A Cohort Study of Childhood Cancer Incidence after Postnatal Diagnostic X-Ray Exposure

Hammer, Gaël P.; Seidenbusch, Michael; Schneider, K.; Regulla, D.F.; Zeeb, Hajo; Spix, Claudia; Blettner, Maria

doi:10.1667/rr1575.1

Cited by 46 publications

(52 citation statements)

References 30 publications

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“…They did not find an increase in cancer incidence, although the radiation doses from radiography are lower than those from CT scanning. 16 In the largest study to date, Pearce et al reviewed more than 170,000 patients who underwent CT scanning in the National Health Service centers in Great Britain. 29 They correlated the radiation dose from multiple scanning sessions to an increased risk of brain tumors and leukemia.…”

Section: Discussionmentioning

confidence: 99%

Risk of radiation-induced malignancies from CT scanning in children who underwent shunt treatment before 6 years of age: a retrospective cohort study with a minimum 10-year follow-up

White

Shaikh

Moore

et al. 2014

PED

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Object A number of mathematical models predict the risk of future cancer from the ionizing radiation exposure of CT scanning. The predictions are alarming. Some models predict 29,000 future cancers and 14,500 deaths in the US will be directly caused by 1 year's worth of CT scanning. However, there are very few clinical data to justify or refute these claims. Young children are theoretically highly susceptible to the damaging effects of radiation. In this study, the authors examined children who underwent CSF shunt placement before 6 years of age. The authors chose to study shunt-treated patients with the assumption that these patients would undergo future imaging, facilitating surveillance. They chose a study period of 1991–2001 to allow more than 10 years of follow-up data. Methods The authors studied 104 consecutive children who underwent CSF shunt placement prior to 6 years of age and who had at least 10 years of follow-up data. Sixty-two of these patients underwent shunt placement prior to 1 year of age. The age at the initial scanning session, the number of future CT scanning sessions, diagnosis, and results of any future studies were recorded. The age-specific radiation dose was calculated for children younger than 1 year. Children younger than 1 year at the time of shunt placement were evaluated separately, based on the assumption that they represented the highest risk cohort. The authors examined all data for any evidence of future leukemia or head/neck tumor (benign or malignant). Results These children underwent a total of 1584 CT scanning sessions over a follow-up period of 1622 person-years. A total of 517 scanning sessions were performed prior to 6 years of age, including 260 in the 1st year of life. Children who underwent shunt placement before 1 year of age underwent an average of 16.3 ± 13.5 CT sessions (range 1–41). Children undergoing placement between 1 and 6 years of age received an average of 14.1 ± 12.5 CT studies (range 5–52). There were no subsequent tumors (benign or malignant) or leukemia detected. Conclusions Previously published models predict a significant number of future cancers directly caused by CT scanning. However, there are very few published clinical data. In the authors' study, zero future radiation-induced malignancies were detected after routine CT scanning in a high-risk group. While the authors do not consider their single-institution study adequate to define the actual risk, their data suggest that the overall risk is low. The authors hope this study encourages future collaborative efforts to define the actual risk to patients.

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Section: Discussionmentioning

confidence: 99%

Risk of radiation-induced malignancies from CT scanning in children who underwent shunt treatment before 6 years of age: a retrospective cohort study with a minimum 10-year follow-up

White

Shaikh

Moore

et al. 2014

PED

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“…Sensitivity analyses will be performed concerning the a priori higher risks of cancer development and mortality for exposed children. Conventional x-rays will not be considered as their dose contribution is considered negligible as compared to CT. Our recent large cohort study did not detect increased cancer risks after conventional x-ray examination [6].…”

Section: Textmentioning

confidence: 56%

Computed tomography in children: multicenter cohort study design for the evaluation of cancer risk

Krille

Jahnen²,

Mildenberger

et al. 2011

Eur J Epidemiol

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“…Among those studies that have been done, the potential risks of diagnostic uses of ionizing radiation such as X-rays in children were reported by Stewart et al [12]. From the results of many case-control studies and estimates of excess absolute risk (EAR), Doll and Wakeford [13] supported the association reported by Stewart et al On the other hand, Hammer et al [11] reported no increase in the risk of childhood cancer for about 100,000 children who had been examined using diagnostic X-rays. This uncertainty in studies of cohorts exposed to radiation in childhood has resulted in continuing controversy regarding the causal interpretation of the association between radiation exposure in children and cancer [14].…”

Section: Introductionmentioning

confidence: 86%

“…The cancer risk in children after postnatal diagnostic irradiation has also been studied less extensively [8][9][10][11]. Among those studies that have been done, the potential risks of diagnostic uses of ionizing radiation such as X-rays in children were reported by Stewart et al [12].…”

Section: Introductionmentioning

confidence: 99%

Cancer mortality among atomic bomb survivors exposed as children

Goto

Watanabe

Miyao

et al. 2011

Environ Health Prev Med

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Objectives To compare cancer mortality among A-bomb survivors exposed as children with cancer mortality among an unexposed control group (the entire population of Japan, JPCG). Methods The subjects were the Hiroshima and Nagasaki A-bomb survivor groups (0-14 years of age in 1945) reported in life span study report 12 (follow-up years were from 1950 to 1990), and a control group consisting of the JPCG. We estimated the expected number of deaths due to all causes and cancers of various causes among the exposed survivors who died in the follow-up interval, if they had died with the same mortality as the JPCG (0-14 years of age in 1945). We calculated the standardized mortality ratio (SMR) of A-bomb survivors in comparison with the JPCG.Results SMRs were significantly higher in exposed boys overall for all deaths, all cancers, leukemia, and liver cancer, and for exposed girls overall for all cancers, solid cancers, liver cancer, and breast cancer. In boys, SMRs were significantly higher for all deaths and liver cancer even in those exposed to very low doses, and for all cancers, solid cancers, and liver cancer in those exposed to low doses. In girls, SMRs were significantly higher for liver cancer and uterine cancer in those exposed to low doses, and for leukemia, solid cancers, stomach cancer, and breast cancer in those exposed to high doses. Conclusions We calculated the SMRs for the A-bomb survivors versus JPCG in childhood and compared them with a true non-exposed group. A notable result was that SMRs in boys exposed to low doses were significantly higher for solid cancer.

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A Cohort Study of Childhood Cancer Incidence after Postnatal Diagnostic X-Ray Exposure

Cited by 46 publications

References 30 publications

Risk of radiation-induced malignancies from CT scanning in children who underwent shunt treatment before 6 years of age: a retrospective cohort study with a minimum 10-year follow-up

Risk of radiation-induced malignancies from CT scanning in children who underwent shunt treatment before 6 years of age: a retrospective cohort study with a minimum 10-year follow-up

Computed tomography in children: multicenter cohort study design for the evaluation of cancer risk

Cancer mortality among atomic bomb survivors exposed as children

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