Overkill: Radioactive iodine for early, low-risk thyroid cancer

According to a new study published in the journal Cancer, patients with early stage, low-risk thyroid cancers should think twice before allowing their doctors to prescribe standard radioactive iodine-131 (RAI) treatment. Utilizing a nationwide database of approximately 37,000 cases of thyroid cancers diagnosed between 1973 and 2007, researchers from Memorial Sloan-Kettering Cancer Center in New York reported that of the 15,000 patients treated with RAI, 3,000 developed secondary cancers (such as salivary gland cancer) within 11 years. Further analysis of the data revealed that, as RAI treatment became more popular towards the end of the study period, about 14 “extra” cancers per 10,000 patients in a given year could be attributed to the RAI treatment.

Surgical removal of these early stage thyroid tumors, on the other hand, is a very effective alternative, says ACSH's Dr. Gilbert Ross. “Most thyroid cancers, with the exception of the rare and aggressive anaplastic and medullary thyroid cancers, are easy to cure with surgery; those with hyper-functioning thyroid activity are also susceptible to RAI. In order to determine if the tumor is responsive to RAI, a nuclear medicine RAI scan must be done, but most thyroid lesions are non-functional. Bottom line: Based on this study, doctors should not resort to RAI so quickly, and patients should not consent to it without a thorough risk-benefit discussion with their physicians.”