Doctors urge better radiation protection for female healthworkers

Doctors have called for female healthcare workers who are regularly exposed to radiation to be given better ionising radiation protection so as to minimise their risk of developing breast cancer.

Ionising radiation is a known human carcinogen and breast tissue is highly radiation sensitive. As such, there are concerns that regular exposure to ionising radiation during image guided procedures such as x-rays may be linked to a higher risk of breast cancer in female healthcare workers.

Personal protective equipment (PPE) such as lead gowns are used to shield the body from harmful radiation during these procedures. But studies have shown that current radiation PPE provides inadequate protection to breast tissue as it leaves the area close to the armpit – the most common site of breast cancer – exposed.

‘Providing adequate breast covering PPE could therefore reduce radiation exposure and potentially help prevent breast cancer in female healthcare workers,” Isobel Pilkington and colleagues wrote in the British Medical Journal.

They acknowledged that measuring the risk of occupational radiation induced breast cancer in women working in healthcare is challenging, but as the number of female trainees entering these specialties increases, they said ‘it is essential that the available evidence is considered and equipment provision improved to minimise this risk.’

They pointed to observational evidence suggesting an increase in breast cancer risk among female US orthopaedic surgeons compared with an age matched female population, and to a small Finnish study showing breast cancer at 1.7 times the expected rate in radiologists, surgeons, and cardiologists compared with female physicians not working with radiation.

In a study using artificial female torsos to measure radiation exposure, researchers found inadequate upper outer quadrant protection and no statistically significant reduction in dose when standard PPE was compared with a torso without PPE.

Occupational radiation exposure has not been identified as a risk factor for male breast cancer. However, the Ionising Radiation Regulations 2017 state that the radiation dose delivered to all workers should be As Low As Reasonably Achievable (ALARA). The most effective way to achieve this, said the authors, is by reducing the duration of exposure, increasing the distance from the source, and shielding all workers with effective PPE.

They pointed to additional protection, such as capped sleeves and axillary wings, that can be worn under standard gowns to protect the upper outer quadrant of the breast, and said the European Society for Vascular Surgery 2023 Clinical Practice Guidelines on Radiation Safety had already recommended female operators consider adopting this extra protection.

‘Providing appropriate protection is a legal requirement of an employer, who has a duty of care to all workers exposed to radiation,” they said. “The female breast appears to be particularly vulnerable and it is therefore important employers invest in protective equipment that enhances the safety of all their staff.’

Image: Ömer Yıldız