Family history of cancer and risk of sporadic differentiated thyroid carcinoma

BACKGROUND:

Thyroid cancer incidence in the United States, particularly in women, has increased dramatically since the 1980s. Although the causes of thyroid cancer in most patients remain largely unknown, evidence suggests the existence of an inherited predisposition to development of differentiated thyroid carcinoma (DTC). Therefore, the authors explored the association between sporadic DTC and family history of cancer.

METHODS:

In a retrospective hospital‐based case‐control study of prospectively recruited subjects who completed the study questionnaire upon enrollment, unconditional logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) as estimates of the DTC risk associated with first‐degree family history of cancer.

RESULTS:

The study included 288 patients with sporadic DTC and 591 cancer‐free controls. Family history of thyroid cancer in first‐degree relatives was associated with increased DTC risk (adjusted OR, 4.1; 95% CI, 1.7‐9.9). All DTC cases in patients with a first‐degree family history of thyroid cancer were cases of papillary thyroid carcinoma (PTC) (adjusted OR, 4.6; 95% CI, 1.9‐11.1). Notably, the risk of PTC was highest in subjects with a family history of thyroid cancer in siblings (OR, 7.4; 95% CI, 1.8‐30.4). In addition, multifocal primary tumor was more common among PTC patients with first‐degree family history of thyroid cancer than among PTC patients with no first‐degree family history of thyroid cancer (68.8% vs 35.5%, P = .01).

CONCLUSIONS:

The study suggests that family history of thyroid cancer in first‐degree relatives, particularly in siblings, is associated with an increased risk of sporadic PTC. Cancer 2012;. © 2011 American Cancer Society.     

The prognostic value of primary tumor size in papillary and follicular thyroid carcinoma

BACKGROUND: A delay in the diagnosis of differentiated thyroid carcinoma often leads to larger tumors, higher prevalence rates of distant metastasis, and earlier cause-specific deaths. Threshold tumor diameters for extrathyroidal growth, lymph node spread, and distant metastasis in papillary (PTC) and follicular thyroid carcinoma (FTC) remain to be defined. METHODS: A comparative correlation of primary tumor size and extrathyroidal growth, lymph node spread, and distant metastasis was performed for 500 institutional patients who received surgery for PTC or FTC. RESULTS: There were 366 patients with PTC (73.2%) and 134 patients with FTC (26.8%). Multifocality (23.5% vs. 9.0%; P < 0.001) and lymph node metastasis (40.2% vs. 19.4%; P < 0.001) were more common in the patients with PTC than in those with FTC. Patients with FTC were older at first diagnosis (51.6 vs. 47.0 years; P = 0.01) compared with the patients with PTC. The FTC tumors were almost twice as large (39.9 vs. 20.6 mm; P < 0.001), and patients had a higher prevalence of distant metastasis (17.9% vs. 6.3%; P < 0.001). When primary tumor diameter was accounted for, cumulative risks of extrathyroidal growth and lymph node metastasis were higher in patients with PTC than in patients with FTC (P < 0.001; log-rank test). In striking contrast, the cumulative risk of distant metastasis was the same for PTC and FTC tumors of equal size (P = 0.89; log-rank test) and increased once the primary tumor size was > 20 mm. Pulmonary metastasis was an earlier event than bone metastasis. CONCLUSIONS: The data suggested that earlier intervention is warranted to keep suspicious thyroid nodules from growing > 20 mm (or greater than T1) and spreading to distant organs.     

