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Long-term risks for thyroid cancer and other neoplasms after exposure to radiation

Abstract

Radiation-related thyroid cancer continues to be a clinical concern for two reasons: the risks associated with the widespread use of radiation treatments for benign conditions in the middle of the last century persist for decades after exposure; and radiation continues to be an effective component of the treatment of several childhood malignancies. Patients who were irradiated in the head and neck area need to be evaluated for thyroid cancer, benign thyroid nodules, hyperparathyroidism, salivary-gland neoplasms and neural tumors, including acoustic neuromas. Radiation-related thyroid cancers appear to have the same clinical behavior as other thyroid cancers, but many irradiated patients are entering the age range when more aggressive neoplasms occur. In this paper, we review how to approach the clinical management of a patient with a history of radiation exposure in the thyroid area, and how to treat radiation-exposed patients who develop related neoplasms, especially thyroid cancer.

Key Points

  • The risk of developing thyroid cancer as a result of childhood exposure to external radiation probably persists for life but may begin to fall after 30–40 years

  • No increase in the incidence of thyroid cancer has been found as a result of the diagnostic use of 131I

  • The Chernobyl accident has indicated dramatically that 131I or other isotopes of iodine can cause thyroid cancers in children

  • Radiation-associated thyroid cancers appear to behave similarly to, and should be treated the same as, non-radiation-associated thyroid cancers

  • Risk factors include high doses of external radiation to the thyroid area, being female, being exposed at a young age, and the presence of other radiation-associated neoplasms

  • Screening strategies include ultrasonography, measuring thyroglobulin and, when large nodules occur, fine-needle aspiration

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Correspondence to Arthur B Schneider.

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Schneider, A., Sarne, D. Long-term risks for thyroid cancer and other neoplasms after exposure to radiation. Nat Rev Endocrinol 1, 82–91 (2005). https://doi.org/10.1038/ncpendmet0022

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