title: Childhood cancer risk from conventional radiographic examinations for selected referral criteria: results from a large cohort study.
abstract: OBJECTIVE
  Little is known about the long-term effects of exposure to diagnostic ionizing radiation in childhood. Current estimates are made with models derived mainly from studies of atomic bomb survivors, a population that differs from today's patients in many respects.
  
  
  METHODS
  We analyzed the cancer incidence among children who underwent diagnostic x-ray exposures between 1976 and 2003 in a large German university hospital. We reconstructed individual radiation doses for each examination and sorted results by groups of referral criteria for all cancers combined, solid tumors, and leukemia and lymphoma combined.
  
  
  RESULTS
  A total of 68 incidence cancer cases between 1980 and 2006 were identified in a 78,527-patient cohort in the German childhood cancer registry: 28 leukemia, nine lymphoma, six tumors of the CNS, and 25 other tumors. The standardized incidence ratio for all cancers was 0.97 (95% CI, 0.75-1.23). Dose-response relations were analyzed by multivariable Poisson regression. Although the cancer incidence risk differed by initial referral criterion for radiographic examination, a positive dose-response relation was observed in five patients with endocrine or metabolic disease.
  
  
  CONCLUSIONS
  Overall, we observed no increase in cancer risk among children and youths with very low radiation doses from diagnostic radiation, which is compatible with model calculations. The growing use of CT warrants further studies to assess associated cancer risk. Our work is an early contribution of epidemiologic data for quantifying these risks among young patients.
authors.affiliation: Institute for Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Johannes Gutenberg University Mainz, Germany. gael.hammer@unimedizin-mainz.de
authors.forename: Gaël P
authors.initials: GP
authors.lastname: Hammer
authors.forename: Michael C
authors.initials: MC
authors.lastname: Seidenbusch
authors.forename: Dieter F
authors.initials: DF
authors.lastname: Regulla
authors.forename: Claudia
authors.initials: C
authors.lastname: Spix
authors.forename: Hajo
authors.initials: H
authors.lastname: Zeeb
authors.forename: Karl
authors.initials: K
authors.lastname: Schneider
authors.forename: Maria
authors.initials: M
authors.lastname: Blettner
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009381:Neoplasms, Radiation-Induced / Q000453:epidemiology*; D016016:Proportional Hazards Models; D011859:Radiography / Q000706:statistics & numerical data*; D018570:Risk Assessment; D012307:Risk Factors; D014965:X-Rays