Survival adjusted cancer risks attributable to radiation exposure from cardiac catheterisations in children

Abstract

ObjectivesTo estimate the risk of developing cancer in relation to the typical radiation doses received from a range of X-ray guided cardiac catheterisations in children, taking variable survival into account.MethodsRadiation doses were estimated for 2749 procedures undertaken at five UK hospitals using Monte Carlo simulations. The lifetime attributable risk (LAR) of cancer incidence was estimated using models developed by the Biological Effects of Ionising Radiation committee, based on both normal life expectancy, and as a function of attained age, from 20 to 80 years, to take reduced life expectancy into account.ResultsThe radiation-related risks from these procedures are dominated by lung and breast cancer (for females). Assuming normal life expectancy, central LAR estimates for cancer incidence, based on median doses, ranged from <1 in 2000 for atrial septal defect occlusions to as high as 1 in 150 for valve replacements. For a reduced life expectancy of 50 years, estimated risks are lower by a factor of around 7. For conditions with especially poor survival (age 20 years), such as hypoplastic left heart syndrome, estimated cancer risks attributable to radiation were <1 in 20 000.ConclusionsBased on recent UK radiation dose levels, the risk of cancer following cardiac catheterisations is relatively low and strongly modified by survival and the type of procedure. The risk of breast cancer, especially following pulmonary artery angioplasty and valve replacements, is the greatest concern.

Transcatheter and intraoperative device closure of atrial septal defect in infants under three years of age

“…Although auxiliary technology (pulmonary vein deployment technique or balloon-assisted technique) could be used to facilitate the transcatheter closure of large secundum ASDs, the procedure would inevitably increase the fluoroscopy time and dosage of contrast agent. Radiation can induce cancer and affect the function of organs, such as bone marrow, genitals, and thyroid gland [18][19][20]. Although radiation-induced cancer with a median follow-up duration of 4.5 years has not been shown in the present study, the effect on infants in the coming decades remains unclear.…”

Diagnosis and Management of Noncardiac Complications in Adults With Congenital Heart Disease: A Scientific Statement From the American Heart Association

“…328 Life expectancy is a strong modifier of cancer risk and taken into account in these discussions. 346 There are no practice guidelines on the surveillance of HCC in patients with Fontan physiology. Table 2 summarizes recommendations for surveillance of FALD.…”

“…345 In a recent study, organ-specific radiation dose from a variety of catheterization procedures in children ranged from an LAR of <1 in 2000 for atrial septal defect closure to 1 in 150 for transcatheter valve replacements. 346 Of particular importance was the strong modification of LAR cancer incidence depending on survival, with a lower LAR incidence by 7-fold for those with a life expectancy of 50 years. Women are at particular risk, and breast cancer is of particular concern especially after transcatheter valve replacement.…”

Heartbeat: Diabetes and heart failure

“…Harbron and colleagues5 estimated lifetime attributable risk (LAR) related to radiation exposure during childhood using radiation doses measured at 2749 procedures performed at 5 UK hospitals and models developed by the Biological Effects of Ionising Radiation committee. This model suggests that the greatest risks associated with cardiac catheterisation are for lung cancer in both sexes and breast cancer in females.…”