Predicted cancer risks induced by computed tomography examinations during childhood, by a quantitative risk assessment approach

The potential adverse effects associated with exposure to ionizing radiation from computed tomography (CT) in pediatrics must be characterized in relation to their expected clinical benefits. Additional epidemiological data are, however, still awaited for providing a lifelong overview of potential cancer risks. This paper gives predictions of potential lifetime risks of cancer incidence that would be induced by CT examinations during childhood in French routine practices in pediatrics. Organ doses were estimated from standard radiological protocols in 15 hospitals. Excess risks of leukemia, brain/central nervous system, breast and thyroid cancers were predicted from dose–response models estimated in the Japanese atomic bomb survivors’ dataset and studies of medical exposures. Uncertainty in predictions was quantified using Monte Carlo simulations. This approach predicts that 100,000 skull/brain scans in 5-year-old children would result in eight (90 % uncertainty interval (UI) 1–55) brain/CNS cancers and four (90 % UI 1–14) cases of leukemia and that 100,000 chest scans would lead to 31 (90 % UI 9–101) thyroid cancers, 55 (90 % UI 20–158) breast cancers, and one (90 % UI <0.1–4) leukemia case (all in excess of risks without exposure). Compared to background risks, radiation-induced risks would be low for individuals throughout life, but relative risks would be highest in the first decades of life. Heterogeneity in the radiological protocols across the hospitals implies that 5–10 % of CT examinations would be related to risks 1.4–3.6 times higher than those for the median doses. Overall excess relative risks in exposed populations would be 1–10 % depending on the site of cancer and the duration of follow-up. The results emphasize the potential risks of cancer specifically from standard CT examinations in pediatrics and underline the necessity of optimization of radiological protocols.

[1]  B. Modan,et al.  Thyroid cancer after exposure to external radiation: a pooled analysis of seven studies. 1995. , 2012, Radiation research.

[2]  D A Pierce,et al.  Calculating excess lifetime risk in relative risk models. , 1990, Environmental health perspectives.

[3]  Sheila Weinmann,et al.  Use of diagnostic imaging studies and associated radiation exposure for patients enrolled in large integrated health care systems, 1996-2010. , 2012, JAMA.

[4]  Yan Liu,et al.  New primary neoplasms of the central nervous system in survivors of childhood cancer: a report from the Childhood Cancer Survivor Study. , 2006, Journal of the National Cancer Institute.

[5]  D. L. Preston,et al.  Solid Cancer Incidence in Atomic Bomb Survivors: 1958–1998 , 2007, Radiation research.

[6]  D. Preston,et al.  Radiation and Smoking Effects on Lung Cancer Incidence among Atomic Bomb Survivors , 2010, Radiation research.

[7]  H. Sugiyama,et al.  The Incidence of Leukemia, Lymphoma and Multiple Myeloma among Atomic Bomb Survivors: 1950–2001 , 2013, Radiation research.

[8]  B. Pasternack,et al.  TUMORS AND OTHER DISEASES FOLLOWING CHILDHOOD X-RAY TREATMENT FOR RINGWORM OF THE SCALP (TINEA CAPITIS) , 2003, Health physics.

[9]  H. Brisse,et al.  Radiation exposure from CT in early childhood: a French large-scale multicentre study. , 2012, The British journal of radiology.

[10]  G. Brix,et al.  Dose reduction by automatic exposure control in multidetector computed tomography: comparison between measurement and calculation , 2009, European Radiology.

[11]  P C Shrimpton,et al.  National survey of doses from CT in the UK: 2003. , 2006, The British journal of radiology.

[12]  G. Chatellier,et al.  [Role of French hospital claims databases from care units in epidemiological studies: the example of the "Cohorte Enfant Scanner" study]. , 2012, Revue d'epidemiologie et de sante publique.

[13]  A M Kellerer,et al.  On the conversion of solid cancer excess relative risk into lifetime attributable risk , 2001, Radiation and environmental biophysics.

[14]  D. Lefkopoulos,et al.  Radiation therapy and late mortality from second sarcoma, carcinoma, and hematological malignancies after a solid cancer in childhood. , 2011, International journal of radiation oncology, biology, physics.

[15]  F. O. Hoffman,et al.  INTERACTIVE RADIOEPIDEMIOLOGICAL PROGRAM (IREP): A WEB-BASED TOOL FOR ESTIMATING PROBABILITY OF CAUSATION/ASSIGNED SHARE OF RADIOGENIC CANCERS , 2008, Health physics.

[16]  M Colonna,et al.  Cancer incidence and mortality in France over the period 1980-2005. , 2008, Revue d'epidemiologie et de sante publique.

