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Cancer and mortality risks of patients with scoliosis from radiation exposure: a systematic review and meta-analysis

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Abstract

Purpose

The study aimed for unraveling the long-term health impact of cumulative radiation exposure from full-spine radiographs on children/adolescents with scoliosis.

Methods

All cohort, case–control or cross-sectional studies about radiation exposure to scoliosis patients with follow-up period as 20 years or more were included. Meta-analyses were performed for outcomes reported in two or more studies.

Results

A total of 9 eligible studies involving 35,641 participants between 1912 and 1990 fulfilled the inclusion criteria, including 18,873 patients with scoliosis and 16,768 controls as regional matched general population. The average number of full-spine radiographs was 23.13 (range: 0–618) according to 14,512 patients between 1912 and 1990 in five studies. The estimated mean cumulated radiation dose of breast was 11.35 cGy. In comparison with controls, pooled incidence rates of cancer, breast cancer and cancer mortality of patients with scoliosis were statistically significant higher [rate of cancer, odds risk (OR) = 1.46, p < 0.00001; breast cancer, OR = 1.20, p = 0.02; cancer mortality, OR = 1.50, p < 0.00001]. No statistically significant differences were found in terms of reproductive events for scoliosis patients, pulmonary function and physical activity for adolescent idiopathic scoliosis patients.

Conclusions

Based on 35,641 participants with over 20 years’ observations from 1912 to 1990, repeated radiographs and pertaining cumulative radiation dose resulted in elevated rates of cancer, breast cancer and cancer mortality for children/adolescents with scoliosis in comparison with matched general population. It is recommended that low-radiation or radiation-free and efficient methods should be used to monitor the evolution of children/adolescents with scoliosis.

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Funding

The study was supported by National Natural Science Foundation of China (No. 81572182) and Foundation of Yongchuan Hospital of Chongqing Medical university (No. YJLC201716).

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Author notes

  1. Fu-Jun Luan and Yi Wan have contributed equally to the study.

Authors and Affiliations

  1. Department of Orthopaedics, Yongchuan Hospital of Chongqing Medical University, 439# Xuanhua Road, Yongchuan District, Chongqing, 402160, China

    Fu-Jun Luan

  2. Department of Health Services, Fourth Military Medical University, 169# Changle Western Rd., Xi’an, 710032, Shaanxi Province, China

    Yi Wan

  3. Spine Central, Specialist Central, The Hong Kong Adventist Hospital, Hong Kong SAR, China

    Kin-Cheung Mak

  4. Department of Orthopaedics, Ankang Hospital of Traditional Chinese Medicine, Shaanxi University of Chinese Medicine, Ankang, 725000, Shaanxi Province, China

    Chi-Jiao Ma

  5. Institute of Integrative Medicine, Shaanxi University of Chinese Medicine, Xixian Avenue, Xixian District, Xi’an, 712046, Shaanxi Province, China

    Hai-Qiang Wang

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  1. Fu-Jun Luan
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  2. Yi Wan
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Contributions

H-QW and F-JL designed the study concept. F-JL, YW and H-QW acquired, analyzed and interpreted the data. F-JL and H-QW drafted manuscript. All authors critically revised the manuscript for important intellectual content. YW made the statistical analysis. H-QW and F-JL obtained funding. H-QW supervised the study.

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Correspondence to Hai-Qiang Wang.

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Luan, FJ., Wan, Y., Mak, KC. et al. Cancer and mortality risks of patients with scoliosis from radiation exposure: a systematic review and meta-analysis. Eur Spine J 29, 3123–3134 (2020). https://doi.org/10.1007/s00586-020-06573-7

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