Top

Published in:

01-06-2017

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

Authors: Emily S. Tonorezos, Dana Barnea, Chaya S. Moskowitz, Joanne F. Chou, Charles A. Sklar, Elena B. Elkin, Richard J. Wong, Duan Li, R. Michael Tuttle, Deborah Korenstein, Suzanne L. Wolden, Kevin C. Oeffinger

Published in: Journal of Cancer Survivorship | Issue 3/2017

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.

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.CrossRef

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.CrossRefPubMedPubMedCentral

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.CrossRefPubMed

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.CrossRef

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.CrossRefPubMed

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.CrossRefPubMed

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.CrossRefPubMed

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.CrossRefPubMed

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.CrossRefPubMed

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.CrossRefPubMed

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.CrossRefPubMedPubMedCentral

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.CrossRefPubMed

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.CrossRef

14.

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

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.CrossRef

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.CrossRefPubMed

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.

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.CrossRefPubMedPubMedCentral

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.CrossRefPubMed

21.

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

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.

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.CrossRef

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.CrossRefPubMed

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.CrossRefPubMed

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.CrossRefPubMed

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.CrossRefPubMedPubMedCentral

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.CrossRefPubMed

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.CrossRefPubMed

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

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.CrossRefPubMed

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.CrossRef

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.CrossRef

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.CrossRefPubMed

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.CrossRef

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.CrossRef

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.CrossRef

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.PubMedPubMedCentral

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.PubMed

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.CrossRefPubMed

42.

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

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.CrossRefPubMed

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.PubMed

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.CrossRefPubMed

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.CrossRefPubMed

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.CrossRef

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.CrossRef

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.CrossRefPubMed

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.CrossRefPubMed

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.CrossRef

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.CrossRefPubMed

Title: Screening for thyroid cancer in survivors of childhood and young adult cancer treated with neck radiation
Authors: Emily S. Tonorezos
Dana Barnea
Chaya S. Moskowitz
Joanne F. Chou
Charles A. Sklar
Elena B. Elkin
Richard J. Wong
Duan Li
R. Michael Tuttle
Deborah Korenstein
Suzanne L. Wolden
Kevin C. Oeffinger
Publication date: 01-06-2017
Publisher: Springer US
Published in: Journal of Cancer Survivorship / Issue 3/2017
Print ISSN: 1932-2259
Electronic ISSN: 1932-2267
DOI: https://doi.org/10.1007/s11764-016-0588-6

Webinar | 19-02-2024 | 17:30 (CET)

Keynote webinar | Spotlight on antibody–drug conjugates in cancer

Watch now

Antibody–drug conjugates (ADCs) are novel agents that have shown promise across multiple tumor types. Explore the current landscape of ADCs in breast and lung cancer with our experts, and gain insights into the mechanism of action, key clinical trials data, existing challenges, and future directions.

Dr. Véronique Diéras

Prof. Fabrice Barlesi

Developed by: Springer Medicine

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Implications for cancer survivors

Condensed abstract

Please log in to get access to this content

Other articles of this Issue 3/2017

The course of anxiety, depression and unmet needs in survivors of diffuse large B cell lymphoma and multiple myeloma in the early survivorship period

Health-related behaviors and mortality outcomes in women diagnosed with ductal carcinoma in situ

Toward the optimal strategy for sustained weight loss in overweight cancer survivors: a systematic review of the literature

Emotional distress impacts quality of life evaluation: a report from the Childhood Cancer Survivor Study

Optimizing patient-reported outcome and risk factor reporting from cancer survivors: a randomized trial of four different survey methods among colorectal cancer survivors

A dance intervention for cancer survivors and their partners (RHYTHM)

Keynote webinar | Spotlight on antibody–drug conjugates in cancer