Second primary cancers in thyroid cancer patients: a multinational record linkage study.
BACKGROUND
Increasing incidence and improved prognosis of thyroid cancer have led to concern about the development of second primary cancers, especially after radioiodine treatment. Thyroid cancer can also arise as a second primary neoplasm after other cancers.


OBJECTIVE
The objective of the study was to assess the risk of second primary cancer after thyroid cancer and vice versa.


METHODS
This was a multinational record linkage study.


METHODS
The study was conducted at 13 population-based cancer registries in Europe, Canada, Australia, and Singapore.


METHODS
A cohort of 39,002 people (356,035 person-yr of follow-up) with primary thyroid cancer were followed up for SPN for up to 25 yr, and 1,990 cases of thyroid cancer were diagnosed after another primary cancer.


METHODS
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-, and 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 second primary cancers (all sites combined) after initial diagnosis of thyroid cancer, SIR of 1.31 (95% confidence interval 1.26-1.36) with significantly elevated risks for many specific cancers. Significantly elevated risks of second primary thyroid cancer were also seen after many types of cancer.


CONCLUSIONS
Pooled data from 13 cancer registries show a 30% increased risk of second primary cancer after thyroid cancer and increased risks of thyroid cancer after various primary cancers. Although bias (detection, surveillance, misclassification) and 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.
Metabolic Unit, Western General Hospital, Edinburgh EH4 2XU, United Kingdom.
Thekkepat C
TC
Sandeep
Mark W J
MW
Strachan
Rebecca M
RM
Reynolds
David H
DH
Brewster
Ghislaine
G
Scélo
Eero
E
Pukkala
Kari
K
Hemminki
Aage
A
Anderson
Elizabeth
E
Tracey
Søren
S
Friis
Mary L
ML
McBride
Chia
C
Kee-Seng
Vera
V
Pompe-Kirn
Erich V
EV
Kliewer
Jon M
JM
Tonita
Jon G
JG
Jonasson
Carmen
C
Martos
Paolo
P
Boffetta
Paul
P
Brennan
D000368:Aged; D015331:Cohort Studies; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008498:Medical Record Linkage; D008875:Middle Aged; D012042:Registries; D018570:Risk Assessment; D013964:Thyroid Neoplasms / Q000150:complications* / Q000453:epidemiology* / Q000473:pathology; D013997:Time Factors; D016896:Treatment Outcome