Spatiotemporal Co-existence of Female Thyroid and Breast Cancers in Hangzhou, China

Thyroid Metastasis from Primary Breast Cancer

Breast cancer (BC), the most commonly diagnosed malignancy, frequently metastasizes to the bone, lungs, brain and liver at advanced stages, whereas the thyroid gland represents a rare target site for secondary disease. We examined the most recent literature about thyroid metastasis (TM) from BC after we encountered a peculiar case of a 71-year-old woman who developed sudden dysphagia, severe hypothyroidism and hypoparathyroidism due to TM 18 years after the diagnosis of her primary cancer. Based on published data, the prevalence of TM in BC ranges from 3% to 34%, with a median onset time of 48.2 months, although longer time intervals are not infrequent. TM negatively impacts the prognosis of these patients, however thyroid surgery can limit the local disease burden. Therefore, we suggest that clinicians involved in the follow-up care of BC patients should consider a differential diagnosis of secondary thyroid malignancy when incidental lesions are diagnosed during radiological evaluations or local symptoms affect the cervical region, even many years after the diagnosis of the primary cancer.

Assessing the causality between thyroid and breast neoplasms: A bidirectional Mendelian randomization study

Aim

This study aimed to evaluate the association between thyroid neoplasms (TN) and the risk of developing breast neoplasms (BN) by assessing data on single nucleotide polymorphisms (SNPs) obtained from the Deutsches Krebsforschungszentrum (DKFZ) and Breast Cancer Association (BCAC).

Methods

Data on SNPs associated with TN and BN were obtained from DKFZ and BCAC, respectively. Secondary data analysis of all pooled data from genome-wide association studies (GWAS) was performed to identify the genetic loci closely associated with TN or BN as instrumental variables (IVs). To evaluate the causal relationship between TN and BN, a bidirectional Mendelian randomization (MR) analysis was performed using MR Egger regression, weighted median, inverse variance weighted (IVW) random effects model, simple mode, weighted mode, maximum likelihood, penalized weighted median, IVW radial, IVW fixed effects, and robust adjusted profile scores (RAPS) method.

Results

The MR in this study demonstrated a modest reverse causal relationship between TN and BN but a significant positive causal relationship between BN and TN.

Conclusions

The MR of this study provided genetic evidence suggesting an association between BN and TN; however, further research is warranted to explore the potential mechanism of interaction between these two malignancies. Moreover, general breast screening should be performed in individuals with TN, but TN screening should be reinforced in individuals with BN.

The spatio-temporal distribution and risk factors of thyroid cancer during rapid urbanization-A case study in China

BACKGROUND

Incidences of thyroid cancer (TC) have been increasing worldwide in recent decades. In this research, we aimed to analyze the spatiotemporal pattern of TC and explore relevant environmental risk factors in Hangzhou (HZ), which is rapidly urbanizing and home to the highest TC incidence in China.

METHODS

Spatial scan statistic was employed to analyze the spatiotemporal pattern of TC in HZ from 2008 to 2012. The geographically weighted regression model (GWR) was implemented to explore environmental risk factors. Its performance was compared to the traditional ordinary least squares model (OLS).

RESULTS

A total of 7147 TC cases (5385 female and 1762 male) were diagnosed in HZ from 2008 to 2012. High TC clusters were detected in the northeast, urban areas and expanded outwards while low clusters were located in the southwest rural areas. The GWR model generally performed better than the OLS in analyzing the associations between TC incidence and environmental factors. The industrial density, chemical oxygen demand of wastewater (COD) and the percentage of building area had a strong positive influence on the TC in the northeastern suburb areas of HZ, while the elevation, slope and the percentage of forest area had a significant negative correlation with TC in the middle, rural areas of HZ. Meanwhile, the accessibility to health care might have an impact on the TC incidence.

CONCLUSION

High clusters were mostly located in the northeastern urban areas and showed an expansion process from the center urban area to the suburb area, especially for female TC. Intensive industrial activities and the emission of organic pollutants, which positively correlated with the high TC clusters in the northeast suburb areas of HZ, should get proper attention.

Contribution of industrial density and socioeconomic status to the spatial distribution of thyroid cancer risk in Hangzhou, China

BACKGROUND

The thyroid cancer (TC) incidence in China has increased dramatically during the last three decades. Typical in this respect is the case of Hangzhou city (China), where 7147 new TC cases were diagnosed during the period 2008-2012. Hence, the assessment of the TC incidence risk increase due to environmental exposure is an important public health matter.

