Endocrinol Metab.  2021 Jun;36(3):590-598. 10.3803/EnM.2021.954.

Effect of Cigarette Smoking on Thyroid Cancer: Meta-Analysis

Affiliations
  • 1Department of Surgery, Gachon University Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
  • 2Department of Surgery, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
  • 3Transdisciplinary Department of Medicine & Advanced Technology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
  • 4Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea

Abstract

Background
Although smoking is generally carcinogenic, its effect on thyroid cancers is still subject to controversy. The purpose of this study was to summarize the role of smoking in relation to thyroid cancer occurrence.
Methods
We performed a meta-analysis of 24 eligible studies: 21 case-control studies and three prospective cohort studies. The summary odds ratio (OR) and 95% confidence interval (CI) of all studies were acquired based on random effect model. Further subgroup analyses were conducted according to gender, histological type of thyroid cancer, and smoking status of patients for the case-control studies.
Results
The summary effect size indicated a negative association of smoking for thyroid cancer (OR, 0.798; 95% CI, 0.681 to 0.935). From the subgroup analyses for the case-control studies, reduced risk of thyroid cancer was observed in both men (OR, 0.734; 95% CI, 0.553 to 0.974) and women (OR, 0.792; 95% CI, 0.700 to 0.897). The protective effect of smoking was observed in studies in which thyroid cancer was limited to differentiated thyroid cancers (DTCs) (OR, 0.798; 95% CI, 0.706 to 0.902).
Conclusion
Our results suggests that smoking may have a protective effect on thyroid cancer, especially on DTCs. Further studies with larger sample sizes should be conducted in elucidating the dose and time dependent effect of smoking on thyroid cancer with specific focus on the types of thyroid cancers.

Keyword

Smoking; Thyroid neoplasms; Association

Figure

  • Fig. 1 Study selection process.

  • Fig. 2 Summary effect size of association between smoking and thyroid cancer occurrence. DTC, differentiated thyroid cancer; CI, confidence interval.

  • Fig. 3 Funnel plot assessing publication bias.

  • Fig. 4 Effect of smoking on differentiated thyroid carcinoma. DTC, differentiated thyroid cancer; CI, confidence interval.


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