Incidence of malignant diseases in humans injected with radium-224.

The "Spiess study" follows the health of 899 persons who received multiple injections of the short-lived alpha-particle emitter (224)Ra mainly between 1945 and 1955 for the treatment of tuberculosis, ankylosing spondylitis and some other diseases. In December 2007, 124 persons were still alive. The most striking health effect, observed shortly after (224)Ra injections, was a temporal wave of 57 malignant bone tumors. During the two most recent decades of observation, a significant excess of non-skeletal malignant diseases has become evident. Expected numbers of cases were computed from the age, gender and calendar year distribution of person years at risk and incidence rates from the German Saarland Cancer Registry. Poisson statistics were applied to test for statistical significance of the standardized incidence ratios. Up to the end of December 2007, the total number of observed malignant non-skeletal diseases was 270 (248 specified cases of non-skeletal solid cancers and 22 other malignant diseases, among these 16 malignant neoplasms of lymphatic and hematopoietic tissue, six without specification of site) compared to 192 expected cases. Accounting for a 5-year minimum latent period and excluding 13 cases of non-melanoma skin cancer, 231 non-skeletal solid cancers were observed compared to 151 expected cases. Significantly increased cancer rates were observed for breast (32 compared to 9.7), soft and connective tissue (11 compared to 1.0), thyroid (7 compared to 1.0), liver (10 compared to 2.4), kidney (13 compared to 5.0), pancreas (9 compared to 4.1), bladder (16 compared to 8.0), and female genital organs (15 compared to 7.8).