Increase in thyroid cancer in US attributed to improved early...( an apparent change based on increased d...),Health

an apparent change based on increased diagnostic scrutiny. The researchers analyzed data, from 1973-2002, from the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) program and data on deaths attributed to thyroid cancer from the National Vital Statistics System.

The researchers found that the incidence of thyroid cancer rose from 3.6 per 100,000 in 1973 to 8.7 per 100,000 in 2002--a 2.4-fold increase. This 5.1 per 100,000 growth in the incidence of thyroid cancer was virtually entirely due to an increase in papillary thyroid cancer, which rose by 5 per 100,000, a 2.9-fold increase. Most of this increase is the result of increased detection of small cancers. Forty-nine percent of the increase consisted of cancers measuring 1 centimeter (cm) or less; 87 percent consisted of cancers measuring 2 cm or less. There was no significant change in the incidence of other types of thyroid cancer. Despite increasing incidence, the death rate from thyroid cancer has remained stable.

"Given the known prevalence of small, asymptomatic papillary thyroid cancers at autopsy, we believe this suggests that increased diagnostic scrutiny has caused an apparent increase in incidence of cancer rather than a real increase," the researchers write. "Because many of these cancers would likely never have caused symptoms during life, epidemiologists have labeled the phenomenon 'overdiagnosis'--a term perhaps most familiar in the setting of prostate cancer," the authors write.

"Further studies will be needed to determine if a more cautious diagnostic approach--perhaps simply providing follow-up for symptomatic thyroid nodules-- is worthwhile. In addition, papillary cancers smaller than 1 cm could be classified as a normal finding," the researchers conclude.

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Contact: Ansem Beach
802-295-9363
JAMA and Archives Journals
9-May-2006

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