garding the quantitative relationship between radiation dose to the thyroid from Chernobyl and the risk of thyroid cancer.

There are only three published population-based case-control studies of thyroid cancer in children that utilize individual estimates of radiation dose and provide quantitative information on thyroid cancer risk (Table 9-3B). The first is based on 107 cases diagnosed in Belarus (Astakhova and others 1998). Although a strong relationship between estimated radiation dose and thyroid cancer was found, thyroid doses were inferred for children from estimates for adults who lived in the same villages. The second is based on confirmed cases of thyroid cancer in children and adolescents aged 0–19 years at the time of the accident, residing in the more highly contaminated areas of the Bryansk Oblast of Russia (Davis and others 2004b).

Based on 26 cases and 52 controls and using a log-linear dose-response model treating estimated individual thyroid radiation dose as a continuous variable, the trend of increasing risk with increasing dose was statistically significant (one-sided p = .009). The third is a population-based, case-control study of thyroid cancer carried out in contaminated regions of Belarus and the Russian Federation (Cardis and others, 2005). The study included 276 cases and 1300 matched controls aged less than 15 years at the time of the accident. Individual doses were calculated for each subject. A very strong dose-response relationship was observed in this study (p < .0001). At 1 Gy, the odds ratio (OR) varied from 5.5 (95% CI 3.1, 9.5) to 8.4 (95% CI 4.1, 17.3) depending on the form of the risk model used. A clear linear dose-response relationship was observed up to about 1 Gy, followed by a marked flattening. The risk appeared to be related mainly to exposure to ¹³¹I. Collectively, data from these studies suggest that exposure to radiation from Chernobyl is associated with an increased risk of thyroid cancer and that the relationship is dose dependent. These findings are consistent with descriptive reports from contaminated areas of Ukraine and Belarus, and the quantitative estimate of thyroid cancer risk is generally consistent with estimates from other radiation-exposed populations.

A number of the studies have also focused on the potentially modifying influence of a number of host and environmental factors. Results from studies of atomic bomb survivors and persons exposed to external irradiation have shown that exposure at the youngest ages is associated with the greatest risk of thyroid cancer. The available data on exposure from the Chernobyl accident are largely in agreement with this observation. For example, a recent paper (Tronko and others 2002) found the highest incidence of thyroid cancer among those exposed at ages 0–4, who also had the highest doses. There have been few studies in persons exposed at older ages, however. One study of thyroid cancer diagnosed in adolescents and adults in the Bryansk region of Russia reported a small excess of thyroid cancer among adults (Ivanov and others 2003), but the excess was not correlated with the imputed doses, and larger studies with longer follow-up and greater statistical power are needed. It has also been postulated that the risk of thyroid cancer may be especially high among persons exposed in utero, because developing fetal thyroid tissue may be highly susceptible to thyroid cancer induction by ¹³¹I exposure. At present there are no data available from Chernobyl regarding the risk of thyroid cancer from in utero exposure.

Fifteen years after the Chernobyl accident, thyroid cancer incidence is still highly elevated. Although based on studies of thyroid cancer in other radiation-exposed populations there is no reason to expect a decrease in the next several years; at the present time the follow-up of Chernobyl-exposed children is too short to determine long-term risks. An increase in thyroid cancer has been observed in both males and females. Most, but not all, of the Chernobyl studies have reported similar relative risks per unit dose for males and females.

Iodine deficiency may also be an important modifier of the risk of radiation-induced thyroid cancer. Some regions contaminated by the Chernobyl accident are areas of mild to moderate iodine deficiency. To date, only two published studies have investigated the relationship between iodine deficiency, radiation dose, and the risk of thyroid cancer in young people. In a study carried out in the Bryansk region of Russia, Shakhtarin and colleagues (2003) report a significantly increased risk of thyroid cancer with increasing radiation dose from Chernobyl that was inversely associated with urinary iodine excretion levels. At 1 Gy, the ERR in territories with severe iodine deficiency was approximately two times that in areas of normal iodine intake, thereby suggesting that iodine deficiency may enhance the risk of thyroid cancer following radiation exposure. The evidence is not conclusive because the study is ecologic and uses approximations for both radiation dose and iodine deficiency. In their case-control study in Belarus and Russia, Cardis and colleagues (2005) also investigated the effects of iodine deficiency and its interaction with radiation exposure in the risk of thyroid cancer. Subjects who resided in the areas of lowest soil iodine content had a 3.1 times (95% CI 1.7, 5.4) higher risk at 1 Gy than subjects residing in areas of higher soil iodine content. It is noted that administration of potassium iodide as a dietary supplement significantly reduced the risk of radiation-induced thyroid cancer.

Finally, relatively little has been published regarding thyroid outcomes other than thyroid cancer, although one study has reported an elevated risk of benign thyroid tumors (Ivanov and others 2003). There have been reports of increases in autoimmune disease and antithyroid antibodies following childhood exposure to Chernobyl (Lomat and others 1997; Vykhovanets and others, 1997; Pacini and others 1998; Vermiglio and others 1999). However, a study by the Sasakawa Foundation, which screened 114,000 children, found no association between a surrogate for thyroid dose