Association between urinary perchlorate and malignancies of endocrine-related tissues in U.S. adults - analysis of National Health and Nutrition Examination Survey (NHANES) data

Q: What was the main goal of the NHANES analysis?

To investigate whether urinary perchlorate exposure is associated with thyroid cancer and pancreatic cancer in a nationally representative U.S. adult population.

Q: How was urinary perchlorate measured and prepared for analysis?

Urinary perchlorate was measured by ion chromatography with electrospray tandem mass spectrometry and corrected using creatinine before analysis.

Q: What did the study find about the association between perchlorate and cancer risk?

Normalized urinary perchlorate was significantly associated with both thyroid cancer (P=0.041) and pancreatic cancer (P<0.001), with associations remaining significant in quartile analyses and supported by Bayesian correlation results.

Sep 30, 2026

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Perchlorate, a persistent environmental contaminant and endocrine disruptor, interferes with iodine uptake, yet evidence linking it to cancers in endocrine-related tissues remains limited. This analysis evaluates urinary perchlorate in a nationally representative U.S. adult population, focusing on thyroid cancer and pancreatic cancer. Data from 20,316 NHANES participants (2003-2018) were assessed using creatinine-corrected perchlorate measurements, weighted multivariable logistic regression, Bayesian correlation, and restricted cubic splines for exposure-response evaluation.

LanguageEnglish

CategoryResearch & Report

FormatPDF

Pages12

Reading Time30 min

AccessFree to download

Introduction

Highlight box: Key findings

Methods

Results

Conclusions

Association between urinary perchlorate and malignancies of endocrine-related tissues in U.S. adults: analysis of National Health and Nutrition Examination Survey (NHANES) data Xiaoyun Zang1,2\#, Kexin Zhang3\#, Yujie Ma2, Chengxia Kan 1,2, Zhenghui Tian2, Guangdong Zhang1,2, Xiaodong Sun1,2^ 1Department of Endocrinology and Metabolism, Shandong Provincial Key Medical and Health Laboratory of Endocrinology and Metabolic Diseases, Affiliated Hospital of Shandong Second Medical University, Weifang, China; 2Clinical Research Center, Affiliated Hospital of Shandong Second Medical University, Weifang, China; 3Department of Endocrinology and Metabolism, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China Contributions: (I) Conception and design: X Zang, K Zhang, X Sun, G Zhang; (II) Administrative support: X Sun; (III) Provision of study materials or patients: None; (IV) Collection and assembly of data: Y Ma, C Kan, Z Tian; (V) Data analysis and interpretation: X Zang, K Zhang; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors. \#These authors contributed equally to this work. Correspondence to: Xiaodong Sun, MD, PhD; Guangdong Zhang, MM. Department of Endocrinology and Metabolism, Shandong Provincial Key Medical and Health Laboratory of Endocrinology and Metabolic Diseases, Affiliated Hospital of Shandong Second Medical University, No. 2428 Yuhe Road, Weifang 261031, China; Clinical Research Center, Affiliated Hospital of Shandong Second Medical University, Weifang, China. [Email: xiaodong.sun@sdsmu.edu.cn](Email: xiaodong.sun@sdsmu.edu.cn); [hongchengfeixue@163.com](hongchengfeixue@163.com). Background: Perchlorate is a persistent environmental contaminant and endocrine disruptor that inhibits iodine uptake through the sodium iodide symporter. While its thyroid toxicity is well recognized, evidence regarding its association with malignancies of endocrine-related tissues is limited. This study aimed to investigate the relationship between urinary perchlorate and the occurrence of thyroid cancer and pancreatic cancer in a nationally representative U.S. adult population. Methods: Data from 20,316 adults in the National Health and Nutrition Examination Survey (NHANES; 2003 to 2018) were analyzed. Urinary perchlorate was measured using ion chromatography with electrospray tandem mass spectrometry. Urinary perchlorate levels were creatinine-corrected before analysis. Weighted multivariable logistic regression was applied to assess associations with self-reported physician-diagnosed thyroid cancer and pancreatic cancer. Bayesian correlation analysis was performed for pancreatic cancer and thyroid cancer due to the small number of cases. Restricted cubic spline models were used to explore dose– response relationships. Results: The normalized urinary perchlorate level was significantly associated with both thyroid (P=0.041) and pancreatic cancer (P<0.001) . This association remained significant across models when analyzed by quartiles [thyroid cancer: odds ratio (OR) =3.81, 95% confidence interval (CI): 1.26–11.5, P=0.02; pancreatic cancer: OR =13.4, 95% CI: 1.13–159, P=0.04] . Bayesian analysis provided robust evidence supporting these associations (Bayes factor: thyroid cancer =139.525; pancreatic cancer =176.853) . No clear dose-response relationship was observed for either cancer type. Conclusions: Perchlorate exposure was associated with both thyroid and pancreatic cancers. This study provides evidence supporting its potential role in endocrine-related carcinogenesis and underscores the need for further research and exposure-reduction strategies. Keywords: Perchlorate; endocrine; malignancy; thyroid cancer; pancreatic cancer ^ ORCID: 0000-0001-7775-2823. © AME Publishing Company. Transl Cancer Res 2025;14(12):8655-8666 | [https://dx.doi.org/10.21037/tcr-2025-1785](https://dx.doi.org/10.21037/tcr-2025-1785) 8656 Zang et al. Urinary perchlora

FAQs

What was the main goal of the NHANES analysis?

To investigate whether urinary perchlorate exposure is associated with thyroid cancer and pancreatic cancer in a nationally representative U.S. adult population.

How was urinary perchlorate measured and prepared for analysis?

Urinary perchlorate was measured by ion chromatography with electrospray tandem mass spectrometry and corrected using creatinine before analysis.

What did the study find about the association between perchlorate and cancer risk?

Normalized urinary perchlorate was significantly associated with both thyroid cancer (P=0.041) and pancreatic cancer (P<0.001), with associations remaining significant in quartile analyses and supported by Bayesian correlation results.

Sep 30, 2026

Upload by Rhys