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    Ultra Sound Sizes Up the Thyroid Factor in Breast Cancer

    Many studies have shown a range of connections between thyroid gland malfunction and breast cancer. However, the significance of this association remains a puzzle.

    The intent of this particular study was to investigate whether the use of high resolution diagnostic ultrasound could discern minute changes in the size of the thyroid in patients with breast cancer. Before the advent of this sophisticated tool for measurement, the usual method used to judge the size of the thyroid was neck palpation.

    This study was conducted in Ireland at a specialist breast clinic. Ultrasound scans were used to determine thyroid size in 200 patients with breast cancer and 354 patients with benign breast disease. Results were then compared with a control group of women with no history of breast disease. Patients from each group were also screened for previous thyroid disease, such as hyper- or hypothyroidism or nontoxic goiter.

    Thyroid enlargement is often associated with iodine deficiency, and there is speculation that iodine deficiency promotes breast disease. However, this study found that the iodine levels did not differ significantly between the groups studied, and found no such correlation. Neither did they find that a previous history of hyper- or hypothyroidism made any difference. However, nontoxic goiter was found more often in the breast cancer and benign breast disease groups than in women without breast disease.

    By using ultrasound scans, the researchers were able to measure thyroid volumes with great precision. They found enlarged thyroids in a high proportion of patients with breast cancer (41.5%) compared to the control group without breast cancer (8.6%). The study was able to establish a direct association between the two conditions that was independent of treatment for breast cancer (it had been thought that chemotherapy might be responsible for enlarging thyroids).

    Does an enlarged thyroid present consequences for breast cancer risk? However striking this association may be, the researchers caution that they can draw no further conclusions other than to say that they are related. How and why remain to be answered in future studies.

    Questions for Dr. Smyth:

    1. How significant are the findings of enlarged thyroid by ultrasound compared with neck palpation?

    Ultrasound is a lot more sensitive than neck palpation. You can get a mathematical value to use as measurement instead of a subjective estimate. We can actually put a figure on the size of a thyroid. While a very experienced clinician can get reproducible results using neck palpation, the problem is that different clinicians may come to different conclusions and the results may be quite subjective. Ultrasound makes results mathematically reproducible, which is very valuable in a study such as this.

    2. Is iodine related to thyroid enlargement and breast cancer?

    The answer is yes, in terms of enlargement. But it is very important, as we learned from our study, that the populations being studied all come from the same geographic pool to make sure that the iodine levels will be similar. Otherwise this can't really be measured.

    The relationship of iodine to the breast is another story altogether; there is an association between thyroid enlargement and breast cancer, but we have no evidence that this confers an increased risk of breast cancer.

    3. Is malignant breast cancer more likely than benign breast disease to be connected with an enlarged thyroid?

    We don't know. We are only saying that there is an association between enlarged thyroid and the breast -- we are in the process of searching for common factors -- but there is no evidence that an enlarged thyroid causes breast cancer. We do not want to give women the message that if they have a goiter they're going to get breast cancer -- this is far from being the case.

    4. Is there a clinical advantage in finding subtle changes in thyroid volume early on in a diagnosis of breast cancer?

    The answer is simply that we don't know.

    Comment from Dr. Smyth:

    We are doing further studies that may help us to clarify the relationship between breast cancer and thyroid enlargement. One study is looking at the question: What is the significance of the thyroid for the outcome of breast cancer patients? That is, will women with breast cancer who do not have thyroid problems do better than women with breast cancer who do have thyroid problems in terms of overall survival? What benefits or risks does having an enlarged thyroid confer? We hope that the results from these studies will provide some straight answers.



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