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Milano MT, Vargo JA, Yorke ED, Ronckers CM, Kremer LC, Chafe SMJ, van Santen HM, Marks LB, Bentzen SM, Constine LS, Vogelius IR. Primary Hypothyroidism in Childhood Cancer Survivors Treated With Radiation Therapy: A PENTEC Comprehensive Review. Int J Radiat Oncol Biol Phys 2024; 119:482-493. [PMID: 33810948 DOI: 10.1016/j.ijrobp.2021.02.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 01/04/2021] [Accepted: 02/01/2021] [Indexed: 12/14/2022]
Abstract
PURPOSE From the Pediatric Normal Tissue Effects in the Clinic (PENTEC) initiative, a systematic review and meta-analysis of publications reporting on radiation dose-volume effects for risk of primary hypothyroidism after radiation therapy for pediatric malignancies was performed. METHODS AND MATERIALS All studies included childhood cancer survivors, diagnosed at age <21 years, whose radiation therapy fields exposed the thyroid gland and who were followed for primary hypothyroidism. Children who received pituitary-hypothalamic or total-body irradiation were excluded. PubMed and the Cochrane Library were searched for studies published from 1970 to 2017. Data on age at treatment, patient sex, radiation dose to neck or thyroid gland, specific endpoints for hypothyroidism that were used in the studies, and reported risks of hypothyroidism were collected. Radiation dose-volume effects were modeled using logistic dose response. Relative excess risk of hypothyroidism as a function of age at treatment and sex was assessed by meta-analysis of reported relative risks (RR) and odds ratios. RESULTS Fifteen publications (of 1709 identified) were included for systematic review. Eight studies reported data amenable for dose-response analysis. At mean thyroid doses of 10, 20, and 30 Gy, predicted rates of uncompensated (clinical) hypothyroidism were 4%, 7%, and 13%, respectively. Predicted rates of compensated (subclinical) hypothyroidism were 12%, 25%, and 44% after thyroid doses of 10, 20, and 30 Gy, respectively. Female sex (RR = 1.7, P < .0001) and age >15 years at radiation therapy (RR = 1.3, P = .005) were associated with higher risks of hypothyroidism. After a mean thyroid dose of 20 Gy, predicted risks of hypothyroidism were 13% for males <14 years of age, increasing to 29% for females >15 years of age. CONCLUSION A radiation dose response for risk of hypothyroidism is evident; a threshold radiation dose associated with no risk is not observed. Thyroid dose exposure should be minimized when feasible. Data on hypothyroidism after radiation therapy should be better reported to facilitate pooled analyses.
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Affiliation(s)
- Michael T Milano
- Department of Radiation Oncology, University of Rochester Medical Center, Rochester, New York.
| | - John A Vargo
- Department of Radiation Oncology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Ellen D Yorke
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Cécile M Ronckers
- Department of Pediatric Oncology, Emma Children's Hospital/Amsterdam UMC Location AMC, Amsterdam, the Netherlands; Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands; Institute for Biostatistics and Registry Research, Brandenburg Medical School-Theodor Fontane, Neuruppin, Germany
| | - Leontien C Kremer
- Department of Pediatric Oncology, Emma Children's Hospital/Amsterdam UMC Location AMC, Amsterdam, the Netherlands; Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Susan M J Chafe
- Division of Radiation Oncology, Cross Cancer Institute, Edmonton, Alberta, Canada
| | - Hanneke M van Santen
- University Medical Center Utrecht and Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Lawrence B Marks
- Department of Radiation Oncology and Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina
| | - Søren M Bentzen
- Greenebaum Comprehensive Cancer Center and Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland
| | - Louis S Constine
- Department of Radiation Oncology, University of Rochester Medical Center, Rochester, New York
| | - Ivan R Vogelius
- Department of Oncology, Section of Radiotherapy, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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Cahoon EK, Grimm E, Mabuchi K, Mai JZ, Zhang R, Drozdovitch V, Hatch M, Little MP, Peters KO, Bogdanova TI, Shelkovoy E, Shpak VM, Terekhova G, Zamotayeva G, Pasteur IP, Masiuk SV, Chepurny M, Zablotska LB, McConnell R, O'Kane P, Tronko MD, Brenner AV. Prevalence of thyroid nodules in residents of Ukraine exposed as children or adolescents to iodine-131 from the Chornobyl accident. Thyroid 2024. [PMID: 38757581 DOI: 10.1089/thy.2023.0654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/18/2024]
Abstract
BACKGROUND Although childhood exposure to radioactive iodine-131 (I-131) is an established risk factor for thyroid cancer, evidence for an association with thyroid nodules is less clear. The objective of this study is to evaluate the association between childhood I-131 exposure and prevalence of ultrasound-detected thyroid nodules overall and by nodule histology/cytology (neoplastic/suspicious/non-neoplastic), size (<10 mm/≥10 mm), and number (single/multiple). METHODS This is a cross-sectional study of radiation dose (mean=0.53 gray, range:0.0003-31 gray) and screen-detected thyroid nodules conducted in 1998-2000 (median population age 21.5 years) in a cohort of 13,243 residents of Ukraine who were under 18 years at the time of the Chornobyl accident on April 26, 1986. Excess odds ratios per gray (EOR/Gy) and 95% confidence intervals (95% CI) were estimated using logistic regression. RESULTS Among 13,078 eligible individuals, we identified 358 (2.7%) with at least one thyroid nodule. Significantly increased dose-response associations were found for all nodules and nodule groups with doses <5 Gy except subjects with non-neoplastic nodules. Among subjects with doses <5 Gy, the EOR/Gy for neoplastic nodules (5.35;95% CI:2.19,15.5) was significantly higher than for non-neoplastic nodules (0.24;95% CI:-0.07,0.74), but the EOR/Gy did not vary by nodule size or number. CONCLUSIONS Childhood exposure to I-131 is associated with an increased risk of thyroid nodules detected 12-14 years following exposure and the risk for neoplastic nodules is higher than for non-neoplastic nodules. Analyses of incident thyroid nodules may help clarify dose-response patterns by nodule characteristics and provide insights into thyroid nodule etiology.
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Affiliation(s)
- Elizabeth Khaykin Cahoon
- National Cancer Institute Division of Cancer Epidemiology and Genetics, Radiation Epidemiology Branch, Bethesda, Maryland, United States;
| | - Eric Grimm
- University of Colorado School of Medicine, Aurora, Colorado, United States
- National Cancer Institute Division of Cancer Epidemiology and Genetics, Radiation Epidemiology Branch, Bethesda, Maryland, United States;
| | - Kiyohiko Mabuchi
- National Cancer Institute Division of Cancer Epidemiology and Genetics, Radiation Epidemiology Branch, Bethesda, Maryland, United States;
| | - Jim Zhiming Mai
- National Cancer Institute Division of Cancer Epidemiology and Genetics, Radiation Epidemiology Branch, 9609 Medical Center Dr., Rockville, Maryland, United States, 20850;
| | - Rui Zhang
- National Cancer Institute Division of Cancer Epidemiology and Genetics, Radiation Epidemiology Branch, Bethesda, Maryland, United States;
| | - Vladimir Drozdovitch
- National Cancer Institute, Division of Cancer Epidemiology and Genetics, Bethesda, Maryland, United States;
| | - Maureen Hatch
- National Cancer Institute, Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics , Bethesda, Maryland, United States;
| | - Mark P Little
- National Cancer Institute Division of Cancer Epidemiology and Genetics, Radiation Epidemiology Branch, Bethesda, Maryland, United States;
| | - Kamau O Peters
- National Cancer Institute Division of Cancer Epidemiology and Genetics, Radiation Epidemiology Branch, Bethesda, Maryland, United States
- US Food and Drug Administration, Silver Spring, Maryland, United States;
| | - Tetiana I Bogdanova
- V.P. Komisarenko Institute of Endocrinology and Metabolism of the National Academy of Medical Sciences of Ukraine, Laboratory of Morphology of Endocrine System, Kyiv , Ukraine;
| | - Evgeniy Shelkovoy
- V.P. Komisarenko Institute of Endocrinology and Metabolism of the National Academy of Medical Sciences of Ukraine, Kyiv , Ukraine;
| | - Victor M Shpak
- V.P. Komisarenko Institute of Endocrinology and Metabolism of the National Academy of Medical Sciences of Ukraine, DCC, Kiev, Ukraine;
| | - Galyna Terekhova
- V.P. Komisarenko Institute of Endocrinology and Metabolism of the National Academy of Medical Sciences of Ukraine, Kyiv, Ukraine;
| | - Galyna Zamotayeva
- V.P. Komisarenko Institute of Endocrinology and Metabolism of the National Academy of Medical Sciences of Ukraine, Kyiv, Ukraine;
| | - Ihor P Pasteur
- V.P. Komisarenko Institute of Endocrinology and Metabolism of the National Academy of Medical Sciences of Ukraine, Kyiv, Ukraine;
| | - Sergii V Masiuk
- Ukrainian Radiation Protection Institute, 53, Melnykova str., Kyiv, Ukraine, 04050;
| | - Mykola Chepurny
- SI National Research Center for Radiation Medicine of National Academy of Medical Sciences of Ukraine, Kyiv, Kyiv, Ukraine;
| | - Lydia B Zablotska
- UCSF School of Medicine, Division of Epidemiology and Biostatistics, 550 16th Street, San Francisco, California, United States, 94143-0410;
| | - Robert McConnell
- Columbia University Medical Center, The Thyroid Center, New York, New York, United States;
| | - Patrick O'Kane
- Jefferson University Hospital, Radiology, 796 Main Bldg, 10th and Walnut Streets, Philadelphia, Pennsylvania, United States, 19107;
| | - Mykola D Tronko
- V.P. Komisarenko Institute of Endocrinology and Metabolism of the National Academy of Medical Sciences of Ukraine, Department of Fundamental and Applied Problems of Endocrinology, 69 Vyshegorodskaya Str., Kyiv 04114, Ukraine;
| | - Alina V Brenner
- Radiation Effects Research Foundation, Epidemiology, Hiroshima, Hiroshima, Japan
- National Cancer Institute Division of Cancer Epidemiology and Genetics, Radiation Epidemiology Branch, Bethesda, Maryland, United States;
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Song C, Luo JY, Pang YY, He RQ, Li XJ, Chen G, Zhao CY, Qu N, Chen YM, Yang L, Li BQ, Shi L. Historical context, process, and development trends of pediatric thyroid cancer research: a bibliometric analysis. Front Oncol 2024; 14:1340872. [PMID: 38463235 PMCID: PMC10921230 DOI: 10.3389/fonc.2024.1340872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 01/24/2024] [Indexed: 03/12/2024] Open
Abstract
Objective At present, the structure of knowledge in the field of childhood thyroid cancer is not clear enough, and scholars lack a sufficient understanding of the developing trends in this field, which has led to a shortage of forward-looking outputs. The purpose of this research is to help scholars construct a complete knowledge framework and identify current challenges, opportunities, and development trends. Methods We searched the literature in the Web of Science Core Collection database on August 7, 2023 and extracted key information from the top 100 most cited articles, such as the countries, institutions, authors, themes, and keywords. We used bibliometric tools such as bibliometrix, VOSviewer, and CiteSpace for a visualization analysis and Excel for statistical descriptions. Results The top 100 most cited articles fluctuated over time, and the research was concentrated in European countries, the United States, and Japan, among which scientific research institutions and scholars from the United States made outstanding contributions. Keyword analysis revealed that research has shifted from simple treatment methods for pediatric thyroid cancer (total thyroidectomy) and inducing factors (the Chernobyl power station accident) to the clinical applications of genetic mutations (such as the BRAF and RET genes) and larger-scale genetic changes (mutation studies of the DICER1 gene). The thematic strategy analysis showed an increasing trend towards the popularity of fusion oncogenes, while the popularity of research on traditional treatments and diagnostics has gradually declined. Conclusion Extensive research has been conducted on the basic problems of pediatric thyroid cancer, and there has been significant outputs in the follow-up and cohort analysis of conventional diagnostic and treatment methods. However, these methods still have certain limitations. Therefore, scholars should focus on exploring fusion genes, the clinical applications of molecular targets, and novel treatment methods. This study provides a strong reference for scholars in this field.
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Affiliation(s)
- Chang Song
- Department of Pathology, Second Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Jia-Yuan Luo
- Department of Pathology, First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Yu-Yan Pang
- Department of Pathology, First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Rong-Quan He
- Department of Medical Oncology, First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Xiao-Jiao Li
- Department of Nuclear Medicine, First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Gang Chen
- Department of Pathology, First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Chun-Yan Zhao
- Department of Pathology, First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Ning Qu
- Department of Pathology, First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Yan-Mei Chen
- Department of Pathology, First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Li Yang
- Department of Pathology, Second Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Bi-Qi Li
- Department of Pathology, Second Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Lin Shi
- Department of Pathology, Second Affiliated Hospital of Guangxi Medical University, Nanning, China
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Partsalaki I, Markantes GK, Michalaki MA. Low-Glycemic Load Diets and Thyroid Function: A Narrative Review and Future Perspectives. Nutrients 2024; 16:347. [PMID: 38337632 PMCID: PMC10857036 DOI: 10.3390/nu16030347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 01/19/2024] [Accepted: 01/22/2024] [Indexed: 02/12/2024] Open
Abstract
Nutrition and calorie intake are associated with subtle changes of thyroid function tests in subjects with an intact Hypothalamic-Pituitary-Thyroid axis. Iodine deficiency and extreme fluctuations in calorie intake, such as those that occur during periods of starvation or overfeeding could lead to alterations in thyroid hormones. The dietary macronutrient and micronutrient composition could also influence the thyroid function. Recently, Low-Glycemic Load (LGL) diets have become very popular and are effective in the treatment and/or prevention of several medical conditions, including diabetes, obesity, cardiovascular disease, and epilepsy. In this review, we report on the available data from the literature regarding the association between LGL diets and thyroid function or dysfunction. Several studies conducted in this field to date have yielded inconsistent results.
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Affiliation(s)
- Ioanna Partsalaki
- Department of Nutrition and Dietetics, University Hospital of Patras, 26504 Rio, Greece;
| | - Georgios K. Markantes
- Division of Endocrinology, Department of Internal Medicine, School of Health Sciences, University of Patras, 26504 Rio, Greece;
| | - Marina A. Michalaki
- Division of Endocrinology, Department of Internal Medicine, School of Health Sciences, University of Patras, 26504 Rio, Greece;
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5
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Saenko V, Mitsutake N. Radiation-Related Thyroid Cancer. Endocr Rev 2024; 45:1-29. [PMID: 37450579 PMCID: PMC10765163 DOI: 10.1210/endrev/bnad022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 04/18/2023] [Accepted: 07/07/2023] [Indexed: 07/18/2023]
Abstract
Radiation is an environmental factor that elevates the risk of developing thyroid cancer. Actual and possible scenarios of exposures to external and internal radiation are multiple and diverse. This article reviews radiation doses to the thyroid and corresponding cancer risks due to planned, existing, and emergency exposure situations, and medical, public, and occupational categories of exposures. Any exposure scenario may deliver a range of doses to the thyroid, and the risk for cancer is addressed along with modifying factors. The consequences of the Chornobyl and Fukushima nuclear power plant accidents are described, summarizing the information on thyroid cancer epidemiology, treatment, and prognosis, clinicopathological characteristics, and genetic alterations. The Chornobyl thyroid cancers have evolved in time: becoming less aggressive and driver shifting from fusions to point mutations. A comparison of thyroid cancers from the 2 areas reveals numerous differences that cumulatively suggest the low probability of the radiogenic nature of thyroid cancers in Fukushima. In view of continuing usage of different sources of radiation in various settings, the possible ways of reducing thyroid cancer risk from exposures are considered. For external exposures, reasonable measures are generally in line with the As Low As Reasonably Achievable principle, while for internal irradiation from radioactive iodine, thyroid blocking with stable iodine may be recommended in addition to other measures in case of anticipated exposures from a nuclear reactor accident. Finally, the perspectives of studies of radiation effects on the thyroid are discussed from the epidemiological, basic science, and clinical points of view.
