CT Scans Increase Cancer Risk in Children



A new study estimates that CT scans performed on children this year will result in almost 5,000 new cases of cancer.


 

CT SCANS INCREASE CANCER RISK IN CHILDREN

As I discuss in my book, A Cancer Prevention Guide for the Human Race, exposure to medical x-rays has only recently been linked to a significant increase in cancer risk, particularly with the use of CT scans that expose patients to relatively large radiation doses at one time.  In fact, the prestigious Institute of Medicine has estimated that as many as 2 percent of all cancer cases are caused by exposure to medical x-rays.

Although cancer is more common during late adulthood, children are also at risk of developing cancer.  Moreover, due to ongoing rapid growth, children are more sensitive to the cancer-causing effects of radiation exposure than adults.

A newly published study, in the journal JAMA Pediatrics, further raises concerns about the current use of CT scans in children.

In this study, the use of CT scans between 1996 and 2010 in children under the age of 15 was analyzed.  Additionally, actual radiation doses were calculated for 744 CT scans performed on children between 2001 and 2011.

Between 1996 and 2006, the use of CT scans doubled among children younger than 5 years of age, and tripled among children between 5 and 14 years of age.  Between 2006 and 2007, the number of CT scans remained stable, and then began to decline somewhat after 2007.

After calculating the radiation dose associated with individual CT scans, the authors of this study calculated that one new case of cancer would be induced in girls for every 300 to 390 CT scans of the abdomen performed, and for every 330 to 480 CT scans of the chest.

When considering the estimated 4 million CT scans performed on children every year in the United States, the authors of this research study estimated that 4,870 children will go on to develop cancer as a result of having undergone a CT scan.  At the same time, they also estimate that reducing the highest 25 percent of CT scan radiation doses to lower levels could prevent at least 43 percent of these radiation-induced cancers.

CT scans can provide enormously important information to treating physicians, but many CT scans performed (on both adults and children) are of questionable clinical value.  Therefore, as a first step in reducing radiation exposure, CT scans should only be ordered when necessary, and only when other types of scans (e.g., plain x-rays, ultrasound or MRI scans) will not suffice.  Secondly, as I have discussed previously, both in A Cancer Prevention Guide for the Human Race and on my website, there is great variability between hospitals, and even within individual hospitals, in the amount of radiation that is used to perform otherwise identical CT scans; and as the authors of this study note, simply reducing excess radiation levels when performing CT scans may cut the number of cancers induced by CT scans nearly in half!

 

For a groundbreaking overview of cancer risks, and evidence-based strategies to reduce your risk of developing cancer, order your copy of my bestselling book, “A Cancer Prevention Guide for the Human Race,” from AmazonBarnes & NobleBooks-A-MillionVroman’s Bookstore, and other fine bookstores!

Within one week of publication, A Cancer Prevention Guide for the Human Race was ranked #6 among all cancer-related books on the Amazon.com “Top 100 Bestseller’s List” for Kindle e-books. Within three months of publication, A Cancer Prevention Guide for the Human Race was the #1 book on the Amazon.com Top 100 New Book Releases in Cancer” list.

 

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According to recent Bureau of Labor Statistics, the unemployment rate for veterans who served on active duty between September 2001 and December 2011 is more than 12 percent.  A new website, Veterans in Healthcare, seeks to connect veterans with potential employers.  If you are a veteran who works in the healthcare field, or if you are an employer who is looking for physicians, advanced practice professionals, nurses, corpsmen/medics, or other healthcare professionals, then please take a look at Veterans in Healthcare. As a retired veteran of the U.S. Army, I would also like to personally urge you to hire a veteran whenever possible.


Disclaimer:  As always, my advice to readers is to seek the advice of your physician before making any significant changes in medications, diet, or level of physical activity


Dr. Wascher is an oncologic surgeon, professor of surgery, cancer researcher, oncology consultant, and a widely published author


 

I and the staff of Weekly Health Update would again like to take this opportunity to thank the more than 100,000 health-conscious people from around the world who visit this premier global health information website every month.  Over the past 12 months, 3.5 million pages of high-quality medical research findings were served to the worldwide audience of health-conscious readers.  As always, we enjoy receiving your stimulating feedback and questions, and I will continue to try and personally answer as many of your inquiries as I possibly can.


