1) This study examined the association between hypothyroidism, hyperthyroidism, and breast cancer risk using nationwide health registries in Denmark.
2) The study included over 4 million women and identified those diagnosed with hypothyroidism or hyperthyroidism between 1978-2013. It linked these women to cancer registries to identify subsequent breast cancer diagnoses.
3) The results found an increased risk of breast cancer in women with hyperthyroidism and a slightly decreased risk in women with hypothyroidism, suggesting an association between thyroid function levels and breast cancer risk.
1) This study examined the association between hypothyroidism, hyperthyroidism, and breast cancer risk using nationwide health registries in Denmark.
2) The study included over 4 million women and identified those diagnosed with hypothyroidism or hyperthyroidism between 1978-2013. It linked these women to cancer registries to identify subsequent breast cancer diagnoses.
3) The results found an increased risk of breast cancer in women with hyperthyroidism and a slightly decreased risk in women with hypothyroidism, suggesting an association between thyroid function levels and breast cancer risk.
1) This study examined the association between hypothyroidism, hyperthyroidism, and breast cancer risk using nationwide health registries in Denmark.
2) The study included over 4 million women and identified those diagnosed with hypothyroidism or hyperthyroidism between 1978-2013. It linked these women to cancer registries to identify subsequent breast cancer diagnoses.
3) The results found an increased risk of breast cancer in women with hyperthyroidism and a slightly decreased risk in women with hypothyroidism, suggesting an association between thyroid function levels and breast cancer risk.
Hypothyroidism and hyperthyroidism and breast cancer risk: a nationwide cohort study Mette Søgaard1, Do´ ra Ko¨ rmendine´ Farkas1, Vera Ehrenstein1, Jens Otto Lunde Jørgensen2, Olaf M Dekkers1,3 and Henrik Toft Sørensen1 Departments of 1Clinical Epidemiology, 2Endocrinology and Internal Medicine (MEA), Aarhus University Hospital, Olof Palmes Alle´ 43-45, DK-8200 Aarhus N, Denmark and 3Departments of Endocrinology and Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands INTRODUCTION INTRODUCTION Objective of the Study: To examine the association between hypothyroidism, hyperthyroidism and breast cancer risk INTRODUCTION SUBJECTS and METHODS Study Setting Location: Denmark
• The data was taken from January 1,1978 to November
31,2013
• Health service utilization is tracked by several nationwide
registries, linkable using each resident’s universal identifier, assigned to all Danish residents at birth or upon immigration since 1968
Source Population: 4 177 429 women
SUBJECTS and METHODS Hypothyroidism and Hyperthyroidism • Danish National Patient Registry (DNPR) contains information on all inpatient hospitalizations at Danish non- psychiatric hospitals since 1977 and outpatient and emergency department visits since 1995.
• Each hospital visit were recorded by physicians with one
primary diagnosis and one or more secondary diagnoses classified according to the International Classification of Diseases, 8th edition until the end of 1993.
• DNPR was used to identify all women with a first time
diagnosis of hyperthyroidism or hyperthyroidism from 1978 through 2013. SUBJECTS and METHODS Hypothyroidism and Hyperthyroidism
Excluded: Women diagnosed of hypothyroidism and
hyperthyroidism on the same date
Women with hyperthyroidism who subsequently
developed hypothyroidism or vice versa were censored on the date of the new diagnosis. SUBJECTS and METHODS Breast Cancer • The cohorts of women with a diagnosis of hypothyroidism or hyperthyroidism were linked to the Danish Cancer Registry (DCR).
• Through the DCR, data on breast cancer stage at diagnosis
were also obtained
• A linkage to the Danish Pathology Registry to retrieve data
on estrogen receptor ER status at breast cancer diagnosis starting 1997 were also performed.
Excluded: Women with a breast cancer diagnosis prior to the
diagnosis of hypothyroidism or hyperthyroidism SUBJECTS and METHODS Comorbid diseases • Charlson Comorbidity Index (CCI) scores were computed for each patient based on all available DNPR inpatient hospitalization records preceding the date of diagnosis of hypothyroidism and hyperthyroidism.
• The severity of comorbidities were categorized as low (CCI
score = 0), medium (CCI score = 1-2) or high (CCI score ≥ 3), excluding breast cancer diagnoses from the CCI score calculation.
• DNPR was also used to access information on clinical
diagnosis of obesity and alcohol-related disease. SUBJECTS and METHODS Statistical Analysis COMPUTATION
• Expected number of breast cancer using rates by age & year
of diagnosis
• Standardized Incidence Ratios (SIRs) for breast cancer as
the ratio of observed to expected cancers
• Confidence Intervals (CIs) for the SIRs
• Absolute risk of breast cancer with death as a competing risk
SUBJECTS and METHODS Statistical Analysis EXCLUDED
• Breast cancer diagnosis in the first 12 months following
diagnosis of thyroid disease
• Patient’s with Grave’s disease is excluded in sensitivity
analysis in order to reduce potential confounding by smoking. R E S U L T S R E S U L T S DISCUSSION • The higher incidence of hyperthyroidism compared with hypothyroidism is in agreement with previous studies, as is the increased incidence of thyroid disease overtime.
• Researchers limitations of their study was the lack of
laboratory data because they were unable to distinguish between clinical and subclinical thyroid disease, as they were also unable to link the hormone levels at time of diagnosis to breast cancer risk
• Analyses were stratified by hospital diagnoses of obesity &
alcohol-related illness, however these diagnoses are likely to capture only the most severe cases. DISCUSSION • The observed association between hyperthyroidism and breast cancer risk may have been underestimated due to incompletely ascertained lifestyle risk factors for breast cancer, such as obesity & alcohol consumption, both of which are associated with a reduced risk of hyperthyroidism but increased risk of hyperthyroidism.
• Smoking has been associated with an increased risk of
Grave’s disease but has no consistent association with breast cancer.
• Hormonal treatment role was not addressed by the
researchers in the observed association. CONCLUSION The researchers found an increased risk of breast cancer in women with hyperthyroidism and a slightly decreased risk in women with hypothyroidism suggesting an association between the thyroid function level and breast cancer risk.