ArticleRadiology2013
Patients with testicular cancer undergoing CT surveillance demonstrate a pitfall of radiation-induced cancer risk estimates: the timing paradox.
Article in Radiology, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers, 1 of them a synthesis that pooled it.
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Who cites it
13 citing papers in PubMed, 1 synthesis or guideline pooled it, 41 citations in OpenAlex.
- Abdominopelvic imaging in the follow-up of testicular germ-cell tumors in adults: recommendations of the Scrotal and Penile Imaging Working Group of the European Society of Urogenital Radiology.European radiology · 2025Guideline
- Chest CT in Testicular Mass Evaluation: A Stepwise Approach to Minimize Radiation Exposure.Urologia internationalis · 2026Article
- Can whole-body MRI replace CT in management of metastatic testicular cancer? A prospective, non-inferiority study.Journal of cancer research and clinical oncology · 2023Article
- An institutional review of hospital resource utilization and patient radiation exposure in shunted idiopathic intracranial hypertension.Neurosurgical review · 2021Article
- Late adverse effects and quality of life in survivors of testicular germ cell tumour.Nature reviews. Urology · 2021Review
- Understanding, justifying, and optimizing radiation exposure for CT imaging in nephrourology.Nature reviews. Urology · 2019Review
- Management of stage I testicular germ cell tumours.Nature reviews. Urology · 2016Review
- A refined risk stratification scheme for clinical stage 1 NSGCT based on evaluation of both embryonal predominance and lymphovascular invasion.Annals of oncology : official journal of the European Society for Medical Oncology · 2015Article
- Radiation exposure from diagnostic imaging in young patients with testicular cancer.European radiology · 2015Article
- Cost analysis of adjuvant management strategies in early stage (stage I) testicular seminoma.Research and reports in urology · 2015Article
- Imaging for appendicitis: should radiation-induced cancer risks affect modality selection?Radiology · 2014Article
- Imaging-based screening: understanding the controversies.AJR. American journal of roentgenology · 2014Review
- Prioritizing examination-centered over patient-centered dose reduction: a hazard of institutional "benchmarking".AJR. American journal of roentgenology · 2014Article
Corrections and comments
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Authors and funding
10 authors at 2 institutions in 1 country.
Funding
Abstract
purposeTo demonstrate a limitation of lifetime radiation-induced cancer risk metrics in the setting of testicular cancer surveillance-in particular, their failure to capture the delayed timing of radiation-induced cancers over the course of a patient's lifetime. MATERIALS AND
methodsInstitutional review board approval was obtained for the use of computed tomographic (CT) dosimetry data in this study. Informed consent was waived. This study was HIPAA compliant. A Markov model was developed to project outcomes in patients with testicular cancer who were undergoing CT surveillance in the decade after orchiectomy. To quantify effects of early versus delayed risks, life expectancy losses and lifetime mortality risks due to testicular cancer were compared with life expectancy losses and lifetime mortality risks due to radiation-induced cancers from CT. Projections of life expectancy loss, unlike lifetime risk estimates, account for the timing of risks over the course of a lifetime, which enabled evaluation of the described limitation of lifetime risk estimates. Markov chain Monte Carlo methods were used to estimate the uncertainty of the results.
resultsAs an example of evidence yielded, 33-year-old men with stage I seminoma who were undergoing CT surveillance were projected to incur a slightly higher lifetime mortality risk from testicular cancer (598 per 100 000; 95% uncertainty interval [UI]: 302, 894) than from radiation-induced cancers (505 per 100 000; 95% UI: 280, 730). However, life expectancy loss attributable to testicular cancer (83 days; 95% UI: 42, 124) was more than three times greater than life expectancy loss attributable to radiation-induced cancers (24 days; 95% UI: 13, 35). Trends were consistent across modeled scenarios.
conclusionLifetime radiation risk estimates, when used for decision making, may overemphasize radiation-induced cancer risks relative to short-term health risks.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.