While there are a number of articles I could choose this October, Tulchinsky and Brill's "Spotlight on the Association of Radioactive Iodine Treatment With Cancer Mortality in Patients With Hyperthyroidism is Keeping the Highest Risk From Antithyroid Drugs in the Blind Spot" is most to the point. Authors address a similarly titled article in JAMA Internal Medicine by Kitahara et al where patient-specific 131I organ dose estimates were used to estimate cancer mortality associated with radioiodine treatment for hyperthyroidism. In the JAMA Internal Medicine article, Kitahara stated that one could "expect between 19 and 32 excess solid cancer deaths per 1000 patients treated at age 40 years and between 18 and 31 excess solid cancer deaths per 1000 patients treated at age 50 years." Tulchinsky and Brill publish herein Table 1, data available to Kitahara that clearly demonstrates greater and statistically significant cancer rates associated with the long-term use of antithyroid medications as compared to the lesser rate of actual cancer deaths associated with 131I therapy for hyperthyroid patients.
Given the actual number of cancer deaths, it is fully illogical to analyze and publish projected cancer deaths. From the large cohort of 18,805 patients with hyperthyroidism, 1065 (5.7%) were from my hospital, LAC+USC Medical Center. I began my practice 12 years after the treatment data collection ended, so by now, according to Kitahara, 18 to 32 of our patients should have presented with cancer. Of course, if 131I causes cancer, some of the hundreds more patients we have treated with 131I should be expected to present with associated cancers. I, nor none of my colleagues recall any such patients; that is patients treated with prior 131I for hyperthyroidism presenting for medical imaging or treatment for cancer. Why were the predicted cancers not registered in Table 1 published here?
Perhaps calculated organ exposure to 100 mGy might not reliably cause cancer? I propose denoting such predicted cancers as icancers. Here "i" is for imaginary. Thus, we may expect between 19i and 32i excess solid cancer deaths per 1000 patients treated… What do you think?
