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• W2063607304 abstract "Authors' reply Sir—In the first paragraph of our Discussion we highlighted the fact that our estimates were based on the assumption that small doses of radiation can cause cancer. It has been estimated that it would require an epidemiological study of more than 5 million people to be able to quantify directly the risk of cancer from exposure to doses of radiation of 10 mSv or less1Land CE Estimating cancer risks from low doses of ionizing radiation.Science. 1980; 209: 1197-1203Crossref PubMed Scopus (198) Google Scholar—ie, typical doses delivered by diagnostic X-rays. Therefore, that there will ever be conclusive epidemiological evidence for or against such risks is unlikely. Hence, rather than supporting our assumption about the risks of cancer from small doses of radiation with results from selected epidemiological studies, such as those referred to by Maurice Tubiana and colleagues and J A Simmons, we thought it preferable to consider reviews of both the experimental and epidemiological evidence. We referenced the most recent report by the US National Council on Radiation Protection and Measurement on the scientific bases for the linearity in the dose-response relation for ionising radiation.2Upton AC The state of the art in the 1990's: NCRP Report No. 136 on the scientific bases for linearity in the dose-response relationship for ionizing radiation.Health Phys. 2003; 85: 15-22Crossref PubMed Scopus (45) Google Scholar This report and another recent review by a team of international experts,3Brenner DJ Doll R Goodhead DT et al.Cancer risks attributable to low doses of ionising radiation: Assessing what we really know.Proc Natl Acad Sci USA. 2003; 100: 13761-13766Crossref PubMed Scopus (1261) Google Scholar both conclude that the linear non-threshold assumption is the most plausible model for the effects of low doses of ionising radiation and support the assumption used in our calculations. We agree with Shigenobu Nagataki that the benefits of diagnostic X-rays should be emphasised, especially the important role that they have in the early detection of some cancers. As both Nagataki and Debasish Debnath point out, the benefits from diagnostic X-ray use need to be weighed against the potential risks of cancer. Formal risk-benefit analysis might well be helpful, but would require detailed study for each type of diagnostic X-ray. As far as we are aware the only example where such an analysis has been done to date is for mammographic screening.4Law J Faulkner K Cancers detected and induced, and associated risk and benefit, in a breast screening programme.Br J Radiol. 2001; 74: 1121-1127Crossref PubMed Scopus (53) Google Scholar In the Commentary that accompanied our article Peter Herzog and Christina Reiger5Herzog P Rieger CT Risk of cancer from diagnostic X-rays.Lancet. 2004; 363: 340-341Summary Full Text Full Text PDF PubMed Scopus (37) Google Scholar suggested that, “In everyday practice, radiologists and clinicians ordering radiological procedures should think carefully about the benefit for and the risk to their patients for each examination.” Our estimates can be used informally for this purpose. Finally, Eugenio Picano mentions several factors that might have resulted in increased risks in recent years, including the increasing use of CT scans since the mid-1990s and diagnostic practice with radiopharmaceuticals, which could add a further 10% to the figures for the estimates of the average radiation exposure that we used in the paper. For all our calculations we used the most recent and comprehensive published data. Therefore our estimates do not take into account recent trends in medical practice for which detailed survey data are not yet available. Risk of cancer from diagnostic X-raysAmy Berrington de González and Sarah Darby (Jan 31, p 345)1 base their estimation of the number of cancers induced by diagnostic X-rays on the hypothesis of a linear non-threshold (LNT) dose-effect relation. Unfortunately, they do not underline the speculative nature of this hypothesis. Full-Text PDF Risk of cancer from diagnostic X-raysAmy Berrington de González and Sarah Darby1 find that, in the UK, about 0·6% of the cumulative risk of cancer to age 75 years can be attributed to diagnostic X-rays. This proportion is equivalent to about 700 cases of cancer per year. Full-Text PDF Risk of cancer from diagnostic X-raysAmy Berrington de González and Sarah Darby1 show that Japan has the highest annual exposure to diagnostic X-rays in the world, and the highest estimated cancer risk attributable to it (3·2%). Full-Text PDF Risk of cancer from diagnostic X-raysRadiation risks must be balanced against the benefits and not be interpreted out of context. It seems that one factor has been forgotten in the heated debate over the risk and benefit of diagnostic radiation1,2—ie, active involvement of the patient. Perhaps patients should be asked to provide informed consent routinely before undergoing any radiography. Such consent should be based on information such as the benefits of undergoing the procedure, risks of radiation, and availability of alternative measures. Full-Text PDF Risk of cancer from diagnostic X-raysAmy Berrington de González and Sarah Darby1 show that the lifetime risk of developing cancer attributable to diagnostic X-rays is 0·6–3·2% in developed countries. The numbers are striking, but there remains a risk of underestimation for three reasons. Full-Text PDF" @default.
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• W2063607304 date "2004-06-01" @default.
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• W2063607304 title "Risk of cancer from diagnostic X-rays" @default.
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• W2063607304 doi "https://doi.org/10.1016/s0140-6736(04)16374-5" @default.
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