Exposure to low-dose ionising radiation from cardiac catheterisation and risk of cancer: the COCCINELLE study cohort profile

PurposeThe COCCINELLE study is a nationwide retrospective French cohort set up to evaluate the risk of cancer in patients who undergone cardiac catheterisation (CC) procedures for diagnosis or treatment of congenital heart disease during childhood.ParticipantsChildren who undergone CC procedures from 1 January 2000 to 31 December 2013, before the age of 16 in one of the 15 paediatric cardiology departments which perform paediatric CC in mainland France were included. The follow-up started at the date of the first recorded CC procedure until the exit date, that is, the date of death, the date of first cancer diagnosis, the date of the 18th birthday or the 31 December 2015, whichever occurred first. The cohort was linked to the National Childhood Cancer Registry to identify patients diagnosed with cancer and with the French National Directory for the Identification of Natural Persons to retrieve the patients’ vital status.Findings to dateA total of 17 104 children were included in the cohort and followed for 110 335 person-years, with 22 227 CC procedures collected. Among the patients, 81.6% received only one procedure. Fifty-nine cancer cases were observed in the cohort. Standardised incidence ratios (SIRs) were increased for all-cancer (SIR=3.8, 95% CI: 2.9 to 4.9), leukaemia (SIR=3.3, 95% CI: 2.0 to 5.4), lymphoma (SIR=14.9, 95% CI: 9.9 to 22.5) and solid cancers excluding central nervous system (CNS) tumours (SIR=3.3, 95% CI: 2.0 to 5.5) compared with the general population.Future plansDose reconstruction is currently underway to estimate individual cumulative doses absorbed to relevant organs, including red bone marrow and brain for respectively haematologic disorders and CNS tumours risk estimation. A dose–response analysis will be conducted with consideration to confounding factors such as age at exposure, gender, predisposing factors to cancer and other sources of medical diagnostic low-dose ionising radiation.

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Current Trends in Estimating Risk of Cancer from Exposure to Low Doses of Ionising Radiation

Archives of Industrial Hygiene and Toxicology ◽

10.2478/10004-1254-65-2014-2425 ◽

2014 ◽

Vol 65 (3) ◽

pp. 251-257 ◽

Cited By ~ 3

Author(s):

Marija Majer ◽

Željka Knežević ◽

Miljanić Saveta

Keyword(s):

Cancer Risk ◽

Low Dose ◽

Ionising Radiation ◽

Low Doses ◽

Current Trends ◽

Current State ◽

Risk Estimates ◽

High Doses ◽

Risk Of Cancer ◽

Made In

AbstractAlthough ionising radiation has proven beneficial in the diagnosis and therapy of a number of diseases, one should keep in mind that irradiating healthy tissue may increase the risk of cancer. In order to justify an exposure to radiation, both the benefits and the risks must be evaluated and compared. The deleterious effects of medium and high doses are well known, but it is much less clear what effects arise from low doses (below 0.1 Gy), which is why such risk estimates are extremely important. This review presents the current state, important assumptions and steps being made in deriving cancer risk estimates for low dose exposures.

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Risk of Cancer Following the Use of N-Nitrosodimethylamine (NDMA) Contaminated Ranitidine Products: A Nationwide Cohort Study in South Korea

Journal of Clinical Medicine ◽

10.3390/jcm10010153 ◽

2021 ◽

Vol 10 (1) ◽

pp. 153

Author(s):

Hong Jin Yoon ◽

Jie-Hyun Kim ◽

Gi Hyeon Seo ◽

Hyojin Park

Keyword(s):

Cohort Study ◽

Cancer Risk ◽

South Korea ◽

Primary Study ◽

Study Cohort ◽

Matched Cohort ◽

Cancer Outcomes ◽

H2 Receptor Antagonist ◽

Carcinogenic Agent ◽

Risk Of Cancer

N-nitrosodimethylamine (NDMA), a known carcinogenic agent, was recently detected in some products of ranitidine. Several studies have investigated the detectability of NDMA, in drugs and their risks. However, only a few epidemiological studies have evaluated cancer risk from the use of such individual drugs. This study investigates the risk of cancer in ranitidine users. We conducted an observational population-based cohort study using the Health Insurance Review and Assessment databases, which contain information about the use of medicines in South Korea. The primary study cohort consisted of ranitidine users (n = 88,416). For controls, we enrolled users of famotidine, another H2-receptor antagonist in which no NDMA has been detected. A 4:1 matched cohort was constructed to compare cancer outcomes of the two groups. Our matched cohort comprised of 40,488 ranitidine users and 10,122 famotidine users. There was no statistical difference in the overall cancer risk between the ranitidine and famotidine groups (7.45% vs. 7.56%, HR 0.99, 95% CI 0.91–1.07, p = 0.716). Additionally, no significant differences were observed in the analysis of 11 single cancer outcomes. We found no evidence that exposure to NDMA through ranitidine increases the risk of cancer.

