Radiation-induced Thyroid Cancer—What's New?
Abstract
Several years ago I wrote that there was little more to be learned about radiation-induced thyroid cancer ( 1 ) . I was mistaken. After 50 years of research, it was known that the thyroid gland of children, but not adults, was especially sensitive to the carcinogenic action of ionizing radiation, that a straight line adequately represented the relationship between dose of radiation and effect, that effects for thyroid cancer were seen at lower dose levels (on the order of 0.10 Gy) than those observed for most other radiation-induced cancers, that very high dose levels resulted in a lowering of risk because of cell killing, that screening had a profound influence, and that mixtures of radioiodines could cause thyroid cancer. However, the carcinogenic effect of 131 I exposure of children was uncertain. The article by Cardis et al. ( 2 ) in this issue of the Journal has provided new and, if confirmed, provocative information on the risk of radiation-induced thyroid cancer and on the modifying role of diets deficient in stable iodine and of administering iodine supplements months after the exposure has occurred.
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Risks of thyroid cancer after external irradiation are highest in children <5 years of age, and they decline with advancing age.
“Although there are sparse clinical data relating to RAI use in children with GD and subsequent thyroid cancer (313), it is known that risks of thyroid cancer after external irradiation are highest in children <5 years of age, and they decline with advancing age (314,315); see discussion of RAI therapy and cancer risk in Section [P3] below.”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [314]
The risk of thyroid neoplasia is greatest with exposure to low-level external radiation (0.1-25 Gy; ~0.09-30 μCi/g or 3.33-1110 Bq/g), not with the higher administered activities used to treat GD.
“The risk of thyroid neoplasia is greatest with exposure to low-level external radiation (0.1-25 Gy; *0.09-30 lCi/g or 3.33-1110 Bq/g) (314,315,352,354,357), not with the higher administered activities used to treat GD.”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [314]
There is an increased risk of thyroid nodules and cancer associated with low-level thyroid irradiation in children.
“Because of an increased risk of thyroid nodules and cancer associated with low-level thyroid irradiation in children (314,(352)(353)(354)) and poor remission rates with low-administered activities of RAI (88)(89)(90), it is important that RAI activities >150 lCi (>5.55 MBq/g) rather than smaller activities of RAI be administered to achieve hypothyroidism (312).”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [314]
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References 22 · Cited by 76
- Authors
- Boice, J. D.
- Affiliations
- Vanderbilt University (US)
- Corresponding author
- Boice, John D.
- ORCID
- Boice, John D.
- Venue
- JNCI: Journal of the National Cancer Institute
- Publisher
- Oxford University Press (OUP)
- Published
- 2005-05-18
- Volume
- 97
- Issue
- 10
- Pages
- 703-705
- ISSN
- 0027-8874 (ISSN-L)
- 1460-2105
- OpenAlex
- W2097310388
- Cited by
- 76
- References
- 22
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 2 · 2023: 1 · 2022: 3 · 2021: 3 · 2020: 2 · 2019: 3 · 2018: 1 · 2017: 4 · 2016: 5 · 2015: 3 · 2014: 4 · 2013: 2 · 2012: 4
- FWCI
- 4.59
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- JNCI Journal of the National Cancer Institute (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Effects of Radiation Exposure
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Cancer Diagnosis and Treatment
- Physical Sciences › Environmental Science › Global and Planetary Change › Radioactive contamination and transfer
- Keywords
- radiation-induced thyroid cancer, ionizing radiation carcinogenesis, pediatric radiation exposure, iodine-131, iodine supplementation, dose-response relationship, screening effects
- MeSH terms
- Age Factors, Child, Child, Preschool, Dose-Response Relationship, Radiation, Humans, Infant, Iodine Radioisotopes, Neoplasms, Radiation-Induced, Potassium Iodide, Surveys and Questionnaires, Radioactive Fallout, Risk Factors, Russia, Thyroid Gland, Thyroid Neoplasms, United States, Linear Models, Case-Control Studies, Risk Assessment, Radioactive Hazard Release, Chernobyl Nuclear Accident
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