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Muller I, Barrett-Lee PJ. The antigenic link between thyroid autoimmunity and breast cancer. Semin Cancer Biol 2019; 64:122-134. [PMID: 31128301 DOI: 10.1016/j.semcancer.2019.05.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Revised: 05/17/2019] [Accepted: 05/21/2019] [Indexed: 02/06/2023]
Abstract
The association between breast cancer and benign thyroid disorders, in particular thyroid autoimmunity, has been debated for decades. Autoantibodies to thyroid peroxidase, the hallmark of thyroid autoimmunity, have a higher prevalence among patients with breast cancer compared with the general population. Furthermore a correlation between their positivity and a better prognosis of breast cancer was found in several independent small-scale studies, even if such observation was not confirmed in a subsequent retrospective study conducted on the largest patient cohort to date. The thyroid and mammary glands present several biological similarities, therefore the hypothesis of an immune response to shared thyroid/breast antigens could in part explain the association between thyroid autoimmunity and breast cancer. The sodium iodide symporter is expressed in both glands, however it seems unlikely to be the key common antigen, considering that autoantibodies targeting it are rare. Instead thyroid peroxidase, one of the major thyroid autoantigens, is also expressed in breast tissue and therefore represents the main antigenic link between thyroid autoimmunity and breast cancer. Furthermore lactoperoxidase, an enzyme of the same family that shares structural similarities with thyroid peroxidase, is expressed in neoplastic breast cells and is responsible for the cross-reactivity with some autoantibodies to thyroid peroxidase. Novel strategies for the diagnosis and treatment of breast cancer might take advantage of the antigenic link between thyroid and breast tissues.
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Affiliation(s)
- Ilaria Muller
- Thyroid Research Group, Division of Infection & Immunity, School of Medicine, Cardiff University, Cardiff, United Kingdom.
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52
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TAAR1 levels and sub-cellular distribution are cell line but not breast cancer subtype specific. Histochem Cell Biol 2019; 152:155-166. [PMID: 31111198 DOI: 10.1007/s00418-019-01791-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/07/2019] [Indexed: 12/23/2022]
Abstract
Trace amine-associated receptors are G protein-coupled receptors of which TAAR1 is the most well-studied. Recently, Vattai et al. (J Cancer Res Clin Oncol 143:1637-1647 https://doi.org/10.1007/s00432-017-2420-8 , 2017) reported that expression of TAAR1 may be a marker of breast cancer (BC) survival, with a positive correlation also suggested between TAAR1 expression and HER2 positivity. Neither a role for TAAR1 in breast tissue, nor in cancer, had previously been suspected. We, therefore, sought to provide independent validation and to further examine these putative relationships. First, a bioinformatic analysis on 58 total samples including normal breast tissue, BC-related cell lines, and tumour samples representing different BC sub-types found no clear correlation between TAAR1 mRNA levels and any BC subtype, including HER2 + . We next confirmed the bioinformatics data correlated to protein expression using a well validated anti-human TAAR1 antibody. TAAR1 mRNA levels correlated with the relative intensity of immunofluorescence staining in six BC cell lines (MCF-7, T47D, MDA-MB-231, SKBR3, MDA-MB-468, BT-474), but not in the MCF-10A immortalized mammary gland line, which had high mRNA but low protein levels. As expected, TAAR1 protein was intracellular in all cell lines. Surprisingly MCF-7, SKBR3, and MDA-MB-468 showed pronounced nuclear localization. The relative protein expression in MCF-7, MDA-MB-231, and MCF-10A lines was further confirmed by semi-quantitative flow cytometry. Finally, we demonstrate that the commercially available anti-TAAR1 antibody has poor selectivity, which likely explains the lack of correlation with the previous study. Therefore, while we clearly demonstrate variable expression and sub-cellular localization of TAAR1 across BC cell lines, we find no evidence for association with BC subtype.
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L'Heureux A, Wieland DR, Weng CH, Chen YH, Lin CH, Lin TH, Weng CH. Association Between Thyroid Disorders and Colorectal Cancer Risk in Adult Patients in Taiwan. JAMA Netw Open 2019; 2:e193755. [PMID: 31099862 PMCID: PMC6537921 DOI: 10.1001/jamanetworkopen.2019.3755] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
IMPORTANCE Thyroid hormones have been shown to affect several important pathways in cancer development, including colorectal cancer (CRC). Clinical studies examining the association between thyroid disorders and colorectal cancer have conflicting results and have predominantly involved white populations. OBJECTIVE To determine if a diagnosis of hyperthyroidism or hypothyroidism is associated with the risk of developing colorectal cancer in an East Asian population. DESIGN, SETTING, AND PARTICIPANTS This nationwide population-based case-control study was conducted from April 27, 2018, to November 8, 2018, using the Taiwanese National Health Insurance Research Database. Participants were adults (n = 139 426) either with a new diagnosis (between 2008 and 2013) of primary colorectal cancer without a history of cancer, or without cancer. Cases and controls were matched 1:1 by age, sex, and index date. Diagnosis of hyperthyroidism or hypothyroidism prior to the diagnosis of colorectal cancer (or the same index date in controls) was then determined. MAIN OUTCOMES AND MEASURES Risk differences in developing colorectal cancer among patients with a medical history of hyperthyroidism or hypothyroidism. RESULTS A total of 139 426 patients were included in the study, and 69 713 individuals made up each case and control group, which were both predominantly male (39 872 [57.2%]). The mean (SD) age for those with CRC was 65.8 (13.7) years and for those without CRC was 66.0 (13.6) years. Both hyperthyroidism (adjusted odds ratio [aOR], 0.77; 95% CI, 0.69-0.86; P < .001) and hypothyroidism (aOR, 0.78; 95% CI, 0.65-0.94; P = .008) were associated with a decreased risk of being diagnosed with colorectal cancer. An inverse association of rectal cancer was found among patients aged 50 years or older with a history of hypothyroidism despite treatment (aOR, 0.54; 95% CI, 0.39-0.74; P < .001). A history of hyperthyroidism in all age groups was associated with a lower risk of colon cancer (aOR, 0.74; 95% CI, 0.64-0.85; P < .001), with a stronger association seen among those younger than 50 years (aOR, 0.55; 95% CI, 0.36-0.85; P = .007). CONCLUSIONS AND RELEVANCE In this study, hypothyroidism appeared to be associated with a lower risk of rectal cancer, whereas hyperthyroidism appeared to be associated with a lower risk of colon cancer. Because of this, biochemical in vivo research and epidemiologic studies appear to be needed to further clarify the nature of these associations.
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Affiliation(s)
- Abby L'Heureux
- Rural Medical Partners at Fallon Medical Center, Baker, Montana
| | | | - Chien-Huan Weng
- Department of Immunology, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Yi-Huei Chen
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Ching-Heng Lin
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Tseng-Hsi Lin
- Division of Hematology and Oncology, Department of Internal Medicine, Wuri Lin Shin Hospital, Taichung, Taiwan
- Department of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Chien-Hsiang Weng
- Department of Family Medicine, Brown University Warren Alpert Medical School, Providence, Rhode Island
- Department of Family Medicine, Providence Community Health Centers, Providence, Rhode Island
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Breast cancer prognosis is better in patients who develop subsequent metachronous thyroid cancer. PLoS One 2019; 14:e0215948. [PMID: 31042767 PMCID: PMC6493754 DOI: 10.1371/journal.pone.0215948] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 03/30/2019] [Indexed: 12/11/2022] Open
Abstract
Breast cancer (BC) and thyroid cancer (TC) are common malignancies among females. However, the connection between TC and BC is not well understood. To explore the relationship between these two cancers and to determine the effect of second metachronous TC on BC survival, we compared BC patients with or without second primary TC using data from the Surveillance, Epidemiology, and End Results (SEER) database. We extracted data from patients with only BC or TC and from BC patients with a second metachronous cancer from 2000–2014. Differences in the clinicopathological and treatment characteristics between BC patients with or without second metachronous TC were analyzed by chi-square tests. Multivariate analyses of BC survival were performed by using Cox regression models. Comparison of disease-specific survival (DSS) curves between these cohorts was performed with the log-rank (Mantel-Cox) test. Survival analyses were also performed using data from 1980–1994. Within this dataset, we found 1,262 BC cases in which a second metachronous TC (BC2TC) developed, accounting for 3.1% of all metachronous cancers following BC from 2000–2014. No significant differences were found in molecular markers. In addition, the mean age at BC diagnosis was younger in the BC2TC group than in the BC group (55.418 y vs 60.273 y). Half of the BC2TC patients developed TC in the first three years following BC diagnosis. Patients with BC2TC showed better DSS than those with BC alone from 2000–2014 (P<0.001). However, this superiority was not significant from 1980–1994 (P = 0.579) or for TNM stage I BC (P = 0.927) and grade I BC (P = 0.431) from 2000–2014. In conclusion, the incidence of BC2TC has increased dramatically during the past 15 years. In addition, patients with BC2TC showed better DSS than patients with BC alone, especially in cases from 2000–2014.
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Kim EY, Chang Y, Lee KH, Yun JS, Park YL, Park CH, Ahn J, Shin H, Ryu S. Serum concentration of thyroid hormones in abnormal and euthyroid ranges and breast cancer risk: A cohort study. Int J Cancer 2019; 145:3257-3266. [PMID: 30882890 DOI: 10.1002/ijc.32283] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 03/06/2019] [Accepted: 03/13/2019] [Indexed: 01/07/2023]
Abstract
The impact of variations in serum thyroid hormone concentration within the euthyroid range on breast cancer risk remains unclear. We investigated the effect of serum thyrotropin (TSH) and thyroid hormone concentration on breast cancer risk. This cohort study involved 62,546 Korean women, aged ≥40 years, who were free of breast cancer at baseline and underwent health examination with determination of free thyroxine (FT4) and TSH. A parametric proportional hazard model was used to estimate the adjusted hazard ratio (aHR) and 95% confidence interval (CI). During a median follow-up of 4.8 years (interquartile range: 2.8-7.3 years), 834 incident breast cancers were identified. Compared to normal FT4 level, abnormally high serum FT4 level was associated with an increased risk of incident breast cancer with a corresponding multivariable aHR (95% CI) of 1.98 (1.02-3.83). This association tended to be stronger in postmenopausal women than in premenopausal women. Within the euthyroid range, the highest TSH tertile was associated with a lower risk of breast cancer than the lowest TSH tertile with a corresponding aHR (95% CI) of 0.68 (0.55-0.84). In contrast, highest FT4 tertile was associated with a higher risk of breast cancer than the lowest FT4 tertile. Abnormally high FT4 as well as higher FT4 within the euthyroid range were positively associated with breast cancer risk, while higher TSH concentration within the euthyroid range was negatively associated with breast cancer risk. Our findings indicate that thyroid function within both the abnormal and euthyroid ranges may contribute to the development of breast cancer.
