Thyroid cancer risk factors

Prevention

Preventable cases of thyroid cancer, UK

Radiation

Thyroid cancer cases linked to ionising radiation exposure, UK

Less than 1% of thyroid cancer cases each year in the UK are linked to major lifestyle and other risk factors.[1]

Thyroid cancer risk is associated with a number of risk factors.[2-4]

Thyroid Cancer Risk Factors

  Increases risk Decreases risk
'Sufficient' or 'convincing' evidence
  • Radioiodines, including Iodine-131
  • X-radiation, gamma-radiation
  • Body fatness[a]
 
'Limited' or 'probable' evidence    

International Agency for Research on Cancer (IARC) classification. World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) classification does not include thyroid cancer because it is not generally recognised to have a relationship to food, nutrition, and physical activity.

a IARC classifies evidence on body fatness as sufficient.

References

  1. Parkin DM, Boyd L, Walker LC. The fraction of cancer attributable to lifestyle and environmental factors in the UK in 2010. Summary and conclusions. Br J Cancer 2011;105 (S2):S77-S81.
  2. International Agency for Research on Cancer. List of Classifications by cancer sites with sufficient or limited evidence in humans, Volumes 1 to 116*. Accessed October 2016.
  3. Lauby-Secretan B, Scoccianti C, Loomis D, et al. Body Fatness and Cancer--Viewpoint of the IARC Working Group. N Engl J Med. 2016 Aug 25;375(8):794-8.
  4. World Cancer Research Fund / American Institute for Cancer Research. Continuous Update Project Findings & Reports. Accessed October 2016.
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Radioiodines, X-radiation and gamma radiation are classified by the International Agency for Research on Cancer (IARC) as causes of thyroid cancer.[1] The highest radiation-associated risks are for those exposed in childhood.[2] Radiation-associated risks may be higher for iodine-deficient people versus those with normal iodine levels.[3]

References

  1. International Agency for Research on Cancer. List of Classifications by cancer sites with sufficient or limited evidence in humans, Volumes 1 to 105*. Accessed October 2014.
  2. World Cancer Research Fund/American Institute for Cancer Research. Food, Nutrition, Physical Activity, and the Prevention of Cancer: a Global Perspective. Washington DC: AICR; 2007.
  3. Shakhtarin VV, Tsyb AF, Stepanenko VF, et al. Iodine deficiency, radiation dose, and the risk of thyroid cancer among children and adolescents in the Bryansk region of Russia following the Chernobyl power station accident. Int J Epidemiol 2003;32(4):584-91. 
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Thyroid cancer risk is 10-15 times higher in people who received a total dose of 10-30 Gray (Gy) of radiotherapy during childhood, compared with the general population a pooled analysis showed.[1] Thyroid cancer risk increases with radiotherapy dose up to around 10Gy, with little if any additional risk beyond this dose; risk also decreases with older age at time of radiotherapy.[1]

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Thyroid cancer risk is not associated with receipt of dental X-rays since 1970, but is 17% higher per 10 dental X-rays received starting before 1970 (when X-ray doses were higher), a cohort study showed.[1]

Thyroid cancer risk is 33-78% higher in people who received computed tomography (CT) scans to the brain, facial bones or spine/neck in childhood, a cohort study showed; CT scans to other body parts were not associated with increased risk.[2]

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Thyroid cancer risk is not associated with receipt of iodine-131 treatment for benign thyroid diseases, a meta-analysis showed; however evidence is methodologically limited.[1]

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Thyroid cancer risk at age 60 is around 1.3 times higher per 1 Gray (Gy) radiation received, in people exposed to atomic bomb radiation during childhood, compared with the general population, a cohort study showed.[1] Thyroid cancer risk decreases with increasing time since atomic bomb radiation exposure and older age at the exposure; exposure aged 20+ is not associated with thyroid cancer risk.[1]

Thyroid cancer risk among radiological or nuclear accident survivors may be reduced using stable iodine (potassium iodide) to block the thyroid’s uptake of radioactive iodine (iodine thyroid blocking).[2]

