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Risk of second primary cancer following differentiated thyroid cancer

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Abstract

Concerns remain over the risk of cancer following differentiated thyroid carcinoma and its causes. Iodine-131 (131I) and external irradiation are known to have potential carcinogenic effects. Thyroid carcinoma is a polygenic disease which may be associated with other malignancies. We investigated the incidence of second cancer and its aetiology in a cohort of 875 patients (146 men, 729 women) with differentiated thyroid carcinoma originating from Basse-Normandie, France. Cancer incidence was compared with that of the general population of the Département du Calvados matched for age, gender and period. The cumulative proportion of second cancer was estimated using the life-table method. Factors that correlated with the risk of second cancer were studied using the Cox model. After a median follow-up of 8 years, 58 second cancers had been observed. Compared with general population incidence rates, there was an overall increased risk of second cancer in women [standardised incidence ratio (SIR)=1.52; P<0.01], but not in men (SIR=1.27; P>0.20). Increased risk related to cancers of the genitourinary tract (SIR=3.31; P<0.001), and particularly to cancer of the kidney (SIR=7.02; P<0.01). Multivariate analysis showed that age above 40 years (P<0.01) and a history of previous primary cancer (P<0.001) correlated with risk. In contrast, neither cervical irradiation nor cumulative activity of 131I was related to the risk. These data confirm that women with differentiated thyroid carcinoma are at risk of developing a second cancer of the genitourinary tract and kidney. Only age and medical history of primary cancer before thyroid carcinoma are risk factors for second cancer. Common environmental or genetic factors as well as long-term carcinogenic effects of primary cancer therapy should be considered.

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Acknowledgements

We are grateful to J.E. Couëtte, who created the multidisciplinary thyroid staff at the Centre François Baclesse in the early 1970s and was responsible for patient follow-up until the end of the 1990s. We are indebted to all participants in the thyroid database, and especially to A. Valdazo and Y. Reznik. We thank all pathologists of the Basse-Normandie region for agreeing to provide histological material for revision and those general practitioners who gave information concerning their patients. This study was supported by grants from le Groupement des Entreprises Françaises dans la Lutte contre le Cancer (GEFLUC) and La Ligue contre le Cancer (Comité du Calvados).

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Authors and Affiliations

  1. Service de Médecine Nucléaire, CLCC François Baclesse, Avenue Général Harris, 14076, Caen Cedex 05, France

    Emmanuelle Berthe, Pascaline Berthet & Stéphane Bardet

  2. Service de Recherche Clinique, CLCC François Baclesse, Caen, France

    Michel Henry-Amar

  3. Service d’Anatomie Pathologique, CLCC François Baclesse, Caen, France

    Jean-Jacques Michels

  4. Service de Chirurgie ORL, CLCC François Baclesse, Caen, France

    Jean-Pierre Rame

  5. Service de Chirurgie ORL, Centre Hospitalo-Universitaire, Caen, France

    Emmanuel Babin

  6. Service de Chirurgie Thoracique, Centre Hospitalo-Universitaire, Caen, France

    Philippe Icard

  7. Service de Chirurgie Générale, Centre Hospitalo-Universitaire, Caen, France

    Guy Samama

  8. Service d’Anatomie Pathologique, Centre Hospitalo-Universitaire, Caen, France

    Françoise Galateau-Sallé

  9. Service d’Endocrinologie, Centre Hospitalo-Universitaire, Caen, France

    Jacques Mahoudeau

Authors
  1. Emmanuelle Berthe
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  2. Michel Henry-Amar
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  3. Jean-Jacques Michels
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  7. Philippe Icard
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  8. Guy Samama
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  9. Françoise Galateau-Sallé
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  10. Jacques Mahoudeau
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  11. Stéphane Bardet
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Correspondence to Stéphane Bardet.

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Berthe, E., Henry-Amar, M., Michels, JJ. et al. Risk of second primary cancer following differentiated thyroid cancer. Eur J Nucl Med Mol Imaging 31, 685–691 (2004). https://doi.org/10.1007/s00259-003-1448-y

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  • DOI: https://doi.org/10.1007/s00259-003-1448-y

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