 


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Increasing Number of CT and PET Scans Raise Cancer Risk Concerns





 

A new research study reveals a striking increase in the number of CT and PET scans being performed, resulting in increased radiation exposure levels


 

 

INCREASING NUMBER OF CT AND PET SCANS RAISE CANCER RISK CONCERNS

Last week, I discussed new data regarding CT scans in children, and the potential increase in lifetime cancer risk associated with these scans.  This week, I will continue with this general theme by reviewing a new clinical study, published in the Journal of the American Medical Association, that documents the continuing rise in the number of medical imaging studies being performed, including computed tomography (CT) scans.  In view of this continuing increase in the number of medical imaging exams being performed, public health experts are concerned that cancer rates may also rise.

As I discuss in my bestselling book, A Cancer Prevention Guide for the Human Race, exposure to medical x-rays, and particularly exposure to radiation from CT scans, is an under-appreciated cancer risk factor.  Based upon conservative estimates, exposure to medical radiation is thought to cause approximately 2 percent of all new cancer cases, and most of this medical x-ray exposure comes from CT scans and positron emission tomography (PET) scans.

It is important to acknowledge that, when ordered and performed appropriately, CT scans, PET scans, and other medical imaging studies offer enormous potential benefits to patients and their doctors, and the benefits of medical imaging far outweigh the risks in such cases.  However, since the advent of CT scans and other forms of advanced medical imaging, many physicians have increasingly come to rely upon these imaging studies when other methods of clinical diagnosis that do not expose patients to large doses of ionizing radiation will work just as well.

In this new clinical study, the electronic medical records systems of 6 large integrated health care systems in the United States were analyzed.  In this very large study, between 1 and 2 million patient records were reviewed every year between 1996 and 2010.  All patient-members enrolled in the following health care organizations during this 15-year period were evaluated:Group Health Cooperative in Washington State; Kaiser Permanente in Colorado, Georgia, Hawaii, Oregon, and Washington; and the Marshfield Clinic and Security Health Plan in Wisconsin.

The focus of this study was on Health Maintenance Organizations (HMOs), because these organizations typically have very robust utilization management systems that are designed to monitor for, and prevent, wasteful or inappropriate medical studies, including unnecessary medical imaging exams.  Given that the use of advanced medical imaging studies has skyrocketed in the fee-for-service world in recent years, the authors of this new study sought to assess trends in the use of advanced medical imaging studies among HMOs, specifically.

During the 15-year study period, the patients of these 6 HMOs underwent 31 million medical imaging exams, equal to an average of 1.2 imaging tests per year for every patient-member.  More than one-third of these medical imaging exams were advanced medical imaging studies (CT scans, MRI scans, PET scans, and ultrasound scans).  When measured on an annual basis during the 15 year duration of this study, CT scan exams increased by 8 percent per year, while MRI scans increased by 10 percent per year.  PET scans, which are typically combined with CT scans, increased by a whopping 57 percent per year from 2004 through 2010.  (Ultrasound scans, which, like MRI scans, do not expose patients to ionizing radiation, increased by 4 percent per year.)

Of particular interest to me, as a cancer prevention expert was the finding that the increased use of CT scans resulted in a per capita doubling of radiation exposure doses among the patient-members of these 6 HMOs.  Moreover, the proportion of patient-members who received high and very high medical radiation doses also doubled during the course of this study, reflecting the increased use of high-energy medical imaging studies, including, primarily, CT scans and CT-PET scans.  Indeed, by 2010, 7 percent of these HMO patient-members received medical imaging studies that placed them within the “high annual radiation exposure” category (> 20-50 millisieverts, or mSv), while 4 percent of patients received “very high annual radiation exposure” doses of medical radiation (> 50 mSv).

