Modan B, Keinan L, Blumstein T, Sadetzki S
Department of Clinical Epidemiology, Chaim Sheba Medical Center, Tel Hashomer, The Stanley Steyer Institute for Cancer Research, Tel Aviv University, Israel.
Int J Epidemiol. 2000 Jun;29(3):424-8.
Low-dose ionizing radiation is one of the definitive risk factors for cancer development. Nevertheless, only a few follow-up studies of children subjected to cardiac catheterization have been performed, yielding inconsistent results.
Our study group included 674 children who underwent cardiac catheterization due to congenital anomalies, between the years 1950-1970 in three major medical centres in Israel. A registered nurse conducted a review of the children's medical files in each hospital. Demographic data and vital status were ascertained from the Israeli National Registry, using a unique identity number. Subsequently, the study cohort was linked with the Israeli National Cancer Registry, in order to identify cancer cases that had been diagnosed through December 1996, the last follow-up date of the study.
Over 75% of the study participants were native-born; 56.2% were males. Approximately 78% of the cohort subjects were alive at the end of follow-up; 28.6% of the participants underwent more than one procedure. All of the diagnosed cases occurred in males. Expected number of malignancies for all sites was 4.75, while the observed number was 11.0 (standardized incidence ratio [SIR] = 2. 3; 95% CI : 1.2-4.1). Of the 11 cancer cases, 4 lymphomas were observed (0.63 were expected, SIR = 6.3; 95% CI : 1.7-16.2). One of these was Hodgkin's Disease. There were also three cases of melanoma as opposed to 0.62 expected (SIR = 4.9; 95% CI : 1.0-14.2).
This finding is compatible with current knowledge about the carcinogenic effect of low-dose irradiation but differs in the occurrence of an excess of lymphoma in the absence of an excess of leukaemia, which has not been reported before. The dissonance between males and females is yet to be resolved.
Radiation doses that are used currently during cardiac catheterization are lower than in the past. Yet, the procedure is more common and frequently involves longer duration due to therapeutic interventions. The possible long-term results of such an exposure should be kept in mind.
低剂量电离辐射是癌症发生的明确危险因素之一。然而，针对接受心脏导管插入术的儿童进行的随访研究较少，结果也不一致。
我们的研究组包括1950年至1970年间在以色列三个主要医疗中心因先天性异常接受心脏导管插入术的674名儿童。一名注册护士对每家医院儿童的病历进行了审查。使用唯一身份号码从以色列国家登记处确定人口统计学数据和生命状态。随后，将研究队列与以色列国家癌症登记处进行关联，以确定截至1996年12月（研究的最后随访日期）确诊的癌症病例。
超过75%的研究参与者为本地出生；56.2%为男性。随访结束时，约78%的队列受试者存活；28.6%的参与者接受了不止一次手术。所有确诊病例均发生在男性中。所有部位恶性肿瘤的预期数量为4.75，而观察到的数量为11.0（标准化发病比[SIR]=2.3；95%置信区间：1.2 - 4.1）。在11例癌症病例中，观察到4例淋巴瘤（预期为0.63，SIR = 6.3；95%置信区间：1.7 - 16.2）。其中1例为霍奇金病。还观察到3例黑色素瘤，而预期为0.62（SIR = 4.9；95%置信区间：1.0 - 14.2）。
这一发现与目前关于低剂量辐射致癌作用的认识相符，但在没有白血病过量的情况下淋巴瘤过量发生这一点上有所不同，此前尚未有过相关报道。男性和女性之间的差异尚待解决。
目前心脏导管插入术中使用的辐射剂量低于过去。然而，该手术更为常见，并且由于治疗干预，通常持续时间更长。应牢记这种暴露可能产生的长期后果。
