Abstract
Purpose
Although many studies have linked obesity with increased risk of thyroid cancer, few have investigated the role of obesity-related lifestyle characteristics and medical conditions in the etiology of this disease. We examined the associations of self-reported physical activity and diabetes history with thyroid cancer risk in a large pooled analysis of prospective cohort studies.
Methods
Data from five prospective studies in the U.S. (n = 362,342 men, 312,149 women) were coded using standardized exposure, covariate, and outcome definitions. Hazard ratios (HR) and 95% confidence intervals (CI) for thyroid cancer were estimated using age as the time metric and adjusting for sex, education, race, marital status, cigarette smoking, body mass index, alcohol intake, and cohort. Effect modification by other risk factors (e.g., age, sex, and body mass index) and differences by cancer subtype (e.g., papillary, follicular) were also examined.
Results
Over follow-up (median = 10.5 years), 308 men and 510 women were diagnosed with a first primary thyroid cancer. Overall, subjects reporting the greatest amount of physical activity had an increased risk of the disease (HR = 1.18, 95% CI:1.00–1.39); however, this association was restricted to participants who were overweight/obese (≥25 kg/m2; HR = 1.34, 95% CI:1.09–1.64) as opposed to normal-weight (<25 kg/m2; HR = 0.92, 95% CI:0.69–1.22; P-interaction = 0.03). We found no overall association between self-reported history of diabetes and thyroid cancer risk (HR = 1.08, 95% CI:0.83–1.40).
Conclusion
Neither physical inactivity nor diabetes history was associated with increased risk of thyroid cancer. While it may have been a chance finding, the possible increased risk associated with greater physical activity warrants further investigation.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Enewold L, Zhu K, Ron E, Marrogi AJ, Stojadinovic A, Peoples GE et al (2009) Rising thyroid cancer incidence in the United States by demographic and tumor characteristics, 1980–2005. Cancer Epidemiol Biomarkers Prev 18:784–791
Flegal KM, Carroll MD, Ogden CL, Curtin LR (2010) Prevalence and trends in obesity among US adults, 1999–2008. JAMA 303:235–241
Suzuki T, Matsuo K, Hasegawa Y, Hiraki A, Kawase T, Tanaka H et al (2008) Anthropometric factors at age 20 years and risk of thyroid cancer. Cancer Causes Control 19:1233–1242
Brindel P, Doyon F, Rachédi F, Boissin JL, Sebbag J, Shan L et al (2009) Anthropometric factors in differentiated thyroid cancer in French Polynesia: a case-control study. Cancer Causes Control 20:581–590
Kitahara CM, Platz EA, Beane Freeman LE, Hsing AW, Linet MS, Park Y et al (2011) Obesity and thyroid cancer risk among U.S. men and women: a pooled analysis of five prospective studies. Cancer Epidemiol Biomarkers Prev 20:464–472
Tulinius H, Sigfusson N, Sigvaldason H, Bjarnadottir K, Tryggvadottir L (1997) Risk factors for malignant diseases: a cohort study on a population of 22,946 Icelanders. Cancer Epidemiol Biomarkers Prev 6:863–873
Oh SW, Yoon YS, Shin SA (2005) Effects of excess weight on cancer incidences depending on cancer sites and histologic findings among men: Korea National Health Insurance Corporation Study. J Clin Oncol 23:4742–4754
Clavel-Chapelon F, Guillas G, Tondeur L, Kernaleguen C, Boutron-Ruault MC (2010) Risk of differentiated thyroid cancer in relation to adult weight, height and body shape over life: the French E3N cohort. Int J Cancer 126:2984–2990
Dal Maso L, La Vecchia C, Francheschi S, Preston-Martin S, Ron E, Levi F et al (2000) A pooled analysis of thyroid cancer studies. V. Anthropometric factors. Cancer Causes Control 11:137–144
Guignard R, Truong T, Rougier Y, Baron-Dubourdieu D, Guénel P (2007) Alcohol drinking, tobacco smoking, and anthropometric characteristics as risk factors for thyroid cancer: a countrywide case-control study in New Caledonia. Am J Epidemiol 166:1140–1149
Engeland A, Tretli S, Akslen LA, Bjørge T (2006) Body size and thyroid cancer in two million Norwegian men and women. Br J Cancer 95:366–370
Iribarren C, Haselkorn T, Tekawa IS, Friedman GD (2001) Cohort study of thyroid cancer in a San Francisco Bay area population. Int J Cancer 93:745–750
Rapp K, Schroeder J, Klenk J, Stoehr S, Ulmer H, Concin H et al (2005) Obesity and incidence of cancer: a large cohort study of over 145,000 adults in Austria. Br J Cancer 93:1062–1067
Samanic C, Chow WH, Gridley G, Jarvholm B, Fraumeni JF (2006) Relation of body mass index to cancer risk in 362,552 Swedish men. Cancer Causes Control 17(901–9):2
Fritz A, Percy C, Jack A, Shanmugaratnam K, Sobin L, Parkin DM et al (2000) International classification of diseases for oncology (ICD-O), 3rd edn. WHO, Geneva
DerSimonian R, Laird N (1986) Meta-analysis in clinical trials. Control Clin Trials 7:177–188
Huedo-Medina TB, Sánchez-Meca J, Marín-Martínez F, Botella J (2006) Assessing heterogeneity in meta-analysis: Q statistic or I2 index? Psychol Methods 11:193–206