Once again, it is important to stress that advanced medical imaging is a very powerful tool that can provide physicians with essential diagnostic information for many of their patients.  However, experts in the fields of Radiology and Public Health have become very concerned, in recent years, regarding the questionable indications for advanced imaging scans in many cases.  Indeed, there is the sense that these powerful diagnostic scans are too easily and too quickly ordered in many cases, and without compelling clinical justification.  Therefore, it behooves both patients and their physicians to ask a simple but very important question:  Does the likely benefit of undergoing a CT scan or CT-PET scan outweigh the possible associated risks?  If the answer to this question is no, then such scans should not be performed.


At this time, 8.2 percent of Americans are unemployed.  According to the Bureau of Labor Statistics, however, the unemployment rate for veterans who served on active duty between September 2001 and December 2011 is now more than 12 percent.  A new website, Veterans in Healthcare, seeks to connect veterans with potential employers.  If you are a veteran who works in the healthcare field, or if you are an employer who is looking for physicians, advanced practice professionals, nurses, corpsmen/medics, or other healthcare professionals, then please take a look at Veterans in Healthcare.


For a groundbreaking overview of cancer risks, and evidence-based strategies to reduce your risk of developing cancer, order your copy of my bestselling book, “A Cancer Prevention Guide for the Human Race,” from AmazonBarnes & NobleBooks-A-MillionVroman’s Bookstore, and other fine bookstores!

Within one week of publication, A Cancer Prevention Guide for the Human Race was ranked #6 among all cancer-related books on the Amazon.com “Top 100 Bestseller’s List” for Kindle e-books. Within three months of publication, A Cancer Prevention Guide for the Human Race was the #1 book on the Amazon.comTop 100 New Book Releases in Cancer” list.




Disclaimer:  As always, my advice to readers is to seek the advice of your physician before making any significant changes in medications, diet, or level of physical activity


 

Dr. Wascher is an oncologic surgeon, professor of surgery, cancer researcher, oncology consultant, and a widely published author


 

I and the staff of Weekly Health Update would again like to take this opportunity to thank the more than 100,000 health-conscious people from around the world who visit this premier global health information website every month.  (More than 1.3 million pages of high-quality medical research findings were served to the worldwide audience of health-conscious people who visited Weekly Health Update in 2011!)  As always, we enjoy receiving your stimulating feedback and questions, and I will continue to try and personally answer as many of your inquiries as I possibly can.


 




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CT Scans and Cancer Risk in Children





 

A new clinical study suggests that performing CT scans during childhood may significantly increase the risk of leukemia and brain cancer.


 

 

CT SCANS AND CANCER RISK IN CHILDREN

As I discuss in my bestselling book, A Cancer Prevention Guide for the Human Race, exposure to medical x-rays, and particularly exposure to radiation from CT scans, is an under-appreciated cancer risk factor.  Based upon even conservative estimates, exposure to medical radiation is thought to cause at least 1 to 2 percent of all new cancer cases, and most of this medical x-ray exposure comes from CT scans.  Additionally, as I also discuss in my book, there is enormous variation in the amount of radiation exposure associated with CT scans between different hospitals, and even within individual hospitals.  Now, a newly published clinical study suggests that the risk of cancer in children due to medical x-rays may be of particular concern.  This new paper appears in the forthcoming issue of the journal The Lancet.

In this study from the United Kingdom, nearly 180,000 patients who underwent CT scans as children, between 1985 and 2002, were followed.  The incidence of cancer in this very large group of patients was then monitored.

In this study, CT scans that delivered a cumulative radiation dose of at least 30 milligray were associated with three times the subsequent risk of leukemia as was observed in patients who received radiation doses less than 5 milligray.  The incidence of brain cancer was also three times higher among patients who received a cumulative radiation dose of 50 milligray or more from CT scans, when compared to patients who received less than 5 milligray.  Now, it is important to mention that these increases in cancer risk were increases in relative risk.  Since both leukemia and brain cancer are rare diseases, the absolute increase in cancer risk was actually quite small (one excess case of leukemia and one excess case of brain cancer per 10,000 CT scans of the head).  However, the findings of this important study point out the need to reduce radiation doses associated with CT scans to as low a level as is possible, especially for CT scans performed on children.  Moreover, alternative imaging studies to CT scans, such as ultrasound and MRI scans, should be used whenever possible to further reduce the exposure of both pediatric patients and adult patients to medical x-rays.


