American Association of Clinical Endocrinologists and American College of Endocrinology Disease State Clinical Review: The Increasing Incidence of Thyroid Cancer |
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| Affiliation: | 1. From the VA Outcomes Group, Department of Veterans fnairs Medical Center, White River Junction, Vermont, the Section of Otolaryngology in Geisel School of Medicine at Dartmouth, and The Dartmouth Institute for Health Policy & Clinical Practice, New York, New York;2. Head & Neck Service, Memorial Sloan-Kettering Cancer Center, New York, New York;3. Division of Metabolism, Endocrinology, and Diabetes, University of Michigan, Ann Arbor, Michigan;4. Department of Otolaryngology, Emory University School of Medicine, Atlanta, Georgia;5. Division of Otolaryngology-Head and Neck Surgery, Penn State College of Medicine, State College, Pennsylvania;6. Division of Endocrinology, Mayo Clinic, Rochester, Minnesota;7. Division of Endocrine Surgery, New York University School of Medicine, New York, New York;8. Department of Otolaryngology, Georgia Regents University, Augusta, Georgia;9. Head & Neck Oncology Service, Vanderbilt Bill Wilkerson Center for Otolaryngology Head & Neck Surgery, Vanderbilt Medical Center, Nashville, Tennessee;10. Division of Thyroid and Parathyroid Endocrine Surgery, Massachusetts Eye and Ear Infirmary, Division of Surgical Oncology Massachusetts General Hospital, Otolaryngology- Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts.;1. Department of Internal Medicine, Section Endocrinology, Leiden University Medical Center, Postbus 9600, 2300 RC Leiden, The Netherlands;2. Department of Clinical Epidemiology, Leiden University Medical Center, Postbus 9600, 2300 RC Leiden, The Netherlands;3. Medisch Centrum Haaglanden, Department of Internal Medicine, Lijnbaan 32, 2512 VA Den Haag, The Netherlands;4. Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, DK-8200 Aarhus, Denmark;1. From the Department of Medicine, Division of Endocrinology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York;2. Department of Pathology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York;3. Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York. |
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| Abstract: | Objective: (1) Describe current epidemiology of thyroid cancer in the United States; (2) evaluate hypothesized causes of the increased incidence of thyroid cancer; and (3) suggest next steps in research and clinical action.Methods: Analysis of data from Surveillance, Epidemiology and End Results System and the National Center for Vital Statistics. Literature review of published English-language articles through December 31, 2013.Results: The incidence of thyroid cancer has tripled over the past 30 years, whereas mortality is stable. The increase is mainly comprised of smaller tumors. These facts together suggest the major reason for the increased incidence is detection of subclinical, nonlethal disease. This has likely occurred through: health care system access, incidental detection on imaging, more frequent biopsy, greater volumes of and extent of surgery, and changes in pathology practices. Because larger-size tumors have increased in incidence also, it is possible that there is a concomitant true rise in thyroid cancer incidence. The only clearly identifiable contributor is radiation exposure, which has likely resulted in a few additional cases annually. The contribution of the following causes to the increasing incidence is unclear: iodine excess or insufficiency, diabetes and obesity, and molecular disruptions. The following mechanisms do not currently have strong evidence to support a link with the development of thyroid cancer: estrogen, dietary nitrate, and autoimmune thyroid disease.Conclusion: Research should focus on illuminating which thyroid cancers need treatment. Patients should be advised of the benefits as well as harms that can occur with treatment of incidentally identified, small, asymptomatic thyroid cancers.Abbreviations: BMI = body mass index CT = computed tomography SEER = Surveillance, Epidemiology, and End Results |
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