Current Thyroid Cancer Trends in the United States
Current Thyroid Cancer Trends in the United States
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DOI：
10.1001/jamaoto.2014.1
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发表时间：
2014-04-01
影响因子：
7.8
通讯作者：
Welch, H. Gilbert
中科院分区：
文献类型：
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作者：
Davies, Louise;Welch, H. Gilbert
我们以前曾报道过甲状腺癌发病率翻倍，主要是由于小乳头状癌的检测。因为它们常见于死于其他原因的人，而且甲状腺癌的死亡率一直很稳定，我们认为发病率的增加代表了过度诊断。目的探讨甲状腺癌发病率是否稳定。设计：利用监测、流行病学和最终结果（SEER）项目和来自国家生命统计系统的甲状腺癌死亡率，分析1975年至2009年诊断为甲状腺癌患者的长期趋势。背景：九个预言区（预言区9）：佐治亚州亚特兰大；康涅狄格;底特律,密歇根州夏威夷;爱荷华州;新墨西哥;加州旧金山-奥克兰；华盛顿州西雅图-普吉特海湾；和犹他州。参与者在1975年至2009年期间居住在SEER 9地区的18岁以上被诊断患有甲状腺癌的男性和女性。干预措施。主要结局和指标甲状腺癌发病率、组织学类型、肿瘤大小和患者死亡率。结果：自1975年以来，甲状腺癌的发病率几乎增加了两倍，从每10万人4.9例增加到14.3例（绝对增加，每10万人9.4例；相对率[RR]， 2.9; 95% CI, 2.7-3.1）。几乎所有的增加都是由于甲状腺乳头状癌：从3.4 / 10万增加到12.5 / 10万（绝对增加，9.1 / 10万；RR, 3.7; 95% CI, 3.4-4.0）。女性甲状腺癌的绝对增长（从6.5到21.4 =每10万名女性14.9）几乎是男性的4倍（从3.1到6.9 =每10万名男性3.8）。1975年至2009年期间，甲状腺癌死亡率保持稳定（每10万人中约有0.5人死亡）。结论和相关性甲状腺癌在美国持续流行。然而，发病率增加的流行病学表明，这不是疾病的流行，而是诊断的流行。这个问题对女性来说尤其严重，她们的甲状腺癌尸检率比男性低，但癌症检出率却比男性高，比例为3:1。
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.