Incidence and survival of Swedish patients with differentiated thyroid cancer

Papillary (PTC) and follicular (FTC) thyroid cancers are rare disorders but are, nevertheless, among the most common cancers in individuals below 40 years of age. From the population-based Swedish Cancer Registry we identified 3,588 individuals with PTC and 1,966 with FTC during 1958-87. Histopathology was determined by examining the original histopathology reports. The relative survival ratio (RSR) was used as the measure of patient survival. Incidence of both PTC and FTC was higher among women, especially for PTC and particularly during the fertile part of female life. Incidence of PTC increased significantly over time, a trend that was not observed for FTC. Five-year relative survival appeared to be higher for patients diagnosed with PTC compared to FTC, although this difference was almost completely explained by the confounding effect of age. Patients with PTC experience lower mortality during the period 7-20 years after diagnosis. Excess mortality was lower among women, although the magnitude of the difference varied with age and histopathology. In contrast to our perceptions based on clinical practice, we observed no difference in excess mortality between patients diagnosed with PTC and FTC during the years immediately after diagnosis (where the majority of deaths occur). Our data suggest that there may exist a subgroup of thyroid tumors with superior prognosis diagnosed in women during the fertile part of female life. Sex hormones may play a role in the etiology of these tumors.     

Expressions of CK-19, NF-kappaB, E-cadherin, beta-catenin and EGFR as diagnostic and prognostic markers by immunohistochemical analysis in thyroid carcinoma

Immunohistochemical markers have been proposed for thyroid cancer diagnosis and prognostic studies. Immunohistochemical analysis of CK-19, NF-kappaB, beta-catenin, E-cadherin and EGFR were done to evaluate their diagnostic and prognostic efficiencies in eighty eight cancer specimen (PTC-52, FTC-16, benign nodule-12 and MNG-8). CK-19 was positive in 91% (62/68) DTC, 98% (51/52) PTC, 69% (11/16) FTC and 15% (3/20) benign thyroid nodules. NF-kappaB was expressed 93% (63/68) DTC, in 96% (50/52) PTC, 81% (11/16) FTC and 15% (3/20) benign thyroid nodules. Both CK-19 and NF-kappaB were significantly differentiated DTC, PTC and FTC from benign thyroid nodule (p < 0.0001) with diagnostic accuracy of 89.74%, 94.4% and 77.4% for CK-19 and 91.0%, 90.5% and 83.5% respectively for NF-kappaB. Though CK-19 and NF-kappaB were equally sensitive but CK-19 was most specific in the diagnosis of DTC and PTC. The diagnostic accuracy of beta-catenin was 96% and 94% and accuracy of E-cadherin was 90.1% and 93.9% for the diagnosis of metastatic PTC and FTC respectively. EGFR showed 90% (18/20) of metastatic PTC (p < 0.0001) and sensitivity, specificity and accuracy were 90%, 71.8% and 78.85% respectively. CK-19 and NF-kappaB were accurately diagnosed in DTC, PTC and FTC whereas, NF-kappaB, E-cadherin, beta-catenin and EGFR were strongly expressed in invasive papillary thyroid cancers and FTC, thus can be important diagnostic and prognostic marker for FTC and metastatic PTC. This may be concluded that immunohistochemical expression of panel of markers CK-19, NF-kappaB, E-cadherin, beta-catenin and EGFR can be useful in diagnosis and prognosis of DTC.     

Possible Roles of the Xenobiotic Transporter P-glycoproteins Encoded by the MDR1 3435 C>T Gene Polymorphism in Differentiated Thyroid Cancers

Background: P-glycoprotein (Pgp), encoded by the multidrug resistance 1 (MDR1) gene, is an efflux transporterwhich plays an important role in pharmacokinetics. The current preliminary study was designed to determineassociations between a germ-line polymorphism in the MDR1 gene with differentiated thyroid carcinoma (DTC).Materials and Methods: In the current case-control study, 60 differentiated thyroid cancers (DTC)- 45 papillaryTC (PTC), 9 follicular TC(FTC) and 6 well-differentiated tumors of uncertain malignant potential (WDT-UMP)were examined. Results were compared to a healthy control group (n=58) from the same population. GenomicDNA was extracted from peripheral blood with EDTA and the target gene was genotyped by real-time PCR.Results: Carriers of the variant allele of MDR1 exon 26 polymorphism were at 2.8-fold higher risk of DTC thanthe control group (odds ratio [OR]: 0.3805, 95% confidence interval [Cl]: 0.1597-0.9065 (p> 0.046). Conclusions:Presented results suggest that the MDR1 3435TT genotype might influence risk of development of DTC andthat the CC genotype might be linked to a poor prognosis. Large-scale studies are now needed to validate thisassociation.     