Balkau B, Mhamda L, Oppert JM, Nolan J, Golay A, Porcellati F et al (2008) Physical activity and insulin sensitivity: the RISC study. Diabetes 57:2613–2618
Hursting SD, Lashinger LM, Wheatley KW, Rogers CJ, Colbert LH, Nunez NP et al (2008) Reducing the weight of cancer: mechanistic targets for breaking the obesity-carcinogenesis link. Best Pract Res Clin Endocrinol Metab 22:659–669
Hard GC (1998) Recent developments in the investigation of thyroid regulation and thyroid carcinogenesis. Environ Health Perspect 106:427–436
Rapp K, Schroeder J, Klenk J, Ulmer H, Concin H, Diem G et al (2006) Fasting blood glucose and cancer risk in a cohort of more than 140,000 adults in Austria. Diabetologia 49:945–952
Leitzmann MF, Brenner A, Moore SC, Koebnick C, Park Y, Hollenbeck A et al (2010) Prospective study of body mass index, physical activity, and thyroid cancer. Int J Cancer 126:2947–2956
Meinhold CL, Ron E, Schonfeld SJ, Alexander BH, Freedman DM, Linet MS et al (2010) Nonradiation risk factors for thyroid cancer in the US Radiologic Technologists Study. Am J Epidemiol 171:242–252
Rossing MA, Remler R, Voigt LF, Wicklund KG, Daling JR (2001) Recreational physical activity and risk of papillary thyroid cancer (United States). Cancer Causes Control 12:881–885
Aschebrook-Kilfoy B, Sabra MM, Brenner A, Moore SC, Ron E, Schatzkin A et al (2011) Diabetes and thyroid cancer risk in the National Institutes of Health-AARP Diet and Health Study. Thyroid 21:957–963
Ferrari P, Friedenreich C, Matthews CE (2007) The role of measurement error in estimating levels of physical activity. Am J Epidemiol 166:832–840
Giovannucci E, Harlan DM, Archer MC, Bergenstal RM, Gapstur SM, Habel LA et al (2010) Diabetes and cancer: a consensus report. Diabetes Care 33:1674–1685
Surveillance Epidemiology and End Results (SEER) (2009) SEER stat fact sheet—cancer of the thyroid. Bethesda, MD: National Cancer Institute, National Institutes of Health. http://seer.cancer.gov/csr/1975_2006/results_single/sect_01_table.11_2pgs.pdf. Accessed 29 Dec 2011
Acknowledgments
This work was supported in part by the Intramural Research Program of the National Cancer Institute, National Institutes of Health. Specific to NIH-AARP: Cancer incidence data from the Atlanta metropolitan area were collected by the Georgia Center for Cancer Statistics, Department of Epidemiology, Rollins School of Public Health, Emory University. Cancer incidence data from California were collected by the California Department of Health Services, Cancer Surveillance Section. Cancer incidence data from the Detroit metropolitan area were collected by the Michigan Cancer Surveillance Program, Community Health Administration, State of Michigan. The Florida cancer incidence data used in this report were collected by the Florida Cancer Data System (FCDC) under contract with the Florida Department of Health (FDOH). The views expressed herein are solely those of the authors and do not necessarily reflect those of the FCDC or FDOH. Cancer incidence data from Louisiana were collected by the Louisiana Tumor Registry, Louisiana State University Medical Center in New Orleans. Cancer incidence data from New Jersey were collected by the New Jersey State Cancer Registry, Cancer Epidemiology Services, New Jersey State Department of Health and Senior Services. Cancer incidence data from North Carolina were collected by the North Carolina Central Cancer Registry. Cancer incidence data from Pennsylvania were supplied by the Division of Health Statistics and Research, Pennsylvania Department of Health, Harrisburg, Pennsylvania. The Pennsylvania Department of Health specifically disclaims responsibility for any analyses, interpretations or conclusions. Cancer incidence data from Arizona were collected by the Arizona Cancer Registry, Division of Public Health Services, Arizona Department of Health Services. Cancer incidence data from Texas were collected by the Texas Cancer Registry, Cancer Epidemiology and Surveillance Branch, Texas Department of State Health Services. We are indebted to the participants in the NIH-AARP Diet and Health Study for their outstanding cooperation. We also thank Sigurd Hermansen and Kerry Grace Morrissey from Westat for study outcomes ascertainment and management and Leslie Carroll at Information Management Services for data support and analysis. In memory of Dr. Arthur Schatzkin, visionary investigator who founded the NIH-AARP Diet and Health Study.
Conflict of interest
None.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Kitahara, C.M., Platz, E.A., Beane Freeman, L.E. et al. Physical activity, diabetes, and thyroid cancer risk: a pooled analysis of five prospective studies. Cancer Causes Control 23, 463–471 (2012). https://doi.org/10.1007/s10552-012-9896-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10552-012-9896-y