Miscellaneous
Brain and Neck Tumors Among Physicians Performing Interventional Procedures

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Physicians performing interventional procedures are chronically exposed to ionizing radiation, which is known to pose increased cancer risks. We recently reported 9 cases of brain cancer in interventional cardiologists. Subsequently, we received 22 additional cases from around the world, comprising an expanded 31 case cohort. Data were transmitted to us during the past few months. For all cases, where possible, we endeavored to obtain the baseline data, including age, gender, tumor type, and side involved, specialty (cardiologist vs radiologist), and number of years in practice. These data were obtained from the medical records, interviews with patients, when possible, or with family members and/or colleagues. The present report documented brain and neck tumors occurring in 31 physicians: 23 interventional cardiologists, 2 electrophysiologists, and 6 interventional radiologists. All physicians had worked for prolonged periods (latency period 12 to 32 years, mean 23.5 ± 5.9) in active interventional practice with exposure to ionizing radiation in the catheterization laboratory. The tumors included 17 cases (55%) of glioblastoma multiforme (GBM), 2 astrocytomas (7%), and 5 meningiomas (16%). In 26 of 31 cases, data were available regarding the side of the brain involved. The malignancy was left sided in 22 (85%), midline in 1, and right sided in 3 operators. In conclusion, these results raise additional concerns regarding brain cancer developing in physicians performing interventional procedures. Given that the brain is relatively unprotected and the left side of the head is known to be more exposed to radiation than the right, these findings of disproportionate reports of left-sided tumors suggest the possibility of a causal relation to occupational radiation exposure.

Section snippets

Methods

The present study included data from 31 interventional physicians with brain and neck cancer. We previously published an initial first small report and a subsequent update as a “letter to the editor.”15, 16 The present study reports the most updated data on previously published cases gathered since publication and information on 13 additional reported cases transmitted to us during the previous few months.

For all cases, where possible, we endeavored to obtain the baseline data, including age,

Results

The demographic variables (age, gender, specialty, and years in practice) and tumor type and clinical outcomes are summarized in Table 1. The age range of the patients was 49 to 67 years (median 54, mean 54.7 ± 7.1). Only 1 of the patients in the present series of malignancies was a woman.

The most common offending tumor type was glioblastoma multiforme, identified in 17 of 31 cases (55%), with 2 cases of astrocytoma and 5 of meningioma.

A striking finding was the disproportionate occurrence of

Discussion

The present observations have expanded those of recent previous reports of brain and neck cancer in interventional physicians.13, 14, 15, 16 Occupational radiation exposure and the orthopedic complications from wearing the heavy leaded aprons necessary to limit such exposure risk have become major concerns among physicians performing interventional procedures.6, 7, 8, 9, 17, 18, 19, 20 The present findings raise additional concern regarding occupational radiation exposure-induced malignancies.21

Disclosures

Dr. Goldstein is an owner of equity in ECLS, Inc., which develops shielding devices for radiation protection. The other authors have no conflicts of interest to disclose.

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