Thyroid Cancer in β-Thalassemia

Abstract

Dear Editor, Poggi et al.(1) described two cases of thyroid cancer diagnosed in a population of more than 100 patients affected by β-thalassemia major (β-TM). The longer life expectancy produced by the modern treatment of this congenital anemia also had the effect of increasing the period of time for long-term complications to evolve. By analogy with liver disease, where an increased risk of hepatocellular carcinoma has emerged in recent years, the suspicion is now emerging of a possible carcinogenic role of the unavoidable iron overload in other tissues (2-4). Poggi et al.(1) focused on thyroid cancer, a malignancy with unknown prevalence in this population; the literature on this topic is sparse, except for the recent description of five cases of papillary carcinoma in the thalassemic patients followed at the Day Hospital for Thalassaemia and Haemoglobinopathies in Ferrara, Italy (5).In this scenario, we think that everyone's experience warrants consideration, and we would like to present our own experience in a tertiary outpatient clinic in Milan, Italy, where about 170 patients with β-TM have been followed. We prescribed thyroid scans, once or repeatedly, for 88 of the patients on the basis of one or more of the following indications: family history of thyroid disease, detection of thyroid or lymph-node enlargement at physical examination of the neck, functional alteration (generally hypothyroidism).Nodules were found in 31 patients; 25 lesions were smaller than 1 cm in diameter at discovery, and free of features suspicious for malignancy. These

Frequency of Thyroid Nodules in Patients with ?-Thalassemias in Southern Iran

“…In contrast to our results, a higher incidence of thyroid nodules was found by Baldini et al in 31 out of 88 patients (35.2 %) with β-TM , who had positive family history of thyroid disease, thyroid or neck lymph node enlargement or hypothyroidism (26). Most of the detected nodules were smaller than 1 cm in diameter and no malignant cases were found.…”

The role of anaemia in oxidative and genotoxic damage in transfused β-thalassaemic patients

“…Despite the complexity of β-thalassaemia and the many confounding factors, our study indicates that appropriate blood transfusion therapy is essential to restrain oxidative and genotoxic damage. The increased life expectancy from improved disease management might make the onset of cancer more likely [37,42]. The significantly higher risk of haematological malignancies, recently observed in the thalassaemic cohorts [43], corroborate our results that showed a strong link between severe anaemia and genotoxicity.…”

“…The analogy, although only partial, between hereditary haemochromatosis and thalassaemia led to the undervaluation of the effects of chronic anaemia in the latter. Excluding hepatocellular carcinoma, malignancies were once considered rare in β-thalassaemia, but the frequency of leukaemia and other cancers is now rising [36,37]. The greater incidence of tumours is not necessarily linked to iron overload; it could also be attributable to anaemia-induced ROS overproduction which, until recently, has been underestimated in thalassaemia.…”