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Childhood cancer risks estimates following CT scans: an update of the French CT cohort study

  • Computed Tomography
  • Published:
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Abstract

Objectives

Increased risks of central nervous system (CNS) tumors and leukemia associated with computed tomography (CT) exposure during childhood have been reported in recent epidemiological studies. However, no evidence of increased risks was suggested in a previous analysis of the French CT cohort. This study benefits from an updated cohort with a longer follow-up and a larger sample size of patients.

Methods

The patients were followed from the date of their first CT (between 2000 and 2011) until their date of cohort exit defined as the earliest among the following: 31 December 2016, date of death, date of first cancer diagnosis or date of their 18th birthday. Cancer incidence, vital status, cancer predisposing factors (PFs), and additional CT scans were collected via external national databases. Hazard ratios (HRs) associated to cumulative organ doses and sex were estimated from Cox models.

Results

At the end of follow-up, mean cumulative doses were 27.7 and 10.3 mGy for the brain and the red bone marrow (RBM), respectively. In patients without PFs, an HR per 10 mGy of 1.05 (95% CI: 1.01–1.09) for CNS tumors, 1.17 (95% CI: 1.09–1.26) for leukemia, and 0.96 (95% CI: 0.63–1.45) for lymphoma was estimated. These estimates were not modified by the inclusion of CT scans performed outside the participating hospitals or after the inclusion period.

Conclusions

This study shows statistically significant dose-response relationships for CNS tumors and leukemia for patients without PFs.

Key Points

• Computed tomography is the most important contributor to the collective dose for diagnostic imaging to the French population.

• Concerns have been raised about possible cancer risks, particularly after exposure to CT in childhood, due to the greater radiation sensitivity of children and to their longer life expectancy.

• Analysis of the updated French CT cohort shows statistically significant dose-response relationships for CNS tumors and leukemia.

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Abbreviations

CI:

Confidence interval

CNS:

Central nervous system

CT:

Computed tomography

HR:

Hazard ratio

ICD-10 classification:

International Classification of Diseases, 10th revision

IR:

Ionizing radiation

LSS:

Life Span Study

MRI:

Magnetic resonance imaging

PF:

Cancer predisposing factor

RBM:

Red bone marrow

RIS:

Radiology information systems

SD:

Standard deviation

SNDS:

Système national des données de santé (National Health Data System)

UK:

United Kingdom

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Acknowledgements

We are grateful to the radiologists, clinicians, physicists, and administrators working in the participating hospitals who took so much of their time to provide us with the necessary radiology and clinical data: N Andreu, F Clémenceau, D Loisel, B Ory, D Weil (CHU Angers), J-M Garcier, J Guersen, S Mangin (CHU Clermont-Ferrand), S Baron, J Charbonnier, C Gaborit, D Sirinelli (CHU Tours), J-M Chave, E Chirpaz, O Fels (CHU La Réunion), N Boutry, A Bruandet, G Potier (CHU Lille), D Defez, Perrot, M Teisseire (CHU Lyon), B Bourlière, P Petit, C Seyler (CHU Marseille), M Saguintaah (CHU Montpellier), M Balde, F Collignon, M-A Galloy, E Pozza, E Schmitt (CHU Nancy), B Dupas, T Lefrançois, M Salaud, N Surer (CHU Nantes), C Barat, C Bertini, M Hajjar (CHU Bordeaux), N Baray, M-A Perrier, H Daubert, L Froment (CHU Rouen), S Dupont, B Giachetto, L Molinier, J Vial (CHU Toulouse), A Bouette, P Chambert (CHU Armand Trousseau—Paris), N Boddaert (CHU Necker-Enfants-Malades—Paris), E Dion (CHU Louis Mourier—Colombes), J Costa (CHU Robert Debré—Paris), G Khalifa (CHU SaintVincent de Paul—Paris), J Betout (APHP Siège), D Musset (CHU Antoine Béclère—Clamart), C Adamsbaum, S Franchi, D Pariente (CHU Bicêtre), N Sellier (CHU Jean Verdier—Bondy). We also warmly thank S Ben Salha, L Faure, B Lacour (Registre National des Cancers de l’Enfant) for their valuable help in providing data about cancer diagnoses.

Funding

The authors state that this work has not received any funding.

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Authors and Affiliations

  1. Laboratory of Epidemiology, Institute for Radiological Protection and Nuclear Safety, BP 17, 92262, Fontenay-aux-Roses, France

    Anaïs Foucault, Sophie Ancelet, Sylvaine Caër-Lorho, Klervi Leuraud & Marie-Odile Bernier

  2. Medical Radiation Protection Assessment Unit, Institute for Radiological Protection and Nuclear Safety, BP 17, 92262, Fontenay-aux-Roses, France

    Serge Dreuil

  3. Department of Radiology, Trousseau University Hospital, 26 avenue du Docteur Arnold-Netter, 75012, Paris, France

    Hubert Ducou Le Pointe

  4. Department of Radiology, Institut Curie, 75005, Paris, France

    Hervé Brisse

  5. Department of Pediatric Radiology, Pellegrin University Hospital, Place Amélie Raba-Léon, 33000, Bordeaux, France

    Jean-François Chateil

  6. Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institute of Health, 9000 Rockville Pike, Bethesda, MD, 20892, USA

    Choonsik Lee

Authors
  1. Anaïs Foucault
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  2. Sophie Ancelet
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  3. Serge Dreuil
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  4. Sylvaine Caër-Lorho
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  5. Hubert Ducou Le Pointe
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  7. Jean-François Chateil
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  8. Choonsik Lee
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  9. Klervi Leuraud
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  10. Marie-Odile Bernier
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Corresponding author

Correspondence to Anaïs Foucault.

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Guarantor

The scientific guarantor of this publication is Marie-Odile Bernier.

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 has significant statistical expertise.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained.

Study subjects or cohorts overlap

Some study subjects or cohorts have been previously reported in Journy N, Roué T, Cardis E et al (2016) Childhood CT scans and cancer risk: impact of predisposing factors for cancer on the risk estimates. J Radiol Prot 36(1), N1

Methodology

• retrospective

• observational

• multicenter study

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Foucault, A., Ancelet, S., Dreuil, S. et al. Childhood cancer risks estimates following CT scans: an update of the French CT cohort study. Eur Radiol 32, 5491–5498 (2022). https://doi.org/10.1007/s00330-022-08602-z

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  • DOI: https://doi.org/10.1007/s00330-022-08602-z

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