How is the risk of radiation-induced cancer influenced by background risk factors? Invited commentary on “A method for determining weights for excess relative risk and excess absolute risk when applied in the calculation of lifetime risk of cancer from radiation exposure” by Walsh and Schneider (2012)

2012 ◽  
Vol 52 (1) ◽  
pp. 147-150 ◽  
Author(s):  
Mark P. Little ◽  
Richard Wakeford
Keyword(s):  
Risk Factors ◽  
Relative Risk ◽  
Radiation Exposure ◽  
Absolute Risk ◽  
Lifetime Risk ◽  
Excess Relative Risk ◽  
Excess Absolute Risk ◽  
Radiation Induced Cancer ◽  
Radiation Induced ◽  
Risk Of Cancer

scholarly journals Determine Cumulative Radiation Dose and Lifetime Cancer Risk in Marfan Syndrome Patients Who Underwent Computed Tomography Angiography of the Aorta in Northeast Thailand: A 5-Year Retrospective Cohort Study

Tomography ◽  
2022 ◽  
Vol 8 (1) ◽  
pp. 120-130
Author(s):  
Narumol Chaosuwannakit ◽  
Phatraporn Aupongkaroon ◽  
Pattarapong Makarawate
Keyword(s):  
Computed Tomography ◽  
Radiation Dose ◽  
Cancer Risk ◽  
Lifetime Risk ◽  
Surveillance Imaging ◽  
Radiation Induced Cancer ◽  
Cumulative Radiation Dose ◽  
Radiation Induced ◽  
The Mean ◽  
Risk Of Cancer

Objective: To evaluate computed tomography angiography (CTA) data focusing on radiation dose parameters in Thais with Marfan syndrome (MFS) and estimate the distribution of cumulative radiation exposure from CTA surveillance and the risk of cancers. Methods: Between 1st January 2015 and 31st December 2020, we retrospectively evaluated the cumulative CTA radiation doses of MFS patients who underwent CTA at Khon Kaen University Hospital, a leading teaching hospital and advanced tertiary care institution in northeastern Thailand. We utilized the Radiation Risk Assessment Tool (RadRAT) established at the National Cancer Institute in Bethesda, Maryland, to evaluate the risk of cancer-related CTA radiation. Results: The study recruited 29 adult MFS patients who had CTA of the aorta during a 5-year study period with 89 CTA studies. The mean cumulative CTDI vol is 21.5 ± 14.68 mGy, mean cumulative DLP is 682.2 ± 466.7 mGy.cm, the mean baseline future risk for all cancer is 26,134 ± 7601 per 100,000, and the excess lifetime risk for all cancer is 2080.3 ± 1330 per 100,000. The excess lifetime risk of radiation-induced cancer associated with the CTA surveillance study is significantly lower than the risk of aortic dissection or rupture and lower than the baseline future cancer risk. Conclusions: We attempted to quantify the radiation-induced cancer risk from CTA surveillance imaging performed for MFS patients in this study, with all patients receiving a low-risk cumulative radiation dose (less than 1 Gy) and all patients having a low excessive lifetime risk of cancer as a result of CTA. The risk–benefit decision must be made at the point of care, and it entails balancing the benefits of surveillance imaging in anticipating rupture and providing practical, safe treatment, therefore avoiding morbidity and mortality.

scholarly journals Quantifying Donor Effects on Transplant Outcomes Using Kidney Pairs from Deceased Donors

2019 ◽  
Vol 14 (12) ◽  
pp. 1781-1787
Author(s):  
Kathleen F. Kerr ◽  
Eric R. Morenz ◽  
Heather Thiessen-Philbrook ◽  
Steven G. Coca ◽  
F. Perry Wilson ◽  
...  
Keyword(s):  
Relative Risk ◽  
Clinical Outcomes ◽  
Graft Failure ◽  
Absolute Risk ◽  
Graft Function ◽  
Delayed Graft Function ◽  
Kidney Donor ◽  
Excess Absolute Risk ◽  
Deceased Donors ◽  
Concordance Measures

