Skip to main content
SpringerLink
Log in

Subsequent cancer risk of children receiving post voiding cystourethrography: A nationwide population-based retrospective cohort study

  • Original Article
  • Published:
Pediatric Nephrology Aims and scope Submit manuscript

Abstract

Background

To estimate the subsequent cancer risk of children receiving post voiding cystourethrography (VCUG), a nationwide population-based retrospective cohort study with the data from the Taiwan National Health Insurance Research Database (NHIRD) were used for the analysis.

Methods

In the VCUG cohort, 31,908 participants younger than 18 years of age who underwent VCUG between 1997 and 2008 were identified from the NHIRD. A comparison cohort, the non-VCUG cohort, was randomly selected among children without VCUG examination histories during 1997–2008, frequency matched for age (every 5 years), sex, geographic region area, parents’ occupation, and index year based on a 1:4 ratio. Cox’s proportional hazard regression analysis was conducted to estimate the subsequent cancer risk of children receiving VCUG.

Results

The overall cancer risk of the VCUG cohort is 1.92-fold (95 % CI = 1.34–2.74) higher than that of the non-VCUG cohort with statistical significance. The genital cancer and urinary system cancer risks of the VCUG cohort are respectively 6.19-fold (95 % CI = 1.37–28.0) and 5.8-fold (95 % CI = 1.54–21.9) higher than those of the non-VCUG cohort with statistical significance. The hazard ratios are higher in genital cancer, urinary system cancer (the major radiation exposure area), and cancer of the abdomen, except for the genitourinary system (the minor radiation exposure area), in sequence.

Conclusions

Pediatric VCUG is associated with increased subsequent cancer risk, especially in the genitourinary system.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Hollowell JG, Greenfield SP (2002) Screening siblings for vesicoureteral reflux. J Urol 168:2138–2141

    Article  PubMed  Google Scholar 

  2. Skoog SJ, Peters CA, Arant BS Jr, Copp HL, Elder JS, Hudson RG, Khoury AE, Lorenzo AJ, Pohl HG, Shapiro E, Snodgress WT (2010) Pediatric vesicoureteral reflux guidelines panel summary report: clinical practice guidelines for screening siblings of children with vesicoureteral reflux and neonates/infants with prenatal hydronephrosis. J Urol 184:1145–1151

    Article  PubMed  Google Scholar 

  3. Williams G, Fletcher JT, Alexander SI, Craig JC (2008) Vesicoureteral reflux. J Am Soc Nephrol 19:847–862

    Article  PubMed  CAS  Google Scholar 

  4. Hannula A, Venhola M, Perhomaa M, Pokka T, Renko M, Uhari M (2011) Imaging the urinary tract in children with urinary tract infection. Acta Paediatr 100:e253–e259

    Article  PubMed  Google Scholar 

  5. Sulieman A, Theodorou K, Vlychou M, Topaltzikis T, Kanavou D, Fezoulidis I, Kappas C (2007) Radiation dose measurement and risk estimation for paediatric patients undergoing micturating cystourethrography. Br J Radiol 80:731–737

    Article  PubMed  CAS  Google Scholar 

  6. Claus EB, Calvocoressi L, Bondy ML, Schildkraut JM, Wiemels JL, Wrensch M (2012) Dental X-rays and risk of meningioma. Cancer 118:4530–4537

    Article  PubMed Central  PubMed  Google Scholar 

  7. Pearce MS, Salotti JA, Little MP, McHugh K, Lee C, Kim KP, Howe NL, Ronckers CM, Rajaraman P, Sir Craft AW, Parker L, Berrington de Gonzalez A (2012) Radiation exposure from CT scans in childhood and subsequent risk of leukaemia and brain tumours: a retrospective cohort study. Lancet 380:499–505

    Article  PubMed Central  PubMed  Google Scholar 

  8. Lin MC, Lee CF, Lin CL, Wu YC, Wange HE, Chen CL, Sung FC, Kao CH (2013) Dental diagnostic X-ray exposure and risk of benign and malignant brain tumors. Ann Oncol 24:1675–1679

