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中华乳腺病杂志(电子版) ›› 2016, Vol. 10 ›› Issue (01) : 50 -53. doi: 10.3877/cma.j.issn.1674-0807.2016.01.012

讲座

乳腺癌诊治及随访过程中过度CT 扫描可能带来风险
汪洋1, 刘锦平2, 吕青3,()   
  1. 1.610041 成都,四川省疾病预防控制中心健康教育所
    2.610072 成都,四川省人民医院乳腺外科
    3.610041 成都,四川大学华西医院乳腺外科
  • 收稿日期:2014-12-15 出版日期:2016-02-01
  • 通信作者: 吕青

Risk of excessive CT scanning in diagnosis, treatment and follow-up of breast cancer patients

Yang Wang, Jinping Liu, Qing Lyu()   

  • Received:2014-12-15 Published:2016-02-01
  • Corresponding author: Qing Lyu
引用本文:

汪洋, 刘锦平, 吕青. 乳腺癌诊治及随访过程中过度CT 扫描可能带来风险[J/OL]. 中华乳腺病杂志(电子版), 2016, 10(01): 50-53.

Yang Wang, Jinping Liu, Qing Lyu. Risk of excessive CT scanning in diagnosis, treatment and follow-up of breast cancer patients[J/OL]. Chinese Journal of Breast Disease(Electronic Edition), 2016, 10(01): 50-53.

低剂量电离辐射的致癌效应是医源性X 射线的主要潜在危害。 乳腺等器官对电离辐射十分敏感,CT 扫描所致的X 射线吸收剂量远高于X 线胸片,过度CT 扫描会增加乳腺癌高危个体的额外致癌风险。 学者们已关注到包括CT 扫描在内的医源性电离辐射给乳腺癌高危人群带来的致癌风险。 了解过度CT 扫描对乳腺癌患者的潜在风险,将有利于消除临床医师的认识误区,利于其谨慎决策CT 扫描,以免给乳腺癌患者及高危人群带来额外的致癌风险。

