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CANCER RISK IN CHILDREN EXPOSED TO CT SCANS

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

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CANCER RISK IN CHILDREN EXPOSED TO CT SCANS

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  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. 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

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

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

  8. 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)

  9. Results

  10. Scans in exposed patients

  11. 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)

  12. Main results

  13. 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

  14. 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

  15. CASP tool

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

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