{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T21:32:54Z","timestamp":1783632774068,"version":"3.55.0"},"reference-count":32,"publisher":"Oxford University Press (OUP)","issue":"5","content-domain":{"domain":["eje.bioscientifica.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2022,5,1]]},"abstract":"<jats:sec>\n<jats:title>Objective<\/jats:title>\n<jats:p>Thyroid cancer survivors have a high risk of second primary malignancies (SPMs). We aimed to evaluate the site-specific incidence, prognosis, and risk factors for metachronous SPMs following thyroid cancer.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>Design<\/jats:title>\n<jats:p>A nationwide cohort study.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>Methods<\/jats:title>\n<jats:p>This study included data from the Korea National Health Insurance Service (between 2002 and 2018). Exposure to diagnostic radiation was defined by the number of computed tomography (CT) and positron emission tomography-CT scans after the index date. A cumulative radioactive iodine (RAI) dose &gt;100 mCi was considered high-dose RAI.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>Results<\/jats:title>\n<jats:p>During the median 6 years of follow-up, among 291 640 patients, 13 083 (4.5%) developed SPMs. Thyroid cancer survivors had a 26% increased risk of SPMs compared with the general population (standardized incidence ratio: 1.26; 95% CI: 1.22\u20131.29). Furthermore, those with SPMs had a significantly poorer survival rate than those without SPMs (hazard ratio: 11.85; 95% CI: 11.21\u201312.54; <jats:italic>P<\/jats:italic>\u2009 &lt; 0.001). Significantly elevated risks were observed in myeloid leukemia and 13 solid cancer sites: lip, salivary gland, small intestine, larynx, lung, mediastinum and pleura, mesothelium, breast, corpus uteri, ovary, prostate, kidney, and bladder. Frequent diagnostic medical radiation exposure and high-dose RAI therapy were independent risk factors for several SPMs, including the cancer of salivary gland, lung, mediastinum and pleura, breast, kidney, and bladder, as well as myeloid leukemia.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>Conclusions<\/jats:title>\n<jats:p>Frequent diagnostic radiation exposure and high-dose RAI therapy are independent risk factors for SPM following thyroid cancer. Clinicians need to consider minimizing unnecessary diagnostic radiation exposure and administering a high dose RAI only when justified in patients with thyroid cancer.<\/jats:p>\n<\/jats:sec>","DOI":"10.1530\/eje-21-1208","type":"journal-article","created":{"date-parts":[[2022,3,14]],"date-time":"2022-03-14T16:38:41Z","timestamp":1647275921000},"page":"561-571","update-policy":"https:\/\/doi.org\/10.1530\/crossmarkpolicy-7","source":"Crossref","is-referenced-by-count":16,"title":["Risk factors for second primary malignancies following thyroid cancer: a nationwide cohort study"],"prefix":"10.1093","volume":"186","author":[{"given":"Mijin","family":"Kim","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Biomedical Research Institute, Pusan National University Hospital, Busan, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hyereen","family":"Kim","sequence":"additional","affiliation":[{"name":"Hyereen Kim\u2019s Internal Medicine Clinic, Yangsan, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sojeong","family":"Park","sequence":"additional","affiliation":[{"name":"Data Science Team, Hanmi Pharmaceuticals Co., Ltd., Seoul, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jaeeun","family":"Joo","sequence":"additional","affiliation":[{"name":"Data Science Team, Hanmi Pharmaceuticals Co., Ltd., Seoul, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"In Ju","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Biomedical Research Institute, Pusan National University Hospital, Busan, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9632-9457","authenticated-orcid":true,"given":"Bo Hyun","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Biomedical Research Institute, Pusan National University Hospital, Busan, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","reference":[{"key":"bib1","series-title":"Journal of Cancer Epidemiology","first-page":"965212","article-title":"Worldwide increasing incidence of thyroid cancer: update on epidemiology and risk factors","volume":"2013","author":"Pellegriti","year":"2013","unstructured":"Pellegriti GFrasca FRegalbuto CSquatrito SVigneri R. Worldwide increasing incidence of thyroid cancer: update on epidemiology and risk factors. Journal of Cancer Epidemiology20132013965212. (https:\/\/doi.org\/10.1155\/2013\/965212)"},{"key":"bib2","series-title":"Cancer Research and Treatment","doi-asserted-by":"publisher","first-page":"127","DOI":"10.4143\/crt.2015.060","article-title":"Cancer statistics in Korea: incidence, mortality, survival, and prevalence in 2012","volume":"47","author":"Jung","year":"2015","unstructured":"Jung KWWon YJKong HJOh CMCho HLee DHLee KH. Cancer statistics in Korea: incidence, mortality, survival, and prevalence in 2012. Cancer Research and Treatment201547127\u2013141. (https:\/\/doi.org\/10.4143\/crt.2015.060)10.4143\/crt.2015.060"},{"key":"bib3","series-title":"International Journal of Cancer","doi-asserted-by":"publisher","first-page":"2187","DOI":"10.1002\/ijc.29251","article-title":"Thyroid cancer mortality and incidence: a global overview","volume":"136","author":"La Vecchia","year":"2015","unstructured":"La Vecchia CMalvezzi MBosetti CGaravello WBertuccio PLevi FNegri E. Thyroid cancer mortality and incidence: a global overview. International Journal of Cancer20151362187\u20132195. (https:\/\/doi.org\/10.1002\/ijc.29251)10.1002\/ijc.29251"},{"key":"bib4","series-title":"Surgery","doi-asserted-by":"publisher","first-page":"1191","DOI":"10.1016\/j.surg.2010.09.022","article-title":"Impact of second primary malignancy on outcomes of differentiated thyroid carcinoma","volume":"148","author":"Lang","year":"2010","unstructured":"Lang BHLo CYWong IOCowling BJ. Impact of second primary malignancy on outcomes of differentiated thyroid carcinoma. 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