Lympho-hematopoietic malignancies risk after exposure to low dose ionizing radiation during cardiac catheterization in childhood

Abstract

Pediatric patients with congenital heart disease (CHD) often undergo low dose ionizing radiation (LDIR) from cardiac catheterization (CC) for the diagnosis and/or treatment of their disease. Although radiation doses from a single CC are usually low, less is known about the long-term radiation associated cancer risks. We aimed to assess the risk of lympho-hematopoietic malignancies in pediatric CHD patients diagnosed or treated with CC. A French cohort of 17,104 children free of cancer who had undergone a first CC from 01/01/2000 to 31/12/2013, before the age of 16 was set up. The follow-up started at the date of the first recorded CC until the exit date, i.e., the date of death, the date of first cancer diagnosis, the date of the 18th birthday, or the 31/12/2015, whichever occurred first. Poisson regression was used to estimate the LDIR associated cancer risk. The median follow-up was 5.9 years, with 110,335 person-years. There were 22,227 CC procedures, yielding an individual active bone marrow (ABM) mean cumulative dose of 3.0 milligray (mGy). Thirty-eight incident lympho-hematopoietic malignancies were observed. When adjusting for attained age, gender and predisposing factors to cancer status, no increased risk was observed for lympho-hematopoietic malignancies RR_/mGy = 1.00 (95% CI: 0.88; 1.10). In summary, the risk of lympho-hematopoietic malignancies and lymphoma was not associated to LDIR in pediatric patients with CHD who undergo CC. Further epidemiological studies with greater statistical power are needed to improve the assessment of the dose-risk relationship.

Keywords: Cardiac catheterization; Childhood; Ionizing radiation; Lympho-hematopoietic malignancies.

Figure C1:

Estimates of relative risk (and profile-based 95% confidence interval) per mGy of cardiac catheterization cumulative dose adjusted on sex, attained age and presence of predisposing factors, for a latency period lying from 0 to 5 years. Red squares represent the observed relative risk with the vertical solid lines, the 95% confidence intervals. The horizontal dotted line gives the relative risk = 1. Dose categories: ≤ 1 mGy, 1-2 mGy, 2-4 mGy and > 4 mGy.

Figure 1:

Distribution of the study population according to cardiac catheterization plus computed tomography according to active bone marrow cumulative dose categories (in mGy)

Figure 2:

Estimates of relative risk (and profile-base 95% confidence interval) per mGy of cardiac catheterization cumulative dose from a univariate log-linear Poisson model across dose categories. Red squares represent the observed relative risk with the vertical solid lines, the 95% confidence intervals. The horizontal dotted blue line gives the relative risk = 1. Dose categories: ≤ 1 mGy, 1-2 mGy, 2-4 mGy and > 4 mGy