Functional polymorphisms in the insulin-like binding protein-3 gene may modulate susceptibility to differentiated thyroid carcinoma in Caucasian Americans

The insulin-like growth factor (IGF) pathway is believed to play a pivotal role in thyroid carcinogenesis. Polymorphisms of IGF-1 and IGF binding protein-3 (IGFBP-3) have been associated with modulation of risk for the emergence of assorted common malignancies, but studies of the influence of such polymorphisms on risk of differentiated thyroid carcinoma (DTC) are lacking. In a case-control study of 173 DTC patients, 101 patients with benign thyroid disease, and 401 controls, an unconditional logistical regression model adjusted for age and sex was applied to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for the associations between polymorphisms of IGF-1 and IGFBP-3 and DTC risk. IGFBP-3 rs2132572 GA/AA genotypes were associated with a decreased risk of DTC (adjusted OR = 0.6, 95% CI: 0.4-0.9), particularly multifocal DTC (adjusted OR = 0.3, 95% CI: 0.1-0.7). The association with DTC was more evident in subjects with a first-degree family history of cancer (adjusted OR = 0.4, 95% CI: 0.2-0.7, P(interaction) = 0.013) and non-drinkers (adjusted OR = 0.4, 95% CI: 0.2-0.7, P(interaction) = 0.028). A four single nucleotide polymorphism haplotype of IGFBP-3 was associated with a decreased risk of DTC (adjusted OR = 0.7, 95% CI: 0.5-1.0, P = 0.030). Our study suggests that polymorphic IGFBP-3 may be involved in susceptibility to DTC.     

分化型甲状腺癌组织中存活素蛋白的表达与细胞增殖和凋亡的关系

背景与目的： 探讨分化型甲状腺癌(differentiated thyroid carcinoma, DTC)组织中存活素(Survivin)蛋白的表达与细胞增殖和凋亡活性的关系,以及在甲状腺癌发生、发展过程中的作用机制及可能的作用途径。 材料与方法： 采用末端脱氧核苷酸转移酶标记(TUNEL)法及免疫组化技术分别对10例结节性甲状腺肿(结甲)、10例甲状腺滤泡状腺瘤、30例甲状腺乳头状癌、12例甲状腺滤泡状癌组织中细胞凋亡指数(apoptosis index,AI)、细胞增殖核抗原增殖指数(PCNA-LI, PI)和Survivin蛋白的表达进行检测。 结果： 甲状腺癌组中Survivin蛋白的表达阳性率均显著高于对照组结甲和腺瘤中的阳性表达率;甲状腺癌组织中Survivin的表达与淋巴结转移和临床分期有关(P<0.05);且Survivin蛋白表达阳性组和阴性组的AI和PI均呈负相关(r分别为－0.72和－0.80,P均<0.01);分别比较Survivin蛋白表达阳性组和阴性组的AI及PI,两组间AI和PI的差异均具有统计学意义(P<0.01)。 结论： Survivin与分化型甲状腺癌细胞增殖和凋亡关系密切,在甲状腺癌发生发展过程中发挥重要的作用。     

甲状腺乳头状癌与甲状腺结节钙化的关系研究

[目的]探讨甲状腺结节合并钙化与甲状腺乳头状癌的关系。[方法]回顾性分析240例甲状腺结节患者的彩色超声资料与病理诊断结果。[结果 ]240例甲状腺结节中,甲状腺良性疾病钙化率为23.3%（38/163）,而甲状腺乳头状癌中钙化率达75.3%（58/77）,两组差异有统计学意义（χ2=58.947,P〈0.001）。钙化诊断甲状腺乳头状癌的ROC曲线下面积为0.811（95%CI：0.750~0.871）。微钙化患甲状腺乳头状癌的风险是非微钙化者的5.348倍（95%CI：2.804~10.200）,而粗钙化患甲状腺乳头状癌的风险是非粗钙化者的4.000倍（95%CI：1.564~10.230）。[结论]钙化尤其是微钙化对于诊断甲状腺癌的特异性较高。当彩超发现甲状腺结节中有微小钙化时应提高警惕,尤其是微钙化,应进一步做针吸细胞学检查。     

