Abstract
Simple SummaryThe inverse association between smoking, alcohol intake, and thyroid cancer has been suggested by observational studies. From the representative data in Korea, we identified the epidemiologic evidence to elucidate the true effect between smoking, alcohol intake, and thyroid cancer incidence by exploring the effect of changes in smoking and alcohol consumption habits.To elucidate potential causality between smoking and alcohol intake on thyroid cancer incidence, we explored the effect of changes in smoking and alcohol consumption habits. From the Korean National Health Insurance database, we identified 4,430,070 individuals who participated in the national health screening program in 2009 and 2011. The level of smoking and alcohol consumption was measured twice, once in 2009 and again in 2011. The risk of thyroid cancer according to their changes was estimated using the Cox proportional hazard model. During the mean follow-up period of 6.32 ± 0.72 years, 29,447 individuals were diagnosed with thyroid cancer. Compared to those who sustained not smoking, non-smokers who initiated smoking to light (adjusted hazard ratio (aHR) 0.96, 95% confidence interval (CI) 0.81–1.15), moderate (aHR 0.90, 95% CI 0.78–1.04), and heavy level (aHR 0.81, 95% CI 0.69–0.96) had a decreased risk of thyroid cancer. Heavy smokers who quit smoking had an increased risk of thyroid cancer (aHR 1.23, 95% CI 1.06–1.42) compared to those who sustained heavy smoking. Change in drinking status was not significantly associated with thyroid cancer risk compared to drinking at the same level, although a non-significant trend of increased risk was noted in quitters. Participants who initiated both smoking and drinking (HR 0.80, 95% CI 0.69–0.93) had a lower risk of thyroid cancer compared with those who continued not to smoke and drink. Our findings provide further evidence that smoking, and possibly alcohol consumption, would have true protective effects on the development of thyroid cancer.
Highlights
Previous studies have found that the risk of thyroid cancer incidence was inversely associated with smoking [1,2,3,4,5,6] and alcohol consumption [5,6,7,8,9]
To the best of our knowledge, this is the first study to date that has investigated the association between changes in smoking and alcohol intake, and thyroid cancer incidence
In addition to the decreased thyroid cancer risk in smokers and drinkers found in previous studies, our study showed that changes in smoking status may change thyroid cancer risk, providing further evidence of a protective effect of smoking on thyroid cancer
Summary
Previous studies have found that the risk of thyroid cancer incidence was inversely associated with smoking [1,2,3,4,5,6] and alcohol consumption [5,6,7,8,9]. Improvements in diagnostic tools and increased accessibility to medical services might cause an increased detection of small and asymptomatic lesions [10]. This led to the increase in incidence [11] without any change in thyroid cancer-related mortality [12]. The situation was similar in other developed countries: between 1998 and 2008 in the United States, about 80% (228,000 cases) of small and asymptomatic thyroid cancer cases were estimated to be the results of overdiagnosis, followed by about 70% of cases in Italy, France, and Australia, and 50% of cases in Nordic countries and England [10]
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