Michele Doody - Academia.edu (original) (raw)

Papers by Michele Doody

International journal of obesity (2005), 2006

To investigate whether the nature of the relationship between body mass index (BMI (kg/m2)) and a... more To investigate whether the nature of the relationship between body mass index (BMI (kg/m2)) and all-cause mortality is direct, J- or U-shaped, and whether this relationship changes as people age. Prospective nationwide cohort study of US radiologic technologists (USRT). Sixty-four thousand seven hundred and thirty-three female and 19 011 male certified radiation technologists. We prospectively followed participants from the USRT study who completed a mail survey in 1983-1989 through 2000. During an average of 14.7 years of follow-up or 1.23 million person-years, 2278 women and 1495 men died. Using Cox's proportional-hazards regression analyses, we analyzed the relationship between BMI and all-cause mortality by gender and by age group (<55 years; > or = 55 years). We also examined risk in never-smokers after the first 5 years of follow-up to limit bias owing to the confounding effects of smoking and illness-related weight loss on BMI and mortality. Risks were generally J-s...

Radiation Research, 2007

Retrospective Biodosimetry among United States Radiologic Technologists. Radiat. Res. 167, 727-73... more Retrospective Biodosimetry among United States Radiologic Technologists. Radiat. Res. 167, 727-734 (2007).

Annals of Epidemiology, 2004

PURPOSE: The incidence of hypertension in black women is two to three times that in white women. ... more PURPOSE: The incidence of hypertension in black women is two to three times that in white women. This discrepancy is largely unexplained by known risk factors such as family history, physical inactivity, smoking, and obesity. It has been proposed that chronic social and environmental stress, related to neighborhood of residence, may be associated with increased rates of hypertension in African Americans. METHODS: We examined the relationship between neighborhood socioeconomic status (SES) and the incidence of hypertension using data from the Black Women's Health Study, a follow-up of 59,000 black women 21 to 69 years of age at entry in 1995. Block groups from the 2000 U.S. Census were used as proxies for neighborhood. A summary score for neighborhood SES was constructed from block group variables on education and wealth. Incident cases of hypertension were identified through follow-up postal questionnaires in 1997, 1999, and 2001. Clustered survival regression models were used to estimate incidence rate ratios (IRR). RESULTS: There were 3633 cases of self-reported hypertension among 183,207 person-years of observation from 1995 to 2001. The IRR for women living in low-SES neighborhoods relative to high-SES neighborhoods was 1.30 (95% confidence interval CI Z 1.17-1.45) after adjusting for individual risk factors. The association was even stronger among younger women (IRR Z 1.53; 95% CI Z 1.18-1.97), women with low body mass index (IRR Z 1.79; 95% CI Z 1.41-2.29), the most educated women (IRR Z 1.32; 95% CI Z 1.12-1.54), and those who exercised regularly (IRR Z 1.56; 95% CI Z 1.09-2.23). CONCLUSION: Our findings indicate that neighborhood SES is strongly associated with the risk of hypertension, and that this is the case even among well-educated black women, thin black women, and black women who exercise regularly.

Annals of Epidemiology, 2001

To determine whether causes of death obtained through National Death Index (NDI) Plus are compara... more To determine whether causes of death obtained through National Death Index (NDI) Plus are comparable to those obtained by requesting death certificates from state vital statistics offices and having deaths coded by contractor nosologists. The authors compared underlying cause of death codes obtained from NDI Plus with those assigned by contractor nosologists for a sample of 250 known decedents. The underlying cause of death codes differed for 18 (7%) of 249 successful matches. Independent coding by an expert National Center for Health Statistics (NCHS) nosologist trainer revealed that seven of these had an NDI Plus code that matched the code provided by the NCHS nosologist and a contractor nosologist code that did not match the NCHS nosologist code, seven had a contractor nosologist code that matched the NCHS nosologist code and an NDI Plus code that did not match the NCHS nosologist code, and four had both an NDI Plus and a contractor nosologist code that did not match the NCHS nosologist code. The level of disagreement with the NCHS nosologist and the organ systems involved were similar for NDI Plus and the contractor nosologist. The authors report that NDI Plus provides comparable information within a substantially shorter time period for most states and, for known decedents, at about half the cost of standard procedures.

