Incidental Thyroid Nodules: Race/Ethnicity Disparities and Outcomes |
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| Institution: | 1. From the Department of Otolaryngology - Head and Neck Surgery, Detroit, Michigan.;2. Division of Endocrinology, Henry Ford Health System, Detroit, Michigan.;3. Department of Public Health Sciences, Henry Ford Health System, Detroit, Michigan.;1. Advocare DelGiorno Endocrinology, Sewell, New Jersey;2. Division of Endocrinology and Metabolism, St. Louis. University, St. Louis, Missouri;3. Endocrinology, Renown Health, Reno, Nevada;4. Endocrinology, Diabetes and Metabolism, State University of New York, Buffalo, New York.;1. Departments of Pathology, Surgery, Medicine, Radiation Oncology, University of Alabama at Birmingham, Birmingham, AL, 35249-7331;2. Cancer Prevention and Control Program, Fox Chase Cancer Center, Temple University Heath, Philadelphia, PA, 19111-2497;1. From the Division of Endocrinology, Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, California;2. Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California;3. Department of Surgery, VA Greater Los Angeles Healthcare System, Los Angeles, California;4. Department of Surgery, UCLA David Geffen School of Medicine, Los Angeles, California;5. Department of Otolaryngology, VA Greater Los Angeles Healthcare System, Los Angeles, California;6. Department of Head and Neck Surgery, UCLA David Geffen School of Medicine, Los Angeles, California, and;7. Division of Endocrinology, Department of Medicine, UCLA David Geffen School of Medicine, Los Angeles, California.;1. From Endocrinology, Diabetes and Metabolism, Department of Medicine, Houston Methodist Hospital, Houston, Texas;2. Houston Methodist Sugar Land Hospital, Sugar Land, Texas;3. Department of Radiology, Houston Methodist Hospital, Houston, Texas;4. Houston Methodist Research Institute, Houston Methodist Hospital, Houston, Texas;5. Weill Cornell Medical College, New York, New York. |
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| Abstract: | Objective: Black patients have a significantly lower incidence of well-differentiated thyroid cancer (WDTC) compared to all other race/ethnic groups, while white patients appear to be at greater risk. This study examines incidental thyroid nodules (ITNs) to assess whether racial disparities in WDTC arise from a differential discovery of ITNs—perhaps due to socioeconomic disparities—or reflect true differences in thyroid cancer rates.Methods: A retrospective review was performed of all patients who underwent fine-needle aspiration (FNA) of thyroid nodules by our academic medical center's endocrinology division between January 2006 and December 2010. Medical records were reviewed to identify whether the biopsied thyroid nodule was discovered incidentally through nonthyroid-related imaging or identified by palpation.Results: FNAs were performed on 1,369 total thyroid nodules in 1,141 study patients; 547 (48%) were classified as white, and 593 (52%) were classified as nonwhite. Among this cohort, 36.6% of patients underwent biopsy for an ITN. White patients were 1.6 times more likely to have undergone a biopsy for a nodule that was incidentally identified compared to nonwhites (P<.0001). Indicators of socioeconomic status (SES) did not have a significant association with ITNs. Within the ITN cohort, 4.9% of nonwhite patients were found to have a thyroid malignancy compared to 12.9% of white patients (P<.01).Conclusion: The higher incidence of thyroid cancer in white patients appears to be not only due to diagnostic bias, but also to a true difference in cancer prevalence.Abbreviations: FNA = fine-needle aspiration; ITN = incidental thyroid nodule; SEER = Surveillance Epidemiology and End Results; SES = socioeconomic status; WDTC = well-differentiated thyroid cancer |
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