Section of Cancer Surveillance, International Agency for Research on Cancer (IARC), Lyon, France.
Section of Cancer Surveillance, International Agency for Research on Cancer (IARC), Lyon, France.
Lancet Diabetes Endocrinol. 2021 Mar;9(3):144-152. doi: 10.1016/S2213-8587(20)30401-0. Epub 2021 Jan 19.
There has been a considerable increase in thyroid cancer incidence among adults in several countries in the past three decades, attributed primarily to overdiagnosis. We aimed to assess global patterns and trends in incidence and mortality of thyroid cancer in children and adolescents, in view of the increased incidence among adults.
We did a population-based study of the observed incidence (in 49 countries and territories) and mortality (in 27 countries) of thyroid cancer in children and adolescents aged 0-19 years using data from the International Incidence of Childhood Cancer Volume 3 study database, the WHO mortality database, and the cancer incidence in five continents database (CI5plus; for adult data [age 20-74 years]). We analysed temporal trends in incidence rates, including absolute changes in rates, and the strength of the correlation between incidence rates in children and adolescents and in adults. We calculated the average annual number of thyroid cancer deaths and the age-standardised mortality rates for children and adolescents.
Age-standardised incidence rates of thyroid cancer among children and adolescents aged 0-19 years ranged from 0·4 (in Uganda and Kenya) to 13·4 (in Belarus) cancers per 1 million person-years in 2008-12. The variability in the incidence rates was mostly accounted for by the papillary tumour subtype. Incidence rates were almost always higher in girls than in boys and increased with age in both sexes. Rapid increases in incidence between 1998-2002 and 2008-12 were observed in almost all countries. Country-specific incidence rates in children and adolescents were strongly correlated (r>0·8) with rates in adults, as were the temporal changes in the respective incidence rates (r>0·6). Thyroid cancer deaths in those aged younger than 20 years were less than 0·1 per 10 million person-years in each country.
The pattern of thyroid cancer incidence in children and adolescents mirrors the pattern seen in adults, suggesting a major role for overdiagnosis, which, in turn, can lead to overtreatment, lifelong medical care, and side effects that can negatively affect quality of life. We suggest that the existing recommendation against screening for thyroid cancer in the asymptomatic adult population who are free from specific risk factors should be extended to explicitly recommend against screening for thyroid cancer in similar populations of children and adolescents.
International Agency for Research on Cancer and the Union for International Cancer Control; French Institut National du Cancer; Italian Association of Cancer Research; and Italian Ministry of Health.
在过去的三十年中，一些国家成年人的甲状腺癌发病率显著上升，主要归因于过度诊断。鉴于成年人发病率的上升，我们旨在评估儿童和青少年甲状腺癌的全球发病和死亡模式及趋势。
我们对国际儿童癌症发病率第 3 卷研究数据库、世界卫生组织死亡率数据库以及五大洲癌症发病率数据库（CI5plus；用于成人数据[20-74 岁]）中 49 个国家和地区观察到的儿童和青少年（0-19 岁）甲状腺癌发病和 27 个国家的死亡数据进行了基于人群的研究。我们分析了发病率的时间趋势，包括发病率的绝对变化以及儿童和青少年与成年人发病率之间的相关性强度。我们计算了甲状腺癌在儿童和青少年中的平均年死亡人数和标准化死亡率。
2008-12 年，0-19 岁儿童和青少年甲状腺癌的年龄标准化发病率在 0.4（乌干达和肯尼亚）至 13.4（白俄罗斯）每 100 万人年之间。肿瘤亚型的差异在很大程度上解释了发病率的变化。在两性中，女孩的发病率几乎总是高于男孩，且随年龄增长而增加。在几乎所有国家中，都观察到了 1998-2002 年至 2008-12 年之间发病率的快速增长。儿童和青少年的特定国家发病率与成年人的发病率密切相关（r＞0.8），且各自发病率的时间变化也密切相关（r＞0.6）。在每个国家中，20 岁以下儿童的甲状腺癌死亡人数不到每 100 万人年 0.1 例。
儿童和青少年甲状腺癌的发病模式与成年人的发病模式相似，表明过度诊断起了主要作用，而过度诊断反过来又可能导致过度治疗、终生医疗护理和副作用，从而对生活质量产生负面影响。我们建议，不应对无症状且无特定危险因素的成年人群体进行甲状腺癌筛查，这一现有的建议也应明确扩展到儿童和青少年的类似人群，不建议对其进行甲状腺癌筛查。
国际癌症研究机构和国际癌症控制联盟；法国国家癌症研究所；意大利癌症研究协会；意大利卫生部。
