Breast cancer incidence and mortality in population studies of radiation exposure: systematic review and meta-analysis.

BACKGROUND

While breast cancer risk from high-dose ionising radiation is known, uncertainties remain about risks at lower doses and risk-modifying factors. We conducted a systematic review and meta-analysis of publications on radiation-associated risk of breast cancer in women.

METHODS

We included studies published in 2005-2022 that assessed breast cancer incidence or mortality in women exposed to ionising radiation. Risk of bias was evaluated. Random-effects meta-analyses estimated excess relative risks per gray (ERR/Gy).

RESULTS

Of the 3522 articles screened, 106 met the inclusion criteria; 40 studies provided 44 ERR/Gy estimates. Overall, radiation exposure was associated with increased breast cancer risk (ERR/Gy = 0.56, 95% CI: 0.29-0.83). Between-study heterogeneity (I2 = 95%) was substantially reduced in subgroup analyses, reaching 5% in low-dose-rate studies. Higher summary ERRs were observed for high dose-rate exposures, moderate (1-5 Gy) doses, childhood exposures, and attained age over 55. Lower but significantly increased risks were estimated for other subgroups and exposure scenarios.

CONCLUSIONS

Radiation exposure was associated with a significantly increased risk of breast cancer among women, particularly following high dose-rates, moderate doses, childhood exposures, and older attained age. PROSPERO registration: CRD42021260610.