American Journal of Industrial Medicine, 2000

Several studies have shown that Catholic nuns have a different mortality experience than women of... more Several studies have shown that Catholic nuns have a different mortality experience than women of similar age in the general population. We had a unique opportunity to evaluate mortality patterns of nuns identified in an occupational study of nearly 145,000 radiologic technologists (73% female). A total of 1,103 women were classified as nuns based on their titles of &amp;amp;amp;amp;amp;amp;quot;Sister&amp;amp;amp;amp;amp;amp;quot; or &amp;amp;amp;amp;amp;amp;quot;SR&amp;amp;amp;amp;amp;amp;quot;. Their mortality experience was compared to other female radiologic technologists and to U.S. white females. Five hundred eighty-three nuns (53%) were deceased as of January 1, 1995. Compared to other technologists, nuns were at significantly increased risk of dying from all causes (Standardized mortality ratio (SMR)=1.1; 95% Confidence interval (CI)=1.0-1.2, stomach cancer (SMR=2.7; 95% CI=1.2-5.4), diabetes (SMR=2.2; 95% CI=1.0-4.1), ischemic heart disease (SMR=1.2; 95% CI=1.1-1.4), all digestive diseases (SMR=2.0; 95% CI=1.3-3.0), and gastric and duodenal ulcers (SMR=8.3; 95% CI=2.3-21.3). In contrast, we observed a significant deficit in lung cancer (SMR=0.5; 95% CI=0.2-0.9), no deaths from cervical cancer, and a breast cancer risk 10% lower than expected (SMR=0.9; 95% CI=0.6-1.3). When compared to U.S. females, nuns experienced significantly reduced mortality from all causes (SMR=0.8; 95% CI=0.7-0.9), cervical cancer (SMR=0.0; 95% CI=0.0-0.7), all endocrine, metabolic and nutritional diseases (SMR=0.5; 95% CI=0.3-0.9), all circulatory diseases (SMR=0.7; 95% CI=0.7-0.8) including ischemic heart disease and cerebrovascular disease, and all respiratory diseases (SMR=0.5; 95% CI=0.3-0.8), and a nearly significant deficit of diabetes (SMR=0.6; 95% CI=0.3-1.0). In contrast, nuns had an almost 3-fold greater risk of tuberculosis (SMR=2.9; 95% CI=1.4-5.3) and a 20% excess of breast cancer (SMR=1. 2; 95% CI=0.8-1.7). The breast cancer excess was concentrated among nuns first certified before 1940 (SMR=2.0; CI=1.3-3.0), when radiation doses were possibly the highest, but the risk did not increase with increasing length of certification. Compared with the general population, the mortality experience of nuns was favorable and reflected the &amp;amp;amp;amp;amp;amp;quot;healthy worker effect&amp;amp;amp;amp;amp;amp;quot; commonly seen in occupational studies. Patterns observed for breast and cervical cancer possibly indicate differences in reproductive and sexual activities associated with belonging to a religious order. The possibility of a radiation-related excess for breast cancer among nuns certified before 1940 cannot be completely discounted, although there was no dose-response relationship with a surrogate measure of exposure (number of years certified). When their mortality experience was compared with other radiologic technologists, the influence of lifestyle factors was not apparent. Am. J. Ind. Med. 37:339-348, 2000. Published 2000 Wiley-Liss, Inc. dagger

AJR. American journal of roentgenology, Jan 21, 2016

The purpose of this study was to examine risks of cancer incidence and mortality among U.S. radia... more The purpose of this study was to examine risks of cancer incidence and mortality among U.S. radiation technologists performing or assisting with fluoroscopically guided interventional procedures. A nationwide prospective cohort of 90,957 radiologic technologists, who responded to a 1994-1998 survey that collected information on whether they had ever worked with fluoroscopically guided interventional procedures, was followed through completion of a subsequent cohort survey during 2003-2005 (for cancer incidence) or December 31, 2008 (for cancer mortality). Sex-adjusted hazard ratios (HRs) and 95% CIs were calculated by use of Cox proportional hazards models for incidence and mortality from all cancers other than nonmelanoma skin cancer and for specific cancer outcomes in participants who reported ever performing fluoroscopically guided interventional procedures compared with technologists who never performed these procedures. The analysis showed an approximately twofold increased ris...

Faculty of Health Institute of Health and Biomedical Innovation School of Public Health Social Work, Jan 15, 2013

Circulating 25-hydroxyvitamin D (25(OH)D), a marker for vitamin D status, is associated with bone... more Circulating 25-hydroxyvitamin D (25(OH)D), a marker for vitamin D status, is associated with bone health and possibly cancers and other diseases; yet, the determinants of 25(OH)D status, particularly ultraviolet radiation (UVR) exposure, are poorly understood. Determinants of 25(OH)D were analyzed in a subcohort of 1,500 participants of the US Radiologic Technologists (USRT) Study that included whites (n = 842), blacks (n = 646), and people of other races/ethnicities (n = 12). Participants were recruited monthly (2008-2009) across age, sex, race, and ambient UVR level groups. Questionnaires addressing UVR and other exposures were generally completed within 9 days of blood collection. The relation between potential determinants and 25(OH)D levels was examined through regression analysis in a random two-thirds sample and validated in the remaining one third. In the regression model for the full study population, age, race, body mass index, some seasons, hours outdoors being physically active, and vitamin D supplement use were associated with 25(OH)D levels. In whites, generally, the same factors were explanatory. In blacks, only age and vitamin D supplement use predicted 25(OH)D concentrations. In the full population, determinants accounted for 25% of circulating 25(OH)D variability, with similar correlations for subgroups. Despite detailed data on UVR and other factors near the time of blood collection, the ability to explain 25(OH)D was modest.

