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This version published online on February 14, 2006
Journal of Clinical Endocrinology & Metabolism, doi:10.1210/jc.2005-2009
A more recent version of this article appeared on May 1, 2006
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Submitted on September 8, 2005
Accepted on February 7, 2006

Second primary cancers in thyroid cancer patients: a multi-national record linkage study

Thekkepat C. Sandeep, Mark W. J. Strachan*, Rebecca M. Reynolds, David H. Brewster, Ghislaine Scélo, Eero Pukkala, Kari Hemminki, Aage Anderson, Elizabeth Tracey, Søren Friis, Mary L. McBride, Chia Kee-Seng, Vera Pompe-Kirn, Erich V. Kliewer, Jon M. Tonita, Jon G Jonasson, Carmen Martos, Paolo Boffetta, and Paul Brennan

Metabolic Unit, Western General Hospital, Edinburgh, UK; Scottish Cancer Registry, Edinburgh, UK; International Agency for Research on Cancer (IARC), Lyon, France; Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland; Division of Molecular Genetic Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany; Department of Biosciences at Novum, Karolinska Institute, Hudinge, Sweden; Institute of Population-based Cancer Research, Oslo, Norway; Central Cancer Registry, Woolloomooloo, New South Wales, Australia; Institute of Cancer Epidemiology, Danish Cancer Society, Copenhagen, Denmark; Cancer Control Research Programme, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; Center for Molecular Epidemiology, Singapore; Cancer Registry of Slovenia, Institute of Oncology, Ljubljana, Slovenia; Epidemiology and Cancer Registry, CancerCare Manitoba, Winnipeg, Canada; Community Health Sciences, University of Manitoba, Winnipeg, Canada; School of Public Health, University of Sydney, Australia; Program Evaluation and Surveillance, Saskatchewan Cancer Agency, Regina, Saskatchewan, Canada; Icelandic Cancer Registry, Icelandic Cancer Society, Reykjavik, Iceland; The Medical Faculty, University of Iceland, Reykjavik, Iceland; Cancer Registry of Zaragoza, Health Department of Aragon Government, Zaragoza, Spain

* To whom correspondence should be addressed. E-mail: mark.strachan{at}luht.scot.nhs.uk.

Context: Increasing incidence and improved prognosis of thyroid cancer has led to concern about the development of second primary cancers (SPN) especially after radio-iodine treatment. Thyroid cancer can also arise as a second primary neoplasm after other cancers.

Objective: To assess the risk of SPN after thyroid cancer and vice versa.

Design: Multi-national record linkage study

Setting: Thirteen population based cancer registries in Europe, Canada, Australia & Singapore

Patients or other participants: A cohort of 39002 people (356035 person-years of follow-up) with primary thyroid cancer followed for second primary cancers for up to 25 yr, & 1990 cases of thyroid cancer diagnosed after another primary cancer.

Main outcome measures: To assess any possible excess of second primary neoplasms after thyroid cancer the observed numbers of neoplasms were compared with expected numbers derived from age-, sex-, & calendar period-specific cancer incidence rates from each of the cancer registries, yielding standardized incidence ratios (SIRs). The SIR of second primary thyroid cancer after various types of cancer was also calculated.

Results: During the observation period there were 2821 sec primary cancers (all sites combined) after initial diagnosis of thyroid cancer, SIR of 1.31 (95% CI 1.26-1.36) with significantly elevated risks for many specific cancers. Significantly elevated risks of second primary thyroid cancer were also seen following many types of cancer.

Conclusion: Pooled data from 13 cancer registries shows a 30% increased risk of second primary cancer after thyroid cancer, and increased risks of thyroid cancer following various primary cancers. Although bias (detection, surveillance, misclassification) & chance may contribute to some of these observations, it seems likely that shared risk factors and treatment effects are implicated in many. When following up patients who have been treated for primary thyroid cancer, clinicians should maintain a high index of suspicion for second primary cancers.
Key words: Thyroid cancer • second primary neoplasm • cancer registries




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E-Letter to the Editor: Second primary cancers after thyroid cancer
William L Harper, et al.
JCEM Online, 11 Dec 2006 [Full text]

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