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CANCER RISK IN CHILDREN EXPOSED TO CT SCANS Allison Low 3.10.2013
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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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X
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X X
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X X
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Discussion points (no trauma CT patients with subsequent leukaemia in Sheffield...) Image Gently/ALARA CT scans vs clinical skill
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