Cancer Epidemiology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy.
International Agency for Research on Cancer, Lyon, France.
J Clin Endocrinol Metab. 2020 Aug 1;105(8):2507-14. doi: 10.1210/clinem/dgaa192.
CONTEXT/OBJECTIVE: Increases of thyroid cancer (TC) incidence emerged in the past several decades in several countries. This study aimed to estimate time trends of TC incidence in India and the proportion of TC cases potentially attributable to overdiagnosis by sex, age, and area.
TC cases aged 0 to 74 years reported to Indian cancer registries during 2006 through 2014 were included. Age-standardized incidence rates (ASR) and TC overdiagnosis were estimated by sex, period, age, and area.
Between 2006 to 2008 and 2012 to 2014, the ASRs for TC in India increased from 2.5 to 3.5/100,000 women (+37%) and from 1.0 to 1.3/100,000 men (+27%). However, up to a 10-fold difference was found among regions in both sexes. Highest ASRs emerged in Thiruvananthapuram (14.6/100,000 women and 4.1/100,000 men in 2012-2014), with 93% increase in women and 64% in men compared with 2006 to 2008. No evidence of overdiagnosis was found in Indian men. Conversely, overdiagnosis accounted for 51% of TC in Indian women: 74% in those aged < 35 years, 50% at ages 35 to 54 years, and 30% at ages 55 to 64 years. In particular, 80% of TC overdiagnosis in women emerged in Thiruvananthapuram, whereas none or limited evidence of overdiagnosis emerged in Kamrup, Dibrugarh, Bhopal, or Sikkim.
Relatively high and increasing TC ASRs emerged in Indian regions where better access to health care was reported. In India, as elsewhere, new strategies are needed to discourage opportunistic screening practice, particularly in young women, and to avoid unnecessary and expensive treatments. Present results may serve as a warning also for other transitioning countries.
背景/目的：在过去几十年中，一些国家的甲状腺癌（TC）发病率有所上升。本研究旨在评估印度 TC 发病率的时间趋势，并按性别、年龄和地区估计 TC 病例中潜在归因于过度诊断的比例。
纳入了 2006 年至 2014 年期间向印度癌症登记处报告的年龄在 0 至 74 岁的 TC 病例。按性别、时期、年龄和地区计算 TC 发病率的年龄标准化率（ASR）和 TC 过度诊断。
2006 年至 2008 年与 2012 年至 2014 年期间，印度女性 TC 的 ASR 从 2.5 升至 3.5/100,000（增加 37%），男性从 1.0 升至 1.3/100,000（增加 27%）。然而，两性之间的地区差异高达 10 倍。在女性中，最高的 ASR 出现在特里凡得琅（2012-2014 年为 14.6/100,000 名妇女和 4.1/100,000 名男子），与 2006 年至 2008 年相比，女性增加了 93%，男性增加了 64%。在印度男性中未发现过度诊断的证据。相反，过度诊断占印度女性 TC 的 51%：年龄<35 岁的女性中占 74%，35 至 54 岁的女性中占 50%，55 至 64 岁的女性中占 30%。特别是，在特里凡得琅，女性 TC 过度诊断的比例高达 80%，而在坎普尔、迪布鲁加尔、博帕尔或锡金，未发现或仅发现有限的过度诊断证据。
在报告有更好的医疗保健机会的印度地区，相对较高且不断上升的 TC ASR 出现。在印度，与其他地方一样，需要采取新的策略来阻止机会性筛查的实践，特别是在年轻女性中，并避免不必要和昂贵的治疗。目前的结果也可能对其他转型国家起到警示作用。
