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The risk of cancer induction in patients receiving these diagnostic radiopharmaceuticals must also be balanced with the benefits of such procedures. Indeed, the advantages of exposure to diagnostic radiopharmaceuticals must be balanced with the potential risk of treatment-induced leukemia [ 35 ]. Certain occupational exposures may increase the risk of second neoplasms in these patients [ 36, 37 ]. Increased risk of death due to radiation therapy exists for recipients of diagnostic radiopharmaceuticals who have received high-dose exposures, and this risk increases as the radiation dose increases [ 35 ]. These risks must be considered when delineating the risk-benefit ratio of any given radiological or nuclear procedure [ 26, 35 ]. Increased cancer risk in patients receiving diagnostic radiopharmaceuticals is due in part to the patient’s age, smoking history, and to pre-existing medical conditions [ 38 ]. For example, leukemia risk in patients receiving diagnostic radiopharmaceuticals is nearly 10 times higher than for the general population [ 38 ]. Patients who receive diagnostic radiopharmaceuticals for multiple scintigraphic studies during different periods of their lives are at increased risk of developing leukemia [ 39 ]. When compared to those who receive only one or two studies, the relative risk of developing leukemia is higher in those who receive multiple studies [ 39 ]. When diagnostic radionuclides are used for therapy, they are predominantly administered to pediatric patients with cancer [ 41 ]. The potential risks of second malignancies should be addressed and considered in evaluating therapies that use diagnostic radionuclides, particularly in pediatric patients [ 42, 43 ]. Risk related to the use of diagnostic radionuclides is thought to be very small [ 41, 44 ].
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