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Nguyen NC, Anigati EM, Desai NB, Öz OK. Radioactive Iodine Therapy in Differentiated Thyroid Cancer: An Update on Dose Recommendations and Risk of Secondary Primary Malignancies. Semin Nucl Med 2024:S0001-2998(24)00042-4. [PMID: 38772827 DOI: 10.1053/j.semnuclmed.2024.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 04/25/2024] [Accepted: 05/03/2024] [Indexed: 05/23/2024]
Abstract
Radioactive iodine (RAI) therapy with iodine-131 is performed in select cases of differentiated thyroid cancer (DTC), typically for remnant ablation, adjuvant therapy, or treatment of known persistent disease. Herein, we review updated RAI dose recommendations and associated risks of secondary primary malignancy (SPM). RAI dose is usually chosen empirically based on the risk assessment of tumor recurrence and other factors. Dose recommendations differ slightly among relevant medical societies. As of April 2024, most medical societies, including the American Thyroid Association (ATA), European Thyroid Association (ETA), Society of Nuclear Medicine and Molecular Imaging/European Association of Nuclear Medicine (SNMMI/ EANM), and National Comprehensive Cancer Network (NCCN), recommend a dose of 1.11 GBq (30 mCi) I-131 for remnant ablation. For adjuvant therapy, the recommended RAI dose ranges from 1.11 to 3.7 GBq (30-100) mCi I-131, although doses up to 5.6 GBq (150 mCi) may also be considered. In patients with known or suspected metastatic disease, at least 3.7 GBq (100 mCi) I-131 should be administered, and RAI doses as high as 7.4 GBq (200 mCi) may be justified depending on the suspected tumor burden and extent. Dosimetry has the advantage of tailoring the RAI dose to each patient's pharmacokinetics, resulting in ≥ 7.4 GBq (200 mCi) of I-131 in most cases. There is an ongoing debate about the risk of developing SPM due to RAI therapy, with several multicenter studies and meta-analyses concerning SPM being published in the last 2 years. The incidence of RAI-associated SPM varies according to the study design and detection method. Several studies showed no increased incidence, and there was no specific secondary cancer or cancer group linked to RAI exposures. Some reports indicated that cumulative RAI doses exceeding 5.6-7.4 GBq (150-200 mCi) were found to represent an increased risk for developing SPM. However, a clearly defined dose threshold cannot be provided based on the current literature. Nonetheless, caution should be exercised when considering repeated RAI therapies for persistent metastatic PTC, with a cumulative dose exceeding 37.0 GBq (1,000 mCi), due to the potential risk of developing SPM and other long-term toxicity. Further research is warranted to understand better the relationship between RAI dose and the risk of SPM.
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Affiliation(s)
- Nghi C Nguyen
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX.
| | - Elena M Anigati
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Neil B Desai
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Orhan K Öz
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX
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Tan H, Wang S, Huang F, Tong Z. Association between breast cancer and thyroid cancer risk: a two-sample Mendelian randomization study. Front Endocrinol (Lausanne) 2023; 14:1138149. [PMID: 37288296 PMCID: PMC10242035 DOI: 10.3389/fendo.2023.1138149] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 05/03/2023] [Indexed: 06/09/2023] Open
Abstract
Background Breast and thyroid cancer are increasingly prevalent, but it remains unclear whether the observed associations are due to heightened medical surveillance or intrinsic etiological factors. Observational studies are vulnerable to residual confounding, reverse causality, and bias, which can compromise causal inference. In this study, we employed a two-sample Mendelian randomization (MR) analysis to establish a causal link between breast cancer and heightened thyroid cancer risk. Methods We obtained the single nucleotide polymorphisms (SNPs) associated with breast cancer from a genome-wide association study (GWAS) conducted by the Breast Cancer Association Consortium (BCAC). The FinnGen consortium's latest and largest accessible GWAS thyroid cancer data at the summary level. We performed four MR analyses, including the inverse-variance-weighted (IVW), weighted median, MR-Egger regression, and weighted mode, to evaluate the potential causal connection between genetically predicted breast cancer and higher risk for thyroid cancer. Sensitivity analysis, heterogeneity and pleiotropy tests were used to ensure the reliability of our findings. Results Our study revealed causal relationship between genetically predicted breast cancer and thyroid cancer (IVW method, odds ratio (OR) = 1.135, 95% confidence interval (CI): 1.006 to 1.279, P = 0.038). However, there was no causal association between genetically predicted triple-negative breast cancer and thyroid cancer (OR = 0.817, 95% CI: 0.610 to 1.095, P = 0.177). There was no directional pleiotropy or horizontal pleiotropy in the present study. Conclusion This two-sample MR study supports a causal link between ER-positive breast cancer and heightened the risk of thyroid cancer. Our analysis did not reveal a direct correlation between triple-negative breast cancer and thyroid cancer.
