The Risk of Second Cancers After Diagnosis of Primary Thyroid Cancer Is Elevated in Thyroid Microcarcinomas

Kim, Christopher; Bi, Xiao; Pan, Dongsheng; Chen, Yingtai; Carling, Tobias; Ma, Shuangge; Udelsman, Robert; Zhang, Yawei

doi:10.1089/thy.2011.0406

Cited by 86 publications

(86 citation statements)

References 39 publications

(38 reference statements)

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“…Importantly, no patient appears to have been harmed by prudent observation. A recent study examined the risk of secondary cancers after a first thyroid cancer primary utilizing the SEER database found that the highest risk was observed in patients with recently diagnosed microcarcinomas, indicating a potential negative impact from treatment for occult thyroid microcarcinomas (13). This epidemic of thyroid cancer is a classic example of ''cancer overdiagnosis'' where the diagnosis is made in a silent disease reservoir and treatment is initiated for individuals who are unlikely to develop symptoms or have their life-spans shortened (14).…”

Section: Discussionmentioning

confidence: 99%

The Epidemic of Thyroid Cancer in the United States: The Role of Endocrinologists and Ultrasounds

Udelsman

Zhang

2014

Thyroid

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199

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Background: The incidence of thyroid cancer has increased at an alarming rate in both men and women in the United States. The etiology of this epidemic is unclear. We tested the hypothesis that a significant component of this epidemic is due to increased detection of occult disease. We examined whether the density of endocrinologists and general surgeons as well as employment of cervical ultrasonography were factors associated with this epidemic. Methods: Thyroid cancer incidence rates by states were obtained from the United States Cancer Statistics 1999-2009 reported by the National Program of Cancer Registries. The densities of endocrinologists and general surgeons and the employment of cervical ultrasonography were calculated on a statewide basis and correlated with the incidence of thyroid cancer. Results: Age-standardized incidence rates of thyroid cancer have increased in every state in the United States. Significant regional variations were noted, with the highest incidence rates in the northeast and the lowest in the south. The incidence rates were significantly correlated with the density of endocrinologists (r = 0.58, p < 0.0001 for males; r = 0.44, p = 0.0031 for females) and the employment of cervical ultrasonography (r = 0.40, p = 0.0091 for males; r = 0.36, p = 0.0197 for females). Both the density of endocrinologists and general surgeons and employment of cervical ultrasonography could explain 57% of the variability in state-level incidence for males and 49% for females. Conclusions: These data offer evidence to suggest that the epidemic of thyroid cancer is due to increased detection of a reservoir of previously occult disease. The increased detection of thyroid cancer results in therapeutic interventions including surgery and radioactive thyroid treatment that may be of limited benefit.

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Section: Discussionmentioning

confidence: 99%

The Epidemic of Thyroid Cancer in the United States: The Role of Endocrinologists and Ultrasounds

Udelsman

Zhang

2014

Thyroid

Self Cite

199

120

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“…Another interesting article is represented by the one by Kim et al [3]. The main novelty of the paper by Kim et al is that they stratified their results according to tumor diameter and therefore they could focus their discussion also on thyroid microcarcinomas ( 10 mm or pT1a [11]).…”

Section: Open Access Peer-reviewedmentioning

confidence: 99%

“…The authors stressed that the increased risk was observed also for thyroid microcarcinomas ( 10 mm or pT1a [11]) and concluded that aggressive radiation treatment of the primary thyroid cancer, the environment, and genetic susceptibility may increase the risk of a second cancer [3]. In patients with papillary microcarcinomas RIA is associated neither to an improved prognosis nor to a decreased risk of recurrence [12,13].…”

Section: Open Access Peer-reviewedmentioning

confidence: 99%

“…The therapy of thyroid cancer consists of thyroidectomy, thyroid hormone treatment and, depending on pathological stage, postsurgical radioactive iodine ablation (RIA). Because of the excellent prognosis of differentiated thyroid cancer (DTC) and the fact that radiation exposure represents a risk factor for many other cancers, in the last years there has been an exponential attention to the possible association between RIA and second malignancies in thyroid cancer patients [1][2][3][4][5][6][7][8][9].…”

mentioning

confidence: 99%

“…In this commentary, we would like to briefly critically review the results of some of the more recent studies and expose our personal perspective. Several studies, comprehensive reviews and at least three meta-analyses on the association between RIA and second cancers have been published in the last years [1][2][3][4][5][6][7][8][9]. To express our consideration we will select some representative papers of these.…”

mentioning

confidence: 99%

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Incidence of Second Cancers in Thyroid Cancer Patients Treated with Radioactive Iodine Ablation: How High Is Really the Risk?

