Risk of thyroid cancer following hysterectomy

Sabbir T Rahman; Nirmala Pandeya; Rachel E Neale; Donald S A McLeod; Peter D Baade; Philippa H Youl; Roger Allison; Susan Leonard; Susan J Jordan

doi:10.1016/j.canep.2021.101931

Risk of thyroid cancer following hysterectomy

Cancer Epidemiol. 2021 Jun:72:101931. doi: 10.1016/j.canep.2021.101931. Epub 2021 Mar 31.

Authors

Sabbir T Rahman¹, Nirmala Pandeya², Rachel E Neale³, Donald S A McLeod⁴, Peter D Baade⁵, Philippa H Youl⁶, Roger Allison⁷, Susan Leonard⁸, Susan J Jordan⁹

Affiliations

¹ Department of Population Health, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia; School of Public Health, The University of Queensland, Brisbane, QLD, Australia; Department of Statistics, Shahjalal University of Science and Technology, Sylhet, Bangladesh. Electronic address: [email protected].
² Department of Population Health, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia; School of Public Health, The University of Queensland, Brisbane, QLD, Australia. Electronic address: [email protected].
³ Department of Population Health, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia; School of Public Health, The University of Queensland, Brisbane, QLD, Australia. Electronic address: [email protected].
⁴ Department of Population Health, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia; Department of Endocrinology and Diabetes, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia. Electronic address: [email protected].
⁵ Cancer Council Queensland, Brisbane, QLD, Australia; Menzies Health Institute, Griffith University, Gold Coast, QLD, Australia. Electronic address: [email protected].
⁶ Cancer Alliance Queensland, Metro South Hospital and Health Service, Woolloongabba, QLD, Australia. Electronic address: [email protected].
⁷ Cancer Care Services, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia. Electronic address: [email protected].
⁸ Cancer Care Services, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia. Electronic address: [email protected].
⁹ Department of Population Health, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia; School of Public Health, The University of Queensland, Brisbane, QLD, Australia. Electronic address: [email protected].

PMID: 33812322
DOI: 10.1016/j.canep.2021.101931

Abstract

Background: Hysterectomy has been associated with increased thyroid cancer risk but whether this reflects a biological link or increased diagnosis of indolent cancers due to greater medical contact remains unclear.

Methods: We recruited 730 women diagnosed with thyroid cancer and 785 age-matched population controls. Multivariable logistic regression was used to assess the association overall, and by tumour BRAF mutational status as a marker of potentially higher-risk cancers. We used causal mediation analysis to investigate potential mediation of the association by healthcare service use.

Results: Having had a hysterectomy was associated with an increased risk of thyroid cancer (odds ratio [OR] = 1.45, 95 % confidence interval [CI] 1.07-1.96). When stratified by indication for hysterectomy, the risk appeared stronger for those who had a hysterectomy for menstrual disorders (OR = 1.67, 95 % CI 1.17-2.37) but did not differ by tumour BRAF status. Approximately 20 % of the association between hysterectomy and thyroid cancer may be mediated by more frequent use of healthcare services.

Conclusions: The observed increased risk of thyroid cancer among those with hysterectomy may be driven, at least partly, by an altered sex steroid hormone milieu. More frequent healthcare service use by women with hysterectomy accounts for only a small proportion of the association.

Keywords: BRAF mutation; Hysterectomy; Mediation; Over-diagnosis; Thyroid cancer.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Adult
Aged
Case-Control Studies
Female
Humans
Hysterectomy / adverse effects*
Middle Aged
Queensland / epidemiology
Risk Assessment
Thyroid Neoplasms / epidemiology*
Young Adult