Department of Cancer Prevention, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou, China.
Cancer Epidemiology Unit, Centro di Riferimento Oncologico di Aviano IRCCS, Aviano, Italy.
Lancet Diabetes Endocrinol. 2024 Nov;12(11):824-836. doi: 10.1016/S2213-8587(24)00223-7. Epub 2024 Oct 7.
The incidence of thyroid cancer has been increasing in many countries, mainly due to overdiagnosis. Given these rapid changes, we aim to assess the specific features of the thyroid cancer diagnosis epidemic and provide estimates of overdiagnosis across countries spanning five continents and identify areas in which coping strategies are needed.
Two types of data were retrieved from the International Agency for Research on Cancer (IARC) Global Cancer Observatory database. The long-term annual incidence of thyroid cancer by sex and 5-year age group for all ages from 1980 to 2017 was obtained from continuous population-based registries available in the Cancer Incidence in Five Continents (CI5) plus, with 97 registries from 43 countries selected. Sex-age-specific thyroid cancer cases, overall and by subtype, along with corresponding population counts were retrieved from all registries included in the latest volume of CI5 (CI5-XII), with 385 registries in 63 countries. Annual mortality data from 1980 to 2022 were obtained from WHO, with population counts supplemented by UN population estimates. We estimated age-standardised rates (ASRs) of thyroid cancer incidence and mortality for all ages by sex using direct age standardisation, with the world population as a reference. Long-term annual trends of ASRs were compared between incidence and mortality since 1980. Subtype distribution was calculated for thyroid cancer incidence during 2013-17. We estimated the numbers of thyroid cancer cases and overdiagnosed cases and extrapolated to the whole country using a previously developed and validated method.
Thyroid cancer incidence rates rose during 1980-2017 for most countries, with the highest rates seen in South Korea, Cyprus, Ecuador, China, and Türkiye for females and males. An upward trend was seen until the early 2010s, followed by a downward trend in South Korea, the USA, Canada, and Israel and some Western European countries, such as France, Italy, Austria, and Ireland. The difference between the highest and lowest incidence rates ranged from less than 10·0 per 100 000 females in the early 1980s to 101·4 per 100 000 females in 2012. For males, the difference between the highest and lowest incidence rates ranged from 2·7 per 100 000 to 23·5 per 100 000 over the study period. Mortality rates were substantially lower, with a difference between the highest and lowest rates across countries of around 1·0-2·0 per 100 000 for both sexes throughout the study period. During 2013-17, papillary thyroid cancer contributed to the large variation in ASRs of thyroid cancer incidence. The mortality rates of thyroid cancer increased with age for all countries, whereas the observed age-specific incidence rates showed an inverted U-shape in most countries. The magnitude of overdiagnosis varied across countries, ranging from no overdiagnosis (in Uganda, Zimbabwe, and Trinidad and Tobago) to more than 85·0% of thyroid cancer cases being overdiagnosed in females (in Cyprus, China, South Korea, and Türkiye). Overall, 1 736 133 (75·6%) of 2 297 057 cases were attributable to overdiagnosis, including 1 368 181 females and 367 952 males.
Although the incidence of thyroid cancer has reached a plateau or decrease in some high-income countries, the magnitude of overdiagnosis is still very large and the expansion of overdiagnosis of thyroid cancer to the transitioning countries has been rapid, which makes it a global public health challenge that needs to be addressed.
National Natural Science Foundation of China, Guangdong Basic and Applied Basic Research Foundation, Young Talents Program of Sun Yat-sen University Cancer Center, Italian Association for Cancer Research, and the Italian Ministry of Health (Ricerca Corrente).
在许多国家，甲状腺癌的发病率一直在上升，主要是由于过度诊断。鉴于这些快速变化，我们旨在评估甲状腺癌诊断流行的具体特征，并提供跨越五大洲的国家的过度诊断估计，并确定需要应对策略的领域。
从国际癌症研究机构（IARC）全球癌症观测站数据库中检索到两种类型的数据。从癌症发病率在五大洲加（CI5）中可用的连续基于人群的登记处获得了 1980 年至 2017 年所有年龄段的男性和女性的甲状腺癌长期年度发病率和 5 年年龄组，其中从 43 个国家的 97 个登记处中选择。从最新的 CI5 卷（CI5-XII）中包含的所有登记处中检索到按性别和亚型划分的甲状腺癌病例、总体和相应的人口计数，其中包括 63 个国家的 385 个登记处。从世卫组织获得了 1980 年至 2022 年的年度死亡率数据，并通过联合国人口估计数补充了人口计数。我们使用直接年龄标准化法，以世界人口为参考，估计所有年龄段的甲状腺癌发病率和死亡率的年龄标准化率（ASR）。自 1980 年以来，比较了发病率和死亡率之间的长期年度趋势。计算了 2013-17 年期间甲状腺癌发病率的亚型分布。我们使用先前开发和验证的方法估计甲状腺癌病例数和过度诊断病例数，并将其外推到整个国家。
在大多数国家，甲状腺癌发病率在 1980 年至 2017 年间上升，女性和男性的发病率最高的国家是韩国、塞浦路斯、厄瓜多尔、中国和土耳其。在 2010 年代初期之前，这一趋势呈上升趋势，随后韩国、美国、加拿大和以色列以及一些西欧国家，如法国、意大利、奥地利和爱尔兰，出现了下降趋势。最高和最低发病率之间的差异范围从 1980 年代早期每 100000 名女性不到 10.0 例到 2012 年每 100000 名女性 101.4 例。对于男性，发病率最高和最低的国家之间的差异范围从研究期间每 100000 名男性 2.7 例到 23.5 例。死亡率要低得多，在整个研究期间，国家之间的最高和最低死亡率之间的差异约为每 100000 名男性和女性 1.0-2.0。在 2013-17 年期间，乳头状甲状腺癌导致了甲状腺癌发病率 ASR 的巨大差异。在所有国家，随着年龄的增长，甲状腺癌的死亡率增加，而观察到的年龄特异性发病率在大多数国家呈倒 U 形。过度诊断的程度因国家而异，从乌干达、津巴布韦和特立尼达和多巴哥没有过度诊断（分别为 0.6%、0.7%和 0.8%）到女性中超过 85.0%的甲状腺癌病例为过度诊断（分别为塞浦路斯、中国、韩国和土耳其）。总的来说，2297057 例病例中有 1736133 例（75.6%）归因于过度诊断，其中包括 1368181 例女性和 367952 例男性。
尽管在一些高收入国家，甲状腺癌的发病率已经达到了一个平台期或下降，但过度诊断的程度仍然很大，而且甲状腺癌过度诊断向过渡性国家的扩展速度很快，这使得它成为一个需要解决的全球公共卫生挑战。
国家自然科学基金、广东省基础与应用基础研究基金、中山大学肿瘤中心青年人才计划、意大利癌症研究协会和意大利卫生部（Ricerca Corrente）。
