RISQUES DE CANCER LIES AUX EXAMENS D’IMAGERIE MEDICALE PENDANT L’ENFANCE : REVUE SYSTEMATIQUE ET META-ANALYSE

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RISQUES DE CANCER LIES AUX EXAMENS D’IMAGERIE MEDICALE PENDANT L’ENFANCE :

REVUE SYSTEMATIQUE ET META-ANALYSE

Kossi Abalo, Marie Odile Bernier, Klervi Leuraud, Dominique Laurier, Estelle Rage

To cite this version:

Kossi Abalo, Marie Odile Bernier, Klervi Leuraud, Dominique Laurier, Estelle Rage. RISQUES DE CANCER LIES AUX EXAMENS D’IMAGERIE MEDICALE PENDANT L’ENFANCE : REVUE SYSTEMATIQUE ET META-ANALYSE. Société Française de RadioProtection, SFRP, Jun 2019, ROCHELLE, France. �hal-03106505�

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I-V Overall (I-squared = 0.0%, p = 0.724) Schuz J 2001 D+L Overall Tettamanti G 2017 Study Rajaraman P 2011 0.93 (0.68, 1.28) OR (95% CI) 0.93 (0.68, 1.28) 0.78 (0.45, 1.36) 0.93 (0.68, 1.28) 0.96 (0.55, 1.68) OR (95% CI) 1.06 (0.63, 1.77) 100.00 31.62 Weight (%) 31.21 37.18 1 .3 2

Results

Context

In utero and childhood medical diagnostic ionizing radiation

exposure and cancer risk: Systematic review and meta-analysis

Intrauterine exposure: 8

All searches: 1674 _{Selected: 1493}

Significant (p<0.05)



Medical ionizing radiation (MIR) has been shown to count for the most

important human-made ionizing radiation (IR) exposure of the general

population [UNSCEAR 2010].



Substantial increase in MIR use have been pointed out during the last

50 years. Between 2000 – 2007, 3.6 billion MIR procedures were

performed in the world annually [UNSCEAR 2010, Mettler 2009].



About 20-fold incrementation in computed tomography (CT) use in USA

and 12-fold in UK from 1980 to 2005 have been reported. In France, 74.5 million medical diagnostic examinations have been performed in

2007 and 81.8 million in 2012 [Hall E 2008, Etard C 2010, IRSN 2014].



Collective dose per inhabitant consecutively, raised from 0.53mSv to

3mSv in USA where around 10% growth was observed in UK [Watson S

2005].



Moderate and high dose of IR exposure have been associated to

increased cancer risk but risk for low doses are still debated.



Fetus and children are more radio sensitive than adult, and their long

life expectancy can lead to the development of radiation-induced malignancies.

Kossi D. Abalo, Marie-Odile Bernier, Klervi Leuraud, Dominique Laurier, Estelle Rage

IRSN, PSE-SANTE, SESANE, BP17, 92262 Fontenay-aux-Roses Cedex, France

Fully read : 154



Systematic review has been performed according to PRISMA (Preferred Reporting

Items for Systematic review and Meta-Analysis) guidelines [Liberati A 2009].



English epidemiological studies (cohort and case-control) published from 2000

to 2018, were retrieved from online databases.



Included subjects have to be aged 22 years or less.



Exposure should take place in 1970’s onward.



Hight dose procedures (radiotherapy) and environmental exposures were

excluded.



Random effect model was used to estimate pooled risk [DerSimonian and Laird 1986].



Statistical analysis were performed with STATA software.

Figure 1 : Studies’ selection flow diagram

Conclusion

Duplicates: 181 Title and abstract non conform: 1339

Relevant: 24

Exclusion criterion: 130 _{Postnatal exposure: 21}



Assess cancer risk following intrauterine or childhood diagnostic MIR exposure

in the last 50 years.

