Abstract
Background: The European EPI-CT study aims to quantify cancer risks from CT examinations of children and young adults. Here, we assess the risk of brain cancer. Methods: We pooled data from nine European countries for this cohort study. Eligible participants had at least one CT examination before age 22 years documented between 1977 and 2014, had no previous diagnosis of cancer or benign brain tumour, and were alive and cancer-free at least 5 years after the first CT. Participants were identified through the Radiology Information System in 276 hospitals. Participants were linked with national or regional registries of cancer and vital status, and eligible cases were patients with brain cancers according to WHO International Classification of Diseases for Oncology. Gliomas were analysed separately to all brain cancers. Organ doses were reconstructed using historical machine settings and a large sample of CT images. Excess relative risks (ERRs) of brain cancer per 100 mGy of cumulative brain dose were calculated with linear dose-response modelling. The outcome was the first reported diagnosis of brain cancer after an exclusion period of 5 years after the first electronically recorded CT examination. Findings: We identified 948 174 individuals, of whom 658 752 (69%) were eligible for our study. 368 721 (56%) of 658 752 participants were male and 290 031 (44%) were female. During a median follow-up of 5·6 years (IQR 2·4–10·1), 165 brain cancers occurred, including 121 (73%) gliomas. Mean cumulative brain dose, lagged by 5 years, was 47·4 mGy (SD 60·9) among all individuals and 76·0 mGy (100·1) among people with brain cancer. A significant linear dose-response relationship was observed for all brain cancers (ERR per 100 mGy 1·27 [95% CI 0·51–2·69]) and for gliomas separately (ERR per 100 mGy 1·11 [0·36–2·59]). Results were robust when the start of follow-up was delayed beyond 5 years and when participants with possibly previously unreported cancers were excluded. Interpretation: The observed significant dose-response relationship between CT-related radiation exposure and brain cancer in this large, multicentre study with individual dose evaluation emphasises careful justification of paediatric CTs and use of doses as low as reasonably possible. Funding: EU FP7; Belgian Cancer Registry; La Ligue contre le Cancer, L'Institut National du Cancer, France; Ministry of Health, Labour and Welfare of Japan; German Federal Ministry of Education and Research; Worldwide Cancer Research; Dutch Cancer Society; Research Council of Norway; Consejo de Seguridad Nuclear, Generalitat de Catalunya, Spain; US National Cancer Institute; UK National Institute for Health Research; Public Health England.
| Original language | English |
|---|---|
| Pages (from-to) | 45-53 |
| Number of pages | 9 |
| Journal | Lancet Oncology |
| Volume | 24 |
| Issue number | 1 |
| DOIs | |
| State | Published - 1 Jan 2023 |
ASJC Scopus subject areas
- Oncology
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In: Lancet Oncology, Vol. 24, No. 1, 01.01.2023, p. 45-53.
Research output › peer-review
TY - JOUR
T1 - Brain cancer after radiation exposure from CT examinations of children and young adults: results from the EPI-CT cohort study
AU - Hauptmann, Michael
AU - Byrnes, Graham
AU - Cardis, Elisabeth
AU - Bernier, Marie-Odile
AU - Blettner, Maria
AU - Dabin, Jérémie
AU - Engels, Hilde
AU - Istad, Tore
AU - Johansen, Christoffer
AU - Kaijser, Magnus
AU - Kjaerheim, Kristina
AU - Journy, Neige
AU - Meulepas, Johanna M.
AU - Moissonnier, Monika
AU - Ronckers, Cecile
AU - Thierry-Chef, Isabelle
AU - Le Cornet, Lucian
AU - Jahnen, Andreas
AU - Pokora, Roman
AU - Bosch de Basea, Magda
AU - Figuerola, Jordi
AU - Maccia, Carlos
AU - Nordenskjöld, Arvid
AU - Harbron, Richard W.
AU - Lee, Choonsik
AU - Simon, Steven L.
