Increasing Incidence of Thyroid Cancer in the United States, 1973-2002

TLDR

Increasing cancer incidence is typically interpreted as an increase in true disease occurrence but may also reflect changing pathological criteria or increased diagnostic scrutiny. The study aimed to assess whether changes in diagnostic approaches to thyroid nodules have led to an apparent rise in thyroid cancer incidence, histology, size distribution, and mortality in the United States. Using a retrospective cohort of SEER‑registered thyroid cancer patients from 1973‑2002 and national mortality data, the authors evaluated incidence trends, histological subtypes, tumor sizes, and mortality rates. Thyroid cancer incidence rose 2.4‑fold from 1973 to 2002, driven almost entirely by a 2.9‑fold increase in papillary cancers, with nearly half of the rise attributable to tumors ≤1 cm and 87 % to tumors ≤2 cm; less common histologies remained unchanged and mortality stayed stable, indicating that the apparent rise reflects heightened detection of small subclinical papillary cancers rather than a true increase in disease occurrence.

Abstract

Increasing cancer incidence is typically interpreted as an increase in the true occurrence of disease but may also reflect changing pathological criteria or increased diagnostic scrutiny. Changes in the diagnostic approach to thyroid nodules may have resulted in an increase in the apparent incidence of thyroid cancer.To examine trends in thyroid cancer incidence, histology, size distribution, and mortality in the United States.Retrospective cohort evaluation of patients with thyroid cancer, 1973-2002, using the Surveillance, Epidemiology, and End Results (SEER) program and data on thyroid cancer mortality from the National Vital Statistics System.Thyroid cancer incidence, histology, size distribution, and mortality.The incidence of thyroid cancer increased from 3.6 per 100,000 in 1973 to 8.7 per 100,000 in 2002-a 2.4-fold increase (95% confidence interval [CI], 2.2-2.6; P<.001 for trend). There was no significant change in the incidence of the less common histological types: follicular, medullary, and anaplastic (P>.20 for trend). Virtually the entire increase is attributable to an increase in incidence of papillary thyroid cancer, which increased from 2.7 to 7.7 per 100,000-a 2.9-fold increase (95% CI, 2.6-3.2; P<.001 for trend). Between 1988 (the first year SEER collected data on tumor size) and 2002, 49% (95% CI, 47%-51%) of the increase consisted of cancers measuring 1 cm or smaller; 87% (95% CI, 85%-89%) consisted of cancers measuring 2 cm or smaller. Mortality from thyroid cancer was stable between 1973 and 2002 (approximately 0.5 deaths per 100,000).The increasing incidence of thyroid cancer in the United States is predominantly due to the increased detection of small papillary cancers. These trends, combined with the known existence of a substantial reservoir of subclinical cancer and stable overall mortality, suggest that increasing incidence reflects increased detection of subclinical disease, not an increase in the true occurrence of thyroid cancer.