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Affiliation(s)
- Hong Tan
- Department of Pathology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
- National Clinical Research Center for Metabolic Diseases, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Sisi Wang
- Department of Medical Laboratory, Brain Hospital of Hunan Province (The Second People’s Hospital of Hunan Province), Changsha, Hunan, China
| | - Feifei Huang
- Department of Pathology, Shenzhen People’s Hospital, Second Clinical Medical College of Jinan University, Shenzhen, Guangdong, China
| | - Zhongyi Tong
- Department of Pathology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
- National Clinical Research Center for Metabolic Diseases, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
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3
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Fu J, He M, Wu Q, Zhang X, Qi X, Shen K, Wang X, Zhang G. The clinical and genetic features in patients coexisting primary breast and thyroid cancers. Front Endocrinol (Lausanne) 2023; 14:1136120. [PMID: 37229458 PMCID: PMC10203615 DOI: 10.3389/fendo.2023.1136120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 04/26/2023] [Indexed: 05/27/2023] Open
Abstract
Background We attempted to examine the clinical characteristics in patients with breast cancer (BC) and thyroid cancer (TC); explore the potential mechanisms of tumorigenesis and progression. Methods Using the Surveillance, Epidemiology, and End Result Program-9 (SEER-9) database, a retrospective study (1975-2017) was conducted on patients with BC and TC. We identified the common differentially expressed genes involved in BC and TC using the Gene Expression Omnibus database (GEO). Immunohistochemical staining (IHC) was performed to verify the expression of the hit gene in patients with co-occurrence of BC and TC. Using The Cancer Genome Atlas (TCGA) database, the relationship between gene expression and clinicopathological characters was determined. Gene set enrichment analysis (GSEA) was used to identify the pathways enriched in BC and TC. Results BC patients had a higher predisposition to develop TC (standardized incidence ratio, SIR: 1.29) and vice-versa (SIR: 1.12). Most of these patients were differentiated thyroid carcinoma (DTC) and hormone receptor (HR) - positive BC. The mRNA expression of COMP (Cartilage oligomeric matrix protein) was significantly overexpressed in BC and TC by analyzing the GEO database. The protein expression of COMP was increased in both BC and TC tissues obtained from the same patients validated by IHC. COMP was correlated with worse OS in BC (stage II-IV) and TC; it was the independent factor for prognosis of BC. GSEA indicated that the estrogen response and epithelial-mesenchymal transition (EMT) pathways were significantly enriched in both TC- and BC- COMP overexpressed groups. Conclusion The co-occurrence risk of BC and TC in the same individual is higher than in the general population. Overexpression of COMP could promote oncogenesis and progression in patients with BC and TC through estrogen signaling and EMT pathways.
