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Heart Attack Imaging Linked To Cancer Risk

February 8, 2011
Written by: , Filed in: Cardiac Imaging, Diagnostic Imaging, Practice Management
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A study published Monday suggests that the “current enthusiasm for imaging” after heart attacks “should be tempered” because the radiation involved can increase the risk of cancer.

Specifically, the study found that each 10 millisieverts of cumulative low-dose radiation corresponded with a 3 percent increased risk of cancer within five years.

Said Louise Pilote, MD, PhD, lead author of the study:

We don’t want patients to get the message ‘don’t do these tests.’ The message is: ‘Use these tests when there is a real benefit.’

Dr. Pilote is an epidemiologist at the Research Institute of the McGill University Health Centre in Montreal. She was quoted by André Picard in The Globe and Mail newspaper, based in Toronto.

The study was published in the Canadian Medical Association Journal, which also published an accompanying commentary. The commentary suggests, not exactly startlingly: “Communication between the referring physician and the radiologist or specialist should be encouraged in an effort to find the optimal diagnostic or therapeutic strategy for the patient.” The commentary also calls it “imperative” that Canadian health-care providers adopt a nationwide program to track patients’ radiation dosages.

The study examined data on 82,861 patients who suffered a heart attack during the period of April 1996 through March 2006. The patients had no history of cancer. Of them, 77 percent underwent at least one cardiac procedure involving low-dose ionizing radiation within a year of the heart attack.

“Although most patients were exposed to low or moderate levels of radiation,” says the study, “a substantial group were exposed to high levels and in general tended to be younger male patients with fewer comorbidities.”

The younger the patient, of course, the greater the expected remaining lifespan during which radiation-related cancer has a chance to develop.

During follow-up, 12,020 cancers were detected, two thirds of them affecting the abdomen, pelvis, or chest. “These results call into question whether our current enthusiasm for imaging and therapeutic procedures after acute myocardial infarction should be tempered,” the study says. It adds:

We should at least consider putting into place a system of prospectively documenting the imaging tests and procedures that each patient undergoes and estimating his or her cumulative exposure to low-dose ionizing radiation.

In her interview with The Globe and Mail, Dr. Pilote said most imaging tests on heart-attack patients—such as coronary CT scans, cardiac perfusion, coronary angiography, and coronary angioplasty—are appropriate. Her real concern, she said, was their possible overuse for screening purposes. For screening, she said, MRI or ultrasound might be more appropriate.

Related seminar: Cardiac Imaging

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