Comparison of Documented and Recalled Histories of Exposure to Diagnostic X-rays in Case-Control Studies of Thyroid Cancer

American Journal of Epidemiology, Apr 2003

Most information concerning possible cancer risks attributable to lifetime exposure to diagnostic x-rays comes from studies in which x-ray history was ascertained by interview or questionnaire, but little is known about the accuracy of such information. The authors assessed agreement between medical x-ray histories obtained through interview and by review of medical records from thyroid cancer case-control studies conducted in Sweden (1985–1992; 123 cases and 123 controls) and from members of a prepaid health plan in the United States (1986–1991; 50 cases and 50 controls). In both studies, substantial disagreement was found between the numbers of x-ray examinations reported in the interview and in the medical records. There was an indication of relatively poorer reporting among controls, particularly for certain types of x-ray examinations and for large numbers of such examinations. Estimates of the risk associated with exposure to diagnostic x-rays were similar, regardless of whether interview or medical record data were used, even though ordinal dose classifications based on the two sources differed considerably. In populations with a high frequency of exposure, spurious associations with numbers of x-ray examinations or estimated thyroid dose might arise because of differences in recall. However, in the present data, reporting errors by cases and controls seemed to be largely nondifferential.

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Comparison of Documented and Recalled Histories of Exposure to Diagnostic X-rays in Case-Control Studies of Thyroid Cancer

American Journal of Epidemiology Copyright © 2003 by the Johns Hopkins Bloomberg School of Public Health All rights reserved Comparison of Documented and Recalled Histories of Exposure to Diagnostic X-rays in Case-Control Studies of Thyroid Cancer Amy Berrington de Gonzalez 2 3 Anders Ekbom 0 1 2 Andrew G. Glass 2 6 Maria Rosaria Galanti 2 5 Lars Grimelius 1 2 Michael J. Allison 2 6 Peter D. Inskip ) 2 4 0 Department of Epidemiology, Harvard School of Public Health , Boston, MA 1 Department of Medical Epidemiology, Karolinska Institute , Stockholm , Sweden 2 Reprint requests to Dr. Peter D. Inskip, Radiation Epidemiology Branch, National Cancer Institute , Executive Plaza South, Room 7052, Bethesda, MD 20892 ( 3 Cancer Research UK Epidemiology Unit, University of Oxford , Oxford , United Kingdom 4 Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, Department of Health and Human Services, National Cancer Institute , Bethesda, MD 5 Centre for Tobacco Prevention , Stockholm , Sweden 6 Oncology Research, Kaiser Permanente Medical Care Program , Portland, OR Most information concerning possible cancer risks attributable to lifetime exposure to diagnostic x-rays comes from studies in which x-ray history was ascertained by interview or questionnaire, but little is known about the accuracy of such information. The authors assessed agreement between medical x-ray histories obtained through interview and by review of medical records from thyroid cancer case-control studies conducted in Sweden (1985-1992; 123 cases and 123 controls) and from members of a prepaid health plan in the United States (1986-1991; 50 cases and 50 controls). In both studies, substantial disagreement was found between the numbers of x-ray examinations reported in the interview and in the medical records. There was an indication of relatively poorer reporting among controls, particularly for certain types of x-ray examinations and for large numbers of such examinations. Estimates of the risk associated with exposure to diagnostic x-rays were similar, regardless of whether interview or medical record data were used, even though ordinal dose classifications based on the two sources differed considerably. In populations with a high frequency of exposure, spurious associations with numbers of x-ray examinations or estimated thyroid dose might arise because of differences in recall. However, in the present data, reporting errors by cases and controls seemed to be largely nondifferential. interviews; medical records; radiography; recall; thyroid neoplasms Minimum Maximum Total * NA, not applicable. United States MATERIALS AND METHODS Study populations and identification of cases and controls plan. No diagnosis of thyroid cancer or adenoma was noted in their Kaiser Permanente records. A total of 50 thyroid tumor cases (28 papillary carcinomas and 22 adenomas) and 50 matched controls were enrolled. Ascertainment of x-ray examinations from medical records Examination Berrington de Gonzalez et al. Cases (n = 123) Controls (n = 123) Medical record Medical record No. of No. of examinations subjects per exposed subject exposed No. of No. of examinations subjects per exposed subject exposed No. of No. of examinations subjects per exposed subject exposed No. of No. of examinations subjects per exposed subject exposed 2 3 9 0 9 3 22 Telephone interview Table continues Examination Cholecystogram Cholangiogram Intravenous pyelogram Other urinary tract examination Any urinary tract* Hysterosalpingogram Mammography Chest fluoroscopy Ribs Any examination*,§ Cases (n = 123) Controls (n = 123) Medical record Medical record No. of No. of examinations subjects per exposed subject exposed No. of No. of examinations subjects per exposed subject exposed No. of No. of examinations subjects per exposed subject exposed No. of No. of examinations subjects per exposed subject exposed to report only the estimated frequency of these exposures as a child and as an adult (if applicable). Data analysis Procedure type Head and neck Upper extremities Lower extremities GI¶ tract Urinary tract Female genital tract Chest fluoroscopy Computed tomography scans Abdomen All types All types (excluding chest fluoroscopies) Minimum, maximum –14, 7 –6, 10 –6, 12 –4, 29 –26, 22 –31, 19 Minimum, maximum –4, 20 –15, 25 –10, 32 –23, 34 –25, 32 RESULTS Examination Higher-dose examinations Head, neck, spine, and ribs and chest fluoroscopy Medium-dose examinations Standard chest, shoulders, and upper GI‡ tract Low-dose examinations Abdomen, pelvis, and upper and lower extremities No. of x-ray examinations Interview data Medical records 95% CI 95% CI 0.5, 2.3 0.4, 5.8 0.4, 17.1 0.3 1.1, 3.5 0.8, 24.7 0.5, 11.9 0.01 0.4, 1.2 0.1, 3.4 0.1, 4.1 0.6, 2.0 0.3, 3.4 0.9, 3.1 0.5, 9.1 0.6, 16.8 0.05 0.3, 1.2 0.3, 3.4 Interview data Medical records 95% CI 95% CI 0.7, 2.5 0.4, 34.1 0.4, 1.5 0.6, 11.0 0.8, 3.9 0.3, 1.1 0.6, 1.8 0.4, 1.6 0.1, 16.0 0.6, 2.2 0.3, 5.7 0.6, 9.9 0.3, 1.4 0.6, 2.1 Subgroup of high-dose x-ray examinations No. of x-ray examinations at age <21 years No. of x-ray examinations before 1960 No. of x-ray examinations in 1960–1969 No. of x-ray examinations in 1970 or later DISCUSSION Quartile† (mGy) 1.00– 2.19 2.20– 6.88 Interview data 95% CI‡ 0.4, 2.5 0.4, 2.4 0.6, 3.3 Quartile (mGy) 0.001–1.19 Medical records 95% CI 0.4, 2.1 0.5, 2.4 0.7, 3.0 Interview quartile (mGy) 1.00–2.19 2.20–6.88 1.00–2.19 2.20–6.88 Medical records quartile (mGy) 1.20– 5.38 Controls 11 27 3 1. 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Amy Berrington de Gonzalez, Anders Ekbom, Andrew G. Glass, Maria Rosaria Galanti, Lars Grimelius, Michael J. Allison, Peter D. Inskip. Comparison of Documented and Recalled Histories of Exposure to Diagnostic X-rays in Case-Control Studies of Thyroid Cancer, American Journal of Epidemiology, 2003, 652-663, DOI: 10.1093/aje/kwg026