The use of X-rays, especially on CT scans, has experienced a sharp spike in the US, with an estimated 80 million CT scans performed every year in the US. The extraordinary benefits of using CT scans in medical procedures almost eliminate the need for common exploratory operations and many other invasive and potentially risky procedures. Increased use of CT scans raises various concerns due to excessive radiation in the body such as increasing cancer risk. CT scans and some other medical imaging use X-rays to produce images and detect various diseases. This article will find out whether X-rays used in various medical imaging such as CT scans can cause cancer. We will find out from various studies and scientific evidence which will be presented below.
Ionizing radiation is a type of radiation that has high energy which can affect our cells, including DNA mutations and can cause cancer. There are several types of ionizing radiation such as gamma rays and X-rays. X-rays are used by radiologists to get images of the inside of the body because they can penetrate your body. X-rays have more energy than visible light or radio waves.
X-rays, gamma rays, and other high-energy radiation can damage DNA and cause cancer. X-ray radiation exposure can be released when there is an accident at a nuclear power plant when atomic weapons are made, tested, and used, and when used for medical imaging. WHO classifies X-rays as carcinogens because they can cause mutations in DNA and cause cancer later in life.
Various types of medical imaging tests that use X-rays such as radiography to see broken bones or your teeth and chest. Fluoroscopy to see your digestive system, mammography to screen for breast cancer, and computed tomography (CT) to detect various diseases.
In addition, X-rays can also detect problems such as broken bones, dental problems, scoliosis, non-cancerous bone tumors and cancer, lung problems (pneumonia and lung cancer), dysphagia, heart problems, and breast cancer. X-rays can also be used to guide doctors or surgeons during certain procedures. For example, it is used to help guide a catheter along one of your arteries during coronary angioplasty.
The biggest dose of X-rays is on a CT scan when compared to other X-ray procedures. Each imaging procedure has different associated risks that depend on the type of X-ray, radiation dose, patient’s age, body part imaged and the use of other treatments such as chemotherapy. The use of X-rays for medical imaging has greater benefits than the health risks that will be experienced.
Evidence and opinions that X-rays can cause cancer
Research in Australia revealed that a person would have a 24% risk of getting cancer when doing a single CT scan before the age of 20. This figure is relatively small of all study participants who more than 680,000 young people who did a CT scan, Australian researchers found only 3,150 total cases of cancer among them.
Some studies reveal X-rays can increase the risk of getting cancer even though it is very small. A study revealed that X-rays would increase cancer risk by 0.6 percent to 1.8 percent by the age of 75. This shows that X-rays have a minimal risk compared to the benefits of medical imaging.
Another study in 2007, published in the New England Journal of Medicine, revealed that the risk of cancer would increase from 0.01% to 0.14% in patients undergoing CT scans under the age of 30. Cancer risk associated with CT is not on the same scale as the risk associated with smoking or other carcinogens.
A study in 2009 by the National Cancer Institute in America revealed that around 2 percent or around 29,000 of the 1.7 million cancers diagnosed in the United States in 2007 were caused by CT scans. Studies in children in the UK who have been exposed to CT scan radiation who received a dose of at least 30 mSv into the bone marrow had 3 times the risk of leukemia compared to those who received a dose of 5 mSv or less. The increased risk of brain tumors also increases 3 times when receiving doses of 50 mSv or more to the brain.
Another study related to radiation can cause cancer in children conducted in Australia, the results of the study found that after an average of about 9.5 years after children were exposed to CT radiation, had a cancer risk 24% higher than overall. Another study in children and adolescents in Taiwan found that head CT scans had no higher risk of brain cancer, but were more likely to be diagnosed with benign brain tumors. Studies involving children were also conducted in the US during the period of nuclear testing showing that they have a risk of developing thyroid cancer as a result of exposure to radioactive iodine in milk.
Other studies involving about a quarter of patients in studies younger than 20 years showed that patients who received high doses of radiation had an increased risk of bone sarcoma and some other cancers such as breast, liver, kidney, bladder and other sarcomas.
Research also links the increased risk of leukemia, thyroid cancer, early breast cancer, and several other cancers to radiation therapy to treat cancer. Another study related to treatment with X-ray radiation in the head and neck region in adults is associated with cancer of the salivary glands and brain and spinal cord. Whereas in children is associated with an increased risk of thyroid cancer. In other studies in some adult patients, treatment with lower radium doses also causes a higher risk of leukemia, but not from other cancers.
