Thyroid Dysfunction in Women With Newly Diagnosed Breast Cancer Compared to Healthy Volunteers

OBJECTIVES:

Primary

* Compare the proportion of hypothyroidism in women with newly diagnosed stage I-IIIB breast cancer (prior to chemotherapy) vs in cancer-free, age-matched healthy volunteers.
* Compare the magnitude of change in thyroid function in these patients from baseline to 24 months vs in cancer-free, age-matched healthy volunteers.

Secondary

* Correlate variation in thyroid function with fatigue symptom scores.
* Correlate variation in thyroid function with anthropometric measurements.

OUTLINE: This is a pilot, multicenter study.

Patients and age-matched healthy volunteers undergo blood collection at baseline and at 12 and 24 months after enrollment. They also undergo anthropometric measurements and complete the Fatigue Symptom Inventory at baseline and at 12 and 24 months after enrollment.

PROJECTED ACCRUAL: A total of 270 patients and 280 healthy volunteers will be accrued for this study.

• physiologic testing (Other), also known as thyroid function tests: Markers of thyroid function including thyroid stimulating hormone (TSH), Free thyroxine (free T4) and Thyroid peroxidase antibody (TPO Ab). These will be performed at baseline, in 12 months and again 24 months after enrollment. All thyroid function marker assays will be performed by LabCorp.
• fatigue assessment and management (Procedure), also known as FSI, Fatigue Symptoms Inventory: Fatigue Symptoms Inventory (FSI) survey
• management of therapy complications (Procedure): If baseline testing results suggest hyperthyroidism or hypothyroidism, the enrolling center will give test results to participants for follow-up with their primary healthcare provider. Participants with hypothyroidism, who are not started on thyroid hormone, will continue on study, given the TSH level is below 10. Those with hypothyroidism who have treatment initiated will not continue on study. Participants who develop hypothyroidism during the study will not continue on-study if replacement therapy is initiated or if the TSH level is 10 or higher. Work up the next control nominated by the patient or contact the patient for the name of another control

Primary outcomes

• Compare proportion of hypothyroidism in women with newly diagnosed stage I-IIIB breast cancer prior to chemotherapy vs in age-matched healthy volunteers [2 years]
• Compare change in thyroid function from baseline to 24 months after enrollment [2 years]

Secondary outcomes

• Correlate variation in thyroid function with fatigue symptom scores and anthropometric measurements at baseline and 24 months after enrollment [2 years]

Sex: Female, ages: 20 Years to 80 Years, accepts healthy volunteers

CASE SELECTION:

* CASE INCLUSION CRITERIA:
* Women between the ages of 25 and 75
* Diagnosed with primary and operable Stage I - IIIB breast cancer
* Scheduled to receive neoadjuvant or adjuvant Adriamycin and Cytoxan (AC) plus a taxane (taxane may be given with AC or follow AC)
* No chemotherapy prior to baseline sample collection
* No prior history of other cancers (except non-melanoma skin cancer)
* Preoperative radiation therapy is permitted
* No diagnosis of hypothyroidism or hyperthyroidism.
* CASE EXCLUSION CRITERIA:
* Stage IV breast cancer
* Scheduled to receive neoadjuvant hormonal therapy (patients who will receive adjuvant hormonal therapy may participate)
* Received adjuvant hormonal therapy or chemotherapy prior to sample collection
* On chemotherapeutic regimen other than Adriamycin and Cytoxan plus a taxane.
* Patients receiving monoclonal antibodies or other biologic therapy may not participate
* Patients scheduled to receive Herceptin may not participate
* Diagnosed with hyperthyroidism or hypothyroidism. (Women being treated for hypothyroidism are not eligible)
* Women with a baseline TSH of 10 or higher will not continue on study
* Women who are pregnant or lactating are not eligible. (Women of childbearing potential who are planning to become pregnant within the next 24 months should not enroll in this study)

CONTROL SELECTION:

* CONTROL INCLUSION CRITERIA:
* Cannot be a blood relative of the case. They can be friends, neighbors, women from social activities, local business, doctors' offices, etc.
* Must live near or in the town of the case
* Women between the ages of 20 and 80 (age-matched to cases +/- 5 years)
* No prior history of cancer (except non-melanoma skin cancer)
* Women ages 40 and older should have had a mammogram within 2 years of study entry, showing no evidence of breast cancer.
* The friend control may bring their mammogram report or send a release and have records faxed to the enrolling center.
* Women under the age of 40 should have had a clinical breast examination within 2 years of study entry, showing no need for diagnostic mammography. If a mammogram was required, it should show no evidence of breast cancer.
* The friend control may bring their mammogram / breast exam report or send a release and have records faxed to the enrolling center.

• Nagi B. Kumar, PhD RD FADA, Study chair, H. Lee Moffitt Cancer Center and Research Institute

NIH grants: U10CA081920