Udelsman Robert, Zhang Yawei
1 Department of Surgery, Yale School of Medicine, Yale School of Public Health ; Yale University, New Haven, Connecticut.
Thyroid. 2014 Mar;24(3):472-9. doi: 10.1089/thy.2013.0257. Epub 2013 Oct 29.
The incidence of thyroid cancer has increased at an alarming rate in both men and women in the United States. The etiology of this epidemic is unclear. We tested the hypothesis that a significant component of this epidemic is due to increased detection of occult disease. We examined whether the density of endocrinologists and general surgeons as well as employment of cervical ultrasonography were factors associated with this epidemic.
Thyroid cancer incidence rates by states were obtained from the United States Cancer Statistics 1999-2009 reported by the National Program of Cancer Registries. The densities of endocrinologists and general surgeons and the employment of cervical ultrasonography were calculated on a statewide basis and correlated with the incidence of thyroid cancer.
Age-standardized incidence rates of thyroid cancer have increased in every state in the United States. Significant regional variations were noted, with the highest incidence rates in the northeast and the lowest in the south. The incidence rates were significantly correlated with the density of endocrinologists (r = 0.58, p<0.0001 for males; r = 0.44, p = 0.0031 for females) and the employment of cervical ultrasonography (r = 0.40, p = 0.0091 for males; r = 0.36, p = 0.0197 for females). Both the density of endocrinologists and general surgeons and employment of cervical ultrasonography could explain 57% of the variability in state-level incidence for males and 49% for females.
These data offer evidence to suggest that the epidemic of thyroid cancer is due to increased detection of a reservoir of previously occult disease. The increased detection of thyroid cancer results in therapeutic interventions including surgery and radioactive thyroid treatment that may be of limited benefit.
在美国，甲状腺癌在男性和女性中的发病率均以惊人的速度上升。这一流行趋势的病因尚不清楚。我们检验了这样一种假设，即这一流行趋势的一个重要因素是隐匿性疾病检测的增加。我们研究了内分泌科医生和普通外科医生的密度以及颈部超声检查的应用是否与这一流行趋势相关。
从国家癌症登记计划报告的1999 - 2009年美国癌症统计数据中获取各州的甲状腺癌发病率。在全州范围内计算内分泌科医生和普通外科医生的密度以及颈部超声检查的应用情况，并将其与甲状腺癌发病率进行关联。
美国每个州的甲状腺癌年龄标准化发病率均有所上升。观察到显著的地区差异，东北部发病率最高，南部最低。发病率与内分泌科医生的密度显著相关（男性r = 0.58，p<0.0001；女性r = 0.44，p = 0.0031）以及颈部超声检查的应用情况显著相关（男性r = 0.40，p = 0.0091；女性r = 0.36，p = 0.0197）。内分泌科医生和普通外科医生的密度以及颈部超声检查的应用情况均可解释男性州级发病率变异的57%和女性的49%。
这些数据提供了证据表明，甲状腺癌的流行是由于对先前隐匿性疾病库的检测增加。甲状腺癌检测的增加导致了包括手术和放射性甲状腺治疗在内的治疗干预，而这些干预可能益处有限。
