The first 2 authors contributed equally to this article. N.G.I., L.G.T.M., and I.G. conceived hypotheses, data acquisition, and analysis and prepared the article; A.R.S. and R.M.T. critically reviewed the data and the article. N.G.I. and L.G.T.M. had full access to all data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.
Rising incidence of second cancers in patients with low-risk (T1N0) thyroid cancer who receive radioactive iodine therapy†
Version of Record online: 22 MAR 2011
Copyright © 2011 American Cancer Society
Volume 117, Issue 19, pages 4439–4446, 1 October 2011
How to Cite
Iyer, N. G., Morris, L. G. T., Tuttle, R. M., Shaha, A. R. and Ganly, I. (2011), Rising incidence of second cancers in patients with low-risk (T1N0) thyroid cancer who receive radioactive iodine therapy. Cancer, 117: 4439–4446. doi: 10.1002/cncr.26070
- Issue online: 16 SEP 2011
- Version of Record online: 22 MAR 2011
- Manuscript Accepted: 1 FEB 2011
- Manuscript Revised: 8 JAN 2011
- Manuscript Received: 23 NOV 2010
- and End Results;
- second primary cancer;
- radioactive iodine;
American Thyroid Association guidelines currently recommend the selective use of radioactive iodine (RAI) therapy in patients with well differentiated thyroid cancer (WDTC). Despite these guidelines, RAI ablation has been used routinely in all but the very lowest risk patients with thyroid cancer over the last 30 years. The objective of this study was to evaluate patterns of RAI use and elevated risk of secondary primary malignancies (SPM) in patients with low-risk (T1N0) WDTC.
The Surveillance, Epidemiology, and End Results (SEER) database was used to analyze trends in RAI use over time in the United States. To determine the excess risk of SPM, the standardized incidence ratio (SIR) and excess absolute risk (EAR) of various cancers were calculated in the 2 cohorts. Between 1973 and 2007, 37,176 patients with WDTC were followed in the SEER Program, equating to 408,750 person-years at risk (PYR). In total, 14,589 patients received RAI, and SPMs were observed in 3223 patients.
During the study period, the rate of RAI use in patients with low-risk (T1N0) WDTC increased from 3.3% to 38.1%. For low-risk patients, the SIR of SPM was 1.21 (95% confidence interval [CI], 0.93-1.54), and the EAR was 4.6 excess cases per 10,000 PYR. SPM with significantly elevated risk because of RAI were salivary gland malignancies (SIR = 11.13; 95% CI, 1.35-40.2) and leukemia (SIR = 5.68; 95% CI, 2.09-12.37). The excess risk of leukemia was significantly greater in patients aged <45 years (SIR = 5.32; 95% CI, 2.75-9.30) compared with the excess risk in older patients (SIR = 2.26; 95% CI, 1.43-3.39).
The increased risk of a SPM in patients with low-risk (T1N0) WDTC, along with a lack of data demonstrating improved survival outcomes with adjuvant RAI, provide a compelling argument in favor of rationing the use of RAI in this patient population. Cancer 2011;. © 2011 American Cancer Society.