(¹³⁷Cs) and thyroid antibodies, hypothyroidism, hyperthyroidism, or goitre (Ashizawa and others 1997).

The evidence from epidemiologic studies regarding the risk of leukemia in populations exposed to radiation from Chernobyl comes from studies of recovery operation workers, some of whom were exposed at a high or moderate dose levels and dose rates (depending on when and where they worked), and the general population who have been subject to low-dose-rate exposure (primarily from ¹³⁷Cs) for a number of years and will continue to be exposed in the future. Worker populations were exposed as adults and are considered in Chapter 8. Resident populations were exposed at all ages, but studies of residents are primarily of persons exposed as children and/or in utero.

Several studies have investigated the risk of leukemia in children exposed to Chernobyl fallout in utero. All are ecologic in design, and results are inconsistent. The initial study compared rates for temporal cohorts born during “exposed” and “unexposed” periods in Greece and found a 2.6-fold increase in leukemia risk and elevated rates for those born in regions with higher levels of radioactive fallout (Petridou and others 1996). However, the numbers of cases in each exposure group were small, and the results could not be duplicated when a similar approach comparing areas with the same categories of contamination (<6 kBq m⁻², 6–10 kBq m⁻², >10 kBq m⁻²) was applied to the analysis of data from the German Childhood Cancer Registry (Steiner and others 1998).

In a study in Belarus (Ivanov and others 1998), where levels of contamination are higher by a factor of 10 or more, the results were similar to the Greek study but the trend was weaker. Nevertheless, although the findings are based on small numbers and are not statistically significant, the highest annual incidence rate was in 1987, the year after the accident, and the largest rate ratio (RR = 1.51; 95% CI 0.63, 3.61) was in the two most contaminated regions: Gomel and Mogilev.

A more recent small study published by Noshchenko and colleagues (2001) compared leukemia incidence during 1986 to 1996 among children born in 1986 and thus exposed in utero in Zhitomir, a contaminated region, to children born in Poltava, a relatively uncontaminated region. The reported risk ratios based on cumulative incidence show significant increases for all leukemia (relative risk [RR]² =2.7; 95% CI 1.9, 3.8) and for the subtype of acute lymphoblastic leukemia (RR = 3.4; 95% CI 1.1, 10.4).

The ongoing European Childhood Leukemia-Lymphoma Incidence Study (ECLIS) has evaluated the risk of leukemia by age using data from population-based cancer registries in Europe (including Belarus and Ukraine). Focusing on the risk of leukemia by age of diagnosis in 6-month intervals in relation to estimated doses from the Chernobyl fallout received in utero, preliminary results suggest a small increase in risk in infant leukemia and leukemia diagnosed between 24 and 29 months.

Thus, at present the available evidence from ecologic studies does not convincingly indicate an increased risk of leukemia among persons exposed in utero to radiation from Chernobyl. However, the statistical power of these studies is low for detecting moderate-sized associations, and the exposure measures are crude. There are no data from analytic epidemiologic studies in which individual dose estimates are available. Consequently, there is neither strong evidence for or against an association between in utero exposure to Chernobyl fallout and an increased risk of leukemia.

Several ecologic studies also have investigated the association between radiation exposure of children from Chernobyl and the occurrence of leukemia. The ECLIS utilized incidence data in children under age 15 from 36 cancer registries in 23 countries. Parkin and colleagues (1996) compared acute leukemia incidence rates before the Chernobyl accident (1980–1985) with those for 1987 and 1988. Although the number of leukemia cases for 1987–1988 significantly exceeded the number of cases expected on the basis of 1980–1985 data, there was no evidence that the excess in leukemia rates was more pronounced in areas that were most affected by Chernobyl-related ionizing radiation exposure. Similar results were observed in the 5-year ECLIS followup report.

Additional reports have focused on changes in childhood leukemia rates before and after the accident in individual European countries and elsewhere. Overall, there was little evidence for an increase in rates of childhood leukemia in Ukraine, Belarus, Russia, Finland, Sweden, Greece, or a number of other countries from Central, Eastern and Southern Europe after the Chernobyl accident. Furthermore, there was no association between the extent of contamination and the increase in risk in these countries. However, one Swedish study (Tondel and others 1996), reported a non-statistically significant increase of acute lymphocytic leukemia (ALL) after the accident in children younger than 5 (OR 1.5; 95% CI 0.8, 2.6). A small study in northern Turkey showed that in one pediatric cancer treatment center, more patients with ALL were seen after the accident than before, but no incidence rates were reported (Gunay and others 1996).

There has been only one analytic (case-control) study of childhood leukemia reported (Noshchenko and others 2002) based on cases identified among residents of the Rivno and Zhytomir Oblasts in Ukraine. Cases were under age 20 at the time of the accident and were diagnosed between 1987 and 1997. Data were collected on 272 cases; however the analysis was based on only 98 cases that were independently verified and interviewed. Controls were selected randomly from