Skip to main content

Advertisement

SpringerLink
Log in

Screening for thyroid cancer in survivors of childhood and young adult cancer treated with neck radiation

  • Published:
Journal of Cancer Survivorship Aims and scope Submit manuscript

Abstract

Background

The optimal method of screening for thyroid cancer in survivors of childhood and young adult cancer exposed to neck radiation remains controversial. Outcome data for a physical exam-based screening approach are lacking.

Methods

We conducted a retrospective review of adult survivors of childhood and young adult cancer with a history of neck radiation followed in the Adult Long-Term Follow-Up Clinic at Memorial Sloan Kettering between November 2005 and August 2014. Eligible patients underwent a physical exam of the thyroid and were followed for at least 1 year afterwards. Ineligible patients were those with prior diagnosis of benign or malignant thyroid nodules.

Results

During a median follow-up of 3.1 years (range 0–9.4 years), 106 ultrasounds and 2277 physical exams were performed among 585 patients. Forty survivors had an abnormal thyroid physical exam median of 21 years from radiotherapy; 50% of those with an abnormal exam were survivors of Hodgkin lymphoma, 60% had radiation at ages 10–19, and 53% were female. Ultimately, 24 underwent fine needle aspiration (FNA). Surgery revealed papillary carcinoma in seven survivors; six are currently free of disease and one with active disease is undergoing watchful waiting. Among those with one or more annual visits, representing 1732 person-years of follow-up, no cases of thyroid cancer were diagnosed within a year of normal physical exam.

Conclusions

These findings support the application of annual physical exam without routine ultrasound for thyroid cancer screening among survivors with a history of neck radiation.

Implications for cancer survivors

Survivors with a history of neck radiation may not require routine thyroid ultrasound for thyroid cancer screening.

Condensed abstract

Among adult survivors of childhood and young adult cancer with a history of radiation therapy to the neck, annual physical exam is an acceptable thyroid cancer screening strategy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Phillips SM, Padgett LS, Leisenring WM, Stratton KK, Bishop K, Krull KR, et al. Survivors of childhood cancer in the United States: prevalence and burden of morbidity. Cancer epidemiology, biomarkers & prevention: a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology. 2015;24(4):653–63. doi:10.1158/1055-9965.EPI-14-1418.

    Article  Google Scholar 

  2. Smith MA, Altekruse SF, Adamson PC, Reaman GH, Seibel NL. Declining childhood and adolescent cancer mortality. Cancer. 2014;120(16):2497–506. doi:10.1002/cncr.28748.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Oeffinger KC, Mertens AC, Sklar CA, Kawashima T, Hudson MM, Meadows AT, et al. Chronic health conditions in adult survivors of childhood cancer. N Engl J Med. 2006;355(15):1572–82. doi:10.1056/NEJMsa060185.

    Article  CAS  PubMed  Google Scholar 

  4. Armstrong GT, Liu Q, Yasui Y, Neglia JP, Leisenring W, Robison LL, et al. Late mortality among 5-year survivors of childhood cancer: a summary from the Childhood Cancer Survivor Study. J Clin Oncol Off J Am Soc Clin Oncol. 2009;27(14):2328–38. doi:10.1200/JCO.2008.21.1425.

    Article  CAS  Google Scholar 

  5. Geenen MM, Cardous-Ubbink MC, Kremer LC, van den Bos C, van der Pal HJ, Heinen RC, et al. Medical assessment of adverse health outcomes in long-term survivors of childhood cancer. JAMA. 2007;297(24):2705–15. doi:10.1001/jama.297.24.2705.

    Article  CAS  PubMed  Google Scholar 

  6. Garwicz S, Anderson H, Olsen JH, Winther JF, Sankila R, Langmark F, et al. Late and very late mortality in 5-year survivors of childhood cancer: changing pattern over four decades—experience from the Nordic countries. International journal of cancer Journal international du cancer. 2012;131(7):1659–66. doi:10.1002/ijc.27393.

