Re: Fallout from Chernobyl Thyroid cancer in children increased dramatically in Belarus
Dear Editor,
The misclassification of advanced cases as aggressive radiogenic cancers has given rise to the concept that supposedly radiogenic thyroid cancers (TC) are more aggressive than sporadic ones. This had consequences for the practice: the surgical treatment of radiogenic TC was recommended to be more radical. In the 1990s, the thyroid surgery in some institutions of the former Soviet Union (SU) adopted more radical approaches; details and references are in [1,2]. Obfuscation of the overdiagnosis and potential overtreatment of post-Chernobyl TCs and other lesions is recognizable in the literature from the former SU. In the earlier report with participation of Prof. E. Dillwyn Williams (2008) it was stated that “The exposed and unexposed tumors from the same geographical area are essentially identical morphologically and in their degree of aggressiveness… childhood PTCs from Japan were much more highly differentiated (p<0.001), showed more papillary differentiation (p<0.001) and were less invasive (p<0.01) than ‘Chernobyl’ tumors” [3]. Later on, in stand-alone publications by the co-authors, the accents were changed, e.g.: “Childhood Japanese PTCs differed from Ukrainian PTCs by more pronounced invasive properties… higher morphological aggressiveness of PTC in young Japanese patients” [4]. In their last paper, Bogdanova et al. (2020) acknowledged that Ukrainian “radiogenic” or “radiation-related” PTCs “had a solid-trabecular growth pattern and displayed morphological features of aggressive biological behavior” [5] without any satisfactory proof that (a considerable part of) tumors in the studied residents of Kiev, Chernigov and Zhitomir provinces [5] were caused or influenced by radiation. What was indeed different about inhabitants of these regions were the screening with detection of neglected cases and some over-diagnosis, radiophobia with increased self-reporting, as well as registration of some unexposed people as Chernobyl victims [1]. The cases coming from non-contaminated areas must have been averagely more advanced as there was no mass screening there. Differences in the histological grade of malignancies may reflect diagnostic quality, that is, averagely earlier or later tumor detection in a given country. Associations of various markers with the tumor progression can become a field for the future research and re-interpretation of data obtained in studies comparing malignancies from different countries. Some markers may reflect efficiency of healthcare services. The overdiagnosis and potential overtreatment od bladder lesions has been discussed previously [6].
References
1. Jargin SV. Markers of radiogenic cancer vs. tumor progression: an overview of Chernobyl studies. J Cancer Sci. 2021;8(1): 7.
2. Jargin SV (2019) Thyroid neoplasia after Chernobyl: a comment. Int J Cancer 144(11): 2897.
3. Williams ED, Abrosimov A, Bogdanova T, Demidchik EP, Ito M, LiVolsi V, et al. (2008) Morphologic characteristics of Chernobyl-related childhood papillary thyroid carcinomas are independent of radiation exposure but vary with iodine intake. Thyroid 18: 847-852.
4. Bogdanova TI, Saenko VA, Hirokawa M, Ito M, Zurnadzhy LY, Hayashi T, et al. (2017) Comparative histopathological analysis of sporadic pediatric papillary thyroid carcinoma from Japan and Ukraine. Endocr J 64: 977-993.
5. Bogdanova TI, Saenko VA, Hashimoto Y, Hirokawa M, Zurnadzhy LY, Hayashi T, et al. (2020) Papillary thyroid carcinoma in Ukraine after Chernobyl and in japan after Fukushima: different histopathological scenarios. Thyroid DOI: 10.1089/thy.2020.0308.
6. Jargin SV (2018) Urological concern after nuclear accidents. Urol Ann 10: 240-242.
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Re: Fallout from Chernobyl Thyroid cancer in children increased dramatically in Belarus
Dear Editor,
The misclassification of advanced cases as aggressive radiogenic cancers has given rise to the concept that supposedly radiogenic thyroid cancers (TC) are more aggressive than sporadic ones. This had consequences for the practice: the surgical treatment of radiogenic TC was recommended to be more radical. In the 1990s, the thyroid surgery in some institutions of the former Soviet Union (SU) adopted more radical approaches; details and references are in [1,2]. Obfuscation of the overdiagnosis and potential overtreatment of post-Chernobyl TCs and other lesions is recognizable in the literature from the former SU. In the earlier report with participation of Prof. E. Dillwyn Williams (2008) it was stated that “The exposed and unexposed tumors from the same geographical area are essentially identical morphologically and in their degree of aggressiveness… childhood PTCs from Japan were much more highly differentiated (p<0.001), showed more papillary differentiation (p<0.001) and were less invasive (p<0.01) than ‘Chernobyl’ tumors” [3]. Later on, in stand-alone publications by the co-authors, the accents were changed, e.g.: “Childhood Japanese PTCs differed from Ukrainian PTCs by more pronounced invasive properties… higher morphological aggressiveness of PTC in young Japanese patients” [4]. In their last paper, Bogdanova et al. (2020) acknowledged that Ukrainian “radiogenic” or “radiation-related” PTCs “had a solid-trabecular growth pattern and displayed morphological features of aggressive biological behavior” [5] without any satisfactory proof that (a considerable part of) tumors in the studied residents of Kiev, Chernigov and Zhitomir provinces [5] were caused or influenced by radiation. What was indeed different about inhabitants of these regions were the screening with detection of neglected cases and some over-diagnosis, radiophobia with increased self-reporting, as well as registration of some unexposed people as Chernobyl victims [1]. The cases coming from non-contaminated areas must have been averagely more advanced as there was no mass screening there. Differences in the histological grade of malignancies may reflect diagnostic quality, that is, averagely earlier or later tumor detection in a given country. Associations of various markers with the tumor progression can become a field for the future research and re-interpretation of data obtained in studies comparing malignancies from different countries. Some markers may reflect efficiency of healthcare services. The overdiagnosis and potential overtreatment od bladder lesions has been discussed previously [6].
References
1. Jargin SV. Markers of radiogenic cancer vs. tumor progression: an overview of Chernobyl studies. J Cancer Sci. 2021;8(1): 7.
2. Jargin SV (2019) Thyroid neoplasia after Chernobyl: a comment. Int J Cancer 144(11): 2897.
3. Williams ED, Abrosimov A, Bogdanova T, Demidchik EP, Ito M, LiVolsi V, et al. (2008) Morphologic characteristics of Chernobyl-related childhood papillary thyroid carcinomas are independent of radiation exposure but vary with iodine intake. Thyroid 18: 847-852.
4. Bogdanova TI, Saenko VA, Hirokawa M, Ito M, Zurnadzhy LY, Hayashi T, et al. (2017) Comparative histopathological analysis of sporadic pediatric papillary thyroid carcinoma from Japan and Ukraine. Endocr J 64: 977-993.
5. Bogdanova TI, Saenko VA, Hashimoto Y, Hirokawa M, Zurnadzhy LY, Hayashi T, et al. (2020) Papillary thyroid carcinoma in Ukraine after Chernobyl and in japan after Fukushima: different histopathological scenarios. Thyroid DOI: 10.1089/thy.2020.0308.
6. Jargin SV (2018) Urological concern after nuclear accidents. Urol Ann 10: 240-242.
Competing interests: No competing interests