Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy; International Agency for Research on Cancer, Lyon, France.
Department of Cancer Prevention, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China.
Lancet Diabetes Endocrinol. 2022 Apr;10(4):264-272. doi: 10.1016/S2213-8587(22)00035-3. Epub 2022 Mar 7.
BACKGROUND: Thyroid cancer incidence rates have increased in many countries and settings; however, mortality rates have remained stable at lower rates. This epidemiological pattern has been largely attributed to an overdiagnosis effect. Timely evidence for the global epidemiological status is necessary to identify the magnitude of this problem and the areas mostly affected by it. We therefore aimed to provide an up-to-date assessment on the global distribution of thyroid cancer incidence and mortality rates in 2020. METHODS: We extracted age-standardised incidence and mortality rates per 100 000 person-years of thyroid cancer as defined by the International Classification of Diseases for Oncology 10th Revision (code C73), for 185 countries or territories by sex and 18 age groups (ie, 0-4, 5-9, …, 80-84, and ≥85 years) from the GLOBOCAN database. Both incidence and mortality estimates were presented by country and aggregated across the 20 UN-defined world regions and according to the UN's four-tier Human Development Index (ie, low, medium, high, and very high) in 2020. FINDINGS: Globally, in 2020, the age-standardised incidence rates of thyroid cancer were 10·1 per 100 000 women and 3·1 per 100 000 men, and age-standardised mortality rates were 0·5 per 100 000 women and 0·3 per 100 000 men. In both sexes, incidence rates were five times higher in high and very high Human Development Index countries than in low and medium Human Development Index countries, whereas mortality rates were relatively similar across different settings. Incidence rates in women differed by more than 15 times across world regions, with the highest incidence rates being in the Federated States of Micronesia and French Polynesia (18·5 per 100 000 women), North America (18·4 per 100 000), and east Asia (17·8 per 100 000, with South Korea reaching 45 per 100 000). Mortality rates were less than one per 100 000 in most countries and in both sexes. South Korea had the highest incidence-to-mortality rate ratio in both sexes, followed by Cyprus and Canada. INTERPRETATION: The current thyroid cancer epidemiological landscape is strongly suggestive of a large effect of overdiagnosis in many countries and settings worldwide, confirming the relevance of thyroid cancer overdiagnosis as a global public health problem. FUNDING: None.
背景：在许多国家和地区，甲状腺癌的发病率都有所增加；然而，死亡率却保持稳定，且处于较低水平。这种流行病学模式在很大程度上归因于过度诊断的影响。为了确定这个问题的严重程度以及受其影响最大的地区，我们需要及时掌握全球的流行病学现状。因此，我们旨在提供 2020 年全球甲状腺癌发病率和死亡率的最新评估。
方法：我们从 GLOBOCAN 数据库中提取了按性别和 18 个年龄组（即 0-4、5-9、……、80-84 和≥85 岁）定义的国际肿瘤学疾病分类第 10 版（代码 C73）每 100000 人年的甲状腺癌的年龄标准化发病率和死亡率。发病率和死亡率估计值按国家和 20 个联合国定义的世界区域以及按联合国的四级人类发展指数（即低、中、高和极高）汇总。
结果：全球范围内，2020 年女性甲状腺癌的年龄标准化发病率为 10.1/100000，男性为 3.1/100000；年龄标准化死亡率女性为 0.5/100000，男性为 0.3/100000。在男性和女性中，高和极高人类发展指数国家的发病率是低和中人类发展指数国家的五倍，而死亡率在不同环境中则相对相似。女性的发病率在世界区域之间相差超过 15 倍，发病率最高的地区是密克罗尼西亚联邦和法属波利尼西亚（女性 18.5/100000）、北美（女性 18.4/100000）和东亚（女性 17.8/100000，韩国达到 45/100000）。大多数国家的男女两性死亡率都低于 1/100000。韩国在男女两性中都具有最高的发病率与死亡率比，其次是塞浦路斯和加拿大。
解释：目前的甲状腺癌流行病学情况强烈表明，在全球许多国家和地区都存在过度诊断的巨大影响，这证实了甲状腺癌过度诊断作为一个全球公共卫生问题的重要性。
资金：无。
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