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Affiliation(s)
- Jingyao Fu
- Department of Thyroid Surgery, China-Japan Union Hospital of Jilin University, Changchun, Jilin, China
- Department of Oral-Maxillofacial-Thyroid Oncosurgery, Jilin Cancer Hospital, Changchun, Jilin, China
| | - Miao He
- Department of Anesthesia, The Second Hospital of Jilin University, Changchun, Jilin, China
| | - Qiong Wu
- Department of Breast Surgery, China-Japan Union Hospital of Jilin University, Changchun, Jilin, China
| | - Xiangkai Zhang
- Department of Breast Surgery, China-Japan Union Hospital of Jilin University, Changchun, Jilin, China
- Department of Thyroid and Breast Surgery, Jining No.1 People’s Hospital, Jining, Shandong, China
| | - Xin Qi
- Department of Breast Surgery, China-Japan Union Hospital of Jilin University, Changchun, Jilin, China
| | - Keyu Shen
- Department of Thyroid Surgery, China-Japan Union Hospital of Jilin University, Changchun, Jilin, China
| | - Xiaochun Wang
- Department of Oral-Maxillofacial-Thyroid Oncosurgery, Jilin Cancer Hospital, Changchun, Jilin, China
| | - Guang Zhang
- Department of Thyroid Surgery, China-Japan Union Hospital of Jilin University, Changchun, Jilin, China
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Rossi M, Mele C, Rossetto Giaccherino R, Meomartino L, Brero D, Marsan G, Aimaretti G, Ghigo E, Pagano L. Post-Surgical Indications to Radioiodine Treatment and Potential Risk Factors for Post-Treatment Recurrence in Patients with Intermediate-Risk Differentiated Thyroid Carcinoma. J Pers Med 2023; 13:jpm13050775. [PMID: 37240945 DOI: 10.3390/jpm13050775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 04/20/2023] [Accepted: 04/28/2023] [Indexed: 05/28/2023] Open
Abstract
In this multicentric retrospective observational study, we investigated the potential risk factors for radioiodine (RAI) indication and the post-treatment recurrence of intermediate-risk differentiated thyroid cancer (DTC) 1 and 3 years from diagnosis. We included 121 patients who underwent thyroidectomy for intermediate-risk DTC. The 92 patients (76.0%) who underwent RAI treatment had a higher prevalence of extra-thyroid micro-extension (mETE) (p = 0.03), pT3 staging (p = 0.03) and recourse to therapeutic central (p = 0.04) and lateral (p = 0.01) neck dissection, as well as higher numbers (p = 0.02) and greater dimensions (p = 0.01) of lymph node metastases, compared with untreated patients. Relapse was observed in 18.1% and 20.7% of cases 1 and 3 years from diagnosis, respectively, with no significant differences between groups. A lower age at diagnosis (p = 0.03) and higher levels of stimulated thyroglobulin (Tg) (p = 0.04) emerged as the only independent risk factors for tumour relapse at 1 year. Tumour relapse at 3 years was only independently predicted by the presence of tumour relapse at 1 year (p = 0.04). In conclusion, mETE, pT3 and the presence of large, multiple or clinically evident lymph node metastases represent the main indicators for referring patients to RAI treatment. Early recurrence may be considered the most relevant factor when planning further surveillance.
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Affiliation(s)
- Mattia Rossi
- Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, University of Turin, 10126 Turin, Italy
| | - Chiara Mele
- Endocrinology, Department of Translational Medicine, Università del Piemonte Orientale, 28100 Novara, Italy
| | - Ruth Rossetto Giaccherino
- Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, University of Turin, 10126 Turin, Italy
| | - Letizia Meomartino
- Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, University of Turin, 10126 Turin, Italy
| | - Denise Brero
- Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, University of Turin, 10126 Turin, Italy
| | - Giulia Marsan
- Endocrinology, Department of Translational Medicine, Università del Piemonte Orientale, 28100 Novara, Italy
| | - Gianluca Aimaretti
- Endocrinology, Department of Translational Medicine, Università del Piemonte Orientale, 28100 Novara, Italy
| | - Ezio Ghigo
- Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, University of Turin, 10126 Turin, Italy
| | - Loredana Pagano
- Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, University of Turin, 10126 Turin, Italy
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Tran TVT, Rubino C, Allodji R, Andruccioli M, Bardet S, Diallo I, Dottorini M, Garsi J, Hall P, Henry-Amar M, Lamart S, Le Thai F, Lönn S, Ricard M, Schvartz C, Schlumberger M, Journy N, de Vathaire F. Breast cancer risk among thyroid cancer survivors and the role of I-131 treatment. Br J Cancer 2022; 127:2118-2124. [PMID: 36224404 PMCID: PMC9726818 DOI: 10.1038/s41416-022-01982-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 08/07/2022] [Accepted: 09/05/2022] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Female thyroid cancer survivors are more likely to have a higher risk of breast cancer compared to the general population, and the underlying causes are yet to be understood. The potential role of I-131 treatment on this association remains controversial. METHODS We pooled individual data of women who were treated for differentiated thyroid cancer from 1934 to 2005 in France, Italy and Sweden. Standardized incidence ratios (SIRs) for breast cancer were estimated by comparison with age, sex and calendar-year expected values of the general population in each country. We estimated breast cancer risk in relation to I-131 treatment using time-dependent Poisson models. RESULTS Of 8475 women (mean age at diagnosis: 45 years, range 2-90 years), 335 were diagnosed with breast cancer [SIR = 1.52, 95% confidence interval (CI): 1.36-1.69] during a median follow-up time of 12.7 years since diagnosis. Overall, breast cancer risk did not differ between women treated or not with I-131 (relative risk=1.07, 95% CI 0.84-1.35). However, breast cancer risk increased with increasing cumulative I-131 activity, without significant departure from linearity (excess relative risk per 100 mCi=17%, 95% CI: 2% to 38%). The higher risk associated with a cumulative I-131 activity of ≥100 mCi and ≥400 mCi was translated into 4 (95% CI -4 to 13) and 42 (95% CI -8 to 93) excess breast cancer cases per 10,000 person-years, respectively. CONCLUSIONS An elevated risk was observed for the highest cumulative administered activity (>=400 mCi), and a significant dose-dependent association was observed among thyroid cancer survivors who were treated with I-131. However, overall, I-131 treatment might only explain partly the increase in breast cancer risk among female thyroid cancer survivors.
