Biography

Ms. Kleinerman received a B.A. from Washington University in 1971 and a M.P.H. in 1979 from Boston University School of Public Health. Ms. Kleinerman joined the NCI Epidemiology and Biostatistics Program in 1979, and she is currently a staff scientist in the Radiation Epidemiology Branch. She was awarded a NIH Individual Merit Award in 2007 for research providing the first definitive evidence of gene-environment interactions underlying excess cancer risks in retinoblastoma, the NCI DCEG Award for Outstanding Research Paper by a Staff Scientist in 2008 on the Risk of soft tissue sarcomas by individual subtype in hereditary retinoblastoma survivors, and a NIH Group Merit Award in 2007 for the first broad-based description of applications of radiation dosimetry to epidemiological studies, an invaluable international resource.

Research Interests

• Gene-environment interaction in retinoblastoma patients
• Interventional radiation and fluroscopically-guided procedures
• Second gastrointestinal cancers following radiotherapy and chemotherapy
• Pediatric CT and cancer risk
• Biodosimetry

Research

Retinoblastoma

Children with hereditary retinoblastoma (Rb) are at exceptionally high risk of sarcomas, melanoma and brain tumors due to a germline mutation in their RB-1 gene, which encodes the cell cycle regulatory protein pRb. Radiotherapy which has been used to treat these patients appears to enhance the risk of these cancers. In collaboration with the Genetics Epidemiology Branch, we continue to investigate cancer incidence and mortality in a series of 1,850 one-year survivors of RB to learn whether these patients continue to be at risk of sarcomas as they age as well as typical epithelial tumors of adulthood. We identified a striking excess of leiomyosarcomas in patients 35 years and later after Rb diagnosis. Efforts are underway to identify specific mutations in the Rb-1 gene in hereditary patients who develop second cancers.

Cancer Mortality in Physicians Conducting Fluoroscopically-guided Procedures

During the past few decades, there has been dramatic growth in the numbers of higher-dose diagnostic x-ray examinations and fluoroscopically–guided (FG) procedures, primarily performed by interventional cardiologists and interventional radiologists. These complex procedures use long and on-time radiological imaging, resulting in high radiation exposure not only to patients but also to physicians. Cancer mortality has not been investigated in the other physicians exposed to radiation from FG procedures We are conducting the first comprehensive study of radiologists, cardiologists and other physicians performing these procedures to determine their risk of dying from cancer. A large cohort of radiologists and other physicians exposed to radiation has been assembled to determine cause of death compared to physicians who are not exposed to radiation.

Keywords

Radiotherapy, retinoblastoma, RB-1 gene, second primary cancers, interventional radiation, CT radiation

Selected Publications

• Yu C-L et al. Cause-specific mortality in long-term survivors of retinoblastoma. JNCI 2009:101;1-11.
• Kim KP, Miller DL, Balter S, Kleinerman RA, Linet MS, Kwon D, Simon SL. Occupational radiation doses to operators performing cardiac catheterization procedures. Health Phys 2008 Mar;94(3):211-27. Review.
• Kleinerman RA, Tucker MA, Abramson DH, Seddon JM, Tarone RE, Fraumeni JF Jr. Risk of soft tissue sarcomas by individual subtype in survivors of hereditary retinoblastoma. J Natl Cancer Inst 2007 Jan 3;99(1):24-31.
• Chaturvedi AK, Engels EA, Gilbert ES, Chen BE, Storm H, Lynch CF, Hall P, Langmark F, Pukkala E, Kaijser M, Andersson M, Fosså SD, Joensuu H, Boice JD, Kleinerman RA, Travis LB. Second cancers among 104,760 survivors of cervical cancer: evaluation of long-term risk. J Natl Cancer Inst 2007 Nov 7;99(21):1634-43.
• Kleinerman RA, Tucker MA, Tarone RE, Abramson DH, Seddon JM, Stovall M, Li FP, Fraumeni JF Jr. Risk of new cancers after radiotherapy in long-term survivors of retinoblastoma: an extended follow-up. J Clin Oncol 2005 Apr 1;23(10):2272-9.

Collaborators

DCEG Collaborators

• Amy Berrington, Andre Bouville, Rochelle Curtis, Joseph F. Fraumeni, Jr., Ethel Gilbert, Martha Linet, Lindsay Morton, Elaine Ron, Steve Simon, Peggy Tucker, Chu-Ling Yu

Other Scientific Collaborators

• David Abramson, M.D., Memorial Sloan-Kettering Cancer Center, New York, NY
• Gabriel Chodick, Ph.D. University of Tel Aviv, School of Public Health, Tel Aviv, Israel
• Graca Dores, M.D., VA Medical Center, Oklahoma, OK
• Sophie Fossa, Norwegian Radium Hospital, Oslo, Norway
• Eric Holowaty, Ph.D., Ontario Cancer Foundation, Canada
• Heikki Joensuu, M.D. Helsinki University Central Hospital, Finland
• Froydis Langmark, Norway Cancer Registry
• Charles Lynch, M.D. Iowa State Cancer Registry
• Jorgen Olsen, Danish Cancer Society, Copenhagen, Denmark
• Johanna Seddon, Tufts New England Medical Center, Boston, MA
• Hans Storm, M.D. Danish Cancer Soceity, Copenhagen, Denmark
• Marilyn Stovall, Ph.D., University of Texas M.D. Anderson Cancer Center, Houston, TX