METHODS

Correlation analysis, Analysis of Variance (ANOVA) and Poisson regression were first used to evaluate the statistical association between TC and key risk factors (industrial density and socioeconomic status). Then, the Bayesian maximum entropy (BME) theory and the integrative disease predictability (IDP) criterion were combined to quantitatively assess both the overall and the spatially distributed strength of the "exposure-disease" association.

RESULTS

Overall, higher socioeconomic status was positively correlated with higher TC risk (Pearson correlation coefficient=0.687, P<0.01). Compared to people of low socioeconomic status, people of median and high socioeconomic status showed higher TC risk: the Relative Risk (RR) and associated 95% confidence interval (CI) were found to be, respectively, RR=2.29 with 95% CI=1.99 to 2.63, and RR=3.67 with 95% CI=3.22 to 4.19. The "industrial density-TC incidence" correlation, however, was non-significant. Spatially, the "socioeconomic status-TC" association measured by the corresponding IDP coefficient was significant throughout the study area: the mean IDP value was -0.12 and the spatial IDP values were consistently negative at the township level. It was found that stronger associations were distributed among residents mainly on a stripe of land from northeast to southwest (consisting mainly of sub-district areas). The "industrial density-TC" association measured by its IDP coefficient was spatially non-consistent.

CONCLUSIONS

Socioeconomic status is an important indicator of TC risk factor in Hangzhou (China) whose effect varies across space. Hence, socioeconomic status shows the highest TC risk effect in sub-district areas.

Breast cancer metastases to the thyroid gland - an uncommon sentinel for diffuse metastatic disease: a case report and review of the literature

Background

Metastases to the thyroid are rare. The most common primary cancer to metastasize to the thyroid is renal cell carcinoma, followed by malignancies of the gastrointestinal tract, lungs, and skin, with breast cancer metastases to the thyroid being rare. Overall, the outcomes in malignancies that have metastasized to the thyroid are poor. There are no prospective studies addressing the role of surgery in metastatic disease of the thyroid. Isolated thyroidectomy has been proposed as a local disease control option to palliate and prevent the potential morbidity of tumor extension related to the airway. Here, we present a case of a patient with breast cancer metastases to the thyroid gland and discuss the role of thyroidectomy in the context of the current literature.

Case presentation

A 62-year-old Afro-Caribbean woman was diagnosed as having bilateral breast carcinoma in 2004, for which she underwent bilateral mastectomy. The pathology revealed multifocal disease on the right, T2N0(0/20)M0 grade 1 and 2 invasive ductal carcinoma, and on the left side, T3N1(2/18)M0 grade 1 invasive ductal carcinoma. Surgery was followed by adjuvant chemotherapy and regional radiotherapy. The disease was under control on hormonal therapy until 2016, when she developed cervical lymphadenopathy. The fine-needle aspiration cytology of the thyroid was reported as papillary thyroid cancer; and the fine-needle biopsy of the left lateral nodal disease was more suggestive of breast malignancy. She underwent a total thyroidectomy and a clearance of the central compartment lymph nodes and a biopsy of the lateral nodal disease. The histopathological analysis was consistent with metastatic breast cancer in the thyroid and lymph nodes with no evidence of a primary thyroid malignancy.

Conclusions

A past history of a malignancy elsewhere should raise the index of suspicion of metastatic disease in patients presenting with thyroid lumps with or without cervical lymphadenopathy. Detection of metastases to the thyroid generally indicates poor prognosis, obviating the need of surgery in an already compromised patient. An empirical thyroidectomy should be considered in select patients for local disease control.

Improving Spatiotemporal Breast Cancer Assessment and Prediction in Hangzhou City, China

Breast cancer (BC) is the main cause of death of female cancer patients in China. Mainstream mapping techniques, like spatiotemporal ordinary kriging (STOK), generate disease incidence maps that improve our understanding of disease distribution. Yet, the implementation of these techniques experiences substantive and technical complications (due mainly to the different characteristics of space and time). A new spatiotemporal projection (STP) technique that is free of the above complications was implemented to model the space-time distribution of BC incidence in Hangzhou city and to estimate incidence values at locations-times for which no BC data exist. For comparison, both the STP and the STOK techniques were used to generate BC incidence maps in Hangzhou. STP performed considerably better than STOK in terms of generating more accurate incidence maps showing a closer similarity to the observed incidence distribution, and providing an improved assessment of the space-time BC correlation structure. In sum, the inter-connections between space, time, BC incidence and spread velocity established by STP allow a more realistic representation of the actual incidence distribution, and generate incidence maps that are more accurate and more informative, at a lower computational cost and involving fewer approximations than the incidence maps produced by mainstream space-time techniques.