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  • Several risk factors have been identified as carcinogenic bo

    2019-08-11

    Several risk factors have been identified as carcinogenic, both exogenous and endogenous: for example, early exposure to Loxapine Succinate (as the thyroid gland is very radiosensitive), including x-rays and nuclear medicine, and Hashimoto’s thyroiditis [2,23]. A study has shown that the individual radiation dose nearly doubled the last 3 decades in the USA [24]. It is unknown whether similar conditions exist in Europe. Iodine plays a crucial role in the formation of thyroid hormones, and low dietary iodine increases the risk for benign thyroid diseases. Therefore, iodization of household salt and salt used for commercial production of bread became mandatory in 2000 in Denmark to prophylactically address iodine deficiency [25]. Iodine intake has been suspected as a risk factor for thyroid cancer. Blomberg et al. [25] investigated the age-adjusted incidence rates in Denmark between 1943 and 2008 and found in their study that the steepest increase in thyroid cancer started before 2000. Further, a Danish study showed that the iodine supplementation program was only partially effective in the age group 18–30 for the entire country and women aged 40–45 living in West Denmark [26]. If the incidence were truly rising because of enhanced iodine intake, we would expect to see the lowest increase among the younger age groups, but this is not the case. Similarly, a Swedish study found an equivalent increase in incidence rates of thyroid cancer among iodine-deficient and iodine-sufficient regions in Sweden [27]. A link between obesity and several malignancies – including thyroid cancer – has been demonstrated [28]. The increase in thyroid cancer could reflect the epidemic of obesity in the civilized world. According to the Danish National Guidelines, treatment of all types of thyroid cancer involves surgery [8]. Increasing incidence rates would similarly produce an increase in surgical procedures. All patients treated surgically are at risk of post-surgical side effects; for example, the most serious side effects are hypoparathyroidism following total thyroidectomy [29], occurring in 7% of the cases [30], and paresis of the recurrent laryngeal nerve(s) [31], which occurs unilaterally and bilaterally in 2.1% and 0.1% of the cases, respectively [32]. As the clinical significance of papillary microcarcinomas has not yet been clarified [6], the clinician should reflect on the cost–benefits of performing surgery on low-risk thyroid cancer as well as the impact of the treatment morbidity. The increasing population of low-risk patients produces an equivalent large group of patients facing post-surgical side effects. In South Korea, incidences of papillary microcarcinomas are watchfully observed if they are not synchronous with risk factors or metastases at presentation [33].
    Conclusions
    Conflict of interest statement
    Author’s contribution
    Background Emotional distress in cancer patients reduces quality of life, has a negative impact on compliance with medical treatment and carries elevated risk of mortality [1]. For most people, the word “cancer” is associated with a serious illness that is usually very aggressive and requires very invasive treatments. Thus, since the event is considered or evaluated as a threat, an anxious emotional reaction arises. Likewise, perceiving it as a significant loss (loss of health, psychological well-being, life expectancy, etc.) will tend to result in sadness, which can trigger depression [2]. The first challenge for this study is to assess the prevalence of anxiety and depression in women with breast cancer, which can be complex due to the diversity of diagnostic criteria, the fact that not all diagnostic cut-offs have been empirically validated, and because prevalence rates are often assessed at different time points during the disease [1]. Some authors estimate that 30% of individuals diagnosed with cancer experience significant levels of distress at some time during of the course of the disease [3].