224例分化型甲状腺癌放射性碘治疗分析

目的:对在我科8年来治疗的分化型甲状腺癌(DTC)患者进行回顾性分析,了解DTC发病规律,并证明131碘治疗DTC的疗效。方法:2002至2010年确诊为DTC并有颈部淋巴结转移的患者,进行甲状腺近全切除,并进行颈部淋巴结清扫,术后131碘治疗。131碘治疗后,每半年随访一次。随访指标:颈部超声检查;血清TSH、FT4、FT3;血清Tg、TgAb检查;全身放射性碘扫描;胸部CT或MRI。疗效判定:当血清Tg、TgAb阴性,颈部超声未见肿大淋巴结,全身放射性碘扫描未见放射性浓聚时,为DTC治愈。当上述指标为阳性时,则进行再次131碘治疗。用SPSS软件进行统计学处理。结果:DTC患者数逐年明显增加;乳头癌与滤泡癌的比例约为12(207):1(17),女性患者远多于男性,男:女患者患病比例约为1(57):3(167);DTC在20-55岁之间为高发年龄段,峰值在25-35岁之间;131碘治疗对DTC治愈率约达90%,近10%的顽固性DTC患者多次131碘治疗效果欠佳。结论:分化型甲状腺癌患病率有明显增加趋势,25-35岁为高发年龄,女性多于男性,早期诊断及早期治疗是关键。手术切除甲状腺后进行131碘治疗对DTC治愈率达90%。近10%的患者131碘治疗效果欠佳,需寻求更好的治疗方法。     

甲状腺乳头状癌颈侧区淋巴结跳跃转移危险因素分析

  目的  探讨甲状腺乳头状癌（papillary thyroid carcinoma,PTC）淋巴结跳跃转移（中央区无淋巴结转移,颈侧区有淋巴结转移）的规律及危险因素。  方法  回顾性分析2013年1月至2016年12月重庆医科大学附属第一医院521例行甲状腺全切+中央区及颈侧区淋巴结清扫的PTC患者的临床病理资料,分析跳跃转移的危险因素。  结果  本研究PTC跳跃转移率为8.3%（43/521）,肿瘤位于甲状腺上极（OR=3.401,95%CI:1.770~6.536;P=0.001）,年龄>45岁（OR=2.856,95%CI:1.488~5.482;P=0.002）,单侧癌（OR=3.424,95%CI:1.182~9.920;P=0.023）是PTC出现颈侧区淋巴结跳跃转移的独立危险因素。本研究比较cN1b的PTC患者和肿瘤位于甲状腺上极的cN0 PTC患者跳跃转移情况,发现肿瘤位于上极cN0的PTC患者出现潜在跳跃转移的可能性高于cN1b患者（P=0.022）。  结论  PTC颈侧区淋巴结跳跃转移并不少见,术前、术中针对颈侧区淋巴结转移状态的评估很重要,尤其是肿瘤位于上极,年龄>45岁的单侧PTC患者,必要时需行患侧颈侧区淋巴结清扫。      

