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Denic-Roberts H, McAdam J, Sjodin A, Davis M, Jones R, Ward MH, Hoang TD, Ma S, Zhang Y, Rusiecki JA. Endocrine disrupting chemical mixture exposure and risk of papillary thyroid cancer in U.S. military personnel: A nested case-control study. THE SCIENCE OF THE TOTAL ENVIRONMENT 2024; 922:171342. [PMID: 38428594 PMCID: PMC11034764 DOI: 10.1016/j.scitotenv.2024.171342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 02/26/2024] [Accepted: 02/27/2024] [Indexed: 03/03/2024]
Abstract
Single-pollutant methods to evaluate associations between endocrine disrupting chemicals (EDCs) and thyroid cancer risk may not reflect realistic human exposures. Therefore, we evaluated associations between exposure to a mixture of 18 EDCs, including polychlorinated biphenyls (PCBs), brominated flame retardants, and organochlorine pesticides, and risk of papillary thyroid cancer (PTC), the most common thyroid cancer histological subtype. We conducted a nested case-control study among U.S. military servicemembers of 652 histologically-confirmed PTC cases diagnosed between 2000 and 2013 and 652 controls, matched on birth year, sex, race/ethnicity, military component (active duty/reserve), and serum sample timing. We estimated mixture odds ratios (OR), 95% confidence intervals (95% CI), and standard errors (SE) for associations between pre-diagnostic serum EDC mixture concentrations, overall PTC risk, and risk of histological subtypes of PTC (classical, follicular), adjusted for body mass index and military branch, using quantile g-computation. Additionally, we identified relative contributions of individual mixture components to PTC risk, represented by positive and negative weights (w). A one-quartile increase in the serum mixture concentration was associated with a non-statistically significant increase in overall PTC risk (OR = 1.19; 95% CI = 0.91, 1.56; SE = 0.14). Stratified by histological subtype and race (White, Black), a one-quartile increase in the mixture was associated with increased classical PTC risk among those of White race (OR = 1.59; 95% CI = 1.06, 2.40; SE = 0.21), but not of Black race (OR = 0.95; 95% CI = 0.34, 2.68; SE = 0.53). PCBs 180, 199, and 118 had the greatest positive weights driving this association among those of White race (w = 0.312, 0.255, and 0.119, respectively). Findings suggest that exposure to an EDC mixture may be associated with increased classical PTC risk. These findings warrant further investigation in other study populations to better understand PTC risk by histological subtype and race.
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Affiliation(s)
- Hristina Denic-Roberts
- Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA; Oak Ridge Institute for Science and Education (ORISE), MD, USA
| | - Jordan McAdam
- Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA; Murtha Cancer Center Research Program, 4494 North Palmer Road, Bethesda, MD, USA; Henry M. Jackson Foundation for the Advancement of Military Medicine, 1401 Rockville Pike, Rockville, MD, USA
| | - Andreas Sjodin
- Centers for Disease Control and Prevention (CDC), National Center for Environmental Health (NCEH), Division of Laboratory Sciences (DLS), Organic Analytical Toxicology Branch, 4770 Buford Hwy NE, Atlanta, GA 30341, USA
| | - Mark Davis
- Centers for Disease Control and Prevention (CDC), National Center for Environmental Health (NCEH), Division of Laboratory Sciences (DLS), Organic Analytical Toxicology Branch, 4770 Buford Hwy NE, Atlanta, GA 30341, USA
| | - Richard Jones
- Centers for Disease Control and Prevention (CDC), National Center for Environmental Health (NCEH), Division of Laboratory Sciences (DLS), Organic Analytical Toxicology Branch, 4770 Buford Hwy NE, Atlanta, GA 30341, USA
| | - Mary H Ward
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Thanh D Hoang
- Division of Endocrinology, Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Shuangge Ma
- Department of Biostatistics, Yale School of Public Health, New Haven, CT, USA
| | - Yawei Zhang
- Department of Environmental Health Sciences, Yale School of Public Health, New Haven, CT, USA; Department of Cancer Prevention and Control, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jennifer A Rusiecki
- Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.
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Bytnar JA, Enewold L, Shriver CD, Zhu K. Incidence of papillary thyroid cancer: Comparison of the military and the general population by race and tumor stage/size. Cancer Epidemiol 2024; 89:102539. [PMID: 38340498 DOI: 10.1016/j.canep.2024.102539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 01/18/2024] [Accepted: 01/21/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND A previous study found higher papillary thyroid cancer incidence in the US military than the general population with larger differences among Black than White individuals. This study compared the two populations in the incidence by sex, race, tumor stage, and size to assess possible factors related to identified differences. METHODS Subjects were aged 18-59 in the military and general populations. Papillary thyroid cancer patients diagnosed during 1990-2013 were identified from the Department of Defense's Automated Central Tumor Registry (ACTUR) and the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) program. Age-adjusted rates and incidence rate ratios (IRR) comparing ACTUR to SEER were calculated. RESULTS Higher incidence rates in ACTUR than SEER were more obvious for Black (IRR=2.07, 95%CI=1.56-2.70) than White men (IRR=1.17, 95%CI=1.07-1.26) and for Black (IRR=2.30, 95%CI=1.91-2.71) than White women (IRR=1.50, 95%CI=1.38-1.64). Population differences by race were observed for localized tumors among both men and women and were larger for Black individuals. Differences were observed regardless of tumor size among Black men and White women, and in smaller tumors among Black women. CONCLUSION Higher incidence in the military than general population primarily in localized tumors suggests universal healthcare in the military may lead to earlier detection. The differences were larger among Blacks than Whites, suggesting universal access in the military may be more impactful among Black persons, who are less likely to have timely care than White persons in the general population. Nevertheless, observed differences for tumors > 2 cm suggest other factors may also play a role.
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Affiliation(s)
- Julie A Bytnar
- Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, United States; The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, United States
| | - Lindsey Enewold
- Division of Cancer Control & Population Science, National Cancer Institute, Rockville, MD, United States
| | - Craig D Shriver
- Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, United States; Department of Surgery, Walter Reed National Military Medical Center, Bethesda, MD, United States
| | - Kangmin Zhu
- Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, United States; The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, United States; Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, United States.
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Girardi FM, Wagner VP, Martins MD. Thyroid Incidentalomas: Scrutinizing the Mode of Detection and Evaluating its Contribution to Thyroid Cancer Diagnosis. Indian J Otolaryngol Head Neck Surg 2024; 76:1733-1740. [PMID: 38566651 PMCID: PMC10982254 DOI: 10.1007/s12070-023-04392-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 11/18/2023] [Indexed: 04/04/2024] Open
Abstract
There is an ongoing debate about the reasons behind the increasing incidence of thyroid cancer in the last two to three decades. Here, we investigate how thyroid nodules were detected in a large series of consultations for thyroid nodular pathology. METHODS In total, 576 patients were analyzed, with a total of 1014 nodules described. RESULTS In 347 (60.2%) cases, the diagnosis of a thyroid nodule was incidental, mostly during imaging tests for other reasons. Incidental diagnosis occurred among all ranges of nodule diameter and between palpable and non-palpable cases, even within a small proportion of symptomatic cases. In univariate analysis, incidental diagnosis was associated with smaller nodule diameter, non-palpable nodules, asymptomatic cases, older patient age, less advanced stages (T1-2), and conservative management. After multivariate analysis, older age, euthyroidism, and smaller diameter were statistically significant. Incidental diagnosis contributed to the diagnosis of 53.8% of the cases of cancer. Advanced T stages (T3-4) were more common in non-incidental diagnoses. CONCLUSION Our results indicate that incidental diagnosis of thyroid nodules is a significant contributor to thyroid cancer diagnosis in all ranges of nodule diameter, especially at earlier stages.
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Affiliation(s)
- Fábio Muradás Girardi
- Integrated Oncology Center of Ana Nery Hospital, Borges de Medeiros Street, 274, 503, Santa Cruz do Sul, RS 96810-034 Brazil
| | - Vivian P. Wagner
- Academic Unit of Oral and Maxillofacial Medicine and Pathology, Department of Clinical Dentistry, University of Sheffield, Sheffield, UK
| | - Manoela Domingues Martins
- Department of Oral Pathology, School of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, RS Brazil
- Department of Oral Medicine, Porto Alegre Clinics Hospital (HCPA/UFRGS), Porto Alegre, RS Brazil
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Rusiecki JA, McAdam J, Denic-Roberts H, Sjodin A, Davis M, Jones R, Hoang TD, Ward MH, Ma S, Zhang Y. Organochlorine pesticides and risk of papillary thyroid cancer in U.S. military personnel: a nested case-control study. Environ Health 2024; 23:28. [PMID: 38504322 PMCID: PMC10949709 DOI: 10.1186/s12940-024-01068-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 03/01/2024] [Indexed: 03/21/2024]
Abstract
BACKGROUND The effects of organochlorine pesticide (OCP) exposure on the development of human papillary thyroid cancer (PTC) are not well understood. A nested case-control study was conducted with data from the U.S. Department of Defense Serum Repository (DoDSR) cohort between 2000 and 2013 to assess associations of individual OCPs serum concentrations with PTC risk. METHODS This study included 742 histologically confirmed PTC cases (341 females, 401 males) and 742 individually-matched controls with pre-diagnostic serum samples selected from the DoDSR. Associations between categories of lipid-corrected serum concentrations of seven OCPs and PTC risk were evaluated for classical PTC and follicular PTC using conditional logistic regression, adjusted for body mass index category and military branch to compute odds ratios (OR) and 95% confidence intervals (CIs). Effect modification by sex, birth cohort, and race was examined. RESULTS There was no evidence of associations between most of the OCPs and PTC, overall or stratified by histological subtype. Overall, there was no evidence of an association between hexachlorobenzene (HCB) and PTC, but stratified by histological subtype HCB was associated with significantly increased risk of classical PTC (third tertile above the limit of detection (LOD) vs.
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Affiliation(s)
- Jennifer A Rusiecki
- Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Room E-2009, Bethesda, MD, 20814, USA.
| | - Jordan McAdam
- Murtha Cancer Center Research Program, 4494 North Palmer Road, Bethesda, MD, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, 1401 Rockville Pike, Rockville, MD, USA
| | - Hristina Denic-Roberts
- Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Room E-2009, Bethesda, MD, 20814, USA
- Oak Ridge Institute for Science and Education (ORISE), Oak Ridge, TN, USA
| | - Andreas Sjodin
- Division of Laboratory Sciences, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Mark Davis
- Division of Laboratory Sciences, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Richard Jones
- Division of Laboratory Sciences, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Thanh D Hoang
- Division of Endocrinology, Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Mary H Ward
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Shuangge Ma
- Department of Biostatistics, Yale School of Public Health, New Haven, CT, USA
| | - Yawei Zhang
- Department of Environmental Health Sciences, Yale School of Public Health, New Haven, CT, USA
- Department of Cancer Prevention and Control, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Pietron WJ, Warenik-Bany M. Terrestrial animal livers as a source of PCDD/Fs, PCBs and PBDEs in the diet. THE SCIENCE OF THE TOTAL ENVIRONMENT 2023; 867:161508. [PMID: 36642267 DOI: 10.1016/j.scitotenv.2023.161508] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 12/05/2022] [Accepted: 01/06/2023] [Indexed: 06/17/2023]
Abstract
The livers of terrestrial animals are an important source of vitamins and minerals, but with the liver being the major filtering and detoxifying organ, it retains xenobiotic material, especially persistent organic pollutants (POPs). The aim of the study was human health risk assessment related to the presence of certain POPs, namely polychlorinated dibenzo-p-dioxins and dibenzofurans (PCDD/Fs), polychlorinated biphenyls (PCBs), and polybrominated diphenyl ethers (PBDEs) in terrestrial animals' livers. HRGC-HRMS was used to determine analyte concentrations in 99 liver samples of chicken, pork, beef, and mutton livers obtained from Polish farms. The ovine livers were the most contaminated by ∑PCDD/F/dl-PCBs (0.06-2.21 pg WHO-TEQ g-1 wet weight), ∑ndl-PCBs (0.036-1.54 ng g-1 wet weight) and ∑PBDEs (0.21-2.27 ng g-1 wet weight). Samples were found of ovine and pork livers that exceeded the maximum concentration limits established for PCDD/Fs. The Kruskal-Wallis test showed that there were statistical differences between regions in the concentrations of the ∑PCDD/Fs and ∑PCDD/F-PCBs, but none in those of the ∑dl-PCBs, ∑ndl-PCBs or ∑PBDEs. According to Dunnett's test results, ovine liver samples from the Podlaskie province contained fewer ∑PCDD/F than those from the Dolnośląskie (p < 0.027) and Małopolskie (p < 0.0342) voivodeships. Taking into account PCDD/F contents and Tolerable Weekly Intake (2 pg WHO-TEQ/kg BW) (TWI2018), the lowest risk was associated with chicken liver consumption (TWI up to 11 % in the 95th percentile), pork (62 %) and bovine (92 %) livers should be eaten in limited amounts for risk avoidance, while mutton liver (400 %) should not be eaten at all. Additionally, there is no risk of ingestion of a harmful amount of PBDEs associated with consumption of the livers of terrestrial animals from Poland based on the margin of exposure values (>15).
