Brain and Neck Tumors Among Physicians Performing Interventional Procedures




Physicians performing interventional procedures are chronically exposed to ionizing radiation, which is known to pose increased cancer risks. We recently reported 9 cases of brain cancer in interventional cardiologists. Subsequently, we received 22 additional cases from around the world, comprising an expanded 31 case cohort. Data were transmitted to us during the past few months. For all cases, where possible, we endeavored to obtain the baseline data, including age, gender, tumor type, and side involved, specialty (cardiologist vs radiologist), and number of years in practice. These data were obtained from the medical records, interviews with patients, when possible, or with family members and/or colleagues. The present report documented brain and neck tumors occurring in 31 physicians: 23 interventional cardiologists, 2 electrophysiologists, and 6 interventional radiologists. All physicians had worked for prolonged periods (latency period 12 to 32 years, mean 23.5 ± 5.9) in active interventional practice with exposure to ionizing radiation in the catheterization laboratory. The tumors included 17 cases (55%) of glioblastoma multiforme (GBM), 2 astrocytomas (7%), and 5 meningiomas (16%). In 26 of 31 cases, data were available regarding the side of the brain involved. The malignancy was left sided in 22 (85%), midline in 1, and right sided in 3 operators. In conclusion, these results raise additional concerns regarding brain cancer developing in physicians performing interventional procedures. Given that the brain is relatively unprotected and the left side of the head is known to be more exposed to radiation than the right, these findings of disproportionate reports of left-sided tumors suggest the possibility of a causal relation to occupational radiation exposure.


Orthopedic complications and radiation exposure have become major occupational health concerns among interventional physicians. Interventionists are chronically exposed to ionizing radiation, which can pose increased cancer risks. Numerous publications have emphasized the potential hazards of accumulated radiation exposure for oncogenesis and cataracts. We recently reported a collection of 9 cases of brain cancers in interventional cardiologists. That report documented that the preponderance of tumors developed on the left side of the brain, the part of the interventionists’ body most directly exposed and often poorly protected. In response to that report, we received numerous additional unsolicited reports of cases. An update was published as a “letter to the editor” a few weeks later. The cohort of reported cases has increased to 31 cases of interventionists with brain cancer.


The aim of the present report was to increase the awareness and request the creation of a large-scale registry.


Methods


The present study included data from 31 interventional physicians with brain and neck cancer. We previously published an initial first small report and a subsequent update as a “letter to the editor.” The present study reports the most updated data on previously published cases gathered since publication and information on 13 additional reported cases transmitted to us during the previous few months.


For all cases, where possible, we endeavored to obtain the baseline data, including age, gender, tumor type and side involved, specialty (cardiologist vs radiologist), and number of years in practice. These data were obtained from the medical records (when available), published studies of previous cases, and interviews with patients, when possible, or with family members and/or colleagues.




Results


The demographic variables (age, gender, specialty, and years in practice) and tumor type and clinical outcomes are summarized in Table 1 . The age range of the patients was 49 to 67 years (median 54, mean 54.7 ± 7.1). Only 1 of the patients in the present series of malignancies was a woman.



Table 1

Patient characteristics




































































































































































































































































































































































































































































Country Year Diagnosed Age at Diagnosis (yrs) Gender Radiation Exposure (Latency Period) (yrs) Tumor Type Side Involved Occupation Prognosis Age at Death (yrs) Survival After Diagnosis Reference
1 Toronto, Canada 1997 62 M 20 GBM Left side IC Died in 1999 64 2 yrs
2 Toronto, Canada 1997 53 M 20 GBM Left side IC Died in 1999 55 4 yrs
3 Haifa, Israel 1998 48 M 12 Meningioma Left temporal IC Alive
4 Paris, France 2001 56 M 25 GBM Left temporal IC Died in 2005 59 4 yrs
5 Paris, France 2005 49 M 22 GBM Left temporo-occipital IC died in 2006 50 16 mo
6 Haifa, Israel 2009 62 M 32 GBM Left frontal IC Died in 2010 63 11 mo
7 Sweden NA M 20 Acoustic neurinoma NA IR
8 Sweden NA M 28 Meningioma NA IR
9 Sweden NA M 31 Oligodendroma NA IR
10 London, UK 2009 62 M 27 Parotids Left IC
11 Zürich, Switzerland 2009 53 M 20 GBM Left frontal Pediatric EP Died in 2010 54 14 mo
12 Virginia 2009 67 M 29 GBM Left EP Alive
13 Dundee, Scotland 2007 59 M 29 Astrocytoma Left IC Died in 2009 61 2 yrs
14 Kentucky 2008 54 M 22 GBM Left IC Died in 2010 56 2 yrs
15 Illinois 2003 65 M 32 GBM Midline IC Died in 2005 67 2 yrs
16 Gainesville, Florida 1990s ∼40 M ∼10 GBM Left occipital lobe IC NA
17 West of Scotland 2008 52 Female NA GBM Left frontal Radiologist Died in 2009 53 1 yr + new data
18 West of Scotland 2011 NA M NA GBM Left temporal IR Alive + new data
19 Leipzig, Germany 2005 55 M 20 GBM Right IC 56 1 yr New
20 Homburg, Germany 2010 54 M 25 Astrocytoma (grade III) Left IC Alive New
21 Linköping, Sweden 2009 49 M 12 GBM Left frontal lobe IC Died in 2011 49 2 yrs New
22 Santa Monica, California 2006 52 M 21 GBM Left IC Died in 2007 53 2 yrs New
23 California 2008 71 M 22 Glioma Left temporal IC Alive New
24 Maryland 2012 57 M 26 Meningioma Right IR Alive New
25 Belgium 1990s NA M NA GBM NA IC Died NA New
26 Belgium 1990s NA M NA GBM NA IC Died NA New
27 Ireland 2011 55 M 31 Neck lymphoma Left IC Alive New
28 Israel 2012 62 M 32 Parotids Right IC Alive New
29 Germany 2003 49 M 19 Meningioma Left IC Alive New
30 Middle East 2009 62 M 30 Meningioma Left IC Alive New
31 Middle East 2009 52 M 19 Tonsillar tumor Left IC Alive New

