Int J Thyroidol.  2020 Nov;13(2):95-110. 10.11106/ijt.2020.13.2.95.

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

• Drozd V
• Branovan DI
• Reiners C

• KMID: 2509188
• DOI: http://doi.org/10.11106/ijt.2020.13.2.95

Abstract

Based on opinions published by many scientists about the increase in the incidence of thyroid cancer in many countries, 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 primary prevention of thyroid cancer. Along with the traditionally discussed risk factors: ethnicity, heredity, sex effects/hormones, comorbidity, radiation exposure, diet (iodine), life-style (smoking), features of the natural environment, the effect of endocrine disrupters and in particular nitrates are also discussed. For the clinician, a simple approach for primary prevention of thyroid cancer is to refer the patient for a radiological examination applying ionizing radiation with exposure of the head and neck region only if the indication is justified according to the International Committee for Radiological Protection. In clinical practice, it is also important to take into account and minimize other risk factors: prevention of obesity and weight reduction, adequate treatment of various 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 withdrawal of contaminated food and drink as well as iodine thyroid blocking especially in vulnerable members of the population as children, pregnant or breastfeeding women. More research is also required to identify other reasons of the increasing incidence and predictors of aggressive vs indolent behavior of thyroid cancer to avoid unnecessary screening activity, overdiagnosis, and overtreatment.

Keyword

Thyroid carcinoma; Risk factors; Screening; Radiation; Nitrate; Prevention

Figure

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  Fig. 1 Scheme of combined effects of nitrate and radia-tion exposure on develop-ment of thyroid cancer. Based on data in Ward et al.129) and Drozd et al.130,131)

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  Fig. 2 Risk factors for thyroid cancer and corresponding preventive measures to be discussed. Based on data in Haugen et al.,1) WHO documents,3,6,143) Drozd et al.,130,131) ICRP document141) and Sinnott et al.34)

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