[1]
Committee to Assess Health Risks from Exposure to Low Levels of Ionizing Radiation. Health risks from exposure to low levels of ionizing radiation: BEIR Ⅶ phase 2 [M]. Washington D.C.: National Academies Press,2006:2-132.
[2]
中国抗癌协会乳腺专业委员会. 中国抗癌协会乳腺癌诊治指南与规范(2013 版)[J]. 中国癌症杂志,2013,23(8):637-684.
[3]
Khatcheressian JL,Hurley P,Bantug E, et al. Breast cancer follow-up and management after primary treatment: American Society of Clinical Oncology clinical practice guideline update[J]. J Clin Oncol, 2013,31(7):961-965.
[4]
Hall EJ. Is there a place for quantitative risk assessment? [J]. J Radiol Prot,2009,29(2A): A171-184.
[5]
Hart D,Wall BF. UK population dose from medical X-ray examinations[J]. Eur J Radiol,2004,50(3):285-291.
[6]
Institute of Medicine of the National Academies. Breast cancer and the environment: a life course approach[M]. Washington D.C.: National Academies Press,2012:108-109.
[7]
Berrington de González A, Mahesh M, Kim KP, et al. Projected cancer risks from computed tomographic scans performed in the United States in 2007 [J]. Arch Intern Med,2009,169(22):2071-2077.
[8]
Valentin J, International Commission on Radiation Protection.Managing patient dose in multi-detector computed tomography(MDCT). ICRP Publication 102[J]. Ann ICRP,2007,37(1):1-79.
[9]
Tsapaki V, Aldrich JE, Sharma R, et al. Dose reduction in CT while maintaining diagnostic confidence: diagnostic reference levels at routine head, chest, and abdominal CT-IAEA-coordinated research project[J].Radiology,2006,240(3):828-834.
[10]
高林峰,郑钧正,卓维海,等. 医用X 射线CT 主要检查类型所致成年受检者剂量研究[J]. 辐射防护,2013,33(2):74-81.
[11]
United Nations Scientific Committee on the Effects of Atomic Radiation.Sources and effects of ionizing radiation-Annesx D: Medical radiation exposures. UNSCEAR 2000 Report to the General Assembly, VolumeⅠ[M]. New York: UNSCEAR,2000:295-466.
[12]
Cohnen M, Poll LJ, Puettmann C, et al. Effective doses in standard protocols for multi-slice CT scanning [J]. Eur Radiol, 2003, 13(5):1148-1553.
[13]
United Nations Scientific Committee on the Effects of Atomic Radiation.Biological mechanisms of radiation actions at low doses--A white paper to guide the Scientific Committee's future programme of work[M].New York: UNSCEAR,2012:4-18.
[14]
Frush DP, Donnelly LF, Rosen NS. Computed tomography and radiation risks: what pediatric health care providers should know [J].Pediatrics,2003,112(4):951-957.
[15]
Brenner DJ. Should we be concerned about the rapid increase in CT usage? [J]. Rev Environ Health,2010,25(1):63-68.
[16]
Oikarinen H, Meriläinen S, Pääkkö E, et al. Unjustified CT examinations in young patients[J]. Eur Radiol, 2009, 19(5): 1161-1165.
[17]
International Commission on Radiological Protection. The 2007 recommendations of the International Commission on Radiological Protection. ICRP publication 103[M]. Amsterdam: Elsevier, 2007:49-58.
[18]
Brooks AL. From cell to organism: the need for multiparametric assessment of exposure and biological effects[EB/OL].[2014-12-10].http:/ /www.birpublications.org/doi/abs/10.1259/bjr/78464782.
[19]
No authors listed. The 2007 recommendations of the International Commission on Radiological Protection. ICRP publication 103[J]. Ann ICRP,2007,37(2/4):1-332.
[20]
Lee CI, Flaster HV, Haims AH, et al. Diagnostic CT scans:institutional informed consent guidelines and practices at academic medical centers[J]. AJR Am J Roentgenol,2006,187(2):282-287.
[21]
Preston DL, Ron E, Tokuoka S, et al. Solid cancer incidence in atomic bomb survivors:1958-1998[J]. Radiat Res, 2007, 168(1):1-64.
[22]
Shiminu Y, Kato H, Sohull WJ. Technical report No. 5-88. Life span study report 11. Part 2. Cancer mortality in the years 1950-85 based on the recently revised doses (DS86) [EB/OL]. [2014-12-10]. http:/ /www.rerf.jp/library/scidata/lssrepor_e/tr05-88.htm.
[23]
Howe GR, McLaughlin J. Breast cancer mortality between 1950 and 1987 after exposure to fractionated moderate-dose-rate ionizing radiation in the Canadian fluoroscopy cohort study and a comparison with breast cancer mortality in the atomic bomb survivors study [J]. Radiat Res,1996,145(6):694-707.
[24]
Cardis E, Vrijheid M, Blettner M, et al. The 15-Country Collaborative Study of Cancer Risk among Radiation Workers in the Nuclear Industry: estimates of radiation-related cancer risks[J]. Radiat Res,2007,167(4):396-416.
[25]
王继先,李本孝,赵永成,等. 中国医用诊断X 射线工作者1950 ~1995 年恶性肿瘤危险分析[J]. 中华放射医学与防护杂志,2002,22(4):234-238.
[26]
Brenner DJ, Hall EJ. Computed tomography--an increasing source of radiation exposure [J]. N Engl J Med,2007,357(22):2277-2284.
[27]
Ronckers CM,Erdmann CA,Land CE. Radiation and breast cancer:a review of current evidence [J]. Breast Cancer Res,2005,7(1):21-32.
[28]
Boice JD Jr, Land CE, Shore RE, et al. Risk of breast cancer following low-dose radiation exposure [J]. Radiology,1979,131(3):589-597.
[29]
Pijpe A, Andrieu N, Easton DF, et al. Exposure to diagnostic radiation and risk of breast cancer among carriers of BRCA1/2 mutations: retrospective cohort study (GENE-RAD-RISK) [J]. BMJ,2012,345:e5660.
[30]
Wang LE, Han CH, Xiong P, et al. Gamma-ray-induced mutagen sensitivity and risk of sporadic breast cancer in young women: a casecontrol study [J]. Breast Cancer Res Treat,2012,132(3):1147-1155.
[31]
Jansen-van der Weide MC, Greuter MJ, Jansen L, et al. Exposure to low-dose radiation and the risk of breast cancer among women with a familial or genetic predisposition: a meta-analysis [J]. Eur Radiol,2010,20(11):2547-2556.
[32]
Yaffe MJ, Mainprize JG. Risk of radiation-induced breast cancer from mammographic screening [J]. Radiology,2011,258(1):98-105.
[33]
Modan B, Chetrit A, Alfandary E, et al. Increased risk of breast cancer after low-dose irradiation[J]. Lancet,1989,1(8639):629-631.
[34]
Baumann BM, Chen EH, Mills AM, et al. Patient perceptions of computed tomographic imaging and their understanding of radiation risk and exposure [J]. Ann Emerg Med,2011,58(1):1-7.
[35]
Lee CI, Haims AH, Monico EP, et al. Diagnostic CT scans:assessment of patient, physician, and radiologist awareness of radiation dose and possible risks[J].Radiology,2004,231(2):393-398.
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