Global trends in thyroid cancer incidence and the impact of overdiagnosis

Li, Mengmeng; Maso, Luigino Dal; Vaccarella, Salvatore

doi:10.1016/s2213-8587(20)30115-7

Cited by 272 publications

(261 citation statements)

References 8 publications

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“…The driver of incidental thyroid cancer in this cohort was the used of neck ultrasound. This nding is consistent with other studies that shows that the use of thyroid ultrasound has increased at a rate of 20% per year from 2002 through 2013 in the United States [36,37] and was associated with more thyroid cancer diagnosis, this cancer found by neck ultrasound was mostly of low risk. Although thyroid cancer histology and mode of presentation did not show any hint to explain thyroid cancer increased mortality, we found that there was evidence of overtreatment and poor surgical outcomes.…”

Section: Discussionsupporting

confidence: 92%

Thyroid Cancer Overdiagnosis and Overtreatment: a cross- sectional study at a thyroid cancer referral center in Ecuador

Solís-Pazmiño¹,

Salazar-Vega

Lincango-Naranjo

et al. 2021

Preprint

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Background: In contrast to the rapid increase in thyroid cancer incidence, the mortality has remained low and stable over the last decades. In Ecuador, however, thyroid cancer mortality has increased. The objective of this study is to determine possible drivers of high rates of thyroid cancer mortality, through a cross-sectional analysis of all patients attending a thyroid cancer referral center in Ecuador.Methods: From June 2014 to December 2017, a cross-sectional study was conducted at the Hospital de Especialidades Eugenio Espejo, a regional reference public hospital for endocrine neoplasia in adults in Quito, Ecuador. We identified the mechanism of detection, histopathology and treatment modalities from a patient interview and review of clinical records. Results: Among 452 patients, 74.8% were young adults and 94.2% (426) were female. 13.7% had a family history of thyroid cancer, and patients’ median tumor size was 2 cm. The incidental finding was 54.2% whereas 45.8% was non-incidental. Thyroid cancer histology reported that 93.3% had papillary thyroid cancer (PTC), 2.7% follicular, 1.5% Hurtle cells, 1.6% medullary, 0.7% poor differentiated, and 0.2% anaplastic carcinoma. The mean MACIS (metastasis, age, completeness, invasion, and size) score was 4.95 (CI 4.15-5.95) with 76.2% of the thyroid cancer patients having MACIS score less than or equal to 6. The very low and low risk of recurrence was 18.1% (79) and 62% (271) respectively. An analysis of 319 patients with non-metastatic thyroid cancer showed that 10.7% (34) of patients had surgical complications. Moreover, around 62.5% (80 from 128 patients with thyroglobulin laboratory results) of TC patients had a stimulated-thyroglobulin value equal or higher than 2 ng/ml. Overall, a poor surgical outcome was present in 35.1% (112) patients. Out of 436 patients with differentiated thyroid carcinoma, 86% (375) received radioactive iodine. Conclusion: Thyroid cancer histological characteristics and method of diagnosis are like those described in other reports without any evidence of the high frequency of aggressive thyroid cancer histology. However, we observed evidence of overtreatment and poor surgical outcomes that demand additional studies to understand their association with thyroid cancer mortality in Ecuador.

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Section: Discussionsupporting

confidence: 92%

Thyroid Cancer Overdiagnosis and Overtreatment: a cross- sectional study at a thyroid cancer referral center in Ecuador

Solís-Pazmiño¹,

Salazar-Vega

Lincango-Naranjo

et al. 2021

Preprint

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“…Previous autopsy series showed that incidental TC lesions were identified in 4.7% to 35.6% of individuals who had no history of TC 27 . Recently, Li et al indicated that large numbers of TC were estimated to be overdiagnosed, including China 36 . The results of this hospital‐based study were broadly coherent with the population‐based estimates.…”

Section: Discussionsupporting

confidence: 78%

“…Li et al indicated that large numbers of TC were estimated to be overdiagnosed, including China. 36 The results of this hospital-based study were broadly coherent with the population-based estimates.…”

Section: Discussionsupporting

confidence: 77%

Screening and the epidemic of thyroid cancer in China: An analysis of national representative inpatient and commercial insurance databases

