Consumption of fish is not associated with risk of differentiated thyroid carcinoma in the European prospective investigation into cancer and nutrition (EPIC) study

Research output: Contribution to journalArticle


Background: Differentiated thyroid cancer (TC) is the most common endocrine cancer. Fish can be an important source of iodine and other micronutrients and contaminants that may affect the thyroid gland and TC risk. Objective: We prospectively evaluated the relations between the consumption of total fish and different fish types and shellfish and TC risk in the EPIC (European Prospective Investigation into Cancer and Nutrition) study. Methods: EPIC is a cohort of > 500,000 men and women, mostly aged 35-70 y, who were recruited in 10 European countries. After a mean follow-up of 14 y, 748 primary differentiated TC cases were diagnosed; 666 were in women and 601 were papillary TC. Data on intakes of lean fish, fatty fish, fish products, and shellfish were collected by using countryspecific validated dietary questionnaires at recruitment. Multivariable Cox regression was used to calculate HRs and 95% CIs adjusted for many potential confounders, including dietary and nondietary factors. Results: No significant association was observed between total fish consumption and differentiated TC risk for the highest compared with the lowest quartile (HR: 1.03; 95% CI: 0.81, 1.32; P-trend = 0.67). Likewise, no significant association was observed with the intake of any specific type of fish, fish product, or shellfish. No significant heterogeneity was found by TC subtype (papillary or follicular tumors), by sex, or between countries with low and high TC incidence. Conclusion: This large study shows that the intake of fish and shellfish was not associated with differentiated TC risk in Europe, a region in which iodine deficiency or excess is rare.


  • Raul Zamora-Ros
  • Jazmín Castañeda
  • Sabina Rinaldi
  • Valerie Cayssials
  • Nadia Slimani
  • Elisabete Weiderpass
  • Konstantinos K Tsilidis
  • Marie-Christine Boutron-Ruault,
  • Kim Overvad
  • Anne K. Eriksen
  • Anne Tjønneland
  • Tilman Kühn
  • Verena Katzke
  • Heiner Boeing
  • Antonia Trichopoulou
  • Carlo La Vecchia
  • Anastasia Kotanidou
  • Domenico Palli
  • Sara Grioni
  • Amalia Mattiello
  • Rosario Tumino
  • Veronica Sciannameo
  • Eiliv Lund
  • Susana Merino
  • Elena Salamanca-Fernández
  • Pilar Amiano
  • José María Huerta
  • Aurelio Barricarte
  • Joakim Hennings
  • Maria Sandström
  • Bas H. Bueno-De-Mesquita
  • Petra H Peeters
  • Kay Tee Khaw
  • Nicholas J Wareham
  • Julie A. Schmidt
  • Amanda J Cross
  • Elio Riboli
  • Augustin Scalbert
  • Isabelle Romieu
  • Antonio Agudo
  • Silvia Franceschi
External organisations
  • Bellvitge Biomedical Research Institute
  • International Agency for Research on Cancer, World Health Organization
  • UiT The Arctic University of Norway, Tromsø
  • Cancer Registry of Norway Institute of Population-Based Cancer Research
  • Karolinska Institutet
  • Folkhälsan Research Center
  • University of Ioannina
  • Imperial College London
  • University of Paris-Saclay
  • Institut Gustave Roussy
  • Aarhus University
  • Danish Cancer Society Research Center
  • German Cancer Research Centre
  • German Institute of Human Nutrition
  • Hellenic Health Foundation, Athens
  • National and Kapodistrian University of Athens
  • University of Milan
  • Cancer Research and Prevention Institute (ISPO)
  • Istituto Nazionale dei Tumori
  • University of Naples Federico II
  • Public Health Directorate
  • Murcia Regional Health Council
  • Health Research Institute of Navarra (IDISNA)
  • Skåne University Hospital
  • Umeå University
  • National Institute for Public Health and the Environment (RIVM)
  • University of Malaya
  • University Medical Center Utrecht
  • University of Cambridge
  • University of Oxford
  • Civic and M.P Arezzo Hospital
  • Azienda Sanitaria Locale Torino 3
  • University of Granada
  • CIBER Epidemiology and Public Health (CIBERESP)
  • Public Health Division of Gipuzkoa
Research areas and keywords

Subject classification (UKÄ) – MANDATORY

  • Cancer and Oncology
  • Nutrition and Dietetics


  • Cohort, EPIC, Fish, Intake, Thyroid cancer
Original languageEnglish
Pages (from-to)1366-1373
Number of pages8
JournalJournal of Nutrition
Issue number7
Publication statusPublished - 2017 Jul 1
Publication categoryResearch