Http Dx Doi Org 10 1667 Rr1985 1, Jan 22, 2010

As genome-wide association studies of breast cancer are replicating findings and refinement studi... more As genome-wide association studies of breast cancer are replicating findings and refinement studies are narrowing the signal location, additional efforts are necessary to elucidate the underlying functional relationships. One approach is to evaluate variation in risk by genotype based on known breast carcinogens, such as ionizing radiation. Given the public health concerns associated with recent increases in medical radiation exposure, this approach may also identify potentially susceptible sub-populations. We examined interaction between 27 newly identified breast cancer risk alleles (identified within the NCI Cancer Genetic Markers of Susceptibility and the Breast Cancer Association Consortium genome-wide association studies) and occupational and medical diagnostic radiation exposure among 859 cases and 1083 controls nested within the United States Radiologic Technologists cohort. We did not find significant variation in the radiation-related breast cancer risk for the variant in RAD51L1 (rs10483813) on 14q24.1 as we had hypothesized. In exploratory analyses, we found that the radiation-associated breast cancer risk varied significantly by linked markers in 5p12 (rs930395, rs10941679, rs2067980, and rs4415084) in the mitochondrial ribosomal protein S30 (MRPS30) gene (p interaction =0.04). Chance, however, may explain these findings, and as such, these results need to be confirmed in other populations with low to moderate levels of radiation exposure. Even though a complete

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, Jan 2, 2015

UV radiation exposure is the primary risk factor for basal cell carcinoma (BCC), the most common ... more UV radiation exposure is the primary risk factor for basal cell carcinoma (BCC), the most common human malignancy. Although the photosensitizing properties of estrogens have been recognized for decades, few studies have examined the relationship between reproductive factors or exogenous estrogen use and BCC. Using data from the US Radiologic Technologists Study, a large, nationwide, prospective cohort, we assessed the relationship between reproductive factors, exogenous estrogen use, and first primary BCC while accounting for sun exposure, personal sun sensitivity, and lifestyle factors for geographically dispersed women exposed to a wide range of ambient UV radiation. Elevated risk of BCC was associated with late age at natural menopause (hazard ratio [HR] for ≥ 55 years v 50 to 54 years, 1.50; 95% CI, 1.04 to 2.17) and any use of menopausal hormone therapy (MHT; HR, 1.16; 95% CI, 1.03 to 1.30; P for trend for duration = .001). BCC risk was most increased among women reporting natu...

Occupational and environmental medicine, Jan 8, 2015

To determine risk for incident basal cell carcinoma from cumulative low-dose ionising radiation i... more To determine risk for incident basal cell carcinoma from cumulative low-dose ionising radiation in the US radiologic technologist cohort. We analysed 65 719 Caucasian technologists who were cancer-free at baseline (1983-1989 or 1994-1998) and answered a follow-up questionnaire (2003-2005). Absorbed radiation dose to the skin in mGy for estimated cumulative occupational radiation exposure was reconstructed for each technologist based on badge dose measurements, questionnaire-derived work history and protection practices, and literature information. Radiation-associated risk was assessed using Poisson regression and included adjustment for several demographic, lifestyle, host and sun exposure factors. Cumulative mean absorbed skin dose (to head/neck/arms) was 55.8 mGy (range 0-1735 mGy). For lifetime cumulative dose, we did not observe an excess radiation-related risk (excess relative risk/Gy=-0.01 (95% CI -0.43 to 0.52). However, we observed that basal cell carcinoma risk was increas...

Occupational and environmental medicine, Jan 8, 2015

Although fluoroscopically guided interventional procedures (FGIP) have provided major advances in... more Although fluoroscopically guided interventional procedures (FGIP) have provided major advances in the treatment of various common diseases, radiation exposures associated with these procedures may cause adverse health effects in workers. We assess risk of circulatory disease incidence and mortality in medical radiation workers performing FGIP. A US nationwide prospective cohort study of 90 957 radiologic technologists who completed a cohort survey during 1994-1998 was followed until completion of a subsequent survey during 2003-2005 for circulatory disease incidence, or until 31 December 2008 for mortality. Incidence analyses were restricted to the 63 482 technologists who completed both the second survey (1994-1998) and the third survey (2003-2005). Cox proportional hazards models were used to assess adjusted HR and 95% CIs for mortality from all causes, all circulatory diseases, all heart diseases, ischaemic heart disease, stroke, acute myocardial infarction and hypertension in pa...