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Affiliation(s)
- Vladimir Saenko
- Department of Radiation Molecular Epidemiology, Atomic Bomb Disease Institute, Nagasaki University, Nagasaki 852-8523, Japan
| | - Norisato Mitsutake
- Department of Radiation Molecular Epidemiology, Atomic Bomb Disease Institute, Nagasaki University, Nagasaki 852-8523, Japan
- Department of Radiation Medical Sciences, Atomic Bomb Disease Institute, Nagasaki University, Nagasaki 852-8523, Japan
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6
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Li H, He Y, Zhao L, Song Y, Liu Y, Zhu Y, Liu S. Impact of lateral cervical lymph node metastasis on lung metastasis in pediatric thyroid cancer: A correlation study. Am J Otolaryngol 2024; 45:104063. [PMID: 37769503 DOI: 10.1016/j.amjoto.2023.104063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 09/16/2023] [Accepted: 09/20/2023] [Indexed: 10/03/2023]
Abstract
BACKGROUND Thyroid cancer (TC) frequently manifests with lung metastases in the pediatric population, occurring at a significant rate of 30 %. This study aims to evaluate the impact of regional patterns of cervical lymph node metastases on lung metastases in pediatric TC. METHODS Retrospective analysis was conducted on data from pediatric TC patients spanning the years 2000 to 2018. We compared the rates of lymph node metastasis (LNR), the number of lymph node metastases, and the number of dissected lymph nodes in the central and lateral cervical regions between patients with and without lung metastases. Statistical methods were employed to adjust for confounders during hypothesis testing. RESULTS A total of 227 pediatric patients, with a median age of 15.12 ± 2.84 years, were included in the study. Of these, 202 (89 %) exhibited LN metastasis, with 40(17.62 %) patients presenting with lung metastasis. Patients with lung metastases were found to be younger (13.40 ± 3.11 vs. 15.50 ± 2.64, p < 0.001), had larger primary tumor diameters (3.49 ± 1.98 vs. 2.31 ± 1.45, p < 0.001), and exhibited a higher number of lymph node metastases (23.40 ± 10.75 vs. 14.65 ± 13.16, p < 0.001). Notably, in patients with LN metastases, the presence of >12 lateral cervical lymph node metastases emerged as a significant risk factor for lung metastases. Among children with metachronous lung metastases, the median time to detection of lung metastases was 43 (12-132) months, and they appeared to receive a greater proportion of radioactive iodine (RAI) treatment compared to those with synchronous lung metastases. CONCLUSION Lateral cervical lymph node metastasis independently predicts the likelihood of lung metastases in pediatric TC. Furthermore, our findings emphasize the importance of thorough examination of the lungs during follow-up, particularly when the number of metastatic lateral cervical lymph nodes exceeds 12.
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Affiliation(s)
- Han Li
- Department of Head and Neck Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Yuqin He
- Department of Head and Neck Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Li Zhao
- Department of Head and Neck Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Yixuan Song
- Department of Head and Neck Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Yang Liu
- Department of Head and Neck Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Yiming Zhu
- Department of Head and Neck Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Shaoyan Liu
- Department of Head and Neck Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.
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Park SJ, Kim M, Jeong S, Park YJ, Choi S, Chang J, Oh YH, Cho SW, Park YJ, Park SM. Association Between Antibiotic Exposure and Thyroid Cancer: A Nationwide Cohort Study in South Korea. Thyroid 2024; 34:112-122. [PMID: 38009221 DOI: 10.1089/thy.2023.0235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2023]
Abstract
Background: Although recent studies have introduced antibiotics as a potential risk factor for thyroid cancer, further studies are necessary. We examined the association between long-term antibiotic usage and thyroid cancer risk. Methods: This nationwide cohort study investigated 9,804,481 individuals aged 20 years or older who participated in health screening (2005-2006) with follow-up ending on December 31, 2019, using the Korean National Health Insurance Service database. Multivariable Cox proportional hazards regression was used to estimate adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) for thyroid cancer risk according to the cumulative days of antibiotic prescription and the number of antibiotic classes, respectively. A 1:1 propensity score (PS) matching was also performed for analysis. Results: Compared with nonusers of antibiotics, participants prescribed ≥365 days of antibiotics showed an increased risk of thyroid cancer (aHR, 1.71; CI, 1.66-1.78) after adjusting for covariates including age, smoking status, comorbidities including thyroid-related diseases, and the number of head and neck computed tomography scans. Participants prescribed ≥365 days of antibiotics also had a significantly increased risk of thyroid cancer (aHR, 1.37; CI, 1.34-1.40) compared with participants prescribed 1-14 days of antibiotics. Association remained significant in the 1:1 PS-matched cohort. Moreover, compared with nonusers of antibiotics, the 5 or more antibiotic class user group had a higher thyroid cancer risk (aHR, 1.71; CI, 1.65-1.78). Conclusions: Long-term antibiotic prescriptions and an increasing number of antibiotic classes may be associated with a higher risk of thyroid cancer in a duration-dependent manner. The effects of long-term antibiotic exposure on thyroid cancer should be further investigated.
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Affiliation(s)
- Sun Jae Park
- Department of Biomedical Sciences, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Minseo Kim
- Department of Biomedical Sciences, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
- College of Medicine, Jeonbuk National University, Jeonju, South Korea
| | - Seogsong Jeong
- Department of Biomedical Informatics, CHA University School of Medicine, Seongnam, South Korea
| | - Young Jun Park
- Medical Research Center, Genomic Medicine Institute, Seoul National University, Seoul, South Korea
| | - Seulggie Choi
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Jooyoung Chang
- Department of Biomedical Sciences, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Yun Hwan Oh
- Department of Family Medicine, Chung-Ang University Gwangmyeong Hospital, Chung-Ang University College of Medicine, Gwangmyeong-si, South Korea
| | - Sun Wook Cho
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Young Joo Park
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
- Department of Molecular Medicine and Biopharmaceutical Sciences, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, South Korea
| | - Sang Min Park
- Department of Biomedical Sciences, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
- Department of Family Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
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8
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Mirkatouli NB, Hirota S, Yoshinaga S. Thyroid cancer risk after radiation exposure in adults-systematic review and meta-analysis. JOURNAL OF RADIATION RESEARCH 2023; 64:893-903. [PMID: 37816676 PMCID: PMC10665305 DOI: 10.1093/jrr/rrad073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 08/16/2023] [Accepted: 09/11/2023] [Indexed: 10/12/2023]
Abstract
Notably, the growing use of radionuclear technology, especially in diagnostic and therapeutic procedures involving radiation exposure, raises concerns about the health effects of radiation. Although epidemiological studies have provided strong evidence for elevated thyroid cancer risk after radiation exposure in childhood, the risk of thyroid cancer associated with adult exposure remains to be investigated. We conducted a systematic review and meta-analysis of relevant studies on the risk of developing thyroid cancer after radiation exposure in adulthood. The PubMed and Web of Science databases were used to select eligible articles. After screening, a total of 15 studies were identified in which estimates of the standardized incidence ratio (SIR) and the relative risk (RR) of thyroid cancer were available in 8 and 11 studies, respectively. The overall SIR estimated by the random effects model was 2.19 [95% confidence interval (CI), 1.54, 3.10]. Cochran's Q test showed significant heterogeneity in the SIRs (Q = 178, P < 0.0001). The overall RR at 10 mGy was 1.0038 (95% CI, 0.9991, 1.0085), with no significant heterogeneity (Q = 9.30, P = 0.5041). The total SIR, as well as that from each study, indicated a statistically significant excess, which could be related to screening bias. Radiation-related thyroid cancer risk was elevated in a few studies; however, the overall estimate of the RR at 10 mGy was not significant. This study demonstrates no strong epidemiological evidence for the risk of thyroid cancer in radiation exposure during adulthood; however, further research is needed.
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Affiliation(s)
- Nafiseh Beygom Mirkatouli
- Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima City, Hiroshima 734-8553, Japan
- Research Institute for Radiation Biology and Medicine, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima City, Hiroshima 732-8553, Japan
| | - Seiko Hirota
- Research Institute for Radiation Biology and Medicine, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima City, Hiroshima 732-8553, Japan
| | - Shinji Yoshinaga
- Research Institute for Radiation Biology and Medicine, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima City, Hiroshima 732-8553, Japan
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Moleti M, Aversa T, Crisafulli S, Trifirò G, Corica D, Pepe G, Cannavò L, Di Mauro M, Paola G, Fontana A, Calapai F, Cannavò S, Wasniewska M. Global incidence and prevalence of differentiated thyroid cancer in childhood: systematic review and meta-analysis. Front Endocrinol (Lausanne) 2023; 14:1270518. [PMID: 37795368 PMCID: PMC10546309 DOI: 10.3389/fendo.2023.1270518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 08/29/2023] [Indexed: 10/06/2023] Open
Abstract
Objective Differentiated thyroid cancer (DTC) is rare in childhood and adolescence although it represents the most frequent endocrine malignancy in this population. DTC includes both papillary thyroid carcinoma (PTC) and follicular thyroid carcinoma (FTC). Most pediatric DTCs are PTCs, while FTCs are rare. To date, no systematic reviews on the global epidemiology of pediatric and adolescent DTC have been published. This systematic review and meta-analysis aims to estimate the overall incidence and prevalence of DTCs in patients aged 0-19 years. Methods The systematic research was conducted from January 2000 to December 2021 through MEDLINE via PubMed, Cochrane Library, and Embase databases. Two separate meta-analyses were performed for PTC and FTC. Results After the selection phase, a total of 15 studies (3,332 screened) met the inclusion criteria and are reported in the present systematic review. Five studies were conducted in Europe, five in North America, two in South America, one in Asia, one reported data for 49 countries and territories across the five continents, and one from both the USA and Africa. Most of the studies (n = 14) reported data obtained from national registries, and only one provided information collected from hospital medical records. Beyond the actual trend over time, our study reported a pooled global incidence rate (IR) of PTC and FTC in the pediatric age of 0.46 (95% CI: 0.33-0.59) and 0.07 (95% CI: 0.02-0.12) per 100,000 person-years, respectively. The highest IRs were recorded among Caucasian girls, and the lowest in black or other races/ethnicities. Conclusion Our data confirm that DTC in the pediatric population is a rare condition. The pooled IRs of the studies included in this meta-analysis are ~0.5 for PTC, which is the most common histological type when both genders and all age groups are considered. The implementation of a prospective international registry on pediatric DTC, as part of the wider European Registries for Rare Endocrine Conditions, has been recently proposed. In addition to providing relevant information on the clinical behavior of this rare disease, standardization of data collection will be pivotal to fill current gaps and allow an accurate estimation of the real incidence and risk factors of DTC.
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Affiliation(s)
- Mariacarla Moleti
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Tommaso Aversa
- Department of Human Pathology of Adulthood and Childhood, University of Messina, Messina, Italy
| | | | - Gianluca Trifirò
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Domenico Corica
- Department of Human Pathology of Adulthood and Childhood, University of Messina, Messina, Italy
| | - Giorgia Pepe
- Department of Human Pathology of Adulthood and Childhood, University of Messina, Messina, Italy
| | - Laura Cannavò
- Department of Human Pathology of Adulthood and Childhood, University of Messina, Messina, Italy
| | - Maria Di Mauro
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Giuseppe Paola
- Unit of Endocrinology, University Hospital Policlinico “G. Martino”, Messina, Italy
| | - Andrea Fontana
- Unit of Biostatistics, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Fabrizio Calapai
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, Messina, Italy
| | - Salvatore Cannavò
- Department of Human Pathology of Adulthood and Childhood, University of Messina, Messina, Italy
| | - Malgorzata Wasniewska
- Department of Human Pathology of Adulthood and Childhood, University of Messina, Messina, Italy
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10
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Jacob RA, Bade B, Joffe L, Makkar P, Alfano CM. The Evaluation and Management of Visceral Complications in Radiation Fibrosis Syndrome Part 1. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2023; 11:1-14. [PMID: 37359732 PMCID: PMC10043528 DOI: 10.1007/s40141-023-00391-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2023] [Indexed: 03/30/2023]
Abstract
Abstract External beam ionizing radiation is a fundamental component of cancer treatment and is incorporated into approximately 50% of cancer treatments. Radiation therapy causes cell death directly by apoptosis and indirectly by disruption of mitosis. Purpose of Review This study aims to inform rehabilitation clinicians of the visceral toxicities of radiation fibrosis syndrome and how to detect and diagnose these complications. Recent Findings Latest research indicates that radiation toxicity is primarily related to radiation dose, patient co-morbidity, and concomitant use of chemotherapies and immunotherapies for the treatment of cancer. While cancer cells are the primary target, surrounding normal cells and tissues are also affected. Radiation toxicity is dose dependent, and tissue injury develops from inflammation that may progress to fibrosis. Thus, radiation dosing in cancer therapy is often limited by tissue toxicity. Although newer radiotherapeutic modalities aim to limit delivery of radiation to non-cancerous tissues, many patients continue to experience toxicity. Summary To ensure early recognition of radiation toxicity and fibrosis, it is imperative that all clinicians are aware of the predictors, signs, and symptoms of radiation fibrosis syndrome. Here, we present part 1 of the visceral complications of radiation fibrosis syndrome, addressing radiation-related toxicity in the heart, lungs, and thyroid gland. Graphical abstract
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11
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Ehrhardt MJ, Dixon SB, Belsky J, Hochberg J. Late effects and frontline treatment selection for children with non-Hodgkin lymphoma. Best Pract Res Clin Haematol 2023; 36:101443. [PMID: 36907640 DOI: 10.1016/j.beha.2023.101443] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 01/31/2023] [Indexed: 02/05/2023]
Abstract
Approximately 1 in 640 adults between 20 and 40 years of age is a survivor of childhood cancer. However, survival has often come at the expense of increased risk of long-term complications, including chronic health conditions and higher mortality rates. Similarly, long-term survivors of childhood non-Hodgkin lymphoma (NHL) experience significant morbidity and mortality related to prior cancer treatments, highlighting the importance of primary and secondary prevention strategies to mitigate late toxicity. As a result, effective treatment regimens for pediatric NHL have evolved to reduce both short- and long-term toxicity through cumulative dose reductions and elimination of radiation. The establishment of effective regimens facilitates shared decision-making opportunities for frontline treatment selection that considers efficacy, acute toxicity, convenience, and late effects of treatments. The current review seeks to merge current frontline treatment regimens with survivorship guidelines to enhance understanding of potential long-term health risks to facilitate best treatment practices.
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Affiliation(s)
- Matthew J Ehrhardt
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA; Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA.
| | - Stephanie B Dixon
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA; Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Jennifer Belsky
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Jessica Hochberg
- Department of Pediatrics, New York Medical College, Valhalla, NY, USA
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12
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Sandy JL, Titmuss A, Hameed S, Cho YH, Sandler G, Benitez-Aguirre P. Thyroid nodules in children and adolescents: Investigation and management. J Paediatr Child Health 2022; 58:2163-2168. [PMID: 36382588 PMCID: PMC10099987 DOI: 10.1111/jpc.16257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 07/19/2022] [Accepted: 10/09/2022] [Indexed: 11/17/2022]
Abstract
Clinically detectable thyroid nodules are less common in children than adults. However, they are associated with an increased risk of malignancy. Therefore, thorough evaluation of paediatric thyroid nodules is necessary, and an understanding of the features associated with a higher risk of malignancy is important to guide management and referral. Thyroid cancer in children differs significantly from that seen in adults in terms of genetics, presentation, response to treatment and prognosis. Children often present with more advanced disease, but the vast majority have excellent long-term prognosis. Evaluation and management of thyroid nodules and thyroid cancer require a multidisciplinary team approach and involvement of specialists with experience in this field. This review summarises investigative pathways for thyroid nodules in children and outlines current management strategies for paediatric thyroid nodules and cancer.