    Article  CAS  PubMed  Google Scholar 

  7. Schaapveld M, Aleman BM, van Eggermond AM, Janus CP, Krol AD, van der Maazen RW, et al. Second cancer risk up to 40 years after treatment for Hodgkin’s lymphoma. N Engl J Med. 2015;373(26):2499–511. doi:10.1056/NEJMoa1505949.

    Article  CAS  PubMed  Google Scholar 

  8. Reulen RC, Winter DL, Frobisher C, Lancashire ER, Stiller CA, Jenney ME, et al. Long-term cause-specific mortality among survivors of childhood cancer. JAMA. 2010;304(2):172–9. doi:10.1001/jama.2010.923.

    Article  CAS  PubMed  Google Scholar 

  9. Reulen RC, Frobisher C, Winter DL, Kelly J, Lancashire ER, Stiller CA, et al. Long-term risks of subsequent primary neoplasms among survivors of childhood cancer. JAMA. 2011;305(22):2311–9. doi:10.1001/jama.2011.747.

    Article  CAS  PubMed  Google Scholar 

  10. Ng AK, Kenney LB, Gilbert ES, Travis LB. Secondary malignancies across the age spectrum. Semin Radiat Oncol. 2010;20(1):67–78. doi:10.1016/j.semradonc.2009.09.002.

    Article  PubMed  Google Scholar 

  11. Veiga LH, Lubin JH, Anderson H, de Vathaire F, Tucker M, Bhatti P, et al. A pooled analysis of thyroid cancer incidence following radiotherapy for childhood cancer. Radiat Res. 2012;178(4):365–76.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Taylor AJ, Croft AP, Palace AM, Winter DL, Reulen RC, Stiller CA, et al. Risk of thyroid cancer in survivors of childhood cancer: results from the British Childhood Cancer Survivor Study. International journal of cancer Journal international du cancer. 2009;125(10):2400–5. doi:10.1002/ijc.24581.

    Article  CAS  PubMed  Google Scholar 

  13. Kovalchik SA, Ronckers CM, Veiga LH, Sigurdson AJ, Inskip PD, de Vathaire F, et al. Absolute risk prediction of second primary thyroid cancer among 5-year survivors of childhood cancer. J Clin Oncol Off J Am Soc Clin Oncol. 2013;31(1):119–27. doi:10.1200/jco.2012.41.8996.

    Article  Google Scholar 

  14. Inskip PD. Thyroid cancer after radiotherapy for childhood cancer. Med Pediatr Oncol. 2001;36(5):568–73. doi:10.1002/mpo.1132.

    Article  CAS  PubMed  Google Scholar 

  15. Howlader N NA, Krapcho M, Garshell J, Miller D, Altekruse SF, Kosary CL, et al. editors. SEER cancer statistics review, 1975–2012, Bethesda, MD; National Cancer Institute; 2015. http://seer.cancer.gov/csr/1975_2012/, based on November 2014 SEER data submission, posted to the SEER web site. April 2015.

  16. Massimino M, Gandola L, Mattavelli F, Pizzi N, Seregni E, Pallotti F, et al. Radiation-induced thyroid changes: a retrospective and a prospective view. European journal of cancer (Oxford, England: 1990). 2009;45(14):2546–51. doi:10.1016/j.ejca.2009.06.009.

    Article  Google Scholar 

  17. Crom DB, Kaste SC, Tubergen DG, Greenwald CA, Sharp GB, Hudson MM. Ultrasonography for thyroid screening after head and neck irradiation in childhood cancer survivors. Med Pediatr Oncol. 1997;28(1):15–21.

    Article  CAS  PubMed  Google Scholar 

  18. Piccardo A, Foppiani L, Puntoni M, Hanau G, Calafiore L, Garaventa A, et al. Role of low-cost thyroid follow-up in children treated with radiotherapy for primary tumors at high risk of developing a second thyroid tumor. The quarterly journal of nuclear medicine and molecular imaging: official publication of the Italian Association of Nuclear Medicine. 2012;56(5):459–67.

