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Risk of cancer incidence before the age of 15 years after exposure to ionising radiation from computed tomography: results from a German cohort study
Abstract
The aim of this cohort study was to assess the risk of developing cancer, specifically leukaemia, tumours of the central nervous system and lymphoma, before the age of 15 years in children previously exposed to computed tomography (CT) in Germany. Data for children with at least one CT between 1980 and 2010 were abstracted from 20 hospitals. Cancer cases occurring between 1980 and 2010 were identified by stochastic linkage with the German Childhood Cancer Registry (GCCR). For all cases and a sample of non-cases, radiology reports were reviewed to assess the underlying medical conditions at time of the CT. Cases were only included if diagnosis occurred at least 2 years after the first CT and no signs of cancer were recorded in the radiology reports. Standardised incidence ratios (SIR) using incidence rates from the general population were estimated. The cohort included information on 71,073 CT examinations in 44,584 children contributing 161,407 person-years at risk with 46 cases initially identified through linkage with the GCCR. Seven cases had to be excluded due to signs possibly suggestive of cancer at the time of first CT. Overall, more cancer cases were observed (O) than expected (E), but this was mainly driven by unexpected and possibly biased results for lymphomas. For leukaemia, the SIR (SIR = O/E) was 1.72 (95 % CI 0.89-3.01, O = 12), and for CNS tumours, the SIR was 1.35 (95 % CI 0.54-2.78, O = 7). Despite careful examination of the medical information, confounding by indication or reverse causation cannot be ruled out completely and may explain parts of the excess. Furthermore, the CT exposure may have been underestimated as only data from the participating clinics were available. This should be taken into account when interpreting risk estimates.
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“EPI-CT was designed to address previous methodological criticisms and limitations of similar studies12–16.”
From Risk of hematological malignancies from CT radiation exposure in children, adolescents and young adults (2023) · cites this paper as [15]
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“Confounding by indication was, however, evaluated either directly—from a review of medical records—or indirectly—through modeling—in several national EPI-CT cohorts15–17,33,34.”
From Risk of hematological malignancies from CT radiation exposure in children, adolescents and young adults (2023) · cites this paper as [15]
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Metadata
- Authors
- Krille, L., Dreger, S., Schindel, R., Albrecht, T., Asmussen, M., Barkhausen, J., Berthold, J. D., Chavan, A., Claussen, C., Forsting, M., Gianicolo, E. A. L., Jablonka, K., Jahnen, A., Langer, M., Laniado, M., Lotz, J., Mentzel, H. J., Queißer-Wahrendorf, A., Rompel, O., Schlick, I., Schneider, K., Schumacher, M., Seidenbusch, M., Spix, C., Spors, B., Staatz, G., Vogl, T., Wagner, J., Weisser, G., Zeeb, H., & Blettner, M.
- Affiliations
- University Medical Center of the Johannes Gutenberg University Mainz (DE)
- University of Bremen (DE)
- Vivantes Klinikum (DE)
- Städtisches Klinikum Karlsruhe (DE)
- University Hospital Schleswig-Holstein (DE)
- Medizinische Hochschule Hannover (DE)
- Klinikum Oldenburg (DE)
- Universitätsklinikum Tübingen (DE)
- Essen University Hospital (DE)
- Klinikum Bremen-Mitte (DE)
- Centre de recherche public Henri-Tudor (LU)
- University Medical Center Freiburg (DE)
- University Hospital Carl Gustav Carus (DE)
- Universitätsmedizin Göttingen (DE)
- Jena University Hospital (DE)
- Johannes Gutenberg University Mainz (DE)
- Universitätsklinikum Erlangen (DE)
- Nuremberg Hospital (DE)
- LMU Klinikum (DE)
- University of Freiburg (DE)
- Charité – Universitätsmedizin Berlin (DE)
- Goethe University Frankfurt (DE)
- Klinikum im Friedrichshain (DE)
- University Medical Centre Mannheim (DE)
- Corresponding author
- Blettner, M.
- ORCID
- Venue
- Radiation and Environmental Biophysics
- Published
- 2015-01-08
- Volume
- 54
- Issue
- 1
- Pages
- 1-12
- ISSN
- 0301-634X (ISSN-L)
- 1432-2099
- OpenAlex
- W4252769413
- Cited by
- 184
- References
- 29
- Citations by year
- 2026: 8 · 2025: 8 · 2024: 12 · 2023: 13 · 2022: 16 · 2021: 21 · 2020: 16 · 2019: 16 · 2018: 22 · 2017: 14 · 2016: 27 · 2015: 10
- FWCI
- 19.69
- Type
- journal article
- Language
- en
- Update notices
- correction (2017-06-13)
- Open access
- closed
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Radiation and Environmental Biophysics (publishedVersion)
- PubMed (publishedVersion)
- GRO (submittedVersion)
- Funders
- World Health Organization
- Bundesministerium für Bildung und Forschung
- Topics
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Radiation Dose and Imaging
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Effects of Radiation Exposure
- Health Sciences › Medicine › Oncology › Global Cancer Incidence and Screening
- Keywords
- childhood cancer, computed tomography, ionizing radiation exposure, leukemia, central nervous system tumors, lymphoma, cancer incidence, confounding by indication, reverse causality, radiation-induced cancer risk, German Childhood Cancer Registry
- MeSH terms
- Adolescent, Child, Child, Preschool, Female, Germany, Humans, Infant, Infant, Newborn, Male, Neoplasms, Radiation-Induced, Radiation, Ionizing, Risk, Tomography, X-Ray Computed, Cohort Studies, Incidence
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