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Qu MY, Tang W, Cui XY, Jin YX, Wang ZY, Guo CY, Jia XD, Shi YQ, Zang JJ. Increased Prevalence of Thyroid Nodules Across Nearly 10 Years in Shanghai, China. Curr Med Sci 2023; 43:191-197. [PMID: 36547870 DOI: 10.1007/s11596-022-2666-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 05/09/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE This study aimed to determine whether the prevalence of thyroid nodules (TNs) increased due to modern lifestyles or other factors, despite the advances in screening and diagnostic tools. METHODS This study included 3474 pairs of participants, who were matched by gender and age (±3 years) from two cross-sectional sampling surveys: (1) the program on the iodine nutritional status and related health status of residents in Shanghai in 2009; (2) the thyroid disease screening program for adults in Shanghai between 2017 and 2018. The prevalence of TNs and thyroid diseases in 2009 and 2017-2018 were compared, and the potential risk factors of TNs were detected. RESULTS The prevalence of TNs in 2009 was 28.9%: 22.5% in males and 34.5% in females. In 2017, this increased to 43.8%: 37.9% in males and 49.1% in females. The prevalence of TNs significantly increased from 2009 to 2017 (odds ratio, 1.486; 95% confidence interval, 1.238-1.786). In addition, female gender, thyroid disease history, and age were the main risk factors for TNs after adjusting for confounders in the logistic regression across the time period. CONCLUSION The prevalence of TNs significantly increased across nearly 10 years in Shanghai.
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Affiliation(s)
- Meng-Ying Qu
- Division of Health Risk Factor Monitoring and Control, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, 200336, China
| | - Wei Tang
- Department of Endocrinology, Changzheng Hospital, Shanghai, 200003, China
| | - Xue-Ying Cui
- Division of Health Risk Factor Monitoring and Control, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, 200336, China
| | - Yu-Xiang Jin
- Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China
| | - Zheng-Yuan Wang
- Division of Health Risk Factor Monitoring and Control, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, 200336, China
| | - Chang-Yi Guo
- Division of Health Risk Factor Monitoring and Control, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, 200336, China
| | - Xiao-Dong Jia
- Division of Health Risk Factor Monitoring and Control, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, 200336, China
| | - Yong-Quan Shi
- Department of Endocrinology, Changzheng Hospital, Shanghai, 200003, China
| | - Jia-Jie Zang
- Division of Health Risk Factor Monitoring and Control, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, 200336, China.
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Zhuo H, Huang H, Sjodin A, Jin L, Ma S, Denic-Roberts H, Warren JL, Jones R, Davis M, Sun P, Yu H, Ward MH, Udelsman R, Zhang Y, Rusiecki JA. A nested case-control study of serum polychlorinated biphenyls and papillary thyroid cancer risk among U.S. military service members. ENVIRONMENTAL RESEARCH 2022; 212:113367. [PMID: 35504340 PMCID: PMC9238631 DOI: 10.1016/j.envres.2022.113367] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 04/19/2022] [Accepted: 04/21/2022] [Indexed: 05/09/2023]
Abstract
BACKGROUND AND OBJECTIVES Although polychlorinated biphenyls (PCBs) were banned decades ago, populations are continuously exposed to PCBs due to their persistence and bioaccumulation/biomagnification in the environment. Results from limited epidemiologic studies linking PCBs to thyroid cancer have been inconclusive. This study aimed to investigate the association between individual PCBs and PCB mixture and papillary thyroid cancer (PTC), the most common thyroid cancer histologic subtype. METHODS We carried out a nested case-control study including 742 histologically confirmed PTC cases diagnosed in 2000-2013 and 742 individually matched controls among U.S. military service members. Pre-diagnostic serum samples that were collected on average nine years before PTC diagnosis were used to measure PCB congeners by gas chromatography isotope dilution high resolution mass spectrometry (GC/ID-HRMS). Conditional logistic regression, Bayesian kernel machine regression (BKMR), and weighted quantile sum (WQS) regression were employed to estimate the association between single PCB congeners as well as their mixture and PTC. RESULTS Four PCB congeners (PCB-74, PCB-99, PCB-105, PCB-118) had significant associations and dose-response relationships with increased risk of PTC in single congener models. When considering the effects from all measured PCBs and their potential interactions in the BKMR model, PCB-118 showed positive trends of association with PTC. Increased exposure to the PCB congeners as a mixturewas also associated with an increased risk of PTC in the WQS model, with the mixture dominated by PCB-118, followed by PCB-74 and PCB-99. One PCB congener, PCB-187, showed an inverse trend of association with PTC in the mixture analysis. DISCUSSION This study suggests that exposure to certain PCBs as well as a mixture of PCBs were associated with an increased risk of PTC. The observed association was mainly driven by PCB-118, and to a lesser extent by PCB-74 and PCB-99. The findings warrant further investigation.
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Affiliation(s)
- Haoran Zhuo
- Department of Environmental Health Sciences, Yale School of Public Health, New Haven, CT, USA
| | - Huang Huang
- Department of Environmental Health Sciences, Yale School of Public Health, New Haven, CT, USA
| | - Andreas Sjodin
- Persistent Pollutants Biomonitoring Laboratory, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Lan Jin
- Department of Neurosurgery, Yale School of Medicine, New Haven, CT, USA
| | - Shuangge Ma
- Department of Biostatistics, Yale School of Public Health, New Haven, CT, USA
| | - Hristina Denic-Roberts
- Oak Ridge Institute for Science and Education (ORISE), MD, USA; Uniformed Services University of the Health Sciences, F. Edward Hébert School of Medicine, Department of Preventive Medicine & Biostatistics, Bethesda, MD, USA
| | - Joshua L Warren
- Department of Biostatistics, Yale School of Public Health, New Haven, CT, USA
| | - Richard Jones
- Persistent Pollutants Biomonitoring Laboratory, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Mark Davis
- Persistent Pollutants Biomonitoring Laboratory, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Peiyuan Sun
- Department of Biostatistics, Yale School of Public Health, New Haven, CT, USA
| | - Herbert Yu
- Epidemiology Program, University of Hawaii Cancer Center, Hawaii, USA
| | - Mary H Ward
- Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Robert Udelsman
- Endocrine Neoplasia Institute, Miami Cancer Institute, Miami, FL, USA
| | - Yawei Zhang
- Department of Environmental Health Sciences, Yale School of Public Health, New Haven, CT, USA
| | - Jennifer A Rusiecki
- Uniformed Services University of the Health Sciences, F. Edward Hébert School of Medicine, Department of Preventive Medicine & Biostatistics, Bethesda, MD, USA.
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Mahar AL, Aiken AB, Cramm H, Cyr KS, Shellenberger J, Kurdyak P. Cancer incidence among Canadian Veterans: A matched cohort study. Cancer Epidemiol 2022; 79:102199. [PMID: 35700609 DOI: 10.1016/j.canep.2022.102199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 06/01/2022] [Accepted: 06/03/2022] [Indexed: 11/02/2022]
Abstract
INTRODUCTION Occupational exposures related to military service may increase the risk of cancer for military Veterans, while high levels of fitness during service may decrease risk. However, few studies have compared this post-career cancer risk directly to the employed general population. METHODS This retrospective cohort study used linked administrative data. Canadian Armed Forces and Royal Canadian Mounted Police Veterans in Ontario, Canada were matched 1:4 on age, sex, geography, and community-level income to a group of non-Veterans most likely to have been employed during a period similar to the Veterans' military service. Cancer diagnoses were identified using the Ontario Cancer Registry. RESULTS During the study period, 642 of 30 576 included Veterans (2.1%) and 3408 of the 122 293 matched general population cohort (2.8%) experienced at least one cancer diagnosis. The crude rate of cancer was 153.5 per 100 000 person-years among Veterans vs. 205.9 per 100 000 person-years for the general population cohort. After adjusting for rurality and matching variables, Veterans had an 27% lower risk of developing any cancer than their matched comparators [hazard ratio = 0.73 (95% CI: 0.67-0.80)]. Among specific cancer types, the risk of lung and colorectal cancer was significantly lower for Veterans relative to the general population cohort; the risk of breast and prostate cancer was similar. DISCUSSION This study adds to the growing international evidence suggesting that risk of many cancers among Veterans is lower or similar to the general population. Further understanding of the complex relationships among occupational exposures, environmental factors, and lifestyle factors is needed.
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Affiliation(s)
- Alyson L Mahar
- ICES, Toronto, Canada; Manitoba Centre for Health Policy, Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada.
| | - Alice B Aiken
- Faculty of Health, Dalhousie University, Halifax, Canada
| | - Heidi Cramm
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Kate St Cyr
- School of Rehabilitation Therapy, Queen's University, Kingston, Canada
| | | | - Paul Kurdyak
- ICES, Toronto, Canada; Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada
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Bytnar JA, Shriver CD, Zhu K. Incidence rates of oral cavity and oropharyngeal cancers among men: a comparison of active-duty military and general populations. Eur J Cancer Prev 2022; 31:166-171. [PMID: 33990095 DOI: 10.1097/cej.0000000000000698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES This study compared oral cavity and oropharyngeal cancer incidence rates and trends among men in the active-duty military and the general population of the USA. METHODS Data were from the Department of Defenses' Automated Central Tumor Registry (ACTUR) and the National Cancer Institute's Surveillance, Epidemiology and End Results (SEER-9) registries. Age-adjusted oral cavity and oropharyngeal cancer incidence rates among men aged 20-59 from 1990-2013 were compared between ACTUR and SEER populations. RESULTS The age-adjusted oral cancer incidence rate was lower in ACTUR than SEER (IRR = 0.89, 95% confidence interval (CI), 0.81-0.98). Incidence was lower in ACTUR for oral cavity cancer (IRR = 0.75, 95% CI, 0.66-0.89) and remained lower when stratified by age and race. ACTUR oropharyngeal cancer rates were higher than SEER among Whites (IRR = 1.19, 95% CI, 1.01-1.39) and men aged 40-59 (IRR = 1.18, 95% CI, 1.00-1.39). Oropharyngeal cancer increased for both populations over time, whereas oral cavity cancer increased in ACTUR but decreased in SEER. CONCLUSION Rates were lower in ACTUR than SEER for oral cavity, but not for oropharyngeal cancer. Temporal oral cancer incidence patterns differed between the two populations. This study provides clues for more research on possible variations between these two populations and related factors.
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Affiliation(s)
- Julie A Bytnar
- John P. Murtha Cancer Center Research Program, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc
| | - Craig D Shriver
- John P. Murtha Cancer Center Research Program, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center
- Department of Surgery
| | - Kangmin Zhu
- John P. Murtha Cancer Center Research Program, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc
- Department of Surgery
- Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
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Pu W, Shi X, Yu P, Zhang M, Liu Z, Tan L, Han P, Wang Y, Ji D, Gan H, Wei W, Lu Z, Qu N, Hu J, Hu X, Luo Z, Li H, Ji Q, Wang J, Zhang X, Wang YL. Single-cell transcriptomic analysis of the tumor ecosystems underlying initiation and progression of papillary thyroid carcinoma. Nat Commun 2021; 12:6058. [PMID: 34663816 PMCID: PMC8523550 DOI: 10.1038/s41467-021-26343-3] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 09/30/2021] [Indexed: 01/08/2023] Open
Abstract
The tumor ecosystem of papillary thyroid carcinoma (PTC) is poorly characterized. Using single-cell RNA sequencing, we profile transcriptomes of 158,577 cells from 11 patients’ paratumors, localized/advanced tumors, initially-treated/recurrent lymph nodes and radioactive iodine (RAI)-refractory distant metastases, covering comprehensive clinical courses of PTC. Our data identifies a “cancer-primed” premalignant thyrocyte population with normal morphology but altered transcriptomes. Along the developmental trajectory, we also discover three phenotypes of malignant thyrocytes (follicular-like, partial-epithelial-mesenchymal-transition-like, dedifferentiation-like), whose composition shapes bulk molecular subtypes, tumor characteristics and RAI responses. Furthermore, we uncover a distinct BRAF-like-B subtype with predominant dedifferentiation-like thyrocytes, enriched cancer-associated fibroblasts, worse prognosis and promising prospect of immunotherapy. Moreover, potential vascular-immune crosstalk in PTC provides theoretical basis for combined anti-angiogenic and immunotherapy. Together, our findings provide insight into the PTC ecosystem that suggests potential prognostic and therapeutic implications. The characterisation of the papillary thyroid carcinoma (PTC) tumour microenvironment remains crucial. Here, the authors perform single-cell RNA sequencing in 11 patients and identify potential opportunities for the use of immunotherapy and its combination with anti-angiogenic therapy in PTC.
