title: Breast cancer mortality after diagnostic radiography: findings from the U.S. Scoliosis Cohort Study.
abstract: METHODS
  A retrospective cohort study was conducted in 5573 female patients with scoliosis who were referred for treatment at 14 orthopedic medical centers in the United States. Patients were less than 20 years of age at diagnosis which occurred between 1912 and 1965.
  
  
  OBJECTIVE
  To evaluate patterns in breast cancer mortality among women with scoliosis, with special emphasis on risk associated with diagnostic radiograph exposures.
  
  
  BACKGROUND
  A pilot study of 1030 women with scoliosis revealed a nearly twofold statistically significant increased risk for incident breast cancer. Although based on only 11 cases, findings were consistent with radiation as a causative factor.
  
  
  METHODS
  Medical records were reviewed for information on personal characteristics and scoliosis history. Diagnostic radiograph exposures were tabulated based on review of radiographs, radiology reports in the medical records, radiograph jackets, and radiology log books. Radiation doses were estimated for individual examinations. The mortality rate of the cohort through January 1, 1997, was determined by using state and national vital statistics records and was compared with that of women in the general U. S. population.
  
  
  RESULTS
  Nearly 138,000 radiographic examinations were recorded. The average number of examinations per patient was 24.7 (range, 0-618); mean estimated cumulative radiation dose to the breast was 10.8 cGy (range, 0-170). After excluding patients with missing information, 5466 patients were included in breast cancer mortality analyses. Their mean age at diagnosis was 10.6 years and average length of follow-up was 40.1 years. There were 77 breast cancer deaths observed compared with the 45.6 deaths expected on the basis of U.S. mortality rates (standardized mortality ratio [SMR] = 1.69; 95% confidence interval [CI] = 1.3-2.1). Risk increased significantly with increasing number of radiograph exposures and with cumulative radiation dose. The unadjusted excess relative risk per Gy was 5.4 (95% CI = 1.2-14.1); when analyses were restricted to patients who had undergone at least one radiographic examination, the risk estimate was 2.7 (95% CI = -0. 2-9.3).
  
  
  CONCLUSIONS
  These data suggest that exposure to multiple diagnostic radiographic examinations during childhood and adolescence may increase the risk of breast cancer among women with scoliosis; however, potential confounding between radiation dose and severity of disease and thus with reproductive history may explain some of the increased risk observed.
authors.affiliation: Radiation Epidemiology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA. doodym@epndce.nci.nih.gov
authors.forename: M M
authors.initials: MM
authors.lastname: Doody
authors.forename: J E
authors.initials: JE
authors.lastname: Lonstein
authors.forename: M
authors.initials: M
authors.lastname: Stovall
authors.forename: D G
authors.initials: DG
authors.lastname: Hacker
authors.forename: N
authors.initials: N
authors.lastname: Luckyanov
authors.forename: C E
authors.initials: CE
authors.lastname: Land
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000209:etiology* / Q000401:mortality*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008875:Middle Aged; D011859:Radiography / Q000009:adverse effects*; D012189:Retrospective Studies; D012307:Risk Factors; D012600:Scoliosis / Q000000981:diagnostic imaging*; D013997:Time Factors