Thyroid cancer risk after thyroid examination with 131I:: A population-based cohort study in Sweden
Thyroid cancer risk after thyroid examination with 131I:: A population-based cohort study in Sweden
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DOI：
10.1002/ijc.11258
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发表时间：
2003-09-10
影响因子：
6.4
通讯作者：
Hall, P
中科院分区：
文献类型：
--
作者：
Dickman, PW;Holm, LE;Hall, P
电离辐射是甲状腺癌的唯一确定原因，尽管诊断性使用1311对甲状腺癌风险的影响似乎很小。目前，全世界每年使用放射性碘进行甲状腺检查的人数为每1 000人5人，因此这一问题具有重要的公共卫生意义。我们的目的是评估用于诊断目的的一系列已知剂量的1311后甲状腺癌的过量风险。我们在瑞典进行了一项全国性的、以人群为基础的队列研究，包括所有36,792人，他们在1952-1969年期间接受了1311诊断，暴露后2年存活且无甲状腺癌。在第一次1311管理后2年开始计算风险人数。癌症的随访一直持续到1998年底。标准化发病率（SIRS）计算为观察到的甲状腺癌数与预期的甲状腺癌数之比。根据既往接受颈部外放射治疗、甲状腺检查的原因、1311剂量、性别、照射时的年龄和照射后的时间对评估结果进行分层。甲状腺癌（n = 129）在886,618人的危险年期间被诊断出来。仅在1767例既往接受过颈部外放射治疗的患者中（SIR = 9.8, 95%可信区间（CI） 6.3-14.6）和最初因怀疑甲状腺肿瘤而转诊的患者中（SIR = 3.5, 95% CI 2.7-4.4, 115,15例未接受过外放射治疗的患者）观察到甲状腺癌过多。24,010名以前没有接受过颈部外放射治疗的患者，由于怀疑甲状腺肿瘤以外的原因而转诊，接受的甲状腺剂量估计为0.94 Gy。在这些患者中，观察到36例甲状腺癌，而预期为39.5例（SIR = 0.91, 95% CI 0.64-1.26）。我们没有发现用于诊断目的的1311用药会增加甲状腺癌风险的证据。然而，我们的研究只包括少数20岁以下的患者，因此结果主要适用于成年人。我们的数据表明，延长剂量可能导致的风险低于相同总剂量的短暂x射线照射。(C) 2003 Wiley-Liss, Inc。
Ionizing radiation is the only established cause of thyroid cancer, though the effect of diagnostic administration of 1311 on thyroid cancer risk appears minimal. The annual number of thyroid examinations using radioiodine is currently 5 per 1,000 individuals worldwide, so this issue is of public health importance. Our objective was to evaluate the excess risk of thyroid cancer following a range of known doses of 1311 administered for diagnostic purposes. We conducted a nationwide, population-based cohort study in Sweden including all 36,792 individuals who received 1311 for diagnostic purposes during 1952-1969 and were alive and free of thyroid cancer 2 years after exposure. Accrual of person-time at risk commenced 2 years after the first 1311 administration. Follow-up for cancer was to the end of 1998. Standardized incidence ratios (SIRS) were calculated as the ratio between the observed and expected numbers of thyroid cancers. Estimates were stratified by previous exposure to external radiation therapy to the neck, reason for thyroid examination, 1311 dose, sex, age at exposure and time since exposure. Thyroid cancers (n = 129) were diagnosed during 886,618 person years at risk. Excess thyroid cancers were observed only among the 1,767 patients who reported previous external radiation therapy to the neck [SIR = 9.8, 95% confidence interval (CI) 6.3-14.6] and among those originally referred due to suspicion of a thyroid tumor (SIR = 3.5, 95% CI 2.7-4.4 for 11,0 15 patients without previous external radiation therapy). The 24,010 patients without previous exposure to external radiation therapy to the neck who were referred for a reason other than suspicion of a thyroid tumor received an estimated dose to the thyroid of 0.94 Gy. Among these patients, 36 thyroid cancers were observed compared to 39.5 expected (SIR = 0.91, 95% CI 0.64-1.26). We found no evidence that administration of 1311 for diagnostic purposes increases risk of thyroid cancer. However, our study included few patients under age 20, so the results apply primarily to exposure among adults. Our data suggest that protraction of dose may result in a lower risk than brief X-ray exposure of the same total dose. (C) 2003 Wiley-Liss, Inc.