References

  1. Furukawa K, Preston D, Funamoto S, et al. Long-term trend of thyroid cancer risk among Japanese atomic-bomb survivors: 60 years after exposure. Int J Cancer 2013;132(5):1222-6.
  2. Spallek L, Krille L, Reiners C, et al. Adverse effects of iodine thyroid blocking: a systematic review. Radiat Prot Dosimetry 2012;150(3):267-77. 
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Thyroid cancer risk is not associated with routine occupational exposure to radiation, cohort studies have shown.[1,2] Thyroid cancer risk is 2.8 times higher in male Chernobyl clear-up workers (higher levels of occupational exposure) compared with the general population, a cohort study showed.[3]

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Thyroid cancer risk is 6.6 times higher in people with a first-degree relative (parent, sibling, child) with the same disease, compared with the general population, a cohort study showed.[1] Familial thyroid cancer risk is higher in people with multiple first-degree relatives affected, relative(s) diagnosed at a younger age, or an affected twin, a cohort study showed.[2]

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Genetic predisposition syndromes account for around 20-25% of medullary thyroid cancers, and around 5–15% of nonmedullary thyroid cancers: [1]

  • Familial adenomatous polyposis Open a glossary item (FAP). Thyroid cancer develops in up to 12% of people with FAP.[2-4]
  • Cowden syndrome Open a glossary item. At least 10% of people with Cowden syndrome develop thyroid cancer in their lifetime.[1,5]
  • Werner’s syndrome (premature aging during late childhood and adolescence). Thyroid cancer is around 9 times more common in Werner’s syndrome patients compared with the general population, analysis of Japanese data indicates.[6]
  • Carney’s complex (increased cancer risk and pigmentation changes). Thyroid cancer is found in up to 60% of people with Carney's complex.[1]
  • RET gene mutations. Medullary thyroid cancer risk is higher in people with RET mutations.[1]

References

  1. Nosé V. Familial thyroid cancer: a review. Mod Pathol 2011;24 Suppl 2:S19-33.
  2. Steinhagen E, Guillem JG, Chang G, et al. The prevalence of thyroid cancer and benign thyroid disease in patients with familial adenomatous polyposis may be higher than previously recognized. Clin Colorectal Cancer 2012;11(4):304-8.
  3. Jarrar AM, Milas M, Mitchell J, et al. Screening for thyroid cancer in patients with familial adenomatous polyposis. Ann Surg 2011;253(3):515-21.
  4. Herraiz M, Barbesino G, Faquin W, et al. Prevalence of thyroid cancer in familial adenomatous polyposis syndrome and the role of screening ultrasound examinations. Clin Gastroenterol Hepatol 2007;5(3):367-73.
  5. Pilarski R, Burt R, Kohlman W, et al. Cowden syndrome and the PTEN hamartoma tumor syndrome: systematic review and revised diagnostic criteria. J Natl Cancer Inst 2013;105(21):1607-16.
  6. Lauper JM, Krause A, Vaughan TL, Monnat RJ Jr. Spectrum and risk of neoplasia in Werner syndrome: a systematic review. PLoS One 2013;8(4):e59709. 
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Thyroid cancer risk is higher in survivors of oesophageal cancer (possibly limited to oesophageal squamous cell carcinoma[1]),[2] testicular cancer (germ cell cancers or seminomas only),[3] or non-Hodgkin lymphoma,[4] meta- and pooled analyses have shown.

