© 2006 The Author(s).
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/2.0/uk/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
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A Cohort Study of Thyroid Cancer and Other Thyroid Diseases After the Chornobyl Accident: Thyroid Cancer in Ukraine Detected During First Screening
Affiliations of authors: Institute of Endocrinology and Metabolism, Kyiv, Ukraine (MDT, TIB, OVE, VVM, VAO, VMS, VPT, OVZ); Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY (GRH, LBZ); Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD (ACB, IJM, MH, NKL, ER, TLT, GWB); Department of Radiation and Radiological Sciences, School of Medicine, Vanderbilt University, Nashville, TN (ABB); Scientific Center for Radiation Medicine, Academy of Medical Sciences, Kyiv, Ukraine (IAL); Department of Pathology, College of Physicians and Surgeons, Columbia University, New York, NY (DJF, EG); Department of Medicine, The Thyroid Clinic, College of Physicians and Surgeons, Columbia University, New York, NY (RJM); Genetics and Biochemistry Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD (JR); MJP Risk Assessment Inc., Denver, CO (PGV)
Correspondence to: Geoffrey R. Howe, PhD, Professor of Epidemiology, Mailman School of Public Health, Columbia University, 722 W. 168th St., Rm. 1104, New York, NY 10032 (e-mail: gh68{at}columbia.edu).
Background: The Chornobyl accident in 1986 exposed thousands of people to radioactive iodine isotopes, particularly 131I; this exposure was followed by a large increase in thyroid cancer among those exposed as children and adolescents, particularly in Belarus, the Russian Federation, and Ukraine. Here we report the results of the first cohort study of thyroid cancer among those exposed as children and adolescents following the Chornobyl accident. Methods: A cohort of 32 385 individuals younger than 18 years of age and resident in the most heavily contaminated areas in Ukraine at the time of the accident was invited to be screened for any thyroid pathology by ultrasound and palpation between 1998 and 2000; 13 127 individuals (44%) were actually screened. Individual estimates of radiation dose to the thyroid were available for all screenees based on radioactivity measurements made shortly after the accident and on interview data. The excess relative risk per gray (Gy) was estimated using individual doses and a linear excess relative risk model. Results: Forty-five pathologically confirmed cases of thyroid cancer were found during the 1998–2000 screening. Thyroid cancer showed a strong, monotonic, and approximately linear relationship with individual thyroid dose estimate (P<.001), yielding an estimated excess relative risk of 5.25 per Gy (95% confidence interval [CI] = 1.70 to 27.5). Greater age at exposure was associated with decreased risk of radiation-related thyroid cancer, although this interaction effect was not statistically significant. Conclusion: Exposure to radioactive iodine was strongly associated with increased risk of thyroid cancer among those exposed as children and adolescents. In the absence of Chornobyl radiation, 11.2 thyroid cancer cases would have been expected compared with the 45 observed, i.e., a reduction of 75% (95% CI = 50% to 93%). The study also provides quantitative risk estimates minimally confounded by any screening effects. Caution should be exercised in generalizing these results to any future similar accidents because of the potential differences in the nature of the radioactive iodines involved, the duration and temporal patterns of exposures, and the susceptibility of the exposed population.
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