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Affiliation(s)
- Eun Young Kim
- Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Yoosoo Chang
- Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.,Department of Occupational and Environmental Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.,Department of Clinical Research Design & Evaluation, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea
| | - Kwan Ho Lee
- Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.,Department of Surgery, Eunpyeong St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Ji-Sup Yun
- Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Yong Lai Park
- Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Chan Heun Park
- Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jiin Ahn
- Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hocheol Shin
- Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.,Department of Family Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Seungho Ryu
- Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.,Department of Occupational and Environmental Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.,Department of Clinical Research Design & Evaluation, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea
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56
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El-Ansari R, Craze ML, Alfarsi L, Soria D, Diez-Rodriguez M, Nolan CC, Ellis IO, Rakha EA, Green AR. The combined expression of solute carriers is associated with a poor prognosis in highly proliferative ER+ breast cancer. Breast Cancer Res Treat 2019; 175:27-38. [PMID: 30671766 DOI: 10.1007/s10549-018-05111-w] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 12/18/2018] [Indexed: 02/06/2023]
Abstract
PURPOSE Breast cancer (BC) is a heterogeneous disease characterised by variant biology, metabolic activity, and patient outcome. Glutamine availability for growth and progression of BC is important in several BC subtypes. This study aimed to evaluate the biological and prognostic role of the combined expression of key glutamine transporters, SLC1A5, SLC7A5, and SLC3A2 in BC with emphasis on the intrinsic molecular subtypes. METHODS SLC1A5, SLC7A5, and SLC3A2 were assessed at the protein level, using immunohistochemistry on tissue microarrays constructed from a large well-characterised BC cohort (n = 2248). Patients were stratified into accredited clusters based on protein expression and correlated with clinicopathological parameters, molecular subtypes, and patient outcome. RESULTS Clustering analysis of SLC1A5, SLC7A5, and SLC3A2 identified three clusters low SLCs (SLC1A5-/SLC7A5-/SLC3A2-), high SLC1A5 (SLC1A5+/SLC7A5-/SLC3A2-), and high SLCs (SLC1A5+/SLC7A5+/SLC3A2+) which had distinct correlations to known prognostic factors and patient outcome (p < 0.001). The key regulator of tumour cell metabolism, c-MYC, was significantly expressed in tumours in the high SLC cluster (p < 0.001). When different BC subtypes were considered, the association with the poor outcome was observed in the ER+ high proliferation/luminal B class only (p = 0.003). In multivariate analysis, SLC clusters were independent risk factor for shorter BC-specific survival (p = 0.001). CONCLUSION The co-operative expression of SLC1A5, SLC7A5, and SLC3A2 appears to play a role in the aggressive subclass of ER+ high proliferation/luminal BC, driven by c-MYC, and therefore have the potential to act as therapeutic targets, particularly in synergism.
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Affiliation(s)
- Rokaya El-Ansari
- Nottingham Breast Cancer Research Centre, Division of Cancer and Stem Cells, School of Medicine, Nottingham City Hospital, University of Nottingham, Hucknall Road, Nottingham, NG5 1PB, UK
| | - Madeleine L Craze
- Nottingham Breast Cancer Research Centre, Division of Cancer and Stem Cells, School of Medicine, Nottingham City Hospital, University of Nottingham, Hucknall Road, Nottingham, NG5 1PB, UK
| | - Lutfi Alfarsi
- Nottingham Breast Cancer Research Centre, Division of Cancer and Stem Cells, School of Medicine, Nottingham City Hospital, University of Nottingham, Hucknall Road, Nottingham, NG5 1PB, UK
| | - Daniele Soria
- School of Computer Science and Engineering, University of Westminster, New Cavendish Street, London, WW1 6UW, UK
| | - Maria Diez-Rodriguez
- Nottingham Breast Cancer Research Centre, Division of Cancer and Stem Cells, School of Medicine, Nottingham City Hospital, University of Nottingham, Hucknall Road, Nottingham, NG5 1PB, UK
| | - Christopher C Nolan
- Nottingham Breast Cancer Research Centre, Division of Cancer and Stem Cells, School of Medicine, Nottingham City Hospital, University of Nottingham, Hucknall Road, Nottingham, NG5 1PB, UK
| | - Ian O Ellis
- Nottingham Breast Cancer Research Centre, Division of Cancer and Stem Cells, School of Medicine, Nottingham City Hospital, University of Nottingham, Hucknall Road, Nottingham, NG5 1PB, UK
- Breast Institute, Nottingham University Hospitals NHS Trust, Hucknall Road, Nottingham, NG5 1PB, UK
| | - Emad A Rakha
- Nottingham Breast Cancer Research Centre, Division of Cancer and Stem Cells, School of Medicine, Nottingham City Hospital, University of Nottingham, Hucknall Road, Nottingham, NG5 1PB, UK
- Breast Institute, Nottingham University Hospitals NHS Trust, Hucknall Road, Nottingham, NG5 1PB, UK
| | - Andrew R Green
- Nottingham Breast Cancer Research Centre, Division of Cancer and Stem Cells, School of Medicine, Nottingham City Hospital, University of Nottingham, Hucknall Road, Nottingham, NG5 1PB, UK.
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57
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Uzair ID, Conte Grand J, Flamini MI, Sanchez AM. Molecular Actions of Thyroid Hormone on Breast Cancer Cell Migration and Invasion via Cortactin/N-WASP. Front Endocrinol (Lausanne) 2019; 10:139. [PMID: 30899247 PMCID: PMC6416158 DOI: 10.3389/fendo.2019.00139] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 02/13/2019] [Indexed: 12/15/2022] Open
Abstract
The thyroid hormone triiodothyronine (T3) plays a fundamental role in growth regulation, differentiation, metabolism and cellular movement. These processes are particularly important considering that deregulation of T3 levels could promote abnormal responsiveness of mammary epithelial cells, which may lead to the development and progression of breast cancer (BC). Once cells migrate and invade different tissues, BC metastasis is the main cause of cancer-related death because it is particularly difficult to revert this multistep process. Cell migration integrates several steps that induce changes in cell structure and morphology to promote BC cell invasion. These sequential steps include actin cytoskeleton remodeling, focal adhesion complex formation and, finally, the turnover of branched actin filament networks. In this article, we demonstrate that T3 has the ability to modify the Epithelial-Mesenchymal Transition process. In addition, we show that T3 induces actin cytoskeleton reorganization, triggers focal adhesion formation and, as a consequence, promotes actin nucleation via non-genomic pathway. These events are specifically modulated by T3 via integrin αvβ3 to FAK/paxillin/cortactin/N-WASP/Arp2/3 complex signaling pathway, increasing cell adhesion, migration and invasion of T-47D BC cells. We suggest that T3 influences the progression of tumor metastasis by controlling signaling pathways that converge in cell motility. This knowledge is crucial for the development of novel therapeutic strategies for BC treatment.
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Affiliation(s)
- Ivonne Denise Uzair
- Laboratory of Signal Transduction and Cell Movement, Institute of Medicine and Experimental Biology of Cuyo, National Scientific and Technical Research Council (CONICET), Mendoza, Argentina
| | - Jeremias Conte Grand
- Laboratory of Signal Transduction and Cell Movement, Institute of Medicine and Experimental Biology of Cuyo, National Scientific and Technical Research Council (CONICET), Mendoza, Argentina
| | - Marina Ines Flamini
- Laboratory of Signal Transduction and Cell Movement, Institute of Medicine and Experimental Biology of Cuyo, National Scientific and Technical Research Council (CONICET), Mendoza, Argentina
- Tumor Biology Laboratory, Institute of Medicine and Experimental Biology of Cuyo, National Scientific and Technical Research Council (CONICET), Mendoza, Argentina
| | - Angel Matias Sanchez
- Laboratory of Signal Transduction and Cell Movement, Institute of Medicine and Experimental Biology of Cuyo, National Scientific and Technical Research Council (CONICET), Mendoza, Argentina
- *Correspondence: Angel Matias Sanchez
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58
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Fröhlich E, Wahl R. The forgotten effects of thyrotropin-releasing hormone: Metabolic functions and medical applications. Front Neuroendocrinol 2019; 52:29-43. [PMID: 29935915 DOI: 10.1016/j.yfrne.2018.06.006] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 06/07/2018] [Accepted: 06/20/2018] [Indexed: 11/18/2022]
Abstract
Thyrotropin-releasing hormone (TRH) causes a variety of thyroidal and non-thyroidal effects, the best known being the feedback regulation of thyroid hormone levels. This was employed in the TRH stimulation test, which is currently little used. The role of TRH as a cancer biomarker is minor, but exaggerated responses to TSH and prolactin levels in breast cancer led to the hypothesis of a potential role for TRH in the pathogenesis of this disease. TRH is a rapidly degraded peptide with multiple targets, limiting its suitability as a biomarker and drug candidate. Although some studies reported efficacy in neural diseases (depression, spinal cord injury, amyotrophic lateral sclerosis, etc.), therapeutic use of TRH is presently restricted to spinocerebellar degenerative disease. Regulation of TRH production in the hypothalamus, patterns of expression of TRH and its receptor in the body, its role in energy metabolism and in prolactin secretion are addressed in this review.
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Affiliation(s)
- Eleonore Fröhlich
- Internal Medicine (Dept. of Endocrinology and Diabetology, Angiology, Nephrology and Clinical Chemistry), University of Tuebingen, Otfried-Muellerstrasse 10, 72076 Tuebingen, Germany; Center for Medical Research, Medical University Graz, Stiftingtalstr. 24, 8010 Graz, Austria
| | - Richard Wahl
- Internal Medicine (Dept. of Endocrinology and Diabetology, Angiology, Nephrology and Clinical Chemistry), University of Tuebingen, Otfried-Muellerstrasse 10, 72076 Tuebingen, Germany.
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Krashin E, Piekiełko-Witkowska A, Ellis M, Ashur-Fabian O. Thyroid Hormones and Cancer: A Comprehensive Review of Preclinical and Clinical Studies. Front Endocrinol (Lausanne) 2019; 10:59. [PMID: 30814976 PMCID: PMC6381772 DOI: 10.3389/fendo.2019.00059] [Citation(s) in RCA: 95] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 01/22/2019] [Indexed: 01/06/2023] Open
Abstract
Thyroid hormones take major part in normal growth, development and metabolism. Over a century of research has supported a relationship between thyroid hormones and the pathophysiology of various cancer types. In vitro studies as well as research in animal models demonstrated an effect of the thyroid hormones T3 and T4 on cancer proliferation, apoptosis, invasiveness and angiogenesis. Thyroid hormones mediate their effects on the cancer cell through several non-genomic pathways including activation of the plasma membrane receptor integrin αvβ3. Furthermore, cancer development and progression are affected by dysregulation of local bioavailability of thyroid hormones. Case-control and population-based studies provide conflicting results regarding the association between thyroid hormones and cancer. However, a large body of evidence suggests that subclinical and clinical hyperthyroidism increase the risk of several solid malignancies while hypothyroidism may reduce aggressiveness or delay the onset of cancer. Additional support is provided from studies in which dysregulation of the thyroid hormone axis secondary to cancer treatment or thyroid hormone supplementation was shown to affect cancer outcomes. Recent preclinical and clinical studies in various cancer types have further shown promising outcomes following chemical reduction of thyroid hormones or inhibition or their binding to the integrin receptor. This review provides a comprehensive overview of the preclinical and clinical research conducted so far.