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Affiliation(s)
- Jessica L Sandy
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Westmead, New South Wales, Australia.,Child & Adolescent Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Angela Titmuss
- Division of Women, Children and Youth, Royal Darwin Hospital, Darwin, Australia.,Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Shihab Hameed
- Child & Adolescent Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.,Paediatric Endocrinology, Sydney Children's Hospital Network, New South Wales, Australia.,School of Women and Children, University of New South Wales, New South Wales, Australia
| | - Yoon Hi Cho
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Westmead, New South Wales, Australia.,Child & Adolescent Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Gideon Sandler
- Department of Surgery, The Children's Hospital at Westmead, Westmead, New South Wales, Australia.,School of Health Sciences, University of Sydney, New South Wales, Australia
| | - Paul Benitez-Aguirre
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Westmead, New South Wales, Australia.,Child & Adolescent Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
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13
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Lebbink CA, Links TP, Czarniecka A, Dias RP, Elisei R, Izatt L, Krude H, Lorenz K, Luster M, Newbold K, Piccardo A, Sobrinho-Simões M, Takano T, Paul van Trotsenburg AS, Verburg FA, van Santen HM. 2022 European Thyroid Association Guidelines for the management of pediatric thyroid nodules and differentiated thyroid carcinoma. Eur Thyroid J 2022; 11:e220146. [PMID: 36228315 PMCID: PMC9716393 DOI: 10.1530/etj-22-0146] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 10/13/2022] [Indexed: 11/08/2022] Open
Abstract
At present, no European recommendations for the management of pediatric thyroid nodules and differentiated thyroid carcinoma (DTC) exist. Differences in clinical, molecular, and pathological characteristics between pediatric and adult DTC emphasize the need for specific recommendations for the pediatric population. An expert panel was instituted by the executive committee of the European Thyroid Association including an international community of experts from a variety of disciplines including pediatric and adult endocrinology, pathology, endocrine surgery, nuclear medicine, clinical genetics, and oncology. The 2015 American Thyroid Association Pediatric Guideline was used as framework for the present guideline. Areas of discordance were identified, and clinical questions were formulated. The expert panel members discussed the evidence and formulated recommendations based on the latest evidence and expert opinion. Children with a thyroid nodule or DTC require expert care in an experienced center. The present guideline provides guidance for healthcare professionals to make well-considered decisions together with patients and parents regarding diagnosis, treatment, and follow-up of pediatric thyroid nodules and DTC.
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Affiliation(s)
- Chantal A Lebbink
- Wilhelmina Children’s Hospital and Princess Máxima Center, Utrecht, The Netherlands
| | - Thera P Links
- Department of Endocrinology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Agnieszka Czarniecka
- The Oncologic and Reconstructive Surgery Clinic, M. Sklodowska-Curie National Research Institute of Oncology Gliwice Branch, Gliwice, Poland
| | - Renuka P Dias
- Department of Paediatric Endocrinology and Diabetes, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, United Kingdom
| | - Rossella Elisei
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Louise Izatt
- Department of Clinical Genetics, Guy's and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Heiko Krude
- Institute of Experimental Pediatric Endocrinology, Charité - Universitätsmedizin, Berlin, Germany
| | - Kerstin Lorenz
- Department of Visceral, Vascular and Endocrine Surgery, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Markus Luster
- Department of Nuclear Medicine, University Hospital Marburg, Marburg, Germany
| | - Kate Newbold
- Thyroid Therapy Unit, The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Arnoldo Piccardo
- Department of Nuclear Medicine, EO Ospedali Galliera, Genoa, Italy
| | - Manuel Sobrinho-Simões
- University Hospital of São João, Medical Faculty and Institute of Molecular Pathology and Immunology, University of Porto, Porto, Portugal
| | - Toru Takano
- Thyroid Center, Rinku General Medical Center, Osaka, Japan
| | - A S Paul van Trotsenburg
- Department of Pediatric Endocrinology, Emma Children's Hospital, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Frederik A Verburg
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Hanneke M van Santen
- Wilhelmina Children’s Hospital and Princess Máxima Center, Utrecht, The Netherlands
- Correspondence should be addressed to H M van Santen;
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14
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Wang Y, Kremer LCM, van Leeuwen FE, Armstrong GT, Leisenring W, de Vathaire F, Hudson MM, Kuehni CE, Arnold MA, Haddy N, Demoor-Goldschmidt C, Diallo I, Howell RM, Ehrhardt MJ, Moskowitz CS, Neglia JP, van der Pal HJH, Robison LL, Schaapveld M, Turcotte LM, Waespe N, Ronckers CM, Teepen JC. Cohort profile: Risk and risk factors for female breast cancer after treatment for childhood and adolescent cancer: an internationally pooled cohort. BMJ Open 2022; 12:e065910. [PMID: 36344003 PMCID: PMC9644351 DOI: 10.1136/bmjopen-2022-065910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE The International Consortium for Pooled Studies on Subsequent Malignancies after Childhood and Adolescent Cancer was established in 2018 to address gaps in knowledge of risk and risk factors for breast cancer subsequent to childhood/adolescent cancer by pooling individual patient data from seven cohorts. Initially, the pooled cohort will focus on three clinically relevant questions regarding treatment-related subsequent breast cancer risk in female survivors, which are the risk related to low-dose radiotherapy exposure to the chest, specific chemotherapy agents and attained age. PARTICIPANTS The consortium database includes pooled data on 21 892 female survivors from seven cohorts in North America and Europe with a primary cancer diagnosis at <21 years of age, and survival ≥5 years from diagnosis. FINDINGS TO DATE This is a newly established pooled study. The cohort profile summarised the data collected from each included cohort, including childhood cancer diagnosis information and treatment details (ie, radiotherapy fields and cumulative doses, and chemotherapy agents and cumulative doses for each agent). Included cohorts' follow-up started 1951-1981 and ended 2013-2021, respectively, for a median follow-up duration of 24.3 (IQR 18.0-32.8) years since primary cancer diagnosis. The median age at primary cancer diagnosis was 5.4 (IQR 2.5-11.9) years. And the median attained age at last follow-up was 32.2 (IQR 24.0-40.4) years. In all, 4240 (19.4%) survivors were treated with radiotherapy to the chest and 9308 (42.5%) with anthracyclines. At the end of the follow-up, 835 females developed a first subsequent breast cancer, including 635 invasive breast cancer only, 184 carcinomas in situ only (172 ductal carcinomas in situ and 12 lobular carcinomas in situ), and 16 with both an invasive and in situ diagnosis at the same moment. The cumulative incidences of subsequent breast cancer (both invasive and in situ) 25 and 35 years after primary cancer diagnosis were 2.2% and 6.2%, respectively. FUTURE PLANS The consortium is intended to serve as a model and robust source of childhood/adolescent cancer survivor data for elucidating other knowledge gaps on subsequent breast cancer risk, and risk of other subsequent malignancies (including data on males) in the future.
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Affiliation(s)
- Yuehan Wang
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Leontien C M Kremer
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- University Medical Center Utrecht, Wilhelmina Children's Hospital, Utrecht, The Netherlands
- Emma Children's Hospital, Amsterdam University Medical Center (UMC), University of Amsterdam, Amsterdam, The Netherlands
| | | | | | - Wendy Leisenring
- Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Florent de Vathaire
- Radiation Epidemiology Team, INSERM U1018, Gustave Roussy, Villejuif, France
| | | | - Claudia E Kuehni
- Childhood Cancer Research Group, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Pediatric Hematology and Oncology, University Children's Hospital Bern, University of Bern, Bern, Switzerland
| | - Michael A Arnold
- Department of Pathology and Laboratory Medicine, Children's Hospital Colorado, Aurora, Colorado, USA
- Department of Pathology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Nadia Haddy
- Radiation Epidemiology Team, INSERM U1018, Gustave Roussy, Villejuif, France
| | - Charlotte Demoor-Goldschmidt
- Radiation Epidemiology Team, INSERM U1018, Gustave Roussy, Villejuif, France
- Department of Pediatric Hematology and Oncology, University-Hospital of Angers, Angers, France
- Radiotherapy department, Francois Baclesse center, Caen, France
- Supportive care department, Francois Baclesse center, Caen, France
| | - Ibrahima Diallo
- Radiation Epidemiology Team, INSERM U1018, Gustave Roussy, Villejuif, France
| | - Rebecca M Howell
- University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA
| | | | | | - Joseph P Neglia
- University of Minnesota Masonic Cancer Center, Minneapolis, Minnesota, USA
| | | | | | | | - Lucie M Turcotte
- University of Minnesota Masonic Cancer Center, Minneapolis, Minnesota, USA
| | - Nicolas Waespe
- Childhood Cancer Research Group, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Pediatric Hematology and Oncology, University Children's Hospital Bern, University of Bern, Bern, Switzerland
- CANSEARCH research platform in pediatric oncology and hematology, University of Geneva, Geneva, Switzerland
| | - Cécile M Ronckers
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Department of Health Services Research, Carl von Ossietzky University of Oldenburg, Oldenburg, Germany
| | - Jop C Teepen
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
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15
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Karapinar E, Varkal M, Saka N. LONG-TERM THYROID DISORDERS IN CHILDREN RECEIVING ONCOLOGIC TREATMENT AND RADIOTHERAPY. ACTA ENDOCRINOLOGICA (BUCHAREST, ROMANIA : 2005) 2022; 18:429-435. [PMID: 37152881 PMCID: PMC10162817 DOI: 10.4183/aeb.2022.429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
Context Childhood cancer survival has increased substantially over the past few decades. However, long-term side effects associated with cancer treatment have also risen. Especially thyroid gland disorders are common. Objective and Design The present retrospective cross-sectional study aimed to investigate risk factors of long-term TD in survivors of leukemia-lymphoma. Subjects and Methods The study included 44 acute lymphoblastic leukemia (ALL) and 26 Hodgkin lymphoma survivors (HL). Abnormal laboratory and pathological ultrasonographic findings of the thyroid gland were accepted as a thyroid disorder. The possible causes of thyroid disorders were investigated. Results Long-term thyroid disorder was found in 40% of the patients. This rate was higher in HL patients than in ALL (65% vs. 25%). Thyroid disorder was significantly more common in patients who received radiotherapy to the neck (57% vs. 17%). Radiotherapy to the neck area was the only significant determinant for thyroid disorders in the regression models [OR 33.17, 95% CI (2.76-398.9) p = 0.006]. However, HL remained significantly associated with TD in the logistic model performed using cancer type [OR 19.25, 95% CI (2.39-155.3) p = 0.006]. Conclusions The study showed that radiotherapy applied to the neck was an essential risk factor for long-term TD in the average 6-year follow-up of cancer survivors. However, we recommend that childhood cancer survivors should be followed closely for a long time since long-term endocrine side effects were reported during longer than six years follow-up periods.
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Affiliation(s)
- E. Karapinar
- Istanbul University, Faculty of Medicine − Pediatrics, Istanbul, Fatih, Turkey
| | - M.A. Varkal
- Istanbul University, Faculty of Medicine − Pediatrics, Istanbul, Fatih, Turkey
| | - N. Saka
- Istanbul University, Faculty of Medicine − Pediatrics, Istanbul, Fatih, Turkey
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16
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Little MP, Cahoon EK, Gudzenko N, Mabuchi K, Drozdovitch V, Hatch M, Brenner AV, Vij V, Chizhov K, Bakhanova E, Trotsyuk N, Kryuchkov V, Golovanov I, Chumak V, Bazyka D. Impact of uncertainties in exposure assessment on thyroid cancer risk among cleanup workers in Ukraine exposed due to the Chornobyl accident. Eur J Epidemiol 2022; 37:837-847. [PMID: 35226216 PMCID: PMC10641599 DOI: 10.1007/s10654-022-00850-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 02/05/2022] [Indexed: 11/03/2022]
Abstract
A large excess risk of thyroid cancer was observed among Belarusian/Russian/Baltic Chornobyl cleanup workers. A more recent study of Ukraine cleanup workers found more modest excess risks of thyroid cancer. Dose errors in this data are substantial, associated with model uncertainties and questionnaire response. Regression calibration is often used for dose-error adjustment, but may not adequately account for the full error distribution. We aimed to examine the impact of exposure-assessment uncertainties on thyroid cancer among Ukrainian cleanup workers using Monte Carlo maximum likelihood, and compare with results derived using regression calibration. Analyses assessed the sensitivity of results to various components of internal and external dose. Regression calibration yielded an excess odds ratio per Gy (EOR/Gy) of 0.437 (95% CI - 0.042, 1.577, p = 0.100), compared with the EOR/Gy using Monte Carlo maximum likelihood of 0.517 (95% CI - 0.039, 2.035, p = 0.093). Trend risk estimates for follicular morphology tumors exhibited much more extreme effects of full-likelihood adjustment, the EOR/Gy using regression calibration of 3.224 (95% CI - 0.082, 30.615, p = 0.068) becoming ~ 50% larger, 4.708 (95% CI - 0.075, 85.143, p = 0.066) when using Monte Carlo maximum likelihood. Results were sensitive to omission of external components of dose. In summary, use of Monte Carlo maximum likelihood adjustment for dose error led to increases in trend risks, particularly for follicular morphology thyroid cancers, where risks increased by ~ 50%, and were borderline significant. The unexpected finding for follicular tumors needs to be replicated in other exposed groups.
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Affiliation(s)
- Mark P Little
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA.
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, Department of Health and Human Services, National Cancer Institute, National Institutes of Health, 9609 Medical Center Drive, Bethesda, MD, 20892-9778, USA.
| | - Elizabeth K Cahoon
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Natalia Gudzenko
- National Research Centre for Radiation Medicine, Kyiv, 04050, Ukraine
| | - Kiyohiko Mabuchi
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Vladimir Drozdovitch
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Maureen Hatch
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | | | - Vibha Vij
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Konstantin Chizhov
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Elena Bakhanova
- National Research Centre for Radiation Medicine, Kyiv, 04050, Ukraine
| | - Natalia Trotsyuk
- National Research Centre for Radiation Medicine, Kyiv, 04050, Ukraine
| | - Victor Kryuchkov
- Burnasyan Federal Medical and Biophysical Centre, 46 Zhivopisnaya Street, Moscow, Russia, 123182
| | - Ivan Golovanov
- Burnasyan Federal Medical and Biophysical Centre, 46 Zhivopisnaya Street, Moscow, Russia, 123182
| | - Vadim Chumak
- National Research Centre for Radiation Medicine, Kyiv, 04050, Ukraine
| | - Dimitry Bazyka
- National Research Centre for Radiation Medicine, Kyiv, 04050, Ukraine
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17
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Kitahara CM, Schneider AB. Epidemiology of Thyroid Cancer. Cancer Epidemiol Biomarkers Prev 2022; 31:1284-1297. [PMID: 35775227 PMCID: PMC9473679 DOI: 10.1158/1055-9965.epi-21-1440] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 03/23/2022] [Accepted: 04/11/2022] [Indexed: 01/03/2023] Open
Affiliation(s)
- Cari M. Kitahara
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Arthur B. Schneider
- University of Illinois at Chicago, College of Medicine, Department of Medicine, Chicago, IL, USA
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18
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It may not all be overdiagnosis: the potential role of environmental exposures in the thyroid cancer incidence increase. Epidemiology 2022; 33:607-610. [PMID: 35731932 DOI: 10.1097/ede.0000000000001519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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19
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Wakeford R, Hauptmann M. The risk of cancer following high, and very high, doses of ionising radiation. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2022; 42:020518. [PMID: 35671754 DOI: 10.1088/1361-6498/ac767b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 06/07/2022] [Indexed: 06/15/2023]
Abstract
It is established that moderate-to-high doses of ionising radiation increase the risk of subsequent cancer in the exposed individual, but the question arises as to the risk of cancer from higher doses, such as those delivered during radiotherapy, accidents, or deliberate acts of malice. In general, the cumulative dose received during a course of radiation treatment is sufficiently high that it would kill a person if delivered as a single dose to the whole body, but therapeutic doses are carefully fractionated and high/very high doses are generally limited to a small tissue volume under controlled conditions. The very high cumulative doses delivered as fractions during radiation treatment are designed to inactivate diseased cells, but inevitably some healthy cells will also receive high/very high doses. How the doses (ranging from <1 Gy to tens of Gy) received by healthy tissues during radiotherapy affect the risk of second primary cancer is an increasingly important issue to address as more cancer patients survive the disease. Studies show that, except for a turndown for thyroid cancer, a linear dose-response for second primary solid cancers seems to exist over a cumulative gamma radiation dose range of tens of gray, but with a gradient of excess relative risk per Gy that varies with the type of second cancer, and which is notably shallower than that found in the Japanese atomic bomb survivors receiving a single moderate-to-high acute dose. The risk of second primary cancer consequent to high/very high doses of radiation is likely to be due to repopulation of heavily irradiated tissues by surviving stem cells, some of which will have been malignantly transformed by radiation exposure, although the exact mechanism is not known, and various models have been proposed. It is important to understand the mechanisms that lead to the raised risk of second primary cancers consequent to the receipt of high/very high doses, in particular so that the risks associated with novel radiation treatment regimens-for example, intensity modulated radiotherapy and volumetric modulated arc therapy that deliver high doses to the target volume while exposing relatively large volumes of healthy tissue to low/moderate doses, and treatments using protons or heavy ions rather than photons-may be properly assessed.
