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hereditary/familial cancer syndromes, genetic test-
ing for specific mutations, such as the CHEK2,
PTEN, MLH1, and MSH2 genes, along with the
consideration of other lifestyle factors, such as
smoking, physical activity, and diet, would have
been useful.22,23 Because 15 of 64 (23.4%) of the
NSPMs were diagnosed in the first 5 years after
DTC, the authors could not exclude the possibility
that some might have been present at or shortly af-
ter DTC and might have not been a result of the
radiation effect of RAI (ie, surveillance bias).
From these data, after adjusting for potential
risk factors in the multivariable analysis, such as
age, gender, period of DTC diagnosis, and DTC
stage, cumulative RAI activity of 3 to 8.9 GBq was
the only independent risk factor for NSPM in
radiation-na€ıve DTC survivors. The risk of devel-
oping NSPM in the female RAI+ group was signifi-
cantly higher than that of the general population,
but this increased risk was not observed in the
RAI group. Therefore, the authors concluded
that female DTC survivors treated by RAI appeared
to be at elevated risk of developing NSPM when
compared to the general population and an excess
risk was not apparent in those survivors not previ-
ously treated by RAI.
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