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Affiliation(s)
- Weilin Pu
- Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Shanghai, 200032, China.,State Key Laboratory of Genetic Engineering, Collaborative Innovation Center for Genetics and Development, School of Life Sciences, Fudan University, Shanghai, 200438, China
| | - Xiao Shi
- Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Shanghai, 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Pengcheng Yu
- Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Shanghai, 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Meiying Zhang
- The Center for Microbes, Development and Health, Key Laboratory of Molecular Virology & Immunology, Institut Pasteur of Shanghai, Chinese Academy of Sciences, Shanghai, 200031, China
| | - Zhiyan Liu
- Department of Pathology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, China
| | - Licheng Tan
- Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Shanghai, 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Peizhen Han
- Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Shanghai, 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Yu Wang
- Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Shanghai, 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Dongmei Ji
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China.,Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai, 200032, China.,Phase I Clinical Trial Center, Fudan University Shanghai Cancer Center, Shanghai, 200032, China
| | - Hualei Gan
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China.,Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, 200032, China
| | - Wenjun Wei
- Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Shanghai, 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Zhongwu Lu
- Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Shanghai, 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Ning Qu
- Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Shanghai, 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Jiaqian Hu
- Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Shanghai, 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Xiaohua Hu
- State Key Laboratory of Genetic Engineering, Collaborative Innovation Center for Genetics and Development, School of Life Sciences, Fudan University, Shanghai, 200438, China
| | - Zaili Luo
- Brain Tumor Center, Division of Experimental Hematology and Cancer Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, 45229, USA
| | - Huajun Li
- Department of Clinical Research & Development, Jiangsu Hengrui Pharmaceuticals Co., Ltd., Shanghai, 201210, China
| | - Qinghai Ji
- Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Shanghai, 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Jiucun Wang
- State Key Laboratory of Genetic Engineering, Collaborative Innovation Center for Genetics and Development, School of Life Sciences, Fudan University, Shanghai, 200438, China.,Human Phenome Institute, Fudan University, Shanghai, 200438, China
| | - Xiaoming Zhang
- The Center for Microbes, Development and Health, Key Laboratory of Molecular Virology & Immunology, Institut Pasteur of Shanghai, Chinese Academy of Sciences, Shanghai, 200031, China.
| | - Yu-Long Wang
- Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Shanghai, 200032, China. .,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China.
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11
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Bytnar JA, Shriver CD, Zhu K. Incidence rates of digestive cancers among U.S. military servicemen: Comparison with the rates in the general U.S. population. PLoS One 2021; 16:e0257087. [PMID: 34478468 PMCID: PMC8415586 DOI: 10.1371/journal.pone.0257087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 08/23/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Digestive cancers greatly contribute to the cancer burden in the United States. These cancers are more common among men and some are increasing among adults under age 50. Military population, which is dominantly male and young, and general populations differ in exposure to risk factors for these cancers. However, no studies have systematically investigated whether the incidence rates of these cancers differ between the two populations. This study aimed to compare incidence rates and trends of select digestive cancers between active-duty military and general populations in men aged 20-59 years. METHODS Data were from the Department of Defenses' Automated Central Tumor Registry (ACTUR) and the National Cancer Institute's Surveillance, Epidemiology, and End Results 9 (SEER-9) registries. Age-adjusted incidence rates of colorectal, stomach, liver, and pancreatic cancers among men aged 20-59 years during 1990-2013 were compared between the two populations. Stratified analyses by age were done for colorectal and stomach cancers. The joinpoint regression analysis was conducted to examine temporal trends for colorectal cancer. RESULTS The age-adjusted incidence rates of colorectal, stomach, liver, and pancreatic cancers were overall lower among active-duty than SEER (IRR = 0.86, 95% CI = 0.81-0.92; IRR = 0.65, 95% CI = 0.55-0.76; IRR = 0.39, 95% CI = 0.30-0.49; IRR = 0.51, 95% CI = 0.41-0.62, respectively). This was observed in the groups of both ages 20-39 and 40-59 years for stomach cancer, and in the group of ages 40-59 years for colorectal cancer. The incidence rates of colorectal cancer tended to decrease since 2008 in ACTUR. CONCLUSION The incidence rates for selected digestive cancers overall were lower in the active-duty military population than the U.S. general population. This study highlights the need for more research enhancing our understanding of variations in these cancers between the two populations.
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Affiliation(s)
- Julie A. Bytnar
- John P. Murtha Cancer Center Research Program, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, Bethesda, Maryland, United States of America
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland, United States of America
| | - Craig D. Shriver
- John P. Murtha Cancer Center Research Program, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, Bethesda, Maryland, United States of America
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland, United States of America
| | - Kangmin Zhu
- John P. Murtha Cancer Center Research Program, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, Bethesda, Maryland, United States of America
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland, United States of America
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland, United States of America
- Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, United States of America
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12
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Bytnar JA, Lin J, Eaglehouse YL, Enewold L, Shriver CD, Zhu K. Brain cancer incidence: a comparison of active-duty military and general populations. Eur J Cancer Prev 2021; 30:328-333. [PMID: 32898014 DOI: 10.1097/cej.0000000000000625] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND In the USA, brain cancer disproportionately affects young adults. The US military has a younger age structure than the general population and may have differential exposures related to brain cancer. This study aimed to compare the incidence rates of brain cancer in the active-duty military and general populations to provide clues for future etiologic research. The rates between military service branches were also compared. METHODS The data for this study were from the Department of Defense's Automated Central Tumor Registry (ACTUR) and the National Cancer Institute's Surveillance, Epidemiology, and End Results 9 (SEER-9) registries. Age- and sex-adjusted incidence rates of malignant neuroepithelial brain cancer among adults 20-54 years of age from 1990-2013 were calculated and compared between the two populations, given as incidence rate ratios (IRRs) with 95% confidence intervals (CIs). RESULTS The age and sex-adjusted incidence rate for malignant neuroepithelial brain cancer was significantly lower in the active-duty population than in the US general population (IRR = 0.62, 95% CI, 0.56-0.68). The reduced incidence rate in the active-duty population was observed in men, all races, individuals 20-44 of age, and for all histological subtypes and time periods assessed. There were no significant differences in rates between the military service branches. CONCLUSION The incidence rates of neuroepithelial brain cancer were lower in the active-duty military population than the US general population. This study highlights the need for more research to enhance our understanding of variations in brain cancer incidence between these two populations.
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Affiliation(s)
- Julie A Bytnar
- John P. Murtha Cancer Center Research Program, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, Bethesda
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Rockledge Drive
| | - Jie Lin
- John P. Murtha Cancer Center Research Program, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, Bethesda
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Rockledge Drive
- Department of Surgery, Uniformed Services University of the Health Sciences
| | - Yvonne L Eaglehouse
- John P. Murtha Cancer Center Research Program, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, Bethesda
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Rockledge Drive
- Department of Surgery, Uniformed Services University of the Health Sciences
| | - Lindsey Enewold
- Division of Cancer Control and Population Sciences, National Cancer Institute, Medical Center Drive
| | - Craig D Shriver
- John P. Murtha Cancer Center Research Program, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, Bethesda
- Department of Surgery, Uniformed Services University of the Health Sciences
| | - Kangmin Zhu
- John P. Murtha Cancer Center Research Program, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, Bethesda
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Rockledge Drive
- Department of Surgery, Uniformed Services University of the Health Sciences
- Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
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13
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Fathoming the link between anthropogenic chemical contamination and thyroid cancer. Crit Rev Oncol Hematol 2020; 150:102950. [DOI: 10.1016/j.critrevonc.2020.102950] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 02/12/2020] [Accepted: 04/02/2020] [Indexed: 01/08/2023] Open
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14
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Colbeth HL, Genere N, Hall CB, Jaber N, Brito JP, El Kawkgi OM, Goldfarb DG, Webber MP, Schwartz TM, Prezant DJ, Zeig-Owens R. Evaluation of Medical Surveillance and Incidence of Post-September 11, 2001, Thyroid Cancer in World Trade Center-Exposed Firefighters and Emergency Medical Service Workers. JAMA Intern Med 2020; 180:888-895. [PMID: 32310290 PMCID: PMC7171583 DOI: 10.1001/jamainternmed.2020.0950] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
IMPORTANCE Elevated incidence rates of thyroid cancer among World Trade Center (WTC)-exposed individuals may be associated with the identification of asymptomatic cancers during medical surveillance. OBJECTIVE To examine the association between WTC exposure and thyroid cancer among Fire Department of the City of New York (hereafter, Fire Department) rescue/recovery workers as well as the association with medical surveillance. DESIGN, SETTING, AND PARTICIPANTS This closed-cohort study classified the method of detection (asymptomatic and symptomatic) of thyroid cancers in 14 987 men monitored through the Fire Department-WTC Health Program diagnosed from September 12, 2001, to December 31, 2018. Age-, sex-, and histologic-specific Fire Department incidence rates were calculated and compared with demographically similar men in Olmsted County, Minnesota, from the Rochester Epidemiology Project using age-standardized rates, relative rates (RRs), and 95% CIs. The secondary analysis was restricted to papillary carcinomas. EXPOSURES World Trade Center exposure was defined as rescue/recovery work at the WTC site from September 11, 2001, to July 25, 2002. MAIN OUTCOMES AND MEASURES The outcomes evaluated comprised (1) number of incident thyroid cancers and their detection method categorizations in the Fire Department and Rochester Epidemiology Project cohorts; (2) Fire Department, Rochester Epidemiology Project, and Surveillance, Epidemiology, and End Results-21 age-standardized incidence rates of thyroid cancer; and (3) RRs comparing Fire Department and Rochester Epidemiology Project overall and by detection method categorization. RESULTS Seventy-two post-9/11 Fire Department cases of thyroid cancer were identified. Among the 65 cases (90.3%) with a categorized detection method, 53 cases (81.5%) were asymptomatic and 12 cases (18.5%) were symptomatic. Median (interquartile range) age at diagnosis was 50.2 (44.0-58.6) vs 46.6 (43.9-52.9) years for asymptomatic vs symptomatic cases. Associated primarily with asymptomatic cancers, the overall age-standardized incidence of Fire Department thyroid cancers (24.7; 95% CI, 17.4-52.3) was significantly higher than the Rochester Epidemiology Project (10.4; 95% CI, 8.5-12.7) and Surveillance, Epidemiology, and End Results-21 (9.1; 95% CI, 9.0-9.1) per 100 000 person-years. Furthermore, the RR of thyroid cancer among symptomatic men in Fire Department cases was not significantly different from that of men in the Rochester Epidemiology Project (0.8; 95% CI, 0.4-1.5); however, the rate of asymptomatic cancers was more than 3-fold that of the Rochester Epidemiology Project rate (RR, 3.1; 95% CI, 2.1-4.7). CONCLUSIONS AND RELEVANCE Excess asymptomatic thyroid cancer in Fire Department WTC-exposed rescue/recovery workers is apparently attributable to the identification of occult lesions during medical surveillance. Among WTC-exposed cohorts and the general population, these findings appear to have important implications for how thyroid cancer incidence rates are interpreted and how diagnoses should be managed.