Occupational and environmental medicine, Jan 28, 2015

The number of nuclear medicine procedures has increased substantially over the past several decad... more The number of nuclear medicine procedures has increased substantially over the past several decades, with uncertain health risks to the medical workers who perform them. We estimated risks of incidence and mortality from cancer and circulatory disease associated with performing procedures involving the use of radionuclides. From a nationwide cohort of 90 955 US radiologic technologists who completed a mailed questionnaire during 1994-1998, 22 039 reported ever performing diagnostic radionuclide procedures, brachytherapy, radioactive iodine therapy, or other radionuclide therapy. We calculated multivariable-adjusted HRs and 95% CIs for incidence (through 2003-2005) and mortality (through 2008) associated with performing these procedures. Ever (versus never) performing radionuclide procedures was not associated with risks for most end points examined. However, we observed increased risks for squamous cell carcinoma of the skin (HR=1.29, 95% CI 1.01 to 1.66) with ever performing diagno...

American Journal of Epidemiology

In a follow-up study, only 64% of 126,628 US radiologic technologists completed a questionnaire d... more In a follow-up study, only 64% of 126,628 US radiologic technologists completed a questionnaire during 1994-1997 after two mailings. The authors conducted a randomized trial of financial incentives and delivery methods to identify the least costly approach for increasing overall participation. They randomly selected nine samples of 300 nonresponders each to receive combinations of no, 1.00 US dollar, 2.00 US dollars, and 5.00 US dollars cash or check incentives delivered by first-class mail or Federal Express. Federal Express delivery did not achieve greater participation than first-class mail (23.2% vs. 23.7%). In analyses pooled across delivery methods, the response was significantly greater for the 2.00 US dollar bill (28.9%, 95% confidence interval (CI): 25.2, 32.7; p < 0.0001), 5.00 US dollars check (27.5%, 95% CI: 22.5, 33.0; p = 0.0001), 1.00 US dollar bill (24.6%, 95% CI: 21.2, 28.3; p = 0.0007), and 2.00 US dollars check (21.8%, 95% CI: 18.5, 25.3; p = 0.02) compared wit...

Occupational and environmental medicine

OBJECTIVES: There have been few studies of work history and mortality risks in medical radiation ... more OBJECTIVES: There have been few studies of work history and mortality risks in medical radiation workers. We expanded by 11 years and more outcomes our previous study of mortality risks and work history, a proxy for radiation exposure. METHODS: Using Cox proportional hazards models, we estimated mortality risks according to questionnaire work history responses from 1983 to 1989 through 2008 by 90 268 US radiological technologists. We controlled for potential confounding by age, birth year, smoking history, body mass index, race and gender. RESULTS: There were 9566 deaths (3329 cancer and 3020 circulatory system diseases). Mortality risks increased significantly with earlier year began working for female breast (p trend=0.01) and stomach cancers (p trend=0.01), ischaemic heart (p trend=0.03) and cerebrovascular diseases (p trend=0.02). The significant trend with earlier year first worked was strongly apparent for breast cancer during baseline through 1997, but not 1998-2008. Risks we...

Cancer Research, 2014

Objectives: There have been few studies on medical radiation work history factors and cancer mort... more Objectives: There have been few studies on medical radiation work history factors and cancer mortality. In this nationwide prospective cohort study of United States radiologic technologists, we expanded our previous evaluation of work history and cancer mortality risks, by extending follow-up by 11 years and examining a broader range of cancers.

Journal of the National Cancer Institute, 2015

Data for multiple common susceptibility alleles for breast cancer may be combined to identify wom... more Data for multiple common susceptibility alleles for breast cancer may be combined to identify women at different levels of breast cancer risk. Such stratification could guide preventive and screening strategies. However, empirical evidence for genetic risk stratification is lacking. We investigated the value of using 77 breast cancer-associated single nucleotide polymorphisms (SNPs) for risk stratification, in a study of 33 673 breast cancer cases and 33 381 control women of European origin. We tested all possible pair-wise multiplicative interactions and constructed a 77-SNP polygenic risk score (PRS) for breast cancer overall and by estrogen receptor (ER) status. Absolute risks of breast cancer by PRS were derived from relative risk estimates and UK incidence and mortality rates. There was no strong evidence for departure from a multiplicative model for any SNP pair. Women in the highest 1% of the PRS had a three-fold increased risk of developing breast cancer compared with women ...

Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology, 2003

We prospectively investigated whether alcohol intake and smoking affect the risk of basal cell ca... more We prospectively investigated whether alcohol intake and smoking affect the risk of basal cell carcinoma (BCC) in subjects from the United States Radiological Technologists (USRT) cohort study. We evaluated 68,371 radiological technologists certified during 1926-1982 who were free of cancer at the time they answered a first questionnaire (1983-1989) and who completed a second questionnaire (1994-1998). The first questionnaire provided baseline information on numerous risk factors, including smoking and alcohol intake, and the second provided self-reported cancer diagnoses. During 698,190 person-years of follow-up, we identified 1,360 cases of BCC: 1,036 in women and 324 in men. Cox proportional hazards regression indicated that the trend in BCC was significantly associated with increased alcohol intake (P for trend = 0.001). Compared with those who reported no alcohol consumption, those who drank <1-2, 3-6, 7-14, and >14 drinks/week had multivariate risks of 1.1 [95% confidenc...

