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Oncology (General Cancer)/Study of Subsequent Cancer Risk Following VCUG

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QUESTION: Dr. Nordquist,

I used to write you about my supposed cancer risks given that I have had 5-6 VCUGs performed on me during the mid 1990s to the year 2000, between the ages of 4-10. I worry about how the exposure will translate to my risk later in life, having had these procedures done as a pediatric. I just came across an actual study that shows some results and I was wondering what you could make of this information:

"Results: The overall cancer risk of the VCUG cohort is 1.92-fold (95 % CI=1.34-2.74) higher than that of the non-VCUG cohort with statistical significance. The genital cancer and urinary system cancer risks of the VCUG cohort are respectively 6.19-fold (95 % CI=1.37-28.0) and 5.8-fold (95 % CI=1.54-21.9) higher than those of the non-VCUG cohort with statistical significance. The hazard ratios are higher in genital cancer, urinary system cancer (the major radiation exposure area), and cancer of the abdomen, except for the genitourinary system (the minor radiation exposure area), in sequence. Conclusions: Pediatric VCUG is associated with increased subsequent cancer risk, especially in the genitourinary system."

http://www.ncbi.nlm.nih.gov/pubmed/24375011

A 1.92, 6.19, and 5.8 fold increase sounds terribly scary to me. This study only follows up persons younger than 18 who had the study or studies (it is unclear) done between '97 and '08. I'd imagine it only gets worse further in the future. This, I suppose is further compounded given the high amount of dental/orthodontist work I've had on my teeth, which involves frequent x-rays, and probably a pretty standard amount of other x-rays done for broken bones and the like throughout my life.

This also combines with some worries wherein I read that having polythelia (third nipple) is already associated with an increased risk of developing genitourinary cancers, and persons born with polythelia often have genitourinary defects, such as vesicoureteral reflux and duplex ureters. I have polythelia, and I've also had the aforementioned issues when I was young.

I once at chanterelles from lower Styria, Austria and read a study about how chanterelles in the area have caesium contamination.

Anyways, as you can see, I'm worried about the risks and would like a realistic evaluation of what the excerpt from the study might mean for my future health. Thanks for your help.

Jesse

ANSWER: Yes I do remember your questions. We all have a general cancer risk of abort 30% over our lite spans. And we are all going to die of something. The risk of passing away from cancer is about the same as getting cancer. Meaning that around a third of all deaths are cancer deaths. That does not mean that all cancer patients will die of their cancers. In fact more than half of them are cured. Ionizing radiation (UV light, X-rays, cosmic rays, gamma rays & radioactivity) can cause cancer. The risk is however low. The increases you mention are real. However since the ordinary risks are very low the increases you mention though higher are still low! So most people who have had all the examinations you mention still do not develop cancer. That is all I can tell you! And I have worked with radiation treating people with radiation. In all likelihood receiving far more radiation than you. And I have had a genitourinary cancer. A prostate cancer. What kind of treatment was my choice? Radiation therapy only! More radiation! No surgery at all! That was more than 7 years ago. In all likelihood I am cured now! And I see no reason to worry about the future. I hope this has reassured you to some extent! Good luck!



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---------- FOLLOW-UP ----------

QUESTION: Alright, thanks. I suppose the *X fold needs to be quite high before it becomes almost like a guarantee of developing cancer? What about the fact that this study ends at people aged 18? Wouldn't there be tons of extra cancers later on considering young exposures have so much longer of a time to develop compared to exposures at elderly ages? I just wonder when taking into account other exposures, including a few plain x rays when I was a newborn - even younger? And the association between polythelia that I have and genitourinary cancers? Radioactive mushrooms from Austria...

Also, this is kind of a different question. Right now I am in Russia and considering riding the Transsiberian across the country to Irkutsk, near lake Baikal. There is a stretch that passes through two towns called Bogdanovitch and Kamyshlow. They are in an area called the East Urals Radioactive Trace, which I guess is some contaminated area after an accident about 150 km SW, wherein a nuclear reactor exploded during the Soviet years and released a great many tons of radioisotopes into the environment. Actually, I believe there were multiple accidents in the area (Present day Ozyorsk/Kyshtyn towns and the depository lake of Karachay)

Do you know anything about this? Is it a big deal to ride the train through this radioactive trace area? The information about how contaminated the region is, is bizarrely vague. I suppose since it happened during the middle years of the Soviet Union, and the existence of Ozyorsk was denied until the 1990s, information and research has been rather limited. I know this is totally different in a lot of ways from medical radiation, I was just curious. If you want to read about it here's a link:

https://en.wikipedia.org/wiki/Kyshtym_disaster

Thanks again,

Jesse

Answer
Yes you need quite high doses to "guarantee" cancer! I received 7000 rads/centigrays in my prostate cancer treatment which is a VERY high dose where some of it ended up in my urine bladder, my rectum and my testicles. Am I worried? No, not very much. I have a colonoscopy done on me once every year - 6 polyps have been removed so far none with cancer - but that is mainly done since colon cancer is also quite common here and I do not want any more nasty surprises.  Yes the older you get the higher the cancer risk usually. So they should look at higher age groups too. But this examination method is not that old! And today they can probably do it just as well - not sure, not my field really - with ultrasound with no cancer risk! Technology moves on!  Over to the Russian problem! Such problems were not uncommon in the Soviet Union, that Socialism should be a good thing for the environment is a myth, a false myth! It is rather the contrary! When you have a political & economic system where the government is in charge of EVERYTHING there are NO checks & balances! All these things were cloaked in secrecy in the Soviet Union and it is not much better today under Putin! But if your train passes through this area or close to it I am rather sure that it will do so at a high speed and that will keep any risks at a minimum since you will be there for a very short while and any dose of radiation will therefore be small. Good luck! Enjoy your trip! And do not quote me on Putin! That may create problems!



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Oncology (General Cancer)

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Claes-Gustaf Nordquist, M.D.

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Questions concerning Cancer, Oncology, radiation Therapy, Tumours, Chemotherapy, Cytotoxic Drugs, Hormonal Therapy, Radiation Protection.

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I'm a Doctor of Medicine and specialist in Medical Oncology and Radiation Therapy educated & trained in Sweden. Now retired. Background in Radiation Therapy, Medical Oncology, Radiation Protection, Nuclear Medicine, Diagnostic Radiology, Gynecological Oncology, Clinical Pathology, Clinical Cytology,Hematology and Internal Medicine. M.D. from the faculty of medicine, Royal Karolinska Institute, Stockholm, Sweden. Have also been an exchange student at the Hebrew University, Hadassah Medical School, Jerusalem Israel. Former medical consultant, Swedish National Board of Radiation Protection. Former Police Surgeon and Medical Examiner, Stockholm Police Department. Former Chief Medical Officer, The Royal Guards, The Royal Horse Guards and the Royal Household Brigade, Royal Swedish Army Medical Corps. You can also reach me on: http://www.lifestylerescue.com/expert/health-fitness-advice/dr-claes-gustaf/128 I have no restrictions in the number of questions there. I also answer questions in these other categories: General History, Military History, Brain Tumors, Breast Cancer, Colon Cancer

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I'm a medical doctor and specialist in medical oncology and radiation therapy

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