Research in patients with peptic ulcers treated with high doses of radiation (an average of 15 Gy or 15,000 mSv) found a higher risk of gastric and pancreatic cancer. The study also revealed the risk of cancer in patients with autoimmune ankylosing spondylitis injected with radium.
Research also reveals radiation treatment to treat fungal infections of the scalp can increase the risk of basal cell skin cancer. This increased risk of cancer is more common in scalp and neck exposed to sunlight, and in white patients.
In a 2009 study from Brigham and Women’s Hospital in Boston estimated the potential cancer risk from CT scans in 31,462 patients over 2 years showing an increase in cancer risk by 0.7%, and patients who had multiple CT scans had a 2.7% higher risk of increase up to 12%.
Opinions and evidence that X-rays cannot cause cancer
Many experts believe that the benefits of using X-rays for medical imaging and treatment outweigh the risks. Radiation therapy is considered not to be the cause of cancer because it is based on the fact that doctors try to focus radiation on cancer cells as much as possible, and only a few normal cells are exposed to radiation. Radiation exposure from medical imaging is now much safer because there are many ways to direct the beam of radiation with extreme accuracy and minimize the amount that reaches the surrounding tissue.
Radiation therapy will be more at risk of cancer if combined with chemotherapy. Every doctor will do their best to ensure the treatment provided can destroy cancer cells and not cause cancer in the future. They usually limit secondary cancers that will develop later in various ways such as providing protection for sensitive areas, such as the thyroid gland and genitals.
Researchers are also still not sure how much radiation exposure increases the risk of childhood cancer in the future. This is because the increase in risk is relatively small and it is important to remember that the cause of cancer can be for various reasons and your child may have cancer later on even if he has never been exposed to X-rays. Children are generally also prescribed lower doses of radiation-based treatments because they are far more sensitive to radiation than adults.
Several studies of radiation and cancer risk generally originate from high levels of radiation exposure, whereas most studies have not been able to detect an increased risk of cancer among people who are exposed to low levels of radiation because it is more difficult to measure the increased risk of cancer. Medical imaging using X-rays generally uses lower doses than those used in research.
Other evidence reveals that people who are exposed to more natural background radiation from cosmic rays because they live in the highlands do not have a higher cancer rate than people who live at sea level. You also need to know that there is no evidence that pilots or flight attendants who often board flights experience increased cancer rates due to increased radiation exposure. The amount of radiation exposure when you board a plane is almost the same as chest X-ray exposure.
Radiation exposure is not only a major factor causing a person to have an increased risk of cancer, there are other factors that also play a large role in causing someone to be exposed to radiation to develop cancer. Some of these factors are examples of a person’s genetic condition that makes the cells more susceptible to radiation damage. This genetic condition, in turn, can increase the risk of getting cancer higher than someone without this gene change.
Another opinion that doubts radiation exposure with X-rays can cause cancer is that it takes a long time to find out cancer begins to develop after radiation. X-rays can damage living cells by producing mutations or other changes in DNA in the cell nucleus. Over time, generally, after years of genetic changes can accumulate to the point of loss of normal control of cell division and eventually cells become cancerous.
Leukemia cancer in many cases develops in 5 to 9 years after exposure to radiation and other cancers often need more time to develop. Most cancers will not be seen at least 10 years after radiation therapy, and even some can only be known after 15 years after radiation exposure. The length of time for the development of this cancer makes there are many possibilities that can be the cause of cancer, not just radiation exposure.
Besides taking a long time to develop cancer, most of the research that links radiation exposure to cancer causes takes a long time and needs to follow patients for years. Information about other exposures that could be cancer risk factors is also needed to see if the possibility of cancer originates from radiation exposure. This makes it difficult to study cancer risk from medical imaging studies that use radiation.
Often research on this subject uses questionnaire studies by comparing exposure among people who have certain cancers with those who don’t. This is certainly very difficult to do for diagnostic radiation exposure because many people cannot accurately remember the information when they were exposed to radiation exposure in previous years such as in childhood. Data related to information about all imaging tests conducted are also often not available. Another difficulty faced by researchers to produce good research results is the concern that people with cancer tend to report exposure that they fear may be the cause of their cancer.
The debate over whether exposure to low-dose X-rays can cause cancer still occurs as published in the American Journal of Clinical Oncology which claims that X-ray procedures carry no risk. Low-dose radiation exposure is not enough to cause long-term damage because any damage caused by low-dose radiation can be repaired by the body without leaving a lasting mutation. This paper also states that permanent damage can be generated when certain thresholds are reached.
