Brain and neck tumors among physicians performing interventional procedures.

Physicians performing interventional procedures are chronically exposed to ionizing radiation, which is known to pose increased cancer risks. We recently reported 9 cases of brain cancer in interventional cardiologists. Subsequently, we received 22 additional cases from around the world, comprising an expanded 31 case cohort. Data were transmitted to us during the past few months. For all cases, where possible, we endeavored to obtain the baseline data, including age, gender, tumor type, and side involved, specialty (cardiologist vs radiologist), and number of years in practice. These data were obtained from the medical records, interviews with patients, when possible, or with family members and/or colleagues. The present report documented brain and neck tumors occurring in 31 physicians: 23 interventional cardiologists, 2 electrophysiologists, and 6 interventional radiologists. All physicians had worked for prolonged periods (latency period 12 to 32 years, mean 23.5 ± 5.9) in active interventional practice with exposure to ionizing radiation in the catheterization laboratory. The tumors included 17 cases (55%) of glioblastoma multiforme (GBM), 2 astrocytomas (7%), and 5 meningiomas (16%). In 26 of 31 cases, data were available regarding the side of the brain involved. The malignancy was left sided in 22 (85%), midline in 1, and right sided in 3 operators. In conclusion, these results raise additional concerns regarding brain cancer developing in physicians performing interventional procedures. Given that the brain is relatively unprotected and the left side of the head is known to be more exposed to radiation than the right, these findings of disproportionate reports of left-sided tumors suggest the possibility of a causal relation to occupational radiation exposure.

[1]  Stephen Yip,et al.  Molecular pathology in adult gliomas: diagnostic, prognostic, and predictive markers , 2010, The Lancet Neurology.

[2]  K. H. Mild,et al.  Ionizing radiation, cellular telephones and the risk for brain tumours , 2001, European journal of cancer prevention : the official journal of the European Cancer Prevention Organisation.

[3]  E. Sakamoto-Hojo,et al.  Evaluation of chromosomal aberrations, micronuclei, and sister chromatid exchanges in hospital workers chronically exposed to ionizing radiation. , 2001, Teratogenesis, carcinogenesis, and mutagenesis.

[4]  Alexander Norbash,et al.  The catheterization laboratory and interventional vascular suite of the future: Anticipating innovations in design and function , 2011, Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions.

[5]  Stephen Balter,et al.  Occupational hazards of interventional cardiologists: Prevalence of orthopedic health problems in contemporary practice , 2004, Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions.

[6]  P. Bigatti,et al.  Cytogenetic monitoring of hospital workers exposed to low-level ionizing radiation. , 1988, Mutation research.

[7]  G. Speit,et al.  Assessment of DNA damage in lymphocytes of workers exposed to X‐radiation using the micronucleus test and the comet assay , 2001, Environmental and molecular mutagenesis.

[8]  D A Savitz,et al.  Occupation and adult gliomas. , 2000, American journal of epidemiology.

[9]  Madan M Rehani,et al.  Risk for radiation‐induced cataract for staff in interventional cardiology: Is there reason for concern? , 2010, Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions.

[10]  Eugenio Picano,et al.  Cumulative patient effective dose and acute radiation-induced chromosomal DNA damage in children with congenital heart disease , 2009, Heart.

[11]  S. Preston‐Martin,et al.  Brain and salivary gland tumors related to prior dental radiography: implications for current practice. , 1990, Journal of the American Dental Association.

[12]  F. Violante,et al.  Spectrum of chromosomal aberrations in peripheral lymphocytes of hospital workers occupationally exposed to low doses of ionizing radiation. , 2004, Mutation research.

[13]  Donald L. Miller,et al.  Occupational health hazards in the interventional laboratory: time for a safer environment. , 2009, Heart rhythm.

[14]  F. Violante,et al.  Micronuclei frequencies in hospital workers occupationally exposed to low levels of ionizing radiation: influence of smoking status and other factors. , 2002, Mutagenesis.

[15]  Donald L. Miller,et al.  Occupational health hazards in the interventional laboratory: progress report of the Multispecialty Occupational Health Group , 2010, Journal of NeuroInterventional Surgery.

[16]  L. Renaud A 5-y follow-up of the radiation exposure to in-room personnel during cardiac catheterization. , 1992, Health physics.

[17]  E. Picano,et al.  Somatic DNA damage in interventional cardiologists: a case‐control study , 2005, FASEB journal : official publication of the Federation of American Societies for Experimental Biology.

[18]  M. Blettner,et al.  Medical exposure to ionising radiation and the risk of brain tumours: Interphone study group, Germany. , 2007, European journal of cancer.

[19]  D. Savitz,et al.  Mortality from brain cancer and leukaemia among electrical workers. , 1990, British journal of industrial medicine.

[20]  M Blettner,et al.  Is cancer risk of radiation workers larger than expected? , 2009, Occupational and Environmental Medicine.

[21]  Donald L. Miller,et al.  Occupational health hazards in the interventional laboratory: progress report of the Multispecialty Occupational Health Group. , 2010, Journal of Vascular and Interventional Radiology.

[22]  J. K. Grayson,et al.  Radiation exposure, socioeconomic status, and brain tumor risk in the US Air Force: a nested case-control study. , 1996, American journal of epidemiology.

[23]  Donald L. Miller,et al.  Occupational health hazards in the interventional laboratory: time for a safer environment. , 2009, Radiology.

[24]  G. Matanoski,et al.  The current mortality rates of radiologists and other physician specialists: specific causes of death. , 1975, American journal of epidemiology.

[25]  Donald L. Miller,et al.  Historical Review of Occupational Exposures and Cancer Risks in Medical Radiation Workers , 2010, Radiation research.

[26]  D. Nass,et al.  Radiation-induced meningioma: a descriptive study of 253 cases. , 2002, Journal of neurosurgery.

[27]  N. Sut,et al.  Sister chromatid exchanges in lymphocytes of nuclear medicine physicians. , 2003, Mutation research.

[28]  J. Barquinero,et al.  Cytogenetic analysis of lymphocytes from hospital workers occupationally exposed to low levels of ionizing radiation. , 1993, Mutation research.

[29]  K. A. Noghabi,et al.  Biological effects of low-dose ionizing radiation exposure on interventional cardiologists. , 2010, Occupational medicine.

[30]  Keith Binks,et al.  The non-cancer mortality experience of male workers at British Nuclear Fuels plc, 1946–2005 , 2008, International journal of epidemiology.

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

[32]  M. Linet,et al.  Etiology of brain tumors in adults. , 1995, Epidemiologic reviews.

[33]  Eugenio Picano,et al.  Cancer risk from professional exposure in staff working in cardiac catheterization laboratory: insights from the National Research Council's Biological Effects of Ionizing Radiation VII Report. , 2009, American heart journal.

[34]  M. Finkelstein Is brain cancer an occupational disease of cardiologists? , 1998, The Canadian journal of cardiology.

[35]  E Vañó,et al.  Radiation exposure to medical staff in interventional and cardiac radiology. , 1998, The British journal of radiology.

[36]  Tarik Tihan,et al.  Brain tumor epidemiology: Consensus from the Brain Tumor Epidemiology Consortium , 2008, Cancer.

[37]  Ariel Roguin,et al.  Brain tumours among interventional cardiologists: a cause for alarm? Report of four new cases from two cities and a review of the literature. , 2012, EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology.

[38]  R. Baggott DISEASE , 1947, Social Policy & Administration.

[39]  A. Roguin,et al.  Brain malignancies and ionising radiation: more cases reported. , 2012, EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology.