Radiation-related cancer risks from CT colonography screening

A risk-benefit analysis

Amy Berrington De González, Kwang Pyo Kim, Amy B. Knudsen, Iris Lansdorp-Vogelaar, Carolyn M. Rutter, Rebecca Smith-Bindman, Judy Yee, Karen M. Kuntz, Marjolein Van Ballegooijen, Ann G. Zauber, Christine D. Berg

Research output: Contribution to journalArticle

85 Citations (Scopus)

Abstract

OBJECTIVE. The purpose of this study was to estimate the ratio of cancers prevented to induced (benefit-risk ratio) for CT colonography (CTC) screening every 5 years from the age of 50 to 80 years. MATERIALS AND METHODS. Radiation-related cancer risk was estimated using risk projection models based on the National Research Council's Biological Effects of Ionizing Radiation (BEIR) VII Committee's report and screening protocols from the American College of Radiology Imaging Network's National CT Colonography Trial. Uncertainty intervals were estimated using Monte Carlo simulation methods. Comparative modeling with three colorectal cancer microsimulation models was used to estimate the potential reduction in colorectal cancer cases and deaths. RESULTS. The estimated mean effective dose per CTC screening study was 8 mSv for women and 7 mSv for men. The estimated number of radiation-related cancers resulting from CTC screening every 5 years from the age of 50 to 80 years was 150 cases/100,000 individuals screened (95% uncertainty interval, 80-280) for men and women. The estimated number of colorectal cancers prevented by CTC every 5 years from age 50 to 80 ranged across the three microsimulation models from 3580 to 5190 cases/100,000 individuals screened, yielding a benefit-risk ratio that varied from 24:1 (95% uncertainty interval, 13:1-45:1) to 35:1 (19:1-65:1). The benefit-risk ratio for cancer deaths was even higher than the ratio for cancer cases. Inclusion of radiation-related cancer risks from CT examinations performed to follow up extracolonic findings did not materially alter the results. CONCLUSION. Concerns have been raised about recommending CTC as a routine screening tool because of potential harms including the radiation risks. Based on these models, the benefits from CTC screening every 5 years from the age of 50 to 80 years clearly outweigh the radiation risks.

Original languageEnglish (US)
Pages (from-to)816-823
Number of pages8
JournalAmerican Journal of Roentgenology
Volume196
Issue number4
DOIs
StatePublished - Apr 1 2011
Externally publishedYes

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Computed Tomographic Colonography
Radiation
Neoplasms
Uncertainty
Colorectal Neoplasms
Odds Ratio
Monte Carlo Method
Ionizing Radiation
Radiology

Keywords

  • Colonography
  • Colorectal cancer
  • CT
  • CT colonography radiation risk
  • Radiation risk
  • Screening

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

Berrington De González, A., Kim, K. P., Knudsen, A. B., Lansdorp-Vogelaar, I., Rutter, C. M., Smith-Bindman, R., ... Berg, C. D. (2011). Radiation-related cancer risks from CT colonography screening: A risk-benefit analysis. American Journal of Roentgenology, 196(4), 816-823. https://doi.org/10.2214/AJR.10.4907

Radiation-related cancer risks from CT colonography screening : A risk-benefit analysis. / Berrington De González, Amy; Kim, Kwang Pyo; Knudsen, Amy B.; Lansdorp-Vogelaar, Iris; Rutter, Carolyn M.; Smith-Bindman, Rebecca; Yee, Judy; Kuntz, Karen M.; Van Ballegooijen, Marjolein; Zauber, Ann G.; Berg, Christine D.

In: American Journal of Roentgenology, Vol. 196, No. 4, 01.04.2011, p. 816-823.

Research output: Contribution to journalArticle

Berrington De González, A, Kim, KP, Knudsen, AB, Lansdorp-Vogelaar, I, Rutter, CM, Smith-Bindman, R, Yee, J, Kuntz, KM, Van Ballegooijen, M, Zauber, AG & Berg, CD 2011, 'Radiation-related cancer risks from CT colonography screening: A risk-benefit analysis', American Journal of Roentgenology, vol. 196, no. 4, pp. 816-823. https://doi.org/10.2214/AJR.10.4907
Berrington De González A, Kim KP, Knudsen AB, Lansdorp-Vogelaar I, Rutter CM, Smith-Bindman R et al. Radiation-related cancer risks from CT colonography screening: A risk-benefit analysis. American Journal of Roentgenology. 2011 Apr 1;196(4):816-823. https://doi.org/10.2214/AJR.10.4907
Berrington De González, Amy ; Kim, Kwang Pyo ; Knudsen, Amy B. ; Lansdorp-Vogelaar, Iris ; Rutter, Carolyn M. ; Smith-Bindman, Rebecca ; Yee, Judy ; Kuntz, Karen M. ; Van Ballegooijen, Marjolein ; Zauber, Ann G. ; Berg, Christine D. / Radiation-related cancer risks from CT colonography screening : A risk-benefit analysis. In: American Journal of Roentgenology. 2011 ; Vol. 196, No. 4. pp. 816-823.
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