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Affiliation(s)
- Hilary L Colbeth
- Fire Department of the City of New York, Bureau of Health Services, Brooklyn, New York.,Montefiore Medical Center, Pulmonology Division, Department of Medicine, Bronx, New York
| | - Natalia Genere
- Mayo Clinic, Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Department of Medicine, Rochester, Minnesota
| | - Charles B Hall
- Albert Einstein College of Medicine, Department of Epidemiology and Population Health, Bronx, New York.,Albert Einstein College of Medicine, Saul R. Korey Department of Neurology, Bronx, New York
| | - Nadia Jaber
- Fire Department of the City of New York, Bureau of Health Services, Brooklyn, New York
| | - Juan P Brito
- Mayo Clinic, Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Department of Medicine, Rochester, Minnesota.,Mayo Clinic, Knowledge and Evaluation Research Unit, Rochester, Minnesota
| | - Omar M El Kawkgi
- Mayo Clinic, Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Department of Medicine, Rochester, Minnesota.,Mayo Clinic, Knowledge and Evaluation Research Unit, Rochester, Minnesota
| | - David G Goldfarb
- Fire Department of the City of New York, Bureau of Health Services, Brooklyn, New York.,Montefiore Medical Center, Pulmonology Division, Department of Medicine, Bronx, New York
| | - Mayris P Webber
- Fire Department of the City of New York, Bureau of Health Services, Brooklyn, New York.,Albert Einstein College of Medicine, Department of Epidemiology and Population Health, Bronx, New York.,Montefiore Medical Center, Department of Epidemiology and Population Health, Bronx, New York
| | - Theresa M Schwartz
- Fire Department of the City of New York, Bureau of Health Services, Brooklyn, New York.,Montefiore Medical Center, Pulmonology Division, Department of Medicine, Bronx, New York
| | - David J Prezant
- Fire Department of the City of New York, Bureau of Health Services, Brooklyn, New York.,Albert Einstein College of Medicine, Department of Medicine, Pulmonology Division, Bronx, New York
| | - Rachel Zeig-Owens
- Fire Department of the City of New York, Bureau of Health Services, Brooklyn, New York.,Montefiore Medical Center, Pulmonology Division, Department of Medicine, Bronx, New York.,Albert Einstein College of Medicine, Department of Epidemiology and Population Health, Bronx, New York
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15
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Huang H, Sjodin A, Chen Y, Ni X, Ma S, Yu H, Ward MH, Udelsman R, Rusiecki J, Zhang Y. Polybrominated Diphenyl Ethers, Polybrominated Biphenyls, and Risk of Papillary Thyroid Cancer: A Nested Case-Control Study. Am J Epidemiol 2020; 189:120-132. [PMID: 31742588 DOI: 10.1093/aje/kwz229] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 09/24/2019] [Accepted: 09/25/2019] [Indexed: 01/22/2023] Open
Abstract
A nested case-control study was carried out using data from the US Department of Defense cohort between 2000 and 2013 to investigate the associations of papillary thyroid cancer (PTC) with serum concentrations of polybrominated diphenyl ethers and polybrominated biphenyls. This study included 742 histologically confirmed PTC cases (in 341 women and 401 men) and 742 matched controls with prediagnostic serum samples from the Department of Defense Serum Repository. Lipid-corrected serum concentrations of 8 congeners were measured. Multivariate conditional logistic regression analyses were performed for classical PTC and follicular variant of PTC, respectively. We also examined effect modification by sex. BDE-28, a polybrominated diphenyl ether congener, was associated with significantly increased risk of classical PTC (for the third tertile vs. below the limit of detection, odds ratio = 2.09, 95% confidence interval: 1.05, 4.15; P for trend = 0.02), adjusting for other congeners, body mass index, and branch of military service. This association was observed mainly for larger classical PTC (tumor size > 10 mm), with a significantly stronger association among women than men (P for interaction = 0.004). No consistent associations were observed for other congeners, including those at higher concentrations. This study found a significantly increased risk of classical PTC associated with increasing levels of BDE-28. The risk varied by sex and tumor size.
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Affiliation(s)
- Huang Huang
- Department of Environmental Health Sciences, Yale School of Public Health, New Haven, Connecticut
| | - Andreas Sjodin
- Persistent Pollutants Biomonitoring Laboratory, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Yingtai Chen
- Department of Surgery, Yale School of Medicine, New Haven, Connecticut
- Yale Cancer Center, New Haven, Connecticut
- Cancer Institute and Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Xin Ni
- Beijing Children’s Hospital, Capital Medical University, Beijing, China
| | - Shuangge Ma
- Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut
| | - Herbert Yu
- Epidemiology Program, University of Hawaii Cancer Center, Honolulu, Hawaii
| | - Mary H Ward
- Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
| | - Robert Udelsman
- Endocrine Neoplasia Institute, Miami Cancer Institute, Miami, Florida
| | - Jennifer Rusiecki
- and Uniformed Services University of the Health Sciences, F. Edward Hébert School of Medicine, Department of Preventive Medicine and Biostatistics, Bethesda, Maryland
| | - Yawei Zhang
- Department of Environmental Health Sciences, Yale School of Public Health, New Haven, Connecticut
- Department of Surgery, Yale School of Medicine, New Haven, Connecticut
- Yale Cancer Center, New Haven, Connecticut
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16
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Marotta V, Russo G, Gambardella C, Grasso M, La Sala D, Chiofalo MG, D'Anna R, Puzziello A, Docimo G, Masone S, Barbato F, Colao A, Faggiano A, Grumetto L. Human exposure to bisphenol AF and diethylhexylphthalate increases susceptibility to develop differentiated thyroid cancer in patients with thyroid nodules. CHEMOSPHERE 2019; 218:885-894. [PMID: 30609493 DOI: 10.1016/j.chemosphere.2018.11.084] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 11/09/2018] [Accepted: 11/12/2018] [Indexed: 05/28/2023]
Abstract
Pollutants represent potential threats to the human health, being ubiquitous in the environment and exerting toxicity even at low doses. This study aims at investigating the role of fifteen multiclass organic pollutants, assumed as markers of environmental pollution, most of which exerting endocrine-disrupting activity, in thyroid cancer development. The increasing incidence of differentiated thyroid cancer (DTC) may be related to the rising production and environmental dissemination of pollutants. Fifty-five patients, twenty-seven with diagnosis of benign thyroid nodules and twenty-eight suffering from differentiated thyroid cancer, were enrolled and the concentration levels of seven bisphenols, two phthalates (i.e. di(2-ethylhexyl) phthalate (DEHP) and its main metabolite, mono-(2-ethyl-hexyl) phthalate) (MEHP)), two chlorobenzenes, (1,4-dichlorobenzene and 1,2,4,5-tetrachlorobenzene), and 3 phenol derivatives (2-chlorophenol, 4- nonylphenol, and triclosan) were determined in their serum by using a validated analytical method based on high performance liquid chromatography with ultraviolet tandem fluorescence detection. A significant relationship was found between malignancy and the detection in the serum of both bisphenol AF and DEHP. Indeed, their presence confers a more than fourteen times higher risk of developing differentiated thyroid cancer. Relationship between these two pollutants and the risk of malignancy was dose-independent and not mediated by higher thyroid stimulating hormone levels. Even if a conclusive evidence cannot still be drawn and larger prospective studies are needed, the exposure to low doses of environmental endocrine-disrupting contaminants can be considered consistent with the development of thyroid cancer.
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Affiliation(s)
- Vincenzo Marotta
- Struttura Complessa Chirurgia Oncologica della Tiroide, Istituto Nazionale Tumori - IRCCS - Fondazione G.Pascale, Napoli, Italia, Italy.
| | - Giacomo Russo
- Pharm-Analysis & Bio-Pharm Laboratory, Department of Pharmacy, School of Medicine and Surgery, University of Naples Federico II, Via D. Montesano, 49, I-80131, Naples, Italy; Consorzio Interuniversitario INBB, Viale Medaglie d'Oro, 305, I-00136, Rome, Italy
| | - Claudio Gambardella
- Department of Anesthesiologic, Surgical and Emergency Sciences, Division of General and Oncologic Surgery, University of Campania Luigi Vanvitelli, Italy
| | - Marica Grasso
- AOU San Giovanni di Dio e Ruggi D'Aragona, Division of General Surgery, Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | - Domenico La Sala
- AOU San Giovanni di Dio e Ruggi D'Aragona, Division of Endocrinology and Diabetology, Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | - Maria Grazia Chiofalo
- Struttura Complessa Chirurgia Oncologica della Tiroide, Istituto Nazionale Tumori - IRCCS - Fondazione G.Pascale, Napoli, Italia, Italy
| | - Raffaella D'Anna
- Struttura Complessa Chirurgia Oncologica della Tiroide, Istituto Nazionale Tumori - IRCCS - Fondazione G.Pascale, Napoli, Italia, Italy
| | - Alessandro Puzziello
- AOU San Giovanni di Dio e Ruggi D'Aragona, Division of General Surgery, Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | - Giovanni Docimo
- Department of Anesthesiologic, Surgical and Emergency Sciences, Division of General and Oncologic Surgery, University of Campania Luigi Vanvitelli, Italy
| | - Stefania Masone
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Francesco Barbato
- Pharm-Analysis & Bio-Pharm Laboratory, Department of Pharmacy, School of Medicine and Surgery, University of Naples Federico II, Via D. Montesano, 49, I-80131, Naples, Italy; Consorzio Interuniversitario INBB, Viale Medaglie d'Oro, 305, I-00136, Rome, Italy
| | - Annamaria Colao
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Antongiulio Faggiano
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Lucia Grumetto
- Pharm-Analysis & Bio-Pharm Laboratory, Department of Pharmacy, School of Medicine and Surgery, University of Naples Federico II, Via D. Montesano, 49, I-80131, Naples, Italy; Consorzio Interuniversitario INBB, Viale Medaglie d'Oro, 305, I-00136, Rome, Italy.
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17
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Can Active Surveillance be an Alternative to Surgery in Papillary Thyroid Microcarcinoma?: The Current Situation Worldwide. MEDICAL BULLETIN OF SISLI ETFAL HOSPITAL 2018; 52:233-243. [PMID: 32774084 PMCID: PMC7406552 DOI: 10.14744/semb.2018.15428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 12/10/2018] [Indexed: 11/20/2022]
Abstract
Papillary thyroid carcinoma is the most common endocrine malignancy. Papillary thyroid microcarcinomas (PTMCs) are tumors with a size of ≤1 cm. The biological behavior of these tumors differs due to the presence of their aggressive features. The prognosis of PTMCs with high-risk features, such as clinical node metastasis, distant metastasis, and significant extrathyroidal extension to the tracheal or recurrent laryngeal nerve invasion, is poor, even if a sufficient immediate surgery is performed at diagnosis. However, PTMCs without these aggressive features are low-risk tumors because of their indolent and slow growth behaviors. The increase in thyroid cancer incidence is mostly a result of overdiagnosis of small low-risk PTMCs with indolent clinical course. Despite the sudden increase in thyroid cancer incidence worldwide, cancer mortality did not increase. Although the traditional treatment strategy for PTMC is immediate surgery at diagnosis, because of the rather low disease-specific mortality rate, low recurrence rate, and potential risk for postoperative complications, active surveillance has been proposed recently as an alternative option for PTMCs without invasion, metastasis, or cytological or molecular characteristics. The recent data support that active surveillance of low-risk PTMC should be the initial treatment modality, because only a small percentage of low-risk PTMCs show signs of progression, and delayed surgery has not caused significant recurrence. However, recent management guidelines are shifting toward more conservative treatments, such as active surveillance. Although there is an increase in the number of studies related to active surveillance, prospective studies have been mostly from academic referral centers in Japan. The world still needs class 1 evidence extended prospective studies originating from different geographic regions. Active surveillance may be a good alternative to immediate surgery for appropriately selected patients with PTMC.
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18
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Luo J, Deziel NC, Huang H, Chen Y, Ni X, Ma S, Udelsman R, Zhang Y. Cell phone use and risk of thyroid cancer: a population-based case-control study in Connecticut. Ann Epidemiol 2018; 29:39-45. [PMID: 30446214 DOI: 10.1016/j.annepidem.2018.10.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 09/11/2018] [Accepted: 10/20/2018] [Indexed: 12/23/2022]
Abstract
PURPOSE This study aims to investigate the association between cell phone use and thyroid cancer. METHODS A population-based case-control study was conducted in Connecticut between 2010 and 2011 including 462 histologically confirmed thyroid cancer cases and 498 population-based controls. Multivariate unconditional logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (95% CIs) for associations between cell phone use and thyroid cancer. RESULTS Cell phone use was not associated with thyroid cancer (OR: 1.05, 95% CI: 0.74-1.48). A suggestive increase in risk of thyroid microcarcinoma (tumor size ≤10 mm) was observed for long-term and more frequent users. Compared with cell phone nonusers, several groups had nonstatistically significantly increased risk of thyroid microcarcinoma: individuals who had used a cell phone >15 years (OR: 1.29, 95% CI: 0.83-2.00), who had used a cell phone >2 hours per day (OR: 1.40, 95% CI: 0.83-2.35), who had the most cumulative use hours (OR: 1.58, 95% CI: 0.98-2.54), and who had the most cumulative calls (OR: 1.20, 95% CI: 0.78-1.84). CONCLUSIONS This study found no significant association between cell phone use and thyroid cancer. A suggestive elevated risk of thyroid microcarcinoma associated with long-term and more frequent uses warrants further investigation.
