Risk of Hematologic Malignancies After Radioactive Iodine Treatment of Thyroid Cancer: An Unjustified Warning

Errare humanum est, sed in errare perseverare diabolicum: methodological errors in the assessment of the relationship between I-131 therapy and possible increases in the incidence of malignancies

“…The first study, published in two different versions with essentially the same message by Molenaar et al [7,8], alleged that I-131 therapy of DTC was associated with if not causative of an elevated risk of hematological malignancies. Much has been stated about the methodological flaws of this study in a host of letters to the editors of both respected journals and we have commented on this paper before in the present journal [10][11][12]. Suffice it to say that save for a more or less adequate choice of control group, this paper has no redeeming methodological qualities in terms of the first three criteria listed above.…”

Analysis of Short-Term and Stable DNA Damage in Patients with Differentiated Thyroid Cancer Treated with 131I in Hypothyroidism or with Recombinant Human Thyroid-Stimulating Hormone for Remnant Ablation

“…Several papers have been published on the potential genetic damage and on the increased risk of secondary cancer in patients treated with 131I, even if with low activities (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20) although the causative association between 131I therapy and an increased risk of secondary cancers has not yet been definitively established. Indeed, no longitudinal study has been published, indicating that an increase in chromosome breaks or translocations after 131I therapy is associated with an increased risk of malignancies.…”

“…Indeed, several reports have shown chromosomal damage induced by 131I, although only chromosomes 1, 2, 4, 8 and 10 have been analyzed (8)(9)(10)(11)(12). Despite this is a very controversial issue (3,5,(13)(14)(15)(16)(17)(18)(19), a significant reduction of ablative treatments has been observed in the last decade. Therefore, it is important to better elucidate the possible presence of stable genetic damage and of radio-induced oxidative stress following treatment with 131I.…”

Discussion on radioactive iodine treatment of hyperthyroidism and the risk of induced cancer

“…dispelled the conclusions of two papers from one team that tried to cast doubt on the riskbenefit from adjuvant 131 I therapy in low and intermediate-risk thyroid cancer [17,18]; again based on biased data and incomplete analysis [15,19].…”