Thyroid cancer risk is probably increased in cancer survivors due to the effects of treatment for the primary cancer (e.g. radiotherapy[1]), shared risk factors with the first cancer (e.g. radiation exposure), or increased medical surveillance.[1]

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Greater adult attained height is classified by the World Cancer Research Fund (WCRF) and the International Agency for Research on Cancer (IARC) as associated with higher thyroid cancer risk, however no judgment on causality is made.[1]

Thyroid cancer risk in women is 6-13% higher per 5cm height increment, pooled analyses of cohort and case-control studies have shown.[2,3] Thyroid cancer risk in men is not associated with height, a pooled analysis of cohort studies showed;[2] however risk in men was associated with height in a pooled analysis of case-control studies.[3]

References

  1. World Cancer Research Fund/American Institute for Cancer Research. Food, Nutrition, Physical Activity, and the Prevention of Cancer: a Global Perspective. Washington DC: AICR; 2007.
  2. Wirén S, Häggström C, Ulmer H, et al. Pooled cohort study on height and risk of cancer and cancer death. Cancer Causes Control 2014;25(2):151-9.
  3. Dal Maso L, La Vecchia C, Franceschi S, et al. A pooled analysis of thyroid cancer studies. V. Anthropometric factors. Cancer Causes Control 2000;11(2):137-44. 
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Body fatness is classified by World Cancer Research Fund (WCRF) and the International Agency for Research on Cancer (IARC) as associated with higher thyroid cancer risk, however no judgment on causality is made.[1]

Thyroid cancer risk in women is 19% higher in those who are obese, but is not higher in those who are overweight (body mass index [BMI] 30+), compared with those of a healthy weight, a meta-analysis showed.[2] Thyroid cancer risk in men is 50% higher in those who are obese, and is also higher in those who are overweight, compared with those of a healthy weight.[2]

References

  1. World Cancer Research Fund/American Institute for Cancer Research. Food, Nutrition, Physical Activity, and the Prevention of Cancer: a Global Perspective. Washington DC: AICR; 2007.
  2. Zhao ZG, Guo XG, Ba CX, et al. Overweight, obesity and thyroid cancer risk: a meta-analysis of cohort studies. J Int Med Res 2012;40(6):2041-50. 
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Autoimmune thyroiditis (Hashimoto’s thyroiditis) is a common cause of hypothyroidism Open a glossary item. Around a quarter of patients with papillary thyroid cancer have autoimmune thyroiditis, a meta-analysis showed.[1]

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Graves’ disease is a common cause of hyperthyroidism Open a glossary item. Thyroid cancer risk is higher in people with Graves’ disease, cohort studies have shown; however this could reflect increased diagnostic activity in these patients.[1,2]

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Thyroid cancer risk is higher in people with thyroid nodules, a large case-control study showed.[1] However only around 5% of thyroid nodules identified incidentally by ultrasound are malignant.[2,3]

Thyroid cancer risk among people with thyroid nodules is higher in those with a family history of thyroid cancer, previous radiation exposure, or larger and taller nodules, meta-analyses have shown.[3,4]

Thyroid cancer risk is higher in people with goitre (swelling of the thyroid gland); risk may be slightly lower in multinodular versus single nodule goitre.[2,5]

References

  1. Smith-Bindman R, Lebda P, Feldstein VA, et al. Risk of thyroid cancer based on thyroid ultrasound imaging characteristics: results of a population-based study. JAMA Intern Med 2013;173(19):1788-96.
  2. Mehanna HM, Jain A, Morton RP, et al. Investigating the thyroid nodule. BMJ 2009;338:b733.
  3. Campanella P, Ianni F, Rota CA, et al. Quantification of cancer risk of each clinical and ultrasonographic suspicious feature of thyroid nodules: a systematic review and meta-analysis. Eur J Endocrinol 2014;170(5):R203-11.
  4. Brito JP, Gionfriddo MR, Al Nofal A, et al. The accuracy of thyroid nodule ultrasound to predict thyroid cancer: systematic review and meta-analysis. J Clin Endocrinol Metab 2014;99(4):1253-63.
  5. Brito JP, Yarur AJ, Prokop LJ, et al. Prevalence of thyroid cancer in multinodular goiter versus single nodule: a systematic review and meta-analysis. Thyroid 2013;23(4):449-55. 
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Thyroid cancer risk in women is 45% higher in diabetics versus non-diabetics, a meta-analysis showed.[1] Thyroid cancer risk in men is not associated with diabetes.[1] Thyroid cancer risk in diabetics may vary with diabetes duration and treatment.[2,3]

