Medical diagnostic X-rays are an important source of ionizing radiation (IR) exposure in the general population; however, it is unclear if the resulting low patient doses increase lymphoma risk. We examined the association between lifetime medical diagnostic X-ray dose and lymphoma risk, taking into account potential confounding factors, including medical history. The international Epilymph study (conducted in the Czech-Republic, France, Germany, Ireland, Italy, and Spain) collected self-reported information on common diagnostic X-ray procedures from 2,362 lymphoma cases and 2,465 frequency-matched (age, sex, country) controls. Individual lifetime cumulative bone marrow (BM) dose was estimated using time period-based dose estimates for different procedures and body parts. The association between categories of BM dose and lymphoma risk was examined using unconditional logistic regression models adjusting for matching factors, socioeconomic variables, and the presence of underlying medical conditions (atopic, autoimmune, infectious diseases, osteoarthritis, having had a sick childhood, and family history of lymphoma) as potential confounders of the association. Cumulative BM dose was low (median 2.25 mGy) and was not positively associated with lymphoma risk. Odds ratios (ORs) were consistently less than 1.0 in all dose categories compared to the reference category (less than 1 mGy). Results were similar after adjustment for potential confounding factors, when using different exposure scenarios, and in analyses by lymphoma subtype and by type of control (hospital-, population-based). Overall no increased risk of lymphoma was observed. The reduced ORs may be related to unmeasured confounding or other sources of systematic bias.We found little evidence that chronic medical conditions confound lymphoma risk and medical radiation associations.

Barcelona Institute for Global Health Barcelona Spain

Cancer Epidemiology and Genetics Masaryk Memorial Cancer Institute and MF MU Brno Czech Republic

Centre of Chronic Immunodeficiency Molecular Epidemiology University Medical Center Freiburg Freiburg Germany

CIBER Epidemiología y Salud Pública Madrid Spain

Department of Public Health Clinical and Molecular Medicine Occupational Health Section University of Cagliari Cagliari Italy

IARC International Agency for Research on Cancer Lyon France

McLaughlin Centre for Population Health Risk Assessment University of Ottawa Ottawa Canada

Registre des Hémopathies Malignes de Côte d'Or INSERM U 1231 Université de Bourgogne Franche Comté et CHU Dijon Bourgogne Dijon France

School of Nursing and Human Science Dublin City University Glasnevin Dublin Ireland

Tisch Cancer Institute and Institute for Translational Epidemiology Icahn School of Medicine at Mount Sinai New York NY United States of America

Unit of Infections and Cancer Cancer Epidemiology Research Programme IDIBELL Catalan Institute of Oncology Barcelona Spain

Universitat Pompeu Fabra Barcelona Spain

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PLoS One. 2020 Dec 1;15(12):e0243396. doi: 10.1371/journal.pone.0243396. PubMed

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