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Affiliation(s)
- Eilon Krashin
- Translational Hemato-Oncology Laboratory, Meir Medical Center, Kfar-Saba, Israel
- Department of Human Molecular Genetics and Biochemistry, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Martin Ellis
- Translational Hemato-Oncology Laboratory, Meir Medical Center, Kfar-Saba, Israel
- Meir Medical Center, Hematology Institute and Blood Bank, Kfar-Saba, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Osnat Ashur-Fabian
- Translational Hemato-Oncology Laboratory, Meir Medical Center, Kfar-Saba, Israel
- Department of Human Molecular Genetics and Biochemistry, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- *Correspondence: Osnat Ashur-Fabian
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60
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Differentiated thyroid cancer: Why does it affect predominantly women during the reproductive period and have higher incidence of mutual association with breast cancer? Med Hypotheses 2018; 122:5-7. [PMID: 30593422 DOI: 10.1016/j.mehy.2018.10.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 09/27/2018] [Accepted: 10/11/2018] [Indexed: 12/17/2022]
Abstract
Differentiated thyroid cancer (DTC) is markedly more common in women than men, and its occurrence and risk for poorer prognosis are associated with pregnancy. Further, it is known that there is a high frequency of co-occurrence of DTC and breast cancer. Although the underlying mechanisms that contribute to these phenomena are not entirely clear, 2 hypotheses are proposed here. First, human chorionic gonadotropin (hCG) produced by the placenta may be involved, since hCG has a similar function to stimulate the thyroid as thyroid-stimulating hormone (TSH), the latter of which is known to play a role in causing DTC and may promote breast cancer through the secretion of thyroid hormones (THs). Second, thyrotropin-releasing hormone (TRH), which is stimulated by suckling in the puerperal period, induces the secretion of not only TSH and thus indirectly THs, but also prolactin (PRL), which can accelerate the development of breast cancer. These hypotheses also explain the pregnancy-associated transient increase in breast cancer risk, while inhibition of estrogen by PRL may have a long-term preventive effect on breast cancer. Pregnancy-associated hyperthyroidism may also account for female preponderance of thyroid disease in general as well as tumors in organs that the thyroid hormone targets such as cardiac myxoma and diffuse-type gastric carcinoma.
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Barrow TM, Peng C, Wilson A, Wang H, Liu H, Shen L, Tang NJ, Sae-Lee C, Li PH, Guo L, Byun HM. Psychosocial stress is associated with benign breast disease in young Chinese women: results from Project ELEFANT. Breast Cancer Res Treat 2018; 173:217-224. [PMID: 30255453 DOI: 10.1007/s10549-018-4979-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 09/20/2018] [Indexed: 12/29/2022]
Abstract
PURPOSE Psychosocial stress, including bereavement and work-related stress, is associated with the risk of breast cancer. However, it is unknown whether it may also be linked with increased risk of benign breast disease (BBD). METHODS Our study leveraged 61,907 women aged 17-55 years old from the Project ELEFANT study. BBD was diagnosed by clinician. Self-reported data on psychosocial stress over a 10-year period was retrospectively collected from questionnaires and categorised by cause (work, social and economic) and severity (none, low and high). Odd ratios (ORs) for the development of BBD were estimated using logistic regression. The model was adjusted for age, BMI, TSH levels, smoking, alcohol consumption, family history, age of menarche, oral contraceptive usage, education and occupation. RESULTS Within our study, 8% (4,914) of participants were diagnosed with BBD. Work-related stress [OR 1.57, 95% confidence interval (CI) 1.46-1.69] and financial stress (OR 1.34, 95% CI 1.24-1.44) were significantly associated with BBD incidence, with a smaller but still significant association with social stress (OR 1.11, 95% CI 1.01-1.21). The associations remained significant after exclusion of participants with first- and second-degree family history of breast disease. The presence of multiple forms of stress did not synergistically increase risk. The neutrophil-lymphocyte ratio (NLR), a marker of systemic inflammation and prognostic marker for breast cancer, was not associated with BBD. CONCLUSIONS Psychosocial stress, particularly work-related and financial stress, is associated with increased risk of benign breast disease among young Chinese women.
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Affiliation(s)
- Timothy M Barrow
- Faculty of Health Sciences & Wellbeing, University of Sunderland, Sunderland, SR1 3SD, UK
| | - Cheng Peng
- Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Ander Wilson
- Department of Statistics, Colorado State University, Fort Collins, CO, USA
| | - Hao Wang
- Tianjin Research Institute for Family Planning, Tianjin, 300131, China
| | - Hongbin Liu
- Tianjin Research Institute for Family Planning, Tianjin, 300131, China
| | - Lilin Shen
- Tianjin Research Institute for Family Planning, Tianjin, 300131, China
| | - Nai-Jun Tang
- Department of Occupational & Environmental Health, School of Public Health, Tianjin Medical University, 22nd Qixiangtai Road, Heping District, Tianjin, 300070, China
| | - Chanachai Sae-Lee
- Human Nutrition Research Centre, Institute of Cellular Medicine, Newcastle University, Campus for Ageing and Vitality, Newcastle Upon Tyne, NE4 5PL, UK.,Research Division, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Peng-Hui Li
- School of Environmental Science and Safety Engineering, Tianjin University of Technology, Tianjin, 300384, China
| | - Liqiong Guo
- Department of Occupational & Environmental Health, School of Public Health, Tianjin Medical University, 22nd Qixiangtai Road, Heping District, Tianjin, 300070, China.
| | - Hyang-Min Byun
- Human Nutrition Research Centre, Institute of Cellular Medicine, Newcastle University, Campus for Ageing and Vitality, Newcastle Upon Tyne, NE4 5PL, UK
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Dong L, Lu J, Zhao B, Wang W, Zhao Y. Review of the possible association between thyroid and breast carcinoma. World J Surg Oncol 2018; 16:130. [PMID: 29976206 PMCID: PMC6034293 DOI: 10.1186/s12957-018-1436-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Accepted: 06/26/2018] [Indexed: 01/28/2023] Open
Abstract
Background Thyroid and breast cancer are two of the malignant diseases with highest incidence in females. Based on clinical experience, breast and thyroid cancer often occur metachronously or synchronously. Therefore, thyroid and breast cancer might share some common etiological factors. The relationship between these diseases has attracted substantial attention, and because these two glands are both regulated by the hypothalamic-pituitary axis, such a relationship is not surprising. A study of this relationship will be useful for obtaining a better understanding of the mechanism by which these two malignancies co-occur. Main body This study reviewed the progress in research on the roles of iodine intake, folate metabolism, obesity, gonadal hormones, and thyroid hormone in thyroid and breast cancer. These studies evaluating the etiological roles of these factors in linking breast and thyroid cancer might also improve our understanding and identify new therapeutic approaches, such as sodium/iodide symporter-mediated radioiodine therapy and thyroid-stimulating hormone receptor antagonists, for breast cancer. In addition, some specific treatments for each cancer, such as radiotherapy for breast cancer or radioactive iodine therapy for thyroid cancer, might be risk factors for secondary malignances, including breast and thyroid cancer. Conclusions Studies of the precise relationship between the co-occurrence of breast and thyroid cancer will certainly improve our understanding of the biological behaviors of these two malignancies and direct evidence-based clinical practice.
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Affiliation(s)
- Liangbo Dong
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100730, People's Republic of China
| | - Jun Lu
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100730, People's Republic of China
| | - Bangbo Zhao
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100730, People's Republic of China
| | - Weibin Wang
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100730, People's Republic of China.
| | - Yupei Zhao
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100730, People's Republic of China.
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63
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Wu CC, Yu YY, Yang HC, Nguyen PA, Poly TN, Islam MM, Iqbal U, Khan HAA, Wang YC, Cheng YT, Li YC, Jian WS. Levothyroxine use and the risk of breast cancer: a nation-wide population-based case–control study. Arch Gynecol Obstet 2018; 298:389-396. [DOI: 10.1007/s00404-018-4837-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2017] [Accepted: 06/20/2018] [Indexed: 11/28/2022]
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Weng CH, Chen YH, Lin CH, Luo X, Lin TH. Thyroid disorders and breast cancer risk in Asian population: a nationwide population-based case-control study in Taiwan. BMJ Open 2018; 8:e020194. [PMID: 29602850 PMCID: PMC5884336 DOI: 10.1136/bmjopen-2017-020194] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE To evaluate whether hyperthyroidism or hypothyroidism increases the risk of subsequent breast cancer in an Asian population. DESIGN Nationwide population-based case-control study. SETTING All healthcare facilities in Taiwan. PARTICIPANTS A total of 103 466 women (mean age 53.3 years) were enrolled. METHODS 51 733 adult women with newly diagnosed primary breast cancer without a previous cancer history between 2006 and 2011 were identified and included in our study. 51 733 women with no cancer diagnosis prior to the index date were age matched as controls. Diagnosis of hyperthyroidism or hypothyroidism prior to the diagnosis of breast cancer or the same index date was identified, age, histories of thyroid disease treatment, oestrogen use and radioactive iodine treatment were adjusted. MAIN OUTCOME MEASURES To identify risk differences in developing breast cancer among patients with a medical history of hyperthyroidism or hypothyroidism. RESULTS There was a significantly increased risk of breast cancer in women with hyperthyroidism under the age of 55 years (age <45: OR 1.16, P=0.049; age 45-55: OR 1.15, P=0.019). Patients with hypothyroidism also showed an increased risk of breast cancer (OR 1.19, P=0.029) without statistical significance after stratification by age group (age <45, 45-55, >55 years). Treatment for thyroid disorders did not alter the association in subgroup analyses (P=0.857; 0.262, respectively). CONCLUSIONS Asian women under 55 years of age with history of hyperthyroidism have a significantly increased risk of breast cancer regardless of treatment. Women with history of hypothyroidism may also have an increased risk.
