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Thyroid Cancer after Childhood Exposure to External Radiation: An Updated Pooled
Analysis of 12 Studies
#MMPMID27128740
Veiga LH
; Holmberg E
; Anderson H
; Pottern L
; Sadetzki S
; Adams MJ
; Sakata R
; Schneider AB
; Inskip P
; Bhatti P
; Johansson R
; Neta G
; Shore R
; de Vathaire F
; Damber L
; Kleinerman R
; Hawkins MM
; Tucker M
; Lundell M
; Lubin JH
Radiat Res
2016[May]; 185
(5
): 473-84
PMID27128740
show ga
Studies have causally linked external thyroid radiation exposure in childhood
with thyroid cancer. In 1995, investigators conducted relative risk analyses of
pooled data from seven epidemiologic studies. Doses were mostly <10 Gy, although
childhood cancer therapies can result in thyroid doses >50 Gy. We pooled data
from 12 studies of thyroid cancer patients who were exposed to radiation in
childhood (ages <20 years), more than doubling the data, including 1,070 (927
exposed) thyroid cancers and 5.3 million (3.4 million exposed) person-years.
Relative risks increased supralinearly through 2-4 Gy, leveled off between 10-30
Gy and declined thereafter, remaining significantly elevated above 50 Gy. There
was a significant relative risk trend for doses <0.10 Gy (P < 0.01), with no
departure from linearity (P = 0.36). We observed radiogenic effects for both
papillary and nonpapillary tumors. Estimates of excess relative risk per Gy
(ERR/Gy) were homogeneous by sex (P = 0.35) and number of radiation treatments (P
= 0.84) and increased with decreasing age at the time of exposure. The ERR/Gy
estimate was significant within ten years of radiation exposure, 2.76 (95% CI,
0.94-4.98), based on 42 exposed cases, and remained elevated 50 years and more
after exposure. Finally, exposure to chemotherapy was significantly associated
with thyroid cancer, with results supporting a nonsynergistic (additive)
association with radiation.
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