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Journal Article
The changing incidence of thyroid cancer
2016
Overview
Key Points
The incidence of thyroid cancer has increased over the past several decades, which, in many countries around the world, has been largely driven by new cases of papillary thyroid cancer
Increased opportunities for detection and diagnosis of small, indolent thyroid cancers seem to explain much, but not all, of the patterns in thyroid cancer incidence
Results from epidemiological studies suggest that a substantial proportion of thyroid cancer diagnoses (>40% in the USA) could be attributable to environmental factors, such as obesity and cigarette smoking
Clinical practice guidelines have recently changed in response to an increasing awareness of the potential for unnecessary diagnosis and treatment in a subset of patients
Large-scale, prospective epidemiological studies and laboratory-based investigations are needed to identify modifiable risk factors for thyroid cancer and promising targets for thyroid cancer prevention
The incidence of thyroid cancer has increased substantially in many countries over the past few decades. In this Review, Kitahara and Sosa describe the changing incidence of the disease and suggest possible explanations for the trends, emphasizing implications for patients and ongoing strategies to combat this growing public health issue.
During the past few decades, the incidence of thyroid cancer has increased substantially in many countries, including the USA. The rise in incidence seems to be attributable both to the growing use of diagnostic imaging and fine-needle aspiration biopsy, which has led to enhanced detection and diagnosis of subclinical thyroid cancers, and environmental factors. The latest American Thyroid Association (ATA) practice guidelines for the management of adult patients with thyroid nodules and differentiated thyroid cancer differ substantially from the previous ATA guidelines published in 2009. Specifically, the problems of overdiagnosis and overtreatment of a disease that is typically indolent, where treatment-related morbidity might not be justified by a survival benefit, now seem to be acknowledged. As few modifiable risk factors for thyroid cancer have been established, the specific environmental factors that have contributed to the rising incidence of thyroid cancer remain speculative. However, the findings of several large, well-designed epidemiological studies have provided new information about exposures (such as obesity) that might influence the development of thyroid cancer. In this Review, we describe the changing incidence of thyroid cancer, suggest potential explanations for these trends, emphasize the implications for patients and highlight ongoing and potential strategies to combat this growing clinical and public health issue.
Publisher
Nature Publishing Group UK,Nature Publishing Group
Subject
/ 692/499
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/ Adenocarcinoma, Follicular - epidemiology
/ Adenocarcinoma, Follicular - pathology
/ Carcinoma - diagnostic imaging
/ Carcinoma, Neuroendocrine - diagnostic imaging
/ Carcinoma, Neuroendocrine - epidemiology
/ Carcinoma, Neuroendocrine - pathology
/ Humans
/ Iodine
/ Prevalence studies (Epidemiology)
/ Radiation Exposure - statistics & numerical data
/ Thyroid Carcinoma, Anaplastic - diagnostic imaging
/ Thyroid Carcinoma, Anaplastic - epidemiology
/ Thyroid Carcinoma, Anaplastic - pathology
/ Thyroid Neoplasms - diagnostic imaging
/ Thyroid Neoplasms - epidemiology
/ Thyroid Neoplasms - pathology
/ Thyroid Nodule - diagnostic imaging
/ Thyroid Nodule - epidemiology
/ Trends