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Affiliation(s)
- Jiajun Luo
- Department of Surgery, Yale School of Medicine, New Haven, CT
| | - Nicole C Deziel
- Department of Environmental Health Sciences, Yale School of Public Health, New Haven, CT
| | - Huang Huang
- Department of Surgery, Yale School of Medicine, New Haven, CT
| | - Yingtai Chen
- National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xin Ni
- Department of Otorhinolaryngology, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Shuangge Ma
- Department of Biostatistics, Yale School of Public Health, New Haven, CT
| | - Robert Udelsman
- Endocrine Neoplasm Institute, Miami Cancer Institute, Miami, FL
| | - Yawei Zhang
- Department of Surgery, Yale School of Medicine, New Haven, CT; Department of Environmental Health Sciences, Yale School of Public Health, New Haven, CT.
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Harris MA, Kirkham TL, MacLeod JS, Tjepkema M, Peters PA, Demers PA. Surveillance of cancer risks for firefighters, police, and armed forces among men in a Canadian census cohort. Am J Ind Med 2018; 61:815-823. [PMID: 30073696 DOI: 10.1002/ajim.22891] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND Firefighters, police, and armed services may be exposed to hazards such as combustion by-products and shift work. METHODS The CanCHEC cohort linked 1991 census data to the Canadian cancer registry for follow up. Cox proportional hazards modeling was used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) to estimate risks for firefighter, police, or armed forces compared to workers in other occupations. RESULTS The cohort of 1 108 410 men included 4535 firefighters, 10 055 police, and 9165 armed forces. For firefighters, elevated risks were noted for Hodgkin's lymphoma (HR: 2.89, 95%CI: 1.29-6.46), melanoma (HR: 1.67, 95%CI: 1.17-2.37), and prostate cancer (HR: 1.18, 95%CI: 1.01-1.37). Police had elevated risks for melanoma (HR:1.69, 95%CI: 1.32-2.16) and prostate cancer (HR:1.28, 95%CI: 1.14-1.42). No significant associations were found for armed forces workers. CONCLUSIONS Canadian firefighters, police, and armed services, may be at an increased risk of developing certain cancers. Results suggested that a healthy worker effect may influence risk estimates.
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Affiliation(s)
- M. Anne Harris
- School of Occupational and Public Health; Ryerson University; Toronto Ontario Canada
- Dalla Lana School of Public Health; University of Toronto; Toronto Ontario Canada
- Occupational Cancer Research Centre; Cancer Care Ontario; Toronto Ontario Canada
| | - Tracy L. Kirkham
- Dalla Lana School of Public Health; University of Toronto; Toronto Ontario Canada
| | - Jill S. MacLeod
- Occupational Cancer Research Centre; Cancer Care Ontario; Toronto Ontario Canada
| | - Michael Tjepkema
- Statistics Canada; Health Analysis Division; Toronto Ontario Canada
| | - Paul A. Peters
- Department of Health Sciences; Carleton University; Toronto Ontario Canada
| | - Paul A. Demers
- Dalla Lana School of Public Health; University of Toronto; Toronto Ontario Canada
- Occupational Cancer Research Centre; Cancer Care Ontario; Toronto Ontario Canada
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20
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Furuya-Kanamori L, Sedrakyan A, Onitilo AA, Bagheri N, Glasziou P, Doi SAR. Differentiated thyroid cancer: millions spent with no tangible gain? Endocr Relat Cancer 2018; 25:51-57. [PMID: 29042396 DOI: 10.1530/erc-17-0397] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 10/17/2017] [Indexed: 11/08/2022]
Abstract
The incidence of differentiated thyroid cancer (DTC) has rapidly increased worldwide over the last decades. It is unknown if the increase in diagnosis has been mirrored by an increase in thyroidectomy rates with the concomitant economic impact that this would have on the health care system. DTC and thyroidectomy incidence as well as DTC-specific mortality were modeled using Poisson regression in New South Wales (NSW), Australia per year and by sex. The incidence of 2002 was the point from which the increase in rates was assessed cumulatively over the subsequent decade. The economic burden of potentially avoidable thyroidectomies due to the increase in diagnosis was estimated as the product of the additional thyroidectomy procedures during a decade attributable to rates beyond those reported for 2002 and the national average hospital cost of an uncomplicated thyroidectomy in Australia. The following results were obtained. The incidence of both DTC and thyroidectomy doubled in NSW between 2003 and 2012, while the DTC-specific mortality rate remained unchanged over the same period. Based on the 2002 incidence, the projected increase over 10 years (2003-2012) in thyroidectomy procedures was 2196. This translates to an extra cost burden of over AUD$ 18,600,000 in surgery-related health care expenditure over one decade in NSW. Our findings suggest that, if this rise is solely attributable to overdetection, then the rising expenditure serves no additional purpose. Reducing unnecessary detection and a conservative approach to managing DTC are sensible and would lead to millions of dollars in savings and reduced harms to patients.
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Affiliation(s)
- Luis Furuya-Kanamori
- Department of Population MedicineCollege of Medicine, Qatar University, Doha, Qatar
| | - Art Sedrakyan
- Research School of Population HealthAustralian National University, Canberra, ACT, Australia
- Department of Healthcare Policy and ResearchWeill Cornell Medicine, New York, New York, USA
| | - Adedayo A Onitilo
- Department of Hematology/OncologyMarshfield Clinic Weston Center, Weston, Wisconsin, USA
| | - Nasser Bagheri
- Research School of Population HealthAustralian National University, Canberra, ACT, Australia
| | - Paul Glasziou
- Centre for Research in Evidence Based PracticeBond University, Gold Coast, QLD, Australia
| | - Suhail A R Doi
- Department of Population MedicineCollege of Medicine, Qatar University, Doha, Qatar
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Sanabria A, Kowalski LP, Shah JP, Nixon IJ, Angelos P, Williams MD, Rinaldo A, Ferlito A. Growing incidence of thyroid carcinoma in recent years: Factors underlying overdiagnosis. Head Neck 2017; 40:855-866. [PMID: 29206325 DOI: 10.1002/hed.25029] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Revised: 09/24/2017] [Accepted: 10/25/2017] [Indexed: 01/03/2023] Open
Abstract
There is an increasing incidence of well-differentiated thyroid cancer worldwide. Much of the increase is secondary to increased detection of small, low-risk tumors, with questionable clinical significance. This review addresses the factors that contribute to the increasing incidence and considers environmental, and patient-based and clinician-led influences. Articles addressing the causes of the increased incidence were critically reviewed. A complex interplay of environmental, medical, and social pressures has resulted in increased awareness of the thyroid disease risk, increased screening of thyroid cancers, and increased diagnosis of thyroid cancers. Although there is evidence to suggest that the true disease incidence may be changing slightly, most of the increase is related to factors that promote early diagnosis of low-risk lesions, which is resulting in a significant phenomenon of overdiagnosis. An improved understanding of these pressures at a global level will enable healthcare policymakers to react appropriately to this challenge in the future.
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Affiliation(s)
- Alvaro Sanabria
- Department of Surgery, School of Medicine, Universidad de Antioquia, Clinica Vida/Instituto de Cancerología Las Americas, Medellin, Colombia, South America
| | - Luiz P Kowalski
- Department of Head and Neck Surgery and Otorhinolaryngology, A.C. Camargo Cancer Center, Sao Paulo, SP, Brazil
| | - Jatin P Shah
- Department of Head and Neck Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - Peter Angelos
- Department of Surgery, University of Chicago, Chicago, Illinois
| | - Michelle D Williams
- Department of Pathology, Division of Pathology/Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | - Alfio Ferlito
- Coordinator of the International Head and Neck Scientific Group
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22
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Barry KH, Martinsen JI, Alavanja MCR, Andreotti G, Blair A, Hansen J, Kjærheim K, Koutros S, Lynge E, Sparèn P, Tryggvadottir L, Weiderpass E, Berndt SI, Pukkala E. Risk of early-onset prostate cancer associated with occupation in the Nordic countries. Eur J Cancer 2017; 87:92-100. [PMID: 29132062 PMCID: PMC6312186 DOI: 10.1016/j.ejca.2017.09.023] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 09/14/2017] [Accepted: 09/18/2017] [Indexed: 11/24/2022]
Abstract
BACKGROUND Early-onset prostate cancer is often more aggressive and may have a different aetiology than later-onset prostate cancer, but has been relatively little studied to date. We evaluated occupation in relation to early- and later-onset prostate cancer in a large pooled study. METHODS We used occupational information from census data in five Nordic countries from 1960 to 1990. We identified prostate cancer cases diagnosed from 1961 to 2005 by linkage of census information to national cancer registries and calculated standardised incidence ratios (SIRs) separately for men aged 30-49 and those aged 50 or older. We also conducted separate analyses by period of follow-up, 1961-1985 and 1986-2005, corresponding to pre- and post-prostate-specific antigen (PSA) screening. RESULTS For early-onset prostate cancer (n = 1521), we observed the highest SIRs for public safety workers (e.g. firefighters) (SIR = 1.71, 95% confidence interval [CI]: 1.23-2.31) and military personnel (SIR = 1.97, 95% CI: 1.31-2.85). These SIRs were significantly higher than the SIRs for later-onset disease (for public safety workers, SIR = 1.10, 95% CI: 1.07-1.14 and for military personnel, SIR = 1.09, 95% CI: 1.05-1.13; pheterogeneity = 0.005 and 0.002, respectively). Administrators and technical workers also demonstrated significantly increased risks for early-onset prostate cancer, but the SIRs did not differ from those of later-onset disease (pheterogeneity >0.05). While our early-onset finding for public safety workers was restricted to the post-PSA period, that for military personnel was restricted to the pre-PSA period. CONCLUSION Our results suggest that occupational exposures, particularly for military personnel, may be associated with early-onset prostate cancer. Further evaluation is needed to explain these findings.
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Affiliation(s)
- Kathryn Hughes Barry
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA; Program in Oncology, University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center, Baltimore, MD, USA; Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.
| | - Jan Ivar Martinsen
- Department of Research, Cancer Registry of Norway - Institute of Population-Based Cancer Research, Oslo, Norway
| | - Michael C R Alavanja
- Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Gabriella Andreotti
- Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Aaron Blair
- Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Johnni Hansen
- Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Kristina Kjærheim
- Department of Research, Cancer Registry of Norway - Institute of Population-Based Cancer Research, Oslo, Norway
| | - Stella Koutros
- Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | | | - Pär Sparèn
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Laufey Tryggvadottir
- Icelandic Cancer Registry, Icelandic Cancer Society, Reykjavik, Iceland; Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Elisabete Weiderpass
- Department of Research, Cancer Registry of Norway - Institute of Population-Based Cancer Research, Oslo, Norway; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Genetic Epidemiology Group, Folkhälsan Research Center, Helsinki, Finland; Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, The Arctic University of Norway, Tromsø, Norway
| | - Sonja I Berndt
- Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Eero Pukkala
- Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland; Faculty of Social Sciences, University of Tampere, Tampere, Finland
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Bautista CT, Wurapa EK, Sateren WB, Morris SM, Hollingsworth BP, Sanchez JL. Repeat infection with Neisseria gonorrhoeae among active duty U.S. Army personnel: a population-based case-series study. Int J STD AIDS 2016; 28:962-968. [PMID: 27885067 PMCID: PMC5542132 DOI: 10.1177/0956462416681940] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Little information is known on the rate of repeat gonorrhea infection among U.S. military personnel. We analyzed all gonorrhea cases reported to the Defense Medical Surveillance System during 2006–2012 to determine the rate of repeat infection. During the seven-year study period, 17,602 active duty U.S. Army personnel with a first incident gonorrhea infection were reported. Among the 4987 women with a first gonorrhea infection, 14.4% had at least one repeat infection. Among the 12,615 men with a first gonorrhea infection, 13.7% had at least one repeat infection. Overall, the rate of repeat gonorrhea infection was 44.5 and 48.9 per 1000 person-years for women and men, respectively. Service members aged 17–19 years (hazard ratio [HR] for women = 1.51; HR for men = 1.71), African-American personnel (HR for women = 1.26; HR for men = 2.17), junior enlisted personnel (HR for women = 2.64; HR for men = 1.37), and those with one year or less of service (HR for women = 1.23; HR for men = 1.37) were at higher risk of repeat infection. The findings from this study highlight the need to develop targeted prevention initiatives including education, counseling, and retesting to prevent gonorrhea reinfections among U.S. Army personnel.
