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J Cancer Metastasis Treat 2019;5:31 I http://dx.doi.org/10.20517/2394-4722.2019.21 Page 18 of 36

22. A strategy for the prevention of thyroid cancer with a focus on the experience of managing
radio-induced thyroid cancer after the Chernobyl Accident

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Valentina Drozd , Daniel Igor Branovan , Michael Fridman , Nikolay Shiglik , Sergey Vershenya , Igor
Makarov , Maxim Lushik , Larisa Danilova 4
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1 New York Ear, Nose and Throat Institute, New York, NY 10003, United States.
2 LTD MedEx-lab, Minsk 220013, Belarus.
3 Republican Centre for Thyroid Tumors, Minsk 220013, Belarus.
4 Belorussian medical academy for postgraduate education, Minsk 220013, Belarus.
One of the lessons learned from Chernobyl is the dramatic increase in incidence of thyroid cancer in
Belarus. However the incidence of thyroid cancer has been steadily increasing during the last 30 years
worldwide most markedly in the Republic of Korea, France, Italy, Australia, and USA. Analyzing this
problem, some scientists have recently identified this epidemic of thyroid cancer as “overdiagnosis” and
“overtreatment”. On the other hand, overall incidence-based mortality for thyroid cancer in USA from 1994
to 2013 substantially increased (1.1% per year), and it increased even faster for patients diagnosed with
advanced-stage papillary thyroid cancer (2.9% per year). These findings are consistent with a true increase
in the occurrence of thyroid cancer. The main factors contributing to this increase continue to be debated.
The experience of managing radio-induced thyroid cancer after the Chernobyl Accident has shown that
radiation exposure and the usage of drinking water with a high concentration of nitrates were significantly
associated with high incidence of thyroid cancer. Better understanding of the combined impact mechanism
of radiation and nitrates exposure and maybe other endocrine disruptors will give us more opportunities to
develop new ways of thyroid cancer preventing.

The rising incidence and optimization of management of nodular goiter are also actual problems for
Belarus. Surgery for treating of low-risk thyroid papillary microcarcinomas and nodular goiter might be an
overtreatment and it is important to develop a less traumatic modalities. To ablate small thyroid nodules
(less than 2 cm in diameter), we started to use new originally developed low-cost device for bipolar
radiofrequency ablation - «Thyrablator» designed as a sterile disposable needle for the fine needle biopsy
(20-gauge). The first experience showed a promising efficacy and safety of new device - «Thyrablator» as a
minimally invasive treatment of thyroid lesions.

More studies are needed to better verify the causes of the epidemic of thyroid cancer in the world and to
concentrate our efforts on the prevention and development of new minimally invasive approaches for the
treatment of nodular goiter and early forms of thyroid cancer.

23. Reducing PD-L1 expression with epigenetic modifiers enhances immunotherapy

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Tessa Knox , Eva Sahakian , Debarati Banik , Melissa Hadley , Erica Palmer , Jennifer Kim , John Powers ,
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Fengdong Cheng , Vincent Gallub , Sarthak Shah , Alejandro Villagra 1
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1 The George Washington University, Washington, DC 20052, USA.
2 H. Lee Moffitt, Tampa, FL 33612, USA.
Histone deacetylases (HDACs), were originally described in a limited context as histone modifiers. New
evidence has demonstrated that HDACs are also involved in a diverse range of cellular processes that are