title: Risk of cancer incidence before the age of 15 years after exposure to ionising radiation from computed tomography: results from a German cohort study.
abstract: The aim of this cohort study was to assess the risk of developing cancer, specifically leukaemia, tumours of the central nervous system and lymphoma, before the age of 15 years in children previously exposed to computed tomography (CT) in Germany. Data for children with at least one CT between 1980 and 2010 were abstracted from 20 hospitals. Cancer cases occurring between 1980 and 2010 were identified by stochastic linkage with the German Childhood Cancer Registry (GCCR). For all cases and a sample of non-cases, radiology reports were reviewed to assess the underlying medical conditions at time of the CT. Cases were only included if diagnosis occurred at least 2 years after the first CT and no signs of cancer were recorded in the radiology reports. Standardised incidence ratios (SIR) using incidence rates from the general population were estimated. The cohort included information on 71,073 CT examinations in 44,584 children contributing 161,407 person-years at risk with 46 cases initially identified through linkage with the GCCR. Seven cases had to be excluded due to signs possibly suggestive of cancer at the time of first CT. Overall, more cancer cases were observed (O) than expected (E), but this was mainly driven by unexpected and possibly biased results for lymphomas. For leukaemia, the SIR (SIR = O/E) was 1.72 (95 % CI 0.89-3.01, O = 12), and for CNS tumours, the SIR was 1.35 (95 % CI 0.54-2.78, O = 7). Despite careful examination of the medical information, confounding by indication or reverse causation cannot be ruled out completely and may explain parts of the excess. Furthermore, the CT exposure may have been underestimated as only data from the participating clinics were available. This should be taken into account when interpreting risk estimates.
authors.affiliation: Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center Mainz, Obere Zahlbacher Straße 69, 55131, Mainz, Germany.|International Agency for Research on Cancer, 69372, Lyon, France.
authors.forename: L
authors.initials: L
authors.lastname: Krille
authors.affiliation: Leibniz - Institute for Prevention Research and Epidemiology - BIPS, Research Focus Health Sciences Bremen, University of Bremen, 28359, Bremen, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Dreger
authors.affiliation: Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center Mainz, Obere Zahlbacher Straße 69, 55131, Mainz, Germany.
authors.forename: R
authors.initials: R
authors.lastname: Schindel
authors.affiliation: Institut für Radiologie und Interventionelle Therapie, Vivantes, Klinikum Neukölln, 12351, Berlin, Germany.
authors.forename: T
authors.initials: T
authors.lastname: Albrecht
authors.affiliation: Städtisches Klinikum Karlsruhe, Zentralinstitut für Bildgebende Diagnostik, 76133, Karlsruhe, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Asmussen
authors.affiliation: Klinik für Radiologie und Nuklearmedizin, Campus Lübeck, Universitätsklinikum Schleswig Holstein, 23538, Lübeck, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Barkhausen
authors.affiliation: Institut für Diagnostische und Interventionelle Radiologie, Medizinische Hochschule Hannover, 30625, Hannover, Germany.
authors.forename: J D
authors.initials: JD
authors.lastname: Berthold
authors.affiliation: Institut für Diagnostische & Interventionelle Radiologie, Klinikum Oldenburg GmbH, 26133, Oldenburg, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Chavan
authors.affiliation: Abt. für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Tübingen, 72076, Tübingen, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Claussen
authors.affiliation: Institut für Diagnostische und Interventionelle Radiologie und Neuroradiologie, Universitätsklinikum Essen, 45147, Essen, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Forsting
authors.affiliation: Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center Mainz, Obere Zahlbacher Straße 69, 55131, Mainz, Germany.|Institute of Clinical Physiology, National Research Council, 73100, Lecce, Italy.
authors.forename: E A L
authors.initials: EAL
authors.lastname: Gianicolo
authors.affiliation: Klinik für Radiologische Diagnostik und Nuklearmedizin, Klinikum Bremen-Mitte, 28177, Bremen, Germany.
