Risk of Breast Cancer in Females With Hypothyroidism: A Nationwide, Population-Based, Cohort Study

Huang, Chun‐Hao; Wei, James Cheng‐Chung; Chien, Tzu-Chien; Lin, Shun-Hung; Su, Yi‐Chang; Hsu, Chung Y.; Chiou, Jeng‐Yuan; Yeh, Ming-Hsin

doi:10.1016/j.eprac.2020.09.007

Cited by 11 publications

(10 citation statements)

References 31 publications

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“…Another analysis showed a significant inverse association between invasive breast cancer and history of hypothyroidism [ 32 ]. Consistent with our results, two national database studies, in Taiwan [ 33 ] and the Netherlands [ 14 ], showed that women with hypothyroidism had a higher risk of breast cancer than the non-hypothyroid.…”

Section: Discussionsupporting

confidence: 92%

“…Although thyroid hormone replacement has been reported to have a protective effect against some cancers [16,33], in our study the risk of all cancers was higher in patients treated with thyroid hormone. This surprising finding could be accounted for by the fact that the subgroup of patients in replacement treatment has a more marked degree of thyroid hormone deficiency and, therefore, a greater predisposition to cancer.…”

Section: Plos Onecontrasting

confidence: 69%

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Malignant neoplasms in people with hypothyroidism in Spain: A population-based analysis

Díez

Iglesias

2022

PLoS ONE

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Purpose The objective of this study was to determine the association between hypothyroidism and overall and site-specific cancer in Spanish population. Methods A cross-sectional study was performed using the population-based database BDCAP (Base de Datos Clínicos de Atención Primaria, primary care clinical database) to analyze the relative risk of cancer in Spanish population with hypothyroidism. Results In a total of 2,414,165 patients diagnosed with hypothyroidism in BDCAP in 2019, the relative risk (OR) of cancer, compared to the non-hypothyroid population, was 1.73 (1.72–1.74) (P<0.0001). The higher risk was observed in both men (OR 2.15 [2.13–2.17]; P<0.0001) and women (OR 1.67 [1.636–1.68]; P<0.0001). However, hypothyroid persons aged 65 years or older had a reduced risk of cancer (OR 0.98 [0.97–0.98]; P<0.0001). In addition, hypothyroid patients aged 65 or over showed a decreased risk of cancers of the bladder, colorectal, gastric, pancreatic and prostate. Socioeconomic characteristics such as income level, municipality size, country of birth and employment situation had limited influence on the association between hypothyroidism and cancer. However, hypothyroid patients receiving replacement therapy exhibited higher cancer risk compared with patients without treatment (OR 1.30 [1.28–1.31]; P<0.0001). Conclusion Spanish hypothyroid patients of both genders have a risk of overall cancer higher than that found in non-hypothyroid population. However, people over 65 years have a reduced risk of various malignancies. This peculiarity of hypothyroidism should be considered by the health authorities.

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Section: Discussionsupporting

confidence: 92%

Section: Plos Onecontrasting

confidence: 69%

Malignant neoplasms in people with hypothyroidism in Spain: A population-based analysis

Díez

Iglesias

2022

PLoS ONE

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“…NHIRD is available for research purposes with appropriate applications. The validity of NHIRD for use in epidemiological cancer research has been shown in the previous publication (17)(18)(19)(20)(21)(22)(23)(24). NHIRD includes patients treated at dedicated veterans' hospitals.…”

Section: Data Sourcesmentioning

confidence: 98%

Older veterans associated with reduced risk of cancer: Retrospective nationwide matched cohort study in Taiwan