This threshold is generally much higher than the standard X-ray dose of all types of scanning. Most studies have also not found an association between exposure to low-level radiation with an increased risk of cancer. X-rays categorized as carcinogens (cancer-causing) by WHO are high-dose X-rays. Whereas most routine diagnostic tests emit radiation in very small amounts. Only about 0.001 mSv of arm x-ray is needed, 0.01 mSv of panoramic dental x-ray, 0.1 mSv of chest X-ray, and 0.4 mSv of mammograms according to Harvard Medical School.
Whereas the CT scan only uses higher-dose X-rays, 7 mSv for chest CT, and 12 mSv for the whole body scan. The use of dose measurements with millisievert (mSv) radiation is used because measuring the impact of radiation on human tissue and health is more difficult.
Research evidence that reveals the risk of cancer associated with X-rays comes largely from studies in certain groups of people such as those who survived the Chernobyl nuclear accident in the Soviet Union in 1986, uranium miners, workers at nuclear power plants whose work requires exposure to radiation in large numbers, and those who survived the atomic bomb explosion in Japan during World War II.
There is uncertainty regarding the estimated risk for low levels of radiation exposure in diagnostic radiology procedures. This happens because the risk is quite low compared to the natural risk of cancer and it takes years and studying millions of people to get adequate evidence for a statistically valid estimate of cancer risk from low-dose radiation exposure. Some scientists even believe that low-dose radiation does not increase the risk of cancer at all.
Another opinion that doubts radiation from X-rays can cause cancer is evidence that no people living near nuclear power plants are at higher risk of developing cancer. The research also shows that there is no increased risk for those under the age of 15 who live within 25 km of a nuclear power plant. The government committee on the Medical Aspects of Radiation in the Environment (COMARE) also concluded there was no evidence to support the view that there is an increased risk of childhood leukemia and other cancers around nuclear power plants in the UK.
Tips to minimize exposure to X-ray radiation
Although several studies have shown that X-rays can cause cancer, most of these studies occur in cases that have been exposed to large amounts of radiation for a long time. The higher and more frequent exposure to X-ray radiation a person receives, the higher the risk of getting cancer. Low-dose radiation exposure when children have an increased risk of cancer is classified as very low. The risk of an unknown cancer increase is definitely causing experts to suggest that a person’s medical radiation exposure is as low as possible.
Minimizing exposure to X-ray radiation is of particular concern to children because they are more sensitive to radiation than adults. Children also have more time to develop cancer and other problems related to radiation exposure.
Some ways to minimize exposure to X-ray radiation in children are only to allow X-rays, fluoroscopy or CT scans when there are clear health benefits for your child. You should talk to your health care provider if you are worried that your child is receiving too many X-ray tests. Avoid repeated tests if possible. If needed, use protection for very sensitive areas, such as the genitals and thyroid gland.
You also have to make sure your child receives the lowest possible amount of radiation (a low dose according to your child’s body size) to get a full picture. Another important point does not repeat the scan unless necessary and only x-ray the area needed. If necessary find other alternatives if possible, namely the type of medical imaging using a lower radiation dose or no radiation at all. Some types of medical imaging such as MRI and ultrasonography do not use X-rays. MRI is often used instead of CT scans, while ultrasonography is often used to examine the abdomen, pelvis, soft tissue, breast, and testes.
If you are pregnant, exposure to X-ray radiation is more risky for an unborn baby than an adult. You should also inform your doctor about any x-rays you may have had before. This might be useful for diagnosing, managing or treating your current condition. If necessary your doctor will not do an x-ray test again and recommend other types of imaging that do not use radiation. Other tests can be done for example using magnetic resonance imaging or ultrasonography (MRI scanning).
What the next
Some facts we can conclude whether X-rays can cause cancer by analyzing various studies that have been done by previous experts. Most of the studies that link the increased risk of cancer with X-rays are derived from long-term studies of people who are exposed to large amounts of radiation such as atomic bomb explosions. Today many people are exposed to X-rays from medical imaging such as X-rays and CT scans, which generally only use radiation with a relatively low dose for a fraction of a second.
The amount of radiation you get from medical imaging is equivalent to between a few days and several years of natural radiation exposure from the environment. The small risk of getting cancer after being exposed to X-rays due to the risk of getting cancer will also occur within a few years or decades later so that it is not certain that someone has cancer due to previous X-ray exposure. The study also revealed that it took nearly 40 x-rays or two CT scans to increase the risk of cancer by 0.05%, of course, this is a very small amount.
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