AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS AND AMERICAN COLLEGE OF ENDOCRINOLOGY DISEASE STATE CLINICAL REVIEW: THE INCREASING INCIDENCE OF THYROID CANCER.
AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS AND AMERICAN COLLEGE OF ENDOCRINOLOGY DISEASE STATE CLINICAL REVIEW: THE INCREASING INCIDENCE OF THYROID CANCER.
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DOI：
10.4158/ep14466.dscr
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发表时间：
2015-06
期刊：
影响因子：
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通讯作者：
AACE Endocrine Surgery Scientific Committee
中科院分区：
文献类型：
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作者：
Davies L;Morris LG;Haymart M;Chen AY;Goldenberg D;Morris J;Ogilvie JB;Terris DJ;Netterville J;Wong RJ;Randolph G;AACE Endocrine Surgery Scientific Committee
(1)描述当前美国甲状腺癌的流行病学；(2)评估甲状腺癌发病率增加的假设原因；(3)建议下一步的研究和临床行动。来自监测、流行病学和最终结果系统和国家生命统计中心的数据分析。截至2013年12月31日发表的英文文章的文献综述。甲状腺癌的发病率在过去30年中增加了两倍，而死亡率却保持稳定。增加的主要是较小的肿瘤。这些事实表明，发病率增加的主要原因是发现了亚临床、非致命性疾病。这可能是通过以下方式发生的：卫生保健系统的使用、影像上的偶然检测、更频繁的活检、更大的手术量和范围以及病理实践的变化。因为更大的肿瘤的发病率也增加了，所以甲状腺癌的发病率可能会同时上升。唯一可明确确定的因素是辐射暴露，这可能每年导致一些额外的病例。以下原因对发病率增加的贡献尚不清楚：碘过量或不足，糖尿病和肥胖，以及分子破坏。以下机制目前没有强有力的证据支持与甲状腺癌发展的联系：雌激素、膳食硝酸盐和自身免疫性甲状腺疾病。研究应侧重于阐明哪些甲状腺癌需要治疗。应告知患者偶然发现的小型无症状甲状腺癌治疗的益处和危害。
(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. 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. 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. 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.