AU - Berrington de Gonzalez, Amy
AU - Schüz, Joachim
AU - Kesminiene, Ausrele
N1 - Score=10 Funding Information: The EPI-CT study was supported by the EU's Seventh Framework Programme (FP7/2007–2013) under grant agreement number 269912-EPI-CT: epidemiological study to quantify risks for paediatric CT and to optimise doses. In Belgium, the Belgian Cancer Registry supported the study by providing cancer incidence data. In France, the national cohort was supported by La Ligue contre le Cancer (PRE09/MOB) and L'Institut National du Cancer (INCa; 2011–1-PL-SHS-01-IRSN-1). IARC received complementary funding from the Ministry of Health, Labour and Welfare of Japan (2012–02–21–01). Complementary funding was received from the German Federal Ministry of Education and Research under the grant numbers 02NUK016A, 02NUK016B and 02NUK016CX. In the Netherlands, complementary funding was received from Worldwide Cancer Research (12–1155). CR was supported by the Dutch Cancer Society. In Norway, the EPI-CT study was supported by the Research Council of Norway (209094). In Spain, complementary funding was received under a grant from the Consejo de Seguridad Nuclear (SRO/3347/2015/227·06). ISGlobal also acknowledges support from the Generalitat de Catalunya through the CERCA Program and support from the Secretariat of Universities and Research of the Department of Business and Knowledge of the Generalitat of Catalonia through AGAUR (the Catalan Agency for Management of University and Research Grants; 2017 SGR 1487). The UK study was supported by contract NO2-CP-75501 from the US National Cancer Institute, which also provided expertise in dosimetry and uncertainty analysis and supported the assignment of staff at the IARC in 2016–17. SLS received a senior visiting scientist's fellowship award from the IARC fellowship programme. The work was partly supported by the UK National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Chemical & Radiation Threats and Hazards at Newcastle University, in partnership with Public Health England (PHE). The views expressed are those of the authors and not necessarily those of the NIHR, the Department of Health, or PHE. Authors who are identified as personnel of the IARC, WHO, are alone responsible for the views expressed in this Article and do not necessarily represent the decisions, policy, or views of the IARC, WHO. Funding Information: The EPI-CT study was supported by the EU's Seventh Framework Programme (FP7/2007–2013) under grant agreement number 269912-EPI-CT: epidemiological study to quantify risks for paediatric CT and to optimise doses. In Belgium, the Belgian Cancer Registry supported the study by providing cancer incidence data. In France, the national cohort was supported by La Ligue contre le Cancer (PRE09/MOB) and L'Institut National du Cancer (INCa; 2011–1-PL-SHS-01-IRSN-1). IARC received complementary funding from the Ministry of Health, Labour and Welfare of Japan (2012–02–21–01). Complementary funding was received from the German Federal Ministry of Education and Research under the grant numbers 02NUK016A, 02NUK016B and 02NUK016CX. In the Netherlands, complementary funding was received from Worldwide Cancer Research (12–1155). CR was supported by the Dutch Cancer Society. In Norway, the EPI-CT study was supported by the Research Council of Norway (209094). In Spain, complementary funding was received under a grant from the Consejo de Seguridad Nuclear (SRO/3347/2015/227·06). ISGlobal also acknowledges support from the Generalitat de Catalunya through the CERCA Program and support from the Secretariat of Universities and Research of the Department of Business and Knowledge of the Generalitat of Catalonia through AGAUR (the Catalan Agency for Management of University and Research Grants; 2017 SGR 1487). The UK study was supported by contract NO2-CP-75501 from the US National Cancer Institute, which also provided expertise in dosimetry and uncertainty analysis and supported the assignment of staff at the IARC in 2016–17. SLS received a senior visiting scientist's fellowship award from the IARC fellowship programme. The work was partly supported by the UK National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Chemical & Radiation Threats and Hazards at Newcastle University, in partnership with Public Health England (PHE). The views expressed are those of the authors and not necessarily those of the NIHR, the Department of Health, or PHE. Authors who are identified as personnel of the IARC, WHO, are alone responsible for the views expressed in this Article and do not necessarily represent the decisions, policy, or views of the IARC, WHO. Publisher Copyright: © 2023 World Health Organization. Published by Elsevier Ltd. All rights reserved.
