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Original Investigation |

Current Thyroid Cancer Trends in the United States ONLINE FIRST

Louise Davies, MD, MS1,2,3; H. Gilbert Welch, MD, MPH3
[+] Author Affiliations
1VA Outcomes Group, Department of Veterans Affairs Medical Center, White River Junction, Vermont
2Section of Otolaryngology, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire
3Dartmouth Institute for Health Policy and Clinical Practice, Hanover, New Hampshire
JAMA Otolaryngol Head Neck Surg. Published online February 20, 2014. doi:10.1001/jamaoto.2014.1
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Importance  We have previously reported on a doubling of thyroid cancer incidence—largely due to the detection of small papillary cancers. Because they are commonly found in people who have died of other causes, and because thyroid cancer mortality had been stable, we argued that the increased incidence represented overdiagnosis.

Objective  To determine whether thyroid cancer incidence has stabilized.

Design  Analysis of secular trends in patients diagnosed with thyroid cancer, 1975 to 2009, using the Surveillance, Epidemiology, and End Results (SEER) program and thyroid cancer mortality from the National Vital Statistics System.

Setting  Nine SEER areas (SEER 9): Atlanta, Georgia; Connecticut; Detroit, Michigan; Hawaii; Iowa; New Mexico; San Francisco–Oakland, California; Seattle–Puget Sound, Washington; and Utah.

Participants  Men and women older than 18 years diagnosed as having a thyroid cancer between 1975 and 2009 who lived in the SEER 9 areas.

Interventions  None.

Main Outcomes and Measures  Thyroid cancer incidence, histologic type, tumor size, and patient mortality.

Results  Since 1975, the incidence of thyroid cancer has now nearly tripled, from 4.9 to 14.3 per 100 000 individuals (absolute increase, 9.4 per 100 000; relative rate [RR], 2.9; 95% CI, 2.7-3.1). Virtually the entire increase was attributable to papillary thyroid cancer: from 3.4 to 12.5 per 100 000 (absolute increase, 9.1 per 100 000; RR, 3.7; 95% CI, 3.4-4.0). The absolute increase in thyroid cancer in women (from 6.5 to 21.4 = 14.9 per 100 000 women) was almost 4 times greater than that of men (from 3.1 to 6.9 = 3.8 per 100 000 men). The mortality rate from thyroid cancer was stable between 1975 and 2009 (approximately 0.5 deaths per 100 000).

Conclusions and Relevance  There is an ongoing epidemic of thyroid cancer in the United States. The epidemiology of the increased incidence, however, suggests that it is not an epidemic of disease but rather an epidemic of diagnosis. The problem is particularly acute for women, who have lower autopsy prevalence of thyroid cancer than men but higher cancer detection rates by a 3:1 ratio.

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Figures

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Figure 1.
Thyroid Cancer Incidence and Mortality, 1975 to 2009

Trends are shown for thyroid cancer of all histologic types. Incidence data are from Surveillance, Epidemiology, and End Results (SEER) 9, 1975 to 2009, maintained by the National Cancer Institute, National Institutes of Health, released April 2012, based on the November 2011 submission. Mortality data are from the National Center for Vital Statistics.

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Figure 2.
Thyroid Cancer Incidence by Histologic Type, 1975 to 2009

Trends are shown for thyroid cancer of all histologic types and for the 3 major histologic groups: papillary, follicular, and poorly differentiated cancers (anaplastic and medullary). Data are from Surveillance, Epidemiology, and End Results (SEER) 9, 1975 to 2009, maintained by the National Cancer Institute, National Institutes of Health, released April 2012, based on the November 2011 submission.

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Figure 3.
Thyroid Cancer Incidence and Mortality by Sex, 1975 to 2009

Trends are shown by sex for thyroid cancer of all histologic types. Incidence data are from Surveillance, Epidemiology, and End Results (SEER) 9, 1975 to 2009, maintained by the National Cancer Institute, National Institutes of Health, released April 2012, based on the November 2011 submission. Mortality data are from the National Center for Vital Statistics.

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Figure 4.
Treatment of Thyroid Cancer in US Women and Men in 2009

Proportions come from Surveillance, Epidemiology, and End Results (SEER 9), 1975 to 2009, maintained by the National Cancer Institute, National Institutes of Health, released April 2012, based on the November 2011 submission. The proportions are then multiplied by the total estimates of new cases by sex as published by the North American Association of Central Cancer Registries, accessed on April 1, 2013.

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