Specifically



Review of published data



Ascertain the overall risk associated

Type of cancer Studies Pooled ERR per mGy (95% CI) Leukemia Mathews 2013, Krille 2015, Journy 2016, Nikkila 2018 0.03 (0.00, 0.04); p=0.005

CNS tumors Mathews 2013, Krille 2015, Journy 2016 0.01 (0.00, 0.01); P<0.001

Objectives

Material and methods

Figure 2 : Leukemia (A) and CNS tumors (B) risk after intrauterine x-ray exposure

Table 2 : Pooled ERRs of leukemia and CNS tumors risk related to postnatal CT scan exposure Table 1 : Cohort studies on postnatal MIR exposure and cancer risk



Common exposures: X-ray and computed tomography (CT).



Type of cancer assessed: hematologic cancers (leukemia and

lymphoma) and central nervous system (CNS) tumors.

Intrauterine exposure



No significant cancers risk reported for fetal x-ray exposure by the

studies

(

Figure 2

)

:

 _{Leukemia: pooled OR 1.08; 95% CI 0.87, 1.33}

 _{CNS tumors: pooled OR 0.93; 95% CI 0.68, 1.28}



No observation of an increased cancer risk after fetal x-ray exposure, but childhood CT scan exposure is associated to slightly excess risk of leukemia and CNS

tumors.



Children and pregnant’s MIR exposure should be kept low by applying the ALARA principle (As Low As Reasonably Achievable).



Further studies are ongoing to provide additional information on childhood MIR exposure and subsequent cancer risk.

Postnatal exposure



Inconsistent results were found for postnatal CT scan exposure and

cancer risk (Table 1).



Significant excess relative risk (ERR) was shown for leukemia and CT

scan exposure

(

Table 1

).



Slightly increased ERR was observed for CNS tumors and CT scan

exposure.

A B

SIR : Standardized Incidence Ratio ; IRR : Incidence Rate Ratio ; HR : Hazard Ratio ; OR : Odds Ratio ; ERR: Excess Relative Risk per mGY

I-V Overall (I-squared = 23.2%, p = 0.272)

D+L Overall Study Roman E 2005 Shu XO 2002 Bailey HD 2010 Rajaraman P 2011 1.08 (0.90, 1.28) 1.08 (0.87, 1.33) OR (95% CI) 1.10 (0.81, 1.50) 1.00 (0.77, 1.30) 0.46 (0.15, 1.40) 1.36 (0.92, 2.02) 100.00 32.36 45.23 2.51 19.89 Weight (%) 1 .1 2 Study Enrolled subject / Cases Period of inclusion Age at inclusion (years) Proced

ures Outcomes Estimate value (95% CI) Latency

Mathews JD 2013 Australia Exposed: 680 211 / 3150 Unexposed: 10261420 / 57524 1985-2005 < 19 CT - All Cancer - Brain cancer - Lymphoma and hematopoietic IRR 1.20 (1.15 - 1.24) 2.13 (1.88 - 2.41) 1.19 (1.10 - 1.29) 1 year Krill L 2015 Germany 39184 / 38 1980-2010 < 15 CT - All Cancers - Leukemia - Lymphoma - CNS tumors SIR 1.82 (1.29 - 2.50) 1.72 (0.89 - 3.01) 2.96 (1.42 - 5.45) 1.35 (0.54 - 2.78) 2 years Journy N 2016 France 67274 / 106 2000-2010 < 10 CT - Leukemia - Lymphoma - CNS tumors ERR 0.057 (– 0.079 - 0.193) 0.018 (– 0.068 - 0.104) 0.022 (– 0.016 - 0.061) 2 years Meulepas JM 2018 The Netherlands 168394 / 454 1979-2012 < 18 CT - All cancers - CNS tumors - Hematolym-phoid proliferative cancers SIR 1.47 (1.34 - 1.61) 2.05 (1.48 - 2.83) 1.39 (1.13 - 1.70) 5 years Harbron RW 2018 UK 11270 / 41 __ < 22 Cardiac cathete-rization - All cancers - Leukemia - Lymphoma SIR 3.01 (2.09 - 4.19) 1.73 (0.43 - 4.53) 9.15 (5.66 - 13.97) - 5 years - 2 years Pearce MS 2012 UK

178 604 / 74 1985-2002 < 22 CT Leukemia ERR 0.036 (0.005 - 0.120) 2 years 176 587 / 135 1986-2002 < 22 CT Brain ERR 0.023 (0.010 - 0.049) 5 years