Background and objectivesIn kidney transplantation, the relative contribution of donor versus other factors on clinical outcomes is unknown. We sought to quantify overall donor effects on transplant outcomes for kidney donations from deceased donors.Design, setting, participants, & measurementsFor paired donations from deceased donors resulting in transplants to different recipients, the magnitude of donor effects can be quantified by examining the excess of concordant outcomes within kidney pairs beyond chance concordance. Using data from the Organ Procurement and Transplantation Network between the years 2013 and 2017, we examined concordance measures for delayed graft function, death-censored 1-year graft failure, and death-censored 3-year graft failure. The concordance measures were excess relative risk, excess absolute risk, and the fixation index (where zero is no concordance and one is perfect concordance). We further examined concordance in strata of kidneys with similar values of the Kidney Donor Profile Index, a common metric of organ quality.ResultsIf the transplant of the kidney mate resulted in delayed graft function, risk for delayed graft function was 19% higher (95% confidence interval [95% CI], 18% to 20%), or 1.76-fold higher (95% CI, 1.73- to 1.80-fold), than baseline. If a kidney graft failed within 1 year, then the kidney mate’s risk of failure was 6% higher (95% CI, 4% to 9%), or 2.85-fold higher (95% CI, 2.25- to 3.48-fold), than baseline. For 3-year graft failure, the excess absolute risk was 7% (95% CI, 4% to 10%) but excess relative risk was smaller, 1.91-fold (95% CI, 1.56- to 2.28-fold). Fixation indices were 0.25 for delayed graft function (95% CI, 0.24 to 0.27), 0.07 for 1-year graft failure (95% CI, 0.04 to 0.09), and 0.07 for 3-year graft failure (95% CI, 0.04 to 0.10). Results were similar in strata of kidneys with a similar Kidney Donor Profile Index.ConclusionsOverall results indicated that the donor constitution has small or moderate effect on post-transplant clinical outcomes.

Imaging Utilization Trends and Radiation Exposure

2016 ◽  
Author(s):  
Christoph I. Lee
Keyword(s):  
Radiation Exposure ◽  
Clinical Context ◽  
Cancer Risks ◽  
Advanced Imaging ◽  
Additional Information ◽  
Radiation Induced Cancer ◽  
Clinical Benefits ◽  
Imaging Utilization ◽  
Radiation Induced ◽  
Study Methodology

This chapter, found in the radiation exposure from medical imaging section of the book, provides a succinct synopsis of a key study examining advanced imaging utilization trends and radiation-induced cancer risks. This summary outlines the study methodology and design, major results, limitations and criticisms, related studies and additional information, and clinical implications. Results showed that the utilization rates for advanced imaging in a population enrolled in various integrated health systems increased substantially from 1995 to 2010. Given the potential radiation-induced cancer risks associated with advanced imaging, researchers concluded that the clinical benefits of advanced imaging should be quantified to determine the relative risk-benefit ratios of advanced imaging procedures. In addition to outlining the most salient features of the study, a clinical vignette is included in order to provide relevant clinical context.

Current perspectives on radiation-induced breast cancer.

1998 ◽  
Vol 16 (1) ◽  
pp. 338-347 ◽  
Author(s):  
P E Goss ◽  
S Sierra
Keyword(s):  
Breast Cancer ◽  
Risk Factors ◽  
Secondary Prevention ◽  
Radiation Exposure ◽  
Hodgkin's Disease ◽  
Hodgkin’S Disease ◽  
Prospective Trial ◽  
Brca1 And Brca2 ◽  
Published Evidence ◽  
Radiation Induced

PURPOSE An approach to screening and detection of radiation-induced breast cancer is offered. Primary and secondary prevention strategies are suggested and the need for prospective clinical trials is emphasized. METHODS Data are reviewed from published evidence of radiation-induced breast cancer secondary to atomic bomb radiation, occupational, and therapeutic exposure, especially that incurred during successful treatment of Hodgkin's disease (HD). Preclinical studies are reviewed to explore potential risk factors. RESULTS Risk factors evident in the link between radiation and breast cancer include the differentiation of breast tissue as mediated by age and hormonal influence. Evidence is presented exploring the link between genetics and breast cancer, including specific genes such as the BRCA1 and BRCA2 genes, the p53 gene, the ataxia telangiectasia (AT) gene, and other nonspecific alterations in DNA repair proficiency. In light of these findings, steps toward primary prevention are discussed, including avoiding radiation exposure, genetic screening, and manipulation of the hormonal milieu. Secondary prevention may also be possible with the use of tamoxifen, low-fat diets, and/or the consumption of flaxseed. CONCLUSION Our current recommendations for patients irradiated before 30 years of age for Hodgkin's disease include breast self-examination (BSE) monthly, yearly mammography 8 years postirradiation, and regular physical examinations every 6 months. Given the clear link between radiation exposure and breast cancer, we strongly recommend a prospective trial randomize patients to different levels of intensity of surveillance to monitor the efficacy of such screening efforts.

