Original article
Vol. 151 No. 4344 (2021)
Incidence and mortality trends of thyroid cancer from 1980 to 2016
- Simon Wirth
- Maria-Eleni Syleouni
- Nena Karavasiloglou
- Sabina Rinaldi
- Dimitri Korol
- Miriam Wanner
- Sabine Rohrmann
Summary
AIMS OF THE STUDY: Thyroid cancer incidence rates have been increasing globally over past decades. However, no study examining those trends in the canton of Zurich, Switzerland exists. In this study, we describe the incidence and mortality trends of thyroid cancer in the canton of Zurich during a 37-year period (1980–2016) including factors such as sex, histological subtypes and age at diagnosis.
METHODS: We analysed population-based cancer registry data from 1980-2016 for the canton of Zurich, Switzerland. We estimated the age-standardised incidence and mortality rates using the European standard population. Joinpoint regression was used to detect average annual percentage changes (AAPCs) and their corresponding 95% confidence intervals (CIs).
RESULTS: We included 2972 primary cases of thyroid cancer (72.3% in women). The papillary cases accounted for the majority of incident cases (65.8%). In 2016, women had a higher age-standardised incidence rate than men for both papillary (10.4 and 3.3, respectively, per 100,000) and non-papillary (1.6 and 0.7, respectively, per 100,000) thyroid cancer. In both men and women, the incidence rates of thyroid cancer increased significantly over the study period with AAPCs of 1.4% (95% CI 0.6–2.2%) and 2.6% (95% CI 2–3.1%), respectively. These increasing incidence trends are mainly driven by papillary thyroid cancer with AAPCs of 3.4% in men (95% CI 2.3% to 4.4%) and 4.3% in women (95% CI 3.7% to 5%). Mortality rates significantly decreased in both sexes (men AAPC –3.6%, 95% CI –4.7% to –2.4%; women AAPC –3.7%, 95% CI –4.8% to –2.6%).
CONCLUSIONS: Our results show significantly increasing age-standardised incidence rates of thyroid cancer over time in both sexes, mainly due to papillary thyroid cancer, the most frequent histological subtype, and the only subtype for which a significant increase was observed. It is possible that many indolent thyroid cancers, and more specifically papillary microcarcinomas, are increasingly diagnosed, which may not lead to symptoms if undetected. Therefore, targeted diagnostic strategies are necessary to avoid overdiagnosis of thyroid cancer. Nevertheless, we cannot completely exclude a partly true increase.
References
- Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018 Nov;68(6):394–424. https://doi.org/10.3322/caac.21492
- World Health Organization (WHO). Cancer Today: World Health Organization; 2020 [Available from: https://gco.iarc.fr/today/online-analysis-table
- La Vecchia C, Malvezzi M, Bosetti C, Garavello W, Bertuccio P, Levi F, et al. Thyroid cancer mortality and incidence: a global overview. Int J Cancer. 2015 May;136(9):2187–95. https://doi.org/10.1002/ijc.29251
- Bouchardy C, Lutz JM, Kühni C. Krebs in der Schweiz Neuchâtel: NICER, FSO, SCCR; 2011 [Available from: https://www.nicer.org/assets/files/publications/others/krebs_in_der_schweiz_e_web.pdf].