References

  1. Yeo Y, Ma SH, Hwang Y, et al. Diabetes mellitus and risk of thyroid cancer: a meta-analysis. PLos One 2014:13;9(6):e98135.
  2. Shih SR, Chiu WY, Chang TC, Tseng CH. Diabetes and thyroid cancer risk: literature review. Exp Diabetes Res 2012;2012:578285.
  3. Tseng CH. Thyroid cancer risk is not increased in diabetic patients. PLoS One 2012;7(12):e53096. 
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Thyroid cancer risk is 7.5 times higher in people with acromegaly (a pituitary condition) versus those without the condition, a meta-analysis showed; thyroid cancer occurs in around 4% of people with acromegaly.[1]

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Iodine is needed for the production of thyroid hormones, so may be implicated in benign and malignant thyroid diseases. Thyroid cancer risk may be associated with iodine intake, and the direction of the association may vary by thyroid cancer type, but evidence is insufficient to draw conclusions.[1]

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Fish consumption is classified by the World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) as associated with lower thyroid cancer risk, however no judgment on causality is made.[1]

Thyroid cancer risk may be associated with fish consumption only in regions where iodine deficiency is or was common, a pooled analysis showed.[2]

Non-cruciferous, non-starchy vegetables consumption is classified by WCRF/AICR as associated with lower thyroid cancer risk, however no judgment on causality is made.[1]

Thyroid cancer risk is 18% lower in people who eat high versus low amounts of non-cruciferous vegetables, a pooled analysis showed.[3]

Thyroid cancer riskis 30% lower in people who drink the most amount of alcohol compared with those who never or rarely drink alcohol, a meta-analysis showed.[4]

References

  1. World Cancer Research Fund/American Institute for Cancer Research. Food, Nutrition, Physical Activity, and the Prevention of Cancer: a Global Perspective. Washington DC: AICR; 2007.
  2. Bosetti C, Kolonel L, Negri E, et al. A pooled analysis of case-control studies of thyroid cancer. VI. Fish and shellfish consumption. Cancer Causes Control 2001;12(4):375-82.
  3. Bosetti C, Negri E, Kolonel L, et al. A pooled analysis of case-control studies of thyroid cancer. VII. Cruciferous and other vegetables (International). Cancer Causes Control 2002;13(8):765-75.
  4. Hong SH, Myung SK, Kim H. et al. Alcohol Intake and Risk of Thyroid Cancer: A Meta-analysis of Observational Studies. Cancer Res Treat. 2016 Jul 7. doi: 10.4143/crt.2016.161.
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Thyroid cancer risk is not associated with the following factors, meta- and pooled analyses or systematic reviews have shown:

  • Reproductive factors.[1]
  • Physical activity.[2]
  • Tobacco smoking (some evidence of lower risk in current smokers).[3]
  • Benign breast diseases (some evidence of higher risk).[4]
  • Dietary nitrate.[5]

References

  1. Peterson E, De P, Nuttall R. BMI, diet and female reproductive factors as risks for thyroid cancer: a systematic review. PLoS One 2012;7(1):e29177.
  2. Schmid D, Behrens G, Jochem C, Keimling M, Leitzmann M. Physical activity, diabetes, and risk of thyroid cancer: a systematic review and meta-analysis. Eur J Epidemiol 2013;28(12):945-58.
  3. Cho YA, Kim J. Thyroid cancer risk and smoking status: a meta-analysis. Cancer Causes Control 2014;25(9):1187-95.
  4. Braganza MZ, de González AB, Schonfeld SJ, et al. Benign breast and gynecologic conditions, reproductive and hormonal factors, and risk of thyroid cancer. Cancer Prev Res (Phila) 2014;7(4):418-25. 
  5. Xie L, Mo M, Jia HX, et al. Association between dietary nitrate and nitrite intake and sitespecific cancer risk: evidence from observational studies. Oncotarget. 2016 Jul 29. doi: 10.18632/oncotarget.
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