[17]  D. Brenner,et al.  Estimated risks of radiation-induced fatal cancer from pediatric CT. , 2001, AJR. American journal of roentgenology.

[18]  A. Elster,et al.  Effective Doses in Radiology and Diagnostic Nuclear Medicine: A Catalog , 2010 .

[19]  Peter Jacob,et al.  Cancer consequences of the Chernobyl accident: 20 years on , 2006, Journal of radiological protection : official journal of the Society for Radiological Protection.

[20]  D. Richardson,et al.  Ionizing Radiation and Leukemia Mortality among Japanese Atomic Bomb Survivors, 1950–2000 , 2009, Radiation research.

[21]  E. Ron,et al.  CANCER RISKS FROM MEDICAL RADIATION , 2003, Health physics.

[22]  G. Stamm,et al.  [CT-expo--a novel program for dose evaluation in CT]. , 2002, RoFo : Fortschritte auf dem Gebiete der Rontgenstrahlen und der Nuklearmedizin.

[23]  H. Zeeb,et al.  A Cohort Study of Childhood Cancer Incidence after Postnatal Diagnostic X-Ray Exposure , 2009, Radiation research.

[24]  Maria Blettner,et al.  Are pre- or postnatal diagnostic X-rays a risk factor for childhood cancer? A systematic review , 2008, Radiation and environmental biophysics.

[25]  C. Land,et al.  Incidence of female breast cancer among atomic bomb survivors, Hiroshima and Nagasaki, 1950-1990. , 1987, Radiation research.

[26]  M. Little.  Comparison of the risks of cancer incidence and mortality following radiation therapy for benign and malignant disease with the cancer risks observed in the Japanese A-bomb survivors , 2001, International journal of radiation biology.

[27]  Varda Shalev,et al.  Excess lifetime cancer mortality risk attributable to radiation exposure from computed tomography examinations in children. , 2007, The Israel Medical Association journal : IMAJ.

[28]  L. Tanoue.  Computed Tomography — An Increasing Source of Radiation Exposure , 2009 .

[29]  Mythreyi Bhargavan,et al.  MEDICAL RADIATION EXPOSURE IN THE U.S. IN 2006: PRELIMINARY RESULTS , 2008, Health physics.

[30]  J. Stockman.  Primary Thyroid Cancer After a First Tumour in Childhood (the Childhood Cancer Survivor Study): A Nested Case-Control Study , 2007 .

[31]  K. P. Kim,et al.  Radiation exposure from CT scans in childhood and subsequent risk of leukaemia and brain tumours: a retrospective cohort study , 2012, The Lancet.

[32]  A. Hercbergs,et al.  Radiation-induced breast cancer: long-term follow-up of radiation therapy for benign breast disease. , 1994, Journal of the National Cancer Institute.

[33]  R. Wakeford.  The risk of childhood leukaemia following exposure to ionising radiation—a review , 2013, Journal of radiological protection : official journal of the Society for Radiological Protection.

[34]  Carl V Phillips,et al.  Quantifying and Reporting Uncertainty from Systematic Errors , 2003, Epidemiology.

[35]  H. Nagel,et al.  CT-Expo - ein neuartiges Programm zur Dosisevaluierung in der CT , 2002 .

[36]  K. P. Kim,et al.  Radiation dose associated with common computed tomography examinations and the associated lifetime attributable risk of cancer. , 2009, Archives of internal medicine.

[37]  H. Brisse,et al.  Diagnostic radiation exposure in children and cancer risk : Current knowledge and perspectives , 2011 .

[38]  B. Modan,et al.  Long-Term Follow-up for Brain Tumor Development after Childhood Exposure to Ionizing Radiation for Tinea Capitis , 2005, Radiation research.

[39]  E Cardis,et al.  The Chernobyl accident--an epidemiological perspective. , 2011, Clinical oncology (Royal College of Radiologists (Great Britain)).

[40]  J. Valentin,et al.  Contents, preface, executive summary, chapters 1 and 2 , 2005 .

[41]  Choonsik Lee,et al.  Assessing Organ Doses from Paediatric CT Scans—A Novel Approach for an Epidemiology Study (the EPI-CT Study) † , 2013, International journal of environmental research and public health.

[42]  Rebecca S Lewis,et al.  Projected cancer risks from computed tomographic scans performed in the United States in 2007. , 2009, Archives of internal medicine.