International journal of obesity (2005), 2006

To investigate whether the nature of the relationship between body mass index (BMI (kg/m2)) and a... more To investigate whether the nature of the relationship between body mass index (BMI (kg/m2)) and all-cause mortality is direct, J- or U-shaped, and whether this relationship changes as people age. Prospective nationwide cohort study of US radiologic technologists (USRT). Sixty-four thousand seven hundred and thirty-three female and 19 011 male certified radiation technologists. We prospectively followed participants from the USRT study who completed a mail survey in 1983-1989 through 2000. During an average of 14.7 years of follow-up or 1.23 million person-years, 2278 women and 1495 men died. Using Cox's proportional-hazards regression analyses, we analyzed the relationship between BMI and all-cause mortality by gender and by age group (<55 years; > or = 55 years). We also examined risk in never-smokers after the first 5 years of follow-up to limit bias owing to the confounding effects of smoking and illness-related weight loss on BMI and mortality. Risks were generally J-s...

Radiation Research, 2007

Retrospective Biodosimetry among United States Radiologic Technologists. Radiat. Res. 167, 727-73... more Retrospective Biodosimetry among United States Radiologic Technologists. Radiat. Res. 167, 727-734 (2007).

Annals of Epidemiology, 2004

PURPOSE: The incidence of hypertension in black women is two to three times that in white women. ... more PURPOSE: The incidence of hypertension in black women is two to three times that in white women. This discrepancy is largely unexplained by known risk factors such as family history, physical inactivity, smoking, and obesity. It has been proposed that chronic social and environmental stress, related to neighborhood of residence, may be associated with increased rates of hypertension in African Americans. METHODS: We examined the relationship between neighborhood socioeconomic status (SES) and the incidence of hypertension using data from the Black Women's Health Study, a follow-up of 59,000 black women 21 to 69 years of age at entry in 1995. Block groups from the 2000 U.S. Census were used as proxies for neighborhood. A summary score for neighborhood SES was constructed from block group variables on education and wealth. Incident cases of hypertension were identified through follow-up postal questionnaires in 1997, 1999, and 2001. Clustered survival regression models were used to estimate incidence rate ratios (IRR). RESULTS: There were 3633 cases of self-reported hypertension among 183,207 person-years of observation from 1995 to 2001. The IRR for women living in low-SES neighborhoods relative to high-SES neighborhoods was 1.30 (95% confidence interval CI Z 1.17-1.45) after adjusting for individual risk factors. The association was even stronger among younger women (IRR Z 1.53; 95% CI Z 1.18-1.97), women with low body mass index (IRR Z 1.79; 95% CI Z 1.41-2.29), the most educated women (IRR Z 1.32; 95% CI Z 1.12-1.54), and those who exercised regularly (IRR Z 1.56; 95% CI Z 1.09-2.23). CONCLUSION: Our findings indicate that neighborhood SES is strongly associated with the risk of hypertension, and that this is the case even among well-educated black women, thin black women, and black women who exercise regularly.

Annals of Epidemiology, 2001

To determine whether causes of death obtained through National Death Index (NDI) Plus are compara... more To determine whether causes of death obtained through National Death Index (NDI) Plus are comparable to those obtained by requesting death certificates from state vital statistics offices and having deaths coded by contractor nosologists. The authors compared underlying cause of death codes obtained from NDI Plus with those assigned by contractor nosologists for a sample of 250 known decedents. The underlying cause of death codes differed for 18 (7%) of 249 successful matches. Independent coding by an expert National Center for Health Statistics (NCHS) nosologist trainer revealed that seven of these had an NDI Plus code that matched the code provided by the NCHS nosologist and a contractor nosologist code that did not match the NCHS nosologist code, seven had a contractor nosologist code that matched the NCHS nosologist code and an NDI Plus code that did not match the NCHS nosologist code, and four had both an NDI Plus and a contractor nosologist code that did not match the NCHS nosologist code. The level of disagreement with the NCHS nosologist and the organ systems involved were similar for NDI Plus and the contractor nosologist. The authors report that NDI Plus provides comparable information within a substantially shorter time period for most states and, for known decedents, at about half the cost of standard procedures.

