% in those without RAI-131 (p = 0.18). Using multivariate analysis, RAI-131 was not significantly associated with NSSPM occurrence (p = 0.35); age was the only independent predictor (p = 0.04). Under log rank statistical analysis, after 10 years of follow-up, it was observed a tendency of lower NSSPM-free survival among patients that received RAI-131 treatment (0.96 vs . 0.87; p = 0.06), what was not affected by age at DTC diagnosis. Conclusion In our cohort of DTC survivors, with a long-term follow-up period, RAI-131 treatment and I-131 cumulative dose were not significantly associated with NSSPM occurrence. A tendency of premature NSSPM occurrence among patients treated with RAI-131 was observed, suggesting an anticipating oncogenic effect by interaction with other risk factors.

Estimates of Radiation Doses and Cancer Risk from Food Intake in Korea

The aim of this study was to estimate internal radiation doses and lifetime cancer risk from food ingestion. Radiation doses from food intake were calculated using the Korea National Health and Nutrition Examination Survey and the measured radioactivity of 134Cs, 137Cs, and 131I from the Ministry of Food and Drug Safety in Korea. Total number of measured data was 8,496 (3,643 for agricultural products, 644 for livestock products, 43 for milk products, 3,193 for marine products, and 973 for processed food). Cancer risk was calculated by multiplying the estimated committed effective dose and the detriment adjusted nominal risk coefficients recommended by the International Commission on Radiation Protection. The lifetime committed effective doses from the daily diet are ranged 2.957-3.710 mSv. Excess lifetime cancer risks are 14.4-18.1, 0.4-0.5, and 1.8-2.3 per 100,000 for all solid cancers combined, thyroid cancer, and leukemia, respectively.