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American Journal of Epidemiology Vol. 127, No. 5: 969-980
Copyright © 1988 by The Johns Hopkins University School of Hygiene and Public Health

research-article

RADIOACTIVE IODINE THERAPY AND BREAST CANCER

A FOLLOW-UP STUDY OF HYPERTHYROID WOMEN

MARLENE B. GOLDMAN1, FARAHE MALOOF2, RICHARD R. MONSON1, ANN ASCHENGRAU1, DAVID S. COOPER2 3 and E. CHESTER RIDGWAY2 4

1Department of Epidemiology, Harvard School of Public Health 677 Huntington Avenue, Boston, MA 02115
2Thyroid Unit, Massachusetts General Hospital Boston, MA

Reprint requests to Dr. Marlene B. Goldman

A follow-up study of 1,762 hyperthyroid women who were treated at the Massachusetts General Hospital Thyroid Unit between 1946 and 1964 was conducted. The average length of follow-up was 17.2 years. A 1978 mailing address or a death certificate was located for 92% of the women, and 88% of 1,058 living patients responded to a mail questionnaire. The standardized mortality ratio (SMR) for all causes of death was 1.3 (95% confidence interval (Cl) 1.2–1.4). The standardized mortality ratios for all malignant neoplasms and for breast cancer were 0.9 (95% Cl 0.7–1.1) and 1.3 (95% Cl 0.8–1.9), respectively. More deaths than expected were observed from endocrine and metabolic diseases (SMR = 1.8, 95% Cl 1.2–2.7), circulatory system diseases (SMR = 1.4, 95% Cl 1.3–1.6), and respiratory system diseases (SMR = 1.9, 95% Cl 1.3–2.6). The standardized incidence ratios (SIR) for all malignant neoplasms and for breast cancer were 0.9 (95% Cl 0.8–1.1) and 1.2 (95% Cl 0.9–1.5), respectively. A nonsignificant excess breast cancer risk was observed 10 years after the onset of thyroid symptoms and was present at the end of 30 years of observation. A statistically significant excess number of pancreatic cancer cases (SIR = 2.0, 95% Cl 1.0–3.7) and a nonsignificant excess of brain cancer cases (SIR = 2.3, 95% Cl 0.7–5.3) were observed. Eighty per cent of the women were treated with radioactive iodine. When age at treatment and year of treatment were controlled, women who were ever treated with radioactive iodine had a standardized rate ratio for breast cancer of 1.9 (95% Cl 0.9–4.1), compared with those who were never treated with radioactive iodine. Women who developed hypothyroidism as a result of their treatment for hyperthyroidism did not have an increased risk of developing breast cancer (SIR = 1.1, 95% Cl 0.8–1.6).

breast neoplasms; follow-up studies; hyperthyroidism; hypothyroidism; iodine; mortality; radiation; thyroid diseases

3Current address: Endocrine Division, Sinai Hospital of Baltimore, Baltimore, MD

4Current address: Endocrine Division, University of Colorado Health Sciences Center, Denver, CO


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