American Journal of Industrial Medicine, 2000

Several studies have shown that Catholic nuns have a different mortality experience than women of... more Several studies have shown that Catholic nuns have a different mortality experience than women of similar age in the general population. We had a unique opportunity to evaluate mortality patterns of nuns identified in an occupational study of nearly 145,000 radiologic technologists (73% female). A total of 1,103 women were classified as nuns based on their titles of &amp;amp;amp;amp;amp;amp;quot;Sister&amp;amp;amp;amp;amp;amp;quot; or &amp;amp;amp;amp;amp;amp;quot;SR&amp;amp;amp;amp;amp;amp;quot;. Their mortality experience was compared to other female radiologic technologists and to U.S. white females. Five hundred eighty-three nuns (53%) were deceased as of January 1, 1995. Compared to other technologists, nuns were at significantly increased risk of dying from all causes (Standardized mortality ratio (SMR)=1.1; 95% Confidence interval (CI)=1.0-1.2, stomach cancer (SMR=2.7; 95% CI=1.2-5.4), diabetes (SMR=2.2; 95% CI=1.0-4.1), ischemic heart disease (SMR=1.2; 95% CI=1.1-1.4), all digestive diseases (SMR=2.0; 95% CI=1.3-3.0), and gastric and duodenal ulcers (SMR=8.3; 95% CI=2.3-21.3). In contrast, we observed a significant deficit in lung cancer (SMR=0.5; 95% CI=0.2-0.9), no deaths from cervical cancer, and a breast cancer risk 10% lower than expected (SMR=0.9; 95% CI=0.6-1.3). When compared to U.S. females, nuns experienced significantly reduced mortality from all causes (SMR=0.8; 95% CI=0.7-0.9), cervical cancer (SMR=0.0; 95% CI=0.0-0.7), all endocrine, metabolic and nutritional diseases (SMR=0.5; 95% CI=0.3-0.9), all circulatory diseases (SMR=0.7; 95% CI=0.7-0.8) including ischemic heart disease and cerebrovascular disease, and all respiratory diseases (SMR=0.5; 95% CI=0.3-0.8), and a nearly significant deficit of diabetes (SMR=0.6; 95% CI=0.3-1.0). In contrast, nuns had an almost 3-fold greater risk of tuberculosis (SMR=2.9; 95% CI=1.4-5.3) and a 20% excess of breast cancer (SMR=1. 2; 95% CI=0.8-1.7). The breast cancer excess was concentrated among nuns first certified before 1940 (SMR=2.0; CI=1.3-3.0), when radiation doses were possibly the highest, but the risk did not increase with increasing length of certification. Compared with the general population, the mortality experience of nuns was favorable and reflected the &amp;amp;amp;amp;amp;amp;quot;healthy worker effect&amp;amp;amp;amp;amp;amp;quot; commonly seen in occupational studies. Patterns observed for breast and cervical cancer possibly indicate differences in reproductive and sexual activities associated with belonging to a religious order. The possibility of a radiation-related excess for breast cancer among nuns certified before 1940 cannot be completely discounted, although there was no dose-response relationship with a surrogate measure of exposure (number of years certified). When their mortality experience was compared with other radiologic technologists, the influence of lifestyle factors was not apparent. Am. J. Ind. Med. 37:339-348, 2000. Published 2000 Wiley-Liss, Inc. dagger

AJR. American journal of roentgenology, Jan 21, 2016

The purpose of this study was to examine risks of cancer incidence and mortality among U.S. radia... more The purpose of this study was to examine risks of cancer incidence and mortality among U.S. radiation technologists performing or assisting with fluoroscopically guided interventional procedures. A nationwide prospective cohort of 90,957 radiologic technologists, who responded to a 1994-1998 survey that collected information on whether they had ever worked with fluoroscopically guided interventional procedures, was followed through completion of a subsequent cohort survey during 2003-2005 (for cancer incidence) or December 31, 2008 (for cancer mortality). Sex-adjusted hazard ratios (HRs) and 95% CIs were calculated by use of Cox proportional hazards models for incidence and mortality from all cancers other than nonmelanoma skin cancer and for specific cancer outcomes in participants who reported ever performing fluoroscopically guided interventional procedures compared with technologists who never performed these procedures. The analysis showed an approximately twofold increased ris...

Faculty of Health Institute of Health and Biomedical Innovation School of Public Health Social Work, Jan 15, 2013

Circulating 25-hydroxyvitamin D (25(OH)D), a marker for vitamin D status, is associated with bone... more Circulating 25-hydroxyvitamin D (25(OH)D), a marker for vitamin D status, is associated with bone health and possibly cancers and other diseases; yet, the determinants of 25(OH)D status, particularly ultraviolet radiation (UVR) exposure, are poorly understood. Determinants of 25(OH)D were analyzed in a subcohort of 1,500 participants of the US Radiologic Technologists (USRT) Study that included whites (n = 842), blacks (n = 646), and people of other races/ethnicities (n = 12). Participants were recruited monthly (2008-2009) across age, sex, race, and ambient UVR level groups. Questionnaires addressing UVR and other exposures were generally completed within 9 days of blood collection. The relation between potential determinants and 25(OH)D levels was examined through regression analysis in a random two-thirds sample and validated in the remaining one third. In the regression model for the full study population, age, race, body mass index, some seasons, hours outdoors being physically active, and vitamin D supplement use were associated with 25(OH)D levels. In whites, generally, the same factors were explanatory. In blacks, only age and vitamin D supplement use predicted 25(OH)D concentrations. In the full population, determinants accounted for 25% of circulating 25(OH)D variability, with similar correlations for subgroups. Despite detailed data on UVR and other factors near the time of blood collection, the ability to explain 25(OH)D was modest.