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Affiliation(s)
| | - Eyako K Wurapa
- 2 Infectious Disease Research Branch, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Warren B Sateren
- 2 Infectious Disease Research Branch, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Sara M Morris
- 1 Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | | | - Jose L Sanchez
- 3 Armed Forces Health Surveillance Branch, Public Health Division, Defense Health Agency, Silver Spring, MD, USA
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24
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Leboulleux S, Tuttle RM, Pacini F, Schlumberger M. Papillary thyroid microcarcinoma: time to shift from surgery to active surveillance? Lancet Diabetes Endocrinol 2016; 4:933-942. [PMID: 27550849 DOI: 10.1016/s2213-8587(16)30180-2] [Citation(s) in RCA: 152] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 07/01/2016] [Accepted: 07/05/2016] [Indexed: 02/08/2023]
Abstract
The incidence of differentiated thyroid cancer is increasing greatly in high-income countries. Roughly 50% of this increase is attributable to the identification of intrathyroidal papillary thyroid microcarcinomas. Since mortality associated with these tumours remains low and stable, the increasing diagnosis has led to concerns about overdiagnosis and overtreatment. Management of papillary thyroid microcarcinomas should take into account the reported absence of mortality when diagnosed in the absence of lymph node metastases and distant metastases, as shown even in recent studies promoting active surveillance; a low recurrence rate of 1-5%; and the risk of permanent complications from surgery that cannot be decreased to less than 1-3%, even in high-volume tertiary care centres with experienced surgeons. On the basis of these data, active surveillance with curative intent, in which active treatment is delayed until the cancer shows signs of significant progression to avoid side-effects of treatment, should be considered in properly selected patients.
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Affiliation(s)
- Sophie Leboulleux
- Department of Nuclear Medicine and Endocrine Oncology, Gustave Roussy and Université Paris Saclay, Villejuif, France.
| | - R Michael Tuttle
- Endocrinology Service, Memorial Sloan Kettering Cancer Center (MSKCC), New York, NY, USA
| | - Furio Pacini
- Section of Endocrinology, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Martin Schlumberger
- Department of Nuclear Medicine and Endocrine Oncology, Gustave Roussy and Université Paris Saclay, Villejuif, France
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25
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Latrofa F, Ricci D, Sisti E, Piaggi P, Nencetti C, Marinò M, Vitti P. Significance of Low Levels of Thyroglobulin Autoantibodies Associated with Undetectable Thyroglobulin After Thyroidectomy for Differentiated Thyroid Carcinoma. Thyroid 2016; 26:798-806. [PMID: 27020734 DOI: 10.1089/thy.2015.0621] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND The management of patients with differentiated thyroid carcinoma (DTC) showing low levels of serum thyroglobulin autoantibodies (TgAb) and undetectable Tg after thyroidectomy is unsettled. This study sought to elucidate the clinical significance of low levels of TgAb and to evaluate their interference with Tg measurement in vitro. METHODS Tg and TgAb levels were correlated with the post-thyroidectomy staging of 177 consecutive DTC patients undergoing (131)I ablation after total thyroidectomy (clinical study). Tg was measured by an immunometric assay (functional sensitivity: 0.1 ng/mL), and TgAb were evaluated by six assays (functional sensitivities: 1.2-96 IU/mL; positive cutoffs: 4-150 IU/mL). The changes in Tg concentration (Tg recovery) of diluted specimens from DTC patients were also measured after incubation with 67 sera from DTC patients with undetectable Tg and low levels of TgAb (in vitro study). DTC sera containing Tg were diluted serially (from 330 to 0.1 ng/mL) and incubated with TgAb samples; Tg was then measured. RESULTS In the clinical study: all patients had residual thyroid tissue, and 10 had metastatic disease. Depending on the TgAb assay, median Tg values were 7.0-10.9, 0.0-5.3, and 0.0-0.0 ng/mL in patients with undetectable, borderline (between functional sensitivities and positive cutoffs), and positive TgAb, respectively (p < 0.001). An undetectable Tg value was associated with borderline levels of TgAb in five assays. Only two patients with metastatic disease had undetectable Tg; both were TgAb positive by three or more assays. Conversely, no patient with undetectable Tg and undetectable or borderline TgAb by sensitive assays had metastatic disease. In the in vitro study, TgAb interfered significantly with Tg recovery (p < 0.001), but low levels of TgAb did not abolish Tg recovery. CONCLUSIONS While low levels of TgAb do not preclude Tg measurement in vitro, they can be associated with an undetectable Tg in DTC patients with residual thyroid tissue after thyroidectomy. However, the finding of low levels of TgAb by sensitive assays associated with an undetectable Tg rules out metastatic disease.
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Affiliation(s)
- Francesco Latrofa
- 1 Endocrinology Unit I, Department of Clinical and Experimental Medicine, University Hospital of Pisa , Pisa, Italy
| | - Debora Ricci
- 1 Endocrinology Unit I, Department of Clinical and Experimental Medicine, University Hospital of Pisa , Pisa, Italy
| | - Eleonora Sisti
- 1 Endocrinology Unit I, Department of Clinical and Experimental Medicine, University Hospital of Pisa , Pisa, Italy
| | - Paolo Piaggi
- 2 Phoenix Epidemiology and Clinical Research Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health , Phoenix, Arizona
| | - Chiara Nencetti
- 1 Endocrinology Unit I, Department of Clinical and Experimental Medicine, University Hospital of Pisa , Pisa, Italy
| | - Michele Marinò
- 1 Endocrinology Unit I, Department of Clinical and Experimental Medicine, University Hospital of Pisa , Pisa, Italy
| | - Paolo Vitti
- 1 Endocrinology Unit I, Department of Clinical and Experimental Medicine, University Hospital of Pisa , Pisa, Italy
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Diagnostic radiography exposure increases the risk for thyroid microcarcinoma: a population-based case-control study. Eur J Cancer Prev 2016; 24:439-46. [PMID: 25932870 DOI: 10.1097/cej.0000000000000169] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Thyroid cancer incidence and diagnostic radiography exposures, particularly computed tomography (CT) scanning and nuclear medicine examinations, have increased substantially in the USA. However, very few epidemiologic studies have directly investigated their associations. A population-based case-control study was conducted in Connecticut in 2010-2011, including 462 histologically confirmed incident thyroid cancer cases and 498 population-based controls. Multivariate unconditional logistic regression models were used to estimate the associations between diagnostic radiography and the risk of thyroid cancer, controlling for potential confounding factors. Exposure to any form of diagnostic radiography was associated with an increased risk of well-differentiated thyroid microcarcinoma [tumor size≤10 mm, odds ratio (OR)=2.76, 95% confidence interval (CI): 1.31-5.81]. The highest risk increase occurred with nuclear medicine examinations (excluding cardiology tests and thyroid uptake studies; OR=5.47, 95% CI: 2.10-14.23), followed by chest CT scanning (OR=4.30, 95% CI: 1.66-11.14), head and neck CT scanning (OR=3.88, 95% CI: 1.75-8.63), upper gastrointestinal series (OR=3.56, 95% CI: 1.54-8.21), lower gastrointestinal series (OR=3.29, 95% CI: 1.41-7.66), kidney radiography involving dye injection into a vein or artery (OR=3.21, 95% CI: 1.20-8.54), mammography (OR=2.95, 95% CI: 1.14-7.61), chest radiography (OR=2.93, 95% CI: 1.37-6.29), and abdomen CT scanning (OR=2.54, 95% CI: 1.02-6.30). No significant associations were found between these imaging modalities and thyroid tumors larger than 10 mm. This study provides the first direct evidence that CT scanning and nuclear medicine examinations are associated with an increased risk of thyroid cancer. The novel finding that an array of diagnostic radiography procedures are associated with thyroid microcarcinomas warrants further investigation.
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Ukrainski MB, Pribitkin EA, Miller JL. Increasing Incidence of Thyroid Nodules and Thyroid Cancer: Does Increased Detection of a Subclinical Reservoir Justify the Associated Anxiety and Treatment? Clin Ther 2015; 38:976-85. [PMID: 26434793 DOI: 10.1016/j.clinthera.2015.07.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Revised: 07/10/2015] [Accepted: 07/16/2015] [Indexed: 02/04/2023]
Abstract
The incidence of thyroid cancer has been increasing over the last few decades, and it is subject to debate regarding whether the incidence is reflective of better diagnostic techniques and therefore better detection or if it is a reflection of a true increase in incidence. This increase in incidence has been most clearly manifested by an exponential increase in the diagnosis of micropapillary thyroid carcinomas. This article reviews the diagnosis of thyroid cancers, the dilemmas facing clinicians in the management of these micropapillary thyroid carcinomas, and the advances in molecular diagnostics that are being used to assist in the decision-making process. We consider the possibility of overtreatment of a relatively indolent disease and propose a less aggressive management plan in the appropriate clinical scenario.
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Affiliation(s)
- Melinda B Ukrainski
- Division of Endocrinology, Diabetes & Metabolic Diseases, Sidney Kimmel Medical College at Thomas Jefferson University and Hospital, Philadelphia, Pennsylvania.
| | - E A Pribitkin
- Department of Otolaryngology, Sidney Kimmel Medical College at Thomas Jefferson University and Hospital, Philadelphia, Pennsylvania
| | - J L Miller
- Division of Endocrinology, Diabetes & Metabolic Diseases, Sidney Kimmel Medical College at Thomas Jefferson University and Hospital, Philadelphia, Pennsylvania
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28
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Meza R, Chang JT. Multistage carcinogenesis and the incidence of thyroid cancer in the US by sex, race, stage and histology. BMC Public Health 2015; 15:789. [PMID: 26282269 PMCID: PMC4539703 DOI: 10.1186/s12889-015-2108-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Accepted: 07/28/2015] [Indexed: 12/18/2022] Open
Abstract
Background Thyroid cancer has the fastest growing incidence in the US. However, the underlying causes are still under debate. Methods We analyzed thyroid cancer incidence in the SEER-9 registry from 1973-2010 using multistage carcinogenesis and age-period-cohort models. Multistage models were used to investigate differences in initiation, promotion and malignant conversion rates of thyroid tumors by sex, race, stage, and histology. Models were adjusted for period and cohort trends to investigate the contributions of each factor, and determine whether birth- or diagnosis-year better correlate with observed incidence patterns. Results Significant increases in thyroid cancer incidence by period or calendar-year were found for all sex, race, stage and histology combinations, particularly for localized cases (a 3- and 4-fold increase from 1973-2010 for females and males, respectively). Multistage analyses suggest that the 3-fold higher incidence in women could be explained by 1.5-fold higher initiation and promotion rates. Analyses by race suggest that the lower incidence in blacks can be attributed to lower promotion rates versus whites. Analysis by histology showed considerable decreases in follicular cancer incidence by birth-cohort since the early 1900s. Conclusions Multistage modeling suggests that variations in thyroid cancer initiation and promotion can explain the observed differences in incidence by sex, race and histology. The consistent increases in incidence by calendar-year for all sex-race-histology-stage combinations suggest that the rise may be predominantly due to more intensive screening-diagnostics, although an environmental factor may be also at play. Our analyses constitute a first step towards the development of thyroid cancer natural history models. Electronic supplementary material The online version of this article (doi:10.1186/s12889-015-2108-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Rafael Meza
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan, SPH II, Room 5533, 1415 Washington Heights, Ann Arbor, MI, 48109-2029, USA.
| | - Joanne T Chang
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan, SPH II, Room 5533, 1415 Washington Heights, Ann Arbor, MI, 48109-2029, USA.
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29
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Ferrari SM, Politti U, Spisni R, Materazzi G, Baldini E, Ulisse S, Miccoli P, Antonelli A, Fallahi P. Sorafenib in the treatment of thyroid cancer. Expert Rev Anticancer Ther 2015; 15:863-74. [PMID: 26152651 DOI: 10.1586/14737140.2015.1064770] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Sorafenib has been evaluated in several Phase II and III studies in patients with locally advanced/metastatic radioactive iodine-refractory differentiated thyroid carcinomas (DTCs), reporting partial responses, stabilization of the disease and improvement of progression-free survival. Best responses were observed in lung metastases and minimal responses in bone lesions. On the basis of these studies, sorafenib was approved for the treatment of metastatic DTC in November 2013. Few studies suggested that reduction of thyroglobulin levels, or of average standardized uptake value at the fluorodeoxyglucose-PET, could be helpful for the identification of responding patients; but further studies are needed to confirm these results. Tumor genetic marker levels did not have any prognostic or predictive role in DTC patients.The most common adverse events observed included skin toxicity and gastrointestinal and constitutional symptoms. Encouraging results have also been observed in patients with medullary thyroid cancer. Many studies are ongoing to evaluate the long-term efficacy and tolerability of sorafenib in DTC patients.
