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

Published

Journal Article

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. 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.

Full Text

Duke Authors

Cited Authors

  • Tonorezos, ES; Barnea, D; Moskowitz, CS; Chou, JF; Sklar, CA; Elkin, EB; Wong, RJ; Li, D; Tuttle, RM; Korenstein, D; Wolden, SL; Oeffinger, KC

Published Date

  • June 2017

Published In

Volume / Issue

  • 11 / 3

Start / End Page

  • 302 - 308

PubMed ID

  • 28028762

Pubmed Central ID

  • 28028762

Electronic International Standard Serial Number (EISSN)

  • 1932-2267

Digital Object Identifier (DOI)

  • 10.1007/s11764-016-0588-6

Language

  • eng

Conference Location

  • United States