Giovacchini¹,

Leoncini²

2016

J Diagn Imaging Ther

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Differentiated thyroid cancer (DTC) is a common endocrine tumor with increasing incidence and excellent prognosis. The therapy of thyroid cancer consists of thyroidectomy, thyroid hormone treatment and, depending on pathological stage, adjuvant radioactive iodine ablation (RIA). Because of the excellent outcome of DTC and the potential cancerous effect of iodine-131, in the last years there has been a huge number of articles addressing the issue of the incidence of second tumors in DTC patients. We will make a short critical review of some of these articles focusing on results reporting and interpretation. Methodological factors that may affect the obtained results will be highlighted for the benefit of the reader so that the risk associated to iodine-131 exposure will be balanced to the risk associated to other risk factors, including enhanced medical surveillance, shared genetic variability and environment factors and proper methodological study design. The review is finally a call to physicians involved in the therapy of these patients, primarily nuclear medicine physicians, endocrinologists and surgeons, to join their complimentary skill for the therapy of these patients.

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Association of Radioactive Iodine Treatment With Cancer Mortality in Patients With Hyperthyroidism

et al. 2019

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IMPORTANCE Radioactive iodine (RAI) has been used extensively to treat hyperthyroidism since the 1940s. Although widely considered a safe and effective therapy, RAI has been associated with elevated risks of total and site-specific cancer death among patients with hypothyroidism. OBJECTIVE To determine whether greater organ-or tissue-absorbed doses from RAI treatment are associated with overall and site-specific cancer mortality in patients with hyperthyroidism. DESIGN, SETTING, AND PARTICIPANTS This cohort study is a 24-year extension of the multicenter Cooperative Thyrotoxicosis Therapy Follow-up Study, which has followed up US and UK patients diagnosed and treated for hyperthyroidism for nearly 7 decades, beginning in 1946. Patients were traced using records from the National Death Index, Social Security Administration, and other resources. After exclusions, 18 805 patients who were treated with RAI and had no history of cancer at the time of the first treatment were eligible for the current analysis. Excess relative risks (ERRs) per 100-mGy dose to the organ or tissue were calculated using multivariable-adjusted linear dose-response models and were converted to relative risks (RR = 1 + ERR). The current analyses were conducted from April 28, 2017, to January 30, 2019. EXPOSURES Mean total administered activity of sodium iodide I 131 was 375 MBq for patients with Graves disease and 653 MBq for patients with toxic nodular goiter. Mean organ or tissue dose estimates ranged from 20 to 99 mGy (colon or rectum, ovary, uterus, prostate, bladder, and brain/central nervous system), to 100 to 400 mGy (pancreas, kidney, liver, stomach, female breast, lung, oral mucosa, and marrow), to 1.6 Gy (esophagus), and to 130 Gy (thyroid gland). MAIN OUTCOMES AND MEASURES Site-specific and all solid-cancer mortality. RESULTS A total of 18 805 patients were included in the study cohort, and the mean (SD) entry age was 49 (14) years. Most patients were women (14 671 [78.0%]), and most had a Graves disease diagnosis (17 615 [93.7%]). Statistically significant positive associations were observed for all solid cancer mortality (n = 1984

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The Risk of Second Cancers After Diagnosis of Primary Thyroid Cancer Is Elevated in Thyroid Microcarcinomas

Cited by 86 publications

References 39 publications

The Epidemic of Thyroid Cancer in the United States: The Role of Endocrinologists and Ultrasounds

The Epidemic of Thyroid Cancer in the United States: The Role of Endocrinologists and Ultrasounds

Incidence of Second Cancers in Thyroid Cancer Patients Treated with Radioactive Iodine Ablation: How High Is Really the Risk?

Association of Radioactive Iodine Treatment With Cancer Mortality in Patients With Hyperthyroidism

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