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Affiliation(s)
- Chien-Hsiang Weng
- Department of Family Medicine, Brown University Warren Alpert Medical School, Providence, Rhode Island, USA
- NH Dartmouth Family Medicine Residency, Concord Hospital, Concord, New Hampshire, USA
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Yi-Huei Chen
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Ching-Heng Lin
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Xun Luo
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Tseng-Hsi Lin
- Division of Transfusion Medicine, Department of Pathology and Laboratory Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Internal Medicine, Chung-Shan Medical University Hospital, Taichung, Taiwan
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65
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Cordel E, Reix N, Molière S, Mathelin C. [Hyperthyroidism and breast cancer: Is there a link?]. ACTA ACUST UNITED AC 2018; 46:403-413. [PMID: 29478847 DOI: 10.1016/j.gofs.2018.01.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Indexed: 12/23/2022]
Abstract
The objective of this review was to determine whether there is an association between hyperthyroidism and the risk of developing a breast cancer from the analysis of data in the literature. METHOD The analyzed articles were extracted from the PUBMED database from 2002 to 2017 using the following keywords "hyperthyroidism AND breast cancer" and "thyroid AND breast cancer". RESULTS A total of 22 studies were selected, including 8 cohort studies, 12 case-control studies and 2 meta-analyzes. Of these 22 studies, 15 have established a significant epidemiological or biological link between hyperthyroidism and breast cancer. Five of them were particularly interested in Graves' disease, and four demonstrated a positive association between this disease and the onset of breast cancer, especially within three years from the thyropathy diagnosis. These different studies also highlighted the increased risk of breast cancer seen in overweight or postmenopausal women. Contradictions persist over the types of mammary cancers observed and their prognosis. CONCLUSION This review reveals that women with hyperthyroidism appear to have a moderately high risk of breast cancer (RR<2). These data are corroborated by solid physiopathological hypotheses. Regardless of the type of thyropathy responsible for hyperthyroidism, care should be taken to ensure that these patients receive a clinical examination of the breasts on an annual basis and mammographic screening every 2 years from the age of 50 years.
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Affiliation(s)
- E Cordel
- Unité de sénologie, hôpital de Hautepierre, hôpitaux universitaires de Strasbourg, CHRU, 1, avenue Molière, 67098 Strasbourg cedex 09, France
| | - N Reix
- Laboratoire de biochimie et biologie moléculaire, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, 67091 Strasbourg, France; ICube UMR 7357, fédération de médecine translationnelle de Strasbourg (FMTS), université de Strasbourg/CNRS, IMIS, 4 rue Kirschleger, 67085 Strasbourg, France
| | - S Molière
- Unité d'imagerie de la femme, hôpital de Hautepierre, hôpitaux universitaires de Strasbourg, CHRU, 1, avenue Molière, 67098 Strasbourg cedex 09, France
| | - C Mathelin
- Unité de sénologie, hôpital de Hautepierre, hôpitaux universitaires de Strasbourg, CHRU, 1, avenue Molière, 67098 Strasbourg cedex 09, France; IGBMC, institut de génétique et de biologie moléculaire et cellulaire, Biologie du Cancer, 1, rue Laurent-Fries, 67400 Illkirch-Graffenstaden, France.
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66
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Abstract
There is preclinical and recent epidemiological evidence that thyroid hormone supports breast cancer. These observations raise the issue of whether management of breast cancer in certain settings should include consideration of reducing the possible contribution of thyroid hormone to the advancement of the disease. In a preliminary experience, elimination of the clinical action of endogenous L-thyroxine (T4) in patients with advanced solid tumors, including breast cancer, has favorably affected the course of the cancer, particularly when coupled with administration of exogenous 3,5,3′-triiodo-L-thyronine (T3) (euthyroid hypothyroxinemia). We discuss in the current brief review the possible clinical settings in which to consider whether endogenous thyroid hormone—or exogenous thyroid hormone in the patient with hypothyroidism and coincident breast cancer—is significantly contributing to breast cancer outcome.
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67
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Lerro CC, Beane Freeman LE, DellaValle CT, Kibriya MG, Aschebrook-Kilfoy B, Jasmine F, Koutros S, Parks CG, Sandler DP, Alavanja MCR, Hofmann JN, Ward MH. Occupational pesticide exposure and subclinical hypothyroidism among male pesticide applicators. Occup Environ Med 2018; 75:79-89. [PMID: 28775130 PMCID: PMC5771820 DOI: 10.1136/oemed-2017-104431] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 06/13/2017] [Accepted: 06/22/2017] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Animal studies suggest that exposure to pesticides may alter thyroid function; however, few epidemiologic studies have examined this association. We evaluated the relationship between individual pesticides and thyroid function in 679 men enrolled in a substudy of the Agricultural Health Study, a cohort of licensed pesticide applicators. METHODS Self-reported lifetime pesticide use was obtained at cohort enrolment (1993-1997). Intensity-weighted lifetime days were computed for 33 pesticides, which adjusts cumulative days of pesticide use for factors that modify exposure (eg, use of personal protective equipment). Thyroid-stimulating hormone (TSH), thyroxine (T4), triiodothyronine (T3) and antithyroid peroxidase (anti-TPO) autoantibodies were measured in serum collected in 2010-2013. We used multivariate logistic regression to estimate ORs and 95% CIs for subclinical hypothyroidism (TSH >4.5 mIU/L) compared with normal TSH (0.4-<4.5 mIU/L) and for anti-TPO positivity. We also examined pesticide associations with TSH, T4 and T3 in multivariate linear regression models. RESULTS Higher exposure to the insecticide aldrin (third and fourth quartiles of intensity-weighted days vs no exposure) was positively associated with subclinical hypothyroidism (ORQ3=4.15, 95% CI 1.56 to 11.01, ORQ4=4.76, 95% CI 1.53 to 14.82, ptrend <0.01), higher TSH (ptrend=0.01) and lower T4 (ptrend=0.04). Higher exposure to the herbicide pendimethalin was associated with subclinical hypothyroidism (fourth quartile vs no exposure: ORQ4=2.78, 95% CI 1.30 to 5.95, ptrend=0.02), higher TSH (ptrend=0.04) and anti-TPO positivity (ptrend=0.01). The fumigant methyl bromide was inversely associated with TSH (ptrend=0.02) and positively associated with T4 (ptrend=0.01). CONCLUSIONS Our results suggest that long-term exposure to aldrin, pendimethalin and methyl bromide may alter thyroid function among male pesticide applicators.
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Affiliation(s)
- Catherine C Lerro
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, USA
| | - Laura E Beane Freeman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, USA
| | - Curt T DellaValle
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, USA
- Environmental Working Group, Washington, DC, USA
| | - Muhammad G Kibriya
- Department of Public Health Sciences, The University of Chicago, Chicago, Illinois, USA
| | | | - Farzana Jasmine
- Department of Public Health Sciences, The University of Chicago, Chicago, Illinois, USA
| | - Stella Koutros
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, USA
| | - Christine G Parks
- National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina, USA
| | - Dale P Sandler
- National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina, USA
| | - Michael C R Alavanja
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, USA
- Department of Biology, Hood College, Frederick, Maryland, USA
| | - Jonathan N Hofmann
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, USA
| | - Mary H Ward
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, USA
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68
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Brandt J, Borgquist S, Almgren P, Försti A, Huss L, Melander O, Manjer J. Thyroid-associated genetic polymorphisms in relation to breast cancer risk in the Malmö Diet and Cancer Study. Int J Cancer 2017; 142:1309-1321. [PMID: 29134650 DOI: 10.1002/ijc.31156] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 10/13/2017] [Accepted: 10/26/2017] [Indexed: 02/06/2023]
Abstract
Previous studies have suggested that thyroid function is associated with breast cancer risk, which could have an important clinical impact, as one in eight women will develop a thyroid disorder during her lifetime. However, the underlying pathomechanism behind the association is still unknown. We used the Malmö Diet and Cancer Study (a population-based prospective study consisting of 17,035 women) to examine 17 single nucleotide polymorphisms (SNPs) previously related to levels of free thyroxine (free T4) and thyroid peroxidase antibodies (TPO-Ab) as potential genetic risk factors for breast cancer. A baseline examination including free T4 and TPO-Ab levels was conducted at the time of inclusion. Genotyping was performed on 901 breast cancer patients and 3335 controls. Odds ratios (95% confidence intervals) for high free T4, TPO-Ab positivity, and breast cancer were calculated by logistic regression and adjusted for confounders. We identified one free T4-related SNP (rs2235544, D101 gene) that was significantly associated with both free T4 level and breast cancer risk. There was a suggested association between rs11675434 (TPO gene) and TPO-Ab level, and TPO-Ab-related rs11675434 (TPO), rs3094228 (HCP5), rs1033662 (no registered gene), and rs301806 (RERE) were associated with breast cancer risk. There was an indicated interaction between rs6485050 (no registered gene) and free T4 level in regards to breast cancer risk. This is the first study to suggest an association between thyroid-related SNPs and breast cancer risk. All SNPs have a biological plausibility of being associated with breast cancer risk, and may contribute to the genetic predisposition to breast cancer.
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Affiliation(s)
- Jasmine Brandt
- Department of Surgery, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Signe Borgquist
- Division of Oncology and Pathology, Department of Clinical Sciences, Lund University, Lund, Sweden.,Clinical Trial Unit, Skåne University Hospital, Lund, Sweden
| | - Peter Almgren
- Department of Clinical Sciences, Skåne University Hospital Malmö Clinical Research Center, Lund University, Malmo, Sweden
| | - Asta Försti
- Division of Molecular Genetic Epidemiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 580, Heidelberg, D-69120, Germany.,Center for Primary Health Care Research, Lund University, Malmö, 205 02, Sweden
| | - Linnea Huss
- Department of Surgery, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Olle Melander
- Department of Clinical Sciences, Skåne University Hospital Malmö Clinical Research Center, Lund University, Malmo, Sweden
| | - Jonas Manjer
- Department of Surgery, Lund University, Skåne University Hospital, Malmö, Sweden
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69
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Hoffman K, Lorenzo A, Butt CM, Hammel SC, Henderson BB, Roman SA, Scheri RP, Stapleton HM, Sosa JA. Exposure to flame retardant chemicals and occurrence and severity of papillary thyroid cancer: A case-control study. ENVIRONMENT INTERNATIONAL 2017; 107:235-242. [PMID: 28772138 DOI: 10.1016/j.envint.2017.06.021] [Citation(s) in RCA: 102] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 06/01/2017] [Accepted: 06/28/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Thyroid cancer is the fastest increasing cancer in the U.S., and papillary thyroid cancer (PTC) accounts for >80% of incident cases. Increasing exposure to flame retardant chemicals (FRs) has raised concerns about their possible role in this 'epidemic'. The current study was designed to test the hypothesis that higher exposure to FRs is associated with increased odds of PTC. METHODS PTC patients at the Duke Cancer Institute were approached and invited to participate. Age- and gender-matched controls were recruited from the Duke Health System and surrounding communities. Because suitable biomarkers of long-term exposure do not exist for many common FRs, and levels of FRs in dust are significantly correlated with exposure, relationships between FRs in household dust and PTC were evaluated in addition to available biomarkers. PTC status, measures of aggressiveness (e.g. tumor size) and BRAF V600E mutation were included as outcomes. RESULTS Higher levels of some FRs, particularly decabromodiphenyl ether (BDE-209) and tris(2-chloroethyl) phosphate in dust, were associated with increased odds of PTC. Participants with dust BDE-209 concentrations above the median level were 2.29 times as likely to have PTC [95% confidence interval: 1.03, 5.08] compared to those with low BDE-209 concentrations. Associations varied based on tumor aggressiveness and mutation status; TCEP was more strongly associated with larger, more aggressive tumors and BDE-209 was associated with smaller, less aggressive tumors. CONCLUSIONS Taken together, these results suggest exposure to FRs in the home, particularly BDE-209 and TCEP, may be associated with PTC occurrence and severity, and warrant further study.