    Article  PubMed  CAS  Google Scholar 

  9. Lee R, Thomas KE, Connolly BL, Falkiner M, Gordon CL (2009) Effective dose estimation for pediatric voiding cystourethrography using an anthropomorphic phantom set and metal oxide semiconductor field-effect transistor (MOSFET) technology. Pediatr Radiol 39:608–615

    Article  PubMed  Google Scholar 

  10. National Research Council (2006) Health risks of exposure to low levels of ionizing radiation: BEIR VII. National Academies Press, Washington, DC

    Google Scholar 

  11. ICRP (1992) 1990 Recommendations of the International Commission on Radiological Protection. Publication 60. Annals of the ICRP 21(1–3). Pergamon, Oxford

    Google Scholar 

  12. Cheng TM (2009) Taiwan’s National Health Insurance system: high value for the dollar. In: Okma KGH, Crivelli L (eds) Six Countries, Six Reform Models: The Health Reform Experience of Israel, the Netherlands, New Zealand, Singapore, Switzerland and Taiwan. World Scientific, New Jersey, pp 71–204

    Google Scholar 

  13. Peters CA, Skoog SJ, Arant BS Jr, Copp HL, Elder JS, Hudson RG, Khoury AE, Lorenzo AJ, Pohl HG, Shapiro E, Snodgrass WT, Diaz M (2010) Summary of the AUA guideline on management of primary vesicoureteral reflux in children. J Urol 184:1134–1144

    Article  PubMed  Google Scholar 

  14. Subcommittee on Urinary Tract Infection, Steering Committee on Quality Improvement and Management (2011) Urinary tract infection: Clinical Practice guideline for the diagnosis and management of the initial UTI in febrile infants and children 2 to 24 months. Pediatrics 128:595–610

    Article  Google Scholar 

  15. Ward VL (2006) Patient dose reduction during voiding cystourethrography. Pediatr Radiol 36:168–172

    Article  PubMed Central  PubMed  Google Scholar 

  16. Ward VL, Strauss KJ, Barnewolt CE, Zurakowski D, Venkatakrishnan V, Fahey FH, Lebowitz RL, Taylor GA (2008) Pediatric radiation exposure and effective dose reduction during voiding cystourethrography. Radiology 249:1002–1009

    Article  PubMed  Google Scholar 

  17. Brook OR, Brook A, Soudack M (2011) Urine sensor device for fluoroscopy time reduction in pediatric voiding cystourethrography. Eur J Radiol 78:394–397

    Article  PubMed  CAS  Google Scholar 

  18. Tekgül S, Riedmiller H, Hoebeke P, Kočvara R, Nijman RJ, Radmayr C, Stein R, Dogan HS (2012) EAU guidelines on vesicoureteral reflux in children. Eur Urol 62:534–542

    Article  PubMed  Google Scholar 

  19. Darge K (2010) Voiding urosonography with US contrast agent for the diagnosis of vesicoureteric reflux in children: an update. Pediatr Radiol 40:956–962

    Article  PubMed  Google Scholar 

  20. Galloy MA, Guillemin F, Couture A, Pracros JP, Didier F, Ducou Le Pointe H, Pefoubou Y, Aubert D, Lortat-Jacob S, Roederer T, Claudon M (2008) Voiding ultrasonography: evaluation of the detection of vesicoureteral reflux based on the review of digital ultrasound clips. Ultraschall Med 29:53–59

    Article  PubMed  Google Scholar 

  21. Johnin K, Takazakura R, Furukawa A, Okamoto K, Murakami Y, Murata K, Okada Y (2013) Magnetic resonance voiding cystourethrography (MRVCUG): a potential alternative to standard VCUG. J Magn Reson Imaging 38:897–904

    Article  PubMed  Google Scholar 

  22. Pendergrass TW (1976) Congenital anomalies in children with Wilms’ tumor: a new survey. Cancer 37:403–408

    Article  PubMed  CAS  Google Scholar 

  23. Woods MS, Sheppard RG, Hardman DA, Woods HJ (1992) Congenital genitourinary anomalies. Is there a predilection for multiple primary malignant neoplasms? Cancer 69:546–549

    Article  PubMed  CAS  Google Scholar 

Download references

Conflict of interest disclosures

All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported. Potential Conflicts of Interest and none were reported.

