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Relationship between paediatric CT scans and subsequent risk of leukaemia and brain tumours: assessment of the impact of underlying conditions

Lookup NU author(s): Dr Jane Salotti, Dr Richard Harbron, Emeritus Professor Alan Craft, Professor Mark Pearce

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Abstract

Background: We previously reported evidence of a dose-response relationship between ionising-radiation exposure from paediatric computed tomography (CT) scans and the risk of leukaemia and brain tumours in a large UK cohort. Underlying unreported conditions could have introduced bias into these findings.Methods: We collected and reviewed additional clinical information from radiology information systems (RIS) databases, underlying cause of death and pathology reports. We conducted sensitivity analyses excluding participants with cancer-predisposing conditions or previous unreported cancers and compared the dose-response analyses with our original results.Results: We obtained information from the RIS and death certificates for about 40% of the cohort (n similar to 180 000) and found cancer-predisposing conditions in 4 out of 74 leukaemia/myelodysplastic syndrome (MDS) cases and 13 out of 135 brain tumour cases. As these conditions were unrelated to CT exposure, exclusion of these participants did not alter the dose-response relationships. We found evidence of previous unreported cancers in 2 leukaemia/MDS cases, 7 brain tumour cases and 232 in non-cases. These previous cancers were related to increased number of CTs. Exclusion of these cancers reduced the excess relative risk per mGy by 15% from 0.036 to 0.033 for leukaemia/MDS (P-trend = 0.02) and by 30% from 0.023 to 0.016 (P-trend < 0.0001) for brain tumours. When we included pathology reports we had additional clinical information for 90% of the cases. Additional exclusions from these reports further reduced the risk estimates, but this sensitivity analysis may have underestimated risks as reports were only available for cases.Conclusions: Although there was evidence of some bias in our original risk estimates, re-analysis of the cohort with additional clinical data still showed an increased cancer risk after low-dose radiation exposure from CT scans in young patients.


Publication metadata

Author(s): de Gonzalez AB, Salotti JA, McHugh K, Little MP, Harbron RW, Lee C, Ntowe E, Braganza MZ, Parker L, Rajaraman P, Stiller C, Stewart DR, Craft AW, Pearce MS

Publication type: Article

Publication status: Published

Journal: British Journal of Cancer

Year: 2016

Volume: 114

Issue: 4

Pages: 388-394

Online publication date: 16/02/2016

Acceptance date: 01/11/2015

ISSN (print): 0007-0920

ISSN (electronic): 1532-1827

Publisher: Nature Publishing Group

URL: http://dx.doi.org/10.1038/bjc.2015.415

DOI: 10.1038/bjc.2015.415


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