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Open Access Study protocol

Risk of cancer associated with cardiac catheterization procedures during childhood: a cohort study in France

Helene Baysson1*, Jean Luc Réhel1, Younes Boudjemline2, Jerôme Petit3, Brigitte Girodon2, Bernard Aubert1, Dominique Laurier1, Damien Bonnet2 and Marie-Odile Bernier1

Author Affiliations

1 Institut de Radioprotection et de Sûreté Nucléaire, PRP-HOM, SRBE, BP 17, Fontenay aux Roses, France

2 Centre de Référence Malformations Cardiaques Congénitales Complexes, M3C, Hôpital Necker-Enfants malades, AP-HP, Université Paris Descartes, Sorbonne Paris Cité, Paris, France

3 Centre de Référence Malformations Cardiaques Congénitales Complexes, M3C, Centre Chirurgical Marie Lannelongue, Le Plessis Robinson, France

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BMC Public Health 2013, 13:266  doi:10.1186/1471-2458-13-266

Published: 22 March 2013

Abstract

Background

Radiation can be used effectively for diagnosis and medical treatment, but it can also cause cancers later on. Children with congenital heart disease frequently undergo cardiac catheterization procedures for diagnostic or treatment purposes. Despite the clear clinical benefit to the patient, the complexity of these procedures may result in high cumulative radiation exposure. Given children’s greater sensitivity to radiation and the longer life span during which radiation health effects can develop, an epidemiological cohort study is being launched in France to evaluate the risks of leukaemia and solid cancers in this specific population.

Methods/design

The study population will include all children who have undergone at least one cardiac catheterization procedure since 2000 and were under 10 years old and permanent residents of France at the time of the procedure. Electronically stored patient records from the departments of paediatric cardiology of the French national network for complex congenital heart diseases (M3C) are being searched to identify the children to be included. The minimum dataset will comprise: identification of the subject (file number in the centre or department, full name, sex, date and place of birth), and characteristics of the intervention (date, underlying disease, type of procedure, technical details, such as fluoroscopy time and dose area product, (DAP), which are needed to reconstruct the doses received by each child). The cohort will be followed up through linkage with the two French paediatric cancer registries, which have recorded all cases of childhood leukaemia and solid cancers in France since 1990 and 2000, respectively. Radiation exposure will be estimated retrospectively for each child. 4500 children with catherizations between 2000 and 2011 have been already included in the cohort, and recruitment is ongoing at the national level. The study is expected to finally include a total of 8000 children.

Discussion

This French cohort study is specifically designed to provide further knowledge about the potential cancer risks associated with paediatric cardiac catheterization procedures. It will also provide new information on typical dose levels associated with these procedures in France. Finally, it should help improve awareness of the importance of radiation protection in these procedures.

Keywords:
Interventional cardiology; Cancer risk; Children; Epidemiology; Cohort study; Radiation exposure