Juan P Brito1,2, Alaa Al Nofal3, Victor M Montori1,2, Ian D Hay1, John C Morris1. 1. 1 Division of Diabetes, Endocrinology, Metabolism, and Nutrition, Department of Medicine, Mayo Clinic , Rochester, Minnesota. 2. 2 Knowledge and Evaluation Research Unit, Mayo Clinic , Rochester, Minnesota. 3. 3 Division of Pediatric Endocrinology and Metabolism, Mayo Clinic , Rochester, Minnesota.
Abstract
BACKGROUND: An ongoing epidemic of thyroid carcinoma (TC) has affected Americans since 1975. Understanding the contribution of subclinical disease and the mechanism of such disease detection may help to alter the course of this epidemic. METHODS: We used Rochester Epidemiology Project resources to examine the incidence of TC cases, disease specific mortality, and method of diagnosis during 1935 through 2012. During 2000-2012, we also extracted the mechanism of detection of clinically occult tumors. RESULTS: The age-adjusted incidence (AAI) for TC increased from 7.1 [95% confidence interval (CI) 5.5-8.8] per 100,000 person-years (p-y) during 1990-1999 to 13.7 [CI 11.8-15.6] per 100,000 p-y during 2000-2012, with no change in disease-specific mortality since 1935. The incidence trend analysis stratified by the mechanism of detection revealed the AAI of clinically recognized TC was 5.5 per 100,000 p-y [CI 3.4-7.5] in 1960-1969, a rate similar to the incidence seen during 2000-2012. However, AAI of clinically occult TC increased from 0.2 per 100,000 p-y [CI 0.0-0.6] in 1935-1949 to 1.9 per 100,000 p-y [CI 1.2-2.9] in 1990-1999 and to 7.4 per 100,000 p-y [CI 6.0-8.8] in 2000-2012. During 2000-2012, the most frequent reasons for recognition of "occult" tumors were (1) incidental discovery during diagnostic neck imaging in 40 (19%), (2) pathology review of specimens from thyroid surgery for benign conditions in 29 (14%), and (3) investigations of patients with symptoms or palpable nodules that were clearly not associated with coexistent but occult TC but triggered the use of diagnostic neck imaging in 37 (27%). CONCLUSIONS: In this population-based study conducted in Olmsted County, Minnesota, the rapid increased incidence of TC during 2000-2012 can be completely attributed to the increased diagnosis of occult TCs, which are mainly found through the use of diagnostic neck imaging. The incidence of clinical TC and disease-specific TC mortality remains stable since 1970, implying that the observed increased incidence is due to the increased detection of subclinical lesions.
BACKGROUND: An ongoing epidemic of thyroid carcinoma (TC) has affected Americans since 1975. Understanding the contribution of subclinical disease and the mechanism of such disease detection may help to alter the course of this epidemic. METHODS: We used Rochester Epidemiology Project resources to examine the incidence of TC cases, disease specific mortality, and method of diagnosis during 1935 through 2012. During 2000-2012, we also extracted the mechanism of detection of clinically occult tumors. RESULTS: The age-adjusted incidence (AAI) for TC increased from 7.1 [95% confidence interval (CI) 5.5-8.8] per 100,000 person-years (p-y) during 1990-1999 to 13.7 [CI 11.8-15.6] per 100,000 p-y during 2000-2012, with no change in disease-specific mortality since 1935. The incidence trend analysis stratified by the mechanism of detection revealed the AAI of clinically recognized TC was 5.5 per 100,000 p-y [CI 3.4-7.5] in 1960-1969, a rate similar to the incidence seen during 2000-2012. However, AAI of clinically occult TC increased from 0.2 per 100,000 p-y [CI 0.0-0.6] in 1935-1949 to 1.9 per 100,000 p-y [CI 1.2-2.9] in 1990-1999 and to 7.4 per 100,000 p-y [CI 6.0-8.8] in 2000-2012. During 2000-2012, the most frequent reasons for recognition of "occult" tumors were (1) incidental discovery during diagnostic neck imaging in 40 (19%), (2) pathology review of specimens from thyroid surgery for benign conditions in 29 (14%), and (3) investigations of patients with symptoms or palpable nodules that were clearly not associated with coexistent but occult TC but triggered the use of diagnostic neck imaging in 37 (27%). CONCLUSIONS: In this population-based study conducted in Olmsted County, Minnesota, the rapid increased incidence of TC during 2000-2012 can be completely attributed to the increased diagnosis of occult TCs, which are mainly found through the use of diagnostic neck imaging. The incidence of clinical TC and disease-specific TC mortality remains stable since 1970, implying that the observed increased incidence is due to the increased detection of subclinical lesions.
Authors: Jennifer L St Sauver; Brandon R Grossardt; Cynthia L Leibson; Barbara P Yawn; L Joseph Melton; Walter A Rocca Journal: Mayo Clin Proc Date: 2012-02 Impact factor: 7.616
Authors: Jennifer L St Sauver; Brandon R Grossardt; Barbara P Yawn; L Joseph Melton; Joshua J Pankratz; Scott M Brue; Walter A Rocca Journal: Int J Epidemiol Date: 2012-11-18 Impact factor: 7.196
Authors: Briseis Aschebrook-Kilfoy; Rebecca B Schechter; Ya-Chen Tina Shih; Edwin L Kaplan; Brian C-H Chiu; Peter Angelos; Raymon H Grogan Journal: Cancer Epidemiol Biomarkers Prev Date: 2013-05-15 Impact factor: 4.254
Authors: Bryan R Haugen; Erik K Alexander; Keith C Bible; Gerard M Doherty; Susan J Mandel; Yuri E Nikiforov; Furio Pacini; Gregory W Randolph; Anna M Sawka; Martin Schlumberger; Kathryn G Schuff; Steven I Sherman; Julie Ann Sosa; David L Steward; R Michael Tuttle; Leonard Wartofsky Journal: Thyroid Date: 2016-01 Impact factor: 6.568
Authors: Nazanene H Esfandiari; David T Hughes; David Reyes-Gastelum; Kevin C Ward; Ann S Hamilton; Megan R Haymart Journal: J Clin Endocrinol Metab Date: 2019-12-01 Impact factor: 5.958
Authors: R Michael Tuttle; James A Fagin; Gerald Minkowitz; Richard J Wong; Benjamin Roman; Snehal Patel; Brian Untch; Ian Ganly; Ashok R Shaha; Jatin P Shah; Mark Pace; Duan Li; Ariadne Bach; Oscar Lin; Adrian Whiting; Ronald Ghossein; Inigo Landa; Mona Sabra; Laura Boucai; Stephanie Fish; Luc G T Morris Journal: JAMA Otolaryngol Head Neck Surg Date: 2017-10-01 Impact factor: 6.223