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Affiliation(s)
- Thi-Van-Trinh Tran
- Radiation Epidemiology Team, INSERM U1018, Center for Research in Epidemiology and Population Health (CESP), F-94805, Villejuif Cedex, France.
- Department of Research, Gustave Roussy, F-94805, Villejuif Cedex, France.
- University of Paris Saclay, Kremlin-Bicêtre, France.
| | - Carole Rubino
- Radiation Epidemiology Team, INSERM U1018, Center for Research in Epidemiology and Population Health (CESP), F-94805, Villejuif Cedex, France.
- Department of Research, Gustave Roussy, F-94805, Villejuif Cedex, France.
- University of Paris Saclay, Kremlin-Bicêtre, France.
| | - Rodrigue Allodji
- Radiation Epidemiology Team, INSERM U1018, Center for Research in Epidemiology and Population Health (CESP), F-94805, Villejuif Cedex, France
- Department of Research, Gustave Roussy, F-94805, Villejuif Cedex, France
- University of Paris Saclay, Kremlin-Bicêtre, France
| | - Milena Andruccioli
- Department of Nuclear Medicine, Sant'Anna Hospital, via Napoleona 60, 22100, Como, Italy
| | - Stéphane Bardet
- Department of Nuclear Medicine and Thyroid Unit, Centre François Baclesse, Caen, France
| | - Ibrahima Diallo
- Radiation Epidemiology Team, INSERM U1018, Center for Research in Epidemiology and Population Health (CESP), F-94805, Villejuif Cedex, France
- Department of Research, Gustave Roussy, F-94805, Villejuif Cedex, France
- University of Paris Saclay, Kremlin-Bicêtre, France
| | - Massimo Dottorini
- Department of Diagnostic Imaging, Nuclear Medicine Unit, Perugia General Hospital, Perugia, Italy
| | - Jérome Garsi
- Radiation Epidemiology Team, INSERM U1018, Center for Research in Epidemiology and Population Health (CESP), F-94805, Villejuif Cedex, France
- Department of Research, Gustave Roussy, F-94805, Villejuif Cedex, France
- University of Paris Saclay, Kremlin-Bicêtre, France
| | - Per Hall
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, 171 65, Stockholm, Sweden
- Department of Oncology, Södersjukhuset, 118 83, Stockholm, Sweden
| | - Michel Henry-Amar
- Centre de Traitement des Données du Cancéropôle Nord-Ouest, Plateforme de Recherche Clinique Ligue Contre le Cancer, Centre François Baclesse, 3 Avenue Général Harris, 14076, Caen, Cedex 5, France
| | - Stephanie Lamart
- Laboratoire d'Évaluation de la Dose Interne, Institut de Radioprotection et de Sûreté Nucléaire, IRSN/PSE-SANTE/SDOS/LEDI, 31 avenue de la Division Leclerc, 92260, Fontenay-aux-Roses, France
| | | | - Stefan Lönn
- Department of Research and Development, Region Halland, Halmstad, Sweden
| | - Marcel Ricard
- Department of Physics, Gustave Roussy and Paris Saclay University, Villejuif, France
| | - Claire Schvartz
- Nuclear medicine-thyroid Unit, Institut Godinot, 1, rue du Général-Koenig, 51100, Reims, France
- Thyroid Cancer Registry of Marne-Ardennes, Institut Godinot, 1, rue du Général-Koenig, 51100, Reims, France
| | - Martin Schlumberger
- Department of Nuclear Medicine and Endocrine Oncology, Gustave Roussy and University Paris-Saclay, 94800, Villejuif, France
| | - Neige Journy
- Radiation Epidemiology Team, INSERM U1018, Center for Research in Epidemiology and Population Health (CESP), F-94805, Villejuif Cedex, France
- Department of Research, Gustave Roussy, F-94805, Villejuif Cedex, France
- University of Paris Saclay, Kremlin-Bicêtre, France
| | - Florent de Vathaire
- Radiation Epidemiology Team, INSERM U1018, Center for Research in Epidemiology and Population Health (CESP), F-94805, Villejuif Cedex, France.