[43]  G R Howe,et al.  Breast cancer mortality between 1950 and 1987 after exposure to fractionated moderate-dose-rate ionizing radiation in the Canadian fluoroscopy cohort study and a comparison with breast cancer mortality in the atomic bomb survivors study. , 1995, Radiation research.

[44]  Marilyn Stovall,et al.  Multiple Diagnostic X-rays for Spine Deformities and Risk of Breast Cancer , 2008, Cancer Epidemiology Biomarkers & Prevention.

[45]  David B. Dunson,et al.  Bayesian Data Analysis , 2010 .

[46]  Yukiko Shimizu,et al.  Effect of Recent Changes in Atomic Bomb Survivor Dosimetry on Cancer Mortality Risk Estimates , 2004, Radiation research.

[47]  H. Zeeb,et al.  Computed tomography in children: multicenter cohort study design for the evaluation of cancer risk , 2011, European Journal of Epidemiology.

[48]  M. Bernier,et al.  [Diagnostic radiation exposure in children and cancer risk: current knowledge and perspectives]. , 2012, Archives de pediatrie : organe officiel de la Societe francaise de pediatrie.

[49]  A. Mattsson,et al.  Intracranial tumors after exposure to ionizing radiation during infancy: a pooled analysis of two Swedish cohorts of 28,008 infants with skin hemangioma. , 1998, Radiation research.

[50]  C. Land,et al.  RadRAT: a radiation risk assessment tool for lifetime cancer risk projection , 2012, Journal of radiological protection : official journal of the Society for Radiological Protection.

[51]  D. Preston,et al.  Frequent chest X-ray fluoroscopy and breast cancer incidence among tuberculosis patients in Massachusetts. , 1991, Radiation research.

[52]  A. Einstein,et al.  Impact of reduced patient life expectancy on potential cancer risks from radiologic imaging. , 2011, Radiology.

[53]  N. Breslow,et al.  Statistical methods in cancer research. Volume II--The design and analysis of cohort studies. , 1987, IARC scientific publications.

[54]  L. Massimi,et al.  Radiation-induced brain tumours after central nervous system irradiation in childhood: a review , 2008, Child's Nervous System.

[55]  S. Sinno-tellier,et al.  French Population Exposure to Ionizing Radiation from Diagnostic Medical Procedures in 2007 , 2012 .

[56]  M. Little.  Leukaemia following childhood radiation exposure in the Japanese atomic bomb survivors and in medically exposed groups. , 2008, Radiation protection dosimetry.

[57]  Walter Huda,et al.  Patient radiation doses from adult and pediatric CT. , 2007, AJR. American journal of roentgenology.

[58]  D. McLean,et al.  Survey of effective dose levels from typical paediatric CT protocols. , 2003, Australasian radiology.

[59]  G. Moneta,et al.  Projected Cancer Risks From Computed Tomographic Scans Performed in the United States in 2007 , 2010 .

[60]  W. J. Meredith.  Report of the United Nations Scientific Committee on the Effects of Atomic Radiation , 1967 .

[61]  Andrew Thomas,et al.  WinBUGS - A Bayesian modelling framework: Concepts, structure, and extensibility , 2000, Stat. Comput..

[62]  J. Mathews,et al.  Cancer risk in 680 000 people exposed to computed tomography scans in childhood or adolescence: data linkage study of 11 million Australians , 2013, BMJ.

[63]  Amy Berrington de González,et al.  Risk of cancer from diagnostic X-rays: estimates for the UK and 14 other countries , 2004, The Lancet.

[64]  Preetha Rajaraman,et al.  Children’s exposure to diagnostic medical radiation and cancer risk: epidemiologic and dosimetric considerations , 2009, Pediatric Radiology.

[65]  L. Penrose.  REPORT OF THE UNITED NATIONS SCIENTIFIC COI\IMITTEE ON THE EFFECTS OF ATOMIC RADIATION , 2006 .

[66]  Yukiko Shimizu,et al.  Studies of the Mortality of Atomic Bomb Survivors, Report 14, 1950–2003: An Overview of Cancer and Noncancer Diseases , 2012, Radiation research.

[67]  R. Shore,et al.  Breast Cancer Risk 55+ Years After Irradiation for an Enlarged Thymus and Its Implications for Early Childhood Medical Irradiation Today , 2010, Cancer Epidemiology, Biomarkers & Prevention.

[68]  Erik Holmberg,et al.  Radiation Effects on Breast Cancer Risk: A Pooled Analysis of Eight Cohorts , 2002, Radiation research.

[69]  Masahiro Ito,et al.  Long‐term trend of thyroid cancer risk among Japanese atomic‐bomb survivors: 60 years after exposure , 2013, International journal of cancer.