在两项大型癌症筛查试验中，随机分组以筛查前列腺癌、肺癌、结直肠癌、卵巢癌及甲状腺癌发病率。
Randomization to screening for prostate, lung, colorectal and ovarian cancers and thyroid cancer incidence in two large cancer screening trials.
作者信息
O'Grady Thomas J, Kitahara Cari M, DiRienzo A Gregory, Boscoe Francis P, Gates Margaret A
机构信息
University at Albany, School of Public Health, Rensselaer, New York, United States of America.
Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland, United States of America.
出版信息
PLoS One. 2014 Sep 5;9(9):e106880. doi: 10.1371/journal.pone.0106880. eCollection 2014.
BACKGROUND
Thyroid cancer incidence has increased significantly over the past three decades due, in part, to incidental detection. We examined the association between randomization to screening for lung, prostate, colorectal and/or ovarian cancers and thyroid cancer incidence in two large prospective randomized screening trials.
METHODS
We assessed the association between randomization to low-dose helical CT scan versus chest x-ray for lung cancer screening and risk of thyroid cancer in the National Lung Screening Trial (NLST). In the Prostate Lung Colorectal and Ovarian Cancer Screening Trial (PLCO), we assessed the association between randomization to regular screening for said cancers versus usual medical care and thyroid cancer risk. Over a median 6 and 11 years of follow-up in NLST and PLCO, respectively, we identified 60 incident and 234 incident thyroid cancer cases. Cox proportional hazards regression was used to calculate the cause specific hazard ratios (HR) and 95% confidence intervals (CI) for thyroid cancer.
RESULTS
In NLST, randomization to lung CT scan was associated with a non-significant increase in thyroid cancer risk (HR = 1.61; 95% CI: 0.96-2.71). This association was stronger during the first 3 years of follow-up, during which participants were actively screened (HR = 2.19; 95% CI: 1.07-4.47), but not subsequently (HR = 1.08; 95% CI: 0.49-2.37). In PLCO, randomization to cancer screening compared with usual care was associated with a significant decrease in thyroid cancer risk for men (HR = 0.61; 95% CI: 0.49-0.95) but not women (HR = 0.91; 95% CI: 0.66-1.26). Similar results were observed when restricting to papillary thyroid cancer in both NLST and PLCO.
CONCLUSION
Our study suggests that certain medical encounters, such as those using low-dose helical CT scan for lung cancer screening, may increase the detection of incidental thyroid cancer.
背景
在过去三十年中，甲状腺癌的发病率显著上升，部分原因是偶然发现。我们在两项大型前瞻性随机筛查试验中研究了随机分配进行肺癌、前列腺癌、结直肠癌和/或卵巢癌筛查与甲状腺癌发病率之间的关联。
方法
在国家肺癌筛查试验（NLST）中，我们评估了随机分配接受低剂量螺旋CT扫描与胸部X光进行肺癌筛查和甲状腺癌风险之间的关联。在前列腺、肺癌、结直肠癌和卵巢癌筛查试验（PLCO）中，我们评估了随机分配进行上述癌症的定期筛查与常规医疗护理和甲状腺癌风险之间的关联。在NLST和PLCO中，分别进行了中位6年和11年的随访，我们确定了60例和234例甲状腺癌病例。采用Cox比例风险回归计算甲状腺癌的病因特异性风险比（HR）和95%置信区间（CI）。
结果
在NLST中，随机分配进行肺部CT扫描与甲状腺癌风险的非显著性增加相关（HR = 1.61；95% CI：0.96 - 2.71）。这种关联在随访的前3年更强，在此期间参与者接受了积极筛查（HR = 2.19；95% CI：1.07 - 4.47），但随后则不然（HR = 1.08；95% CI：0.49 - 2.37）。在PLCO中，与常规护理相比，随机分配进行癌症筛查与男性甲状腺癌风险的显著降低相关（HR = 0.61；95% CI：0.49 - 0.95），但与女性无关（HR = 0.91；95% CI：0.66 - 1.26）。在NLST和PLCO中，当仅限于乳头状甲状腺癌时，观察到了类似的结果。
结论
我们的研究表明，某些医疗检查，如使用低剂量螺旋CT扫描进行肺癌筛查，可能会增加偶然发现的甲状腺癌的检出率。
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