The Impact of Subclinical Disease and Mechanism of Detection on the Rise in Thyroid Cancer Incidence: A Population-Based Study in Olmsted County, Minnesota During 1935 Through 2012
The Impact of Subclinical Disease and Mechanism of Detection on the Rise in Thyroid Cancer Incidence: A Population-Based Study in Olmsted County, Minnesota During 1935 Through 2012
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DOI：
10.1089/thy.2014.0594
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发表时间：
2015-09-01
期刊：
影响因子：
6.6
通讯作者：
Morris, John C.
中科院分区：
文献类型：
--
作者：
Brito, Juan P.;Al Nofal, Alaa;Morris, John C.
背景：自1975年以来，甲状腺癌（TC）一直在美国流行。了解亚临床疾病的贡献和这种疾病检测的机制可能有助于改变这种流行病的进程。研究方法：我们利用罗切斯特流行病学项目资源，研究了1935年至2012年期间TC病例的发病率、疾病特异性死亡率和诊断方法。在2000 - 2012年期间，我们还提取了临床隐匿性肿瘤的检测机制。结果如下：TC的年龄校正发病率（AAI）从1990 - 1999年期间的7.1 [95%置信区间（CI）5.5 - 8.8]/100，000人-年（p-y）增加到2000 - 2012年期间的13.7 [CI 11.8 - 15.6]/100，000 p-y，自1935年以来疾病特异性死亡率没有变化。按检测机制分层的发生率趋势分析显示，1960 - 1969年临床公认TC的AAI为5.5/100，000 p-y [CI 3.4 - 7.5]，与2000 - 2012年期间观察到的发生率相似。然而，临床隐匿性TC的AAI从1935 - 1949年的0.2/100，000 p-y [CI 0.0 - 0.6]增加到1990 - 1999年的1.9/100，000 p-y [CI 1.2 - 2.9]，2000 - 2012年增加到7.4/100，000 p-y [CI 6.0 - 8.8]。在2000 - 2012年期间，识别"隐匿性"肿瘤的最常见原因是（1）40例（19%）在诊断性颈部成像期间偶然发现，（2）29例（14%）甲状腺手术标本的病理学检查为良性疾病，以及（3）对有症状或可触及结节的患者进行调查，这些症状或结节明显与共存但隐匿的TC无关，但触发了使用诊断性颈淋巴结转移。影像学检查37例（27%）。结论：在明尼苏达州奥姆斯特德县进行的这项基于人群的研究中，2000 - 2012年期间TC发病率的快速增加完全归因于隐匿性TC的诊断增加，主要通过使用诊断性颈部成像发现。自1970年以来，临床TC和疾病特异性TC死亡率保持稳定，这意味着观察到的发病率增加是由于亚临床病变的检测增加。
Background: An ongoing epidemic of thyroid carcinoma (TC) has affected Americans since 1975. Understanding the contribution of subclinical disease and the mechanism of such disease detection may help to alter the course of this epidemic. Methods: We used Rochester Epidemiology Project resources to examine the incidence of TC cases, disease specific mortality, and method of diagnosis during 1935 through 2012. During 2000-2012, we also extracted the mechanism of detection of clinically occult tumors. Results: The age-adjusted incidence (AAI) for TC increased from 7.1 [95% confidence interval (CI) 5.5-8.8] per 100,000 person-years (p-y) during 1990-1999 to 13.7 [CI 11.8-15.6] per 100,000 p-y during 2000-2012, with no change in disease-specific mortality since 1935. The incidence trend analysis stratified by the mechanism of detection revealed the AAI of clinically recognized TC was 5.5 per 100,000 p-y [CI 3.4-7.5] in 1960-1969, a rate similar to the incidence seen during 2000-2012. However, AAI of clinically occult TC increased from 0.2 per 100,000 p-y [CI 0.0-0.6] in 1935-1949 to 1.9 per 100,000 p-y [CI 1.2-2.9] in 1990-1999 and to 7.4 per 100,000 p-y [CI 6.0-8.8] in 2000-2012. During 2000-2012, the most frequent reasons for recognition of "occult" tumors were (1) incidental discovery during diagnostic neck imaging in 40 (19%), (2) pathology review of specimens from thyroid surgery for benign conditions in 29 (14%), and (3) investigations of patients with symptoms or palpable nodules that were clearly not associated with coexistent but occult TC but triggered the use of diagnostic neck imaging in 37 (27%). Conclusions: In this population-based study conducted in Olmsted County, Minnesota, the rapid increased incidence of TC during 2000-2012 can be completely attributed to the increased diagnosis of occult TCs, which are mainly found through the use of diagnostic neck imaging. The incidence of clinical TC and disease-specific TC mortality remains stable since 1970, implying that the observed increased incidence is due to the increased detection of subclinical lesions.