Relationship between paediatric CT scans and subsequent risk of leukaemia and brain tumours: assessment of the impact of underlying conditions
Open accessAbstract
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∼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.
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Confounding by indication was evaluated either directly from medical records or indirectly through modeling in several national EPI-CT cohorts.
“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 [34]
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- Authors
- de Gonzalez, A. B., Salotti, J. A., McHugh, K., Little, M. P., Harbron, R. W., Lee, C., Ntowe, E., Braganza, M. Z., Parker, L., Rajaraman, P., Stiller, C., Stewart, D. R., Craft, A. W., & Pearce, M. S.
- Affiliations
- Royal Victoria Infirmary (GB)
- Great Ormond Street Hospital (GB)
- National Cancer Institute (US)
- Dalhousie University (CA)
- University of Oxford (GB)
- ORCID
- Venue
- British Journal of Cancer
- Published
- 2016-02
- Volume
- 114
- Issue
- 4
- Pages
- 388-394
- ISSN
- 0007-0920 (ISSN-L)
- 1532-1827
- PMC
- PMC4815765
- OpenAlex
- W2344227124
- Cited by
- 244
- References
- 26
- Citations by year
- 2026: 9 · 2025: 11 · 2024: 14 · 2023: 26 · 2022: 35 · 2021: 31 · 2020: 37 · 2019: 19 · 2018: 31 · 2017: 15 · 2016: 15 · 2014: 1
- FWCI
- 23.13
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- British Journal of Cancer (publishedVersion, cc-by-nc-sa)
- PubMed Central (publishedVersion, cc-by-nc-sa)
- PubMed (publishedVersion)
- Newcastle University ePrints (Newcastle Univesity)
- Funders
- Cancer Research UK (16015)
- National Institute for Health and Care Research
- National Institutes of Health
- 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 › Radiology, Nuclear Medicine and Imaging › Radiology practices and education
- Keywords
- pediatric computed tomography, ionizing radiation exposure, leukemia, brain tumors, myelodysplastic syndrome, cancer risk, dose-response relationship, low-dose radiation, childhood cancer
- MeSH terms
- Adolescent, Adult, Brain Neoplasms, Child, Female, Humans, Leukemia, Male, Neoplasms, Radiation-Induced, Retrospective Studies, Tomography, X-Ray Computed, Cohort Studies, Young Adult
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