- Department of Research, Gustave Roussy, F-94805, Villejuif Cedex, France.
- University of Paris Saclay, Kremlin-Bicêtre, France.
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Piek MW, de Boer JP, van Duijnhoven F, van der Wal JE, Vriens M, van Leeuwaarde RS, van der Ploeg IMC. The co-occurrence of both breast- and differentiated thyroid cancer: incidence, association and clinical implications for daily practice. BMC Cancer 2022; 22:1018. [PMID: 36163009 PMCID: PMC9511724 DOI: 10.1186/s12885-022-10069-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 07/25/2022] [Indexed: 11/14/2022] Open
Abstract
Background Breast cancer (BC) and differentiated thyroid cancer (TC) are two common cancer types with the highest incidence in women. BC and TC can develop synchronous or metachronous and the occurrence of both is higher than expected by chance. This study aimed to examine the association between BC and TC in the Netherlands. Methods This is a retrospective cohort study during the period of 1989–2020 retrieved from the Netherlands Cancer Registry (NCR). Patients diagnosed with BC-TC and BC alone as control group and TC-BC and TC alone as control group were included. The primary outcome was the standardized incidence ratio (SIR) of BC-TC and TC-BC. Secondary outcomes included data on the demographics, type of malignancy, treatment and overall survival (OS). Results The incidence of TC among 318.002 women with BC (BC-TC) was 0.1% (423 patients) (SIR = 1.86 (95% CI: 1.40–2.32)) and the incidence of BC among 12,370 patients with TC (TC-BC) was 2.9% (355 patients) (SIR = 1.46 (95% CI: 1.09–1.83)). BC-TC patients were younger compared to the BC alone group at BC diagnosis (55 vs 60 years, p < 0.001). The age-adjusted odds ratio to develop TC was not significantly increased for patients who received chemotherapy and radiotherapy. Most TC cases were synchronous tumors after BC diagnosis (19%) with a TNM stage 1. Only 6% of the BC tumors after TC occurred synchronous with a TNM stage 1 in most cases. The OS of all groups was the most favorable in patients with both BC and TC compared to BC- and TC alone. Conclusion and relevance The SIR of TC after BC diagnosis and BC after TC diagnosis was higher than predicted based on the rates of the general population. TC and BC as second primary tumors were diagnosed in an early stage and did not affect overall survival. Therefore, Dutch women who have been treated for BC or TC require no special surveillance for their thyroid- and breast gland.
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Affiliation(s)
- Marceline W Piek
- Department of Surgical Oncology, The Netherlands, Cancer Institute-Antoni Van Leeuwenhoek Hospital, Plesmanlaan 121, NL-1066 CX, Amsterdam, The Netherlands
| | - Jan Paul de Boer
- Department of Medical Oncology, The Netherlands, Cancer Institute-Antoni Van Leeuwenhoek Hospital, Plesmanlaan 121, NL-1066 CX, Amsterdam, The Netherlands
| | - Frederieke van Duijnhoven
- Department of Surgical Oncology, The Netherlands, Cancer Institute-Antoni Van Leeuwenhoek Hospital, Plesmanlaan 121, NL-1066 CX, Amsterdam, The Netherlands
| | - Jacqueline E van der Wal
- Department of Pathology, The Netherlands Cancer Institute-Antoni Van Leeuwenhoek Hospital, Plesmanlaan 121, NL-1066 CX, Amsterdam, The Netherlands
| | - Menno Vriens
- Department of Endocrine Surgery, University Medical Centre of Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Rachel S van Leeuwaarde
- Department of Medical Oncology, The Netherlands, Cancer Institute-Antoni Van Leeuwenhoek Hospital, Plesmanlaan 121, NL-1066 CX, Amsterdam, The Netherlands.,Department of Endocrine Oncology, University Medical Centre of Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Iris M C van der Ploeg
- Department of Surgical Oncology, The Netherlands, Cancer Institute-Antoni Van Leeuwenhoek Hospital, Plesmanlaan 121, NL-1066 CX, Amsterdam, The Netherlands.