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Exploring the Epidemiology of Cancer after Solid Organ Transplantation (EpCOT): an observational cohort study

BMJ Open ◽

10.1136/bmjopen-2020-043731 ◽

2021 ◽

Vol 11 (4) ◽

pp. e043731

Author(s):

Adnan Sharif ◽

Javeria Peracha ◽

David Winter ◽

Raoul Reulen ◽

Mike Hawkins

Keyword(s):

Organ Transplantation ◽

Record Linkage ◽

Solid Organ Transplantation ◽

Organ Transplant ◽

Solid Organ Transplant ◽

Study Cohort ◽

Solid Organ ◽

Post Transplantation ◽

Increased Risk ◽

Risk Of Cancer

IntroductionSolid organ transplant patients are counselled regarding increased risk of cancer (principally due to their need for lifelong immunosuppression) and it ranks as one of their biggest self-reported worries. Post-transplantation cancer is common, associated with increased healthcare costs and emerging as a leading cause of post-transplant mortality. However, epidemiology of cancer post-transplantation remains poorly understood, with limitations including translating data from different countries and national data being siloed across different registries and/or data warehouses.Methods and analysisStudy methodology for Epidemiology of Cancer after Solid Organ Transplantation involves record linkage between the UK Transplant Registry (from NHS Blood and Transplant), Hospital Episode Statistics (for secondary care episodes from NHS Digital), National Cancer Registry (from cancer registration data hosted by Public Health England) and the National Death Registry (from NHS Digital). Deterministic record linkage will be conducted by NHS Digital, with a fully anonymised linked dataset available for analysis by the research team. The study cohort will consist of up to 85 410 solid organ transplant recipients,who underwent a solid organ transplant in England between 1 January 1985 and 31 December 2015, with up-to-date outcome data.Ethics and disseminationThis study has been approved by the Confidentiality Advisory Group (reference: 16/CAG/0121), Research Ethics Committee (reference: 15/YH/0320) and Institutional Review Board (reference: RRK5471). The results of this study will be presented at national and international conferences, and manuscripts with results will be submitted for publication in high-impact peer-reviewed journals. The information produced will also be used to develop national evidence-based clinical guidelines to inform risk stratification to enable risk-based clinical follow-up.Trial registration numberNCT02991105.

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Risk of cancer associated with low-dose radiation exposure: comparison of results between the INWORKS nuclear workers study and the A-bomb survivors study

Radiation and Environmental Biophysics ◽

10.1007/s00411-020-00890-7 ◽

2021 ◽

Vol 60 (1) ◽

pp. 23-39

Author(s):

Klervi Leuraud ◽

David B. Richardson ◽

Elisabeth Cardis ◽

Robert D. Daniels ◽

Michael Gillies ◽

...

Keyword(s):

Low Dose ◽

Atomic Bomb ◽

Absolute Risk ◽

Joint Analysis ◽

Solid Cancer ◽

Atomic Bomb Survivors ◽

Nuclear Workers ◽

Long Term Follow Up ◽

Primary Basis ◽

Risk Of Cancer

AbstractThe Life Span Study (LSS) of Japanese atomic bomb survivors has served as the primary basis for estimates of radiation-related disease risks that inform radiation protection standards. The long-term follow-up of radiation-monitored nuclear workers provides estimates of radiation-cancer associations that complement findings from the LSS. Here, a comparison of radiation-cancer mortality risk estimates derived from the LSS and INWORKS, a large international nuclear worker study, is presented. Restrictions were made, so that the two study populations were similar with respect to ages and periods of exposure, leading to selection of 45,625 A-bomb survivors and 259,350 nuclear workers. For solid cancer, excess relative rates (ERR) per gray (Gy) were 0.28 (90% CI 0.18; 0.38) in the LSS, and 0.29 (90% CI 0.07; 0.53) in INWORKS. A joint analysis of the data allowed for a formal assessment of heterogeneity of the ERR per Gy across the two studies (P = 0.909), with minimal evidence of curvature or of a modifying effect of attained age, age at exposure, or sex in either study. There was evidence in both cohorts of modification of the excess absolute risk (EAR) of solid cancer by attained age, with a trend of increasing EAR per Gy with attained age. For leukemia, under a simple linear model, the ERR per Gy was 2.75 (90% CI 1.73; 4.21) in the LSS and 3.15 (90% CI 1.12; 5.72) in INWORKS, with evidence of curvature in the association across the range of dose observed in the LSS but not in INWORKS; the EAR per Gy was 3.54 (90% CI 2.30; 5.05) in the LSS and 2.03 (90% CI 0.36; 4.07) in INWORKS. These findings from different study populations may help understanding of radiation risks, with INWORKS contributing information derived from cohorts of workers with protracted low dose-rate exposures.

