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Can computed tomography scanning in adults lead to an increased risk of thyroid cancer? A nationwide nested case–control study

  • Computed Tomography
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objective

To evaluate the association between computed tomography (CT) scanning and newly diagnosed thyroid cancer cases in relation to the confounding effect of the healthcare utilization rate.

Methods

This nested case–control study used the Korean National Health Insurance Service-National Sample Cohort 2002–2015: 3557 adult thyroid cancer cases were matched to 17,785 controls by age, sex, and diagnosis date. Odds ratios (ORs) were estimated for thyroid cancer associated with cumulative exposure to CT scanning > 3 years before cancer diagnosis. Changes in estimated ORs with and without adjustment for outpatient visit frequency were investigated.

Results

ORs for newly diagnosed thyroid cancer increased according to the higher number of total CT scans and thyroid-exposing CT scans (CT scans of the head, neck, or chest compartment; OR and 95% confidence interval [CI], 1.09 [1.03–1.16] and 1.28 [1.05–1.57], respectively). ORs for thyroid cancer increased according to higher outpatient visit frequency. The association between thyroid cancer incidence and CT scans became insignificant when outpatient visit frequency was adjusted in the models (OR [95% CI], 1.03 [0.97–1.10]: total CT scans, 1.14 [0.93–1.41]: thyroid-exposing CT scans). Subgroup analyses stratified by age, sex, and history of other malignancies did not reveal independent associations between CT scanning and thyroid cancer.

Conclusions

The high incidence of thyroid cancer in adults exposed to ionizing radiation during CT scanning can be largely explained by the confounding effect of the healthcare utilization rate. These effects should be considered to avoid overestimation of the CT scanning–associated risk of thyroid cancer.

Key Points

• Studies indicate that diagnostic imaging using low-ionizing radiation may increase risks for thyroid cancer in adults.

• Our findings suggest that the risk for radiation-induced thyroid cancer following CT scanning in adults may have been overestimated in observational studies due to medical surveillance–related biases.

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Abbreviations

BMI:

Body mass index

C73:

Code for thyroid cancer (International Classification of Diseases, Tenth Revision)

CCI:

Charlson Comorbidity Index

CI:

Confidence interval

CT:

Computed tomography

ICD-10:

Classification of Diseases, 10th Revision

NA:

Not applicable

NHI:

National Health Insurance

NHIS-NSC:

National Health Insurance Service-National Sample Cohort

NHS:

National Health Screening

OR:

Odds ratio

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Funding

This work was supported by grants from the Korean Ministry of Health and Welfare (1520240) and the National Cancer Center, Korea (1810153).

Author information

Author notes

  1. Young Ki Lee and Sangwon Lee contributed equally to this work.

Authors and Affiliations

  1. Center for Thyroid Cancer, National Cancer Center, Goyang, Republic of Korea

    Young Ki Lee, Eun Kyung Lee & Yul Hwangbo

  2. Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea

    Young Ki Lee & Hyeon Chang Kim

  3. Cancer Big Data Center, National Cancer Center, Goyang, Republic of Korea

    Sangwon Lee & Hyo Soung Cha

  4. Department of Laboratory Medicine, National Cancer Center, Goyang, Republic of Korea

    Sun-Young Kong

Authors
  1. Young Ki Lee
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  2. Sangwon Lee
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Corresponding authors

Correspondence to Hyo Soung Cha or Yul Hwangbo.

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Guarantor

The scientific guarantor of this publication is Yul Hwangbo.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

One of the authors (Sangwon Lee) has significant statistical expertise.

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Written informed consent was waived by the Institutional Review Board.

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Institutional Review Board approval was obtained.

Methodology

• Retrospective

• Observational

• Performed at one institution

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Lee, Y.K., Lee, S., Lee, E.K. et al. Can computed tomography scanning in adults lead to an increased risk of thyroid cancer? A nationwide nested case–control study. Eur Radiol 32, 415–423 (2022). https://doi.org/10.1007/s00330-021-08186-0

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  • DOI: https://doi.org/10.1007/s00330-021-08186-0

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