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Affiliation(s)
- Kate Hoffman
- Nicholas School of the Environment, Duke University, Durham, NC 27708, United States
| | - Amelia Lorenzo
- Nicholas School of the Environment, Duke University, Durham, NC 27708, United States
| | - Craig M Butt
- Nicholas School of the Environment, Duke University, Durham, NC 27708, United States
| | - Stephanie C Hammel
- Nicholas School of the Environment, Duke University, Durham, NC 27708, United States
| | - Brittany Bohinc Henderson
- Division of Endocrinology, Diabetes, and Metabolism, Department of Internal Medicine, Wake Forest University Baptist Medical Center and Wake Forest Comprehensive Cancer Center, Winston-Salem, NC 27157, United States
| | - Sanziana A Roman
- Department of Surgery, Duke University Medical Center, Durham, NC 27710, United States
| | - Randall P Scheri
- Department of Surgery, Duke University Medical Center, Durham, NC 27710, United States
| | - Heather M Stapleton
- Nicholas School of the Environment, Duke University, Durham, NC 27708, United States
| | - Julie Ann Sosa
- Department of Medicine, Duke University Medical Center, Durham, NC 27710, United States; Department of Surgery, Duke University Medical Center, Durham, NC 27710, United States; Duke Cancer Institute, Duke University Medical Center, Durham, NC 27710, United States; Duke Clinical Research Institute, Duke University Medical Center, Durham, NC 27710, United States.
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70
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Fang Y, Yao L, Sun J, Yang R, Chen Y, Tian J, Yang K, Tian L. Does thyroid dysfunction increase the risk of breast cancer? A systematic review and meta-analysis. J Endocrinol Invest 2017; 40:1035-1047. [PMID: 28516372 DOI: 10.1007/s40618-017-0679-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Accepted: 04/24/2017] [Indexed: 12/13/2022]
Abstract
PURPOSE To investigate the relationship between hypothyroidism, hyperthyroidism, thyroid hormone replacement, and the risk of breast cancer. METHODS We searched the PubMed, Cochrane Library, EMbase, Web of Science, and China Biology Medicine (CBM) databases through June 2016 to identify researches that assessed the relationship between thyroid dysfunction and the risk of breast cancer together with the impact of thyroid hormone substitution treatment on incidence of breast cancer. Quality of evidence was assessed per outcome, using GRADE. RESULTS A total of 13 population-based studies including 24,808 participants were identified as eligible for this meta-analysis. A meta-analysis of 12 researches illustrated that hypothyroidism was not related to the risk for breast cancer [odds ratio (OR) = 0.83, 95% confidence interval (CI) 0.64-1.08, P = 0.162]. 10 researches illustrated that hyperthyroidism was also not related to the risk of breast cancer (OR = 1.03, 95% CI 0.83-1.30, P = 0.767). The impact of therapy was evaluated in six researches; there was no proof of a relationship between thyroid hormone substitution treatment and breast cancer with an overall OR of 0.83 (95% CI 0.57-1.21, P = 0.965). CONCLUSIONS Our meta-analysis illustrated that thyroid dysfunction may not be related to increased risk of breast cancer as well as the thyroid hormone substitution treatment did not reduce the incidence of breast cancer; while this study has some confounders that might weaken the results of this meta-analysis, we believe that the findings provide valuable information for stakeholders concerned with outcomes in patients with thyroid dysfunction.
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Affiliation(s)
- Y Fang
- Department of Endocrinology, Gansu Provincial Hospital, Dong gang West Road, Lanzhou, 730000, Gansu, People's Republic of China
| | - L Yao
- Clinical Evidence Based Medicine Center, Gansu Provincial Hospital, Dong gang West Road, Lanzhou, 730000, Gansu, People's Republic of China
| | - J Sun
- Department of Endocrinology, Gansu Provincial Hospital, Dong gang West Road, Lanzhou, 730000, Gansu, People's Republic of China
| | - R Yang
- Department of Endocrinology, Gansu Provincial Hospital, Dong gang West Road, Lanzhou, 730000, Gansu, People's Republic of China
| | - Y Chen
- Evidence Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, 730000, People's Republic of China
| | - J Tian
- Evidence Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, 730000, People's Republic of China
| | - K Yang
- Evidence Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, 730000, People's Republic of China.
| | - L Tian
- Department of Endocrinology, Gansu Provincial Hospital, Dong gang West Road, Lanzhou, 730000, Gansu, People's Republic of China.
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Lodi M, Scheer L, Reix N, Heitz D, Carin AJ, Thiébaut N, Neuberger K, Tomasetto C, Mathelin C. Breast cancer in elderly women and altered clinico-pathological characteristics: a systematic review. Breast Cancer Res Treat 2017; 166:657-668. [PMID: 28803352 DOI: 10.1007/s10549-017-4448-5] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 08/07/2017] [Indexed: 01/09/2023]
Abstract
PURPOSE Breast cancer is the most common malignancy in women in terms of incidence and mortality. Age is undoubtedly the biggest breast cancer risk factor. In this study we examined clinical, histological, and biological characteristics and mortality of breast cancer in elderly women along with their changes with advancing age. METHODS We reviewed 63 original articles published between 2006 and 2016 concerning women over 70 years with breast cancer. RESULTS Compared to patients 70-79 years, patients aged 80 and over had larger tumor size with fewer T1 (42.9% vs 57.7%, p < 0.01) and more T2 lesions (43.5% vs 33.0%, p < 0.01). Lymph nodes and distant metastases were more frequent, with more N + (49.5% vs 44.0%, p < 0.01) and more M1 (8.0% vs 5.9%, p < 0.01). Infiltrating mucinous carcinomas were more frequent (4.3% vs 3.7%, p < 0.01). Tumors had lower grades, with more grade 1 (23.2% vs 19.8%, p = 0.01) and fewer grade 3 (21.5% vs 25.5%, p < 0.01), and were more hormone-sensitive: PR was more often expressed (72.6% vs 67.3%, p < 0.01). Lympho-vascular invasion was less frequent in the 80 years and over (22.9% vs 29.7%, p = 0.01). Breast cancer-specific mortality was higher both at 5 years (25.8% vs 17.2%, p < 0.01) and 10 years (32.7% vs 26.6%, p < 0.01). CONCLUSION Clinico-pathological characteristics, increased incidence, and mortality associated with aging can be explained on one hand by biological changes of the breast such as increased estrogen sensitivity, epithelial cell alterations, immune senescence, and tumor microenvironment modifications. However, sociologic factors such as increased life expectancy, under-treatment, late diagnosis, and insufficient individual screening, are also involved.
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Affiliation(s)
- M Lodi
- Senology Unit, Strasbourg University Hospital, Hôpital de Hautepierre 1, Avenue Molière, 67200, Strasbourg, France.
| | - L Scheer
- Senology Unit, Strasbourg University Hospital, Hôpital de Hautepierre 1, Avenue Molière, 67200, Strasbourg, France
| | - N Reix
- ICube, UMR 7357, Strasbourg University/CNRS, Fédération de Médecine Translationnelle de Strasbourg (FMTS), 300 Boulevard Sébastien Brant, 67400, Illkirch-Graffenstaden, France.,Biochemistry and Molecular Biology Laboratory, Strasbourg University Hospital, 1 Place de l'Hôpital, 67000, Strasbourg, France
| | - D Heitz
- Onco-geriatric Unit, Strasbourg University Hospital, 1 Avenue Molière, 67200, Strasbourg, France
| | - A-J Carin
- Gynecology Department, Haguenau General Hospital, 64 Avenue du Professeur Leriche, 67504, Haguenau, France
| | - N Thiébaut
- Quantmetry, 128 rue du Faubourg Saint-Honoré, 75008, Paris, France
| | - K Neuberger
- Quantmetry, 128 rue du Faubourg Saint-Honoré, 75008, Paris, France
| | - C Tomasetto
- Institue de Génétique et de Biologie Moléculaire et Cellulaire (IGBMC), CNRS, UMR7104 INSERM U964, 1 rue Laurent Fries, 67400, Illkirch-Graffenstaden, France
| | - C Mathelin
- Senology Unit, Strasbourg University Hospital, Hôpital de Hautepierre 1, Avenue Molière, 67200, Strasbourg, France.,Institue de Génétique et de Biologie Moléculaire et Cellulaire (IGBMC), CNRS, UMR7104 INSERM U964, 1 rue Laurent Fries, 67400, Illkirch-Graffenstaden, France.,Hôpital Saint Nicolas, Sarrebourg General Hospital, 25 Avenue du Général de Gaulle, 57400, Sarrebourg, France
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72
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Vulic R, Tyciakova S, Dubrovcakova M, Skultety L, Lakota J. Silencing of CA1 mRNA in tumour cells does not change the gene expression of the extracellular matrix proteins. J Cell Mol Med 2017; 22:695-699. [PMID: 28782909 PMCID: PMC5742735 DOI: 10.1111/jcmm.13315] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 06/15/2017] [Indexed: 11/29/2022] Open
Abstract
We report the silencing of CA1 mRNA in PC3 and MDA cells. The levels of mRNA coding CA1 protein in the knock-down mRNA (CA1 siRNA) cells have been measured by RT-PCR and were approximately 5% (PC3) and 20% (MDA-MB-231), respectively, of the level of control (Mock siRNA) used during silencing. In PC3 and MDA-MB-231 cells, the mRNAs for COL1A1 and COL4A4 were up-regulated. The mRNAs for CTHRC1, LAMC2, and WNT7B were not changed when compared to the control. The morphology of the cells during the treatments remained the same. On the Western blots, the lysate from the silenced cells showed lower levels of CA I as well.