PY - 2023/1/1
Y1 - 2023/1/1
N2 - Background: The European EPI-CT study aims to quantify cancer risks from CT examinations of children and young adults. Here, we assess the risk of brain cancer. Methods: We pooled data from nine European countries for this cohort study. Eligible participants had at least one CT examination before age 22 years documented between 1977 and 2014, had no previous diagnosis of cancer or benign brain tumour, and were alive and cancer-free at least 5 years after the first CT. Participants were identified through the Radiology Information System in 276 hospitals. Participants were linked with national or regional registries of cancer and vital status, and eligible cases were patients with brain cancers according to WHO International Classification of Diseases for Oncology. Gliomas were analysed separately to all brain cancers. Organ doses were reconstructed using historical machine settings and a large sample of CT images. Excess relative risks (ERRs) of brain cancer per 100 mGy of cumulative brain dose were calculated with linear dose-response modelling. The outcome was the first reported diagnosis of brain cancer after an exclusion period of 5 years after the first electronically recorded CT examination. Findings: We identified 948 174 individuals, of whom 658 752 (69%) were eligible for our study. 368 721 (56%) of 658 752 participants were male and 290 031 (44%) were female. During a median follow-up of 5·6 years (IQR 2·4–10·1), 165 brain cancers occurred, including 121 (73%) gliomas. Mean cumulative brain dose, lagged by 5 years, was 47·4 mGy (SD 60·9) among all individuals and 76·0 mGy (100·1) among people with brain cancer. A significant linear dose-response relationship was observed for all brain cancers (ERR per 100 mGy 1·27 [95% CI 0·51–2·69]) and for gliomas separately (ERR per 100 mGy 1·11 [0·36–2·59]). Results were robust when the start of follow-up was delayed beyond 5 years and when participants with possibly previously unreported cancers were excluded. Interpretation: The observed significant dose-response relationship between CT-related radiation exposure and brain cancer in this large, multicentre study with individual dose evaluation emphasises careful justification of paediatric CTs and use of doses as low as reasonably possible. Funding: EU FP7; Belgian Cancer Registry; La Ligue contre le Cancer, L'Institut National du Cancer, France; Ministry of Health, Labour and Welfare of Japan; German Federal Ministry of Education and Research; Worldwide Cancer Research; Dutch Cancer Society; Research Council of Norway; Consejo de Seguridad Nuclear, Generalitat de Catalunya, Spain; US National Cancer Institute; UK National Institute for Health Research; Public Health England.
AB - Background: The European EPI-CT study aims to quantify cancer risks from CT examinations of children and young adults. Here, we assess the risk of brain cancer. Methods: We pooled data from nine European countries for this cohort study. Eligible participants had at least one CT examination before age 22 years documented between 1977 and 2014, had no previous diagnosis of cancer or benign brain tumour, and were alive and cancer-free at least 5 years after the first CT. Participants were identified through the Radiology Information System in 276 hospitals. Participants were linked with national or regional registries of cancer and vital status, and eligible cases were patients with brain cancers according to WHO International Classification of Diseases for Oncology. Gliomas were analysed separately to all brain cancers. Organ doses were reconstructed using historical machine settings and a large sample of CT images. Excess relative risks (ERRs) of brain cancer per 100 mGy of cumulative brain dose were calculated with linear dose-response modelling. The outcome was the first reported diagnosis of brain cancer after an exclusion period of 5 years after the first electronically recorded CT examination. Findings: We identified 948 174 individuals, of whom 658 752 (69%) were eligible for our study. 368 721 (56%) of 658 752 participants were male and 290 031 (44%) were female. During a median follow-up of 5·6 years (IQR 2·4–10·1), 165 brain cancers occurred, including 121 (73%) gliomas. Mean cumulative brain dose, lagged by 5 years, was 47·4 mGy (SD 60·9) among all individuals and 76·0 mGy (100·1) among people with brain cancer. A significant linear dose-response relationship was observed for all brain cancers (ERR per 100 mGy 1·27 [95% CI 0·51–2·69]) and for gliomas separately (ERR per 100 mGy 1·11 [0·36–2·59]). Results were robust when the start of follow-up was delayed beyond 5 years and when participants with possibly previously unreported cancers were excluded. Interpretation: The observed significant dose-response relationship between CT-related radiation exposure and brain cancer in this large, multicentre study with individual dose evaluation emphasises careful justification of paediatric CTs and use of doses as low as reasonably possible. Funding: EU FP7; Belgian Cancer Registry; La Ligue contre le Cancer, L'Institut National du Cancer, France; Ministry of Health, Labour and Welfare of Japan; German Federal Ministry of Education and Research; Worldwide Cancer Research; Dutch Cancer Society; Research Council of Norway; Consejo de Seguridad Nuclear, Generalitat de Catalunya, Spain; US National Cancer Institute; UK National Institute for Health Research; Public Health England.
KW - Computerized tomography
KW - CT
KW - Epidemiology
KW - Pediatric patients
KW - Brain cancer
UR - https://ecm.sckcen.be/OTCS/llisapi.dll/open/53579905
UR - http://www.scopus.com/inward/record.url?scp=85143885446&partnerID=8YFLogxK
U2 - 10.1016/S1470-2045(22)00655-6
DO - 10.1016/S1470-2045(22)00655-6
M3 - Article
SN - 1470-2045
VL - 24
SP - 45
EP - 53
JO - Lancet Oncology
JF - Lancet Oncology
IS - 1
ER -