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7
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Zhao X, Yang G, Zhang W, Dong Q, Yang Q. Age-related risk for second breast cancer and gynecological malignant neoplasms after differentiated thyroid cancer. Endocrine 2022; 76:385-394. [PMID: 35122212 DOI: 10.1007/s12020-022-02999-9] [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: 11/21/2021] [Accepted: 01/22/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE In this study, we aimed to investigate the age-related risk of second breast cancer (SBC) and second gynecological malignant neoplasms (SGMNs) in female differentiated thyroid cancer (DTC) survivors by utilizing the Surveillance, Epidemiology, and End Results (SEER) database. METHODS A total number of 55,622 female DTC patients were identified between 1975 and 2016, including 2168 patients who developed SBC and SGMNs. The Fine and Gray model was used to calculate the cumulative incidence and sub-distribution hazards ratios (SHR). Poisson regression analysis was employed to calculate the relative risk (RR) and standardized incidence ratio (SIR). Kaplan-Meier survival and log-rank test analyses were also performed. RESULTS The overall 40-year cumulative incidence of SBC and SGMNs was 18.9%. Their incidence in the adolescent and young adults (AYA) group increased slowly in the first 30 years, but then was rapidly elevated in the last decade. It increased gradually in the middle-aged adults group and in the first 25 years in the older adults group, but it scarcely increased thereafter. Both the middle-aged adults (adjusted SHR, 2.09; RR, 1.76) and the older adults (adjusted SHR, 1.32; RR, 1.58) groups had higher risks of developing combined SBC and SGMNs than the AYA group. The risks increased mainly in the early latency period. The three groups also had higher SIRs than the US general population. Besides, the best survival after SBC and SGMNs was observed in the AYA group. CONCLUSIONS Age was an independent risk factor for SBC and SGMNs incidences among female DTC survivors.
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Affiliation(s)
- Xianlan Zhao
- People's Hospital of Honghuagang District, Zunyi, China
| | - Guangrong Yang
- Department of Oncology, Qijiang Hospital of the First Affiliated Hospital of Chongqing Medical University, Qijiang, China
| | - Weina Zhang
- Department of Critical Care Medicine, The 941st Hospital of the PLA Joint Logistic Support Force, Xining, China
| | - Qiang Dong
- Department of General Medicine, Qijiang Hospital of the First Affiliated Hospital of Chongqing Medical University, Qijiang, China
| | - Qiao Yang
- Department of Ultrasound, The 941st Hospital of the PLA Joint Logistic Support Force, Xining, China.
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8
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Seo GH, Kong KA, Kim BS, Kang SY, Moon BS, Yoon HJ, Kim HO. Radioactive Iodine Treatment for Children and Young Adults with Thyroid Cancer in South Korea: A Population-based Study. J Clin Endocrinol Metab 2021; 106:e2580-e2588. [PMID: 33755732 DOI: 10.1210/clinem/dgab192] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Indexed: 12/13/2022]
Abstract
PURPOSE This study investigated radioactive iodine treatment (RAIT) patterns and the secondary cancer incidence among children and young adults receiving RAIT after thyroidectomy for thyroid cancer. METHODS This population-based cohort study used the Health Insurance Review and Assessment database of South Korea to identify a total of 18 617 children and young adults (0-29 years) who underwent thyroidectomy for thyroid cancer between 2008 and 2018. We recorded age at surgery, sex, the interval from surgery to RAIT, the doses of RAI, the number of RAIT sessions, and secondary cancer incidence. RESULTS A total of 9548 (51.3%) children and young adults underwent 1 or more RAIT sessions. The initial dose of RAIT was 4.35 ± 2.19 GBq. The overall RAIT frequency fell from 60.9% to 38.5%, and the frequency of high-dose RAIT (>3.7 GBq) fell from 64.2% to 36.5% during the observational period. A total of 124 cases of secondary cancer developed during 120 474 person-years of follow-up; 43 (0.5%) in the surgery cohort and 81 (0.8%) in the RAIT cohort. Thus, the RAIT cohort was at an increased risk of secondary cancer (adjusted hazard ratio 1.52 [95% confidence interval 1.03-2.24], P = 0.035). CONCLUSION The proportion of children and young adults receiving RAIT, and the RAI dose, fell significantly over the observational period. RAIT was associated with secondary cancers. This is of major concern in the context of child and young adult thyroid cancer survivors.
