Saturday, June 25, 2022

Burden of Thyroid Cancer: Substantial and Increasing

The global burden of thyroid cancer is substantial, and incidence rates are increasing in many developed countries including the Unites States, concludes a new analysis based on 30 years of observational data.

“We report overall increases in the burden of thyroid cancer across the majority of EU15+ countries between 1990 and 2019, evidenced by plateaus in incidence rates and reductions in mortality and DALY [disability-adjusted life-years] rates,” the authors report.

“However, in a number of countries, including the US, there are unfavorable increasing mortality and DALY trends over this time period…[and] a better understanding of the trends in the disease burden of thyroid cancer may help to inform future health-system planning,” they add.

The study was published online March 10 in JAMA Otolaryngology-Head & Neck Surgery.

Trends in Thyroid Cancer

For the analysis, James Schuster-Bruce, MBChB, from St. George’s University Hospital NHS Foundation Trust, London, United Kingdom and colleagues compared trends in thyroid cancer across 30 years of follow-up among 15 countries of the (pre-2004) European Union as well as those in the US, Australia, Canada, and Norway (EU15+).

Data from the Global Burden of Disease (GBD) study database were used to track these trends. “We extracted age-standardized incidence rates (ASIRs), age-standardized mortality rates (ASMRs) and DALYs for thyroid cancer from EU15+ countries between 1990 and 2019 using the dedicated GBD study results tool,” the investigators explain.

In 2019, ASIRs were highest in Italy at 6.36 per 100,000 population followed by the US at a rate of 5.59 per 100,000 population — although incidence rates of thyroid cancer have actually recently decreased in US women, they note.

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“Thirteen of 19 countries showed an average annual percentage increase in ASIR across the study period,” the investigators add. That average annual percentage change (AAPC) was the highest in Australia at 2.5 per 100,000 population and the US at 1.2 per 100,000 out of all of the EU15+ countries.

On the other hand, a largely plateauing trend in incidence rates across the majority of EU15+ nations has been observed since 1990, as reflected by incidence rates ranging from -0.8 to 0.8 per 100,000 in the most recent period, researchers add. ASMRs ranged from a 0.40 per 100,000 in Greece to 0.57 per 100,000 in Luxembourg.

In the US, the ASMR in 2019 was 0.43 per 100,000 population while the ASMR was the lowest in the UK in the same year at 0.38 per 100,000 population.

Australia, Denmark, and the US were the only countries showing positive AAPC changes, the team observes. For example, in the most recent period to 2019, Denmark and Australia had reductions in ASMR trends whereas in the US, the trend was toward increasing ASMRs

In 2019, the DALYs of the EU15+ nations ranged from 9.63 per 100,000 in the UK to 14.46 per 100,000 in Luxembourg. In the most recent period, a downward trend in DALYs was observed in Australia and Denmark while it plateaued in the US.

“Overall, we identified improvements in thyroid cancer mortality and DALYs, but overall increases in thyroid cancer incidence in EU15+ countries over the past 3 decades,” the investigators comment.

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It has been widely suggested that improvements in diagnostic techniques have contributed significantly to increasing incidence rates of thyroid cancer, but there is concern about overdiagnosis, as previously reported by Medscape Medical News, Newer diagnostic techniques detect significant numbers of slow-growing, subclinical papillary thyroid cancers that make up at least one quarter of all thyroid cancer subtypes, the authors point out.

“It has therefore been suggested that an increase in subclinical disease has inflated the data to look more substantial than the clinical reality,” the authors write. However, they insist that overdiagnosis alone is unlikely to account entirely for increasing incidence trends in the current analysis.

Rather, their concern for countries with high incidence rates of thyroid cancer is the surveillance burden of disease that does not affect mortality. “Close observation of future time trends in thyroid cancer disease burden should be performed in the context of recent changes in international clinical practice guidelines, which have suggested more conservative diagnostic and management strategies,” the authors suggest.

“In the context of the more conservative treatment guidelines and reported increase in true disease, it is important to closely observe mortality and DALYs over the coming years to ensure optimum thyroid cancer management in these nations,” they add.

The study had no specific funding. Schuster-Bruce has disclosed no relevant financial relationships.

JAMA Otolaryngol Head Neck Surg. Published online March 10, 2022. Abstract

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