Reproductive and menstrual history and papillary thyroid cancer risk: The San Francisco Bay Area thyroid cancer study

Thyroid cancer rates are three times higher in women than men during the period between puberty and menopause, suggesting that the etiology of thyroid cancer may be related to female sex hormones and reproductive function. However, the results from epidemiological studies have been mixed. To assess this hypothesis, data on menstrual history, pregnancy history, and exogenous hormone use were analyzed from a population-based, case-control study conducted in the San Francisco Bay Area. Of 817 incident thyroid cancer patients (cases), ages 20-74 years, who were diagnosed in 1992-1998 and 793 controls, identified by random-digit dialing and frequency matched to cases on age and race/ethnicity, 608 (74%) cases and 558 (70%) controls were interviewed. Of these cases, 544 were of papillary histology and included in the present analysis. Women who reported onset of menarche before age 12 or after age 14 were at about 50% increased risk for papillary thyroid cancer; however, this effect differed among age- and ethnic-specific subgroups. Among parous women younger than age 45, risk was elevated for several variables measuring recency of pregnancy. Risk was reduced for women who had ever used oral contraceptives [odds ratio (OR), 0.73; 95% confidence interval (CI), 0.52-0.97], but there was no trend with duration of use. Although it remains unclear how sex hormones influence thyroid carcinogenesis, these relationships warrant further investigation.