EP = electrophysiologist; F = female; GBM = glioblastoma multiforme; IC = invasive cardiologist; IR = invasive radiologist; M = male; NA = not available.


The most common offending tumor type was glioblastoma multiforme, identified in 17 of 31 cases (55%), with 2 cases of astrocytoma and 5 of meningioma.


A striking finding was the disproportionate occurrence of tumors on the left side of the brain. Anatomic localization data were available for 26 cases, and in 22 (85%), the malignancy was left sided. The tumor was midline in 1 interventional cardiologist (who had performed most cases using the Sones technique in which the head was typically centered nearest the x-ray source). The tumor was right sided in 3 operators (2 cardiologists and 1 radiologist).


The mean number of years in active interventional practice was 23.5 ± 5.9 years. The latency period from the start of work until the cancer diagnosis was 12 to 32 years (median 22). Data were unavailable regarding the years in practice for 5 patients.




Results


The demographic variables (age, gender, specialty, and years in practice) and tumor type and clinical outcomes are summarized in Table 1 . The age range of the patients was 49 to 67 years (median 54, mean 54.7 ± 7.1). Only 1 of the patients in the present series of malignancies was a woman.



Table 1

Patient characteristics




































































































































































































































































































































































































































































Country Year Diagnosed Age at Diagnosis (yrs) Gender Radiation Exposure (Latency Period) (yrs) Tumor Type Side Involved Occupation Prognosis Age at Death (yrs) Survival After Diagnosis Reference
1 Toronto, Canada 1997 62 M 20 GBM Left side IC Died in 1999 64 2 yrs
2 Toronto, Canada 1997 53 M 20 GBM Left side IC Died in 1999 55 4 yrs
3 Haifa, Israel 1998 48 M 12 Meningioma Left temporal IC Alive
4 Paris, France 2001 56 M 25 GBM Left temporal IC Died in 2005 59 4 yrs
5 Paris, France 2005 49 M 22 GBM Left temporo-occipital IC died in 2006 50 16 mo
6 Haifa, Israel 2009 62 M 32 GBM Left frontal IC Died in 2010 63 11 mo
7 Sweden NA M 20 Acoustic neurinoma NA IR
8 Sweden NA M 28 Meningioma NA IR
9 Sweden NA M 31 Oligodendroma NA IR
10 London, UK 2009 62 M 27 Parotids Left IC
11 Zürich, Switzerland 2009 53 M 20 GBM Left frontal Pediatric EP Died in 2010 54 14 mo
12 Virginia 2009 67 M 29 GBM Left EP Alive
13 Dundee, Scotland 2007 59 M 29 Astrocytoma Left IC Died in 2009 61 2 yrs
14 Kentucky 2008 54 M 22 GBM Left IC Died in 2010 56 2 yrs
15 Illinois 2003 65 M 32 GBM Midline IC Died in 2005 67 2 yrs
16 Gainesville, Florida 1990s ∼40 M ∼10 GBM Left occipital lobe IC NA
17 West of Scotland 2008 52 Female NA GBM Left frontal Radiologist Died in 2009 53 1 yr + new data
18 West of Scotland 2011 NA M NA GBM Left temporal IR Alive + new data
19 Leipzig, Germany 2005 55 M 20 GBM Right IC 56 1 yr New
20 Homburg, Germany 2010 54 M 25 Astrocytoma (grade III) Left IC Alive New
21 Linköping, Sweden 2009 49 M 12 GBM Left frontal lobe IC Died in 2011 49 2 yrs New
22 Santa Monica, California 2006 52 M 21 GBM Left IC Died in 2007 53 2 yrs New
23 California 2008 71 M 22 Glioma Left temporal IC Alive New
24 Maryland 2012 57 M 26 Meningioma Right IR Alive New
25 Belgium 1990s NA M NA GBM NA IC Died NA New
26 Belgium 1990s NA M NA GBM NA IC Died NA New
27 Ireland 2011 55 M 31 Neck lymphoma Left IC Alive New
28 Israel 2012 62 M 32 Parotids Right IC Alive New
29 Germany 2003 49 M 19 Meningioma Left IC Alive New
30 Middle East 2009 62 M 30 Meningioma Left IC Alive New
31 Middle East 2009 52 M 19 Tonsillar tumor Left IC Alive New

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Dec 5, 2016 | Posted by in CARDIOLOGY | Comments Off on Brain and Neck Tumors Among Physicians Performing Interventional Procedures

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