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Brain, Neck Tumors Reported in 3 Dozen Cath Lab Operators
Data presented at SOLACI-CACI 2014 have found brain and neck tumors among 36 interventional cardiologists, electrophysiologists and interventional radiologists.
Currently, cath lab operators can wear lead to protect the trunk and thyroid and special glasses to protect the eyes during an interventional procedure; however, the head remains completely exposed to radiation.
In order to better understand whether there is a link between this exposure and the incidence of tumors among interventional physicians, Ariel Roguin, MD, PhD, presented an update on data previously published in the American Journal of Cardiology in 2013, which observed 31 cases of brain cancer among interventional physicians with sustained practices involving radiation.
Roguin, with Rambam Medical Center and the Technion, Haifa, Israel, compiled reports of brain and neck tumors among physicians exposed to ionizing radiation in the cath lab. Overall, brain and neck tumors were found in 36 cath lab physicians — 28 interventional cardiologists, two electrophysiologists and six interventional radiologists.
Ariel Roguin
All physicians worked for prolonged periods (latency period, 12-32 years; mean, 23.5 ± 5.9 years) in an active interventional practice with exposure to ionizing radiation.
Tumors reported included 18 cases of glioblastoma multiforme, two cases of astrocytomas and five meningiomas.
Of the 36 physicians with tumors, data were available regarding the side of the brain in 30 cases, indicating that the malignancy was on the left side — the side directed toward the radiation source— in 26 cases (87%; P<.01), whereas the right side was involved in three cases and the midline in one.
“Due to many confounding factors, it is difficult to demonstrate a direct correlation between radiation exposure and cancer,” Roguin said during the presentation. “A connection to occupational radiation exposure is biologically plausible, but risk assessment is difficult due to the small population of interventional cardiologists. Since interventional cardiologists have the highest radiation exposure among health professionals, major awareness of radiation safety and training in radiological protection are essential and imperative and should be used in every procedure.”
For more information:
Roguin A. Brain malignancies among interventional cardiologists — A call for alarm? Presented at: SOLACI-CACI; April 23-25, 2014; Buenos Aires.
Disclosure: Roguin reports no relevant financial disclosures.
Perspective
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The data that Dr. Roguin presented concerning the possibility of an increased incidence of brain tumors in interventional cardiologists is intriguing and thought provoking. Certain high-profile cases and the left-sided predominance clearly build a story that there may be an association that suggests an occupational hazard. As I called for in 2009, there needs to be a scientific inquiry into the preliminary findings that he and his colleagues have published to see if their plausible hypothesis is true. As I also stated, there are too many agendas that oppose such an inquiry, and it therefore falls upon us in the field to lead the way.
Finding cases of brain tumors based on the kind of word-of-mouth investigation highlighted here is a great way to uncover if there is something to investigate, and obviously there is, but it’s not a good way to scientifically and systematically discover all such cases. What is needed besides an accurate numerator is a denominator and comparator group. Here, the Society for Cardiovascular Angiography and Interventions and the American College of Cardiology have lists of cardiologists and could be of great assistance in determining health status of members, including interventionalists, electrophysiologists and noninvasive subspecialists. Then, one would need a relatively accurate dose-response curve — how many cases did the proven cases have, and do others with large caseloads have an increased risk? Finally, the NHLBI or other federal organization would optimally become involved.
What I hope does not happen, but may, is that the next interventionalist who develops a tumor sues his/her employer for occupational exposure and lack of protection. I do not like using the tort system to resolve such disputes, but I have to admit, American history of occupational hazards has shown that litigation might be the only way to bring attention to the problem.
The solutions would be, as this presentation shows, to remove the doctor from the side of the patient, creating a permanent shield to work in or wearing helmets. But there is a further solution: limiting absolutely the number of cases, annually or over a career, that interventionalists may perform. No one would want that to occur, but it may turn out to be necessary. Further investigation is called for — and the interventional community needs to be vocal on our own behalf.