et al. 2023

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ImportanceIt remains unknown whether Taiwanese veterans have a lower risk of subsequent cancer compared with non-veterans.ObjectiveTo examine whether veterans are associated with reduced cancer risk.MethodsFrom January 2004 to December 2017, this study included 957 veterans and 957 civilians who were propensity score (PS) matched by years of birth, sex, residence, index year, days in the hospital, frequency of outpatient visits, and relevant comorbidities at baseline. Multivariate Cox proportional hazards regression analysis was applied to compare the risks of cancer, overall and by subgroup, and mortality. All the participants were cancer free at the baseline.ExposuresVeterans retrieved from Taiwan National Health Insurance Research Database (NHIRD).Main outcomeCancer extracted from the Registry for Catastrophic Illness Patients Database (RCIPD).ResultsOverall, 1,914 participants were included, and 957 veterans with a mean (SD) age of 75.9 (6.79) years and 946 men (98.9%). The mean follow-up was about 10.5 (±4.51) years. Cancer was recorded in 6.68% (N = 64) and 12.12% (N = 116) of veterans and non-veterans, respectively. Veterans were associated with decreased risk [adjusted hazard ratio (aHR), 0.57; 95% CI: 0.41–0.78; P < 0.001] of cancer compared with civilians after controlling for age, sex, urbanization, hypertension, diabetes, hyperlipidemia, cardiovascular event, COPD, asthma, chronic liver disease, alcohol-related illness, and Parkinson’s disease. Cancer subgroup analyses verified this finding (HRs <1.0). The decreased incidence rate was predominantly for liver cancer (aHR, 0.18; 95% CI: 0.05–0.72; P < 0.05).ConclusionTaiwanese older veterans are associated with reduced overall cancer risk than individuals without veteran status.

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“…1). Of these, 15 studies (10 cohort studies and 5 case-control studies) were new articles which had not been included in our previous meta-analysis, and 1 study (Huang et al 2021) used the same population as a previously included paper (Chen et al 2013b) but with more recent updates on breast cancer cases. In total, those studies contributed 3272 and 5488 additional exposed cases of breast cancer to the quantitative analyses for hyper-and hypothyroidism, respectively.…”

Section: Study Characteristicsmentioning

confidence: 99%

The effect of thyroid dysfunction on breast cancer risk: an updated meta-analysis

Tran

Kitahara

Leenhardt

et al. 2023

Endocrine-Related Cancer

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In a previous systematic review and meta-analysis of studies reporting associations between hyper-/hypothyroidism and breast cancer incidence published through January 29, 2019, we identified a higher risk with diagnosed hyperthyroidism compared to euthyroidism, but no association with diagnosed hypothyroidism. This two-year updated meta-analysis aims to investigate the role of menopause in this association and the dose-response relationship with blood levels of TSH and thyroid hormones. After exclusion of studies with only mortality follow-up, with thyroid dysfunction evaluated as a cancer biomarker or after prior breast cancer diagnosis, we reviewed 25 studies that were published up to December 01, 2021 and identified in MEDLINE, the COCHRANE library, Embase, or Web of Science; of these, 9 were included in the previous meta-analysis. Risk estimates from 22 of the 25 studies were included in the meta-analysis and pooled using random-effects models. Compared to euthyroidism, hyperthyroidism and hypothyroidism diagnoses were associated with higher [pooled risk ratio (RR): 1.12, 95%CI: 1.06-1.18, 3829 exposed cases] and lower risks (RR = 0.93, 95%CI: 0.86-1.00, 5632 exposed cases) of breast cancer, respectively. The increased risk after hyperthyroidism was greater among postmenopausal women (RR=1.19, 95%CI 1.09-1.30) and the decreased risk after hypothyroidism was more pronounced among premenopausal women (RR=0.69, 95%CI 0.53-0.89). Among women with no prior history of thyroid disease, every 1 mIU/L increase in TSH level was associated with a 0.8% (95%CI >0 to 1.5%) lower risk of breast cancer. In conclusion, this meta-analysis supports an association between thyroid hormone levels and breast cancer risk, which could be modified by menopausal status.

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Risk of Breast Cancer in Females With Hypothyroidism: A Nationwide, Population-Based, Cohort Study

Cited by 11 publications

References 31 publications

Malignant neoplasms in people with hypothyroidism in Spain: A population-based analysis

Malignant neoplasms in people with hypothyroidism in Spain: A population-based analysis

Older veterans associated with reduced risk of cancer: Retrospective nationwide matched cohort study in Taiwan

The effect of thyroid dysfunction on breast cancer risk: an updated meta-analysis

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