- Kilfoy BA, Zheng T, Holford TR, Han X, Ward MH, Sjodin A, et al. International patterns and trends in thyroid cancer incidence, 1973-2002. Cancer Causes Control. 2009 Jul;20(5):525–31. https://doi.org/10.1007/s10552-008-9260-4
- Davies L, Welch HG. Increasing incidence of thyroid cancer in the United States, 1973-2002. JAMA. 2006 May;295(18):2164–7. https://doi.org/10.1001/jama.295.18.2164
- Horn-Ross PL, Lichtensztajn DY, Clarke CA, Dosiou C, Oakley-Girvan I, Reynolds P, et al. Continued rapid increase in thyroid cancer incidence in california: trends by patient, tumor, and neighborhood characteristics. Cancer Epidemiol Biomarkers Prev. 2014 Jun;23(6):1067–79. https://doi.org/10.1158/1055-9965.EPI-13-1089
- Raposo L, Morais S, Oliveira MJ, Marques AP, José Bento M, Lunet N. Trends in thyroid cancer incidence and mortality in Portugal. Eur J Cancer Prev. 2017 Mar;26(2):135–43. https://doi.org/10.1097/CEJ.0000000000000229
- Vaccarella S, Franceschi S, Bray F, Wild CP, Plummer M, Dal Maso L. Worldwide Thyroid-Cancer Epidemic? The Increasing Impact of Overdiagnosis. N Engl J Med. 2016 Aug;375(7):614–7. https://doi.org/10.1056/NEJMp1604412
- Li M, Dal Maso L, Vaccarella S. Global trends in thyroid cancer incidence and the impact of overdiagnosis. Lancet Diabetes Endocrinol. 2020 Jun;8(6):468–70. https://doi.org/10.1016/S2213-8587(20)30115-7
- Kitahara CM, Sosa JA. The changing incidence of thyroid cancer. Nat Rev Endocrinol. 2016 Nov;12(11):646–53. https://doi.org/10.1038/nrendo.2016.110
- Bosetti C, Bertuccio P, Malvezzi M, Levi F, Chatenoud L, Negri E, et al. Cancer mortality in Europe, 2005-2009, and an overview of trends since 1980. Ann Oncol. 2013 Oct;24(10):2657–71. https://doi.org/10.1093/annonc/mdt301
- Kachuri L, De P, Ellison LF, Semenciw R ; Advisory Committee on Canadian Cancer Statistics. Cancer incidence, mortality and survival trends in Canada, 1970-2007. Chronic Dis Inj Can. 2013 Mar;33(2):69–80. https://doi.org/10.24095/hpcdp.33.2.03
- Siegel R, Ma J, Zou Z, Jemal A. Cancer statistics, 2014. CA Cancer J Clin. 2014 Jan-Feb;64(1):9–29. https://doi.org/10.3322/caac.21208
- Dyntar, D, Lorez M, Diebold J. Incidence-based mortality trends for thyroid cancer: Is there a "true" increase in incidence of thyroid cancer in Switzerland? : Schweizer Krebs-Bulletin = Bulletin Suisse du Cancer; 2018 [Available from: https://www.zora.uzh.ch/id/eprint/162152/].
- European Network of Cancer Registries (ENCR). Thyroid cancer Factsheet: ENCR Factsheets; 2017 [Available from: https://encr.eu/sites/default/files/factsheets/ENCR_Factsheet_Thyroid_2017-2.pdf].
- Sant M, Allemani C, Santaquilani M, Knijn A, Marchesi F, Capocaccia R ; EUROCARE Working Group. EUROCARE-4. Survival of cancer patients diagnosed in 1995-1999. Results and commentary. Eur J Cancer. 2009 Apr;45(6):931–91. https://doi.org/10.1016/j.ejca.2008.11.018
- Wanner M, Matthes KL, Korol D, Dehler S, Rohrmann S. Indicators of Data Quality at the Cancer Registry Zurich and Zug in Switzerland. BioMed Res Int. 2018 Jun;2018:7656197. https://doi.org/10.1155/2018/7656197
- Fritz A, Percy C. A., Jack, K. Shanmugaratnam, L.H. Sobin, M.D. Parkin, C. WHO, Percy, V. Van, Holten,C. Muir: International Classification of Diseases for Oncology. 3rd ed., Geneva (2013).
- WHO. World Health Organization. International statistical classification of diseases and related health problems. 10th revision. Geneva. (1992).
- Boyle P, Parkin DM. Cancer registration: principles and methods. Statistical methods for registries. IARC Sci Publ. 1991;(95):126–58.
- Federal Statistical Office. STAT-TAB – interactive tables (FSO). https://www.pxweb.bfs.admin.ch/pxweb/en/. 2020.
