Environmental mineral density and thyroid malignancy: A multicenter cross-sectional study

doi:10.5493/wjem.v15.i2.103371

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World Journal of Experimental Medicine

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World J Exp Med. Jun 20, 2025; 15(2): 103371
Published online Jun 20, 2025. doi: 10.5493/wjem.v15.i2.103371

Environmental mineral density and thyroid malignancy: A multicenter cross-sectional study

John Bukasa-Kakamba, Ayrton I Bangolo, Shruti Wadhwani, Pascal Bayauli, Nikita Wadhwani, Vignesh K Nagesh, Maria J Mou, Princejeet S Chahal, Branly Mbunga, Sindhuja Chindam, Taieba Mushfiq, Abhishek Thapa, Nidhi L Rao, Isis Kapinga Kalambayi, Rahul Y Rajesh, Ipek B Sarioguz, Vishal KR Thoomkuntla, Shamsul Arefin, Navneet Kaur, Manasse Bukasa Mutombo, Satyajeet Singh, Natalia Muto, Surya Vamsi, Pujita Mallampalli, Aliocha Natuhoyila Nkodila, Simcha Weissman, Jean-René M'Buyamba-Kabangu

John Bukasa-Kakamba, Pascal Bayauli, Manasse Bukasa Mutombo, Department of Endocrinology and Metabolic Diseases, University of Kinshasa, Kinshasa 999069, Congo

John Bukasa-Kakamba, Department of Endocrinology, Liege University Hospital Center, Liège 4000, Belgium

Ayrton I Bangolo, Department of Hematology and Oncology, John Theurer Cancer Center at Hackensack University Medical Center, Hackensack, NJ 07601, United States

Shruti Wadhwani, Nikita Wadhwani, Vignesh K Nagesh, Maria J Mou, Princejeet S Chahal, Sindhuja Chindam, Taieba Mushfiq, Abhishek Thapa, Nidhi L Rao, Rahul Y Rajesh, Ipek B Sarioguz, Vishal KR Thoomkuntla, Shamsul Arefin, Navneet Kaur, Satyajeet Singh, Natalia Muto, Surya Vamsi, Pujita Mallampalli, Simcha Weissman, Department of Internal Medicine, Hackensack Palisades Medical Center, North Bergen, NJ 07047, United States

Branly Mbunga, Department of School of Public Health, University of Kinshasa, Kinshasa 999069, Congo

Isis Kapinga Kalambayi, Department of Ophthalmology, Avignon Hospital Center, Avignon 84000, France

Aliocha Natuhoyila Nkodila, Department of Family Medicine and Primary Health Care, Protestant University of Congo, Kinshasa 999069, Congo

Jean-René M'Buyamba-Kabangu, Department of Internal Medicine, University of Kinshasa, Kinshasa 999069, Congo

Author contributions: Bukasa-Kakamba J, Bangolo AI, Wadhwani S, Bayauli P, Wadhwani N, Nagesh VK, Mou MJ, Chahal PS, Mbunga B, Chindam S, Mushfiq T, Thapa A, Rao NL, Kalambayi IK, Rajesh RY, Sarioguz IB, Thoomkuntla VK, Arefin S, Kaur N, Mutombo MB, Singh S, Muto N, Vamsi S, Mallampalli P, Nkodila AN, and Weissman S wrote and edited the manuscript; M'Buyamba-Kabangu JR revised and approved the final version; all authors certify that they have contributed sufficiently towards data analysis and manuscript preparation; each author has reviewed the final manuscript version and approves it for publication.

Institutional review board statement: Institutional review board approval was granted by all the participating hospitals across the three provinces.

Informed consent statement: The need for obtaining informed consent was waived by the National Health Ethics Committee of the Democratic Republic of Congo under the Institutional Review Board approval No. 197/CNES/BN/PMMF/2020, as all the patient data had been de-identified to protect the privacy of study participants.

Conflict-of-interest statement: Authors report no conflicts of interest.

STROBE statement: Sample wording: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.

Data sharing statement: No additional data are available.

Corresponding author: Ayrton I Bangolo, MD, Department of Hematology and Oncology, John Theurer Cancer Center at Hackensack University Medical Center, 92 2^nd Street, Hackensack, NJ 07601, United States. ayrtonbangolo@yahoo.com

Received: November 18, 2024
Revised: December 29, 2024
Accepted: January 7, 2025
Published online: June 20, 2025
Processing time: 149 Days and 7.8 Hours

Abstract

BACKGROUND

Several trace minerals have been shown to be associated with thyroid cancer. Democratic Republic of Congo (DRC) is deemed the most mineral-rich country globally. Data on the characteristics of thyroid nodules in various mineral-rich regions of the DRC is scarce.

AIM

To analyze the differential spectrum of thyroid nodules based on locoregional variance in mineral density.

METHODS

We conducted a cross-sectional study on 529 patients with thyroid nodules residing in Katanga, South Kivu and Kinshasa between 2005 and 2019. Of these three provinces, Katanga and South Kivu have the highest mineral density with the DRC.

RESULTS

Mean patient age was 44.2 years ± 14.6 years with a female predominance, with a female to male ratio of 5.4. The 66.5% of patients had a family history of thyroid disease. Total 74 patients had simple nodules, and the remaining 455 patients had multiple nodules. The 87.7% of patients were euthyroid. The nodules exhibited varying characteristics namely hypoechogenicity (84.5%), solid echostructure (72.2%), macronodular appearance (59.8%), calcifications (14.4%) and associated lymphadenopathy (15.5%). The 22.3% of the nodules were malignant. Factors independently associated with malignancy were older age (≥ 60 years) [adjusted odds ratio (aOR) = 2.81], Katanga province (aOR = 8.19), solid echostructure (aOR = 7.69), hypoechogenicity (aOR = 14.19), macronodular appearance (aOR = 9.13), calcifications (aOR = 2.6) and presence of lymphadenopathy (aOR = 6.94).

CONCLUSION

Thyroid nodules emanating from the mineral-laden province of Katanga were more likely to be malignant. Early and accurate risk-stratification of patients with thyroid nodules residing in high-risk areas could be instrumental in optimizing survival in these patients.

Keywords: Thyroid; Cancer; Nodules; Minerals; Heavy metals

Core Tip: Geographical variation in mineral density can potentially impact the prevalence of thyroid malignancies. Our study demonstrated that a higher environmental mineral burden was associated with an increased prevalence of thyroid cancer after adjusting for other covariates. More studies utilizing sophisticated assays to measure serum and environmental levels of various heavy metals could reinforce our study findings. This association holds significant potential in accurate risk-stratification and early detection of thyroid neoplasms amongst patients residing in mineral-laden provinces within the Democratic Republic of Congo.