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Affiliation(s)
- Richard Wakeford
- Centre for Occupational and Environmental Health, The University of Manchester, Oxford Road, Manchester M13 9PL, United Kingdom
| | - Michael Hauptmann
- Institute of Biostatistics and Registry Research, Brandenburg Medical School, Fehrbelliner Strasse 38, 16816 Neuruppin, Germany
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Duarte V, Maciel J, Cavaco D, Donato S, Damásio I, Pinheiro S, Figueiredo A, Ferreira A, Pereira JS. Predictive factors for thyroid complications after radiation therapy-data from a cohort of cancer patients closely followed since they were irradiated. Clin Endocrinol (Oxf) 2022; 96:728-733. [PMID: 34978354 DOI: 10.1111/cen.14665] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 11/13/2021] [Accepted: 12/14/2021] [Indexed: 01/13/2023]
Abstract
INTRODUCTION Cancer survivors are at an increased risk of adverse outcomes, including thyroid neoplasms, given the high radiosensitivity of this gland. The aim of this study is to assess the incidence and timeframe of thyroid complications in cancer patients, followed systematically since their radiation therapy, and to identify risk factors for the development of hypothyroidism and thyroid cancer. METHODS We performed a retrospective study, including 282 subjects, who received neck, craniospinal, or total body irradiation (TBI). Patients were grouped into four primary diagnostic clusters: leukaemia, Hodgkin's disease, central nervous system, and head and neck tumours. RESULTS Hypothyroidism was observed in 56.7% of patients, on average 6.8 ± 5.9 years after the treatment. Neck and craniospinal irradiation presented a 3.5-fold increased risk for the development of hypothyroidism compared to TBI. Papillary thyroid cancer was diagnosed in 8.5% of the patients, on average, 18.5 ± 4.9 years after radiotherapy (RT). Female gender, younger age, and lower irradiation doses were independently associated with thyroid cancer development. CONCLUSION Our study provides useful information about the risk of hypothyroidism and thyroid cancer after RT, as it was performed in a cohort of patients closely followed since the oncological therapies, and, thus, may give new insights into the follow-up management of these patients.
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Affiliation(s)
- Vitoria Duarte
- Endocrinology Department, Hospital das Forças Armadas, Lisboa, Portugal
| | - Joana Maciel
- Endocrinology Department, Instituto Português de Oncologia Francisco Gentil, Lisboa, Portugal
| | - Daniela Cavaco
- Endocrinology Department, Instituto Português de Oncologia Francisco Gentil, Lisboa, Portugal
| | - Sara Donato
- Endocrinology Department, Instituto Português de Oncologia Francisco Gentil, Lisboa, Portugal
| | - Inês Damásio
- Endocrinology Department, Instituto Português de Oncologia Francisco Gentil, Lisboa, Portugal
| | - Sara Pinheiro
- Endocrinology Department, Instituto Português de Oncologia Francisco Gentil, Lisboa, Portugal
| | - Ana Figueiredo
- Endocrinology Department, Instituto Português de Oncologia Francisco Gentil, Lisboa, Portugal
| | - Ana Ferreira
- Endocrinology Department, Hospital Garcia da Orta, Almada, Portugal
| | - Joana S Pereira
- Endocrinology Department, Instituto Português de Oncologia Francisco Gentil, Lisboa, Portugal
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Tringale KR, Casey DL, Niyazov G, Lavery JA, Moskowitz C, Friedman DN, Wolden SL. Second cancer risk in childhood cancer survivors treated with intensity-modulated radiation therapy: An updated analysis of more than 10 years of follow-up. Pediatr Blood Cancer 2022; 69:e29600. [PMID: 35234340 PMCID: PMC9476885 DOI: 10.1002/pbc.29600] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 01/24/2022] [Accepted: 01/29/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND It is unclear how intensity-modulated radiation therapy (IMRT) impacts long-term risk of second malignant neoplasms (SMNs) in childhood cancer patients. PROCEDURE Patients aged ≤21 years treated with IMRT between 1998 and 2009 and who survived ≥5 years after IMRT were included. SMN site in relation to isodose level (IDL) of IMRT was evaluated. Standardized incidence ratios (SIR) and excess absolute risks (EAR) were calculated. Cumulative incidences were estimated with death as a competing risk. RESULTS Three-hundred twenty-five patients were included with median follow-up of 11.2 years from IMRT (interquartile range: 9.4-14.0) among patients alive at the end of follow-up. Two hundred (62%) patients had ≥10 years of follow-up and 284 (87%) patients were alive at the time of analysis. Fifteen patients developed SMNs (11 solid, four hematologic). Median time from IMRT to solid SMN was 11.0 years (range: 6.8-19.2) with 10- and 15-year cumulative incidences 1.8% (95% CI: 0.7-3.9) and 3.5% (95% CI: 1.4-7.5), respectively; SIR was 13.7 (95% CI: 6.9-24.6) and EAR was 2.8 per 1000 person-years (95% CI: 1.0-4.6). Eight solid SMNs developed within the IMRT field (100% IDL [n = 5], 80% IDL [n = 1], 50% IDL [n = 1], 40% IDL [n = 1]), one within the 70%-80% IDL of a conventional field, one was out-of-field, and one could not be determined. CONCLUSIONS With median follow-up of >10 years, many solid SMNs after IMRT in childhood cancer survivors develop in the high-dose region. These data serve as a foundation for comparison with other modalities of radiation treatment (e.g., proton therapy).
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Affiliation(s)
| | - Dana L. Casey
- Department of Radiation Oncology, University of North Carolina
| | - Gregory Niyazov
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center
| | - Jessica A. Lavery
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center
| | - Chaya Moskowitz
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center
| | | | - Suzanne L. Wolden
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center
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Duque CS, Vélez A, Cuartas J, Jaimes F, Dueñas JP, Agudelo M, Nikiforova MN, Nikiforov YE, Condello V. Molecular profiling of papillary thyroid carcinomas in healthcare workers exposed to low dose radiation at the workplace. Endocrine 2022; 76:95-100. [PMID: 35094311 DOI: 10.1007/s12020-021-02972-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 12/22/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE Exposure to ionizing radiation, especially during childhood, is a well-established risk factor for thyroid cancer. The vast majority of radiation-induced cancers are papillary carcinomas (PTCs). These tumors typically have gene fusions in contrast to point mutations prevalent in sporadic PTCs. The aim of this study was to investigate the molecular profiles of PTC patients with workplace exposure to ionizing radiation. METHODS A retrospective review of 543 patients who underwent surgery with diagnosis of PTC was performed. A cohort of nine healthcare specialists previously exposed to radiation sources during their professional practice was selected and analyzed using the ThyroSeq mutation panel for point mutations and gene fusions associated with thyroid cancer. RESULTS The molecular analysis of surgical samples of PTCs was informative and revealed genetic alterations in five patients. BRAF V600E was found in four (67%) cases whereas RET/PTC1 fusion in one (17%) and one sample (17%) was wild type for point mutations and fusions. One sample completely failed molecular analysis while two others were negative for genes fusions but failed DNA analysis; these three samples were excluded. CONCLUSIONS In this limited cohort of healthcare workers exposed to low dose of ionizing radiation at the workplace and developed PTC, the molecular profiling determined BRAF V600E point mutation as the most common event, arguing against the role of workplace radiation exposure in the etiology of these tumors.
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Affiliation(s)
- Carlos S Duque
- Department of Surgery, Pablo Tobón Uribe Hospital, Medellin, 050021, Colombia
| | - Alejandro Vélez
- Department of Surgery, Pablo Tobón Uribe Hospital, Medellin, 050021, Colombia
- Department of Pathology, Pablo Tobón Uribe Hospital, Medellin, 050021, Colombia
| | - Jorge Cuartas
- Ophthalmology Clinic San Diego, Medellin, 050021, Colombia
| | - Fabian Jaimes
- Department of Internal Medicine, University of Antioquia, Medellin, 050021, Colombia
| | - Juan Pablo Dueñas
- Department of Surgery, Pablo Tobón Uribe Hospital, Medellin, 050021, Colombia
| | | | - Marina N Nikiforova
- Department of Pathology, University of Pittsburgh, Pittsburgh, 15213, PA, USA
| | - Yuri E Nikiforov
- Department of Pathology, University of Pittsburgh, Pittsburgh, 15213, PA, USA
| | - Vincenzo Condello
- Department of Pathology, University of Pittsburgh, Pittsburgh, 15213, PA, USA.
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Lugat A, Drui D, Baron S, Thebaud E, Supiot S, Jouglar E, Doré M. Effets secondaires endocriniens de la radiothérapie : diagnostic, prévention et traitements. Cancer Radiother 2022; 26:1078-1089. [DOI: 10.1016/j.canrad.2021.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 11/19/2021] [Accepted: 12/24/2021] [Indexed: 11/30/2022]
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Abstract
Background: Sex dimorphism strongly impacts tumor biology, with most cancers having a male predominance. Uniquely, thyroid cancer (TC) is the only nonreproductive cancer with striking female predominance with three- to four-fold higher incidence among females, although males generally have more aggressive disease. The molecular basis for this observation is not known, and current approaches in treatment and surveillance are not sex specific. Summary: Although TC has overall good prognosis, 6-20% of patients develop regional or distant metastasis, one third of whom are not responsive to conventional treatment approaches and suffer a 10-year survival rate of only 10%. More efficacious treatment strategies are needed for these aggressive TCs, as tyrosine kinase inhibitors and immunotherapy have major toxicities without demonstrable overall survival benefit. Emerging evidence indicates a role of sex hormones, genetics, and the immune system in modulation of both risk for TC and its progression in a sex-specific manner. Conclusion: Greater understanding of the molecular mechanisms underlying sex differences in TC pathogenesis could provide insights into the development of sex-specific, targeted, and effective strategies for prevention, diagnosis, and management. This review summarizes emerging evidence for the importance of sex in the pathogenesis, progression, and response to treatment in differentiated TC with emphasis on the role of sex hormones, genetics, and the immune system.
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Affiliation(s)
- Leila Shobab
- MedStar Washington Hospital Center, Washington, District of Columbia, USA
| | - Kenneth D Burman
- MedStar Washington Hospital Center, Washington, District of Columbia, USA
| | - Leonard Wartofsky
- Medstar Health Research Institute, Washington, District of Columbia, USA
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25
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Neuroblastoma survivors at risk for developing subsequent neoplasms: A systematic review. Cancer Treat Rev 2022; 104:102355. [DOI: 10.1016/j.ctrv.2022.102355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 01/31/2022] [Accepted: 02/02/2022] [Indexed: 11/30/2022]
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Ambient particulate matter air pollution is associated with increased risk of papillary thyroid cancer. Surgery 2022; 171:212-219. [PMID: 34210530 PMCID: PMC8688174 DOI: 10.1016/j.surg.2021.05.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 04/27/2021] [Accepted: 05/01/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND The association between exposure to air pollution and papillary thyroid carcinoma is unknown. We sought to estimate the relationship between long-term exposure to the fine (diameter ≤ 2.5 μm) particulate matter component of air pollution and the risk of papillary thyroid cancer. METHODS Adult (age ≥18) patients with newly diagnosed papillary thyroid carcinoma between January 1, 2013 and December 31, 2016 across a single health system were identified using electronic medical records. Data from 1,990 patients with papillary thyroid carcinoma were compared with 3,980 age- and sex-matched control subjects without any evidence of thyroid disease. Cumulative fine (diameter <2.5 μm) particulate matter exposure was estimated by incorporating patients' residential zip codes into a deep learning neural networks model, which uses both meteorological and satellite-based measurements. Conditional logistic regression was performed to assess for association between papillary thyroid carcinoma and increasing fine (diameter ≤2.5 μm) particulate matter concentrations over 1, 2, and 3 years of cumulative exposure preceding papillary thyroid carcinoma diagnosis. RESULTS Increased odds of developing papillary thyroid carcinoma was associated with a 5 μg/m3 increase of fine (diameter ≤2.5 μm) particulate matter concentrations over 2 years (adjusted odds ratio = 1.18, 95% confidence interval: 1.00-1.40) and 3 years (adjusted odds ratio = 1.23, 95% confidence interval: 1.05-1.44) of exposure. This risk differed by smoking status (pinteraction = 0.04). Among current smokers (n = 623), the risk of developing papillary thyroid carcinoma was highest (adjusted odds ratio = 1.35, 95% confidence interval: 1.12-1.63). CONCLUSION Increasing concentration of fine (diameter ≤2.5 μm) particulate matter in air pollution is significantly associated with the incidence of papillary thyroid carcinoma with 2 and 3 years of exposure. Our novel findings provide additional insight into the potential associations between risk factors and papillary thyroid carcinoma and warrant further investigation, specifically in areas with high levels of air pollution both nationally and internationally.
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Cattoni A, Molinari S, Riva B, Di Marco S, Adavastro M, Faraguna MC, Garella V, Medici F, Nicolosi ML, Pellegrinelli C, Lattuada M, Fraschini D, Pagni F, Biondi A, Balduzzi A. Thyroid function disorders and secondary cancer following haematopoietic stem cell transplantation in pediatrics: State of the art and practical recommendations for a risk-based follow-up. Front Endocrinol (Lausanne) 2022; 13:1064146. [PMID: 36619560 PMCID: PMC9811586 DOI: 10.3389/fendo.2022.1064146] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 12/01/2022] [Indexed: 12/24/2022] Open
Abstract
Thyroid disorders (TD) represent a remarkable share of all the late morbidities experienced following pediatric haematopoietic stem cell transplantation (HSCT), with long-term reported occurrence often exceeding 70%. In addition, the data collected on wide cohorts of survivors assessed longitudinally outlined a progressive increase in the cumulative incidence of TD as far as 30 years following transplantation. Accordingly, a life-long monitoring of thyroid health is warranted among patients exposed to HSCT in childhood, in order to early detect TD and undertake a prompt dedicated treatment. Although several national and international consortia have provided recommendations for the early detection of thyroid disorders among childhood cancer survivors exposed to radiotherapy and alkylating agents, no guidelines specifically and thoroughly focused on HSCT-related TD have been published to date. As stem cell transplantation has become the standard-of-care in a growing body of non-oncological conditions, this urge has become pivotal. To highlight the challenging issues specifically involving this cohort of patients and to provide clinicians with the proposal of a practical follow-up protocol, we reviewed published literature in the light of the shared experience of a multidisciplinary team of pediatric oncologists, transplantologists, pathologists and endocrinologists involved in the long-term care of HSCT survivors. As a final result, we hereby present the proposals of a practical and customized risk-based approach to tailor thyroid health follow-up based on HSCT-related detrimental factors.