- Surveillance E, Results E. (SEER) NCI. Rate Algorithms: National Cancer Institute (SEER); 2020 [Available from: https://seer.cancer.gov/
- National Cancer Institute. Joinpoint Trend Analysis Software: National Cancer Institute; 2020 [Available from: https://surveillance.cancer.gov/joinpoint/
- Pandeya N, McLeod DS, Balasubramaniam K, Baade PD, Youl PH, Bain CJ, et al. Increasing thyroid cancer incidence in Queensland, Australia 1982-2008 - true increase or overdiagnosis? Clin Endocrinol (Oxf). 2016 Feb;84(2):257–64. https://doi.org/10.1111/cen.12724
- Harari A, Singh RK. Increased rates of advanced thyroid cancer in California. J Surg Res. 2016 Mar;201(1):244–52. https://doi.org/10.1016/j.jss.2015.10.037
- Safavi A, Azizi F, Jafari R, Chaibakhsh S, Safavi AA. Thyroid Cancer Epidemiology in Iran: a Time Trend Study. Asian Pac J Cancer Prev. 2016;17(1):407–12. https://doi.org/10.7314/APJCP.2016.17.1.407
- Keinan-Boker L, Silverman BG. Trends of Thyroid Cancer in Israel: 1980-2012. Rambam Maimonides Med J. 2016 Jan;7(1):e0001. https://doi.org/10.5041/RMMJ.10228
- Colonna M, Uhry Z, Guizard AV, Delafosse P, Schvartz C, Belot A, et al.; FRANCIM network. Recent trends in incidence, geographical distribution, and survival of papillary thyroid cancer in France. Cancer Epidemiol. 2015 Aug;39(4):511–8. https://doi.org/10.1016/j.canep.2015.04.015
- Lim H, Devesa SS, Sosa JA, Check D, Kitahara CM. Trends in Thyroid Cancer Incidence and Mortality in the United States, 1974-2013. JAMA. 2017 Apr;317(13):1338–48. https://doi.org/10.1001/jama.2017.2719
- Lukas J, Drabek J, Lukas D, Dusek L, Gatek J. The epidemiology of thyroid cancer in the Czech Republic in comparison with other countries. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2013 Sep;157(3):266–75. https://doi.org/10.5507/bp.2012.086
- dos Santos Silva I, Swerdlow AJ. Thyroid cancer epidemiology in England and Wales: time trends and geographical distribution. Br J Cancer. 1993 Feb;67(2):330–40. https://doi.org/10.1038/bjc.1993.61
- Pettersson B, Adami HO, Wilander E, Coleman MP. Trends in thyroid cancer incidence in Sweden, 1958-1981, by histopathologic type. Int J Cancer. 1991 Apr;48(1):28–33. https://doi.org/10.1002/ijc.2910480106
- Akslen LA, Haldorsen T, Thoresen SO, Glattre E. Incidence of thyroid cancer in Norway 1970-1985. Population review on time trend, sex, age, histological type and tumour stage in 2625 cases. Acta Pathol Microbiol Scand Suppl. 1990 Jun;98(6):549–58. https://doi.org/10.1111/j.1699-0463.1990.tb01070.x
- Montanaro F, Pury P, Bordoni A, Lutz JM, Network SC ; Swiss Cancer Registries Network. Unexpected additional increase in the incidence of thyroid cancer among a recent birth cohort in Switzerland. Eur J Cancer Prev. 2006 Apr;15(2):178–86. https://doi.org/10.1097/01.cej.0000197450.94980.36
- Husson O, Haak HR, van Steenbergen LN, Nieuwlaat WA, van Dijk BA, Nieuwenhuijzen GA, et al. Rising incidence, no change in survival and decreasing mortality from thyroid cancer in The Netherlands since 1989. Endocr Relat Cancer. 2013 Mar;20(2):263–71. https://doi.org/10.1530/ERC-12-0336
