Cancer-specific mortality in breast cancer patients with hypothyroidism: a UK population-based study

Abstract

Purpose Epidemiological studies have indicated a higher prevalence of hypothyroidism in breast cancer patients, possibly related to shared risk factors and breast cancer treatments. However, few studies have evaluated how hypothyroidism impacts survival outcomes in breast cancer patients. We aimed to determine the association between hypothyroidism and breast cancer-specific and all-cause mortality. Methods We conducted a population-based study using the Scottish Cancer Registry to identify women diagnosed with breast cancer between 2010 and 2017. A matched comparison cohort of breast cancer-free women was also identified. Using hospital diagnoses and dispensed prescriptions for levothyroxine, we identified hypothyroidism diagnosed before and after breast cancer diagnosis and determined associations with breast cancer-specific and all-cause mortality. Cox proportional hazards regression was used to calculate hazard ratios (HR) and 95% confidence intervals (CI) adjusted for potential confounders. Results A total of 33,500 breast cancer patients were identified, of which 3,802 had hypothyroidism before breast cancer diagnosis and 565 patients went on to develop hypothyroidism after. Breast cancer patients had higher rates of hypothyroidism compared with cancer-free controls (HR 1.14, 95% CI 1.01–1.30). Among breast cancer patients, we found no association between hypothyroidism (diagnosed before or after) and cancer-specific mortality (before: HR 0.99, 95% CI 0.88–1.12, after: HR 0.97, 95% CI 0.63–1.49). Similar associations were seen for all-cause mortality. Conclusion In a large contemporary breast cancer cohort, there was little evidence that hypothyroidism, either at diagnosis or diagnosed after breast cancer, was associated with cancer-specific or all-cause mortality.

Incidence and risk factors of hypothyroidism after treatment for early breast cancer: a population-based cohort study

“…Hypothyroidism is relatively common in the general population with a prevalence of up to 5.3% with most of the cases being subclinical and consequently diagnosed as an accidental nding [3]. Although patients in the general population diagnosed with hypothyroidism seem to face an increased risk for multiple morbidities and higher mortality [4], hypothyroidism either at breast cancer diagnosis or diagnosed after breast cancer does not seem to affect cancer-speci c or all-cause mortality [5].…”

Incidence and risk factors of hypothyroidism after treatment for early breast cancer: a population-based cohort study

“…Hypothyroidism is relatively common in the general population with a prevalence of up to 5.3% with most of the cases being subclinical and consequently diagnosed as an accidental finding [ 3 ]. Although patients in the general population diagnosed with hypothyroidism seem to face an increased risk for multiple morbidities and higher mortality [ 4 ], hypothyroidism either at breast cancer diagnosis or diagnosed after breast cancer does not seem to affect cancer-specific or all-cause mortality [ 5 ].…”