• Boaventura, P.,
• Soares, P.,
• Pereira, D.,
• Teixeira-Gomes, J.,
• Sobrinho-Simões, M.
• View Correspondence (jump link)

• ^aInstitute of Molecular Pathology and Immunology, University of Porto, 4200-465 Porto, Portugal
• ^bMedical Faculty, University of Porto, 4200-465 Porto, Portugal
• ^cDepartment of Pathology, Hospital de São João, Porto, Portugal

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• 1

  Paula Boaventura a Paula Soares a b [email protected] Dina Pereira a José Teixeira-Gomes a Manuel Sobrinho-Simões a b c a Institute of Molecular Pathology and Immunology, University of Porto, 4200-465 Porto, Portugal b Medical Faculty, University of Porto, 4200-465 Porto, Portugal c Department of Pathology, Hospital de São João, Porto, Portugal We read with interest Shifra Shvarts and colleagues' Historical Review on the tinea capitis treatment campaign in 1950s Serbia. ). 1 Treatment of tinea capitis infection that included radiation was also used in Portugal in the same period, in accordance with the same Kienbock-Adamson technique. 2 We had access to the registries of a cohort treated in the north of Portugal, which included patients' details, treatment dates, tinea diagnoses (type of infection), and doses received ( table In March, 2006, we started to locate and contact the cohort members; this was a difficult task because 40–50 years have passed since their tinea capitis treatment. Nevertheless we have traced 3548 individuals, to whom we sent information letters with a free-phone contact number. This method allowed us to clinically examine 1287 individuals, all by the same clinician (TG), and report that 292 are dead and 85 are living abroad. We recommended neck ultrasounds, and 886 (70%) of the participants had the examination. A fine-needle aspiration biopsy was advised in 221 patients who had nodules with suspicious features. Surgery was proposed for 45 people whose biopsy samples showed malignant or follicular lesions. At clinical examination, 18 individuals had been previously diagnosed with thyroid carcinoma, and we diagnosed 15 more. In total, we recorded a 2·6% prevalence of thyroid carcinoma; similar to the 2·1% reported for survivors of the Hiroshima and Nagasaki atomic bombs in a survey study by Misa Imaizumi and colleagues 3 that used a similar protocol (thyroid ultrasonography). If we exclude from our study the previous diagnoses, the prevalence decreases to 1·4%, which is similar to the 0·95% reported by Siegal Sadetzki and co-workers. 4 Our data seem to agree with the high risk of thyroid tumours reported in Shvarts and colleagues' study. 1 We have observed in our cohort a high prevalence of meningiomas and basal-cell carcinoma (data not shown), not mentioned by Shvarts and colleagues. We have also shown in this cohort that the favus tinea infection gives an eight-times increase in risk of alopecia when compared with trichophytic tinea, even after adjustment for age and irradiation dose. 5 Our data support and emphasise the arguments presented by Shvarts and colleagues, that physicians should be aware of particular subsets of population that might be at risk of late radiation-associated health effects. These data justify a close follow-up of the irradiated tinea capitis cohorts to identify those head and neck lesions that are undiagnosed. This work was supported by a grant from Fundação Calouste Gulbenkian ( ref 76636 ) and Portuguese Foundation for Science and Technology (FCT) (project: PIC/IC/83154/2007 ), and further funding from the FCT by a grant to PB ( SFRH/BPD/34276/2007 ). IPATIMUP is an Associate Laboratory of the Portuguese Ministry of Science, Technology and Higher Education , and is partly supported by the FCT. We thank all the individuals that agreed to participate in this study as well as all the physicians who provided us the clinical material and information.