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Affiliation(s)
| | | | | | | | - Jan Lakota
- Cancer Research Institute BMC SAS, Bratislava, Slovakia.,St. Elizabeth Cancer Institute, Bratislava, Slovakia.,Institute of Normal and Pathological Physiology, SAS, Bratislava, Slovakia
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73
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Journy NM, Bernier MO, Doody MM, Alexander BH, Linet MS, Kitahara CM. Hyperthyroidism, Hypothyroidism, and Cause-Specific Mortality in a Large Cohort of Women. Thyroid 2017; 27:1001-1010. [PMID: 28578598 PMCID: PMC5564026 DOI: 10.1089/thy.2017.0063] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND The prevalence of hyperthyroidism and hypothyroidism is 0.5-4% in iodine-replete communities, but it is 5-10 times higher in women than in men. Those conditions are associated with a broad range of metabolic disorders and cardiovascular diseases. Biological evidence of a role of thyroid hormones in carcinogenesis also exists. However, the association between thyroid dysfunction and cardiovascular disease or cancer mortality risk remains controversial. In a large cohort of women, the associations of hyperthyroidism and hypothyroidism with cause-specific mortality were evaluated after nearly 30 years of follow-up. METHODS The prospective study included 75,076 women aged 20-89 years who were certified as radiologic technologists in the United States in 1926-1982, completed baseline questionnaires in 1983-1998 from which medical history was ascertained, and reported no malignant disease or benign thyroid disease except thyroid dysfunction. A passive follow-up of this cohort was performed through the Social Security Administration database and the National Death Index-Plus. Cause-specific mortality risks were compared according to self-reported thyroid status, with proportional hazards models adjusted for baseline year and age, race/ethnicity, body mass index, family history of breast cancer, and life-style and reproductive factors. RESULTS During a median follow-up of 28 years, 2609 cancer, 1789 cardiovascular or cerebrovascular, and 2442 other non-cancer deaths were recorded. Women with hyperthyroidism had an elevated risk of breast cancer mortality after 60 years of age (hazard ratio [HR] = 2.04 [confidence interval (CI) 1.16-3.60], 13 cases in hyperthyroid women) compared to women without thyroid disease. Hypothyroid women had increased mortality risks for diabetes mellitus (HR = 1.58 [CI 1.03-2.41], 27 cases in hypothyroid women), cardiovascular disease (HR = 1.20 [CI 1.01-1.42], 179 cases), and cerebrovascular disease (HR = 1.45 [CI 1.01-2.08], 35 cases, when restricting the follow-up to ≥10 years after baseline). Other causes of death were not associated with hyperthyroidism or hypothyroidism, though there was a suggestion of an elevated risk of ovarian cancer mortality in hyperthyroid women based on very few cases. CONCLUSION The excess mortality risks observed in a large, prospective 30-year follow-up of patients with thyroid dysfunction require confirmation, and, if replicated, further investigation will be needed because of the clinical implications.
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Affiliation(s)
- Neige M.Y. Journy
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Marie-Odile Bernier
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
- Laboratoire d'épidémiologie des rayonnements ionisants, Service de Radiobiologie et d'Epidémiologie, Institut de Radioprotection et de Sûreté Nucléaire, Fontenay-aux-Roses, France
| | - Michele M. Doody
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Bruce H. Alexander
- Division of Environmental Health Sciences, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - Martha S. Linet
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Cari M. Kitahara
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
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Muller I, Kilburn LS, Taylor PN, Barrett-Lee PJ, Bliss JM, Ellis P, Ludgate ME, Dayan CM. TPOAb and Thyroid Function Are Not Associated with Breast Cancer Outcome: Evidence from a Large-Scale Study Using Data from the Taxotere as Adjuvant Chemotherapy Trial (TACT, CRUK01/001). Eur Thyroid J 2017; 6:197-207. [PMID: 28868260 PMCID: PMC5567117 DOI: 10.1159/000460246] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Revised: 02/07/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Small-scale studies correlated the presence of thyroid autoimmunity with both improved or worsened breast cancer outcome. OBJECTIVES We aimed to clarify this association in a large cohort using the phase III, randomized, controlled Taxotere as Adjuvant Chemotherapy Trial (TACT, CRUK01/001). METHODS TACT women >18 years old with node-positive or high-risk node-negative early breast cancer (pT1-3a, pN0-1, M0), with stored plasma (n = 1,974), taken 15.5 (median; IQR 7.0-24.0) months after breast surgery were studied. Patients had also received chemotherapy (100%), radiotherapy (1,745/1,974; 88.4%), hormonal therapy (1,378/ 1,974; 69.8%), or trastuzumab (48/1,974; 2.4%). History of thyroid diseases and/or related treatments was not available. The prognostic significance of autoantibodies to thyroid peroxidase (TPOAb; positive ≥6 kIU/L), free-thyroxine and thyrotropin (combined: euthyroid, hypothyroid, hyperthyroid) was evaluated for disease-free survival (DFS), overall-survival (OS), and time-to-recurrence (TTR), with Cox regression models in univariate and multivariable analyses. The extended median follow-up was 97.5 months. RESULTS No difference in DFS was found by TPOAb status (unadjusted hazard ratio [HR]: 0.97, 95%CI: 0.78-1.19; p = 0.75) and/or thyroid function (unadjusted HR [hypothyroid vs. euthyroid]: 1.15, 95% CI: 0.79-1.68; p = 0.46; unadjusted HR [hyperthyroid vs. euthyroid]: 1.14, 95% CI: 0.82-1.61; p = 0.44). Similar results were obtained for OS, TTR, multivariable analyses, when TPOAb titre by tertiles was considered, and in a subgroup of 123 patients with plasma collected before adjuvant treatments. CONCLUSIONS No evidence for a prognostic role of TPOAb and/or thyroid function in moderate-to-high-risk early breast cancer was found in the largest and longest observational study to date.
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Affiliation(s)
- Ilaria Muller
- Thyroid Research Group, School of Medicine, Cardiff University, Cardiff, UK
| | - Lucy S. Kilburn
- Institute of Cancer Research – Clinical Trials & Statistics Unit (ICR-CTSU), London, UK
| | - Peter N. Taylor
- Thyroid Research Group, School of Medicine, Cardiff University, Cardiff, UK
| | | | - Judith M. Bliss
- Institute of Cancer Research – Clinical Trials & Statistics Unit (ICR-CTSU), London, UK
| | - Paul Ellis
- Guy's Hospital and King's College, London, UK
| | - Marian E. Ludgate
- Thyroid Research Group, School of Medicine, Cardiff University, Cardiff, UK
| | - Colin M. Dayan
- Thyroid Research Group, School of Medicine, Cardiff University, Cardiff, UK
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Godlewska M, Arczewska KD, Rudzińska M, Łyczkowska A, Krasuska W, Hanusek K, Ruf J, Kiedrowski M, Czarnocka B. Thyroid peroxidase (TPO) expressed in thyroid and breast tissues shows similar antigenic properties. PLoS One 2017; 12:e0179066. [PMID: 28575127 PMCID: PMC5456382 DOI: 10.1371/journal.pone.0179066] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Accepted: 05/23/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Thyroid peroxidase (TPO) is essential for physiological function of the thyroid gland. The high prevalence of thyroid peroxidase antibodies (TPOAbs) in patients with breast cancer and their protective role had previously been demonstrated, indicating a link between breast cancer and thyroid autoimmunity. Recently, TPO was shown to be present in breast cancer tissue samples but its antigenicity has not been analyzed. METHODS In this study, we investigated TPO expression levels in a series of fifty-six breast cancer samples paired with normal (peri-tumoral) tissue and its antigenic activity using a panel of well-characterized murine anti-human TPOAbs. RESULTS We have shown that TPO transcripts were present in both normal and cancer tissue samples, although the amounts in the latter were reduced. Additionally, we observed that TPO levels are lower in more advanced cancers. TPO protein expression was confirmed in all tissue samples, both normal and cancerous. We also found that the antigenicity of the immunodominant regions (IDRs) in breast TPO resembles that of thyroid TPO, which is crucial for effective interactions with human TPOAbs. CONCLUSIONS Expression of TPO in breast cancer together with its antigenic activity may have beneficial effects in TPOAb-positive breast cancer patients. However, further studies are needed to confirm the beneficial role of TPOAbs and to better understand the underlying mechanism.
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Affiliation(s)
- Marlena Godlewska
- Department of Biochemistry and Molecular Biology, Center of Postgraduate Medical Education, Warsaw, Poland
| | - Katarzyna D. Arczewska
- Department of Biochemistry and Molecular Biology, Center of Postgraduate Medical Education, Warsaw, Poland
| | - Magdalena Rudzińska
- Department of Biochemistry and Molecular Biology, Center of Postgraduate Medical Education, Warsaw, Poland
| | - Anna Łyczkowska
- Department of Biochemistry and Molecular Biology, Center of Postgraduate Medical Education, Warsaw, Poland
| | - Wanda Krasuska
- Department of Biochemistry and Molecular Biology, Center of Postgraduate Medical Education, Warsaw, Poland
| | - Karolina Hanusek
- Department of Biochemistry and Molecular Biology, Center of Postgraduate Medical Education, Warsaw, Poland
| | - Jean Ruf
- UMR-MD2, Aix-Marseille University, Marseille Medical School, Marseille, France
| | - Mirosław Kiedrowski
- Clinical Department of Oncology and Hematology, Central Clinical Hospital of the Ministry of Interior in Warsaw, Warsaw, Poland
| | - Barbara Czarnocka
- Department of Biochemistry and Molecular Biology, Center of Postgraduate Medical Education, Warsaw, Poland
- * E-mail:
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76
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Thyroid disorders and mammographic density in Spanish women: Var-DDM study. Breast 2017; 34:12-17. [PMID: 28456099 DOI: 10.1016/j.breast.2017.04.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 04/17/2017] [Accepted: 04/21/2017] [Indexed: 01/24/2023] Open
Abstract
OBJECTIVES The association between breast cancer (BC) and thyroid disorders has been widely explored with unclear results. Mammographic density (MD) is one of the strongest risk factor for BC. This study explores the relationship between thyroid diseases and MD in Spanish women. MATERIALS & METHODS This cross-sectional study covered 2883 women aged 47-71 years participating in 7 BC screening programs in 2010. They allowed access to their mammograms, had anthropometrical-measures taken, and answered a telephonic epidemiological interview which included specific questions on thyroid diseases. Percentage of MD was assessed with a semiautomatic-computer tool (DM-scan) by two trained radiologists. We calculated the geometric mean of MD percentages (mean MD). Multivariable mixed linear regression models with random screening-center-specific intercepts were fitted, using log-transformed percentage of MD as dependent variable and adjusting for age, body mass index, menopausal status and other confounders. eβ represents the relative increase of mean MD. RESULTS 13.9% of the participants reported personal history of thyroid disease. MD was not associated to hyperthyroidism (eβ:1.05, 95%CI: 0.82-1.36), hypothyroidism (eβ:1.02, 95%CI: 0.75-1.38), thyroid nodules (eβ:1.01, 95%CI: 0.85-1.19) or thyroid cancer (eβ:1.03, 95%CI: 0.56-1.92). However, women with goiter had lower MD (mean MDno-goiter: 13.4% vs mean MDgoiter: 10.6%; eβ:0.79, 95%CI: 0.64-0.98) and those with Hashimoto thyroiditis had higher MD (mean MDno-thyroiditis: 13.3% vs mean MDthyroidits: 25.8%; eβ:1.94, 95%CI: 1.00-3.77). CONCLUSION Functional thyroid disorders were not related to MD. However, MD was lower in women with goiter and higher in those reporting Hashimoto's thyroiditis. These relationships should be confirmed in future studies.
