About papillary carcinoma true statements are all except

For papillary thyroid cancer, radiation is a very impoant risk factor. Other risk factors include a history of thyroid carcinoma in a first-degree relative and the presence of a familial syndrome that includes thyroid carcinoma, such as Werner syndrome, Cowden syndrome, Carney complex, and familial polyposis. Multicentricity can be anticipated in 70% of patients with papillary thyroid cancer Cervical lymph node metastases are common, paicularly in children, who may have a 50% incidence of clinically detectable nodal disease at presentation. Distant metastases can occur and are present in 3% to 5% of patients at the time of diagnosis. The two most common sites of spread are to the lungs and bones. Source : Sabiston 20th edition Pg : 902-904