    CAS  Google Scholar 

  19. Shafford EA, Kingston JE, Healy JC, Webb JA, Plowman PN, Reznek RH. Thyroid nodular disease after radiotherapy to the neck for childhood Hodgkin’s disease. Br J Cancer. 1999;80(5–6):808–14. doi:10.1038/sj.bjc.6690425.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Brignardello E, Corrias A, Isolato G, Palestini N, Cordero di Montezemolo L, Fagioli F, et al. Ultrasound screening for thyroid carcinoma in childhood cancer survivors: a case series. J Clin Endocrinol Metab. 2008;93(12):4840–3. doi:10.1210/jc.2008-1528.

    Article  CAS  PubMed  Google Scholar 

  21. Printz C. Diagnosis: overload. Cancer. 2016;122(21):3257–8. doi:10.1002/cncr.30386.

    Article  Google Scholar 

  22. Children's Oncology Group. Long-term follow-up guidelines for survivors of childhood, adolescent and young adult cancers, version 4.0 [database on the Internet]. 2013. www.survivorshipguidelines.org. Accessed Oct 2015.

  23. Gharib H, Papini E, Garber JR, Duick DS, Harrell RM, Hegedus L, et al. American Association of Clinical Endocrinologists, American College of Endocrinology, and Associazione Medici Endocrinologi medical guidelines for clinical practice for the diagnosis and management of thyroid nodules—2016 update. Endocrine practice: official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists. 2016;22(5):622–39. doi:10.4158/EP161208.GL.

    Google Scholar 

  24. Davies L, Welch HG. Current thyroid cancer trends in the United States. JAMA otolaryngology-- head & neck surgery. 2014;140(4):317–22. doi:10.1001/jamaoto.2014.1.

    Article  Google Scholar 

  25. Ahn HS, Kim HJ, Welch HG. Korea's thyroid-cancer “epidemic”—screening and overdiagnosis. N Engl J Med. 2014;371(19):1765–7. doi:10.1056/NEJMp1409841.

    Article  PubMed  Google Scholar 

  26. Clement SC, Kremer LC, Links TP, Mulder RL, Ronckers CM, van Eck-Smit BL, et al. Is outcome of differentiated thyroid carcinoma influenced by tumor stage at diagnosis? Cancer Treat Rev. 2015;41(1):9–16. doi:10.1016/j.ctrv.2014.10.009.

    Article  CAS  PubMed  Google Scholar 

  27. Hauch A, Al-Qurayshi Z, Randolph G, Kandil E. Total thyroidectomy is associated with increased risk of complications for low- and high-volume surgeons. Ann Surg Oncol. 2014;21(12):3844–52. doi:10.1245/s10434-014-3846-8.

    Article  PubMed  Google Scholar 

  28. Cho H, Mariotto AB, Schwartz LM, Luo J, Woloshin S. When do changes in cancer survival mean progress? The insight from population incidence and mortality. J Natl Cancer Inst Monogr. 2014;2014(49):187–97. doi:10.1093/jncimonographs/lgu014.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Vaccarella S, Franceschi S, Bray F, Wild CP, Plummer M, Dal Maso L. Worldwide thyroid-cancer epidemic? The increasing impact of overdiagnosis. N Engl J Med. 2016;375(7):614–7. doi:10.1056/NEJMp1604412.

    Article  PubMed  Google Scholar 

  30. La Vecchia C, Malvezzi M, Bosetti C, Garavello W, Bertuccio P, Levi F, et al. Thyroid cancer mortality and incidence: a global overview. Int J Cancer. 2015;136(9):2187–95. doi:10.1002/ijc.29251.

    Article  CAS  PubMed  Google Scholar 

  31. Somerville HM, Steinbeck KS, Stevens G, Delbridge LW, Lam AH, Stevens MM. Thyroid neoplasia following irradiation in adolescent and young adult survivors of childhood cancer. Med J Aust. 2002;176(12):584–7.

    PubMed  Google Scholar 

  32. Oeffinger KC, Hudson MM. Long-term complications following childhood and adolescent cancer: foundations for providing risk-based health care for survivors. CA Cancer J Clin. 2004;54(4):208–36.

