Elsevier

Cancer Epidemiology

Volume 36, Issue 4, August 2012, Pages 335-340
Cancer Epidemiology

Smoking and alcohol consumption in relation to risk of thyroid cancer in postmenopausal women

https://doi.org/10.1016/j.canep.2012.03.013Get rights and content

Abstract

Background: Few cohort studies have examined smoking and alcohol consumption in relation to risk of thyroid cancer, and their findings are conflicting. Methods: We therefore assessed the association of smoking and alcohol intake with risk of thyroid cancer in a cohort of 159,340 women enrolled in the Women's Health Initiative. Over 12.7 years of follow-up 331 cases of thyroid cancer, of which 276 were papillary thyroid cancer, were identified. Cox proportional hazards models were used to estimate hazard ratios (HR) and 95% confidence intervals (CI). Results: Compared to never smokers, ever smokers did not have altered risk. Current smokers had reduced risk for all thyroid cancer (HR 0.54, 95% CI 0.29–1.00) and for papillary thyroid cancer (HR 0.34, 95% CI 0.15–0.78); however, the number of current smokers among cases was small. No associations or trends were seen for amount smoked, age of starting smoking, or age at quitting. Smokers of ≥40 pack-years had a significantly reduced risk of papillary thyroid cancer (HR 0.44, 95% CI 0.21–0.89). In contrast, women who had smoked for < 20 years had increased risk of thyroid cancer (HR 1.35, 95% CI 1.05–1.74) and papillary cancer (HR 1.43, 95% CI 1.09–1.89). Alcohol intake was not associated with risk. Conclusion: Our findings suggest that current smoking and having higher pack-years of exposure are associated with a modestly reduced risk of thyroid cancer, whereas alcohol consumption does not appear to affect risk.

Section snippets

Methods

The Women's Health Initiative (WHI) is a large, multi-center, multi-faceted study designed to advance understanding of the determinants of major chronic diseases in postmenopausal women. It is composed of a Clinical Trial component (CT, N = 68,132) and an Observational Study component (OS, N = 93,676) [18]. The clinical trial component included three randomized controlled intervention studies: hormone therapy, low-fat diet modification and calcium + vitamin D supplementation. Women between the ages

Results

At baseline, compared to non-cases, thyroid cancer cases were significantly younger, taller, had lower alcohol intake, and greater frequency of thyroid nodules and goiter (Table 1). Other factors differed little between the two groups. The distribution of cases by stage was: 76.4% localized, 18.2% regional, 4.2% distant, and 1.2% unknown.

In multivariable analyses, ever having smoked was not associated with risk of thyroid cancer or papillary thyroid cancer (Table 2). Current smokers had a

Discussion

In the present study, ever smokers did not have an altered risk of thyroid cancer. Being a current cigarette smoker was associated with reduced risk of thyroid cancer and papillary thyroid cancer, and having a cumulative exposure of 40 or more pack-years of cigarette smoking was associated with reduced risk of papillary thyroid cancer; however, the numbers of cases among the exposed were small. Having smoked for a shorter duration and having quit smoking ≥30 years before enrollment appeared to

Conflict of interest statement

All authors state that they have no conflicts-of-interest that are pertinent to this work.

Acknowledgments

Short list of WHI investigators

Program Office: (National Heart, Lung, and Blood Institute, Bethesda, Maryland) Jacques Rossouw, Shari Ludlam, Dale Burwen, Joan McGowan, Leslie Ford, and Nancy Geller.

Clinical Coordinating Center: (Fred Hutchinson Cancer Research Center, Seattle, WA) Garnet Anderson, Ross Prentice, Andrea LaCroix, and Charles Kooperberg.

Investigators and Academic Centers: (Brigham and Women's Hospital, Harvard Medical School, Boston, MA) JoAnn E. Manson; (MedStar Health Research

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