Research reveals higher thyroid cancer risk for menopausal women with longer reproductive years

自1975年以来，甲状腺癌的发病率几乎增加了两倍，妇女的发病率几乎四倍化。“帮助找到增加的原因，研究人员Penn State Cancer Institute,宾夕法尼亚州立医学院and Harvard Medical School performed a retrospective study using one of the nation’s largest women’s health databases.

The study revealed that women who entered menopause at age 45 or older had a higher risk of thyroid cancer compared with women who entered menopause at a younger age. The study also identified a linear trend between later age at menopause and increased risk of thyroid cancer.²

“One of our main goals is to understand the rise in thyroid cancer and locate the real reason for it, and not just blame overdiagnosis,” said head and neck surgeonDr. David Goldenberg, Professor and Chair of the Department of Otolaryngology – Head and Neck Surgery and a co-author of the study. “We found that the longer the reproductive period a woman had, the more likely she was to develop thyroid cancer.”

该团队是第一次授予使用护士卫生研究II队队列进行甲状腺癌研究的允许，这是对妇女主要慢性病危险因素的最大调查之一。该数据库包括从1989年 - 2013年收集的信息。

Goldenberg and his team examined 620 cases of thyroid cancer from the Nurses Health Study II cohort. Eighty-four percent of those cases were confirmed by pathology; the remainder were self-reported. Papillary thyroid cancer accounted for a majority (90%) of cases. Eight percent were follicular thyroid cancer, and 2% were medullary thyroid cancer.

In addition to looking at age at menopause, the team also considered multiple reproductive and hormonal risk factors, including age at menarche, oral contraceptive use, postmenopausal hormone therapy and history of breastfeeding.

该团队发现由于前肢或绝经后妇女的母乳喂养的平价或母乳喂养的母乳母细量增加，该团队没有显着关联。“虽然月经初潮的年龄显示与甲状腺癌的薄弱，但它没有统计学意义，”Goldenberg说。口服避孕药和绝经后激素治疗也没有与甲状腺癌风险相关的关系。

Goldenberg’s co-authors in the study were Jane Schubart, PhD, associate professor, Departments of Surgery, Medicine and Public Health Science at the College of Medicine; Amber Schilling, Department of Surgery at the College of Medicine; and A. Heather Eliassen, ScD, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School.

The research builds on prior thyroid cancer risk studies conducted by Goldenberg and other researchers. A study published in 2015 showed a strong association with obesity, Type 2 diabetes mellitus and differentiated thyroid cancer, identifying body mass index as a strong predictive variable.⁴

While additional studies are needed to further examine root causes for the rise in thyroid cancer incidence, physicians should continue to be vigilant in identifying thyroid cancer. “Early diagnosis is key to successful treatment,” Goldenberg said. “Women should get their annual general and gynecological exam by their doctors, and any mass discovered in the neck should be further evaluated”

参考

1. 戴维斯L，Welch Hg。目前美国的甲状腺癌趋势。jama otolaryngol头颈surg。2014;140(4):317-322.doi:10.1001/jamaoto.2014.1
2. Schubart JR, Eliassen AH, Schilling A, Goldenberg D. Reproductive Factors and Risk of Thyroid Cancer in Women: An Analysis in the Nurses’ Health Study II [published online ahead of print, 2021 Apr 30].Womens Health Issues。2021; S1049-3867（21）00031-1。DOI：10.1016 / J.WHI.2021.03.008
3. Bao Y，Bertoia ml，Lenart Eb，等。三项护士健康研究的起源，方法和演变。Am J Public Health。2016;106(9):1573-1581.DOI：10.2105 / ajph.2016.303338
4. Oberman B，Khaku A，Camacho F，Goldenberg D.肥胖，糖尿病与甲状腺癌风险之间的关系。Am J Otolaryngol。2015; 36（4）：535-541。doi:10.1016/j.amjoto.2015.02.015