Enhancement of lymph node metastasis and distant metastasis of thyroid carcinoma

BACKGROUND: The mechanisms of local and distant metastases are imperfectly understood. The goal of the current study was to add to the body of knowledge regarding local and distant metastases of thyroid malignancies. METHODS: The authors performed multivariate analysis of 573 patients who underwent surgery between November 1994 and May 2002 for follicular (FTC; n = 100), papillary (PTC; n = 236), or medullary thyroid carcinoma (MTC; n = 237) at a university hospital. RESULTS: In multivariate analysis, extrathyroidal extension consistently evolved as the key risk factor for both lymph node metastasis and distant metastasis. This correlation was most pronounced in MTC and least pronounced in FTC. The risk of lymph node metastasis also increased with reoperative status in patients with MTC and with primary tumor diameter in patients with MTC (tumor diameter > 10 mm) and patients with PTC (tumor diameter > 20 mm). In the PTC group, lymph node metastasis was more common among patients younger than age 45. In the MTC group, extrathyroidal growth and distant metastasis were associated exclusively with lymph node metastasis. Lymph node metastasis was the only secondary risk factor for distant metastasis. In the analysis of risk factors for distant metastasis in the FTC and PTC groups, no interaction was found between extrathyroidal growth and lymph node metastasis. This finding suggests that extrathyroidal growth and lymph node metastasis of FTC and PTC, and presumably also MTC, represent separate mechanisms and routes of distant metastasis. CONCLUSIONS: Screening for both local residual disease and distant metastases should be intensified in the high-risk population of patients whose primary tumors exhibit large diameters, extrathyroidal growth, or lymph node metastasis.     

Postoperative recurrence of papillary thyroid carcinoma with lymph node metastasis

Background and Objectives

: The purpose of this study was to retrospectively analyze the features of patients with papillary thyroid carcinoma (PTC) presenting with neck lymph node (LN) metastasis.

Methods

: The study enrolled 909 patients with PTC who had undergone total thyroidectomy. After a median follow‐up of 14.6 years, 73 (8.0%) patients died of thyroid cancer. A total of 536 patients had the tumor confined to the thyroid (intra‐thyroid), 111 had lymph node (LN) metastasis, 225 showed soft tissue invasion, and 37 had distant metastasis.

Results

: Compared with the intra‐thyroid group, the group with LN metastases showed larger tumor size, higher postoperative thyroglobulin levels, advanced TNM stage, higher recurrence rates (5.2% vs. 31.5%), and higher disease‐specific mortality (1.3% vs. 12.6%). Of the 111 patients with PTC and LN metastases, 35 (31.5%) were diagnosed with recurrence during a mean follow‐up period of 16.9 ± 0.6 years. Among the 35 patients with recurrent PTC, 14 (40.0%) died of thyroid cancer. The mortality group was characterized by older, mostly male patients who presented with larger initial tumor size compared with survivors.

Conclusions

: In patients with PTC, the rates of recurrence and cancer mortality were higher in the group with LN metastasis than that in the intra‐thyroid tumor group. J. Surg. Oncol. 2015 111:149–154. © 2015 The Authors. Journal of Surgical Oncology Published by Wiley Periodicals, Inc.     

224例分化型甲状腺癌放射性碘治疗分析

目的：对在我科8年来治疗的分化型甲状腺癌（DTC）患者进行回顾性分析,了解DTC发病规律,并证明131碘治疗DTC的疗效。方法：2002至2010年确诊为DTC并有颈部淋巴结转移的患者,进行甲状腺近全切除,并进行颈部淋巴结清扫,术后^131碘治疗。^131碘治疗后,每半年随访一次。随访指标：颈部超声检查;血清TSH、FT4、FT3;血清Tg、TgAb检查;全身放射性碘扫描;胸部CT或MRI。疗效判定：当血清Tg、TgAb阴性,颈部超声未见肿大淋巴结,全身放射性碘扫描未见放射性浓聚时,为DTC治愈。当上述指标为阳性时,则进行再次^131碘治疗。用SPSS软件进行统计学处理。结果：DTC患者数逐年明显增加;乳头癌与滤泡癌的比例约为12（207）：1（17）,女性患者远多于男性,男：女患者患病比例约为1（57）：3（167）;DTC在20-55岁之间为高发年龄段,峰值在25-35岁之间;^131碘治疗对DTC治愈率约达90%,近10%的顽固性DTC患者多次^131碘治疗效果欠佳。结论：分化型甲状腺癌患病率有明显增加趋势,25-35岁为高发年龄,女性多于男性,早期诊断及早期治疗是关键。手术切除甲状腺后进行^131碘治疗对DTC治愈率达90%。近10%的患者^131碘治疗效果欠佳,需寻求更好的治疗方法。     