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77
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Increased trace amine-associated receptor 1 (TAAR1) expression is associated with a positive survival rate in patients with breast cancer. J Cancer Res Clin Oncol 2017; 143:1637-1647. [PMID: 28409272 DOI: 10.1007/s00432-017-2420-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 04/07/2017] [Indexed: 12/14/2022]
Abstract
PURPOSE A correlation between breast cancer and thyroid disorders has been described in previous studies. Degraded thyroid hormones are referred to as trace amines. These endogenous amines have the ability to bind to the G-protein-coupled receptor TAAR1 (trace amine-associated receptor) and thereby activate it. TAAR1 is able to modulate the serotonergic and dopaminergic system in the brain and has so far been studied in the neurological field. The following study represents the first investigation of the regulation of TAAR1 in primary breast cancer (no metastases, M0). METHODS Immunohistochemical analyses were carried out to detect TAAR1 expression in formalin fixed paraffin embedded breast cancer samples. Survival times of primary breast cancer patients (M0) with and without TAAR1 expression in their tumours were compared by Kaplan-Meier curves, and correlations between ordinal variables were determined with Spearman's rank correlation coefficient. RESULTS The investigation showed a correlation between TAAR1 expression and tumour differentiation grade. A well differentiated tumour grade (G1) was associated with higher TAAR1 expression and HER2 and HER4 positivity predicted higher TAAR1 expression. A TAAR1 overexpression (IRS ≥ 6) was associated with significantly longer overall survival (OS) (p = 0.02) than that of reduced TAAR1 expression (IRS < 6) during a maximum follow-up of 14 years, demonstrating that TAAR1 has a favourable effect on OS of early breast cancer patients. CONCLUSIONS We conclude that TAAR1 seems to be an independent predictor for breast cancer survival. Modulation of TAAR1 may represent a novel targeting strategy for breast cancer prevention and therapy.
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78
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López Fontana CM, Zyla LE, Santiano FE, Sasso CV, Cuello-Carrión FD, Pistone Creydt V, Fanelli MA, Carón RW. Hypothyroidism reduces mammary tumor progression via Β-catenin-activated intrinsic apoptotic pathway in rats. Histochem Cell Biol 2017; 147:759-769. [PMID: 28191619 DOI: 10.1007/s00418-017-1544-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2017] [Indexed: 01/26/2023]
Abstract
Experimental hypothyroidism retards mammary carcinogenesis promoting apoptosis of tumor cells. β-catenin plays a critical role in cell adhesion and intracellular signaling pathways conditioning the prognosis of breast cancer. However, the mechanistic connections associated with the expression of β-catenin in thyroid status and breast cancer are not known. Therefore, we studied the relationship between the expression and localization of β-catenin and apoptosis in mammary tumors induced by 7,12-dimethylbenz(a)anthracene (DMBA) in hypothyroid (Hypot) and euthyroid (EUT) rats. Female Sprague Dawley rats were treated with a dose of DMBA (15 mg/rat) at 55 days of age and were then divided into two groups: HypoT (0.01% 6-N-propyl-2-thiouracil in drinking water, n = 54) and EUT (untreated control, n = 43). Latency, incidence and progression of tumors were determined. At sacrifice, tumors were obtained for immunohistological studies and Western Blot. The latency was longer (p < 0.05), the incidence was lower (p < 0.0001) and tumor growth was slower (p < 0.01) in HypoT rats compared to EUT. The expression of Bax, cleaved caspase-9 and caspase-3 was significantly higher in tumors of HypoT than in EUT (p < 0.05) indicating the activation of the intrinsic pathway. In this group, β-catenin was expressed in the plasma membrane and with less intensity, while its expression was nuclear and with greater intensity in the EUT (p < 0.05). Moreover, the expression of survivin was reduced in tumors of HypoT rats (p < 0.05). In conclusion, decreased expression of β-catenin and its normal location in membrane of mammary tumors are associated with augmented apoptosis via activation of the intrinsic pathway in HypoT rats.
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Affiliation(s)
- C M López Fontana
- Instituto de Medicina y Biología Experimental de Cuyo (IMBECU), CCT-Mendoza CONICET, Av. Adrián Ruiz-Leal s/n, CC855, Mendoza, Argentina.
| | - L E Zyla
- Instituto de Medicina y Biología Experimental de Cuyo (IMBECU), CCT-Mendoza CONICET, Av. Adrián Ruiz-Leal s/n, CC855, Mendoza, Argentina
| | - F E Santiano
- Instituto de Medicina y Biología Experimental de Cuyo (IMBECU), CCT-Mendoza CONICET, Av. Adrián Ruiz-Leal s/n, CC855, Mendoza, Argentina
| | - C V Sasso
- Instituto de Medicina y Biología Experimental de Cuyo (IMBECU), CCT-Mendoza CONICET, Av. Adrián Ruiz-Leal s/n, CC855, Mendoza, Argentina
| | - F D Cuello-Carrión
- Instituto de Medicina y Biología Experimental de Cuyo (IMBECU), CCT-Mendoza CONICET, Av. Adrián Ruiz-Leal s/n, CC855, Mendoza, Argentina
| | - V Pistone Creydt
- Instituto de Medicina y Biología Experimental de Cuyo (IMBECU), CCT-Mendoza CONICET, Av. Adrián Ruiz-Leal s/n, CC855, Mendoza, Argentina
| | - M A Fanelli
- Instituto de Medicina y Biología Experimental de Cuyo (IMBECU), CCT-Mendoza CONICET, Av. Adrián Ruiz-Leal s/n, CC855, Mendoza, Argentina
| | - R W Carón
- Instituto de Medicina y Biología Experimental de Cuyo (IMBECU), CCT-Mendoza CONICET, Av. Adrián Ruiz-Leal s/n, CC855, Mendoza, Argentina
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Hercbergs A, Davis PJ, Lin HY, Mousa SA. Possible contributions of thyroid hormone replacement to specific behaviors of cancer. Biomed Pharmacother 2016; 84:655-659. [DOI: 10.1016/j.biopha.2016.09.053] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 09/14/2016] [Accepted: 09/15/2016] [Indexed: 12/30/2022] Open
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Khan SR, Chaker L, Ruiter R, Aerts JGJV, Hofman A, Dehghan A, Franco OH, Stricker BHC, Peeters RP. Thyroid Function and Cancer Risk: The Rotterdam Study. J Clin Endocrinol Metab 2016; 101:5030-5036. [PMID: 27648963 DOI: 10.1210/jc.2016-2104] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT In vitro and in vivo experiments have assigned both oncosuppressive and oncogenic properties to thyroid hormones. Population-based studies have found inconclusive results. OBJECTIVE We aimed to prospectively assess the relation between thyroid function and incident cancer in a population-based setting. DESIGN, SETTING, AND PARTICIPANTS The current study is a prospective population-based cohort study including 10 318 participants for whom baseline measurements of free T4 (FT4) and/or TSH were available. MAIN OUTCOME MEASURES Cox proportional hazards models were used to assess hazard ratios (HRs) of any solid non-skin cancer, as well as lung, breast, prostate, and gastrointestinal cancer specifically. RESULTS Higher FT4 levels were associated with a higher risk of any solid cancer (HR, 1.42; 95% confidence interval [CI], 1.12-1.79), lung cancer (HR, 2.33; 95% CI, 1.39-3.92) and breast (HR, 1.77; 95% CI, 1.10-2.84) cancer. The risk estimates were similar after exclusion of thyroid-altering medication, but the association lost significance for breast cancer. Compared with the lowest FT4 tertile, the highest tertile was associated with a 1.13-fold increased risk of any solid, 1.79-fold increased risk of lung, and 1.14-fold increased risk of breast cancer (P for trend <.05 for all). For TSH levels we found no associations with cancer risk. There was no differential effect of sex or age on the association between thyroid function and cancer risk. CONCLUSIONS Higher FT4 levels are significantly associated with an increased risk of any solid, lung, and breast cancer. Further research should elucidate the underlying pathophysiological mechanisms.
