Trends in Thyroid Cancer Incidence and Mortality in the United States, 1974-2013

Lim, Heon Kil; Devesa, Susan S.; Sosa, Julie Ann; Check, David P.; Kitahara, Cari M.

doi:10.1001/jama.2017.2719

Cited by 1,652 publications

(1,353 citation statements)

References 30 publications

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“…[1][2][3][4] The most common histologic type is papillary thyroid cancer (PTC), accounting for . 85% of all thyroid malignancies, with conventional PTC (CPTC) being the dominant variant.…”

Section: Introductionmentioning

confidence: 99%

Patient Age–Associated Mortality Risk Is Differentiated by BRAF V600E Status in Papillary Thyroid Cancer

Shen

Zhu

Liu

et al. 2018

JCO

105

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For the past 65 years, patient age at diagnosis has been widely used as a major mortality risk factor in the risk stratification of papillary thyroid cancer (PTC), but whether this is generally applicable, particularly in patients with different BRAF genetic backgrounds, is unclear. The current study was designed to test whether patient age at diagnosis is a major mortality risk factor. Patients and MethodsWe conducted a comparative study of the relationship between patient age at diagnosis and PTCspecific mortality with respect to BRAF status in 2,638 patients (623 men and 2,015 women) with a median age of 46 years (interquartile range, 35 to 58 years) at diagnosis and a median follow-up time of 58 months (interquartile range, 26 to 107 months). Eleven medical centers from six countries participated in this study. ResultsThere was a linear association between patient age and mortality in patients with BRAF V600E mutation, but not in patients with wild-type BRAF, in whom the mortality rate remained low and flat with increasing age. Kaplan-Meier survival curves rapidly declined with increasing age in patients with BRAF V600E mutation but did not decline in patients with wild-type BRAF, even beyond age 75 years. The association between mortality and age in patients with BRAF V600E was independent of clinicopathologic risk factors. Similar results were observed when only patients with the conventional variant of PTC were analyzed. ConclusionThe long-observed age-associated mortality risk in PTC is dependent on BRAF status; age is a strong, continuous, and independent mortality risk factor in patients with BRAF V600E mutation but not in patients with wild-type BRAF. These results question the conventional general use of patient age as a high-risk factor in PTC and call for differentiation between patients with BRAF V600E and wild-type BRAF when applying age to risk stratification and management of PTC.

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“…[1][2][3][4] The most common histologic type is papillary thyroid cancer (PTC), accounting for . 85% of all thyroid malignancies, with conventional PTC (CPTC) being the dominant variant.…”

Section: Introductionmentioning

confidence: 99%

Patient Age–Associated Mortality Risk Is Differentiated by BRAF V600E Status in Papillary Thyroid Cancer

Shen

Zhu

Liu

et al. 2018

JCO

105

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“…Moreover, even with early detection and treatment, the incidence of large tumors and cancer-related mortality also slightly increased [25], suggesting other factors leading to the growth of thyroid cancer incidence. Therefore, environmental/lifestyle factors (e.g., radiation, iodine intake, and nitrates), as well as comorbidities (e.g., chronic lymphocytic thyroiditis), and perhaps a complex multiplication of these factors are considered possible causes for a true increase in thyroid cancer incidence.…”

Section: Risk Factors For Thyroid Cancermentioning

confidence: 99%

Review of Factors Related to the Thyroid Cancer Epidemic

Liu

Xiao

2017

International Journal of Endocrinology

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Thyroid cancer is the most common endocrine cancer, of which the incidence has dramatically increased worldwide in the past few decades. The reasons for the observed rapid increase still are not fully understood, but evidence suggests that overdiagnosis, with the advancement in detection methods and screening policies, is not the sole driver of the substantial increase of the incidence. However, the effect of environmental/lifestyle factors remains speculative other than that of radiation exposure at a young age. This review tries to give a balanced view of debated factors leading to the thyroid cancer epidemic, to offer some alternatives in understanding the controversies, and to suggest potential directions in the search of modifiable risk factors to help reduce thyroid cancer.

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“…Consistent with these estimates, small thyroid cancers that are best discovered using new technologies (ultrasound and fine-needle aspiration biopsy) have shown a sharply increased incidence [14]. However, improved medical surveillance and "overdiagnosis" do not completely explain the rise in rates of papillary thyroid carcinoma (PTC), since a significant increase also has been observed for larger tumors (>10 mm) [15][16][17][18].…”

Section: Introductionmentioning

confidence: 99%

Thyroid Cancer Induction: Nitrates as Independent Risk Factors or Risk Modulators after Radiation Exposure, with a Focus on the Chernobyl Accident

Дрозд¹,

Branovan²,

Shiglik³

et al. 2018

Eur Thyroid J

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In recent decades, differentiated thyroid cancer (DTC) incidence has been increasing worldwide. The important contributions to this phenomenon of “overdiagnosis” driven by wider use of improved ultrasound systems are amply documented, notwithstanding the “real” carcinogenic effects of ionizing radiation, e.g., from the Chernobyl accident or health care interventions. Less well understood is the role of nitrates – as environmental pollutants, in diet, and in medication – in thyroid carcinogenesis. Increasing exposure to nitrates is associated with rising incidence of esophageal, stomach, bladder, and colon cancers. Recent data suggest that in agricultural areas with higher mean nitrate levels in groundwater, DTC risk is also elevated. Our work in Belarus after Chernobyl has shown that children in districts with high nitrate concentrations in drinking water had significantly higher thyroid cancer incidence after irradiation than did their counterparts in areas with lower nitrate concentrations. Notwithstanding thyroid shielding, increasing use of computed tomography and dental X-rays heightens radiation exposure of the salivary glands in the general population, especially in children and adolescents. When nitrate intake is increased, salivary gland irradiation may potentially result in carcinogenic elevations in plasma nitric oxide concentrations. In conclusion, excess nitrate intake seems to be an independent risk factor for DTC. Additionally, we hypothesize from our data that high nitrate levels modulate the carcinogenic effect of radiation on the thyroid. Cohort studies, case-control studies, or both, are needed to quantify the effects of nitrates on DTC risk in the presence or absence of radiation exposure, e.g., that associated with diagnostic or therapeutic health care interventions.

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Trends in Thyroid Cancer Incidence and Mortality in the United States, 1974-2013

Cited by 1,652 publications

References 30 publications

Patient Age–Associated Mortality Risk Is Differentiated by BRAF V600E Status in Papillary Thyroid Cancer

Patient Age–Associated Mortality Risk Is Differentiated by BRAF V600E Status in Papillary Thyroid Cancer

Review of Factors Related to the Thyroid Cancer Epidemic

Thyroid Cancer Induction: Nitrates as Independent Risk Factors or Risk Modulators after Radiation Exposure, with a Focus on the Chernobyl Accident

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