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P1.05
Higher risk of prostate cancer and
thyroid cancer in doctors in Taiwan
Yueh-Han Hsu1,2, MD, MPH, PhD; Wen-Chen Tsai2, DrPH; Wei Chen1, MD
1 Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi City, Taiwan
2 Department of Health Services Administration, China Medical University, Taichung City, Taiwan
Abstract Introduction
The health of physicians may influence the quality of the national health care; only physicians with sound health may
deliver high quality health services. With profound medical knowledge and healthcare network, doctors were expected to
have lower risk of cancer. However, doctors have heavy work-loads since their student ear, they might not necessarily
conduct healthy life pattern. Previous research were inconsistent with regards to area and study design.
Purpose and Methods
We investigated the risk of 15 major cancers of the doctors in Taiwan from a nation-wide health claims database
2000~2012 and Taiwan Cancer Registry File. We included all doctors aged over 25 who practiced medicine in 2000. The
control group included all non-health care people with same age limit in 2000. The exclusion criteria were previous history
of cancers, AIDS and organ transplant. We conducted propensity score matches of 1:1 ratio with gender, age, residence
urbanization and severity of comorbidity by Charles Comorbidity Index (CCI). We used Cox proportional hazard to
evaluate the risks of cancers among these groups.
Results
In all, the case numbers in both groups were 29713. Till the end of follow-ups, there were 1326 and 1533 incident cases
of cancers in the doctors and non-doctors groups.
The distribution of cancers in both groups were different. In the doctor group, the most prevalent 5 cansers were breast
cancer, colorectal cancer, prostate cancer, hepatoma and lung cancer; for non-doctor group, they were breast cancer,
hepatoma, colorectoal cancer, lung caner and orapharyngeal cancer. The cancer distributions in both genders of doctors
were also different.
Under Cox model, doctors had 10% lower overall cancer risk (4.46% vs 5.16%, p<0.001). Among doctors, male had lower
cancer risk (adjusted HR (aHR) 0.63, 95% confidence interval (CI) 0.51-0.78, p <0.001). Comparing the cancer risks in 15
major cancers between doctors and non-doctors, doctors had higher risks of prostate cancer (aHR 1.26, 95%CI 1-1.59,
p=0.046) and thyroid cancer (aHR 3.16, 95%CI 1.69-5.90, p<0.001).
Table. 11 Characteristics
Characteristics of
of participants
participants after
after 1:1
1:1 propensity
propensity
Table.
score matching
matching
score
Table. 2 Risk factors of cancer in doctors under Cox proportional model
Variable
After matching (1:1)
Variable
Total
Total
Non-doctors
Doctors
N
%
N
%
N
59426
100.00
29713
50.00
29713
%
Male
Adjusted
HR
1.33
0.005
0.63
0.51
0.78
<0.001
95% CI
P value
Female (ref)
Male
1.000
Female
P value
Sex
P value
50.00
Sex
Unadjusted HR
CCI score
6406
10.78
3203
10.78
3203
10.78
0 (ref)
53020
89.22
26510
89.22
26510
89.22
1~3
8.31
<0.001
8.08
4.42
14.77
<0.001
4~6
19.76
<0.001
14.79
8.11
26.96
<0.001
Age
1.000
≦34
15544
26.16
7772
26.16
7772
26.16
7~9
42.68
<0.001
23.45
12.84
42.82
<0.001
35-44
20220
34.03
10110
34.03
10110
34.03
≧10
63.41
<0.001
26.67
14.56
48.86
<0.001
45-54
11630
19.57
5815
19.57
5815
19.57
55-64
4266
7.18
2133
7.18
2133
7.18
65-74
4170
7.02
2085
7.02
2085
7.02
≧75
3596
6.05
1798
6.05
1798
6.05
45.20
14.51
45.14
14.63
45.25
14.39
Average age (Mean, Std)
Level of residence urbanization
Level 1 (ref)
Also adjusted for age and level of residence of urbanization
Table. 3 The adjusted risk of cancers in doctors and non-doctors under Cox proportional model
1.000
23872
40.17
11936
40.17
11936
Non-doctors
40.17
Level 2 and 3
27156
45.7
13578
45.7
13578
45.7
Level 4 and 5
6374
10.73
3187
10.73
3187
10.73
Level 6 and 7
2024
3.41
1012
3.41
1012
3.41
CCI score
Cancers of primary anatomic sites
1.000
Adjusted HRd
Doctors
No
Incidencea
No
Breast cancer c
30
85.47
Colon, rectum, rectosigmoid junction and anus cancer
227
Prostate gland cancer b
Incidence
a
HR
95%CI
P value
47
134.20
1.58
1.00
2.49
0.052
69.67
235
72.10
1.03
0.86
1.24
0.742
130
44.65
165
56.71
1.26
1.00
1.59
0.046
0
20530
34.55
10265
34.55
10265
34.55
Liver and intrahepatic bile ducts cancer
232
71.21
158
48.44
0.68
0.56
0.83
<0.001
1~3
21984
36.99
10992
36.99
10992
36.99
Trachea, bronchus and lung cancer
209
64.12
146
44.75
0.69
0.56
0.86
<0.001
4~6
10988
18.49
5494
18.49
5494
18.49
Ovary, fallopian tube and broad ligament cancer c
0
0.00
11
31.24
--
--
--
--
7~9
4182
7.04
2091
7.04
2091
7.04
Stomach cancer
76
23.27
81
24.80
1.06
0.78
1.45
0.716
≧10
1742
2.93
871
2.93
871
2.93
Corpus uteri cancer c
2
5.68
6
17.04
3.00
0.61
14.85
0.179
Bladder cancer
67
20.51
43
13.16
0.64
0.44
0.94
0.022
Thyroid gland cancer
13
3.98
41
12.54
3.16
1.69
5.90
<0.001
Nasopharynx cancer
45
13.77
29
8.87
0.65
0.41
1.03
0.066
Cervix uteri cancer c
3
8.51
3
8.51
1.00
0.20
4.94
0.997
Oral cavity, oropharynx and hypopharynx cancer
147
45.05
25
7.65
0.17
0.11
0.26
<0.001
Esophagus cancer
61
18.67
16
4.89
0.26
0.15
0.45
<0.001
Skin cancer
20
6.12
13
3.98
0.65
0.32
1.31
0.226
Other cancer
283
86.92
317
97.43
1.12
0.95
1.31
0.170
Conclusions
a Incidence:
Doctors have higher risk of prostate
cancer and thyroid cancer in Taiwan
per 100,000 person-years. b Incidence of per 100,000 person-years for men.
person-years for women. d adjusted for age, sex
c
Incidence of per 100,000