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American Journal of Epidemiology 2005 161(11):1056-1065; doi:10.1093/aje/kwi136
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American Journal of Epidemiology Copyright © 2005 by the Johns Hopkins Bloomberg School of Public Health All rights reserved

ORIGINAL CONTRIBUTIONS

Role of Goiter and of Menstrual and Reproductive Factors in Thyroid Cancer: A Population-based Case-Control Study in New Caledonia (South Pacific), a Very High Incidence Area

Thérèse Truong1, Laurent Orsi1, Dominique Dubourdieu2, Yannick Rougier3, Denis Hémon1 and Pascal Guénel1

1 INSERM (National Institute of Health and Medical Research) U170 - IFR69, Villejuif, France
2 Laboratory of Anatomy and Cytopathology, Nouméa, New Caledonia
3 Pasteur Institute of New Caledonia, Nouméa, New Caledonia

Reprint requests to Dr. Pascal Guénel, INSERM U170, 16 avenue Paul Vaillant-Couturier, 94807 Villejuif Cedex, France (e-mail: guenel{at}vjf.inserm.fr).

Exceptionally high incidence rates of thyroid cancer have been reported for Melanesian women in New Caledonia (South Pacific). To investigate the occurrence of thyroid cancer in that country and to clarify the role of goiter and hormonal factors in that disease in women, a countrywide population-based case-control study was conducted in 1993–1999. The study included 293 cases, identified through pathology registers and whose thyroid cancer was verified histologically, and 354 population controls. Thyroid cancer was associated with goiter, age at menarche, irregular menstruation, and hysterectomy. There was a dose-response trend with number of full-term pregnancies (p = 0.01), with an odds ratio of 2.2 (95% confidence interval: 1.1, 4.3) for women with eight or more pregnancies. Miscarriage, particularly as an outcome of the first pregnancy, was also indicated as a risk factor. The association between voluntary abortion and thyroid microcarcinoma could be explained by enhanced medical surveillance and improved cancer detection in women undergoing abortion. Oral contraceptives and hormone replacement therapy were unrelated to thyroid cancer. The very high birth rate among Melanesian women in New Caledonia, as well as late age at menarche, may explain, in part, their elevated incidence of thyroid cancer.

case-control studies; goiter; menarche; menopause; New Caledonia; pregnancy; thyroid neoplasms

Abbreviations: OR, odds ratio


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