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Affiliation(s)
- Alessandro Cattoni
- Department of Pediatrics, Università degli Studi di Milano-Bicocca, Fondazione Monza e Brianza per il Bambino e la sua Mamma (MBBM), Ospedale San Gerardo, Monza, Italy
- *Correspondence: Alessandro Cattoni,
| | - Silvia Molinari
- Department of Pediatrics, Università degli Studi di Milano-Bicocca, Fondazione Monza e Brianza per il Bambino e la sua Mamma (MBBM), Ospedale San Gerardo, Monza, Italy
| | - Benedetta Riva
- Department of Pediatrics, Università degli Studi di Milano-Bicocca, Fondazione Monza e Brianza per il Bambino e la sua Mamma (MBBM), Ospedale San Gerardo, Monza, Italy
| | - Santo Di Marco
- Department of Pediatrics, Università degli Studi di Milano-Bicocca, Fondazione Monza e Brianza per il Bambino e la sua Mamma (MBBM), Ospedale San Gerardo, Monza, Italy
| | - Marta Adavastro
- Department of Pediatrics, Università degli Studi di Milano-Bicocca, Fondazione Monza e Brianza per il Bambino e la sua Mamma (MBBM), Ospedale San Gerardo, Monza, Italy
| | - Martha Caterina Faraguna
- Department of Pediatrics, Università degli Studi di Milano-Bicocca, Fondazione Monza e Brianza per il Bambino e la sua Mamma (MBBM), Ospedale San Gerardo, Monza, Italy
| | - Vittoria Garella
- Department of Pediatrics, Università degli Studi di Milano-Bicocca, Fondazione Monza e Brianza per il Bambino e la sua Mamma (MBBM), Ospedale San Gerardo, Monza, Italy
| | - Francesco Medici
- Department of Pediatrics, Università degli Studi di Milano-Bicocca, Fondazione Monza e Brianza per il Bambino e la sua Mamma (MBBM), Ospedale San Gerardo, Monza, Italy
| | - Maria Laura Nicolosi
- Department of Pediatrics, Università degli Studi di Milano-Bicocca, Fondazione Monza e Brianza per il Bambino e la sua Mamma (MBBM), Ospedale San Gerardo, Monza, Italy
| | - Claudia Pellegrinelli
- Department of Pediatrics, Università degli Studi di Milano-Bicocca, Fondazione Monza e Brianza per il Bambino e la sua Mamma (MBBM), Ospedale San Gerardo, Monza, Italy
| | - Martina Lattuada
- Department of Pediatrics, Università degli Studi di Milano-Bicocca, Fondazione Monza e Brianza per il Bambino e la sua Mamma (MBBM), Ospedale San Gerardo, Monza, Italy
| | - Donatella Fraschini
- Department of Pediatrics, Università degli Studi di Milano-Bicocca, Fondazione Monza e Brianza per il Bambino e la sua Mamma (MBBM), Ospedale San Gerardo, Monza, Italy
| | - Fabio Pagni
- Department of Pathology, Università degli Studi di Milano-Bicocca, Ospedale San Gerardo, Monza, Italy
| | - Andrea Biondi
- Department of Pediatrics, Università degli Studi di Milano-Bicocca, Fondazione Monza e Brianza per il Bambino e la sua Mamma (MBBM), Ospedale San Gerardo, Monza, Italy
| | - Adriana Balduzzi
- Department of Pediatrics, Università degli Studi di Milano-Bicocca, Fondazione Monza e Brianza per il Bambino e la sua Mamma (MBBM), Ospedale San Gerardo, Monza, Italy
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Gudzenko N, Mabuchi K, Brenner AV, Little MP, Hatch M, Drozdovitch V, Vij V, Chumak V, Bakhanova E, Trotsyuk N, Kryuchkov V, Golovanov I, Bazyka D, Cahoon EK. Risk of thyroid cancer in Ukrainian cleanup workers following the Chornobyl accident. Eur J Epidemiol 2022; 37:67-77. [PMID: 34897585 PMCID: PMC10655930 DOI: 10.1007/s10654-021-00822-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 11/18/2021] [Indexed: 10/19/2022]
Abstract
Although much is known about the radiation-related risk of thyroid cancer in those exposed at young ages, less is known about the risk due to adult exposure, particularly in men. We aimed to examine the association between thyroid radiation dose received during adulthood and thyroid cancer risk in men. We conducted a nested case-control study (149 cases; 458 controls) of male, Ukrainian cleanup workers who first worked in the Chornobyl zone between ages 18 and 59 years, with cases identified through linkage with the National Cancer Registry of Ukraine from 1988 to 2012. Individual thyroid doses due to external and internal exposure during the cleanup mission and during residence in contaminated settlements were estimated (total dose mean 199 mGy; range 0.15 mGy to 9.0 Gy). The excess odds ratio per gray (EOR/Gy) for overall thyroid cancer was 0.40 (95% CI: - 0.05, 1.48; p-value = 0.118). Time since exposure was borderline significant (p-value = 0.061) in modifying this association so that less time since exposure was associated with a stronger EOR/Gy. An elevated, but nonsignificant association was observed for follicular thyroid cancer (EOR/Gy = 1.72; 95% CI: - 0.25, 13.69; p-value = 0.155) based on a small number of cases (n = 24). Our findings for radiation-related overall thyroid cancer risk are consistent with evidence of increased risks observed in most of the other studies of adult exposure, though the magnitude of the effect in this study is lower than in the previous case-control study of Chornobyl cleanup workers.
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Affiliation(s)
- Natalia Gudzenko
- National Research Centre for Radiation Medicine, Kyiv, 04050, Ukraine
| | - Kiyohiko Mabuchi
- Radiation Epidemiology Branch, DCEG, Division of Cancer Epidemiology and Genetics, NIH, DHHS, National Cancer Institute, 9609 Medical Center Dr., Rm 7E542, Bethesda, MD, MS 9778, USA
| | | | - Mark P Little
- Radiation Epidemiology Branch, DCEG, Division of Cancer Epidemiology and Genetics, NIH, DHHS, National Cancer Institute, 9609 Medical Center Dr., Rm 7E542, Bethesda, MD, MS 9778, USA
| | - Maureen Hatch
- Radiation Epidemiology Branch, DCEG, Division of Cancer Epidemiology and Genetics, NIH, DHHS, National Cancer Institute, 9609 Medical Center Dr., Rm 7E542, Bethesda, MD, MS 9778, USA
| | - Vladimir Drozdovitch
- Radiation Epidemiology Branch, DCEG, Division of Cancer Epidemiology and Genetics, NIH, DHHS, National Cancer Institute, 9609 Medical Center Dr., Rm 7E542, Bethesda, MD, MS 9778, USA
| | - Vibha Vij
- Radiation Epidemiology Branch, DCEG, Division of Cancer Epidemiology and Genetics, NIH, DHHS, National Cancer Institute, 9609 Medical Center Dr., Rm 7E542, Bethesda, MD, MS 9778, USA
| | - Vadim Chumak
- National Research Centre for Radiation Medicine, Kyiv, 04050, Ukraine
| | - Elena Bakhanova
- National Research Centre for Radiation Medicine, Kyiv, 04050, Ukraine
| | - Natalia Trotsyuk
- National Research Centre for Radiation Medicine, Kyiv, 04050, Ukraine
| | - Victor Kryuchkov
- Burnasyan Federal Medical and Biophysical Centre, 46 Zhivopisnaya Street, Moscow, 123182, Russia
| | - Ivan Golovanov
- Burnasyan Federal Medical and Biophysical Centre, 46 Zhivopisnaya Street, Moscow, 123182, Russia
| | - Dimitry Bazyka
- National Research Centre for Radiation Medicine, Kyiv, 04050, Ukraine
| | - Elizabeth K Cahoon
- Radiation Epidemiology Branch, DCEG, Division of Cancer Epidemiology and Genetics, NIH, DHHS, National Cancer Institute, 9609 Medical Center Dr., Rm 7E542, Bethesda, MD, MS 9778, USA.
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Abstract
Epidemiological studies have focused on the effects of iodine intake on the risk of thyroid cancer. However, their relationship is still obscure. The objective of the present study was to examine the association in the Chinese population. A new ecological study which combined the Data of Annual Report of Cancer, the Survey of Iodine Deficiency Disorders (IDD) surveillance and the Water Iodine Survey was conducted to analyse the relationship between iodine intake and the thyroid cancer incidence in China. In total, 281 counties were included. Thyroid cancer incidence was negatively correlated with the consumption rate of qualified iodised salt (CRQIS) and positively correlated with goiter prevalence (GP) of children aged 8-10 years, residents' annual income and coastal status. Areas with a low CRQIS and areas with a high GP had a relatively high incidence of thyroid cancer. Regression models showed that a low CRQIS and a high GP in children aged 8-10 years (both reflecting iodine deficiency status) play a substantial role in thyroid cancer incidence in both males and females. Additionally, living in coastal areas and having a high annual income may also increase the risk of thyroid cancer. These findings suggest that mild iodine deficiency may contribute to the exceptionally high incidence of thyroid cancer in some areas in China. Maintaining appropriate iodine nutrition not only helps to eliminate IDD but also may help to reduce the occurrence of thyroid cancer.
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30
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Out-of-field organ doses and associated risk of cancer development following radiation therapy with photons. Phys Med 2021; 90:73-82. [PMID: 34563834 DOI: 10.1016/j.ejmp.2021.09.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 09/06/2021] [Accepted: 09/13/2021] [Indexed: 11/21/2022] Open
Abstract
Innovations in cancer treatment have contributed to the improved survival rate of these patients. Radiotherapy is one of the main options for cancer management nowadays. High doses of ionizing radiation are usually delivered to the tumor site with high energy photon beams. However, the therapeutic radiation exposure may lead to second cancer induction. Moreover, the introduction of intensity-modulated radiation therapy over the last decades has increased the radiation dose to out-of-field organs compared to that from conventional irradiation. The increased organ doses might result in elevated probabilities for developing secondary malignancies to critical organs outside the treatment volume. The organ-specific dosimetry is considered necessary for the theoretical second cancer risk assessment and the proper analysis of data derived from epidemiological reports. This study reviews the methods employed for the measurement and calculation of out-of-field organ doses from exposure to photons and/or neutrons. The strengths and weaknesses of these dosimetric approaches are described in detail. This is followed by a review of the epidemiological data associated with out-of-field cancer risks. Previously published theoretical cancer risk estimates for adult and pediatric patients undergoing radiotherapy with conventional and advanced techniques are presented. The methodology for the theoretical prediction of the probability of carcinogenesis to out-of-field sites and the limitations of this approach are discussed. The article also focuses on the factors affecting the magnitude of the probability for developing radiotherapy-induced malignancies. The restriction of out-of-field doses and risks through the use of different types of shielding equipment is presented.
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Matsuu-Matsuyama M, Shichijo K, Matsuda K, Fujimoto N, Kondo H, Miura S, Kurashige T, Nagayama Y, Nakashima M. Age-dependent effects on radiation-induced carcinogenesis in the rat thyroid. Sci Rep 2021; 11:19096. [PMID: 34580369 PMCID: PMC8476610 DOI: 10.1038/s41598-021-98481-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 09/09/2021] [Indexed: 11/09/2022] Open
Abstract
Childhood radiation exposure is a known thyroid cancer risk factor. This study evaluated the effects of age on radiation-induced thyroid carcinogenesis in rats irradiated with 8 Gy X-rays. We analyzed cell proliferation, cell death, DNA damage response, and autophagy-related markers in 4-week-old (4W) and 7-month-old (7M) rats and the incidence of thyroid tumors in 4W, 4-month-old (4M), and 7M rats 18 months after irradiation. Cell death and DNA damage response were increased in 4W rats compared to those in controls at 1 month post-irradiation. More Ki-67-positive cells were observed in 4W rats at 12 months post-irradiation. Thyroid tumors were confirmed in 61.9% (13/21), 63.6% (7/11), and 33.3% (2/6) of irradiated 4W, 4M, and 7M rats, respectively, compared to 0%, 14.3% (1/7), and 16.7% (1/6) in the respective nonirradiated controls. There were 29, 9, and 2 tumors in irradiated 4W, 4M, and 7M rats, respectively. The expression of several autophagy components was downregulated in the area surrounding radiation-induced thyroid carcinomas in 4W and 7M rats. LC3 and p62 expression levels decreased in radiation-induced follicular carcinoma in 4W rats. Radiosensitive cells causing thyroid tumors may be more prevalent in young rats, and abrogation of autophagy may be associated with radiation-induced thyroid carcinogenesis.
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Affiliation(s)
- Mutsumi Matsuu-Matsuyama
- Tissue and Histopathology Section, Atomic Bomb Disease Institute, Nagasaki University, 1-12-4 Sakamoto, Nagasaki, 852-8523, Japan.
| | - Kazuko Shichijo
- Department of Tumor and Diagnostic Pathology, Atomic Bomb Disease Institute, Nagasaki University, 1-12-4 Sakamoto, Nagasaki, 852-8523, Japan
| | - Katsuya Matsuda
- Department of Tumor and Diagnostic Pathology, Atomic Bomb Disease Institute, Nagasaki University, 1-12-4 Sakamoto, Nagasaki, 852-8523, Japan
| | - Nariaki Fujimoto
- Department of Disease Model, Research Institute for Radiation Biology and Medicine, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8553, Japan
| | - Hisayoshi Kondo
- Biostatistics Section, Atomic Bomb Disease Institute, Nagasaki University, 1-12-4 Sakamoto, Nagasaki, 852-8523, Japan
| | - Shiro Miura
- National Hospital Organization Nagasaki Medical Center, 2-1001-1 Kubara, Ōmura, Nagasaki, 856-8562, Japan
| | - Tomomi Kurashige
- Department of Molecular Medicine, Atomic Bomb Disease Institute, Nagasaki University, 1-12-4 Sakamoto, Nagasaki, 852-8523, Japan
| | - Yuji Nagayama
- Department of Molecular Medicine, Atomic Bomb Disease Institute, Nagasaki University, 1-12-4 Sakamoto, Nagasaki, 852-8523, Japan
| | - Masahiro Nakashima
- Tissue and Histopathology Section, Atomic Bomb Disease Institute, Nagasaki University, 1-12-4 Sakamoto, Nagasaki, 852-8523, Japan
- Department of Tumor and Diagnostic Pathology, Atomic Bomb Disease Institute, Nagasaki University, 1-12-4 Sakamoto, Nagasaki, 852-8523, Japan
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Song N, Liu Q, Wilson CL, Sapkota Y, Ehrhardt MJ, Gibson TM, Morton LM, Chanock SJ, Neglia JP, Arnold MA, Michael JR, Gout AM, Mulder HL, Easton J, Bhatia S, Armstrong GT, Zhang J, Delaney A, Hudson MM, Robison LL, Yasui Y, Wang Z. Polygenic Risk Score Improves Risk Stratification and Prediction of Subsequent Thyroid Cancer after Childhood Cancer. Cancer Epidemiol Biomarkers Prev 2021; 30:2096-2104. [PMID: 34465587 DOI: 10.1158/1055-9965.epi-21-0448] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 07/05/2021] [Accepted: 08/23/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Subsequent thyroid cancer (STC) is one of the most common malignancies in childhood cancer survivors. We aimed to evaluate the polygenic contributions to STC risk and potential utility in improving risk prediction. METHODS A polygenic risk score (PRS) was calculated from 12 independent SNPs associated with thyroid cancer risk in the general population. Associations between PRS and STC risk were evaluated among survivors from St. Jude Lifetime Cohort (SJLIFE) and were replicated in survivors from Childhood Cancer Survivor Study (CCSS). A risk prediction model integrating the PRS and clinical factors, initially developed in SJLIFE, and its performance were validated in CCSS. RESULTS Among 2,370 SJLIFE survivors with a median follow-up of 28.8 [interquartile range (IQR) = 21.9-36.1] years, 65 (2.7%) developed STC. Among them, the standardized PRS was associated with an increased rate of STC [relative rate (RR) = 1.57; 95% confidence interval (CI) = 1.24-1.98; P < 0.001]. Similar associations were replicated in 6,416 CCSS survivors, among whom 121 (1.9%) developed STC during median follow-up of 28.9 (IQR = 22.6-34.6) years (RR = 1.52; 95% CI = 1.25-1.83; P < 0.001). A risk prediction model integrating the PRS with clinical factors showed better performance than the model considering only clinical factors in SJLIFE (P = 0.004, AUC = 83.2% vs. 82.1%, at age 40), which was further validated in CCSS (P = 0.010, AUC = 72.9% vs. 70.6%). CONCLUSIONS Integration of the PRS with clinical factors provided a statistically significant improvement in risk prediction of STC, although the magnitude of improvement was modest. IMPACT PRS improves risk stratification and prediction of STC, suggesting its potential utility for optimizing screening strategies in survivorship care.
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Affiliation(s)
- Nan Song
- St. Jude Children's Research Hospital, Memphis, Tennessee.,College of Pharmacy, Chungbuk National University, Cheongju, Republic of South Korea
| | - Qi Liu
- University of Alberta, Edmonton, Alberta, Canada
| | | | - Yadav Sapkota
- St. Jude Children's Research Hospital, Memphis, Tennessee
| | | | | | | | | | | | | | | | | | | | - John Easton
- St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Smita Bhatia
- University of Alabama at Birmingham, Birmingham, Alabama
| | | | - Jinghui Zhang
- St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Angela Delaney
- St. Jude Children's Research Hospital, Memphis, Tennessee
| | | | | | - Yutaka Yasui
- St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Zhaoming Wang
- St. Jude Children's Research Hospital, Memphis, Tennessee.