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Affiliation(s)
- Samer R Khan
- Rotterdam Thyroid Center (S.R.K., L.C., R.P.P.), Department of Epidemiology (S.R.K., L.C., R.R., A.H., A.D., O.H.F., B.H.C.S., R.P.P.), Department of Internal Medicine (L.C., R.P.P.), and Department of Pulmonology (J.G.J.V.A.), Erasmus University Medical Center, 3015 GE, Rotterdam, The Netherlands; and Department of Epidemiology (A.H.), Harvard T.H. Chan School of Public Health, Boston, Massachusetts 02115
| | - Layal Chaker
- Rotterdam Thyroid Center (S.R.K., L.C., R.P.P.), Department of Epidemiology (S.R.K., L.C., R.R., A.H., A.D., O.H.F., B.H.C.S., R.P.P.), Department of Internal Medicine (L.C., R.P.P.), and Department of Pulmonology (J.G.J.V.A.), Erasmus University Medical Center, 3015 GE, Rotterdam, The Netherlands; and Department of Epidemiology (A.H.), Harvard T.H. Chan School of Public Health, Boston, Massachusetts 02115
| | - Rikje Ruiter
- Rotterdam Thyroid Center (S.R.K., L.C., R.P.P.), Department of Epidemiology (S.R.K., L.C., R.R., A.H., A.D., O.H.F., B.H.C.S., R.P.P.), Department of Internal Medicine (L.C., R.P.P.), and Department of Pulmonology (J.G.J.V.A.), Erasmus University Medical Center, 3015 GE, Rotterdam, The Netherlands; and Department of Epidemiology (A.H.), Harvard T.H. Chan School of Public Health, Boston, Massachusetts 02115
| | - Joachim G J V Aerts
- Rotterdam Thyroid Center (S.R.K., L.C., R.P.P.), Department of Epidemiology (S.R.K., L.C., R.R., A.H., A.D., O.H.F., B.H.C.S., R.P.P.), Department of Internal Medicine (L.C., R.P.P.), and Department of Pulmonology (J.G.J.V.A.), Erasmus University Medical Center, 3015 GE, Rotterdam, The Netherlands; and Department of Epidemiology (A.H.), Harvard T.H. Chan School of Public Health, Boston, Massachusetts 02115
| | - Albert Hofman
- Rotterdam Thyroid Center (S.R.K., L.C., R.P.P.), Department of Epidemiology (S.R.K., L.C., R.R., A.H., A.D., O.H.F., B.H.C.S., R.P.P.), Department of Internal Medicine (L.C., R.P.P.), and Department of Pulmonology (J.G.J.V.A.), Erasmus University Medical Center, 3015 GE, Rotterdam, The Netherlands; and Department of Epidemiology (A.H.), Harvard T.H. Chan School of Public Health, Boston, Massachusetts 02115
| | - Abbas Dehghan
- Rotterdam Thyroid Center (S.R.K., L.C., R.P.P.), Department of Epidemiology (S.R.K., L.C., R.R., A.H., A.D., O.H.F., B.H.C.S., R.P.P.), Department of Internal Medicine (L.C., R.P.P.), and Department of Pulmonology (J.G.J.V.A.), Erasmus University Medical Center, 3015 GE, Rotterdam, The Netherlands; and Department of Epidemiology (A.H.), Harvard T.H. Chan School of Public Health, Boston, Massachusetts 02115
| | - Oscar H Franco
- Rotterdam Thyroid Center (S.R.K., L.C., R.P.P.), Department of Epidemiology (S.R.K., L.C., R.R., A.H., A.D., O.H.F., B.H.C.S., R.P.P.), Department of Internal Medicine (L.C., R.P.P.), and Department of Pulmonology (J.G.J.V.A.), Erasmus University Medical Center, 3015 GE, Rotterdam, The Netherlands; and Department of Epidemiology (A.H.), Harvard T.H. Chan School of Public Health, Boston, Massachusetts 02115
| | - Bruno H C Stricker
- Rotterdam Thyroid Center (S.R.K., L.C., R.P.P.), Department of Epidemiology (S.R.K., L.C., R.R., A.H., A.D., O.H.F., B.H.C.S., R.P.P.), Department of Internal Medicine (L.C., R.P.P.), and Department of Pulmonology (J.G.J.V.A.), Erasmus University Medical Center, 3015 GE, Rotterdam, The Netherlands; and Department of Epidemiology (A.H.), Harvard T.H. Chan School of Public Health, Boston, Massachusetts 02115
| | - Robin P Peeters
- Rotterdam Thyroid Center (S.R.K., L.C., R.P.P.), Department of Epidemiology (S.R.K., L.C., R.R., A.H., A.D., O.H.F., B.H.C.S., R.P.P.), Department of Internal Medicine (L.C., R.P.P.), and Department of Pulmonology (J.G.J.V.A.), Erasmus University Medical Center, 3015 GE, Rotterdam, The Netherlands; and Department of Epidemiology (A.H.), Harvard T.H. Chan School of Public Health, Boston, Massachusetts 02115
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Caria P, Cantara S, Frau DV, Pacini F, Vanni R, Dettori T. Genetic Heterogeneity of HER2 Amplification and Telomere Shortening in Papillary Thyroid Carcinoma. Int J Mol Sci 2016; 17:E1759. [PMID: 27775641 PMCID: PMC5085783 DOI: 10.3390/ijms17101759] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 09/20/2016] [Accepted: 10/12/2016] [Indexed: 02/05/2023] Open
Abstract
Extensive research is dedicated to understanding if sporadic and familial papillary thyroid carcinoma are distinct biological entities. We have previously demonstrated that familial papillary thyroid cancer (fPTC) cells exhibit short relative telomere length (RTL) in both blood and tissues and that these features may be associated with chromosome instability. Here, we investigated the frequency of HER2 (Human Epidermal Growth Factor Receptor 2) amplification, and other recently reported genetic alterations in sporadic PTC (sPTC) and fPTC, and assessed correlations with RTL and BRAF mutational status. We analyzed HER2 gene amplification and the integrity of ALK, ETV6, RET, and BRAF genes by fluorescence in situ hybridization in isolated nuclei and paraffin-embedded formalin-fixed sections of 13 fPTC and 18 sPTC patients. We analyzed BRAFV600E mutation and RTL by qRT-PCR. Significant HER2 amplification (p = 0.0076), which was restricted to scattered groups of cells, was found in fPTC samples. HER2 amplification in fPTCs was invariably associated with BRAFV600E mutation. RTL was shorter in fPTCs than sPTCs (p < 0.001). No rearrangements of other tested genes were observed. These findings suggest that the association of HER2 amplification with BRAFV600E mutation and telomere shortening may represent a marker of tumor aggressiveness, and, in refractory thyroid cancer, may warrant exploration as a site for targeted therapy.
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Affiliation(s)
- Paola Caria
- Department of Biomedical Sciences, University of Cagliari, Cittadella Universitaria, Monserrato 09042, Italy.
| | - Silvia Cantara
- Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena 53100, Italy.
| | - Daniela Virginia Frau
- Department of Biomedical Sciences, University of Cagliari, Cittadella Universitaria, Monserrato 09042, Italy.
| | - Furio Pacini
- Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena 53100, Italy.
| | - Roberta Vanni
- Department of Biomedical Sciences, University of Cagliari, Cittadella Universitaria, Monserrato 09042, Italy.
| | - Tinuccia Dettori
- Department of Biomedical Sciences, University of Cagliari, Cittadella Universitaria, Monserrato 09042, Italy.
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Abstract
PURPOSE OF REVIEW The female predominance of diseases of the thyroid and breast makes difficult the separation of an expected association with a causal linkage. This review will examine recent reports on associations between thyroid disease and breast cancer, comparing them with previous studies, with a view to elucidating what pointers are available to suggest either a common pathogenesis or novel thyroid-related therapeutic approach, which might arise from this association. RECENT FINDINGS Reports on thyroid-breast cancer associations are reviewed under the following headings: breast cancer prevalence in different thyroid disorders and their effect on risk and outcome; the possible role of thyroid autoimmunity, thyroid enlargement, effect of radioactive iodine treatment, role of stable iodine, possible joint antigens sodium iodide transporter and thyroid peroxidase and thyroid-breast cancer coincidence. SUMMARY Current studies on thyroid and breast cancer associations confirm earlier findings of the lack of definitive evidence of a causal relationship. The predominant relationship continues to be hypothyroidism or autoimmune thyroid disease perhaps contributing to increased breast cancer risk or outcomes. However, despite many studies and the findings of meta-analyses, elucidating the mechanisms underlying the association remains elusive. At present, there is little justification for utilizing thyroid insights as a possible therapeutic intervention in breast cancer.
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Affiliation(s)
- Peter P A Smyth
- aUniversity College Dublin, Dublin bNational University of Ireland, Galway, Ireland
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83
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Chaker L, Visser TJ. Thyroid function: Thyroid dysfunction and breast cancer risk - an unfinished story. Nat Rev Endocrinol 2016; 12:313-4. [PMID: 27020258 DOI: 10.1038/nrendo.2016.48] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Layal Chaker
- Rotterdam Thyroid Center; the Department of Internal Medicine; and the Department of Epidemiology, Erasmus University Medical Center, PO Box 2040, 3000 CA, Rotterdam, Netherlands
| | - Theo J Visser
- Department of Internal Medicine, Erasmus University Medical Center, PO Box 2040, 3000 CA, Rotterdam, Netherlands
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84
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Goldvaser H, Rizel S, Hendler D, Neiman V, Shepshelovich D, Shochat T, Sulkes A, Brenner B, Yerushalmi R. The Association between Treatment for Metabolic Disorders and Breast Cancer Characteristics. Int J Endocrinol 2016; 2016:4658469. [PMID: 27648070 PMCID: PMC5018344 DOI: 10.1155/2016/4658469] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Revised: 07/16/2016] [Accepted: 08/09/2016] [Indexed: 12/12/2022] Open
Abstract
Purpose. To evaluate the associations between metformin, insulin, statins, and levothyroxine and breast cancer characteristics and outcome. Methods. Retrospective chart review of patients treated in our institute for early estrogen receptor (ER) positive, human epidermal growth factor receptor 2 negative breast cancer, whose tumors were sent to Oncotype DX (ODX) analysis. Patients were grouped according to medications usage during the time of breast cancer diagnosis. Each group was compared to the rest of the study population. Results. The study cohort included 671 patients. Sixty (9.1%) patients were treated with metformin, 9 (1.4%) with insulin, 208 (31.7%) with statins, and 62 (9.4%) with levothyroxine. Patients treated with metformin had more intense ER stain (p = 0.032) and a lower ODX recurrence score (RS) (p = 0.035). Diagnosis of diabetes mellitus was also associated with lower ODX RS (p = 0.014). Insulin usage was associated with a higher rate of angiolymphatic invasion (p = 0.041), but lower Ki67% (p = 0.017). Levothyroxine usage was associated with different histological subtype distribution (p = 0.02). Extended levothyroxine usage was associated with lower ODX RS (p = 0.005). Statin usage had no impact on tumor characteristics. Outcome was comparable in the studied subgroups. Conclusions. Common medications for metabolic disorders might be associated with breast cancer characteristics.
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Affiliation(s)
- Hadar Goldvaser
- Institute of Oncology, Davidoff Cancer Center, Beilinson Hospital, Rabin Medical Center, 39 Jabotinski St., Petah Tikva, Israel
- *Hadar Goldvaser:
| | - Shulamith Rizel
- Institute of Oncology, Davidoff Cancer Center, Beilinson Hospital, Rabin Medical Center, 39 Jabotinski St., Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, P.O. Box 39040, Tel Aviv, Israel
| | - Daniel Hendler
- Institute of Oncology, Davidoff Cancer Center, Beilinson Hospital, Rabin Medical Center, 39 Jabotinski St., Petah Tikva, Israel
| | - Victoria Neiman
- Institute of Oncology, Davidoff Cancer Center, Beilinson Hospital, Rabin Medical Center, 39 Jabotinski St., Petah Tikva, Israel
| | - Daniel Shepshelovich
- Sackler Faculty of Medicine, Tel Aviv University, P.O. Box 39040, Tel Aviv, Israel
- Department of Medicine A, Beilinson Hospital, Rabin Medical Center, 39 Jabotinski St., Petah Tikva, Israel
| | - Tzippy Shochat
- Statistical Consulting Unit, Beilinson Hospital, Rabin Medical Center, 39 Jabotinski St., Petah Tikva, Israel
| | - Aaron Sulkes
- Institute of Oncology, Davidoff Cancer Center, Beilinson Hospital, Rabin Medical Center, 39 Jabotinski St., Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, P.O. Box 39040, Tel Aviv, Israel
| | - Baruch Brenner
- Institute of Oncology, Davidoff Cancer Center, Beilinson Hospital, Rabin Medical Center, 39 Jabotinski St., Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, P.O. Box 39040, Tel Aviv, Israel
| | - Rinat Yerushalmi
- Institute of Oncology, Davidoff Cancer Center, Beilinson Hospital, Rabin Medical Center, 39 Jabotinski St., Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, P.O. Box 39040, Tel Aviv, Israel
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