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Affiliation(s)
- Gi Hyeon Seo
- Health Insurance Review and Assessment Service, Seoul, Korea
| | - Kyoung Ae Kong
- Department of Preventive Medicine, College of Medicine, Ewha Womans University, Seoul, Korea
| | - Bom Sahn Kim
- Department of Nuclear Medicine, College of Medicine, Ewha Womans University, Seoul, Korea
| | - Seo Young Kang
- Department of Nuclear Medicine, College of Medicine, Ewha Womans University, Seoul, Korea
| | - Byung Seok Moon
- Department of Nuclear Medicine, College of Medicine, Ewha Womans University, Seoul, Korea
| | - Hai-Jeon Yoon
- Department of Nuclear Medicine, College of Medicine, Ewha Womans University, Seoul, Korea
| | - Hye Ok Kim
- Department of Nuclear Medicine, College of Medicine, Ewha Womans University, Seoul, Korea
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Abstract
The aim of this study was to evaluate whether there are thyroid diseases in which breast cancer will appear later as well as the role of autoimmunity. This was a retrospective observational study. A total of 410 females (thyroid surgery and later breast cancer) and 524 females (thyroid surgery only) were compared with regard to pathological thyroid findings, thyroid hormones, thyroid autoimmunity and type of breast cancer. Thyroid autoimmunity, especially antithyroid peroxidase antibodies, significantly increased the risk of breast cancer (p < 0.01); however, this was not true for other thyroid diseases, including thyroid cancer. No variant of breast cancer was predominant, and only thyroid autoimmunity was associated with the risk of breast cancer. Further research is needed to explain the impacts of different antithyroid antibodies. Several studies have long hypothesized a link between thyroid disease and breast cancer. The authors' study retrospectively examined a large cohort of patients who initially underwent thyroid surgery and subsequently had breast cancer compared with a control group consisting of patients with only breast cancer. This comparison showed that only autoimmune thyroid disease was a risk factor for subsequent breast cancer, whereas no significant association of thyroid cancer with breast cancer was found.
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Zhao X, Chen M, Qi X, Zhu H, Yang G, Guo Y, Dong Q, Yang Q. Association of Radioiodine for Differentiated Thyroid Cancer and Second Breast Cancer in Female Adolescent and Young Adult. Front Endocrinol (Lausanne) 2021; 12:805194. [PMID: 35154006 PMCID: PMC8832493 DOI: 10.3389/fendo.2021.805194] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 12/13/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Exposure to radiation is related to breast cancer occurrence. While whether the radioiodine (RAI) increases the risk of second breast cancer (SBC) in female differentiated thyroid cancer (DTC) patients is not well addressed. METHODS All patients were identified from Surveillance, Epidemiology, and End Results database. At least a 5-year latency was guaranteed since exposure to RAI. Fine and Gray model was used to calculate the cumulative incidence and hazards ratios (HR) and 95% confidence interval (CI). Standardized incidence ratio (SIR) was calculated by Poisson regression analysis. Propensity score matching was used for match analysis. Survival analyses were performed by the Kaplan-Meier method and the log-rank test. RESULTS A total of 406 out of 16,850 patients in the RAI group and 733 out of 22,135 patients in the no RAI group developed SBC. The cumulative incidences of SBC were higher in patients with RAI compared with patients without RAI in the adolescent and young adult (AYA) group and the middle-aged adult group. In the AYA group, patients with RAI had increased HR (1.65; 95% CI, 1.33-2.05, p < 0.001) compared with those without RAI, and the HR increased slightly with latency. In addition, the SIR (1.21; 95% CI, 1.02-1.44, p < 0.05) increased compared with the general population. Whereas, in the middle-aged adult group, only a slightly higher HR (1.18) was found. The survival after SBC was inferior to those with matched only primary breast cancer. CONCLUSIONS RAI treatment increased the risk of SBC in female AYA DTC patients. A long-term follow-up should be performed in this population.
