ArticleJournal of the Endocrine Society2026
Exploring the link between nitrate exposure and thyroid cancer: A nationwide state-level analysis.
Article in Journal of the Endocrine Society, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Context: Early-onset thyroid cancer incidence has been increasing, raising concerns about contributing factors. Objective: We aimed to investigate the role of nitrate contamination in drinking water as a contributor to early-onset thyroid cancer incidence. Methods: We designed an ecological study, analyzing population-based data from the National Program of Cancer Registries. We quantified the association between nitrate exposure and early-onset thyroid cancer with a set of Poisson generalized estimating equations (GEE). Analyses adjusted for current and 7-year lagged obesity rates and access to screening. Our nationwide study includes data from all 50 states in the United States. Patients between ages 0 to 14, 15 to 39, and 40 to 59 who were diagnosed with thyroid cancer between 2003 and 2022. States were categorized into 2 groups based on predicted groundwater nitrate levels. States with nitrate < 2.0 mg/L were classified as "Low," and states with levels ≥ 2.0 mg/L as "High." Population-adjusted cases of thyroid cancer incidence, with patients grouped by age and sex. Results: For the 0 to 14 or 40 to 59 age groups, we found no differences in thyroid cancer incidence by nitrate exposure. For ages 15 to 39, there were 41.6 (CI: 6.2, 77.1) more cases in high nitrate states, reflecting an 18.5% difference. Stratified by sex, in the 15 to 39 age group of females had 32.7 (CI: 6.3, 59.1) more cases and males had 8.2 (CI: 0.1, 16.4) more cases, reflecting a 17.8% and 20.4% difference respectively. Conclusion: Elevated exposure to groundwater nitrate may be a significant preventable contributor to thyroid cancer in adolescents and young adults.
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