Http Dx Doi Org 10 1667 Rr1985 1, Jan 22, 2010

As genome-wide association studies of breast cancer are replicating findings and refinement studi... more As genome-wide association studies of breast cancer are replicating findings and refinement studies are narrowing the signal location, additional efforts are necessary to elucidate the underlying functional relationships. One approach is to evaluate variation in risk by genotype based on known breast carcinogens, such as ionizing radiation. Given the public health concerns associated with recent increases in medical radiation exposure, this approach may also identify potentially susceptible sub-populations. We examined interaction between 27 newly identified breast cancer risk alleles (identified within the NCI Cancer Genetic Markers of Susceptibility and the Breast Cancer Association Consortium genome-wide association studies) and occupational and medical diagnostic radiation exposure among 859 cases and 1083 controls nested within the United States Radiologic Technologists cohort. We did not find significant variation in the radiation-related breast cancer risk for the variant in RAD51L1 (rs10483813) on 14q24.1 as we had hypothesized. In exploratory analyses, we found that the radiation-associated breast cancer risk varied significantly by linked markers in 5p12 (rs930395, rs10941679, rs2067980, and rs4415084) in the mitochondrial ribosomal protein S30 (MRPS30) gene (p interaction =0.04). Chance, however, may explain these findings, and as such, these results need to be confirmed in other populations with low to moderate levels of radiation exposure. Even though a complete

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, Jan 2, 2015

UV radiation exposure is the primary risk factor for basal cell carcinoma (BCC), the most common ... more UV radiation exposure is the primary risk factor for basal cell carcinoma (BCC), the most common human malignancy. Although the photosensitizing properties of estrogens have been recognized for decades, few studies have examined the relationship between reproductive factors or exogenous estrogen use and BCC. Using data from the US Radiologic Technologists Study, a large, nationwide, prospective cohort, we assessed the relationship between reproductive factors, exogenous estrogen use, and first primary BCC while accounting for sun exposure, personal sun sensitivity, and lifestyle factors for geographically dispersed women exposed to a wide range of ambient UV radiation. Elevated risk of BCC was associated with late age at natural menopause (hazard ratio [HR] for ≥ 55 years v 50 to 54 years, 1.50; 95% CI, 1.04 to 2.17) and any use of menopausal hormone therapy (MHT; HR, 1.16; 95% CI, 1.03 to 1.30; P for trend for duration = .001). BCC risk was most increased among women reporting natu...

Occupational and environmental medicine, Jan 8, 2015

To determine risk for incident basal cell carcinoma from cumulative low-dose ionising radiation i... more To determine risk for incident basal cell carcinoma from cumulative low-dose ionising radiation in the US radiologic technologist cohort. We analysed 65 719 Caucasian technologists who were cancer-free at baseline (1983-1989 or 1994-1998) and answered a follow-up questionnaire (2003-2005). Absorbed radiation dose to the skin in mGy for estimated cumulative occupational radiation exposure was reconstructed for each technologist based on badge dose measurements, questionnaire-derived work history and protection practices, and literature information. Radiation-associated risk was assessed using Poisson regression and included adjustment for several demographic, lifestyle, host and sun exposure factors. Cumulative mean absorbed skin dose (to head/neck/arms) was 55.8 mGy (range 0-1735 mGy). For lifetime cumulative dose, we did not observe an excess radiation-related risk (excess relative risk/Gy=-0.01 (95% CI -0.43 to 0.52). However, we observed that basal cell carcinoma risk was increas...

Occupational and environmental medicine, Jan 8, 2015

Although fluoroscopically guided interventional procedures (FGIP) have provided major advances in... more Although fluoroscopically guided interventional procedures (FGIP) have provided major advances in the treatment of various common diseases, radiation exposures associated with these procedures may cause adverse health effects in workers. We assess risk of circulatory disease incidence and mortality in medical radiation workers performing FGIP. A US nationwide prospective cohort study of 90 957 radiologic technologists who completed a cohort survey during 1994-1998 was followed until completion of a subsequent survey during 2003-2005 for circulatory disease incidence, or until 31 December 2008 for mortality. Incidence analyses were restricted to the 63 482 technologists who completed both the second survey (1994-1998) and the third survey (2003-2005). Cox proportional hazards models were used to assess adjusted HR and 95% CIs for mortality from all causes, all circulatory diseases, all heart diseases, ischaemic heart disease, stroke, acute myocardial infarction and hypertension in pa...