For a groundbreaking overview of cancer risks, and evidence-based strategies to reduce your risk of developing cancer, order your copy of my bestselling book, “A Cancer Prevention Guide for the Human Race,” from AmazonBarnes & NobleBooks-A-MillionVroman’s Bookstore, and other fine bookstores!

Within one week of publication, A Cancer Prevention Guide for the Human Race was ranked #6 among all cancer-related books on the Amazon.com “Top 100 Bestseller’s List” for Kindle e-books. Within three months of publication, A Cancer Prevention Guide for the Human Race was the #1 book on the Amazon.comTop 100 New Book Releases in Cancer” list.




Disclaimer:  As always, my advice to readers is to seek the advice of your physician before making any significant changes in medications, diet, or level of physical activity


 

Dr. Wascher is an oncologic surgeon, professor of surgery, cancer researcher, oncology consultant, and a widely published author


 

I and the staff of Weekly Health Update would again like to take this opportunity to thank the more than 100,000 health-conscious people from around the world who visit this premier global health information website every month.  (More than 1.3 million pages of high-quality medical research findings were served to the worldwide audience of health-conscious people who visited Weekly Health Update in 2011!)  As always, we enjoy receiving your stimulating feedback and questions, and I will continue to try and personally answer as many of your inquiries as I possibly can.


 





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CT Scans & Cancer Risk

December 20, 2009 by  
Filed under Cancer, Cancer Prevention, CT Scans

Welcome to Weekly Health Update



 

“A critical weekly review of important new research findings for health-conscious readers”




HAPPY HOLIDAYS FROM WEEKLY HEALTH UPDATE!

 

 

 

CT SCANS & CANCER RISK

 

 

CT (computed tomography) scanners have revolutionized the practice of medicine since they were first introduced into routine clinical practice in 1974.  CT scanners utilize a rotating x-ray device to create hundreds of individual images that can then be reconstructed into a complex three dimensional view of the body by computers.  Current generation CT scanners are able to image the entire human body within seconds, and these high definition images provide physicians with an incredibly detailed view of the organs and tissues deep within us. 

 

CT scanners have become an indispensible diagnostic tool within virtually every medical and surgical specialty, and an estimated 75 million CT scans are now performed annually in the United States, alone.  As the popularity of these complex and powerful diagnostic imaging machines has continued to grow, so has their use for clinically dubious reasons.  For example, routine scans of the heart, and its coronary arteries, have, increasingly, been used for “screening purposes” in patients without any clinical evidence of heart disease.  Likewise, there has been an explosion in the number of private radiology imaging centers offering fee-based “body scans” for clinically healthy people who are interested in having their internal organs examined for any early signs of diseases that can be detected by CT scans.  Another area of concern regarding the use of CT scanners is that physicians have become so dependent on these machines, and the exquisite images of the human body that they provide, that many (if not most) doctors have a very low threshold to order CT scans as a routine part of their diagnostic work-up of patients.  (For example, in my own specialty of Surgery, the diagnosis of appendicitis is now routinely made with a CT scanner, rather than by the traditional method of the surgeon’s clinical evaluation of the patient.) 

 

While CT scanners have become essential diagnostic tools, they also expose patients to much higher doses of radiation than most conventional x-ray examinations.    It has long been known that exposure to radiation increases the risk of developing cancer, and that the risk of developing cancer is proportional to the dose of radiation received by patients.  (Based upon recent estimates, it has been estimated that at least 2 percent of all cancer cases may be caused by prior exposure to medical x-rays.)  Moreover, there is no known “safe” dose of radiation in terms of radiation-induced cancer risk.  As if this was not already bad enough, there has been a growing concern regarding the actual dose of radiation that is being delivered to patients from CT scanners across the country, as there is a great deal of variability in the radiation dose settings being used among different CT scan imaging facilities.  (This alarming point was recently brought to the public’s attention when it was revealed that Cedars Sinai Medical Center, a prestigious private hospital in the Beverly Hills area, was being investigated after multiple patients who had undergone CT scans of their brain there began to notice that their hair was falling out.  Authorities subsequently determined that these patients had received grossly excessive radiation doses during their scans.)