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Affiliation(s)
- Xianlan Zhao
- People's Hospital of Honghuagang District, Zunyi, China
| | - Mingjing Chen
- Department of Infectious Diseases, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xiaojing Qi
- Department of Ultrasound, The 941st Hospital of the People’s Liberation Army (PLA) Joint Logistic Support Force, Xining, China
| | - Haizhen Zhu
- Department of Oncology, Guizhou Provincial People’s Hospital, Guizhou Cancer Center, Guiyang, China
| | - Guangrong Yang
- Department of Oncology, Qijiang Hospital of the First Affiliated Hospital of Chongqing Medical University, Qijiang, China
| | - Yi Guo
- Department of Basic Knowledge, Guiyang Nursing Vocational College, Guiyang, China
| | - Qiang Dong
- Department of General Medicine, Qijiang Hospital of the First Affiliated Hospital of Chongqing Medical University, Qijiang, China
- *Correspondence: Qiao Yang, ; Qiang Dong,
| | - Qiao Yang
- Department of Ultrasound, The 941st Hospital of the People’s Liberation Army (PLA) Joint Logistic Support Force, Xining, China
- *Correspondence: Qiao Yang, ; Qiang Dong,
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11
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Drozd V, Schneider R, Platonova T, Panasiuk G, Leonova T, Oculevich N, Shimanskaja I, Vershenya I, Dedovich T, Mitjukova T, Grelle I, Biko J, Reiners C. Feasibility Study Shows Multicenter, Observational Case-Control Study Is Practicable to Determine Risk of Secondary Breast Cancer in Females With Differentiated Thyroid Carcinoma Given Radioiodine Therapy in Their Childhood or Adolescence; Findings Also Suggest Possible Fertility Impairment in Such Patients. Front Endocrinol (Lausanne) 2020; 11:567385. [PMID: 33193085 PMCID: PMC7655975 DOI: 10.3389/fendo.2020.567385] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 08/27/2020] [Indexed: 12/20/2022] Open
Abstract
Objective: This single-center, observational case-control feasibility study sought to test key elements of a protocol for an eventual long-term international observational case-control study of a larger patient cohort, to evaluate the risk of breast cancer as a second primary malignancy in females with differentiated thyroid cancer (DTC) given radioiodine therapy (RAI) during childhood or adolescence. Patients: Females developing DTC after the Chernobyl accident in Belarus and ≤19 years old at the time of thyroid surgery were enrolled: patients given RAI (n = 111) and controls of similar age not given RAI (n = 90). Results: One case of breast cancer was newly diagnosed among the RAI patients, but none in controls. Patients given RAI significantly less frequently needed 2nd surgeries than did controls (23%, 26/111 vs. 39%, 35/90, P < 0.05); the main indication for such procedures usually is suspicion of local recurrence. RAI patients appeared to have had more frequent reproductive difficulties than did controls: 78% (87/111) of the former vs. 93% (84/90) of the latter had a history of pregnancy (P < 0.01), and the mean number of pregnancies was 1.5 ± 1.2 in RAI patients vs. 1.9±1.1 in controls (P < 0.05). Most notably, infertility was observed in 23% (26/111) of RAI patients vs. 4% (4/90) of controls (P < 0.01). In conclusion, a international observational case-control study on breast cancer after DTC in patients given RAI vs. not given RAI appears to be feasible. Additional research and everyday clinical attention should be devoted to reproductive function after RAI in young females.
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Affiliation(s)
- Valentina Drozd
- International Foundation “Arnica,”Minsk, Belarus
- *Correspondence: Valentina Drozd
| | - Rita Schneider
- Department of Nuclear Medicine, University Hospital, Würzburg, Germany
| | | | | | - Tatjana Leonova
- The Center of Thyroid Tumors, Minsk City Oncological Dispensary, Minsk, Belarus
| | | | | | | | | | | | - Inge Grelle
- Department of Nuclear Medicine, University Hospital, Würzburg, Germany
| | - Johannes Biko
- Department of Nuclear Medicine, University Hospital, Würzburg, Germany
| | - Christoph Reiners
- Department of Nuclear Medicine, University Hospital, Würzburg, Germany
- Christoph Reiners
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