In situ breast carcinoma after treatment during adolescence for thyroid cancer with radioiodine

Abstract

We reviewed the courses of patients treated during childhood or adolescence for thyroid cancer to estimate the frequency of, and to identify possible risk factors for, the occurrence of second malignant tumors in this population. We identified all patients treated for thyroid cancer in a cohort of 1,406 pediatric cancer patients who were diagnosed prior to 20 years of age during the period January 1, 1960 through December 31, 1988 and who were treated at Roswell Park Cancer Institute. Twelve patients were treated for thyroid cancer, of whom nine were women. In situ breast carcinoma was diagnosed 25 and 26 years after diagnosis of thyroid cancer in two of four women treated with radioiodine. No new cancers were diagnosed in the five women treated with thyroidectomy only. Two of four women treated for thyroid cancer during adolescence with radioiodine, which is concentrated in the breast as well as other organs, developed in situ breast carcinoma. Review of a large cohort of adolescent female thyroid cancer patients treated with radioiodine is necessary to provide an accurate estimate of their risk of developing breast cancer. These patients must remain under medical surveillance throughout their lifetimes to facilitate prompt diagnosis of and early intervention for new conditions, such as the occurrence of breast cancer.

The development of breast carcinoma in women with thyroid carcinoma

“…However, recent reports on outcome of children with thyroid carcinoma indicate that subsequent breast carcinoma may occur in this population as well; after at least 10 years of follow‐up, 5–7% developed treatment‐related lethal complications or second neoplasms, such as breast carcinoma 7. Another study of adolescent females with thyroid carcinoma corroborated these results; Green et al8 suggested that there may be an association between thyroid carcinoma and breast carcinoma that can be shown only in large population‐based studies.…”

Conservative surgical approach for thyroid and lymph‐node involvement in papillary thyroid carcinoma of childhood and adolescence

“…Results from the literature highlight that the percentage of permanent post‐operative complications after radical surgery is not likely to be changed 4–16. When considering the initial treatment and subsequent care of a child with PTC, one should take into account the possible impact of the morbidity of chronic therapy and follow‐up of endocrine disabilities (hypoparathyroidism and later on calcitonin deprivation); furthermore, consideration should be given to the possible iatrogenic effects of RAI therapy 18,19, and the generally indolent course of the disease considered along with this latter characteristic being independent of both the extent of disease at onset and the surgical approach undertaken. By applying a conservative surgical approach, the percentage of post‐operative complications can be reduced considerably without a deleterious influence on survival.…”

“…After total thyroidectomy, permanent hypoparathyroidism and recurrent laryngeal nerve paralysis often occurred (Table I), while after neck dissection, spinal accessory nerve paralysis was the major complication 17. In addition, iatrogenic effects of RAI therapy were reported 18,19.…”

Incidence of breast carcinoma in women with thyroid carcinoma

“…11,12 In addition, an increase in the risk of breast carcinoma after thyroid carcinoma also has been reported and attributed to the carcinogenicity of RAI used to treat the thyroid carcinoma by the majority of but not all investigators. 2,[13][14][15] Apropos of the 50th anniversary of the Connecticut Tumor Registry, the NCI performed an extensive study of multiple primary cancers utilizing data from the Connecticut Tumor Registry and the Danish Cancer Registry. In an analysis of the Danish data, a study of secondary cancers in women after breast carcinoma did not show an increase in thyroid carcinoma risk (RR ϭ 1.1).…”