 

 

Two very important public health studies have just been published in the Archives of Internal Medicine, and the findings of these two related studies have significantly raised the level of concern regarding the current use of CT scanners among public health experts. 

 

The first of these two studies quantified the amount of radiation dose delivered to 1,119 patients for 11 common types of CT scan examinations that were performed at 4 different hospitals in the San Francisco area.  In addition to calculating the radiation doses received by these patients, the authors also estimated the probable lifetime cancer risk associated with these CT scans.  As the Cedars Sinai case has already shown, there appears to be considerable variability in the amount of radiation used at different institutions to conduct the same exact type of CT scan.  However, the sheer magnitude of this variability in radiation doses, as measured by these researchers, is both mind-boggling and disturbing.  Not only was there an enormous difference in radiation doses associated with performing the same exact type of CT scan between the 4 different institutions that were studied, but significant radiation exposure differences were also present within each individual institution when performing the same type of CT scan examination on different patients.  When the researchers had finished their calculations, they noted an almost unbelievable 13-fold difference, on average, in radiation exposure for the same type of CT scan between the highest and lowest observed radiation doses for each individual type of CT examination. 

 

Based largely upon cancer incidence data collected after the Hiroshima and Nagasaki atomic bombings, this clinical study’s researchers calculated that an estimated 1 in 270 women who underwent a CT scans of their coronary arteries at age 40 will eventually develop cancer as a direct result of these CT scans (versus 1 in 600 men), while 1 in 8,100 women who underwent CT scans of the brain at age 40 will develop cancer from these scans (versus 1 in 11,080 men).  For men and women who underwent CT scans at age 20 (instead of age 40), the projected lifetime risk of CT scan-associated cancer was nearly double the projected risk of the 40 year-old patients. 

 

The findings of this study indicate that the variability in radiation exposure between hospitals for the same type of CT scan examination is much greater than was previously believed.  Perhaps even more surprising was the finding that identical CT scan examinations performed within a single hospital also subjected patients to significantly different amounts of radiation exposure.  Finally, the calculated range of radiation exposure for CT scans revealed that, in general, patients are receiving far higher doses of radiation from routine CT scans than has generally been appreciated.  (For example, a single CT coronary artery angiogram delivers the same amount of radiation as 310 chest x-rays!)

 

The second research study used public health data to estimate the average number of radiation-induced cancers caused by CT scans in the United States.  Based upon current CT scan use, these researchers predicted that approximately 29,000 future cases of cancer could be expected to arise from CT scans performed in 2007 in the United States, resulting in approximately 15,000 deaths due to cancers caused directly by CT scans!

 

These two studies are eye-openers that should cause all of us, physicians and patients alike, to reconsider the benefits versus the risks of each and every CT scan that is considered before such scans are performed.  Although most CT scans are performed because they offer vitally important clinical information on patients that could only otherwise be obtained by surgical exploration, too many CT scans are still being ordered and performed for far less compelling reasons (one of them being, unquestionably, the tendency of many physicians to order multiple unnecessary tests on patients as part of their practice of “defensive medicine,” in the absence of tort reform throughout most areas of the United States…).  Moreover, the striking variation in CT-associated radiation doses, and the unexpectedly high level of these radiation doses in general, points to the need to improve standardization and compliance at every one of the thousands of institutions in the United States that operates a CT scanner.


As a dedicated cancer specialist, I am already well aware of the potential for radiation-induced cancers, and I have, for many years, tried to be very selective in ordering CT scans on my patients.  In cases where I can gather the necessary clinical information without resorting to radiographic imaging, then I try to avoid obtaining any form of x-ray examination (including CT scans).  In other cases, where I must obtain some sort of imaging examination, then I will often initially use ultrasound or MRI studies in place of CT scans, when appropriate.  Even so, the dramatic findings of these two studies suggest to me that all physicians need to further decrease their routine use of CT scans whenever possible. 

 

   


Disclaimer: As always, my advice to readers is to seek the advice of your physician before making any significant changes in medications, diet, or level of physical activity

Dr. Wascher is an oncologic surgeon, a professor of surgery, a cancer researcher, an oncology consultant, and a widely published author

 

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