Leukemia in Radiologists

For many years there has been prevalent an impression of a possible relationship between exposure to radiation and the subsequent development of leukemia. As early as 1911 there appeared the first report on the matter by von Jagic and coworkers (1), in which a brief statement—based in part on hearsay—is made concerning the occurrence of leukemia in four persons who had experienced prolonged exposure to radiation. Of only one of these cases did the authors have any personal knowledge. Since that time there have appeared perhaps a dozen reports on the specific subject of the development of leukemia in persons non-therapeutically exposed to small doses of radiation over prolonged periods. Twenty-three cases have been recorded in the literature, including the four by von Jagic. In a few of the cases details are lacking and the relationship is not well established. In 1912 Aubertin (2) referred to a case of myeloid leukemia discovered in a French radiologist and followed by Vaquez. In 1924 Carman and Miller (3) reported a case of lymphatic leukemia in an American roentgenologist. The following year Emile-Weil and Lacassagne (4) published a report of myeloid leukemia in a research worker in radioactive bodies and recalled that Beclere had observed a similar case in a radiologist. In 1927 Davey and Whitby (5) added a case of acute leukemia in a “medical man who had worked with x-rays for many years,” and in 1928 Evans and Roberts (6) reported a case of myeloid leukemia occurring in an x-ray worker, at the same time reviewing the ten cases that had been recorded up to that time. They concluded that the case against radiations as a cause of leukemia was not yet proved, since actually only the two cases of Carman and Miller and Emile-Weil and Lacassagne occurred in persons who were known from definite first-hand information to have experienced prolonged exposures to small amounts of radiation. Aubertin (7), in 1931, stated that over a period of nineteen years he had the opportunity of seeing five radiologists afflicted with myeloid leukemia, while during the same space of time he had observed only one case in a physician other than a radiologist. Since the radiologists constitute only a small proportion of the medical profession, he concluded, on the basis of his personal experience, that myeloid leukemia is undoubtedly more frequent in radiologists than in other doctors. In the same year Haagensen (8), at the Memorial Hospital, New York, cited a case of leukemia developing in a person exposed to radiation over a prolonged period. The following year a case was added by Nielsen (10) and another by Laubry and Marchal (9). The latter writers quote a case of Znajewska. In 1937 Emile-Weil (11) reported a case of a leukemic lymphatic leukemia in a radiologist and stated: “There have been published more and more cases of leukemia, lymphatic as well as myelogenous, in radiologists, the disorder being an occupational one with them.”