Thyroid Cancer in Women
Name: Talia Kuchan
Course: HL-S-380V M71
Date: November 11, 2012
Thyroid cancer is admittedly the commonest endocrine malignancy often detected among young patients and frequently among the women. In most populations, the median age of its detection tends to be quite low, actually below 40 in most cases. It is currently the fastest growing cancers among women. Despite the fact that the cancer is still quite rare, it continues to be increasingly on the rise among women across the globe and especially pregnant women. Most experts are not quite certain on the causes despite the fact that they have been able to identify the risk factors at play.
Essentially, there are four main types of thyroid cancer: Follicular, papillary, medullary and anaplastic. Papillary and follicular thyroid cancers are jointly referred to as differentiated thyroid cancer since their prognosis is more favorable relative to the other types. Among most young women, their pregnancy periods are usually accompanied with differentiated thyroid cancer. The management of this type of cancer poses risks due to the concerns of maternal and fetal health. With most women experiencing rises in differentiated thyroid cancer during pregnancy with a prevalence rate of 14 per 100,000, it has become necessary to discern the management of the ailment (Smith, Danielsen, Allen & Cress, 2003)
Differentiated thyroid cancer (DTC) has a higher incident among women within their reproductive ages. It has long been speculated that the association between human chorionic gonadotropin (HCG), estrogen and DTC exists. Numerous studies have pointed out an association between high parity and the risk of DTC in pregnant women (Kravdal, Glattre, & Haldorsen, 1991). However, the data on the association between DTC and estrogen seem to be gravely inconsistent with some studies indicating a pro-proliferative effect on the thyroid cancer cell lines occasioned with estrogen while other studies point at estrogens stimulatory effect on the adenomatous and normal thyroid only (Lee et al., 2005)
Clinical data also conflicts; one study revealed a high risk of DTC infection among women exposed to oral contraceptives containing estrogen with another reporting no association between DTC and usage of exogenous hormones Data on the effect of HCG on DTC tends to be very discordant and non confirmatory. Despite the fact that rising levels of HCG during pregnancy tends to stimulate the production of thyroid hormones, there has not been any coherent evidence that links HCG and DTC. On the basis of women cohort using fertility drugs for treatment, there was no association observed between use of HCG and DTC. Simply put, according to available epidemiologic data, high parity and the risk to DTC are associated; but there is still some lack of clarity with regard to outcomes of DTC diagnosed at pregnancy (Mack, Preston-Martin, Bernstein, Qian, & Xiang, 1999).
As a result of the overt female to male ratio in the incidence of thyroid cancer, particularly the differentiated cancers, within their reproductive years, epidemiological studies have seriously focused on the role of reproductive exposures among women. Most studies have generally come up with findings that concur with the role of reproductive exposures. There is a minimal contribution of reproductive factors in the etiology and development of thyroid cancer among women. In fact, several case control studies have revealed increased risk with abortion or miscarriage, particularly during the first pregnancy (McTiernan Weiss & Daling, 1987). Arguably, this is one of the most recognized reproductive risk factor for differentiated thyroid cancer among women.
There is an elevated risk of developing thyroid cancer among women who use lactation suppressants and this risk seems to increase with the number of...