Trends in Thyroid Cancer Incidence in Texas from 1995 to 2008 by Socioeconomic Status and Race/Ethnicity

Abstract

Background: Thyroid cancer incidence is increasing, potentially due to enhanced diagnostic practices. However, access to healthcare may be dependent on socioeconomic status (SES) and race/ethnicity. Consequently, certain segments of the population may experience thyroid cancer overdiagnosis as a result of greater access to and use of enhanced diagnostic technology. The current study examined trends by SES in thyroid cancer incidence at the census tract level from 1995 to 2008 for the population of Texas, as well as by racial/ethnic subgroup. Methods: Joinpoint regressions were used to examine incidence trends over time by SES for the study population, and for the non-Hispanic white, non-Hispanic black, and Hispanic subgroups separately. Other race/ ethnicities were not adequately represented for subgroup analyses. Results: There were 22,390 incident thyroid cancer cases (65.0% white, 6.7% black, 24.3% Hispanic, 4.1% Asian/ other races; 85.9% papillary histology). The low SES group experienced a steady increase in incidence since 1995 (6.7% per year, p < 0.05), whereas incidence among the high SES group has increased at a rate of 8.6% per year since 1999 ( p < 0.05). The joinpoint projected incidence trends for the low and high SES groups were significantly different ( p = 0.047). Whites experienced a steady increase in incidence over time among both high and low SES groups (7.6% per year p < 0.05), whereas blacks and Hispanics of higher SES had a much more pronounced increase in incidence over time relative to their lower SES counterparts (blacks = 12.8% vs. 4.1%; Hispanics = 11.2% vs. 8.3%, p < 0.05). For blacks and Hispanics, joinpoint projected incidence trends for the low and high SES groups were significantly different from one another ( p < 0.001-0.004). Conclusions: These results identify groups experiencing the greatest problem of increasing thyroid cancer incidence, and raise concern that greater access to healthcare may be accompanied by thyroid cancer overdiagnosis. A dual focus on delineating and preventing disease-related causal factors and focusing clinical attention on avoiding overdiagnosis among certain populations (e.g., high SES) may be advisable to address thyroid cancer in Texas. Clinicians are encouraged to adhere to ATA/NCCN guidelines when choosing patients for thyroid ultrasound, selecting which nodules to examine, and deciding which patients should proceed to biopsy.

Overdiagnosis of Thyroid Cancer

“…Several reports documenting a correlative relationship between access to health care and thyroid cancer incidence support the notion that increased detection and/or workup of thyroid abnormalities is a major contributor to the observed increase in thyroid cancer diagnoses. Thyroid cancer incidence has been found to correlate positively with socioeconomic status (42,43). In one study, geographic regions with higher use of discretionary medical tests and better education had higher rates of thyroid cancer diagnoses (44).…”

Initial Treatment Patterns in Younger Adult Patients with Differentiated Thyroid Cancer in California

“…As the natural history of thyroid cancer is long and this population-based cohort is relatively recent, survival outcomes based on initial treatment and sociodemographics were not examined. Nonetheless, the recent rise in thyroid cancer incidence has been tied to SES, suggesting that greater health utilization and access to care may impact the diagnosis of thyroid cancer (19,20). Younger patients tended to have lower neighborhood SES levels in this study.…”

Geospatial and Temporal Analysis of Thyroid Cancer Incidence in a Rural Population

“…The basis for the increase in thyroid cancer incidence is not known. Some studies suggest enhanced diagnostic scrutiny and better detection of subclinical cancers result in widespread overdiagnosis and thus not a true increase in incidence (4,8,(10)(11)(12)(13)(14)(15). Other studies note that an increase in both large tumors and microcarcinomas as well as a change in relative frequencies of histological types implicate other contributing factors (1,(16)(17)(18)(19).…”