Prophylactic hepatic arterial infusion chemotherapy for the prevention of liver metastasis in patients with colon carcinoma: a randomized control trial

BACKGROUND: The liver is the most frequent site of recurrence after curative resection in patients with colon carcinoma. For liver metastasis, a high response rate can be achieved with hepatic arterial infusion (HAI) chemotherapy. In the current study, the authors administered 5-fluorouracil (5-FU) as adjuvant chemotherapy by HAI to patients with colon carcinoma without liver metastases and studied its effects on recurrence in the liver and survival. METHODS: A total of 316 patients with preoperative Stage II or Stage III colon carcinoma (according to the 1997 revision of the International Union Against Cancer TNM staging system) were randomly assigned to receive surgery plus 3-week continuous HAI of 5-FU or surgery alone. There were 305 eligible patients, of whom the 119 patients assigned to the HAI arm actually received 5-FU. The primary endpoint was disease-free survival, whereas the secondary endpoints were overall survival and liver metastasis-free survival. Analysis was by intent to treat. RESULTS: There were no significant differences noted in morbidity between the two treatment arms. During the follow-up period (median, 59.0 months), the incidence of liver metastasis was significantly decreased in the HAI arm whereas there were no significant differences reported between the 2 arms with regard to the frequency of metastasis at other sites. In the HAI arm, the risk ratio for recurrence was 0.40 (95% confidence interval [95% CI], 0.24-0.64; P=0.0002), the risk ratio for death was 0.37 (95% CI, 0.21-0.67; P=0.0009), and the risk ratio for liver metastasis was 0.38 (95% CI, 0.22-0.66; P=0.0005). These differences were found to be significant only for patients with Stage III disease. Toxicities were mild. CONCLUSIONS: A schedule of 3-week HAI of 5-FU given as adjuvant chemotherapy to patients with Stage III colon carcinoma appeared to contribute to a significant decrease in the frequency of liver metastases and was associated with an improved survival rate.     

桥本甲状腺炎与甲状腺乳头状癌临床病理特征的相关性分析

目的:探讨桥本甲状腺炎（Hashimoto's thyroiditis,HT）对甲状腺乳头状癌（papillary thyroid carcinoma,PTC）的影响。方法:分析882例经甲状腺切除术且病理证实为PTC患者的临床资料,比较PTC合并HT和非合并HT患者临床病理特征和甲状腺功能,分析HT与PTC临床病理特征的相关性。结果:PTC合并HT组239例（27.10%）,非合并HT组643例（72.90%）,两组间比较,合并HT组女性、癌灶多发、双侧及淋巴结转移比例显著高于非合并HT组,差异均有统计学意义（均P＜0.05）,而年龄、原发灶直径、远处转移、复发危险度分层及TNM分期均无显著性差异（均P＞0.05）。与非合并HT组相比,PTC合并HT组TPOAb、TGAb、TSH水平升高,FT4、FT3水平降低（均P＜0.05）。分别进行Logistic回归分析显示:HT与女性、癌灶多发、淋巴结转移呈独立相关（OR值分别为2.690、1.491、1.514,均P＜0.05）;癌灶多发、原发灶直径>1 cm、合并HT与PTC淋巴结转移独立相关（OR值分别为2.150、2.751、1.465,均P＜0.05）。结论:合并HT的PTC患者女性、多灶及淋巴结转移多见,但不影响预后;癌灶多发、原发灶直径>1 cm、合并HT是PTC淋巴结转移的独立危险因素。     