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Thankamony P, Nirmal G, Chandar R, Nair AKR, Veeramoni Iyer Mriduladevi P. Differentiated thyroid carcinoma in children: A retrospective analysis of 125 pediatric cases from a single institution in India. Pediatr Blood Cancer 2021; 68:e29076. [PMID: 33900677 DOI: 10.1002/pbc.29076] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 03/30/2021] [Accepted: 04/02/2021] [Indexed: 01/05/2023]
Abstract
BACKGROUND Thyroid carcinoma (TC) is extremely rare in children. We assessed the clinicopathological features, outcomes, recurrence pattern, and associated risk factors of differentiated thyroid carcinoma (DTC). METHODS Children aged ≤14 years, pathologically diagnosed as DTC at a tertiary cancer institute between January 1998 and December 2015 were retrospectively analyzed. Survival outcomes were estimated using the Kaplan-Meier method. RESULTS During 18 years, 125 children with DTC were treated with a male:female ratio of 1:2.3. The median age was 12 years (2-14 years). Anterior neck swelling was the commonest presentation (72.8%). Histopathology revealed papillary thyroid carcinoma (PTC) in 123 children (98.4%). Extrathyroidal extension was seen in 32 children (25.6%). Sixty-eight children (54.4%) had nodal metastases and seven had distant metastasis. Relapse developed in 12 children. All were salvaged with subsequent surgery and radioiodine therapy. Eight children had persistent disease and one had a second malignant neoplasm. The median follow-up period was 9 years 1 month (1-20 years). Five-year recurrence-free survival (RFS) was 94.8% and 5-year overall survival was 100%. Larger tumors (p-value = .001), extrathyroidal extension (p-value = .001), and nodal metastasis (p-value = .022) were significant predictors for RFS in univariate analysis. CONCLUSIONS Pediatric DTC showed aggressive behavior characterized by a high rate of extrathyroidal extension and nodal and pulmonary metastasis. Persistent disease should be distinguished from recurrent disease as DTCs with metastatic disease remain stable for long time and usually respond well to radioiodine therapy. Our study reaffirmed favorable prognosis despite aggressive presentation and even after relapse.
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Affiliation(s)
- Priyakumari Thankamony
- Department of Pediatric Oncology, Regional Cancer Centre, Thiruvananthapuram, Kerala, India
| | - Garima Nirmal
- Department of Pediatric Oncology, Regional Cancer Centre, Thiruvananthapuram, Kerala, India
| | - Rumesh Chandar
- Department of Pediatric Oncology, Regional Cancer Centre, Thiruvananthapuram, Kerala, India
| | - Anila K R Nair
- Department of Pathology, Regional Cancer Centre, Thiruvananthapuram, Kerala, India
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Sapuppo G, Tavarelli M, Cannata E, La Spina M, Russo M, Scollo C, Spadaro A, Masucci R, Lo Nigro L, Russo G, Di Cataldo A, Pellegriti G. Risk of Benign and Malignant Thyroid Disorders in Subjects Treated for Paediatric/Adolescent Neoplasia: Role of Morphological and Functional Screening. CHILDREN-BASEL 2021; 8:children8090767. [PMID: 34572198 PMCID: PMC8468117 DOI: 10.3390/children8090767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 08/23/2021] [Accepted: 08/30/2021] [Indexed: 11/25/2022]
Abstract
Background: Patients treated for paediatric/adolescent (P/A) neoplasia have a high incidence of both benign and malignant thyroid diseases. Given the high incidence of sequelae, literature data show a clinical benefit of morpho-functional thyroid screening in paediatric/adolescent cancer survivors and a careful lifetime follow-up. Patients and methods: The incidence of thyroid alterations was evaluated in a consecutive series of 343 patients treated with chemotherapy (CHE) and radiotherapy (RTE) or only with CHE for P/A tumours between 1976 and 2018 (mean age at time of primary paediatric malignancy 7.8 ± 4.7 years). All patients underwent thyroidal morpho-functional evaluation between 2000 and 2019. Results: 178 patients (51.9%) were treated only with CHE and 165 (48.1%) with CHE+RTE. A functional and/or structural thyroid disease was diagnosed in 147 (42.5%; 24.2% in CHE and 62.4% in CHE+RTE group; p = 0.0001). Of note, 71 (20.7%) patients with no evidence of disease at first evaluation developed a thyroid alteration during the follow-up. Primitive hypothyroidism was diagnosed in 54 patients (15.7%; 11.2% in CHE vs. 20.6% in CHE+RTE group; p = 0.01) and hyperthyroidism in 4. Sixty-three patients developed thyroid nodules (18.4%; 4.0% in CHE and 14.1% in CHE+RTE group; p < 0.001); thyroid cancer was diagnosed in 30 patients (8.7%; 4.5% in CHE and 12.4% in CHE + RTE group; p = 0.007). Conclusions: In patients treated with CHE+RTE, the prevalence of hypothyroidism and nodular pathology, both malignant and benign, were significantly greater than in patients treated with CHE. However, also in the CHE group, the frequency of thyroid disease is not negligible and the pathogenetic mechanisms remain to be clarified. Our data suggest the clinical benefit of morpho-functional thyroid screening in P/A cancer survivors.
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Affiliation(s)
- Giulia Sapuppo
- Endocrinology, Garibaldi-Nesima Medical Center, Department of Clinical and Experimental Medicine, University of Catania, 95122 Catania, Italy;
| | - Martina Tavarelli
- Endocrinology, Garibaldi-Nesima Medical Center, Via Palermo 636, 95122 Catania, Italy; (M.T.); (M.R.); (C.S.); (A.S.)
| | - Emanuela Cannata
- Onco-Ematology Unit, Department of Clinical and Experimental Medicine, University of Catania, 95122 Catania, Italy; (E.C.); (M.L.S.); (L.L.N.); (G.R.); (A.D.C.)
| | - Milena La Spina
- Onco-Ematology Unit, Department of Clinical and Experimental Medicine, University of Catania, 95122 Catania, Italy; (E.C.); (M.L.S.); (L.L.N.); (G.R.); (A.D.C.)
| | - Marco Russo
- Endocrinology, Garibaldi-Nesima Medical Center, Via Palermo 636, 95122 Catania, Italy; (M.T.); (M.R.); (C.S.); (A.S.)
| | - Claudia Scollo
- Endocrinology, Garibaldi-Nesima Medical Center, Via Palermo 636, 95122 Catania, Italy; (M.T.); (M.R.); (C.S.); (A.S.)
| | - Angela Spadaro
- Endocrinology, Garibaldi-Nesima Medical Center, Via Palermo 636, 95122 Catania, Italy; (M.T.); (M.R.); (C.S.); (A.S.)
| | - Romilda Masucci
- Garibaldi-Nesima Medical Center, Department of Surgical Oncology, 95122 Catania, Italy;
| | - Luca Lo Nigro
- Onco-Ematology Unit, Department of Clinical and Experimental Medicine, University of Catania, 95122 Catania, Italy; (E.C.); (M.L.S.); (L.L.N.); (G.R.); (A.D.C.)
| | - Giovanna Russo
- Onco-Ematology Unit, Department of Clinical and Experimental Medicine, University of Catania, 95122 Catania, Italy; (E.C.); (M.L.S.); (L.L.N.); (G.R.); (A.D.C.)
| | - Andrea Di Cataldo
- Onco-Ematology Unit, Department of Clinical and Experimental Medicine, University of Catania, 95122 Catania, Italy; (E.C.); (M.L.S.); (L.L.N.); (G.R.); (A.D.C.)
| | - Gabriella Pellegriti
- Endocrinology, Garibaldi-Nesima Medical Center, Via Palermo 636, 95122 Catania, Italy; (M.T.); (M.R.); (C.S.); (A.S.)
- Correspondence:
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Lee YK, Lee S, Lee EK, Kim HC, Kong SY, Cha HS, Hwangbo Y. Can computed tomography scanning in adults lead to an increased risk of thyroid cancer? A nationwide nested case-control study. Eur Radiol 2021; 32:415-423. [PMID: 34245323 DOI: 10.1007/s00330-021-08186-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 06/18/2021] [Accepted: 06/29/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To evaluate the association between computed tomography (CT) scanning and newly diagnosed thyroid cancer cases in relation to the confounding effect of the healthcare utilization rate. METHODS This nested case-control study used the Korean National Health Insurance Service-National Sample Cohort 2002-2015: 3557 adult thyroid cancer cases were matched to 17,785 controls by age, sex, and diagnosis date. Odds ratios (ORs) were estimated for thyroid cancer associated with cumulative exposure to CT scanning > 3 years before cancer diagnosis. Changes in estimated ORs with and without adjustment for outpatient visit frequency were investigated. RESULTS ORs for newly diagnosed thyroid cancer increased according to the higher number of total CT scans and thyroid-exposing CT scans (CT scans of the head, neck, or chest compartment; OR and 95% confidence interval [CI], 1.09 [1.03-1.16] and 1.28 [1.05-1.57], respectively). ORs for thyroid cancer increased according to higher outpatient visit frequency. The association between thyroid cancer incidence and CT scans became insignificant when outpatient visit frequency was adjusted in the models (OR [95% CI], 1.03 [0.97-1.10]: total CT scans, 1.14 [0.93-1.41]: thyroid-exposing CT scans). Subgroup analyses stratified by age, sex, and history of other malignancies did not reveal independent associations between CT scanning and thyroid cancer. CONCLUSIONS The high incidence of thyroid cancer in adults exposed to ionizing radiation during CT scanning can be largely explained by the confounding effect of the healthcare utilization rate. These effects should be considered to avoid overestimation of the CT scanning-associated risk of thyroid cancer. KEY POINTS • Studies indicate that diagnostic imaging using low-ionizing radiation may increase risks for thyroid cancer in adults. • Our findings suggest that the risk for radiation-induced thyroid cancer following CT scanning in adults may have been overestimated in observational studies due to medical surveillance-related biases.
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Affiliation(s)
- Young Ki Lee
- Center for Thyroid Cancer, National Cancer Center, Goyang, Republic of Korea.,Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sangwon Lee
- Cancer Big Data Center, National Cancer Center, Goyang, Republic of Korea
| | - Eun Kyung Lee
- Center for Thyroid Cancer, National Cancer Center, Goyang, Republic of Korea
| | - Hyeon Chang Kim
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sun-Young Kong
- Department of Laboratory Medicine, National Cancer Center, Goyang, Republic of Korea
| | - Hyo Soung Cha
- Cancer Big Data Center, National Cancer Center, Goyang, Republic of Korea.
| | - Yul Hwangbo
- Center for Thyroid Cancer, National Cancer Center, Goyang, Republic of Korea.
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Yamamoto H, Hayashi K, Scherb H. A comment on: 'Absorbed radiation doses in the thyroid as estimated by UNSCEAR and subsequent risk of childhood thyroid cancer following the Great East Japan'. JOURNAL OF RADIATION RESEARCH 2021; 62:420-424. [PMID: 33561205 PMCID: PMC8127645 DOI: 10.1093/jrr/rraa145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 06/08/2020] [Indexed: 05/20/2023]
Affiliation(s)
- Hidehiko Yamamoto
- Osaka Red Cross Hospital attached facility of physically handicapped children, 5-30 Fudegasaki-cho, Tennouji-ku Osaka-Shi 543-8555 Osaka, Japan
| | - Keiji Hayashi
- Hayashi Children’s Clinic, 4-6-11-1F Nagata, Joto-ku Osaka-Shi 536-0022 Osaka, Japan
| | - Hagen Scherb
- Corresponding author: Helmholtz Zentrum München, German Research Center for Environmental Health, Institute of Computational Biology, Ingolstädter Landstr. 1, D-85764 Neuherberg, Germany. Tel: +49 8141 72892,
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Suzuki G. Communicating with residents about 10 years of scientific progress in understanding thyroid cancer risk in children after the Fukushima Dai-ichi Nuclear Power Station accident. JOURNAL OF RADIATION RESEARCH 2021; 62:i7-i14. [PMID: 33978170 PMCID: PMC8114208 DOI: 10.1093/jrr/rraa097] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 09/15/2020] [Indexed: 06/12/2023]
Abstract
After the Fukushima Dai-ichi Nuclear Power Station (FDNPS) accident in 2011, radiation-related risk of childhood thyroid cancer remains a matter of concern among residents living in areas affected by radioactive plumes. As a countermeasure to that, the Fukushima Prefectural Government-in conjunction with Fukushima Medical University-began the Fukushima Thyroid Examination (FTE) campaign in 2011. As 116 definite or suspected thyroid cancer cases were found after the first round of FTE and the total number of cases was >240 as of June 2020, residents' concerns have deepened. Some researchers claim that these cases are radiation-induced, while others claim a screening effect (because FTE uses high-resolution ultrasound equipment) and express concern about over-diagnosis. Researchers therefore must address two conflicting issues: one is to elucidate radiation effects on thyroid cancer, which requires continuation of FTE; the other is to solve ethical problems associated with FTE. As to over-diagnosis, surgeons claim that early diagnosis benefits children by reducing the side-effects of treatment and prolonging disease-free survival, while cancer epidemiologists claim that early diagnosis will result in overtreatment without reducing the death rate. 'To receive FTE or not' and 'to stop FTE or not' are ongoing dilemmas for children (and their parents) and other stakeholders, respectively. To facilitate building a consensus among stakeholders, I overview recent findings about dose reconstruction, the dose-response relationship of thyroid cancer, over-diagnosis, and the natural history of thyroid cancer, all of which contribute to judging the risk-benefit balance of thyroid screening.
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Affiliation(s)
- Gen Suzuki
- Corresponding author. International University of Health and Welfare Clinic, 2600-6, Kitakanemaru, Ohtawara city, Tochigi Prefecture, Japan 324-8501.Tel: +81-287-24-1001; Fax: +81-287-24-1003;
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Tiong YS, Hao ETY, Lee CC, Parameswaran R, Cheo T, Ho WLC, Yang SP. Prevalence of thyroid malignancy and hormonal dysfunction following radiation exposure in childhood. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2021; 50:402-410. [PMID: 34100517 DOI: 10.47102/annals-acadmedsg.2020378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Childhood radiation exposure is a known risk factor for thyroid malignancy and dysfunction. However, local data are limited and there is no consensus on the modality and frequency of screening in this high-risk group. METHODS Retrospective analysis study evaluating patients with childhood radiation exposure in 2006-2016 and minimum of 1-year follow-up. RESULTS Of the 132 childhood cancer survivors in the study, thyroid malignancy was detected in 2 cases (1.5%) and thyroid nodules in 13 (9.8%). The earliest thyroid malignancy was detected 5 years post-radiotherapy via ultrasound. Of the 84 patients who had screening thyroid function test, 26 (31.0%) were detected with abnormal test results post-radiation, majority being subclinical hypothyroidism. CONCLUSION Regular screening via clinical examination for thyroid nodules should be performed at least annually. Where feasible and if resources permit, consideration should be given to using ultrasound for thyroid nodule(s) and malignancy screening at 5 years post-radiation therapy. Screening for thyroid dysfunction can be considered from 6-12 months post-radiotherapy.
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Affiliation(s)
- Yee Sian Tiong
- Department of Endocrinology, National University Health System, Singapore
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Kulkarni O, Sugier PE, Guibon J, Boland-Augé A, Lonjou C, Bacq-Daian D, Olaso R, Rubino C, Souchard V, Rachedi F, Lence-Anta JJ, Ortiz RM, Xhaard C, Laurent-Puig P, Mulot C, Guizard AV, Schvartz C, Boutron-Ruault MC, Ostroumova E, Kesminiene A, Deleuze JF, Guénel P, De Vathaire F, Truong T, Lesueur F. Gene network and biological pathways associated with susceptibility to differentiated thyroid carcinoma. Sci Rep 2021; 11:8932. [PMID: 33903625 PMCID: PMC8076215 DOI: 10.1038/s41598-021-88253-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 04/09/2021] [Indexed: 12/11/2022] Open
Abstract
Variants identified in earlier genome-wide association studies (GWAS) on differentiated thyroid carcinoma (DTC) explain about 10% of the overall estimated genetic contribution and could not provide complete insights into biological mechanisms involved in DTC susceptibility. Integrating systems biology information from model organisms, genome-wide expression data from tumor and matched normal tissue and GWAS data could help identifying DTC-associated genes, and pathways or functional networks in which they are involved. We performed data mining of GWAS data of the EPITHYR consortium (1551 cases and 1957 controls) using various pathways and protein-protein interaction (PPI) annotation databases and gene expression data from The Cancer Genome Atlas. We identified eight DTC-associated genes at known loci 2q35 (DIRC3), 8p12 (NRG1), 9q22 (FOXE1, TRMO, HEMGN, ANP32B, NANS) and 14q13 (MBIP). Using the EW_dmGWAS approach we found that gene networks related to glycogenolysis, glycogen metabolism, insulin metabolism and signal transduction pathways associated with muscle contraction were overrepresented with association signals (false discovery rate adjusted p-value < 0.05). Additionally, suggestive association of 21 KEGG and 75 REACTOME pathways with DTC indicate a link between DTC susceptibility and functions related to metabolism of cholesterol, amino sugar and nucleotide sugar metabolism, steroid biosynthesis, and downregulation of ERBB2 signaling pathways. Together, our results provide novel insights into biological mechanisms contributing to DTC risk.
