The impact of overdiagnosis on thyroid cancer epidemic in Italy,1998–2012

Maso, Luigino Dal; Panato, Chiara; Franceschi, Silvia; Serraino, Diego; Buzzoni, Carlotta; Busco, Susanna; Ferretti, Stefano; Torrisi, Antonietta; Falcini, Fabio; Zorzi, Manuel; Crimi, Claudia; Mazzucco, Walter; Magoni, Michele; Collarile, Paolo; Pannozzo, Fabio; Caiazzo, Anna Luisa; Russo, Antonio; Gili, Alessio; Caldarella, Adele; Zanetti, Roberto; Michiara, Maria; Mangone, Lucìa; Filiberti, Rosa Angela; Fusco, Mario; Gasparini, Francesca; Tagliabue, Giovanna; Cesaraccio, Rosaria; Tumino, Rosario; Gatti, Luciana V.; Tisano, F.; Piffer, Silvano; Sini, Giovanna; Mazzoleni, Guido; Rosso, Stefano; Fanetti, Anna Clara; Vaccarella, Salvatore; Fedeli, Ugo; Varvarà, Massimo; Ravaioli, Alessandra; Pennelli, Gianmaria; Valla, K; Cusimano, Rosanna; Gasparotti, Cinzia; Taborelli, Martina; Iannelli, A.; Leite, Sílvia; Manneschi, Gianfranco; Patriarca, S; Sgargi, Paolo; Vicentini, Massimo; Puppo, Antonella; Vitale, Maria Francesca; Barigelletti, Giulio; Pirino, D; Spata, Eugenia; Ricci, Paolo; Madeddu, A; Rizzello, Roberto; Usala, M.; Bulatko, A.; Vercellino, P; Cometti, I; Cuccaro, Francesco; Sampietro, Giuseppe; Scalzi, Santo; Gola, G; Guarda, Linda; Melcarne, Anna; d’Oro, Luca Cavalieri; Borciani, E; Carone, Simona; Candela, G; Stoppa, Giorgia

doi:10.1016/j.ejca.2018.01.083

Cited by 67 publications

(51 citation statements)

References 35 publications

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“…This international comparison confirms the very high TC incidence rates in some — but not all — HICs in 2008–2012 and shows very high incidence rates in several LMICs, particularly in urban areas. Besides, the proportion of papillary carcinomas — the histological type making up the bulk of the increase in and overdiagnoses of TC in several countries — is similar in the HICs and LMICs with the highest incidence rates. Together with the uniformly low mortality rates, these findings support the existence of overdiagnosis of TC cases in LMICs.…”

Section: Discussionmentioning

confidence: 97%

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Thyroid cancer “epidemic” also occurs in low‐ and middle‐income countries

Lortet‐Tieulent

Franceschi

Maso

et al. 2018

Intl Journal of Cancer

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Thyroid cancer incidence varies greatly between and within high‐income countries (HICs), and overdiagnosis likely plays a major role in these differences. Yet, little is known about the situation in low‐ and middle‐income countries (LMICs). We compare up‐to‐date thyroid cancer incidence and mortality at national and subnational levels. 599,851 thyroid cancer cases in subjects aged 20–74 reported in Cancer Incidence in Five Continents volume XI from 55 countries with at least 0.5 million population, aged 20–74 years, covered by population‐based cancer registration, and 22,179 deaths from the WHO Mortality Database for 36 of the selected countries, over 2008–2012, were included. Age‐standardized rates were computed. National incidence rates varied 50‐fold. Rates were 4 times higher among women than men, with similar patterns between countries. The highest rates (>25 cases per 100,000 women) were observed in the Republic of Korea, Israel, Canada, the United States, Italy, France, and LMICs such as Turkey, Costa Rica, Brazil, and Ecuador. Incidence rates were low (<8) in a few HICs (the Netherlands, the United Kingdom, and Denmark) and lowest (3–4) in some LMICs (such as Uganda and India). Within‐country incidence rates varied up to 45‐fold, with the largest differences recorded between rural and urban areas in Canada (HIC) and Brazil, India, and China (LMICs). National mortality rates were very low (<2) in all countries and in both sexes, and highest in LMICs. The very high thyroid cancer incidence and low mortality rates in some LMICs also strongly suggest a major role of overdiagnosis in these countries.

