Franceschi S, La Vecchia C
Epidemiology Unit, Aviano Cancer Center.
Cancer Surv. 1994;19-20:393-422.
Thyroid cancer is one of the rarest forms of cancer, and yet there are wide variations in the degree of malignancy, ranging from the most rapidly fatal to the relatively benign. This difference depends almost entirely on the histological type. A "pool" of individuals with occult thyroid carcinomas (in the vast majority of the papillary type) is probably present in most populations even at a young age. Large differences in the estimated frequency of cancer at this site can therefore be caused by variation in diagnostic intensity. Data on changing trends of incidence and mortality are thus subject to reservation, depending on the degree to which they have been influenced by changing diagnostic criteria and the precision of histopathological description. Nevertheless, there is evidence that mortality is slowly falling, whereas incidence is increasing, in several countries. This chapter considers the upward temporal trends of incidence and substantially stable mortality rates for thyroid carcinoma in the past three decades and attempts to interpret these trends in the light of concurrent changes in diagnostic standards and histological classification. Attention will also be drawn to the public health implications of the recent intensive detection and treatment of occult thyroid carcinomas.
甲状腺癌是最罕见的癌症形式之一，但其恶性程度差异很大，从最迅速致命到相对良性不等。这种差异几乎完全取决于组织学类型。即使在年轻时，大多数人群中可能都存在隐匿性甲状腺癌（绝大多数为乳头状类型）患者“群体”。因此，该部位癌症估计发病率的巨大差异可能是由诊断强度的变化所致。因此，关于发病率和死亡率变化趋势的数据存在保留意见，这取决于它们受诊断标准变化和组织病理学描述精度影响的程度。然而，有证据表明，在一些国家，死亡率正在缓慢下降，而发病率却在上升。本章探讨了过去三十年甲状腺癌发病率的上升趋势以及死亡率基本稳定的情况，并试图根据诊断标准和组织学分类的同期变化来解释这些趋势。还将关注近期对隐匿性甲状腺癌进行强化检测和治疗对公共卫生的影响。
