cancer risk in children exposed to ct scans allison low 3.10.2013
TRANSCRIPT
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CANCER RISK IN CHILDREN CANCER RISK IN CHILDREN EXPOSED TO CT SCANSEXPOSED TO CT SCANS
Allison Low3.10.2013
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Clinical Question• Do CT scans in children and adolescents increase
their subsequent risk of developing cancer?• P - children and adolescents• I - CT scans• C - no CT scans• O - cancer
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Clinical cases• 13 year old boy with an incidental finding of
papilloedema, neurological examination otherwise normal
• 4 year old girl, RTA, GCS of 9, visible head injury, no external abdominal injuries, haemodynamically stable
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Current practice
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Methods• population based, cohort, data linkage study• Australia• 10.9 million people aged 0-19 (Medicare) over a 20
year period ending in 2005• monitoring until 2007
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Methods• Medicare records record all (funded) CT scans• Australian Cancer Database (ICD-10 codes)• socioeconomic status from SEIFA
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Methods - missed scans• state-based tertiary hospitals (not on records)• scans outside of Australia
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Analysis• one year lag period (also five and ten year lags)• IRRs exposed vs unexposed• dosage: estimate by site, year of scan, age (changed
after 2001)
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Results
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Scans in exposed patients
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Results• mean length of follow up: 17.3 years (unexposed), 9.5
years (exposed)• 3150 exposed individuals developed cancer• 57 524 non-exposed developed cancer• overall, IRR 24% higher in exposed group (IRR 1.24,
95% CI 1.20-1.29)
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Main results
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Other results• IRR increased with each additional CT scan (0.16 ,
95% CI 0.13-0.19)• IRR increased for all cancers combined, also for all
solid organ cancers, all lymphoid and haematopoeitic cancers
• site-specific eg leukaemia after CT abdo/pelvis• gender difference for non-brain solid organ tumours:
F>M (1.23)• socioeconomic status: no significant difference
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Brain cancer• brain cancer - highest risk 1-4 years after exposure,
higher risk for 15 years• under five years riskiest• ? reverse causation - analysis repeated excluding all
brain cancers after CT brain - 1.20, 95% CI 1.15-1.24
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CASP tool
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Discussion points• (no trauma CT patients with subsequent leukaemia in
Sheffield...)• Image Gently/ALARA• CT scans vs clinical skill