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CANCER RISK IN CHILDREN EXPOSED TO CT SCANS Allison Low 3.10.2013.

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Presentation on theme: "CANCER RISK IN CHILDREN EXPOSED TO CT SCANS Allison Low 3.10.2013."— Presentation transcript:

1 CANCER RISK IN CHILDREN EXPOSED TO CT SCANS Allison Low 3.10.2013

2 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

3 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

4 Current practice

5

6 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

7 Methods Medicare records record all (funded) CT scans Australian Cancer Database (ICD-10 codes) socioeconomic status from SEIFA

8 Methods - missed scans state-based tertiary hospitals (not on records) scans outside of Australia

9 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)

10 Results

11 Scans in exposed patients

12 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)

13 Main results

14 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

15 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

16 CASP tool

17 X

18 X

19 X

20 X

21 X X

22 X X

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25 X

26 X

27 X

28 Discussion points (no trauma CT patients with subsequent leukaemia in Sheffield...) Image Gently/ALARA CT scans vs clinical skill


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