Frequency of imaging procedures in the follow-up of testicular cancer patients in Israel

• Applicant: Professor Dr. Andreas Stang, since 3/2016
• Subject Area: Public Health, Healthcare Research, Social and Occupational Medicine ; Epidemiology and Medical Biometry/Statistics
• Term: from 2015 to 2018
• Project identifier: Deutsche Forschungsgemeinschaft (DFG) - Project number 276998111

Current evidence-based international guidelines on treatment of germ cell cancers have been increasingly recommended a postorchiectomy surveillance strategy including mostly computed tomography (CT) of abdomen for clinical stage I disease (roughly 60% of cases with testicular cancer) instead of applying traditional adjuvant therapy. Exposure to radiation resulting from diagnostic imaging procedures probably increases late cancer risk. The risks are of particular concern for younger patients. International guidelines vary widely regarding frequency and extent of CT imaging in the management of testicular cancers.Yet notably, despite concerns that even surveillance may have negative health consequences because of the radiation exposure from CT, to our knowledge only two population-based studies assessed the actual number of CT scans employed during follow-up care. In Canada, 97.8% of men in the cohort (N=2,569) had at least one CT scan of the abdomen-pelvis with a median of 10 scans (Interquartile range [IQR]: 4 to 18) within the first 5 years after diagnosis of testicular cancer. In a population-based study from Germany (N=139), 77.7% of men had at least one CT scan of the abdomen with a median of only 2 scans (IQR: 1 to 4) within a 3-year observation period after diagnosis.The aim of this study is to provide similar descriptive epidemiological measures of imaging procedures in the follow-up of testicular cancer patients in the different healthcare setting of Israel with higher resolution by histology, CS, prior treatment and CT scan details than preliminary studies. In contrast to preliminary works, the study will allow a head-to-head comparison of the number of CT examinations observed with the number recommended by guidelines. It is planned to utilize the computerized data of Maccabi Healthcare Services (MHS), the second largest, publicly funded, health maintenance organization in Israel. For the period 2003-2007, incident cases of testicular cancer among eligible MHS members will be obtained by direct linkage with the Israel National Cancer Registry. Data on diagnostic imaging procedures including CT and alternatives like magnetic resonance imaging of the chest, abdomen, pelvis and unspecified sites will be extracted during a 5-year period of follow-up for each individual patient. Risk models based on the Biological Effects of Ionizing Radiations VII Report and organ-specific radiation doses will be used to estimate the lifetime attributable risk of radiation induced cancer from CT examinations.

• DFG Programme: Research Grants
• International Connection: Israel
• International Co-Applicant: Professor Gabriel Chodick, Ph.D.
• Ehemaliger Antragsteller: Dr. Carsten Rusner, until 3/2016