Liu

Lai

Long

et al. 2020

Intl Journal of Cancer

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Reasons behind the rapid increase of thyroid cancer (TC) in China are uncertain. We assessed the burden of TC and the role of access to screening and salt iodization. We analyzed two national databases in China: Hospital Quality Monitoring System (HQMS) and China Reinsurance Company (CRC) database. HQMS covered 1037 (44.3%) Class 3 hospitals and 76 263 617 Class 3 hospital inpatients in 2013 to 2017 and CRC covered 93 123 018 clients in 2000 to 2016. The proportion of TC inpatients among inpatients in HQMS and TC incidence in critical illness insurance buyers were used to evaluate the association with screening and iodine status. Between 2013 and 2017, the proportion of TC patients in HQMS with urban employee medical insurance and good access to screening increased sharply while there was little change among those with the other two forms of medical insurance. Across provinces, the proportion of TC inpatients in HQMS was positively correlated with per capita disposable income but not with median urinary iodine. Similar findings were observed in the CRC database. In 2017, approximately 1000 individuals were overdiagnosed with TC daily. We conservatively forecast that 5.1 million healthy individuals would become TC patients unnecessarily between 2019 and 2030. Our findings suggested the epidemic of TC in China was substantially underestimated. It was associated with screening but not with salt iodization.

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“…At the same time, other countries have not reproduced these ndings [38]. A recent report suggested a substantial contribution of overdiagnosis to the rising incidence in high-income, but also in less a uent countries [39]. [9].…”

Section: Incidencementioning

confidence: 99%

“…One possible explanation for women's survival advantage is that they have higher proportion of papillary tumors than men (67% vs 55%, data not shown), and women have their tumors diagnosed at a signi cantly earlier stage (stage I proportion 44% for women, 26% for men, data not shown). Also, overdiagnosis may be more common among women, in ating survival estimates [39].…”

Section: Incidencementioning

confidence: 99%

Incidence and Survival of Head & Neck Cancers in Estonia, 1996–2016

Kase

Baburin

Kuddu

et al. 2020

Preprint

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Background and MaterialChanging patterns of alcohol and tobacco consumption and human papillomavirus (HPV) infection have affected the epidemiology of head & neck cancers. The aim of the study was to examine 20-year trends in the incidence and survival of head & neck cancers in Estonia by site, sex, morphology and stage.MethodsData on all adult cases of invasive head & neck cancers diagnosed in Estonia in 1996–2016 were obtained from the population-based cancer registry. TNM stage was available for 2010–2016. Incidence trends were modelled with joinpoint regression and five-year relative survival ratios (RSR) were calculated.ResultsA total of 6769 cases were included, 64% among men. We observed significant decline in the incidence of lip and laryngeal cancer and significant increase in the incidence of hypopharyngeal and oropharyngeal cancers. Over 60% of mouth & pharyngeal cancers were diagnosed at stage IV.Age-standardized five-year RSR for mouth & pharyngeal cancer increased significantly over the study period, from 21% in 1996–2002 to 33% in 2010–2016. The largest survival increases were seen for cancers of oral cavity (44% in 2010–2016), tongue (41%) and larynx (63%), while modest changes were seen for oropharynx (24%) and hypopharynx (17%). The latest five-year RSR was 90% for thyroid cancers (99% for papillary carcinoma). Large female survival advantage was seen for most sites.ConclusionsThe observed trends suggest an emerging role of HPV infection in combination with traditional risk factors in the development of head & neck cancers in Estonia. Efforts targeting health behavior, HPV vaccination and earlier diagnosis are crucial for reducing mortality from these cancers.

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Global trends in thyroid cancer incidence and the impact of overdiagnosis

Cited by 272 publications

References 8 publications

Thyroid Cancer Overdiagnosis and Overtreatment: a cross- sectional study at a thyroid cancer referral center in Ecuador

Thyroid Cancer Overdiagnosis and Overtreatment: a cross- sectional study at a thyroid cancer referral center in Ecuador

Screening and the epidemic of thyroid cancer in China: An analysis of national representative inpatient and commercial insurance databases

Incidence and Survival of Head & Neck Cancers in Estonia, 1996–2016

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Global trends in thyroid cancer incidence and the impact of overdiagnosis

Cited by 272 publications

References 8 publications

Thyroid Cancer Overdiagnosis and Overtreatment: a cross- sectional study at a thyroid cancer referral center in Ecuador

Thyroid Cancer Overdiagnosis and Overtreatment: a cross- sectional study at a thyroid cancer referral center in Ecuador

Screening and the epidemic of thyroid cancer in China: An analysis of national representative inpatient and commercial insurance databases

Incidence and Survival of Head &amp; Neck Cancers in Estonia, 1996–2016

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Incidence and Survival of Head & Neck Cancers in Estonia, 1996–2016