Association of hormonal and reproductive factors with differentiated thyroid cancer risk in women: a pooled prospective cohort analysis

Thomas J O'Grady^{1

2}, Sabina Rinaldi³, Kara A Michels^{1

4}, Hans-Olov Adami^{5

6}, Julie E Buring^{7

8}, Yu Chen⁹, Tess V Clendenen⁹, Aimee D'Aloisio¹⁰, Jessica Clague DeHart¹¹, Silvia Franceschi¹², Neal D Freedman¹, Gretchen L Gierach¹, Graham G Giles^{13

14

15}, James V Lacey¹⁶, I-Min Lee^{7

8}, Linda M Liao¹, Martha S Linet¹, Marjorie L McCullough¹⁷, Alpa V Patel¹⁷, Anna Prizment¹⁸, Kim Robien¹⁹, Dale P Sandler²⁰, Rachael Stolzenberg-Solomon¹, Elisabete Weiderpass³, Emily White^{21

22}, Alicja Wolk²³, Wei Zheng²⁴, Amy Berrington de Gonzalez^{1

25}, Cari M Kitahara¹

Affiliations

¹ Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA.
² Department of Epidemiology and Biostatistics, University at Albany School of Public Health, Albany, NY, USA.
³ International Agency for Research on Cancer (IARC/WHO), Lyon, France.
⁴ Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA.
⁵ Clinical Effectiveness Group, Institute of Health and Society, University of Oslo, Oslo, Norway.
⁶ Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
⁷ Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
⁸ Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA, USA.
⁹ Division of Epidemiology, Department of Population Health and NYU Cancer Institute, NYU School of Medicine, New York, NY, USA.
¹⁰ Social & Scientific Systems, DLH Holdings Corporation, Durham, NC, USA.
¹¹ School of Community and Global Health, Claremont Graduate University, Claremont, CA, USA.
¹² Aviano Cancer Institute, IRCCS, Aviano, Italy.
¹³ Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Australia.
¹⁴ Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Australia.
¹⁵ Precision Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia.
¹⁶ Division of Health Analytics Department of Computational and Quantitative Medicine, Beckman Research Institute, City of Hope, Atlanta, GA, USA.
¹⁷ Department of Population Science, American Cancer Society, Atlanta, GA, USA.
¹⁸ Division of Hematology, Oncology and Transplantation, Department of Medicine, University of Minnesota, Minneapolis, MN, USA.
¹⁹ Exercise and Nutrition Sciences, Milken Institute School of Public Health, George Washington University, Washington, DC, USA.
²⁰ Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, NC, USA.
²¹ Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
²² Department of Epidemiology, University of Washington, Seattle, Washington, USA.
²³ Division of Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
²⁴ Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, TN, USA.
²⁵ The Institute of Cancer Research, London, UK.

PMID: 38110618
PMCID: PMC10859160
DOI: 10.1093/ije/dyad172

Association of hormonal and reproductive factors with differentiated thyroid cancer risk in women: a pooled prospective cohort analysis

Thomas J O'Grady et al. Int J Epidemiol. 2024.

. 2024 Feb 1;53(1):dyad172.

doi: 10.1093/ije/dyad172.

Authors

Affiliations

¹ Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA.
² Department of Epidemiology and Biostatistics, University at Albany School of Public Health, Albany, NY, USA.
³ International Agency for Research on Cancer (IARC/WHO), Lyon, France.
⁴ Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA.
⁵ Clinical Effectiveness Group, Institute of Health and Society, University of Oslo, Oslo, Norway.
⁶ Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
⁷ Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
⁸ Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA, USA.
⁹ Division of Epidemiology, Department of Population Health and NYU Cancer Institute, NYU School of Medicine, New York, NY, USA.
¹⁰ Social & Scientific Systems, DLH Holdings Corporation, Durham, NC, USA.
¹¹ School of Community and Global Health, Claremont Graduate University, Claremont, CA, USA.
¹² Aviano Cancer Institute, IRCCS, Aviano, Italy.
¹³ Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Australia.
¹⁴ Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Australia.
¹⁵ Precision Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia.
¹⁶ Division of Health Analytics Department of Computational and Quantitative Medicine, Beckman Research Institute, City of Hope, Atlanta, GA, USA.
¹⁷ Department of Population Science, American Cancer Society, Atlanta, GA, USA.
¹⁸ Division of Hematology, Oncology and Transplantation, Department of Medicine, University of Minnesota, Minneapolis, MN, USA.
¹⁹ Exercise and Nutrition Sciences, Milken Institute School of Public Health, George Washington University, Washington, DC, USA.
²⁰ Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, NC, USA.
²¹ Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
²² Department of Epidemiology, University of Washington, Seattle, Washington, USA.
²³ Division of Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
²⁴ Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, TN, USA.
²⁵ The Institute of Cancer Research, London, UK.

PMID: 38110618
PMCID: PMC10859160
DOI: 10.1093/ije/dyad172

Abstract

Background: The incidence of differentiated thyroid cancer (DTC) is higher in women than in men but whether sex steroid hormones contribute to this difference remains unclear. Studies of reproductive and hormonal factors and thyroid cancer risk have provided inconsistent results.

Methods: Original data from 1 252 907 women in 16 cohorts in North America, Europe, Australia and Asia were combined to evaluate associations of DTC risk with reproductive and hormonal factors. Multivariable-adjusted Cox proportional hazard models were used to estimate hazard ratios (HRs) and 95% CIs.

Results: During follow-up, 2142 women were diagnosed with DTC. Factors associated with higher risk of DTC included younger age at menarche (<10 vs 10-11 years; HR, 1.28; 95% CI, 1.00-1.64), younger (<40; HR, 1.31; 95% CI, 1.05-1.62) and older (≥55; HR, 1.33; 95% CI, 1.05-1.68) ages at menopause (vs 40-44 years), ever use of menopausal hormone therapy (HR, 1.16; 95% CI, 1.02-1.33) and previous hysterectomy (HR, 1.25; 95% CI, 1.13-1.39) or bilateral oophorectomy (HR, 1.14; 95% CI, 1.00-1.29). Factors associated with lower risk included longer-term use (≥5 vs <5 years) of oral contraceptives (HR, 0.86; 95% CI, 0.76-0.96) among those who ever used oral contraception and baseline post-menopausal status (HR, 0.82; 95% CI, 0.70-0.96). No associations were observed for parity, duration of menopausal hormone therapy use or lifetime number of reproductive years or ovulatory cycles.

Conclusions: Our study provides some evidence linking reproductive and hormonal factors with risk of DTC. Results should be interpreted cautiously considering the modest strength of the associations and potential for exposure misclassification and detection bias. Prospective studies of pre-diagnostic circulating sex steroid hormone measurements and DTC risk may provide additional insight.

Keywords: Thyroid cancer; hormone replacement therapy; hysterectomy; menarche; menopause; oophorectomy; oral contraceptives; parity.

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Conflict of interest statement

None declared.

References

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Association of hormonal and reproductive factors with differentiated thyroid cancer risk in women: a pooled prospective cohort analysis

Affiliations

Association of hormonal and reproductive factors with differentiated thyroid cancer risk in women: a pooled prospective cohort analysis

Authors

Affiliations

Abstract

Conflict of interest statement

References

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Medical