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Concerns expressed for study linking dental xrays to brain tumor

May 18, 2013

X-rays and meningioma



Controversial study questioned
A study finding an
increased risk of meningioma reportedly generated by dental X-rays was the topic
of an article published in the May 2013 issue of the Journal of Dental


The JDR report was the work of researchers in prosthetic dentistry at the
University of Muenster in Germany, who disputed findings from a study published
online April 10, 2012, and in the September 2012 issue of Cancer.


The JDR researchers contend there were weaknesses in both study design and
central findings. In their view, a fundamental failing of the case control
design in the Cancer investigation was that it suggested a cause-and-effect
relationship between dental X-rays and meningioma.


"… the empirical probability of a patient having been subjected to a certain
exposure is calculated, not the probability that an exposure is related to a
disease," JDR authors said. They went on to identify what they saw as other
design flaws, including biases in subject sampling and patient recall.


The JDR authors stated concerns about a number of the Cancer study's results.
Among them:

  • The description of a nearly five-fold increase in meningioma for patients
    who had at least one panorex when younger than 10 years of age. "With this
    result, it should be kept in mind that case-control studies possess inherent
    uncertainties amplified by the method of data collection, which is based on
    recall of treatments, which, in this case, occurred, on average, five decades
    previously and is prone to personal bias," JDR authors said.
  • The assertion that, over a lifetime, patients who experienced meningioma
    were more than twice as likely as healthy control individuals to report having
    ever had a bitewing examination.
    Because both patient cases and healthy
    controls reported having had at least one bitewing in their lives with nearly
    the same (high) relative frequency—95.8 percent of cases and 92.2 percent of
    healthy controls—the odds ratio may not simply be translated into a probability
    ratio (relative risk), JDR researchers said.
  • That exposure to full-mouth series was not significantly associated with
    meningioma at any age or frequency, despite corresponding to a much larger
    radiation dose.




In discussion, authors of the Cancer study, led by Elizabeth B. Claus, M.D.,
of Yale University School of Medicine and Brigham and Women's Hospital, said,
"Our findings indicate a statistically significant increased risk with both
bitewing and panoramic films. Risk estimates for full-mouth films, although not
statistically significant, were consistently in the same direction as for the
other two film types."


In addition to questioning why findings postulating an increased risk of
meningioma are prominently placed in the abstract (while this third finding
describing a null result is in the discussion section), JDR authors said the
finding reveals a "severe inconsistency." They propose that an impression is
initially produced that doesn't stand up to closer inspection.


Ensuing reports in the literature show that these and other concerns have
arisen regarding the Cancer study entitled "Dental X-rays and Risk of
Meningioma." A note of advice proposed by JDR authors recommends that future
studies on the subject focus on the dose-response relationship. "Further studies
on this topic should pay more attention to dosimetry," the JDR authors advise in
their conclusions.

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