Paediatric head CT scan and subsequent risk of malignancy and benign brain tumour: a nation-wide population-based cohort study

Abstract

Background:To evaluate the possible association between paediatric head computed tomography (CT) examination and increased subsequent risk of malignancy and benign brain tumour.Methods:In the exposed cohort, 24 418 participants under 18 years of age, who underwent head CT examination between 1998 and 2006, were identified from the Taiwan National Health Insurance Research Database (NHIRD). Patients were followed up until a diagnosis of malignant disease or benign brain tumour, withdrawal from the National Health Insurance (NHI) system, or at the end of 2008.Results:The overall risk was not significantly different in the two cohorts (incidence rate=36.72 per 100 000 person-years in the exposed cohort, 28.48 per 100 000 person-years in the unexposed cohort, hazard ratio (HR)=1.29, 95% confidence interval (CI)=0.90–1.85). The risk of benign brain tumour was significantly higher in the exposed cohort than in the unexposed cohort (HR=2.97, 95% CI=1.49–5.93). The frequency of CT examination showed strong correlation with the subsequent overall risk of malignancy and benign brain tumour.Conclusions:We found that paediatric head CT examination was associated with an increased incidence of benign brain tumour. A large-scale study with longer follow-up is necessary to confirm this result.

Medical conditions associated with the use of CT in children and young adults, Great Britain, 1995–2008

“…14 Since the previously published risk analyses, [3][4][5][6][7][8][9][10][11][12][13][14] additional information on CT exposures and scan reports was collected for the period [2003][2004][2005][2006][2007][2008] in half of the participating hospitals and the follow-up (diagnosis of cancer, vital status) was extended up to 31 December 2010. Available information for scans performed before 1995 was sparse and not included in this report.…”

“…Other cohort studies have found comparable results. [4][5][6][7] The interpretation of these results nevertheless requires an understanding of whether the excess risks of later malignancies observed after CT scans were due to the radiation exposure or to the underlying medical condition. 8,9 It is indeed possible that the increased incidence rates observed after receipt of CT scans were, at least in part, attributable to the indication for CT use, whether it was the first symptoms of a tumour, a followup for cancer predisposition or a non-cancer disease associated with an elevated risk of developing cancer.…”

“…In all the previously reported epidemiological studies, the analyses were conducted after excluding cancers occurring within the first 1-10 years after exposures to reduce the possibility that scans were performed to investigate early symptoms of a tumour diagnosed later. [3][4][5][6][7] Ad hoc analyses 7,14,15 showed little to no evidence of an overestimation of radiation-related risks owing to the presence of cancer-predisposing conditions, such as Down syndrome, neurofibromatosis or ataxia telangiectasia, or immune deficiencies known to be associated with an elevated risk of haematopoietic tumours. 16,17 To complement these findings, we aim here to describe medical conditions associated with the use of CT in children or young adults with no previous diagnosis of cancer, among members of the previously reported UK CT cohort.…”

Confounding of the Association between Radiation Exposure from CT Scans and Risk of Leukemia and Brain Tumors by Cancer Susceptibility Syndromes

“…Five epidemiologic studies on cancer following radiation exposure from pediatric computed tomography (CT) scans have shown elevated risks of leukemia and brain tumors (1)(2)(3)(4)(5) and other studies are under way (6,7). These studies are record-linkage cohort studies on large numbers of patients collected from existing databases (health insurances and hospitals) with limited or no information on potential confounding factors, which may bias the radiation-cancer association.…”

The Think A-Head campaign: an introduction to ImageGently 2.0

“…In addition, there is variability in adherence to best practice clinical guidelines [30][31][32][33][34]. The issue of head CT and cancer risk is debated [35][36][37][38][39][40][41]; parental as well as emergency department providers' understanding of medical radiation exposure and cancer risk can vary [42][43][44][45]. Emergent care involves multiple stakeholders, including the patient and family, primary care physicians; nurses; emergency medicine physicians; trauma, pediatric and neurosurgeons; and the imaging team.…”