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Affiliation(s)
- Om Kulkarni
- Inserm, U900, Institut Curie, PSL University, Mines ParisTech, 75248, Paris, France
| | | | - Julie Guibon
- Inserm, U900, Institut Curie, PSL University, Mines ParisTech, 75248, Paris, France
- Université Paris-Saclay, UVSQ, Gustave Roussy, Inserm, CESP, 94807, Villejuif, France
| | - Anne Boland-Augé
- Université Paris-Saclay, CEA, Centre National de Recherche en Génomique Humaine, 91057, Evry, France
| | - Christine Lonjou
- Inserm, U900, Institut Curie, PSL University, Mines ParisTech, 75248, Paris, France
| | - Delphine Bacq-Daian
- Université Paris-Saclay, CEA, Centre National de Recherche en Génomique Humaine, 91057, Evry, France
| | - Robert Olaso
- Université Paris-Saclay, CEA, Centre National de Recherche en Génomique Humaine, 91057, Evry, France
| | - Carole Rubino
- Université Paris-Saclay, UVSQ, Gustave Roussy, Inserm, CESP, 94807, Villejuif, France
| | - Vincent Souchard
- Université Paris-Saclay, UVSQ, Gustave Roussy, Inserm, CESP, 94807, Villejuif, France
| | - Frédérique Rachedi
- Centre Hospitalier Territorial de Polynésie Française, CHTPF, Pirae, Tahiti, 98713, Papeete, French Polynesia
| | | | - Rosa Maria Ortiz
- Instituto Nacional de Oncologia y de Radiobiologia, INOR, La Havana, Cuba
| | - Constance Xhaard
- Université Paris-Saclay, UVSQ, Gustave Roussy, Inserm, CESP, 94807, Villejuif, France
- University of Lorraine, INSERM CIC 1433, Nancy CHRU, Inserm U1116, FCRIN, INI-CRCT, 54000, Nancy, France
| | - Pierre Laurent-Puig
- Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, USPC, Université Paris Descartes, Université Paris Diderot, EPIGENETEC, 75006, Paris, France
| | - Claire Mulot
- Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, USPC, Université Paris Descartes, Université Paris Diderot, EPIGENETEC, 75006, Paris, France
| | - Anne-Valérie Guizard
- Registre Général des Tumeurs du Calvados, Centre François Baclesse, 14000, Caen, France
- Inserm U1086-UCNB, Cancers and Prevention, 14000, Caen, France
| | - Claire Schvartz
- Registre des Cancers Thyroïdiens, Institut Jean Godinot, 51100, Reims, France
| | | | - Evgenia Ostroumova
- Environment and Radiation Section, International Agency for Research on Cancer, 69008, Lyon, France
| | - Ausrele Kesminiene
- Environment and Radiation Section, International Agency for Research on Cancer, 69008, Lyon, France
| | - Jean-François Deleuze
- Université Paris-Saclay, CEA, Centre National de Recherche en Génomique Humaine, 91057, Evry, France
| | - Pascal Guénel
- Université Paris-Saclay, UVSQ, Gustave Roussy, Inserm, CESP, 94807, Villejuif, France
| | - Florent De Vathaire
- Université Paris-Saclay, UVSQ, Gustave Roussy, Inserm, CESP, 94807, Villejuif, France
| | - Thérèse Truong
- Université Paris-Saclay, UVSQ, Gustave Roussy, Inserm, CESP, 94807, Villejuif, France
| | - Fabienne Lesueur
- Inserm, U900, Institut Curie, PSL University, Mines ParisTech, 75248, Paris, France.
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Morton LM, Karyadi DM, Stewart C, Bogdanova TI, Dawson ET, Steinberg MK, Dai J, Hartley SW, Schonfeld SJ, Sampson JN, Maruvka YE, Kapoor V, Ramsden DA, Carvajal-Garcia J, Perou CM, Parker JS, Krznaric M, Yeager M, Boland JF, Hutchinson A, Hicks BD, Dagnall CL, Gastier-Foster JM, Bowen J, Lee O, Machiela MJ, Cahoon EK, Brenner AV, Mabuchi K, Drozdovitch V, Masiuk S, Chepurny M, Zurnadzhy LY, Hatch M, Berrington de Gonzalez A, Thomas GA, Tronko MD, Getz G, Chanock SJ. Radiation-related genomic profile of papillary thyroid carcinoma after the Chernobyl accident. Science 2021; 372:science.abg2538. [PMID: 33888599 DOI: 10.1126/science.abg2538] [Citation(s) in RCA: 62] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 03/25/2021] [Indexed: 12/13/2022]
Abstract
The 1986 Chernobyl nuclear power plant accident increased papillary thyroid carcinoma (PTC) incidence in surrounding regions, particularly for radioactive iodine (131I)-exposed children. We analyzed genomic, transcriptomic, and epigenomic characteristics of 440 PTCs from Ukraine (from 359 individuals with estimated childhood 131I exposure and 81 unexposed children born after 1986). PTCs displayed radiation dose-dependent enrichment of fusion drivers, nearly all in the mitogen-activated protein kinase pathway, and increases in small deletions and simple/balanced structural variants that were clonal and bore hallmarks of nonhomologous end-joining repair. Radiation-related genomic alterations were more pronounced for individuals who were younger at exposure. Transcriptomic and epigenomic features were strongly associated with driver events but not radiation dose. Our results point to DNA double-strand breaks as early carcinogenic events that subsequently enable PTC growth after environmental radiation exposure.
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Affiliation(s)
- Lindsay M Morton
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD 20892, USA.
| | - Danielle M Karyadi
- Laboratory of Genetic Susceptibility, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD 20892, USA
| | - Chip Stewart
- Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA
| | - Tetiana I Bogdanova
- Laboratory of Morphology of the Endocrine System, V. P. Komisarenko Institute of Endocrinology and Metabolism of the National Academy of Medical Sciences of Ukraine, Kyiv 04114, Ukraine
| | - Eric T Dawson
- Laboratory of Genetic Susceptibility, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD 20892, USA.,Nvidia Corporation, Santa Clara, CA 95051, USA
| | - Mia K Steinberg
- Cancer Genomics Research Laboratory, Leidos Biomedical Research Inc., Frederick National Laboratory for Cancer Research, Bethesda, MD 20892, USA
| | - Jieqiong Dai
- Cancer Genomics Research Laboratory, Leidos Biomedical Research Inc., Frederick National Laboratory for Cancer Research, Bethesda, MD 20892, USA
| | - Stephen W Hartley
- Laboratory of Genetic Susceptibility, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD 20892, USA
| | - Sara J Schonfeld
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD 20892, USA
| | - Joshua N Sampson
- Biostatistics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD 20892, USA
| | - Yosef E Maruvka
- Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA
| | - Vidushi Kapoor
- Cancer Genomics Research Laboratory, Leidos Biomedical Research Inc., Frederick National Laboratory for Cancer Research, Bethesda, MD 20892, USA
| | - Dale A Ramsden
- Department of Biochemistry and Biophysics, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC 27599, USA
| | - Juan Carvajal-Garcia
- Curriculum in Genetics and Molecular Biology, University of North Carolina, Chapel Hill, NC 27599, USA
| | - Charles M Perou
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC 27599, USA.,Department of Genetics, University of North Carolina, Chapel Hill, NC 27599, USA
| | - Joel S Parker
- Department of Genetics, University of North Carolina, Chapel Hill, NC 27599, USA
| | - Marko Krznaric
- Department of Surgery and Cancer, Imperial College London, Charing Cross Hospital, London W6 8RF, UK
| | - Meredith Yeager
- Cancer Genomics Research Laboratory, Leidos Biomedical Research Inc., Frederick National Laboratory for Cancer Research, Bethesda, MD 20892, USA
| | - Joseph F Boland
- Cancer Genomics Research Laboratory, Leidos Biomedical Research Inc., Frederick National Laboratory for Cancer Research, Bethesda, MD 20892, USA
| | - Amy Hutchinson
- Cancer Genomics Research Laboratory, Leidos Biomedical Research Inc., Frederick National Laboratory for Cancer Research, Bethesda, MD 20892, USA
| | - Belynda D Hicks
- Cancer Genomics Research Laboratory, Leidos Biomedical Research Inc., Frederick National Laboratory for Cancer Research, Bethesda, MD 20892, USA
| | - Casey L Dagnall
- Cancer Genomics Research Laboratory, Leidos Biomedical Research Inc., Frederick National Laboratory for Cancer Research, Bethesda, MD 20892, USA
| | - Julie M Gastier-Foster
- Nationwide Children's Hospital, Biospecimen Core Resource, Columbus, OH 43205, USA.,Departments of Pathology and Pediatrics, Ohio State University College of Medicine, Columbus, OH 43210, USA
| | - Jay Bowen
- Nationwide Children's Hospital, Biospecimen Core Resource, Columbus, OH 43205, USA
| | - Olivia Lee
- Laboratory of Genetic Susceptibility, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD 20892, USA
| | - Mitchell J Machiela
- Integrative Tumor Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD 20892, USA
| | - Elizabeth K Cahoon
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD 20892, USA
| | - Alina V Brenner
- Radiation Effects Research Foundation, Hiroshima 732-0815, Japan
| | - Kiyohiko Mabuchi
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD 20892, USA
| | - Vladimir Drozdovitch
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD 20892, USA
| | - Sergii Masiuk
- Radiological Protection Laboratory, Institute of Radiation Hygiene and Epidemiology, National Research Center for Radiation Medicine of the National Academy of Medical Sciences of Ukraine, Kyiv 04050, Ukraine
| | - Mykola Chepurny
- Radiological Protection Laboratory, Institute of Radiation Hygiene and Epidemiology, National Research Center for Radiation Medicine of the National Academy of Medical Sciences of Ukraine, Kyiv 04050, Ukraine
| | - Liudmyla Yu Zurnadzhy
- Laboratory of Morphology of the Endocrine System, V. P. Komisarenko Institute of Endocrinology and Metabolism of the National Academy of Medical Sciences of Ukraine, Kyiv 04114, Ukraine
| | - Maureen Hatch
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD 20892, USA
| | - Amy Berrington de Gonzalez
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD 20892, USA
| | - Gerry A Thomas
- Department of Surgery and Cancer, Imperial College London, Charing Cross Hospital, London W6 8RF, UK
| | - Mykola D Tronko
- Department of Fundamental and Applied Problems of Endocrinology, V. P. Komisarenko Institute of Endocrinology and Metabolism of the National Academy of Medical Sciences of Ukraine, Kyiv 04114, Ukraine
| | - Gad Getz
- Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA.,Center for Cancer Research and Department of Pathology, Massachusetts General Hospital, Boston, MA 02114, USA.,Harvard Medical School, Boston, MA 02115, USA
| | - Stephen J Chanock
- Laboratory of Genetic Susceptibility, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD 20892, USA.
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Deziel NC, Zhang Y, Wang R, Wiemels JL, Morimoto L, Clark CJ, Metayer C, Ma X. Birth Characteristics and Risk of Pediatric Thyroid Cancer: A Population-Based Record-Linkage Study in California. Thyroid 2021; 31:596-606. [PMID: 32912083 PMCID: PMC8195873 DOI: 10.1089/thy.2020.0217] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Background: Incidence rates of thyroid cancer in children and young adults (age 0-19 years) have nearly doubled over a recent 15-year period in the United States. Children with thyroid cancer may require long-term therapy and surveillance and are at greater risk for second primary malignancies. High-dose exposure to ionizing radiation is the only known nongenetic risk factor; the vast majority of cases have an unknown etiology. Methods: We conducted a population-based nested case-control study to evaluate the relationship between a range of birth characteristics and the risk of pediatric thyroid cancer. Using linked birth records and cancer registry data from California, we included 1012 cases who were diagnosed with first primary thyroid cancer at the age of 0-19 years from 1988 to 2015 and 50,600 birth-year matched controls (1:50 case to control ratio). We estimated adjusted odds ratios (OR) and 95% confidence intervals (CI) by using multivariable logistic regression models applied to the full population and stratified by thyroid cancer subtypes (papillary and follicular), race/ethnicity (white and Hispanic), and age at diagnosis (0-14 and 15-19 years). Results: Hispanic ethnicity (OR: 1.20 [CI 1.01-1.42]), higher birth weight (OR: 1.11 [CI 1.04-1.18] per 500g), and higher maternal education (13-15 years OR: 1.35 [CI 1.09-1.68], 16+ years OR: 1.35 [CI 1.07-1.71]) were associated with an increased risk of pediatric thyroid cancer, while male sex (OR: 0.21 [CI 0.18-0.25]) and higher birth order (third or higher OR: 0.81 [CI 0.68-0.98]) were associated with a decreased risk. Some heterogeneity was observed across subtype, most notably an elevated OR with higher birth order for follicular thyroid cancer, in contrast to the reduced risk for this category among papillary thyroid cancer cases (p-value for interaction = 0.01). Hispanic ethnicity was a risk factor for papillary, but not follicular thyroid cancer (p-value for interaction = 0.07). Conclusions: In this population-based study of birth characteristics and pediatric thyroid cancer, we identified several important risk factors for pediatric thyroid cancer, including female sex, Hispanic ethnicity, higher birth weight, higher maternal educational attainment, and lower birth order. Our data provide new areas for replication and investigation of biological mechanisms for this poorly understood malignancy.
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Affiliation(s)
- Nicole C. Deziel
- Department of Environmental Health Sciences and Yale School of Public Health, New Haven, Connecticut, USA
- Address correspondence to: Nicole C. Deziel, PhD, Department of Environmental Health Sciences, Yale School of Public Health, 60 College Street, New Haven, CT 06510, USA
| | - Yawei Zhang
- Department of Environmental Health Sciences and Yale School of Public Health, New Haven, Connecticut, USA
- Section of Surgical Outcomes and Epidemiology, Department of Surgery, Yale School of Medicine, New Haven, Connecticut, USA
| | - Rong Wang
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut, USA
| | - Joseph L. Wiemels
- Center for Genetic Epidemiology, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California, USA
| | - Libby Morimoto
- Department of Epidemiology, School of Public Health, University of California Berkeley, Berkeley, California, USA
| | - Cassandra J. Clark
- Department of Environmental Health Sciences and Yale School of Public Health, New Haven, Connecticut, USA
| | - Catherine Metayer
- Department of Epidemiology, School of Public Health, University of California Berkeley, Berkeley, California, USA
| | - Xiaomei Ma
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut, USA
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Lamartina L, Leboulleux S, Schlumberger M. Thyroid cancer incidence in children and adolescents. Lancet Diabetes Endocrinol 2021; 9:128-129. [PMID: 33482108 DOI: 10.1016/s2213-8587(20)30430-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 12/09/2020] [Indexed: 12/16/2022]
Affiliation(s)
- Livia Lamartina
- Department of Nuclear Medicine and Endocrine Oncology, Institut Gustave Roussy and University Paris-Saclay, Villejuif 94800, France
| | - Sophie Leboulleux
- Department of Nuclear Medicine and Endocrine Oncology, Institut Gustave Roussy and University Paris-Saclay, Villejuif 94800, France
| | - Martin Schlumberger
- Department of Nuclear Medicine and Endocrine Oncology, Institut Gustave Roussy and University Paris-Saclay, Villejuif 94800, France.
