Reinertsen Kristin Valborg, Cvancarova Milada, Wist Erik, Bjøro Trine, Dahl Alv A, Danielsen Turi, Fosså Sophie D
Department of Clinical Cancer Research, The Norwegian Radium Hospital, Rikshospitalet University Hospital, Oslo, Norway.
Int J Radiat Oncol Biol Phys. 2009 Nov 1;75(3):764-70. doi: 10.1016/j.ijrobp.2008.11.037. Epub 2009 Mar 13.
A possible association between thyroid diseases (TD) and breast cancer (BC) has been debated. We examined prevalence and development of TD in women after multimodal treatment for Stage II/III BC compared with women from a general population. Secondarily, we explored the impact of two different radiotherapy (RT) techniques (standardized field arrangements vs. computed tomography [CT]-based dose planning) on TD in BC patients examined 35-120 months after primary BC treatment.
A total of 403 BC patients completed a questionnaire about TD and had blood samples taken for analyses of thyroid function. All had undergone postoperative RT with or without (2%) adjuvant systemic treatment. The results in the BC patients were compared with a cancer-free, age-matched control group from a general population (CGr).
There was higher prevalence of self-reported hypothyroidism in the BC patients as compared with the CGr (18% vs. 6%, p < 0.001). The raised prevalence was predominantly due to a substantial increase in the development of hypothyroidism after BC diagnosis, whereas the prevalence of hypothyroidism before BC diagnosis was similar to that observed in the CGr. Patients treated with CT-based RT showed a trend for increased post-BC development of hypothyroidism as compared with those treated with standardized field arrangements (p = 0.08).
Hypothyroidism is significantly increased in women after multimodal treatment for Stage II/III BC. Radiation to the thyroid gland may be a contributing factor. BC patients should be routinely screened for hypothyroidism.
甲状腺疾病（TD）与乳腺癌（BC）之间可能存在的关联一直存在争议。我们研究了II/III期BC多模式治疗后女性TD的患病率和发展情况，并与普通人群中的女性进行比较。其次，我们探讨了两种不同的放射治疗（RT）技术（标准化野照射与基于计算机断层扫描[CT]的剂量规划）对原发性BC治疗后35 - 120个月接受检查的BC患者TD的影响。
共有403例BC患者完成了关于TD的问卷调查，并采集血样进行甲状腺功能分析。所有患者均接受了术后放疗，部分（2%）还接受了辅助全身治疗。将BC患者的结果与普通人群中无癌症、年龄匹配的对照组（CGr）进行比较。
与CGr相比，BC患者自我报告的甲状腺功能减退患病率更高（18%对6%，p < 0.001）。患病率升高主要是由于BC诊断后甲状腺功能减退的发生率大幅增加，而BC诊断前甲状腺功能减退的患病率与CGr中观察到的相似。与接受标准化野照射的患者相比，接受基于CT的RT治疗的患者在BC后甲状腺功能减退的发生率有增加趋势（p = 0.08）。
II/III期BC多模式治疗后女性甲状腺功能减退显著增加。甲状腺受辐射可能是一个促成因素。BC患者应常规筛查甲状腺功能减退。
