Twenty years' experience with post-Chernobyl thyroid cancer

Strangeways Research Laboratory, Worts Causeway, Cambridge CB1 8RN, UK.
Best Practice & Research: Clinical Endocrinology & Metabolism (Impact Factor: 4.6). 01/2009; 22(6):1061-73. DOI: 10.1016/j.beem.2008.09.020
Source: PubMed


Chernobyl, the largest ever nuclear accident, caused a huge release of radioactive isotopes, including nearly 2x10(18) Bq of iodine-131. Four years later an increase in thyroid cancer incidence, virtually all papillary carcinomas in children, occurred in the highly exposed areas. The increase has continued, and with increasing latency the tumour molecular and morphological pathology has changed; further changes may occur in the future. Children under the age of 1 at exposure show the highest susceptibility, and carry this risk with them into adult life; 4000 cases have been attributed to the accident, but so far very few have died. The risk falls rapidly with increasing age at exposure; it is doubtful if there is any risk for adults at exposure. Other factors linked to susceptibility to thyroid carcinogenesis after Chernobyl include dose, iodine deficiency, and genetic factors. Other consequences are briefly covered.

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    • "The great majority of post-Chernobyl tumors are papillary cancers. D.Williams [24] pointed out that radiation-induced thyroid cancers are not more aggressive than sporadic cancers and that there is no radiation–specific molecular marker. "
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    ABSTRACT: The risk of developing thyroid cancer increases considerably after exposure to external or internal radiation, especially in children below the age of 10. After the Chernobyl reactor accident, the yearly incidence of childhood thyroid cancer in Belarus increased to approximately 40 per 1.000.000 in girls and to roughly 20 per 1.000.000 in boys compared to approximately 0.5 cases per 1.000.000 prior to the accident. Typically, young children with thyroid cancer after radiation exposure present in ≈95% of the cases as papillary cancers, in ≈50% as invasive tumors growing outside the thyroid capsule, in ≈65% with lymph node metastases and in ≈15% with distant metastases. A joint Belarusian-German project starting in April 1993 that combined treatment with surgery and radioiodine was organized in 237 selected children from Belarus who were exposed to the Chernobyl fallout and had advanced stages of thyroid cancer. The study group included 141 girls and 96 boys. Their median age at the time of the accident was 1.7 years; whereas the median age at the time of diagnosis was 12.4 years. With the exception of two cases with follicular histology, the majority of the patients had been diagnosed with papillary thyroid cancers. In 63%, the tumor had grown outside the thyroid capsule and invaded the tissue of the neck (pT4). Nearly all of the selected cases (96%) showed-up with lymph node metastases (pN1) and 43% of the patients with distant metastases mainly to the lungs (pM1). In 58% of the children, complete remissions of thyroid cancer could be achieved until December 31st 2010 and in 34% of the children, stable partial remissions; in the remaining 8% of the patients, partial remissions were observed. The risk of radiation-induced thyroid cancer increased considerably in children and adolescents who were affected by the Chernobyl reactor accident. In spite of the fact, that thyroid cancers in young children seem to behave more aggressively than in older patients, the results of combined treatment with thyroidectomy, radioiodine therapy and thyroid hormone replacement are excellent.
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