Per- and polyfluoroalkyl substances and the associated thyroid cancer risk: A case-control study in China

Haoran Li; Ming Yang; Jing Yang; Samuel Seery; Chaoying Ma; Yi Liu; Xiaoguang Zhang; Ang Li; Huicai Guo

doi:10.1016/j.chemosphere.2023.139411

Per- and polyfluoroalkyl substances and the associated thyroid cancer risk: A case-control study in China

Chemosphere. 2023 Oct:337:139411. doi: 10.1016/j.chemosphere.2023.139411. Epub 2023 Jul 5.

Authors

Haoran Li¹, Ming Yang², Jing Yang³, Samuel Seery⁴, Chaoying Ma³, Yi Liu⁵, Xiaoguang Zhang⁶, Ang Li⁷, Huicai Guo⁸

Affiliations

¹ Department of Toxicology, School of Public Health, Hebei Medical University, Shijiazhuang, 050017, PR China; Department of Pharmacy, The Second Hospital of Hebei Medical University, Shijiazhuang, 050000, PR China.
² Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College, Beijing, 100005, PR China; Center of Environmental and Health Sciences, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, 100005, PR China.
³ Department of Toxicology, School of Public Health, Hebei Medical University, Shijiazhuang, 050017, PR China.
⁴ Faculty of Health and Medicine, Division of Health Research, Lancaster University, Lancaster, LA1 4YW, UK; School of Humanities and Social Sciences, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, PR China.
⁵ Department of Toxicology, School of Public Health, Hebei Medical University, Shijiazhuang, 050017, PR China; Hebei Key Laboratory of Environment and Human Health, Hebei Province, Shijiazhuang, 050017, PR China.
⁶ Core Facilities and Centers of Hebei Medical University, Shijiazhuang, 050017, PR China.
⁷ Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College, Beijing, 100005, PR China; Center of Environmental and Health Sciences, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, 100005, PR China. Electronic address: pumcleon@ibms.pumc.edu.cn.
⁸ Department of Toxicology, School of Public Health, Hebei Medical University, Shijiazhuang, 050017, PR China; Hebei Key Laboratory of Environment and Human Health, Hebei Province, Shijiazhuang, 050017, PR China. Electronic address: huicaiguo@hebmu.edu.cn.

PMID: 37419160
DOI: 10.1016/j.chemosphere.2023.139411

Abstract

The role of perfluoroalkyl and polyfluoroalkyl substances (PFAS) as thyroid carcinogens is unclear. Therefore, we intended to identify associations between each PFAS congener and their mixture with thyroid cancer risk. This case-control study of thyroid cancer was conducted in Shijiazhuang, Hebei Province, China. Three hundred participants were recruited from January to May 2022 and were matched according to sex and age. Twelve PFAS were assessed using ultra-high-performance liquid chromatography-tandem mass spectrometry. Associations between PFAS congeners and thyroid cancer risk were considered under conditional logistic regression analysis and a restricted cubic spline model. Mixture effects were also assessed with quantile g-computation and a Bayesian kernel machine regression model. Compared to the first tertile, third tertile PFOA, PFNA, PFHxS, PFDA, and PFUnDA concentrations were associated with lower thyroid cancer risk (OR_PFOA: 0.32, 95% confidence interval (CI): 0.15-0.69; OR_PFNA: 0.18, 95% CI: 0.07-0.46; OR_PFHxS: 0.37, 95% CI: 0.15-0.92; OR_PFDA: 0.07, 95% CI: 0.02-0.23; OR_PFUnDA: 0.12, 95% CI: 0.05-0.30) after adjusting for confounding factors. PFNA, PFDA, and PFUnDA had a negative dose-response relationship with thyroid cancer risk. Mixture analysis also showed that thyroid cancer risk is negatively associated with the overall mixture and carboxylates. In the overall mixture, PFOS and PFDA contributed most to positive and negative changes in thyroid cancer risk, respectively. However, PFOS, PFNA, PFDA, and PFUnDA were of equally high importance. This study is the first to confirm the effects of the PFAS mixture on thyroid cancer, and further large-scale prospective studies are still warranted to test these inverse associations.

Keywords: Case-control study; Mixture; PFAS; Per- and polyfluoroalkyl substances; Thyroid cancer.

MeSH terms

Alkanesulfonic Acids*
Bayes Theorem
Case-Control Studies
China / epidemiology
Environmental Pollutants*
Fluorocarbons* / toxicity
Humans
Prospective Studies
Thyroid Neoplasms* / chemically induced
Thyroid Neoplasms* / epidemiology

Substances

perfluoroundecanoic acid
Environmental Pollutants
Fluorocarbons
Alkanesulfonic Acids