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Section: Discussionmentioning

confidence: 97%

“…The incidence of thyroid cancer (TC) has been increasing markedly in several high‐income countries (HICs), including France, Italy, and the United States, since the 1980s, and in the Republic of Korea since the mid‐1990s . In contrast, TC mortality has remained low and stable, or has even declined .…”

Section: Introductionmentioning

confidence: 99%

Thyroid cancer “epidemic” also occurs in low‐ and middle‐income countries

Lortet‐Tieulent

Franceschi

Maso

et al. 2018

Intl Journal of Cancer

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“…As observed in other high‐income countries, including in Italy, the overuse of ultrasound screening in asymptomatic patients has led to an increased detection of thyroid nodules and the overtreatment of low‐risk papillary carcinomas . Moreover, thyroid nodules and thyroid neoplasm are very common in the Campania region (southern Italy), where the high incidence is attributed in part to volcanic activity .…”

Section: Introductionmentioning

confidence: 99%

Evaluation of BRAF, RAS, RET/PTC, and PAX8/PPARg alterations in different Bethesda diagnostic categories: A multicentric prospective study on the validity of the 7‐gene panel test in 1172 thyroid FNAs deriving from different hospitals in South Italy

Bellevicine

Migliatico

Sgariglia

et al. 2019

Cancer Cytopathology

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BACKGROUND: Thyroid fine-needle aspiration (FNA) is a reliable and cost-effective diagnostic tool for establishing the nature of thyroid nodules, although up to 30% of FNAs are still classified as "indeterminate." Molecular testing of FNAs could improve preoperative diagnosis, thereby reducing unnecessary surgery. In this multicenter prospective study the authors investigated, using a 7-gene assay, the distribution and diagnostic impact of BRAF, RAS, RET/PTC, and PAX8/ PPARg, the most frequent genomic alterations occurring during thyroid oncogenesis. METHODS: In total, of 1172 routine FNAs from 7 centers in southern Italy were classified according to the Bethesda System for Reporting ThyroidCytopathology. Each specimen was tested, and molecular data were compared with available histology or cytologic follow-up. RESULTS: In particular, for atypia of undetermined significance/follicular lesion of undetermined significance cases, the 7-gene test confirmed the high positive predictive value of BRAFV600E and BRAF-like mutations (80%) and the moderate positive predictive value of RAS-like alterations (32.4%), suggesting different surgical management, depending on the type of mutation. The rate of mutation-positive FNAs was strictly related to the risk of malignancy of each diagnostic class, supporting the identification of prognostically relevant diagnostic categories. CONCLUSIONS:The 7-gene panel test improves the preoperative risk stratification of indeterminate thyroid FNAs, especially when considering the biologic significance of the different types of mutations. Moreover, the rate of mutation-positive FNAs is related to the risk of malignancy of each diagnostic class.

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“…Family, particularly the patient's spouse, is central to all aspects of social support, including emotional, instrumental, and informational support. The introduction of advances in diagnostic methods combined with increased medical surveillance and access to health care services led to the overdiagnosis of thyroid cancer, 30,31 which may have never caused symptoms or harm if undetected. 32,33 In addition, the majority of patients who were diagnosed with thyroid cancer underwent total thyroidectomy.…”

Section: Discussionmentioning

confidence: 99%

<p>Risk Factors of Deterioration in Quality of Life Scores in Thyroid Cancer Patients After Thyroidectomy</p>

Li¹,

Xue²,

Gong³

et al. 2019

CMAR

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Objective: Despite the expectation of normal life expectancy for thyroid cancer, there are concerns about the decreased quality of life (QoL). The present study investigated the potential risk factors of deterioration in QoL scores in thyroid cancer patients after thyroidectomy. Materials and methods: A total of 286 patients who were diagnosed with thyroid cancer after thyroidectomy were involved in this prospective, single-center, observational study from November 2018 to June 2019. The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 was used to assess the QoL 3 months after thyroidectomy. We investigated the effects of demographics (age, gender, education, marital status, area of residence, and annual mean income), tumor characteristics (histology, clinical stage, presence of metastasis, surgery type, and radiotherapy), and neurological deficits induced by recurrent nerve or superior laryngeal injury on QoL. Results: The mean overall QoL in thyroid cancer survivors was 65.93 ±9.00 (on a scale of 0-100, where 100 was the best). Multivariate regression analysis confirmed that clinical stage (P < 0.010), surgery type (P < 0.001), histology (P < 0.001), neurological deficits (P < 0.001), and marital status (P < 0.001) were independent risk factors for decreased QoL 3 months after thyroidectomy. Conclusion: Our study indicated that clinical stage, surgery type, histology, neurological deficits, and marital status were independent risk factors for decreased QoL at 3 months after thyroidectomy. Further exploration and validation of these findings in larger prospective studies are warranted.

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The impact of overdiagnosis on thyroid cancer epidemic in Italy,1998–2012

Cited by 67 publications

References 35 publications

Thyroid cancer “epidemic” also occurs in low‐ and middle‐income countries

Thyroid cancer “epidemic” also occurs in low‐ and middle‐income countries

Evaluation of BRAF, RAS, RET/PTC, and PAX8/PPARg alterations in different Bethesda diagnostic categories: A multicentric prospective study on the validity of the 7‐gene panel test in 1172 thyroid FNAs deriving from different hospitals in South Italy

<p>Risk Factors of Deterioration in Quality of Life Scores in Thyroid Cancer Patients After Thyroidectomy</p>

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