Tobacco smoking and risk of thyroid cancer according to BRAFV600E mutational subtypes

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Rahman, Sabbir T
Pandeya, Nirmala
Neale, Rachel E
McLeod, Donald SA
Baade, Peter D
Youl, Philippa H
Allison, Roger
Leonard, Susan
Jordan, Susan J
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OBJECTIVE: Smoking has been associated with a reduced risk of thyroid cancer, but whether the association varies between higher- and lower-risk cancers remains unclear. We aimed to assess the association between smoking and risk of thyroid cancer overall as well as by tumour BRAF mutational status as a marker of potentially higher-risk cancer. DESIGN AND PATIENTS: We recruited 1013 people diagnosed with thyroid cancer and 1057 population controls frequency-matched on age and sex. METHODS: Multivariable logistic regression was used to assess the association overall and in analyses stratified by tumour characteristics. We used sensitivity analysis to assess the potential for selection bias. RESULTS: We found little evidence of an association with current smoking (odds ratio [OR] = 0.93; 95% confidence interval [CI]: 0.69-1.26; current vs. never smoking), but a higher number of pack-years of smoking was associated with a lower risk of thyroid cancer (OR = 0.75; 95% CI: 0.57-0.99; ≥20 pack-years vs. never). However, after correcting for potential selection bias, we observed a statistically significant inverse association between current smoking and risk of thyroid cancer (bias-corrected OR = 0.65; 95% CI: 0.51-0.83). Those with BRAF-positive cancers were less likely to be current smokers than those with BRAF-negative cancers (prevalence ratio: 0.79; 95% CI: 0.62-0.99). CONCLUSION: We found smoking was inversely related to thyroid cancer risk and, in particular, current smoking was associated with a reduced risk of potentially more aggressive BRAF-positive than the likely more indolent BRAF-negative papillary thyroid cancers.

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Clinical Endocrinology

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Clinical sciences

Oncology and carcinogenesis


Reproductive medicine


bias analysis

population-based sample

thyroid cancer

tobacco smoking

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Rahman, ST; Pandeya, N; Neale, RE; McLeod, DSA; Baade, PD; Youl, PH; Allison, R; Leonard, S; Jordan, SJ, Tobacco smoking and risk of thyroid cancer according to BRAFV600E mutational subtypes, Clinical Endocrinology, 2021