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43
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Ory C, Leboulleux S, Salvatore D, Le Guen B, De Vathaire F, Chevillard S, Schlumberger M. Consequences of atmospheric contamination by radioiodine: the Chernobyl and Fukushima accidents. Endocrine 2021; 71:298-309. [PMID: 33025561 DOI: 10.1007/s12020-020-02498-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 09/07/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE After the accidents of nuclear power plants at Chernobyl and at Fukushima, huge amounts of radioactive iodine were released into the atmosphere. METHODS We reviewed data on the health consequences of these accidents with a focus on thyroid consequences. RESULTS Among the 2 million children who were living in highly contaminated regions in Belarus, Ukraine and Russia, 7000 cases of thyroid cancer had occurred in 2005. This is the most significant radiation-induced consequence of the Chernobyl accident. The increased incidence of thyroid cancer observed in adult population who lived in these highly contaminated regions is at least in major part related to screening and it is not possible to individualize among these thyroid cancers those that are potentially caused by radiation exposure. For populations who lived outside these regions at the time of the accident, there is no detectable consequence of the radiation exposure on the thyroid gland. Among children who lived nearby the Fukushima power plant in 2011, there is currently no evidence of an increased incidence of thyroid cancer. Ultrasonography screening in these individuals detected a number of thyroid cancers that are probably not related to the accident. Because thyroid cancer is frequent, studies have been carried out to distinguish radiation-induced from their sporadic counterparts, and genomic signatures might be helpful. CONCLUSIONS The consequences of the Chernobyl accident clearly demonstrate that populations living nearby a nuclear power plant should be protected in case of accident by sheltering, food restrictions and prophylaxis of thyroid irradiation by potassium iodine administration, if the predicted estimated dose to the thyroid gland of children might be >50 mGy. These countermeasures should be applied in priority to children, adolescents and pregnant women; they are safe and effective.
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Affiliation(s)
- C Ory
- CEA DRF, iBFJ, iRCM, and University Paris-Saclay, Route du Panorama, 92265, Fontenay-aux-Roses cedex, France
| | - S Leboulleux
- Gustave Roussy and University Paris-Saclay, rue Edouard Vaillant, 94800, Villejuif, France
| | - D Salvatore
- Department of Public Health, University of Naples "Federico II", Naples, Italy
| | - B Le Guen
- Electricité de France (EDF), DPNT, DPN, Site de Cap Ampère, 1 place Pleyel, 93282, Saint Denis, Cedex, France
| | - F De Vathaire
- INSERM U1018, Radiation Epidemiology Teams, 94800, Villejuif, France
| | - S Chevillard
- CEA DRF, iBFJ, iRCM, and University Paris-Saclay, Route du Panorama, 92265, Fontenay-aux-Roses cedex, France
| | - M Schlumberger
- Gustave Roussy and University Paris-Saclay, rue Edouard Vaillant, 94800, Villejuif, France.
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44
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Cléro E, Ostroumova E, Demoury C, Grosche B, Kesminiene A, Liutsko L, Motreff Y, Oughton D, Pirard P, Rogel A, Van Nieuwenhuyse A, Laurier D, Cardis E. Lessons learned from Chernobyl and Fukushima on thyroid cancer screening and recommendations in case of a future nuclear accident. ENVIRONMENT INTERNATIONAL 2021; 146:106230. [PMID: 33171378 DOI: 10.1016/j.envint.2020.106230] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 10/16/2020] [Accepted: 10/18/2020] [Indexed: 05/06/2023]
Abstract
Exposure of the thyroid gland to ionizing radiation at a young age is the main recognized risk factor for differentiated thyroid cancer. After the Chernobyl and Fukushima nuclear accidents, thyroid cancer screening was implemented mainly for children, leading to case over-diagnosis as seen in South Korea after the implementation of opportunistic screening (where subjects are recruited at healthcare sites). The aim of cancer screening is to reduce morbidity and mortality, but screening can also cause negative effects on health (with unnecessary treatment if over-diagnosis) and on quality of life. This paper from the SHAMISEN special issue (Nuclear Emergency Situations - Improvement of Medical And Health Surveillance) presents the principles of cancer screening, the lessons learned from thyroid cancer screening, as well as the knowledge on thyroid cancer incidence after exposure to iodine-131. The SHAMISEN Consortium recommends to envisage systematic health screening after a nuclear accident, only when appropriately justified, i.e. ensuring that screening will do more good than harm. Based on the experience of the Fukushima screening, the consortium does not recommend mass or population-based thyroid cancer screening, as the negative psychological and physical effects are likely to outweigh any possible benefit in affected populations; thyroid health monitoring should however be made available to persons who request it (regardless of whether they are at increased risk or not), accompanied with appropriate information and support.
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Affiliation(s)
- Enora Cléro
- Health and Environment Division, Institute for Radiological Protection and Nuclear Safety (IRSN), Fontenay-aux-Roses, France.
| | - Evgenia Ostroumova
- International Agency for Research on Cancer (IARC), World Health Organization, Lyon, France
| | - Claire Demoury
- Risk and Health Impact Assessment Unit, Sciensano, Brussels, Belgium
| | - Bernd Grosche
- Federal Office for Radiation Protection (BfS), Munich, Germany
| | - Ausrele Kesminiene
- International Agency for Research on Cancer (IARC), World Health Organization, Lyon, France
| | - Liudmila Liutsko
- Institute for Global Health (ISGlobal), Barcelona, Spain; Pompeu Fabra University (UPF), Barcelona, Spain; Spanish Consortium for Research and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
| | | | - Deborah Oughton
- Norwegian University of Life Sciences (NMBU), Center for Environmental Radioactivity (CERAD), Aas, Norway
| | | | - Agnès Rogel
- Santé publique France, Saint-Maurice, France
| | - An Van Nieuwenhuyse
- Risk and Health Impact Assessment Unit, Sciensano, Brussels, Belgium; Centre for Environment and Health, Department of Public Health and Primary Care, Leuven, Belgium
| | - Dominique Laurier
- Health and Environment Division, Institute for Radiological Protection and Nuclear Safety (IRSN), Fontenay-aux-Roses, France
| | - Elisabeth Cardis
- Institute for Global Health (ISGlobal), Barcelona, Spain; Pompeu Fabra University (UPF), Barcelona, Spain; Spanish Consortium for Research and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
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van Santen HM, Chemaitilly W, Meacham LR, Tonorezos ES, Mostoufi-Moab S. Endocrine Health in Childhood Cancer Survivors. Pediatr Clin North Am 2020; 67:1171-1186. [PMID: 33131540 DOI: 10.1016/j.pcl.2020.08.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Endocrine late effects, including reproductive disorders and secondary thyroid cancer, have been reported in up to 50 %childhood cancer survivors (CCS) more than 5 years after treatment. Most endocrine disorders are amenable to treatment; awareness of symptoms is therefore of great importance. Recognition of these symptoms may be delayed however because many are nonspecific. Timely treatment of endocrine disorders improves quality of life in CCS and prevents possible consequences, such as short stature, bone and cardiovascular disorders, and depression. At-risk CCS must therefore be regularly and systematically monitored. This article provides a summary of the most commonly reported endocrine late effects in CCS.
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Affiliation(s)
- Hanneke M van Santen
- Department of Pediatric Endocrinology, Wilhelmina Children's Hospital, UMCU, PO Box 85090, Utrecht 3505 AB, the Netherlands; Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands.
| | - Wassim Chemaitilly
- Division of Endocrinology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Lillian R Meacham
- Division of Hematology/Oncology/BMT, Department of Pediatrics, Emory University, Atlanta, GA, USA
| | - Emily S Tonorezos
- Department of Medicine, Memorial Sloan Kettering and Weill Cornell Medical College, Memorial Sloan Kettering Cancer Center, 485 Lexington Avenue, 2nd Floor, New York, NY 10017, USA
| | - Sogol Mostoufi-Moab
- Division of Endocrinology, Department of Pediatrics, The Children's Hospital of Philadelphia, Roberts Pediatric Clinical Research Building, 2716 South Street, Philadelphia, PA 19146, USA; Division of Oncology, Department of Pediatrics, The Children's Hospital of Philadelphia, Roberts Pediatric Clinical Research Building, 2716 South Street, Philadelphia, PA 19146, USA
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46
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Cahoon EK, Zhang R, Simon SL, Bouville A, Pfeiffer RM. Projected Cancer Risks to Residents of New Mexico from Exposure to Trinity Radioactive Fallout. HEALTH PHYSICS 2020; 119:478-493. [PMID: 32881740 PMCID: PMC7497483 DOI: 10.1097/hp.0000000000001333] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/15/2020] [Indexed: 05/30/2023]
Abstract
The Trinity nuclear test, conducted in 1945, exposed residents of New Mexico to varying degrees of radioactive fallout. Companion papers in this issue have detailed the results of a dose reconstruction that has estimated tissue-specific radiation absorbed doses to residents of New Mexico from internal and external exposure to radioactive fallout in the first year following the Trinity test when more than 90% of the lifetime dose was received. Estimated radiation doses depended on geographic location, race/ethnicity, and age at the time of the test. Here, these doses were applied to sex- and organ-specific risk coefficients (without applying a dose and dose rate effectiveness factor to extrapolate from a population with high-dose/high-dose rates to those with low-dose/low-dose rates) and combined with baseline cancer rates and published life tables to estimate and project the range of radiation-related excess cancers among 581,489 potentially exposed residents of New Mexico. The total lifetime baseline number of all solid cancers [excluding thyroid and non-melanoma skin cancer (NMSC)] was estimated to be 183,000 from 1945 to 2034. Estimates of ranges of numbers of radiation-related excess cancers and corresponding attributable fractions from 1945 to 2034 incorporate various sources of uncertainty. We estimated 90% uncertainty intervals (UIs) of excess cancer cases to be 210 to 460 for all solid cancers (except thyroid cancer and NMSC), 80 to 530 for thyroid cancer, and up to 10 for leukemia (except chronic lymphocytic leukemia), with corresponding attributable fractions ranging from 0.12% to 0.25%, 3.6% to 20%, and 0.02% to 0.31%, respectively. In the counties of Guadalupe, Lincoln, San Miguel, Socorro, and Torrance, which received the greatest fallout deposition, the 90% UI for the projected fraction of thyroid cancers attributable to radioactive fallout from the Trinity test was estimated to be from 17% to 58%. Attributable fractions for cancer types varied by race/ethnicity, but 90% UIs overlapped for all race/ethnicity groups for each cancer grouping. Thus, most cancers that have occurred or will occur among persons exposed to Trinity fallout are likely to be cancers unrelated to exposures from the Trinity nuclear test. While these ranges are based on the most detailed dose reconstruction to date and rely largely on methods previously established through scientific committee agreement, challenges inherent in the dose estimation, and assumptions relied upon both in the risk projection and incorporation of uncertainty are important limitations in quantifying the range of radiation-related excess cancer risk.
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Affiliation(s)
- Elizabeth K. Cahoon
- Division of Cancer Epidemiology & Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Rui Zhang
- Division of Cancer Epidemiology & Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Steven L. Simon
- Division of Cancer Epidemiology & Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | | | - Ruth M. Pfeiffer
- Division of Cancer Epidemiology & Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD
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47
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External Radiation Dose, Obesity, and Risk of Childhood Thyroid Cancer After the Fukushima Daiichi Nuclear Power Plant Accident: The Fukushima Health Management Survey. Epidemiology 2020; 30:853-860. [PMID: 31259849 DOI: 10.1097/ede.0000000000001058] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND The 2011 Great East Japan Earthquake led to a nuclear accident at Fukushima Daiichi Nuclear Power Plant. This study examines the associations of radiation dose and lifestyle factors with incidence of thyroid cancer in Fukushima. METHODS We designed a prospective study with 300,473 participants aged 18 years or younger, who underwent thyroid examinations from October 2011. Follow-up surveys were conducted through June 2017, and 245,530 participants (123,480 men and 122,050 women, 82% follow-up) received follow-up examinations. Fukushima Prefecture was divided into five areas based on individual external radiation dose. We calculated relative risks and 95% confidence intervals (CIs) for thyroid cancer in each area, with area of lowest dose as reference, using age-adjusted Poisson regression models. We also calculated risks associated with overweight and obesity. RESULTS The incidence per 100,000 for Groups A (highest dose), B, C, D, and E (lowest dose) were 13.5, 19.2, 17.3, 9.0, and 8.3, respectively. Compared with Group E, the age-adjusted risks (95% CIs) were 1.62 (0.59, 4.47) for group A, 2.32 (0.86, 6.24) for group B, 2.21 (0.82, 5.94) for group C, and 1.02 (0.36, 2.86) for group D. Obesity was positively associated with thyroid cancer incidence; the multivariable-adjusted risk of thyroid cancer was 2.23 (1.01, 4.90) for obese individuals compared with nonobese individuals. CONCLUSION Regional differences in radiation dose were not associated with increased risk of thyroid cancer among children in Fukushima within 4 to 6 years after the nuclear power plant accident. Obesity may be an important factor for further follow-up in Fukushima.
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48
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Rivas AM, Larumbe-Zabala E, Diaz-Trastoy O, Schurr RN, Jones C, Abdulrahman R, Dar N, Lado-Abeal J. Effect of chemoradiation on the size of the thyroid gland. Proc AMIA Symp 2020; 33:541-545. [PMID: 33100524 DOI: 10.1080/08998280.2020.1786227] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
We aimed to evaluate changes in thyroid gland size during the treatment of malignancies outside the head and neck with chemotherapy and/or external beam radiation. We performed a retrospective review of records of adult patients treated at our institution with external beam radiation to the chest and/or chemotherapy with taxanes, alkylating agents, and/or a topoisomerase II inhibitor. Neck and chest computed tomography (CT) images were used to calculate thyroid gland volume before and after therapy, using Vitrea® software or the volumetric ellipsoid method. Thirty-seven patients were included. After treatment, there was a significant reduction in thyroid gland volume of 14.0% (P < 0.01) using Vitrea and 17.1% (P < 0.05) using the volumetric ellipsoid method. Exposure to radiation or chemotherapy was not found to be associated with the degree of thyroid gland reduction, nor was the number of days between CT scans or the stage of the malignancy being treated. Finally, the degree of thyroid gland size reduction did not predict mortality. Our results showed that the treatment of malignancies outside the head and neck with chemotherapy and/or external beam radiation results in a reduction in thyroid gland size. The impact on thyroid gland function remains unknown.
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Affiliation(s)
- Ana Marcella Rivas
- Division of Endocrinology, Department of Internal Medicine, School of Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Eneko Larumbe-Zabala
- Clinical Research Institute, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Olaia Diaz-Trastoy
- Department of Endocrinology and Nutrition, Complejo Hospitalario Universitario de Pontevedra, Pontevedra, Spain
| | - Ryan Nicholas Schurr
- CTSI Oncology Solutions, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Catherine Jones
- Division of Medical Oncology, Department of Internal Medicine, School of Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Ramzi Abdulrahman
- Division of Radiation Oncology, Department of Internal Medicine, School of Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Nabeel Dar
- Department of Pathology, School of Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Joaquin Lado-Abeal
- Division of Endocrinology, Department of Internal Medicine, School of Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas.,Division of Endocrinology, Department of Internal Medicine, Truman Medical Center, University of Missouri-Kansas City, Kansas City, Missouri
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Lee SH, Kim K, Kim H, Kim S, Han S, Kim EH. Development of the Korean-specific radiation-induced cancer risk model for level 3 probabilistic safety assessment (PSA). J NUCL SCI TECHNOL 2020. [DOI: 10.1080/00223131.2020.1720849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Seung-Hee Lee
- Department of Radiation and Environment, FNC Technology Co, Yongin-si, Gyeonggi-do, Republic of Korea
- Department of Nuclear Engineering, Seoul National University, Seoul, Republic of Korea
| | - Keonmin Kim
- Department of Radiation and Environment, FNC Technology Co, Yongin-si, Gyeonggi-do, Republic of Korea
| | - Hyejin Kim
- Department of Radiation and Environment, FNC Technology Co, Yongin-si, Gyeonggi-do, Republic of Korea
| | - Sukhoon Kim
- Department of Radiation and Environment, FNC Technology Co, Yongin-si, Gyeonggi-do, Republic of Korea
| | - Seokjung Han
- Risk and Environmental Safety Research Division, Korea Atomic Energy Research Institute, Daejeon, Republic of Korea
| | - Eun-Hee Kim
- Department of Nuclear Engineering, Seoul National University, Seoul, Republic of Korea
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50
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Morton LM. Testicular Cancer as a Model for Understanding the Impact of Evolving Treatment Strategies on the Long-Term Health of Cancer Survivors. JNCI Cancer Spectr 2020; 4:pkaa013. [PMID: 32455333 PMCID: PMC7236779 DOI: 10.1093/jncics/pkaa013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 02/20/2020] [Indexed: 01/05/2023] Open
Affiliation(s)
- Lindsay M Morton
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD USA
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