Occupational and environmental medicine, Jan 28, 2015

The number of nuclear medicine procedures has increased substantially over the past several decad... more The number of nuclear medicine procedures has increased substantially over the past several decades, with uncertain health risks to the medical workers who perform them. We estimated risks of incidence and mortality from cancer and circulatory disease associated with performing procedures involving the use of radionuclides. From a nationwide cohort of 90 955 US radiologic technologists who completed a mailed questionnaire during 1994-1998, 22 039 reported ever performing diagnostic radionuclide procedures, brachytherapy, radioactive iodine therapy, or other radionuclide therapy. We calculated multivariable-adjusted HRs and 95% CIs for incidence (through 2003-2005) and mortality (through 2008) associated with performing these procedures. Ever (versus never) performing radionuclide procedures was not associated with risks for most end points examined. However, we observed increased risks for squamous cell carcinoma of the skin (HR=1.29, 95% CI 1.01 to 1.66) with ever performing diagno...

American Journal of Epidemiology

In a follow-up study, only 64% of 126,628 US radiologic technologists completed a questionnaire d... more In a follow-up study, only 64% of 126,628 US radiologic technologists completed a questionnaire during 1994-1997 after two mailings. The authors conducted a randomized trial of financial incentives and delivery methods to identify the least costly approach for increasing overall participation. They randomly selected nine samples of 300 nonresponders each to receive combinations of no, 1.00 US dollar, 2.00 US dollars, and 5.00 US dollars cash or check incentives delivered by first-class mail or Federal Express. Federal Express delivery did not achieve greater participation than first-class mail (23.2% vs. 23.7%). In analyses pooled across delivery methods, the response was significantly greater for the 2.00 US dollar bill (28.9%, 95% confidence interval (CI): 25.2, 32.7; p < 0.0001), 5.00 US dollars check (27.5%, 95% CI: 22.5, 33.0; p = 0.0001), 1.00 US dollar bill (24.6%, 95% CI: 21.2, 28.3; p = 0.0007), and 2.00 US dollars check (21.8%, 95% CI: 18.5, 25.3; p = 0.02) compared wit...

Occupational and environmental medicine

OBJECTIVES: There have been few studies of work history and mortality risks in medical radiation ... more OBJECTIVES: There have been few studies of work history and mortality risks in medical radiation workers. We expanded by 11 years and more outcomes our previous study of mortality risks and work history, a proxy for radiation exposure. METHODS: Using Cox proportional hazards models, we estimated mortality risks according to questionnaire work history responses from 1983 to 1989 through 2008 by 90 268 US radiological technologists. We controlled for potential confounding by age, birth year, smoking history, body mass index, race and gender. RESULTS: There were 9566 deaths (3329 cancer and 3020 circulatory system diseases). Mortality risks increased significantly with earlier year began working for female breast (p trend=0.01) and stomach cancers (p trend=0.01), ischaemic heart (p trend=0.03) and cerebrovascular diseases (p trend=0.02). The significant trend with earlier year first worked was strongly apparent for breast cancer during baseline through 1997, but not 1998-2008. Risks we...

Cancer Research, 2014

Objectives: There have been few studies on medical radiation work history factors and cancer mort... more Objectives: There have been few studies on medical radiation work history factors and cancer mortality. In this nationwide prospective cohort study of United States radiologic technologists, we expanded our previous evaluation of work history and cancer mortality risks, by extending follow-up by 11 years and examining a broader range of cancers.

Journal of the National Cancer Institute, 2015

Data for multiple common susceptibility alleles for breast cancer may be combined to identify wom... more Data for multiple common susceptibility alleles for breast cancer may be combined to identify women at different levels of breast cancer risk. Such stratification could guide preventive and screening strategies. However, empirical evidence for genetic risk stratification is lacking. We investigated the value of using 77 breast cancer-associated single nucleotide polymorphisms (SNPs) for risk stratification, in a study of 33 673 breast cancer cases and 33 381 control women of European origin. We tested all possible pair-wise multiplicative interactions and constructed a 77-SNP polygenic risk score (PRS) for breast cancer overall and by estrogen receptor (ER) status. Absolute risks of breast cancer by PRS were derived from relative risk estimates and UK incidence and mortality rates. There was no strong evidence for departure from a multiplicative model for any SNP pair. Women in the highest 1% of the PRS had a three-fold increased risk of developing breast cancer compared with women ...

Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology, 2003

We prospectively investigated whether alcohol intake and smoking affect the risk of basal cell ca... more We prospectively investigated whether alcohol intake and smoking affect the risk of basal cell carcinoma (BCC) in subjects from the United States Radiological Technologists (USRT) cohort study. We evaluated 68,371 radiological technologists certified during 1926-1982 who were free of cancer at the time they answered a first questionnaire (1983-1989) and who completed a second questionnaire (1994-1998). The first questionnaire provided baseline information on numerous risk factors, including smoking and alcohol intake, and the second provided self-reported cancer diagnoses. During 698,190 person-years of follow-up, we identified 1,360 cases of BCC: 1,036 in women and 324 in men. Cox proportional hazards regression indicated that the trend in BCC was significantly associated with increased alcohol intake (P for trend = 0.001). Compared with those who reported no alcohol consumption, those who drank <1-2, 3-6, 7-14, and >14 drinks/week had multivariate risks of 1.1 [95% confidenc...