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Affiliation(s)
- Silvia Martina Ferrari
- Department of Clinical and Experimental Medicine, University of Pisa, Via Savi, 10, 56126, Pisa, Italy
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30
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Choi H, Lim JA, Ahn HY, Cho SW, Lee KE, Kim KW, Yi KH, Sung MW, Youn YK, Chung JK, Park YJ, Park DJ, Cho BY. Secular trends in the prognostic factors for papillary thyroid cancer. Eur J Endocrinol 2014; 171:667-75. [PMID: 25163726 DOI: 10.1530/eje-14-0225] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE With the recent increasing rates of screening for thyroid cancer, the cancers now tend to be smaller and less aggressive than those that are diagnosed when presented with symptoms, suggesting changes in the clinical validity of conventional prognostic factors for outcomes. We performed the retrospective study to identify the secular trends in the prognostic factors of thyroid cancer. METHODS We used medical records of 3147 patients diagnosed with papillary thyroid cancer (PTC) at the Seoul National University Hospital Thyroid Cancer Clinic between 1962 and 2009. RESULTS During the median 5.1-year follow-up, the overall recurrence rate was 13.3%, and male sex, tumor size, lymph node (LN) involvement, and extrathyroidal extension (ETE) were the significant prognostic factors for recurrence. Thyroid cancer-specific mortality was 1.4%, and the associated prognostic factors were older age, male sex, and LN involvement. For tumor recurrence, the hazard ratio (HR) for male sex decreased from 2.809 (95% CI, 1.497-5.269) in the pre-1989 period to 1.142 (95% CI, 0.736-1.772) in the post-1999 period. The pathologic characteristics, such as tumor size, LN involvement, and ETE, showed similar or increasing HRs over the time periods. For cancer-specific mortality, the HR for male sex decreased from 6.460 (95% CI, 1.714-24.348) in the pre-1990 period to 0.781 (95% CI, 0.083-7.379) in the post-1999 period. CONCLUSION The risk for poor outcomes in PTC associated with male sex decreased over time; in contrast, the risk associated with pathologic characteristics remained the same or increased over time. These trends might be associated with recent changes in the characteristics of patients with thyroid cancer.
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Affiliation(s)
- Hoonsung Choi
- Department of Internal MedicineSeoul National University College of Medicine, Seoul, KoreaDepartment of Internal MedicineChung-Ang University College of Medicine, Seoul, KoreaDepartment of Internal MedicineNational Medical Center, Seoul, KoreaDepartment of Surgery and Cancer Research InstituteSeoul National University College of Medicine, Seoul, KoreaDepartment of Otorhinolaryngology and Head and Neck SurgerySeoul National University College of Medicine, Seoul, KoreaDepartment of SurgeryNational Medical Center, Seoul, KoreaDepartment of Nuclear MedicineSeoul National University College of Medicine, Seoul, Korea
| | - Jung Ah Lim
- Department of Internal MedicineSeoul National University College of Medicine, Seoul, KoreaDepartment of Internal MedicineChung-Ang University College of Medicine, Seoul, KoreaDepartment of Internal MedicineNational Medical Center, Seoul, KoreaDepartment of Surgery and Cancer Research InstituteSeoul National University College of Medicine, Seoul, KoreaDepartment of Otorhinolaryngology and Head and Neck SurgerySeoul National University College of Medicine, Seoul, KoreaDepartment of SurgeryNational Medical Center, Seoul, KoreaDepartment of Nuclear MedicineSeoul National University College of Medicine, Seoul, Korea
| | - Hwa Young Ahn
- Department of Internal MedicineSeoul National University College of Medicine, Seoul, KoreaDepartment of Internal MedicineChung-Ang University College of Medicine, Seoul, KoreaDepartment of Internal MedicineNational Medical Center, Seoul, KoreaDepartment of Surgery and Cancer Research InstituteSeoul National University College of Medicine, Seoul, KoreaDepartment of Otorhinolaryngology and Head and Neck SurgerySeoul National University College of Medicine, Seoul, KoreaDepartment of SurgeryNational Medical Center, Seoul, KoreaDepartment of Nuclear MedicineSeoul National University College of Medicine, Seoul, Korea
| | - Sun Wook Cho
- Department of Internal MedicineSeoul National University College of Medicine, Seoul, KoreaDepartment of Internal MedicineChung-Ang University College of Medicine, Seoul, KoreaDepartment of Internal MedicineNational Medical Center, Seoul, KoreaDepartment of Surgery and Cancer Research InstituteSeoul National University College of Medicine, Seoul, KoreaDepartment of Otorhinolaryngology and Head and Neck SurgerySeoul National University College of Medicine, Seoul, KoreaDepartment of SurgeryNational Medical Center, Seoul, KoreaDepartment of Nuclear MedicineSeoul National University College of Medicine, Seoul, Korea Department of Internal MedicineSeoul National University College of Medicine, Seoul, KoreaDepartment of Internal MedicineChung-Ang University College of Medicine, Seoul, KoreaDepartment of Internal MedicineNational Medical Center, Seoul, KoreaDepartment of Surgery and Cancer Research InstituteSeoul National University College of Medicine, Seoul, KoreaDepartment of Otorhinolaryngology and Head and Neck SurgerySeoul National University College of Medicine, Seoul, KoreaDepartment of SurgeryNational Medical Center, Seoul, KoreaDepartment of Nuclear MedicineSeoul National University College of Medicine, Seoul, Korea
| | - Kyu Eun Lee
- Department of Internal MedicineSeoul National University College of Medicine, Seoul, KoreaDepartment of Internal MedicineChung-Ang University College of Medicine, Seoul, KoreaDepartment of Internal MedicineNational Medical Center, Seoul, KoreaDepartment of Surgery and Cancer Research InstituteSeoul National University College of Medicine, Seoul, KoreaDepartment of Otorhinolaryngology and Head and Neck SurgerySeoul National University College of Medicine, Seoul, KoreaDepartment of SurgeryNational Medical Center, Seoul, KoreaDepartment of Nuclear MedicineSeoul National University College of Medicine, Seoul, Korea
| | - Kyung Won Kim
- Department of Internal MedicineSeoul National University College of Medicine, Seoul, KoreaDepartment of Internal MedicineChung-Ang University College of Medicine, Seoul, KoreaDepartment of Internal MedicineNational Medical Center, Seoul, KoreaDepartment of Surgery and Cancer Research InstituteSeoul National University College of Medicine, Seoul, KoreaDepartment of Otorhinolaryngology and Head and Neck SurgerySeoul National University College of Medicine, Seoul, KoreaDepartment of SurgeryNational Medical Center, Seoul, KoreaDepartment of Nuclear MedicineSeoul National University College of Medicine, Seoul, Korea
| | - Ka Hee Yi
- Department of Internal MedicineSeoul National University College of Medicine, Seoul, KoreaDepartment of Internal MedicineChung-Ang University College of Medicine, Seoul, KoreaDepartment of Internal MedicineNational Medical Center, Seoul, KoreaDepartment of Surgery and Cancer Research InstituteSeoul National University College of Medicine, Seoul, KoreaDepartment of Otorhinolaryngology and Head and Neck SurgerySeoul National University College of Medicine, Seoul, KoreaDepartment of SurgeryNational Medical Center, Seoul, KoreaDepartment of Nuclear MedicineSeoul National University College of Medicine, Seoul, Korea
| | - Myung-Whun Sung
- Department of Internal MedicineSeoul National University College of Medicine, Seoul, KoreaDepartment of Internal MedicineChung-Ang University College of Medicine, Seoul, KoreaDepartment of Internal MedicineNational Medical Center, Seoul, KoreaDepartment of Surgery and Cancer Research InstituteSeoul National University College of Medicine, Seoul, KoreaDepartment of Otorhinolaryngology and Head and Neck SurgerySeoul National University College of Medicine, Seoul, KoreaDepartment of SurgeryNational Medical Center, Seoul, KoreaDepartment of Nuclear MedicineSeoul National University College of Medicine, Seoul, Korea
| | - Yeo-Kyu Youn
- Department of Internal MedicineSeoul National University College of Medicine, Seoul, KoreaDepartment of Internal MedicineChung-Ang University College of Medicine, Seoul, KoreaDepartment of Internal MedicineNational Medical Center, Seoul, KoreaDepartment of Surgery and Cancer Research InstituteSeoul National University College of Medicine, Seoul, KoreaDepartment of Otorhinolaryngology and Head and Neck SurgerySeoul National University College of Medicine, Seoul, KoreaDepartment of SurgeryNational Medical Center, Seoul, KoreaDepartment of Nuclear MedicineSeoul National University College of Medicine, Seoul, Korea Department of Internal MedicineSeoul National University College of Medicine, Seoul, KoreaDepartment of Internal MedicineChung-Ang University College of Medicine, Seoul, KoreaDepartment of Internal MedicineNational Medical Center, Seoul, KoreaDepartment of Surgery and Cancer Research InstituteSeoul National University College of Medicine, Seoul, KoreaDepartment of Otorhinolaryngology and Head and Neck SurgerySeoul National University College of Medicine, Seoul, KoreaDepartment of SurgeryNational Medical Center, Seoul, KoreaDepartment of Nuclear MedicineSeoul National University College of Medicine, Seoul, Korea
| | - June-Key Chung
- Department of Internal MedicineSeoul National University College of Medicine, Seoul, KoreaDepartment of Internal MedicineChung-Ang University College of Medicine, Seoul, KoreaDepartment of Internal MedicineNational Medical Center, Seoul, KoreaDepartment of Surgery and Cancer Research InstituteSeoul National University College of Medicine, Seoul, KoreaDepartment of Otorhinolaryngology and Head and Neck SurgerySeoul National University College of Medicine, Seoul, KoreaDepartment of SurgeryNational Medical Center, Seoul, KoreaDepartment of Nuclear MedicineSeoul National University College of Medicine, Seoul, Korea
| | - Young Joo Park
- Department of Internal MedicineSeoul National University College of Medicine, Seoul, KoreaDepartment of Internal MedicineChung-Ang University College of Medicine, Seoul, KoreaDepartment of Internal MedicineNational Medical Center, Seoul, KoreaDepartment of Surgery and Cancer Research InstituteSeoul National University College of Medicine, Seoul, KoreaDepartment of Otorhinolaryngology and Head and Neck SurgerySeoul National University College of Medicine, Seoul, KoreaDepartment of SurgeryNational Medical Center, Seoul, KoreaDepartment of Nuclear MedicineSeoul National University College of Medicine, Seoul, Korea
| | - Do Joon Park
- Department of Internal MedicineSeoul National University College of Medicine, Seoul, KoreaDepartment of Internal MedicineChung-Ang University College of Medicine, Seoul, KoreaDepartment of Internal MedicineNational Medical Center, Seoul, KoreaDepartment of Surgery and Cancer Research InstituteSeoul National University College of Medicine, Seoul, KoreaDepartment of Otorhinolaryngology and Head and Neck SurgerySeoul National University College of Medicine, Seoul, KoreaDepartment of SurgeryNational Medical Center, Seoul, KoreaDepartment of Nuclear MedicineSeoul National University College of Medicine, Seoul, Korea
| | - Bo Youn Cho
- Department of Internal MedicineSeoul National University College of Medicine, Seoul, KoreaDepartment of Internal MedicineChung-Ang University College of Medicine, Seoul, KoreaDepartment of Internal MedicineNational Medical Center, Seoul, KoreaDepartment of Surgery and Cancer Research InstituteSeoul National University College of Medicine, Seoul, KoreaDepartment of Otorhinolaryngology and Head and Neck SurgerySeoul National University College of Medicine, Seoul, KoreaDepartment of SurgeryNational Medical Center, Seoul, KoreaDepartment of Nuclear MedicineSeoul National University College of Medicine, Seoul, Korea
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Horn-Ross PL, Lichtensztajn DY, Clarke CA, Dosiou C, Oakley-Girvan I, Reynolds P, Gomez SL, Nelson DO. Continued rapid increase in thyroid cancer incidence in california: trends by patient, tumor, and neighborhood characteristics. Cancer Epidemiol Biomarkers Prev 2014; 23:1067-79. [PMID: 24842625 PMCID: PMC4071298 DOI: 10.1158/1055-9965.epi-13-1089] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Thyroid cancer incidence is increasing worldwide. Incorporating 22 years of incidence data through 2009, we extend examination of these trends among a wide array of subgroups defined by patient (age, sex, race/ethnicity, and nativity), tumor (tumor size and stage), and neighborhood (socioeconomic status and residence in ethnic enclaves) characteristics, to identify possible reasons for this increase. METHODS Thyroid cancer incidence data on 10,940 men and 35,147 women were obtained from the California Cancer Registry for 1988-2009. Population data were obtained from the 1990 and 2000 U.S. Census. Incidence rates and 95% confidence intervals (CI) were calculated and incidence trends were evaluated using Joinpoint regression to evaluate the timing and magnitude of change [annual percentage change (APC) and rate ratios]. RESULTS The incidence of papillary thyroid cancer continues to increase in both men (APC, 5.4; 95% CI, 4.5-6.3 for 1998-2009) and women (APC, 3.8; 95% CI, 3.4-4.2 for 1998-2001 and APC, 6.3; 95% CI, 5.7-6.9 for 2001-2009). Increasing incidence was observed in all subgroups examined. CONCLUSIONS Although some variation in the magnitude or temporality of the increase in thyroid cancer incidence exists across subgroups, the patterns (i) suggest that changes in diagnostic technology alone do not account for the observed trends and (ii) point to the importance of modifiable behavioral, lifestyle, or environmental factors in understanding this epidemic. IMPACT Given the dramatic and continued increase in thyroid cancer incidence rates, studies addressing the causes of these trends are critical. Cancer Epidemiol Biomarkers Prev; 23(6); 1067-79. ©2014 AACR.