Funding/support

The study was supported in part by Taiwan Department of Health Clinical Trial and Research Center and for Excellence (DOH102-TD-B-111-004), Taiwan Department of Health Cancer Research Center for Excellence (DOH102-TD-C-111-005), Bureau of Health Promotion, Department of Health, R.O.C. (Taiwan) (DOH99-HP-1205), and International Research-Intensive Centers of Excellence in Taiwan (I-RiCE) (NSC101-2911-I-002-303).

Role of the sponsor

The Taiwan Department of Health had no role in the design and conduct of the study; in the collection, analysis, and interpretation of the data; or in the preparation, review, or approval of the manuscript.

Disclaimer

The interpretations and conclusions contained in this article do not represent those of the Bureau of National Health Insurance, Department of Health, or the NHRI. National Health Insurance Research Database, Taiwan. http://www.nhri.org.tw/nhird/en/index.htm.

Author contributions

Study concept and design: Yen-Hsiu Liao, Chia-Hung Kao.

Acquisition of data: Chang-Ching Wei, Po-Pang Tsai, Wu-Chung Shen, Fung-Chang Sung, Tsai-Chung Li.

Analysis and interpretation of data: Yen-Hsiu Liao, Cheng-Li Lin, Chang-Ching Wei, Chia-Hung Kao.

Drafting of the manuscript: All authors.

Critical revision of the manuscript for important intellectual content: Yen-Hsiu Liao, Chia-Hung Kao.

Statistical analysis: Cheng-Li Lin.

Obtained funding: Fung-Chang Sung, Tsai-Chung Li, Chia-Hung Kao

Administrative, technical, or material support: Fung-Chang Sung, Tsai-Chung Li.

Study supervision: Chia-Hung Kao

Author information

Authors and Affiliations

  1. Department of Radiology, China Medical University Hospital, Taichung, Taiwan

    Yen-Hsiu Liao, Po-Pang Tsai & Wu-Chung Shen

  2. Graduate Institute of Clinical Medical Science, School of Medicine, College of Medicine, China Medical University, No. 2, Yuh-Der Road, Taichung, 404, Taiwan

    Yen-Hsiu Liao, Chang-Ching Wei, Po-Pang Tsai, Fung-Chang Sung & Chia-Hung Kao

  3. Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan

    Cheng-Li Lin & Fung-Chang Sung

  4. Department of Public Health, China Medical University, Taichung, Taiwan

    Tsai-Chung Li

  5. Department of Pediatrics, China Medical University Hospital, China Medical University, Taichung, Taiwan

    Chang-Ching Wei

  6. Department of Biomedical Imaging and Radiological Science, College of Health Care, China Medical University, Taichung, Taiwan

    Wu-Chung Shen

  7. Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan

    Chia-Hung Kao

Authors
  1. Yen-Hsiu Liao
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Cheng-Li Lin
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Chang-Ching Wei
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Po-Pang Tsai
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Wu-Chung Shen
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Fung-Chang Sung
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Tsai-Chung Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Chia-Hung Kao
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Chia-Hung Kao.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Liao, YH., Lin, CL., Wei, CC. et al. Subsequent cancer risk of children receiving post voiding cystourethrography: A nationwide population-based retrospective cohort study. Pediatr Nephrol 29, 885–891 (2014). https://doi.org/10.1007/s00467-013-2703-5

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00467-013-2703-5

Keywords

Search

Navigation