Risk of Hematologic Malignant Neoplasms from Abdominopelvic Computed Tomographic Radiation in Patients Who Underwent Appendectomy

Kyung Hee Lee, Seungjae Lee, Ji Hoon Park, Sung Soo Lee, Hae Young Kim, Won Jin Lee, Eun Shil Cha, Kwang Pyo Kim, Woojoo Lee, Ji Yun Lee, Kyoung Ho Lee

Research output: Contribution to journalArticlepeer-review

47 Citations (Scopus)


Importance: Whether computed tomography (CT) radiation is truly carcinogenic remains controversial. Large epidemiological studies that purportedly showed an association between CT radiation and carcinogenesis were limited by confounding by indication and reverse causation, because the reasons for CT examination were unknown. Objective: To measure the risk of hematologic malignant neoplasms associated with perioperative abdominopelvic CT radiation among patients who underwent appendectomy for acute appendicitis. Design, Setting, and Participants: This nationwide population-based cohort study used the National Health Insurance Service claims database in South Korea to assess 825820 patients who underwent appendectomy for appendicitis from January 1, 2005, to December 31, 2015, and had no underlying risk factors for cancer. Patients were divided into CT-exposed (n = 306727) or CT-unexposed (n = 519093) groups. The study was terminated on December 31, 2017, and data were analyzed from October 30, 2018, to September 27, 2020. Exposures: Perioperative abdominopelvic CT examination from 7 days before to 7 days after appendectomy. Main Outcomes and Measures: The primary outcome was the incidence rate ratio (IRR) of hematologic malignant neoplasms for both groups. The secondary outcomes were IRR of abdominopelvic organ cancers and IRR of all cancers. The lag period was 2 years for the primary outcome and 5 years for secondary outcomes. The IRRs were calculated using Poisson regression models with adjustment for age and sex. Results: Among the study population of 825 820 patients (52.9% male; median age, 28 [interquartile range, 15-41] years), hematologic malignant neoplasms developed in 323 patients in the CT-exposed group during 1486518 person-years and 500 patients in the CT-unexposed group during 3422059 person-years. For all hematologic malignant neoplasms, the IRR for the CT-exposed vs CT-unexposed group was 1.26 (95% CI, 1.09-1.45; P =.002). In terms of individual categories of hematologic malignant neoplasms, the CT-exposed group had an elevated risk only for leukemia (IRR, 1.40 [98.75% CI, 1.04-1.87, adjusted by Bonferroni correction]; P =.005). There was no between-group difference in incidence rate of abdominopelvic organ cancers (IRR, 1.07 [95% CI, 1.00-1.15]; P =.06) and that of all cancers (IRR, 1.04 [95% CI, 0.99-1.09]; P =.14). Conclusions and Relevance: This study controlled for reverse causation bias by defining the reasons for CT scan, and findings suggest that abdominopelvic CT radiation is associated with a higher incidence of hematologic malignant neoplasms. Efforts should be continued for judicious use of CT examinations.

Original languageEnglish
Pages (from-to)343-351
Number of pages9
JournalJAMA Surgery
Issue number4
Publication statusPublished - 2021 Apr

Bibliographical note

Funding Information:
reported receiving grants from the National Research Foundation of Korea funded by the Korea government outside the submitted work. Dr Park reported receiving grants from the Basic Science Research Program through the National Research Foundation of Korea funded by the Ministry of Education and Seoul National University Bundang Hospital Research Fund. No other disclosures were reported.

Funding Information:
Funding/Support: This research was supported by

Publisher Copyright:
© 2021 American Medical Association. All rights reserved.

ASJC Scopus subject areas

  • Surgery


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