authors.forename: K
authors.initials: K
authors.lastname: Jablonka
authors.affiliation: Centre de Recherche Public Henri Tudor, 1855, Luxembourg, Luxembourg.
authors.forename: A
authors.initials: A
authors.lastname: Jahnen
authors.affiliation: Klinik für Radiologie, Universitätsklinikum Freiburg, 79106, Freiburg, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Langer
authors.affiliation: Institut und Poliklinik für Radiologische Diagnostik, Universitätsklinikum Carl Gustav Carus Dresden, 01307, Dresden, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Laniado
authors.affiliation: Institut für Diagnostische und Interventionelle Radiologie, Universitätsmedizin Göttingen, 37075, Göttingen, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Lotz
authors.affiliation: Institut für Diagnostische und Interventionelle Radiologie, Sektion Kinderradiologie, Universitätsklinikum Jena, 07740, Jena, Germany.
authors.forename: H J
authors.initials: HJ
authors.lastname: Mentzel
authors.affiliation: Zentrum für Kinder- und Jugendmedizin, Universitätsmedizin Mainz, 55131, Mainz, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Queißer-Wahrendorf
authors.affiliation: Radiologisches Institut, Universitätsklinikum Erlangen, 91054, Erlangen, Germany.
authors.forename: O
authors.initials: O
authors.lastname: Rompel
authors.affiliation: Institut für Radiologie und Neuroradiologie, Klinikum Nürnberg Süd, 90471, Nuremberg, Germany.
authors.forename: I
authors.initials: I
authors.lastname: Schlick
authors.affiliation: Klinikum der Universität München, Dr. von Haunersches Kinderspital, Institut für Klinische Radiologie, 80337, Munich, Germany.
authors.forename: K
authors.initials: K
authors.lastname: Schneider
authors.affiliation: Klinik für Neuroradiologie, Neurozentrum, Universitätsklinik Freiburg, 78106, Freiburg, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Schumacher
authors.affiliation: Klinikum der Universität München, Dr. von Haunersches Kinderspital, Institut für Klinische Radiologie, 80337, Munich, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Seidenbusch
authors.affiliation: German Childhood Cancer Registry, University Medical Center Mainz, 55131, Mainz, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Spix
authors.affiliation: Kinderradiologie, Standort Campus Virchow Klinikum, Charité - Universitätsmedizin Berlin, 13353, Berlin, Germany.
authors.forename: B
authors.initials: B
authors.lastname: Spors
authors.affiliation: Klinik und Poliklinik für diagnostische und interventionelle Radiologie, Sektion Kinderradiologie, Universitätsmedizin Mainz, 55131, Mainz, Germany.
authors.forename: G
authors.initials: G
authors.lastname: Staatz
authors.affiliation: Institut für Diagnostische und Interventionelle Radiologie, Klinikum der Johann Wolfgang Goethe-Universität Frankfurt/Main, 60590, Frankfurt, Germany.
authors.forename: T
authors.initials: T
authors.lastname: Vogl
authors.affiliation: Institut für Radiologie und Interventionelle Therapie, Vivantes, Klinikum im Friedrichshain, 10249, Berlin, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Wagner
authors.affiliation: Institut für Klinische Radiologie und Nuklearmedizin, Universitätsklinikum Mannheim, 68167, Mannheim, Germany.
authors.forename: G
authors.initials: G
authors.lastname: Weisser
authors.affiliation: Leibniz - Institute for Prevention Research and Epidemiology - BIPS, Research Focus Health Sciences Bremen, University of Bremen, 28359, Bremen, Germany.
authors.forename: H
authors.initials: H
authors.lastname: Zeeb
authors.affiliation: Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center Mainz, Obere Zahlbacher Straße 69, 55131, Mainz, Germany. blettner@uni-mainz.de.
authors.forename: M
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*; D011839:Radiation, Ionizing; D012306:Risk; D014057:Tomography, X-Ray Computed / Q000009:adverse effects*