Reducing the Lifetime Risk of Cancer From Spinal Radiographs Among People With Adolescent Idiopathic Scoliosis

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Abstract

Study Design

Data from a retrospective cohort study of people with adolescent idiopathic scoliosis were combined with information on full-spinal radiographs to estimate contemporary x-ray doses and lifetime risks for development of cancer.

Objectives

To project the lifetime risk for development of cancer from diagnostic radiographs for people with adolescent idiopathic scoliosis.

Summary of Background Data

Although a twofold excess risk for breast cancer has been reported for women treated for scoliosis between 1925 and 1965, information on the cancer risks associated with scoliosis management today is sparse. Specifically, there is a lack of up-to-date information on the number of spinal radiographs taken, the organ-specific x-ray doses from current radiographic techniques, and the projected cancer risks.

Methods

The cohort consisted of subjects with adolescent idiopathic scoliosis who were referred to the scoliosis clinic of a large pediatric hospital between 1965 and 1979 in Montreal, Quebec, Canada. Based on radiographic equipment and practices implemented in 1982, organ-specific x-ray doses to the thyroid gland, female breast, respiratory organs, digestive organs, and bone marrow were calculated using Monte Carlo methods. These doses were incorporated into a life table procedure to calculate theoretic lifetime cancer risks. For all organs except the thyroid gland, dose-response models from the United States National Academy of Sciences Fifth Committee on the Biological Effects of lonizing Radiation were used. For thyroid cancer, a risk model was derived from a study of thyroid cancer incidence after x-ray treatment for tinea capitis.

Results

The average number of spinal radiographs was 12 for women (80% anteroposterior or posteroanterior) and 10 for men (78% anteroposterior or posteroanterior). Cumulative x-ray doses were in general higher in adolescents who were referred as younger teenagers than at later ages, and doses increased with the size of the spinal curve. Depending on the age at referral and curve size, the total excess lifetime cancer risks were calculated to range from 42 to 238 cases per 100,000 women and 14 to 79 cases per 100,000 men. For subjects who underwent surgery (those exposed to the highest doses), the lifetime number of cancer cases over and above background was almost as great as the number of thyroid cancers that would occur in the absence of radiation exposure. If the anteroposterior view was replaced by the posteroanterior view, a three- to sevenfold reduction in cumulative doses to the thyroid gland and the female breast would be achieved, yielding three- to fourfold reductions in the lifetime risk of breast cancer and a halving of the lifetime risk of thyroid cancer.

Conclusions

The cancer risks from full-spinal radiographs for scoliosis are not negligible and can be reduced from one half to three quarters if the anteroposterior view is replaced with the posteroanterior view.

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