| 摘要: | 目的：癌症一直是國人居高不下的死亡原因，特別是對女性乳腺癌患者，相比於歐美國家，乳腺癌的發病率較高，患者在台灣更年輕，研究報導乳腺癌的風險被相關聯的使用的一些藥物如雌激素、甲狀腺素等，另外乳腺癌和甲狀腺疾病都是在婦女常見的疾病，因為社會環境已經改變，人們的飲食習慣、生物學途徑和遺傳等，但是對甲狀腺疾病的使用甲狀腺素的是值得探討是否長時間使用可能會容易導致乳腺癌的發生率較高，因此本研究的初步目標是研究近年來甲狀腺癌和乳腺癌之間的關聯，研究結果可以幫助醫生和供應商在實踐中治療和改善護理的早期乳腺癌患者生存質量。
方法：本研究資料取自2001-2011年二千三百萬歸人檔篩選做為研究族群，進行11年的病例對照組研究，排除小於20歲的病人，分為乳癌(病例組)病人(ICD-9-CM:174)65,491人，即相同年齡配對的4倍非癌症(對照組)病人261,964人，總數為327,455人，比較此兩組進行1:4傾向分數配對，在年齡、常用藥物、共病症的差異減小後，再分析兩組11年的有使用甲狀腺素罹患乳癌機率有無差別，最後分析年齡、常用藥物、共病症是否為使用甲狀腺素罹患乳癌有關連性。
結果：本研究用邏輯斯廻歸之統計結果發現，藉由我們11年的研究世代發現，讓我們知道接受甲狀腺素藥物對罹乳癌的發生率，在年齡、常用藥物使用、共病症分布相似的兩組研究對象，在疾病合併症方面，所占比率最高的前五項依序為：消化性潰瘍、肝臟疾病、慢性阻塞性疾病、風濕性疾病、腎臟疾病；常用藥物中angiotensin和statin有顯著性較高之癌症風險，結果顯示發現有使用甲狀腺素用藥和未使用的女性，有使用甲狀腺素者發生乳癌(校正勝算比1.24，95%信賴區間為1.15 - 1.33）；年齡小於65歲有使用甲狀腺素者發生乳癌（校正勝算比1.19，95%信賴區間為1.09 - 1.29），大於65歲有使用甲狀腺素者發生乳癌（校正勝算比1.45，95%信賴區間為1.23 - 1.71）；在察爾森共病症分數(CCI< 4)，有使用甲狀腺素者發生乳癌（校正勝算比1.22，95%信賴區間為1.09 - 1.36），在察爾森共病症分數(CCI ≥ 4)，有使用甲狀腺素者發生乳癌（校正勝算比1.43，95%信賴區間為1.21 - 1.68）；總體用藥有使用甲狀腺素者發生乳癌（校正勝算比1.24，95%信賴區間為1.15 - 1.33），甲狀腺素用藥天數60天-1年，有使用甲狀腺素者發生乳癌（校正勝算比1.22，95%信賴區間為1.11 - 1.35），甲狀腺素用藥天數超過1年，有使用甲狀腺素者發生乳癌（校正勝算比1.26，95%信賴區間為1.12 - 1.41），P 值小於 0.001，具相當顯著效果，其後發生乳癌的累積發生率較高。
結論與建議：本研究顯示，2001-2011年二千三百萬歸人檔篩選出研究族群，衛生福利部衛生福利資料科學中心資料庫，乳癌的發生風險與長期使用甲狀腺素用藥的女性有較高風險的安全疑慮，長期使用甲狀腺用藥的病人，而醫療機構、醫生、營養師、衛教師等，對於患有甲狀腺疾病的病人，給予良好用藥及飲食正確觀念，可以避免甲狀腺功能惡化，也期許能做到預防衛教，建議可加入乳癌篩檢等項目，做到早期診斷早期預防。
purpose:
Cancer is the highly cause of death in worldwide, especially for women with breast cancer. Compared to European and American, a higher incidence of breast cancer in Taiwanese younger patients was reported elsewhere. Studies reported that the risk of breast cancer was associated with a number of drugs used, such as estrogen, thyroxine, etc. In addition, the breast and thyroid disorders are common diseases in women, because of the social environment has changed, diets, biological pathways, and genetic. The anit-thyroid as thyroxine is worth exploring whether long-term use could easily lead to the higher incidence risk of breast cancer; therefore, the initial goal of this research is to assess the association between breast cancer and thyroid cancer in recent years, the research results might help doctors and suppliers and improve the treatment of early breast cancer patients in order to improve quality of life.
Method:
We used Health and Welfare Data Science Center (MOHW) data of 23 million Taiwanese population in between 2001 to 2011. We then conducted a retrospective case-control study with 65,491 patients who were newly diagnosed with female breast cancer (ICD9CM, 174) and the first visit date was defined as the index date. Four controls were randomly selected by using propensity matching with variables as age, sex, year, month of the diagnosis. All participants were checked for the use of levothyroxine three years before the index date. Conditional logistic regression with 95% confidence intervals was used to analyze the results.
Result:
In this study, female patients who used levothyroxine were observed higher risk of breast cancer compared to non-use group (OR, 1.24; 95% CI: 1.15 to 1.33). The use of levothyroxine in elderly patients (age>=65) were found higher risk of breast cancer compared to younger adults (age>=65, OR, 1.45; 95% CI, 1.23 to 1.71 vs. age<65, OR, 1.19; 95% CI, 1.09 to 1.29). Patients used levothyroxine with their comorbidities (CCI>0) were observed higher risk of breast cancer compared to those did not have any comorbidities. Moreover, the patients who were long-term use levothyroxine also found much higher than those did not (60 days to 1 year, OR, 1.22; 95% CI, 1.11 to 1.35; p-value<0.001; over 1 year, OR, 1.26; 95% CI, 1.12 to 1.41; p-value<0.001).
Conclusion and suggestion:
This study shows that, in 2001 - 2011 twenty-three million people classified archives selected study population, the Ministry of Health and Welfare Health and Welfare Information Center for Science in the database, and the risk of long-term use of hormone drugs in female breast cancer have a higher risk, the patient long-term use of thyroid medications, and medical institutions, doctors, nutritionists, health teachers, for patients with thyroid disease give good treatment and proper diet concept, to avoid deterioration of thyroid function, can also expect to achieve a pre defense education, breast cancer screening recommendations can be added to other projects, so early diagnosis and prevention. |
