良性乳腺和妇科疾病、生殖和激素因素与甲状腺癌风险。
Benign breast and gynecologic conditions, reproductive and hormonal factors, and risk of thyroid cancer.
机构信息
National Cancer Institute, National Institutes of Health, 9609 Medical Center Drive, Bethesda, MD 20892.
出版信息
Cancer Prev Res (Phila). 2014 Apr;7(4):418-25. doi: 10.1158/1940-6207.CAPR-13-0367. Epub 2014 Jan 21.
The higher incidence of thyroid cancer in women compared with men suggests an influence of sex steroid hormones in the etiology of this malignancy. We investigated a comprehensive set of potential indicators of lifetime sex steroid hormone exposure in relation to thyroid cancer risk. Using data from the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial, which enrolled 70,047 women, 50 to 78 years old, we prospectively examined associations of self-reported history of benign breast and gynecologic conditions, reproductive factors, and exogenous sex hormone use with thyroid cancer risk. Multivariable-adjusted HRs and 95% confidence intervals (CI) were calculated in models using age as the time metric. During follow-up (median, 11 years), 127 women were diagnosed with first primary thyroid cancer. Older age at natural menopause (≥55 vs. <50 years; HR, 2.24; 95% CI, 1.20-4.18), greater estimated lifetime number of ovulatory cycles (≥490 vs. <415 cycles; HR, 2.40; 95% CI, 1.33-4.30), greater number of live births (≥5 vs. 1-2; HR, 1.72; 95% CI, 1.05-2.82), and history of uterine fibroids (HR, 1.72; 95% CI, 1.18-2.50) were associated with an increased risk of thyroid cancer. Earlier age at menarche, greater number of reproductive years, history of a tubal ligation, and history of ovarian cysts were nonsignificantly associated with increased thyroid cancer risk. No associations were observed for oral contraceptive use, menopausal hormone therapy, or history of benign breast disease or endometriosis. In general, we found that factors reflecting a greater length of exposure to endogenous hormones, particularly during the reproductive years, were associated with risk of postmenopausal thyroid cancer.
与男性相比,女性甲状腺癌的发病率更高,这表明性激素在这种恶性肿瘤的发病机制中起作用。我们研究了一套全面的潜在终生性激素暴露指标,以探讨其与甲状腺癌风险的关系。我们使用了来自前列腺癌、肺癌、结直肠癌和卵巢癌筛查试验的数据,该试验招募了 70047 名年龄在 50 至 78 岁之间的女性,前瞻性地研究了良性乳腺和妇科疾病、生殖因素以及外源性性激素使用史与甲状腺癌风险的关系。多变量调整后的 HR 和 95%置信区间(CI)在使用年龄作为时间指标的模型中进行计算。在随访期间(中位数为 11 年),有 127 名女性被诊断为原发性甲状腺癌。自然绝经年龄较大(≥55 岁 vs. <50 岁;HR,2.24;95%CI,1.20-4.18)、估计终生排卵周期数较多(≥490 周期 vs. <415 周期;HR,2.40;95%CI,1.33-4.30)、活产数较多(≥5 次 vs. 1-2 次;HR,1.72;95%CI,1.05-2.82)和子宫肌瘤史(HR,1.72;95%CI,1.18-2.50)与甲状腺癌风险增加相关。初潮年龄较早、生育年限较长、输卵管结扎史和卵巢囊肿史与甲状腺癌风险增加无显著相关性。未观察到口服避孕药使用、绝经后激素治疗或良性乳腺疾病或子宫内膜异位症史与甲状腺癌风险增加相关。总的来说,我们发现反映更长时间暴露于内源性激素的因素,尤其是在生育期,与绝经后甲状腺癌的风险相关。
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