Diagnostics and treatment of thyroid nodules after the Chernobyl accident

Abstract

Thyroid cancer is rare in children but often presents at an advanced stage with aggressive features. Following the Chernobyl accident (CA), a marked increase in pediatric papillary thyroid carcinoma (PTC) was reported in contaminated areas, coinciding with the initiation of mass screening and heightened diagnostic scrutiny. This review summarizes prior publications on thyroid lesions related to the CA and examines potential biases in associated epidemiological research. Based on the linear no-threshold theory, an increase in the incidence of various malignancies was predicted after the accident. In reality, however, no elevation in cancer frequency has been conclusively linked to Chernobyl-related radiation exposure, except for PTC in residents exposed at a young age. It remains plausible that a considerable proportion of these thyroid cancers were indeed caused by ionizing radiation from the accident. Before the CA, pediatric thyroid cancer was infrequently diagnosed in Belarus and Ukraine. It is well established that screening can significantly increase the detection rate of thyroid tumors. Post-accident screening efforts identified not only small lesions but also previously undiagnosed cancers - some of which were labeled as aggressive radiogenic carcinomas. This labeling contributed to the perception of exceptional tumor aggressiveness. Such interpretations influenced clinical practice: certain experts recommended more radical approaches for thyroid nodules diagnosed as radiogenic carcinoma, diverging from standard international guidelines. Overestimations of the medical and environmental consequences of low-dose ionizing radiation have played a role in constraining the development of nuclear energy. Several studies on Chernobyl-related thyroid malignancies warrant reassessments. Lifelong animal studies represent a promising approach for elucidating dose-response relationships.

Keywords

Radioactivity / Chernobyl accident / Thyroid carcinoma / Thyroidectomy

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