Trends in Thyroid Cancer Incidence and Mortality in the United States, 1974-2013

TLDR

Thyroid cancer incidence in the United States has risen markedly over the past four decades, largely due to papillary thyroid cancer. The study aims to compare trends in thyroid cancer incidence and mortality by tumor characteristics to determine whether the rising incidence of papillary thyroid cancer correlates with mortality trends. The authors analyzed SEER‑9 registry data from 1974‑2013, calculating annual percent changes in age‑adjusted incidence and incidence‑based mortality by histologic type and SEER stage using log‑linear regression. Incidence of thyroid cancer increased 3.6% annually (4.4% for papillary), with papillary cancer rising at all stages, while incidence‑based mortality grew 1.1% overall and 2.9% for distant‑stage papillary, indicating a genuine rise in both incidence and mortality, especially for advanced papillary disease.

Abstract

Thyroid cancer incidence has increased substantially in the United States over the last 4 decades, driven largely by increases in papillary thyroid cancer. It is unclear whether the increasing incidence of papillary thyroid cancer has been related to thyroid cancer mortality trends.To compare trends in thyroid cancer incidence and mortality by tumor characteristics at diagnosis.Trends in thyroid cancer incidence and incidence-based mortality rates were evaluated using data from the Surveillance, Epidemiology, and End Results-9 (SEER-9) cancer registry program, and annual percent change in rates was calculated using log-linear regression.Tumor characteristics.Annual percent changes in age-adjusted thyroid cancer incidence and incidence-based mortality rates by histologic type and SEER stage for cases diagnosed during 1974-2013.Among 77 276 patients (mean [SD] age at diagnosis, 48 [16] years; 58 213 [75%] women) diagnosed with thyroid cancer from 1974-2013, papillary thyroid cancer was the most common histologic type (64 625 cases), and 2371 deaths from thyroid cancer occurred during 1994-2013. Thyroid cancer incidence increased, on average, 3.6% per year (95% CI, 3.2%-3.9%) during 1974-2013 (from 4.56 per 100 000 person-years in 1974-1977 to 14.42 per 100 000 person-years in 2010-2013), primarily related to increases in papillary thyroid cancer (annual percent change, 4.4% [95% CI, 4.0%-4.7%]). Papillary thyroid cancer incidence increased for all SEER stages at diagnosis (4.6% per year for localized, 4.3% per year for regional, 2.4% per year for distant, 1.8% per year for unknown). During 1994-2013, incidence-based mortality increased 1.1% per year (95% CI, 0.6%-1.6%) (from 0.40 per 100 000 person-years in 1994-1997 to 0.46 per 100 000 person-years in 2010-2013) overall and 2.9% per year (95% CI, 1.1%-4.7%) for SEER distant stage papillary thyroid cancer.Among patients in the United States diagnosed with thyroid cancer from 1974-2013, the overall incidence of thyroid cancer increased 3% annually, with increases in the incidence rate and thyroid cancer mortality rate for advanced-stage papillary thyroid cancer. These findings are consistent with a true increase in the occurrence of thyroid cancer in the United States.