Cancer risks in thyroid cancer patients

Hall, Per; Holm, L. E.; Lundell, G. E. F.; Bjelkengren, Göran; Lg, Larsson; Lindberg, S.; Tennvall, Jan; Wicklund, Harriet; Boice, Jr Jd

doi:10.1038/bjc.1991.261

Cited by 97 publications

(43 citation statements)

References 15 publications

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“…In addition, we identified a strong relationship between the cumulative activity of 131 I and risk of bone and soft-tissue cancer, colorectal cancer, and salivary gland cancer. The increased incidence of SPM seen in the present study and previously reported (Tucker et al, 1985;Hall et al, 1990Hall et al, , 1991Dottorini et al, 1995;Edhemovic et al, 1998) could also be related to an increased medical surveillance, common aetiological factors including hereditary factors, or misclassified metastases. Although increased medical surveillance could contribute to an earlier detection of cancers with a long latency, it could hardly explain the excess of leukaemia and of solid cancers with a poor prognosis and a rapid evolution.…”

Section: Discussionsupporting

confidence: 71%

“…The excess of colorectal cancer was previously evidenced only in the French cohort (de Vathaire et al, 1997), and the excess of salivary gland cancer was found in the Swedish (Hall et al, 1991) and Italian (Dottorini et al, 1995) cohorts. In contrast, the excess of bone and soft-tissue cancers following 131 I administration has not been previously reported.…”

Section: Discussionmentioning

confidence: 93%

“…Patients with a malignancy prior to thyroid cancer, with a second malignancy within the first 2 years of follow-up, or dying within 2 years of diagnosis were excluded. The treatment modalities in each cohort have been described previously (Hall et al, 1991;Dottorini et al, 1995;de Vathaire et al, 1997).…”

Section: Patientsmentioning

confidence: 99%

“…The Swedish cohort consisted of patients initially treated between 1951 and 1977 at the Departments of Oncology of the six university hospitals in Sweden (Hall et al, 1991). The Italian cohort included patients initially treated between 1958 and 1995 in the Nuclear Medicine Department of the General Hospital in Busto Arsizio (Dottorini et al, 1995).…”

Section: Patientsmentioning

confidence: 99%

“…However, the late health effects associated with 131 I given as treatment for thyroid cancer are difficult to assess since the number of thyroid cancer patients treated at each centre is comparatively small. To date, the impact of 131 I on the occurrence of SPM in thyroid cancer patients has been studied in only three large cohorts (Hall et al, 1991;Dottorini et al, 1995;de Vathaire et al, 1997). In an effort to obtain a more accurate quantification of the overall risk of SPM, a pooled analysis of these three cohorts was performed and follow-up data were extended beyond the original publications.…”

mentioning

confidence: 99%

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Second primary malignancies in thyroid cancer patients

et al. 2003

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The late health effects associated with radioiodine ( 131 I) given as treatment for thyroid cancer are difficult to assess since the number of thyroid cancer patients treated at each centre is limited. The risk of second primary malignancies (SPMs) was evaluated in a European cohort of thyroid cancer patients. A common database was obtained by pooling the 2-year survivors of the three major Swedish, Italian, and French cohorts of papillary and follicular thyroid cancer patients. A time-dependent analysis using external comparison was performed. The study concerned 6841 thyroid cancer patients, diagnosed during the period 1934 -1995, at a mean age of 44 years. In all, 17% were treated with external radiotherapy and 62% received 131 I. In total, 576 patients were diagnosed with a SPM. Compared to the general population of each of the three countries, an overall significantly increased risk of SPM of 27% (95% CI: 15 -40) was seen in the European cohort. An increased risk of both solid tumours and leukaemias was found with increasing cumulative activity of 131 I administered, with an excess absolute risk of 14.4 solid cancers and of 0.8 leukaemias per GBq of 131 I and 10 5 person-years of follow-up. A relationship was found between 131 I administration and occurrence of bone and soft tissue, colorectal, and salivary gland cancers. These results strongly highlight the necessity to delineate the indications of 131 I treatment in thyroid cancer patients in order to restrict its use to patients in whom clinical benefits are expected.

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Section: Discussionsupporting

confidence: 71%

Section: Discussionmentioning

confidence: 93%

Section: Patientsmentioning

confidence: 99%

Section: Patientsmentioning

confidence: 99%

mentioning

confidence: 99%

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Second primary malignancies in thyroid cancer patients

et al. 2003

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Cancer Mortality Following Treatment for Adult Hyperthyroidism

Ron

Doody²,

Becker³

et al. 1998

JAMA

323

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; for the Cooperative Thyrotoxicosis Therapy Follow-up Study Group Context.-High-dose iodine 131 is the treatment of choice in the United States for most adults with hyperthyroid disease. Although there is little evidence to link therapeutic 131 I to the development of cancer, its extensive medical use indicates the need for additional evaluation. Objective.-To evaluate cancer mortality among hyperthyroid patients, particularly after 131 I treatment. Design.-A retrospective cohort study. Setting.-Twenty-five clinics in the United States and 1 clinic in England. Patients.-A total of 35 593 hyperthyroid patients treated between 1946 and 1964 in the original Cooperative Thyrotoxicosis Therapy Follow-up Study; 91% had Graves disease, 79% were female, and 65% were treated with 131 I. Main Outcome Measure.-Standardized cancer mortality ratios (SMRs) after 3 treatment modalities for hyperthyroidism. Results.-Of the study cohort, 50.5% had died by the end of follow-up in December 1990. The total number of cancer deaths was close to that expected based on mortality rates in the general population (2950 vs 2857.6), but there was a small excess of mortality from cancers of the lung, breast, kidney, and thyroid, and a deficit of deaths from cancers of the uterus and the prostate gland. Patients with toxic nodular goiter had an SMR of 1.16 (95% confidence interval [CI], 1.03-1.30). More than 1 year after treatment, an increased risk of cancer mortality was seen among patients treated exclusively with antithyroid drugs (SMR, 1.31; 95% CI, 1.06-1.60). Radioactive iodine was not linked to total cancer deaths (SMR, 1.02; 95% CI, 0.98-1.07) or to any specific cancer with the exception of thyroid cancer (SMR, 3.94; 95% CI, 2.52-5.86). Conclusions.-Neither hyperthyroidism nor 131 I treatment resulted in a significantly increased risk of total cancer mortality. While there was an elevated risk of thyroid cancer mortality following 131 I treatment, in absolute terms the excess number of deaths was small, and the underlying thyroid disease appeared to play a role. Overall, 131 I appears to be a safe therapy for hyperthyroidism.

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