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Cited by 1,124Effects of Radiation ExposureThyroid Cancer Diagnosis and TreatmentRadiation Dose and Imaging

Thyroid Cancer after Exposure to External Radiation: A Pooled Analysis of Seven Studies

Ron, Elaine, Lubin, Jay H., Shore, Roy E., Mabuchi, Kiyohiko, Modan, Baruch, Pottern, Linda M., Schneider, Arthur B., Tucker, Margaret A. +1 more·2012·Radiation Research
DOI 10.1667/rrav05.1
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Abstract

The thyroid gland of children is especially vulnerable to the carcinogenic action of ionizing radiation. To provide insights into various modifying influences on risk, seven major studies with organ doses to individual subjects were evaluated. Five cohort studies (atomic bomb survivors, children treated for tinea capitis, two studies of children irradiated for enlarged tonsils, and infants irradiated for an enlarged thymus gland) and two case-control studies (patients with cervical cancer and childhood cancer) were studied. The combined studies include almost 120,000 people (approximately 58,000 exposed to a wide range of doses and 61,000 nonexposed subjects), nearly 700 thyroid cancers and 3,000,000 person years of follow-up. For persons exposed to radiation before age 15 years, linearity best described the dose response, even down to 0.10 Gy. At the highest doses (> 10 Gy), associated with cancer therapy, there appeared to be a decrease or leveling of risk. For childhood exposures, the pooled excess relative risk per Gy (ERR/Gy) was 7.7 (95% CI = 2.1, 28.7) and the excess absolute risk per 10(4) PY Gy (EAR/10(4) PY Gy) was 4.4 (95% CI = 1.9, 10.1). The attributable risk percent (AR%) at 1 Gy was 88%. However, these summary estimates were affected strongly by age at exposure even within this limited age range. The ERR was greater (P = 0.07) for females than males, but the findings from the individual studies were not consistent. The EAR was higher among women, reflecting their higher rate of naturally occurring thyroid cancer. The distribution of ERR over time followed neither a simple multiplicative nor an additive pattern in relation to background occurrence. Only two cases were seen within 5 years of exposure. The ERR began to decline about 30 years after exposure but was still elevated at 40 years. Risk also decreased significantly with increasing age at exposure, with little risk apparent after age 20 years. Based on limited data, there was a suggestion that spreading dose over time (from a few days to > 1 year) may lower risk, possibly due to the opportunity for cellular repair mechanisms to operate. The thyroid gland in children has one of the highest risk coefficients of any organ and is the only tissue with convincing evidence for risk about 1.10 Gy.

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  • 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 [353]

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Authors
Ron, E., Lubin, J. H., Shore, R. E., Mabuchi, K., Modan, B., Pottern, L. M., Schneider, A. B., Tucker, M. A., & Boice, J. D.
Affiliations
  • National Institutes of Health (US)
  • NYU Langone Health (US)
  • Sheba Medical Center (IL)
  • University of Illinois Chicago (US)
Corresponding author
Boice, John D.
ORCID
Venue
Radiation Research
Publisher
Radiation Research Society
Published
2012-08
Volume
178
Issue
2
Pages
AV43-AV60
ISSN
  • 0033-7587 (ISSN-L)
  • 1938-5404
DOI
10.1667/rrav05.1
OpenAlex
W2163592796
Cited by
1,124
References
48
Citations by year
2026: 1 · 2025: 4 · 2024: 18 · 2023: 16 · 2022: 16 · 2021: 24 · 2020: 40 · 2019: 27 · 2018: 34 · 2017: 50 · 2016: 43 · 2015: 60 · 2014: 57 · 2013: 50 · 2012: 62
FWCI
55.31
Type
journal article
Language
en
Open access
closed
Locations
  • Radiation Research (publishedVersion)
  • PubMed (publishedVersion)
  • BioOne Complete (BioOne) (submittedVersion)
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
  • Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Radiation Dose and Imaging
Keywords
thyroid cancer, pediatric radiation exposure, ionizing radiation carcinogenesis, dose-response relationship, age at exposure, sex differences in cancer risk, atomic bomb survivors, thymus irradiation, cervical cancer, childhood cancer, excess relative risk, excess absolute risk
MeSH terms
Adolescent, Adult, Aged, Aged, 80 and over, Humans, Middle Aged, Neoplasms, Radiation-Induced, Thyroid Neoplasms, History, 20th Century

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