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Risk of cancer incidence before the age of 15 years after exposure to ionising radiation from computed tomography: results from a German cohort study

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An Erratum to this article was published on 13 June 2017

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.

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Acknowledgments

The authors thank S Blomemkamp, C Bremensdorfer, J Hermen, I Jung, DM R Lange, C Lehmann, G Miritz, Dr. A Schiefer, Dr. G Stolz and K Taylor for their valuable technical and intellectual support during the conduct of the study. The study was funded by the German Federal Ministry of Education and Research under grant numbers 02NUK016A, 02NUK016B and 02NUK016CX. Complementary funding was received from the European Community’s Seventh Framework Programme (FP7/2007-2013) under Grant Agreement Number 269912. The funding bodies had no role in the study design, data analysis or reporting.

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Authors and Affiliations

  1. Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center Mainz, Obere Zahlbacher Straße 69, 55131, Mainz, Germany

    L. Krille, R. Schindel, E. A. L. Gianicolo & M. Blettner

  2. International Agency for Research on Cancer, 69372, Lyon, France

    L. Krille

  3. Leibniz - Institute for Prevention Research and Epidemiology – BIPS, Research Focus Health Sciences Bremen, University of Bremen, 28359, Bremen, Germany

    S. Dreger & H. Zeeb

  4. Institut für Radiologie und Interventionelle Therapie, Vivantes, Klinikum Neukölln, 12351, Berlin, Germany

    T. Albrecht

  5. Städtisches Klinikum Karlsruhe, Zentralinstitut für Bildgebende Diagnostik, 76133, Karlsruhe, Germany

    M. Asmussen

  6. Klinik für Radiologie und Nuklearmedizin, Campus Lübeck, Universitätsklinikum Schleswig Holstein, 23538, Lübeck, Germany

    J. Barkhausen

  7. Institut für Diagnostische und Interventionelle Radiologie, Medizinische Hochschule Hannover, 30625, Hannover, Germany

    J. D. Berthold

  8. Institut für Diagnostische & Interventionelle Radiologie, Klinikum Oldenburg GmbH, 26133, Oldenburg, Germany

    A. Chavan

  9. Abt. für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Tübingen, 72076, Tübingen, Germany

    C. Claussen

  10. Institut für Diagnostische und Interventionelle Radiologie und Neuroradiologie, Universitätsklinikum Essen, 45147, Essen, Germany

    M. Forsting

  11. Institute of Clinical Physiology, National Research Council, 73100, Lecce, Italy

    E. A. L. Gianicolo

  12. Klinik für Radiologische Diagnostik und Nuklearmedizin, Klinikum Bremen-Mitte, 28177, Bremen, Germany

    K. Jablonka

  13. Centre de Recherche Public Henri Tudor, 1855, Luxembourg, Luxembourg

    A. Jahnen

  14. Klinik für Radiologie, Universitätsklinikum Freiburg, 79106, Freiburg, Germany

    M. Langer

  15. Institut und Poliklinik für Radiologische Diagnostik, Universitätsklinikum Carl Gustav Carus Dresden, 01307, Dresden, Germany

    M. Laniado

  16. Institut für Diagnostische und Interventionelle Radiologie, Universitätsmedizin Göttingen, 37075, Göttingen, Germany

    J. Lotz

  17. Institut für Diagnostische und Interventionelle Radiologie, Sektion Kinderradiologie, Universitätsklinikum Jena, 07740, Jena, Germany

    H. J. Mentzel

  18. Zentrum für Kinder- und Jugendmedizin, Universitätsmedizin Mainz, 55131, Mainz, Germany

    A. Queißer-Wahrendorf

  19. Radiologisches Institut, Universitätsklinikum Erlangen, 91054, Erlangen, Germany

    O. Rompel

  20. Institut für Radiologie und Neuroradiologie, Klinikum Nürnberg Süd, 90471, Nuremberg, Germany

    I. Schlick

  21. Klinikum der Universität München, Dr. von Haunersches Kinderspital, Institut für Klinische Radiologie, 80337, Munich, Germany

    K. Schneider & M. Seidenbusch

  22. Klinik für Neuroradiologie, Neurozentrum, Universitätsklinik Freiburg, 78106, Freiburg, Germany

    M. Schumacher

  23. German Childhood Cancer Registry, University Medical Center Mainz, 55131, Mainz, Germany

    C. Spix

  24. Kinderradiologie, Standort Campus Virchow Klinikum, Charité - Universitätsmedizin Berlin, 13353, Berlin, Germany

    B. Spors

  25. Klinik und Poliklinik für diagnostische und interventionelle Radiologie, Sektion Kinderradiologie, Universitätsmedizin Mainz, 55131, Mainz, Germany

    G. Staatz

  26. Institut für Diagnostische und Interventionelle Radiologie, Klinikum der Johann Wolfgang Goethe-Universität Frankfurt/Main, 60590, Frankfurt, Germany

    T. Vogl

  27. Institut für Radiologie und Interventionelle Therapie, Vivantes, Klinikum im Friedrichshain, 10249, Berlin, Germany

    J. Wagner

  28. Institut für Klinische Radiologie und Nuklearmedizin, Universitätsklinikum Mannheim, 68167, Mannheim, Germany

    G. Weisser

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  1. L. Krille
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  29. G. Weisser
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  30. H. Zeeb
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  31. M. Blettner
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Corresponding author

Correspondence to M. Blettner.

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An erratum to this article is available at http://dx.doi.org/10.1007/s00411-017-0694-5.

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Krille, L., Dreger, S., Schindel, R. et al. Risk of cancer incidence before the age of 15 years after exposure to ionising radiation from computed tomography: results from a German cohort study. Radiat Environ Biophys 54, 1–12 (2015). https://doi.org/10.1007/s00411-014-0580-3

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