    Article  PubMed  Google Scholar 

  33. Francis GL, Waguespack SG, Bauer AJ, Angelos P, Benvenga S, Cerutti JM, et al. Management guidelines for children with thyroid nodules and differentiated thyroid cancer. Thyroid: official journal of the American Thyroid Association. 2015;25(7):716–59. doi:10.1089/thy.2014.0460.

    Article  Google Scholar 

  34. Li Z, Franklin J, Zelcer S, Sexton T, Husein M. Ultrasound surveillance for thyroid malignancies in survivors of childhood cancer following radiotherapy: a single institutional experience. Thyroid: official journal of the American Thyroid Association. 2014;24(12):1796–805. doi:10.1089/thy.2014.0132.

    Article  Google Scholar 

  35. Eden K, Mahon S, Helfand M. Screening high-risk populations for thyroid cancer. Med Pediatr Oncol. 2001;36(5):583–91. doi:10.1002/mpo.1134.

    Article  CAS  PubMed  Google Scholar 

  36. Thompson CA, Charlson ME, Schenkein E, Wells MT, Furman RR, Elstrom R, et al. Surveillance CT scans are a source of anxiety and fear of recurrence in long-term lymphoma survivors. Annals of oncology: official journal of the European Society for Medical Oncology/ESMO. 2010;21(11):2262–6. doi:10.1093/annonc/mdq215.

    Article  CAS  Google Scholar 

  37. Guy Jr GP, Yabroff KR, Ekwueme DU, Smith AW, Dowling EC, Rechis R, et al. Estimating the health and economic burden of cancer among those diagnosed as adolescents and young adults. Health Aff. 2014;33(6):1024–31. doi:10.1377/hlthaff.2013.1425.

    Article  Google Scholar 

  38. Guy Jr GP, Ekwueme DU, Yabroff KR, Dowling EC, Li C, Rodriguez JL, et al. Economic burden of cancer survivorship among adults in the United States. J Clin Oncol Off J Am Soc Clin Oncol. 2013;31(30):3749–57. doi:10.1200/JCO.2013.49.1241.

    Article  Google Scholar 

  39. Landwehr MS, Watson SE, Macpherson CF, Novak KA, Johnson RH. The cost of cancer: a retrospective analysis of the financial impact of cancer on young adults. Cancer medicine. 2016; doi:10.1002/cam4.657.

    PubMed  PubMed Central  Google Scholar 

  40. Schneider AB, Bekerman C, Leland J, Rosengarten J, Hyun H, Collins B, et al. Thyroid nodules in the follow-up of irradiated individuals: comparison of thyroid ultrasound with scanning and palpation. J Clin Endocrinol Metab. 1997;82(12):4020–7. doi:10.1210/jcem.82.12.4428.

    CAS  PubMed  Google Scholar 

  41. Martinez-Tello FJ, Martinez-Cabruja R, Fernandez-Martin J, Lasso-Oria C, Ballestin-Carcavilla C. Occult carcinoma of the thyroid. A systematic autopsy study from Spain of two series performed with two different methods. Cancer. 1993;71(12):4022–9.

    Article  CAS  PubMed  Google Scholar 

  42. Wang C, Crapo LM. The epidemiology of thyroid disease and implications for screening. Endocrinol Metab Clin N Am. 1997;26(1):189–218.

    Article  CAS  Google Scholar 

  43. Harach HR, Franssila KO, Wasenius VM. Occult papillary carcinoma of the thyroid. A “normal” finding in Finland. A systematic autopsy study. Cancer. 1985;56(3):531–8.

    Article  CAS  PubMed  Google Scholar 

  44. Hanson GA, Komorowski RA, Cerletty JM, Wilson SD. Thyroid gland morphology in young adults: normal subjects versus those with prior low-dose neck irradiation in childhood. Surgery. 1983;94(6):984–8.

    CAS  PubMed  Google Scholar 

  45. Yamamoto Y, Maeda T, Izumi K, Otsuka H. Occult papillary carcinoma of the thyroid. A study of 408 autopsy cases. Cancer. 1990;65(5):1173–9.