A lower risk of recurrent venous thrombosis in women compared with men is explained by sex-specific risk factors at time of first venous thrombosis in thrombophilic families

Blood ◽  
2009 ◽  
Vol 114 (10) ◽  
pp. 2031-2036 ◽  
Author(s):  
Willem M. Lijfering ◽  
Nic J. G. M. Veeger ◽  
Saskia Middeldorp ◽  
Karly Hamulyák ◽  
Martin H. Prins ◽  
...  
Keyword(s):  
Risk Factors ◽  
Relative Risk ◽  
Venous Thrombosis ◽  
Lifetime Risk ◽  
First Episode ◽  
Adjusted Relative Risk ◽  
Men And Women ◽  
Increased Risk ◽  
The Difference ◽  
Recurrent Venous Thrombosis

Abstract Why men appear to have an increased risk of recurrent venous thrombosis compared with women is unknown. In a cohort study of families with thrombophilia, lifetime risk of recurrent venous thrombosis was assessed in men and women (n = 816). Adjusted relative risk of recurrence was 1.6 (95% CI, 1.3-2.0) in men compared with women. Women were younger at time of their first event (mean, 34 years vs 44 years; P < .001) and at time of recurrence (40 years vs 48 years, P < .001). After excluding provoked first and recurrent venous thrombosis, adjusted relative risk was 1.2 (95% CI, 0.8-1.7), although mean age at recurrence was comparable in men and women (50 years vs 49 years, P = .595). In women with a hormonal first event, median interval between first event and recurrence was 10.4 years versus 2.7 years in men (P < .001). This difference was not observed when only unprovoked events were considered (P = .938). The difference in lifetime risk of recurrent venous thrombosis between men and women in thrombophilic families can be explained by a younger age of women at time of first venous thrombosis due to hormonal risk factors, and a longer interval between a provoked first episode of venous thrombosis and recurrence in women.

Pediatric neurointervention: collimation on radiation exposure-associated lifetime excess tumor risk

2016 ◽  
Vol 9 (9) ◽  
pp. 895-898 ◽  
Author(s):  
Karen Chen ◽  
Srinivasan Paramasivam ◽  
Alejandro Berenstein
Keyword(s):  
Relative Risk ◽  
Radiation Exposure ◽  
Vascular Malformations ◽  
Pediatric Population ◽  
Tumor Development ◽  
Population Based ◽  
Excess Relative Risk ◽  
External Beam Radiation ◽  
Treatment Modalities ◽  
Beam Radiation

BackgroundIntracranial vascular malformations in children are being addressed through a variety of treatment modalities including open surgery, external beam radiation, and image-guided neuroendovascular procedures. These patients often receive multiple treatments and incur serial exposures to ionizing radiation which has been linked to tumor development in population-based data.ObjectiveThis study quantifies the effect of collimation on exposures from single procedures and over patient lifetimes to estimate excess risk of lifetime tumor development.Methods215 patients aged 0–21 years from a single center took part in the study. Radiation exposure from neuroendovascular procedures was tabulated and converted to brain doses using modeled data and extrapolated to risk ratios using results of population-based estimates found in the literature.ResultsLifetime and per procedure risk was highest in patients with brain arteriovenous malformations, brain arteriovenous fistulas, and vein of Galen malformations, a reflection of our institutional referral patterns. Across all pathologies the per procedure excess relative risk decreased from 13.4 to 2.3 when full collimation was employed. Lifetime excess relative risk decreased from 49.0 to 7.7 for full collimation.ConclusionsThis is the first study to quantify the effect of collimation on lifetime and per procedure risk of tumor development in a pediatric population. In addition to collimation, technical and operator-based aspects of the neurointerventional suite are discussed to further reduce patient exposure without sacrificing image quality.

Risk stratification and risk assessment

2015 ◽  
Author(s):  
Ian Graham ◽  
Therese Cooney ◽  
Dirk De Bacquer
Keyword(s):  
Risk Factors ◽  
Relative Risk ◽  
Risk Estimation ◽  
Absolute Risk ◽  
Cvd Risk ◽  
Mortality And Morbidity ◽  
Risk Factor Management ◽  
Estimation System ◽  
Very High ◽  
Apparently Healthy

Cardiovascular disease (CVD) is the biggest cause of death worldwide. The underlying atherosclerosis starts in childhood and is often advanced when it becomes clinically apparent many years later. CVD is manageable: in countries where it has reduced this is due to changes in lifestyle and risk factors and to therapy. Risk factor management reduces mortality and morbidity. In apparently healthy people CVD risk is most frequently the result of multiple interacting risk factors and a risk estimation system such as SCORE can assist in making logical management decisions. In younger people a low absolute risk may conceal a very high relative risk, and use of the relative risk chart or calculation of their ‘risk age’ may help in advising them of the need for intensive life style efforts. All risk estimation systems are relatively crude and require attention to qualifying statements.

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