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Affiliation(s)
- Pamela L Horn-Ross
- Authors' Affiliations: Cancer Prevention Institute of California, Fremont; Division of Epidemiology, Department of Health Research and Policy and Division of Endocrinology, Department of Medicine; and Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CaliforniaAuthors' Affiliations: Cancer Prevention Institute of California, Fremont; Division of Epidemiology, Department of Health Research and Policy and Division of Endocrinology, Department of Medicine; and Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CaliforniaAuthors' Affiliations: Cancer Prevention Institute of California, Fremont; Division of Epidemiology, Department of Health Research and Policy and Division of Endocrinology, Department of Medicine; and Stanford Cancer Institute, Stanford University School of Medicine, Stanford, California
| | - Daphne Y Lichtensztajn
- Authors' Affiliations: Cancer Prevention Institute of California, Fremont; Division of Epidemiology, Department of Health Research and Policy and Division of Endocrinology, Department of Medicine; and Stanford Cancer Institute, Stanford University School of Medicine, Stanford, California
| | - Christina A Clarke
- Authors' Affiliations: Cancer Prevention Institute of California, Fremont; Division of Epidemiology, Department of Health Research and Policy and Division of Endocrinology, Department of Medicine; and Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CaliforniaAuthors' Affiliations: Cancer Prevention Institute of California, Fremont; Division of Epidemiology, Department of Health Research and Policy and Division of Endocrinology, Department of Medicine; and Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CaliforniaAuthors' Affiliations: Cancer Prevention Institute of California, Fremont; Division of Epidemiology, Department of Health Research and Policy and Division of Endocrinology, Department of Medicine; and Stanford Cancer Institute, Stanford University School of Medicine, Stanford, California
| | - Chrysoula Dosiou
- Authors' Affiliations: Cancer Prevention Institute of California, Fremont; Division of Epidemiology, Department of Health Research and Policy and Division of Endocrinology, Department of Medicine; and Stanford Cancer Institute, Stanford University School of Medicine, Stanford, California
| | - Ingrid Oakley-Girvan
- Authors' Affiliations: Cancer Prevention Institute of California, Fremont; Division of Epidemiology, Department of Health Research and Policy and Division of Endocrinology, Department of Medicine; and Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CaliforniaAuthors' Affiliations: Cancer Prevention Institute of California, Fremont; Division of Epidemiology, Department of Health Research and Policy and Division of Endocrinology, Department of Medicine; and Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CaliforniaAuthors' Affiliations: Cancer Prevention Institute of California, Fremont; Division of Epidemiology, Department of Health Research and Policy and Division of Endocrinology, Department of Medicine; and Stanford Cancer Institute, Stanford University School of Medicine, Stanford, California
| | - Peggy Reynolds
- Authors' Affiliations: Cancer Prevention Institute of California, Fremont; Division of Epidemiology, Department of Health Research and Policy and Division of Endocrinology, Department of Medicine; and Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CaliforniaAuthors' Affiliations: Cancer Prevention Institute of California, Fremont; Division of Epidemiology, Department of Health Research and Policy and Division of Endocrinology, Department of Medicine; and Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CaliforniaAuthors' Affiliations: Cancer Prevention Institute of California, Fremont; Division of Epidemiology, Department of Health Research and Policy and Division of Endocrinology, Department of Medicine; and Stanford Cancer Institute, Stanford University School of Medicine, Stanford, California
| | - Scarlett Lin Gomez
- Authors' Affiliations: Cancer Prevention Institute of California, Fremont; Division of Epidemiology, Department of Health Research and Policy and Division of Endocrinology, Department of Medicine; and Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CaliforniaAuthors' Affiliations: Cancer Prevention Institute of California, Fremont; Division of Epidemiology, Department of Health Research and Policy and Division of Endocrinology, Department of Medicine; and Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CaliforniaAuthors' Affiliations: Cancer Prevention Institute of California, Fremont; Division of Epidemiology, Department of Health Research and Policy and Division of Endocrinology, Department of Medicine; and Stanford Cancer Institute, Stanford University School of Medicine, Stanford, California
| | - David O Nelson
- Authors' Affiliations: Cancer Prevention Institute of California, Fremont; Division of Epidemiology, Department of Health Research and Policy and Division of Endocrinology, Department of Medicine; and Stanford Cancer Institute, Stanford University School of Medicine, Stanford, California
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Abstract
Numerous occupational and environmental exposures have been shown to disrupt thyroid hormones, but much less is known about their relationships with thyroid cancer. Here we review the epidemiology studies of occupations and occupational exposures and thyroid cancer incidence to provide insight into preventable risk factors for thyroid cancer. The published literature was searched using the Web of Knowledge database for all articles through August 2013 that had in their text 'occupation' 'job' 'employment' or 'work' and 'thyroid cancer'. After excluding 10 mortality studies and 4 studies with less than 5 exposed incident cases, we summarised the findings of 30 articles that examined thyroid cancer incidence in relation to occupations or occupational exposure. The studies were grouped by exposure/occupation category, study design and exposure assessment approach. Where available, gender-stratified results are reported. The most studied (19 of 30 studies) and the most consistent associations were observed for radiation-exposed workers and healthcare occupations. Suggestive, but inconsistent, associations were observed in studies of pesticide-exposed workers and agricultural occupations. Findings for other exposures and occupation groups were largely null. The majority of studies had few exposed cases and assessed exposure based on occupation or industry category, self-report, or generic (population-based) job exposure matrices. The suggestive, but inconsistent findings for many of the occupational exposures reviewed here indicate that more studies with larger numbers of cases and better exposure assessment are necessary, particularly for exposures known to disrupt thyroid homeostasis.
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Affiliation(s)
| | - Mary H. Ward
- Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Rockville, MD, USA
| | - Curt T. Della Valle
- Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Rockville, MD, USA
| | - Melissa C. Friesen
- Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Rockville, MD, USA
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Abstract
BACKGROUND The incidence of thyroid cancer has increased at an alarming rate in both men and women in the United States. The etiology of this epidemic is unclear. We tested the hypothesis that a significant component of this epidemic is due to increased detection of occult disease. We examined whether the density of endocrinologists and general surgeons as well as employment of cervical ultrasonography were factors associated with this epidemic. METHODS Thyroid cancer incidence rates by states were obtained from the United States Cancer Statistics 1999-2009 reported by the National Program of Cancer Registries. The densities of endocrinologists and general surgeons and the employment of cervical ultrasonography were calculated on a statewide basis and correlated with the incidence of thyroid cancer. RESULTS Age-standardized incidence rates of thyroid cancer have increased in every state in the United States. Significant regional variations were noted, with the highest incidence rates in the northeast and the lowest in the south. The incidence rates were significantly correlated with the density of endocrinologists (r = 0.58, p<0.0001 for males; r = 0.44, p = 0.0031 for females) and the employment of cervical ultrasonography (r = 0.40, p = 0.0091 for males; r = 0.36, p = 0.0197 for females). Both the density of endocrinologists and general surgeons and employment of cervical ultrasonography could explain 57% of the variability in state-level incidence for males and 49% for females. CONCLUSIONS These data offer evidence to suggest that the epidemic of thyroid cancer is due to increased detection of a reservoir of previously occult disease. The increased detection of thyroid cancer results in therapeutic interventions including surgery and radioactive thyroid treatment that may be of limited benefit.
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Affiliation(s)
- Robert Udelsman
- Department of Surgery, Yale School of Medicine, Yale University, New Haven, Connecticut
| | - Yawei Zhang
- Department of Environmental Health Sciences, Yale School of Public Health, Yale University, New Haven, Connecticut
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Liu CL, Cheng SP, Lin HW, Lai YL. Risk of thyroid cancer in patients with thyroiditis: a population-based cohort study. Ann Surg Oncol 2013; 21:843-9. [PMID: 24201747 DOI: 10.1245/s10434-013-3363-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2013] [Indexed: 12/14/2022]
Abstract
BACKGROUND The causative relationship between autoimmune thyroiditis and thyroid cancer remains a controversial issue. The aim of this population-based study was to investigate the risk of thyroid cancer in patients with thyroiditis. METHODS From the Longitudinal Health Insurance Database 2005 (LHID2005) of Taiwan, we identified adult patients newly diagnosed with thyroiditis between 2004 and 2009 (n = 1,654). The comparison cohort (n = 8,270) included five randomly selected age- and sex-matched controls for each patient in the study cohort. All patients were followed up from the date of cohort entry until they developed thyroid cancer or to the end of 2010. Multivariate Cox regression was used to assess the risk of developing thyroid cancer. A total of 1,000 bootstrap replicates were created for internal validation. RESULTS A total of 35 patients developed thyroid cancer during the study period, of whom 24 were from the thyroiditis cohort and 11 were from the comparison cohort (incidence 353 and 22 per 100,000 person-years, respectively). After adjusting for potential confounding factors, the hazard ratio (HR) for thyroid cancer in patients with thyroiditis was 13.24 (95 % CI 6.40-27.39). Excluding cancers occurring within 1 year of follow-up, the HR remained significantly increased (6.64; 95 % CI 2.35-18.75). Hypothyroidism was not an independent factor associated with the occurrence of thyroid cancer. CONCLUSIONS We found an increased risk for the development of thyroid cancer after a diagnosis of thyroiditis, independent of comorbidities.
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Affiliation(s)
- Chien-Liang Liu
- Mackay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan,
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Abstract
In many parts of the world, incidence of papillary thyroid cancer is increasing faster than any other malignancy. Most papillary thyroid cancers that are diagnosed are small and are generally regarded as being low risk, with little or no effect on mortality. Papillary thyroid cancer is a clinical challenge because it is difficult to prove benefit from the traditional therapeutic triad for this disorder (ie, total thyroidectomy with or without prophylactic central neck dissection, radioiodine remnant ablation, and suppression of serum thyroid-stimulating hormone with levothyroxine). However, risk of disease recurrence might be reduced by these therapies in a subset of patients with more aggressive disease. In the past decade, professional societies and other groups have established evidence-based clinical practice guidelines for management of papillary thyroid cancer, but these efforts have been made difficult by a paucity of randomised controlled trials. In this review, we summarise epidemiological data for disease incidence, discuss some controversies in disease management, and outline a therapeutic framework founded in the best available medical evidence and existing recommendations from clinical practice guidelines.
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Affiliation(s)
- Donald S A McLeod
- Department of Internal Medicine and Aged Care, Royal Brisbane and Women's Hospital, Herston, QLD, Australia
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Caturegli P, De Remigis A, Chuang K, Dembele M, Iwama A, Iwama S. Hashimoto's thyroiditis: celebrating the centennial through the lens of the Johns Hopkins hospital surgical pathology records. Thyroid 2013; 23:142-50. [PMID: 23151083 PMCID: PMC3569966 DOI: 10.1089/thy.2012.0554] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Hashimoto's thyroiditis is now considered the most prevalent autoimmune disease, as well as the most common endocrine disorder. It was initially described in 1912, but only rarely reported until the early 1950s. To celebrate this centennial, we reviewed the surgical pathology archives of the Johns Hopkins hospital for cases of Hashimoto's thyroiditis, spanning the period from May 1889 to October 2012. Approximately 15,000 thyroidectomies were performed at this hospital over 124 years. The first surgical case was reported in 1942, 30 years after the original description. Then, 867 cases of Hashimoto's thyroiditis were seen from 1942 to 2012, representing 6% of all thyroidectomies. Hashimoto's thyroiditis was the sole pathological finding in 462 cases; it accompanied other thyroid pathologies in the remaining 405 cases. The most commonly associated pathology was papillary thyroid cancer, an association that increased significantly during the last two decades. The most common indication for thyroidectomy was a thyroid nodule that was cytologically suspicious for malignancy. Hashimoto's thyroiditis remains a widespread, intriguing, and multifaceted disease of unknown etiology one century after its description. Advances in the understanding of its pathogenesis and preoperative diagnosis will improve recognition and treatment of this disorder, and may one day lead to its prevention.
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Affiliation(s)
- Patrizio Caturegli
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Alessandra De Remigis
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Kelly Chuang
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Marieme Dembele
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Akiko Iwama
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Shintaro Iwama
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
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