Sanabria Alvaro, Kowalski Luiz P, Shah Jatin P, Nixon Iain J, Angelos Peter, Williams Michelle D, Rinaldo Alessandra, Ferlito Alfio
Department of Surgery, School of Medicine, Universidad de Antioquia, Clinica Vida/Instituto de Cancerología Las Americas, Medellin, Colombia, South America.
Department of Head and Neck Surgery and Otorhinolaryngology, A.C. Camargo Cancer Center, Sao Paulo, SP, Brazil.
Head Neck. 2018 Apr;40(4):855-866. doi: 10.1002/hed.25029. Epub 2017 Dec 5.
There is an increasing incidence of well-differentiated thyroid cancer worldwide. Much of the increase is secondary to increased detection of small, low-risk tumors, with questionable clinical significance. This review addresses the factors that contribute to the increasing incidence and considers environmental, and patient-based and clinician-led influences. Articles addressing the causes of the increased incidence were critically reviewed. A complex interplay of environmental, medical, and social pressures has resulted in increased awareness of the thyroid disease risk, increased screening of thyroid cancers, and increased diagnosis of thyroid cancers. Although there is evidence to suggest that the true disease incidence may be changing slightly, most of the increase is related to factors that promote early diagnosis of low-risk lesions, which is resulting in a significant phenomenon of overdiagnosis. An improved understanding of these pressures at a global level will enable healthcare policymakers to react appropriately to this challenge in the future.
全球范围内,高分化甲状腺癌的发病率呈上升趋势。发病率上升主要是由于对小的、低风险肿瘤的检测增加,而这些肿瘤的临床意义存疑。本综述探讨了导致发病率上升的因素,并考虑了环境因素、基于患者的因素以及临床医生主导的影响。对探讨发病率上升原因的文章进行了严格审查。环境、医学和社会压力的复杂相互作用导致了对甲状腺疾病风险的认识增加、甲状腺癌筛查增加以及甲状腺癌诊断增加。尽管有证据表明实际疾病发病率可能略有变化,但大部分增长与促进低风险病变早期诊断的因素有关,这导致了严重的过度诊断现象。在全球层面更好地理解这些压力将使医疗保健政策制定者能够在未来对这一挑战做出适当反应。