Incidence of hypothyroidism after treatment for breast cancer—a Danish matched cohort study

Breast Cancer Research

Buket Ö. Esen¹  Anne Mette Falstie-Jensen¹  Anders Kjærsgaard¹  Deirdre P. Cronin-Fenton¹  Olaf M. Dekkers²  Marianne Ewertz³  Jeanette D. Jensen³  Ebbe L. Lorenzen³  Kristin V. Reinertsen⁴ 

[1] Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, DK-8200, Aarhus N, Denmark;Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, DK-8200, Aarhus N, Denmark;Department of Epidemiology, Leiden University Medical Center, Leiden, The Netherlands;Department of Oncology, Odense University Hospital, Odense, Denmark;Institute of Clinical Research, University of Southern Denmark, Odense, Denmark;National Advisory Unit on Late Effects after Cancer Treatment, Department of Oncology, Oslo University Hospital, Oslo, Norway;

关键词: Breast cancer;    Hypothyroidism;    Matched cohort study;    Radiation therapy;    Chemotherapy;    Late effect;    Cancer survivorship;   

DOI  :  10.1186/s13058-020-01337-z

来源: Springer

【 摘 要 】

BackgroundBreast cancer survivors (BCS) may have increased risk of hypothyroidism, but risk according to treatment modality is unclear. We estimated the incidence of hypothyroidism in women with breast cancer, and according to cancer treatment.MethodsUsing nationwide registries, we identified all Danish women aged ≥ 35 years diagnosed with non-metastatic breast cancer (1996–2009). We matched up to five cancer-free women (controls) for each BCS. We excluded women with prevalent thyroid disease. Cancer treatment was chemotherapy with or without radiotherapy (RT) targeting the breast/chest wall only, or also the lymph nodes (RTn). We identified hypothyroidism using diagnostic codes, and/or levothyroxine prescriptions. We calculated the cumulative incidence, incidence rates (IR) per 1000 person-years, and used Cox regression to estimate hazard ratios (HR) and associated 95% confidence intervals (CIs) of hypothyroidism, adjusting for comorbidities.ResultsWe included 44,574 BCS and 203,306 matched controls with 2,631,488 person-years of follow-up. BCS had a slightly higher incidence of hypothyroidism than controls [5-year cumulative incidence, 1.8% (95%CI = 1.7–1.9) and 1.6% (95%CI = 1.5–1.6), respectively]. The overall IR was 4.45 (95%CI = 4.25–4.67) and 3.81 (95%CI = 3.73–3.90), corresponding to an adjusted HR = 1.17 (95%CI = 1.11–1.24). BCS who received RTn with chemotherapy (HR = 1.74, 95%CI = 1.50–2.02) or without chemotherapy (HR = 1.31, 95%CI = 1.14–1.51) had an elevated risk of hypothyroidism compared with matched controls and compared with BCS who underwent surgery alone [HR = 1.71, 95%CI = 1.45–2.01 and HR = 1.36, 95%CI = 1.17–1.58, respectively].ConclusionsBCS have an excess risk of hypothyroidism compared with age-matched controls. BCS and those working in cancer survivorship settings ought to be aware that this risk is highest in women treated with radiation therapy to the lymph nodes and chemotherapy.

【 授权许可】

CC BY