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Lung Cancer Screening by Low-Dose Computed Tomography: Part 2 – Key Elements for Programmatic Implementation of Lung Cancer Screening

RöFo - Fortschritte auf dem Gebiet der Röntgenstrahlen und der bildgebenden Verfahren ◽

10.1055/a-1290-7817 ◽

2020 ◽

Author(s):

Stefan Delorme ◽

Rudolf Kaaks

Keyword(s):

Lung Cancer ◽

Cancer Screening ◽

Low Dose ◽

Lung Cancer Screening ◽

Cancer Registries ◽

Computer Assisted ◽

Management Algorithm ◽

Epidemiologic Surveillance ◽

Set Up ◽

High Level

Purpose For screening with low-dose CT (LDCT) to be effective, the benefits must outweigh the potential risks. In large lung cancer screening studies, a mortality reduction of approx. 20 % has been reported, which requires several organizational elements to be achieved in practice. Materials and Methods The elements to be set up are an effective invitation strategy, uniform and quality-assured assessment criteria, and computer-assisted evaluation tools resulting in a nodule management algorithm to assign each nodule the needed workup intensity. For patients with confirmed lung cancer, immediate counseling and guideline-compliant treatment in tightly integrated regional expert centers with expert skills are required. First, pulmonology contacts as well as CT facilities should be available in the participant’s neighborhood. IT infrastructure, linkage to clinical cancer registries, quality management as well as epidemiologic surveillance are also required. Results An effective organization of screening will result in an articulated structure of both widely distributed pulmonology offices as the participants’ primary contacts and CT facilities as well as central expert facilities for supervision of screening activities, individual clarification of suspicious findings, and treatment of proven cancer. Conclusion In order to ensure that the benefits of screening more than outweigh the potential harms and that it will be accepted by the public, a tightly organized structure is needed to ensure wide availability of pulmonologists as first contacts and CT facilities with expert skills and high-level equipment concentrated in central facilities. Key Points: Citation Format

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Low-dose ionising radiation and cardiovascular diseases – Strategies for molecular epidemiological studies in Europe

Mutation Research/Reviews in Mutation Research ◽

10.1016/j.mrrev.2015.03.002 ◽

2015 ◽

Vol 764 ◽

pp. 90-100 ◽

Cited By ~ 38

Author(s):

Michaela Kreuzer ◽

Anssi Auvinen ◽

Elisabeth Cardis ◽

Janet Hall ◽

Jean-Rene Jourdain ◽

...

Keyword(s):

Cardiovascular Diseases ◽

Low Dose ◽

Epidemiological Studies ◽

Ionising Radiation

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Increased radioresistance, modelling of carcinogenesis and low-dose risk estimation

Journal of Radiological Protection ◽

10.1088/0952-4746/22/3a/309 ◽

2002 ◽

Vol 22 (3A) ◽

pp. A51-A55 ◽

Cited By ~ 1

Author(s):

Peter Jacob ◽

Vesna Prokic

Keyword(s):

Low Dose ◽

Risk Estimation ◽

Increased Radioresistance

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Incorporation of Pharmacokinetics in Low-Dose Risk Estimation

Toxicological Risk Assessment ◽

10.1201/9780429289965-10 ◽

2019 ◽

pp. 205-214

Author(s):

D. G. Hoel

Keyword(s):

Low Dose ◽

Risk Estimation

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Ionising radiation in urology: consideration of individuals of childbearing age

Journal of Prescribing Practice ◽

10.12968/jprp.2020.2.1.42 ◽

2020 ◽

Vol 2 (1) ◽

pp. 42-46

Author(s):

Robert W McConkey ◽

Maura Dowling

Keyword(s):

Nurse Practitioner ◽

Low Dose ◽

Ionising Radiation ◽

Special Consideration ◽

Childbearing Age ◽

Teratogenic Effects ◽

X Ray ◽

Systematic Assessment ◽

Dose Limitation ◽

Pregnancy Status

Nurse referrers of medical ionising radiation (X-ray) are educated to refer appropriately. One particular cohort of patients who warrant special consideration regarding the risks associated with X-ray are individuals of childbearing age. In the context of advanced nurse practitioner practice in urology, these patients attend for removal of ureteric stents and may require an abdominal X-ray. In reaching a decision, ANPs undertake a systematic assessment considering the individual's pregnancy status, as an X-ray of the abdomen, although low dose, carries a much higher risk of teratogenic effects than an X-ray of the extremities. This article considers the risks of ionising radiation in individuals of childbearing age, while paying attention to legislation and the application of the principles of justification, optimisation and dose limitation.

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