    Article  CAS  PubMed  Google Scholar 

  46. Lang W, Borrusch H, Bauer L. Occult carcinomas of the thyroid. Evaluation of 1, 020 sequential autopsies. Am J Clin Pathol. 1988;90(1):72–6.

    Article  CAS  PubMed  Google Scholar 

  47. Rubino C, Cailleux AF, Abbas M, Diallo I, Shamsaldin A, Caillou B, et al. Characteristics of follicular cell-derived thyroid carcinomas occurring after external radiation exposure: results of a case control study nested in a cohort. Thyroid: official journal of the American Thyroid Association. 2002;12(4):299–304. doi:10.1089/10507250252949423.

    Article  Google Scholar 

  48. Sassolas G, Hafdi-Nejjari Z, Casagranda L, Berger C, Bournaud C, Decaussin-Petrucci M, et al. Thyroid cancers in children, adolescents, and young adults with and without a history of childhood exposure to therapeutic radiation for other cancers. Thyroid: official journal of the American Thyroid Association. 2013;23(7):805–10. doi:10.1089/thy.2011.0370.

    Article  Google Scholar 

  49. Acharya S, Sarafoglou K, LaQuaglia M, Lindsley S, Gerald W, Wollner N, et al. Thyroid neoplasms after therapeutic radiation for malignancies during childhood or adolescence. Cancer. 2003;97(10):2397–403. doi:10.1002/cncr.11362.

    Article  PubMed  Google Scholar 

  50. Gow KW, Lensing S, Hill DA, Krasin MJ, McCarville MB, Rai SN, et al. Thyroid carcinoma presenting in childhood or after treatment of childhood malignancies: an institutional experience and review of the literature. J Pediatr Surg. 2003;38(11):1574–80.

    Article  PubMed  Google Scholar 

  51. Podda MG, Terenziani M, Gandola L, Collini P, Pizzi N, Marchiano A, et al. Thyroid carcinoma after treatment for malignancies in childhood and adolescence: from diagnosis through follow-up. Medical oncology (Northwood, London, England). 2014;31(8):121. doi:10.1007/s12032-014-0121-6.

    Article  Google Scholar 

  52. Metzger ML, Howard SC, Hudson MM, Gow KW, Li CS, Krasin MJ, et al. Natural history of thyroid nodules in survivors of pediatric Hodgkin lymphoma. Pediatr Blood Cancer. 2006;46(3):314–9. doi:10.1002/pbc.20541.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Emily S. Tonorezos, Dana Barnea, R. Michael Tuttle, Deborah Korenstein & Kevin C. Oeffinger

  2. Department of Medicine, Weill Cornell Medical College, New York, NY, USA

    Emily S. Tonorezos

  3. Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Dana Barnea, Charles A. Sklar & Kevin C. Oeffinger

  4. Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Chaya S. Moskowitz, Joanne F. Chou & Elena B. Elkin

  5. Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Richard J. Wong

  6. Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Duan Li

  7. Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Suzanne L. Wolden

Authors
  1. Emily S. Tonorezos
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Dana Barnea
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Chaya S. Moskowitz
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Joanne F. Chou
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Charles A. Sklar
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Elena B. Elkin
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Richard J. Wong
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Duan Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. R. Michael Tuttle
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Deborah Korenstein
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Suzanne L. Wolden
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Kevin C. Oeffinger
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kevin C. Oeffinger.

Ethics declarations

Funding/support

This work was supported by the National Cancer Institute (K05CA160724; R01CA187397; P30CA008748), and the Meg Berté Owen Fund.

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. As a retrospective analysis, MSK IRB approval was obtained and the need for informed consent was waived.

Additional information

Emily S. Tonorezos and Dana Barnea are co-first author

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Tonorezos, E.S., Barnea, D., Moskowitz, C.S. et al. Screening for thyroid cancer in survivors of childhood and young adult cancer treated with neck radiation. J Cancer Surviv 11, 302–308 (2017). https://doi.org/10.1007/s11764-016-0588-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11764-016-0588-6

Key words

Search

Navigation