Cancer incidence among children and young adults who have undergone x-ray guided cardiac catheterization procedures

Abstract

Children and young adults with heart disease appear to be at increased risk of developing cancer, although the reasons for this are unclear. A cohort of 11,270 individuals, who underwent cardiac catheterizations while aged ≤ 22 years in the UK, was established from hospital records. Radiation doses from cardiac catheterizations and CT scans were estimated. The cohort was matched with the NHS Central Register and NHS Transplant Registry to determine cancer incidence and transplantation status. Standardized incidence ratios (SIR) with associated confidence intervals (CI) were calculated. The excess relative risk (ERR) of lymphohaematopoietic neoplasia was also calculated using Poisson regression. The SIR was raised for all malignancies (2.32, 95% CI 1.65, 3.17), lymphoma (8.34, 95% CI 5.22, 12.61) and leukaemia (2.11, 95% CI 0.82, 4.42). After censoring transplant recipients, post-transplant, the SIR was reduced to 0.90 (95% CI 0.49, 1.49) for all malignancies. All lymphomas developed post-transplant. The SIR for all malignancies developing 5 years from the first cardiac catheterization (2 years for leukaemia/lymphoma) remained raised (3.01, 95% CI 2.09, 4.19) but was again reduced after censoring transplant recipients (0.98, 95% CI 0.48, 1.77). The ERR per mGy bone marrow dose for lymphohaematopoietic neoplasia was reduced from 0.541 (95% CI 0.104, 1.807) to 0.018 (95% CI − 0.002, 0.096) where transplantation status was accounted for as a time-dependent background risk factor. In conclusion, transplantation appears to be a large contributor to elevated cancer rates in this patient group. This is likely to be mainly due to associated immunosuppression, however, radiation exposure may also be a contributing factor.

Radiation exposure from computerized tomography and risk of childhood leukemia: Finnish register-based case-control study of childhood leukemia (FRECCLE)

“…Some studies have suggested increased risks associated with background radiation and following x-ray examinations in utero and post-natally. 18–22 Computed tomography (CT) imaging has been used for almost four decades and its frequency of utilization increased greatly during the 1980s–1990s. The annual number of scans peaked around year 2002; more recently CT scans have been partly replaced by magnetic resonance imaging in pediatric imaging, partly because of the risk of cancer from ionizing radiation.…”

Early life ionizing radiation exposure and cancer risks: systematic review and meta-analysis

“…A study of adults with congenital heart defects reported significantly higher cancer risks associated with increasing numbers of diagnostic and treatment cardiac procedures [73]. Cancer risk associated with cardiac catheterization during childhood has been analyzed in three studies with divergent results [51,74,75]. The most recent study from the UK with individual dose reconstruction [51] reported no increase in all cancers after disregarding transplant patiens, whose condition might predispose to cancer.…”

“…at first exposure, varied from 0 to 22 years, with some studies focusing only on children first exposed before the Organ doses were estimated only for CT studies, based on patient characteristics (age, gender), type of examination and machine-specific settings retrieved from radiology protocols [28], published radiologic survey data [30,45,49], or from the Picture Archiving and Communication System (PACS) [57]. The cumulative estimated doses ranged from 5.9 mGy to 10.1 mGy to the red bone marrow and from 18.3 mGy to 49 mGy to the brain (Table 2 [51] but were no more increased after censoring transplant recipients (SIR 0.90, 95% CI 0.49, 1.49 for all cancers with 0 case for lymphoma).…”

A Triaxial Flexible Magnetic Tunnel Junction Sensor for Catheter Tracking

“…To perform the procedure, x-ray images together with contrast agents are used to visualize the blood vessels and track the orientation and location of the catheter. Obviously, X-ray exposure is harmful to the patients as well as the medical staff [5][6][7]. The excessive use of the contrast dye poses a serious risk of contrast medium-induced nephropathy, which has been reported to have increased to 30% in patients with congestive heart failure [8][9][10].…”