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Increasing Incidence of Thyroid Carcinoma: Risk Factors and Seeking Approaches for Primary Prevention

Valentina Drozd|Daniel I. Branovan|Christoph Reiners
대한갑상선학회 (Korean Thyroid Association)|2020.11|International Journal of Thyroidology|제13권 제2호|pp. 95-110|DOI 10.11106/ijt.2020.13.2.95

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참고문헌

키워드

PreventionScreeningRisk factorsRadiationThyroid carcinomaNitrate
주제분류의학일반

초록

Based on opinions published by many scientists about the increase in the incidence of thyroid cancer in manycountries, this paper intends to identify research to be done on one hand with respect to reasons for this increase,the natural course of thyroid cancer and risk factors and - on the other hand - to support the clinician in primaryprevention of thyroid cancer. Along with the traditionally discussed risk factors: ethnicity, heredity, sexeffects/hormones, comorbidity, radiation exposure, diet (iodine), life-style (smoking), features of the naturalenvironment, the effect of endocrine disrupters and in particular nitrates are also discussed. For the clinician, asimple approach for primary prevention of thyroid cancer is to refer the patient for a radiological examinationapplying ionizing radiation with exposure of the head and neck region only if the indication is justified accordingto the International Committee for Radiological Protection. In clinical practice, it is also important to take intoaccount and minimize other risk factors: prevention of obesity and weight reduction, adequate treatment ofvarious thyroid diseases, avoidance of excessive consumption of nitrates and other endocrine disruptors/environmental pollutants. In case of a nuclear emergency, attention has to be paid for immediate withdrawalof contaminated food and drink as well as iodine thyroid blocking especially in vulnerable members of thepopulation as children, pregnant or breastfeeding women. More research is also required to identify other reasonsof the increasing incidence and predictors of aggressive vs indolent behavior of thyroid cancer to avoid unnecessaryscreening activity, overdiagnosis, and overtreatment.

Abstract

Based on opinions published by many scientists about the increase in the incidence of thyroid cancer in manycountries, this paper intends to identify research to be done on one hand with respect to reasons for this increase,the natural course of thyroid cancer and risk factors and - on the other hand - to support the clinician in primaryprevention of thyroid cancer. Along with the traditionally discussed risk factors: ethnicity, heredity, sexeffects/hormones, comorbidity, radiation exposure, diet (iodine), life-style (smoking), features of the naturalenvironment, the effect of endocrine disrupters and in particular nitrates are also discussed. For the clinician, asimple approach for primary prevention of thyroid cancer is to refer the patient for a radiological examinationapplying ionizing radiation with exposure of the head and neck region only if the indication is justified accordingto the International Committee for Radiological Protection. In clinical practice, it is also important to take intoaccount and minimize other risk factors: prevention of obesity and weight reduction, adequate treatment ofvarious thyroid diseases, avoidance of excessive consumption of nitrates and other endocrine disruptors/environmental pollutants. In case of a nuclear emergency, attention has to be paid for immediate withdrawalof contaminated food and drink as well as iodine thyroid blocking especially in vulnerable members of thepopulation as children, pregnant or breastfeeding women. More research is also required to identify other reasonsof the increasing incidence and predictors of aggressive vs indolent behavior of thyroid cancer to avoid unnecessaryscreening activity, overdiagnosis, and overtreatment.

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