血管内皮生长因子的表达与亚洲胃癌患者病理学特征相关性的Meta分析

目的:利用Meta分析定量评价血管内皮生长因子(vascular endothelial growth factor,VEGF)与亚洲胃癌患者临床病理学特征的关联性.方法:检索PubMed、中国知网(China National Knowledge Infrastructure,CNKI)和维普全文期刊数据库中所有已发表胃癌组织中VEGF表达与病理学参数及其预后的相关性研究,应用STATAg.0SE软件进行不同组间VEGF表达比值比(odd ratio,OR)和95％可信区间(95％ confidence interval,CI)以及文献异质性和偏倚评估.结果:共纳入132篇研究文献;胃癌组织中VEGF的表达显著高于正常胃黏膜组织(P=0.000);且癌组织中VEGF的表达与肿瘤浸润深度(OR=3.32,95％ CI=2.82～3.91)、淋巴转移(OR=3.52,95％CI=3.02～4.10)、远处转移(OR=2.88,95％ CI=1.94～4.27)、静脉侵犯(OR=2.19,95％CI=1.68～2.85)和TNM分期(OR=3.98,95％ CI=3.31～4.78)均有显著相关性.结论:VEGF蛋白可作为预测胃癌浸润转移以及评价患者预后的生物学指标,成为胃癌诊治中较有价值的早期分子标志物.     

Is cervical screening preventing adenocarcinoma and adenosquamous carcinoma of the cervix?

While the incidence of squamous carcinoma of the cervix has declined in countries with organised screening, adenocarcinoma has become more common. Cervical screening by cytology often fails to prevent adenocarcinoma. Using prospectively recorded cervical screening data in England and Wales, we conducted a population‐based case–control study to examine whether cervical screening leads to early diagnosis and down‐staging of adenocarcinoma. Conditional logistic regression modelling was carried out to provide odds ratios (ORs) and 95% confidence intervals (CIs) on 12,418 women with cervical cancer diagnosed between ages 30 and 69 and 24,453 age‐matched controls. Of women with adenocarcinoma of the cervix, 44.3% were up to date with screening and 14.6% were non‐attenders. The overall OR comparing women up to date with screening with non‐attenders was 0.46 (95% CI: 0.39–0.55) for adenocarcinoma. The odds were significantly decreased (OR: 0.22, 95% CI: 0.15–0.33) in up to date women with Stage 2 or worse adenocarcinoma, but not for women with Stage1A adenocarcinoma 0.71 (95% CI: 0.46–1.09). The odds of Stage 1A adenocarcinoma was double among lapsed attenders (OR: 2.35, 95% CI: 1.52–3.62) compared to non‐attenders. Relative to women with no negative cytology within 7 years of diagnosis, women with Stage1A adenocarcinoma were very unlikely to be detected within 3 years of a negative cytology test (OR: 0.08, 95% CI: 0.05–0.13); however, the odds doubled 3–5 years after a negative test (OR: 2.30, 95% CI: 1.67–3.18). ORs associated with up to date screening were smaller for squamous and adenosquamous cervical carcinoma. Although cytology screening is inefficient at preventing adenocarcinomas, invasive adenocarcinomas are detected earlier than they would be in the absence of screening, substantially preventing Stage 2 and worse adenocarcinomas.     

Previous thyroid disease and risk of thyroid cancer in Switzerland

A hospital-based case-control study of 86 cases of thyroid cancer and 317 controls was done in the Swiss Canton of Vaud. Patients with thyroid cancer tended to be better educated (odds ratio [OR] 2.1 for ≥ 14 vs. ≤ 8 years of education 95% CI 1.1–4.1) and of higher social class than controls. Cases more often had a history of benign thyroid nodules (OR 25.2, 95% CI 7.6–83.6) and non-toxic goitre (OR 5.3, 95% CI 2.5–11.2). Furthermore, patients with thyroid cancer were more likely to have resided in endemic goitre areas (OR 1.7, 95% CI 1.0–3.0) and to have had first-degree relatives affected by benign thyroid disease (OR 3.9, 95% CI 2.1–7.1). Therefore, this study offers quantitative evidence of the association between various thyroid diseases and the risk of thyroid cancer which, despite difficulties in the classification of benign and malignant thyroid diseases, is remarkably consistent in studies from different countries.