- Moynihan R, Doust J, Henry D. Preventing overdiagnosis: how to stop harming the healthy. BMJ. 2012 May;344(may28 4):e3502. https://doi.org/10.1136/bmj.e3502
- Shin S, Sawada N, Saito E, Yamaji T, Iwasaki M, Shimazu T, et al.; JPHC Study Group. Menstrual and reproductive factors in the risk of thyroid cancer in Japanese women: the Japan Public Health Center-Based Prospective Study. Eur J Cancer Prev. 2018 Jul;27(4):361–9. https://doi.org/10.1097/CEJ.0000000000000338
- Ahn HS, Kim HJ, Welch HG. Korea’s thyroid-cancer “epidemic”—screening and overdiagnosis. N Engl J Med. 2014 Nov;371(19):1765–7. https://doi.org/10.1056/NEJMp1409841
- Iglesias ML, Schmidt A, Ghuzlan AA, Lacroix L, Vathaire F, Chevillard S, et al. Radiation exposure and thyroid cancer: a review. Arch Endocrinol Metab. 2017 Mar-Apr;61(2):180–7. https://doi.org/10.1590/2359-3997000000257
- Bundesamt für Gesundheit (BAG). Jahresbericht Umweltradioaktivität und Strahlendosis in der Schweiz 2019 [Available from: https://www.bag.admin.ch/bag/de/home/das-bag/publikationen/taetigkeitsberichte/jahresberichte-umweltradioaktiviaet.html].
- Rybach L, Bächler D, Bucher B, Schwarz G. Radiation doses of Swiss population from external sources. J Environ Radioact. 2002;62(3):277–86. https://doi.org/10.1016/S0265-931X(01)00169-2
- Swissinfo. Swiss assess effects of Chernobyl disaster: Swissinfo; 2006 [Available from: https://www.swissinfo.ch/eng/swiss-assess-effects-of-chernobyl-disaster/5003874].
- Cao LZ, Peng XD, Xie JP, Yang FH, Wen HL, Li S. The relationship between iodine intake and the risk of thyroid cancer: A meta-analysis. Medicine (Baltimore). 2017 May;96(20):e6734. https://doi.org/10.1097/MD.0000000000006734
- Stalder E, Haldimann M, Blanc A, Dudler V, Ponte B, Pruijm M, et al. Use of day and night urinary iodine excretion to estimate the prevalence of inadequate iodine intakes via the estimated average requirement cut-point method. Swiss Med Wkly. 2019 Jun;149:w20090. https://doi.org/10.4414/smw.2019.20090
- Kwon H, Han KD, Park CY. Weight change is significantly associated with risk of thyroid cancer: A nationwide population-based cohort study. Sci Rep. 2019 Feb;9(1):1546. https://doi.org/10.1038/s41598-018-38203-0
- Xu L, Port M, Landi S, Gemignani F, Cipollini M, Elisei R, et al. Obesity and the risk of papillary thyroid cancer: a pooled analysis of three case-control studies. Thyroid. 2014 Jun;24(6):966–74. https://doi.org/10.1089/thy.2013.0566
- Faeh D, Bopp M. Increase in the prevalence of obesity in Switzerland 1982-2007: birth cohort analysis puts recent slowdown into perspective. Obesity (Silver Spring). 2010 Mar;18(3):644–6. https://doi.org/10.1038/oby.2009.310
- Peterson E, De P, Nuttall R. BMI, diet and female reproductive factors as risks for thyroid cancer: a systematic review. PLoS One. 2012;7(1):e29177. https://doi.org/10.1371/journal.pone.0029177
- Zamora-Ros R, Rinaldi S, Biessy C, Tjønneland A, Halkjaer J, Fournier A, et al. Reproductive and menstrual factors and risk of differentiated thyroid carcinoma: the EPIC study. Int J Cancer. 2015 Mar;136(5):1218–27. https://doi.org/10.1002/ijc.29067
- Zhu J, Zhu X, Tu C, Li YY, Qian KQ, Jiang C, et al. Parity and thyroid cancer risk: a meta-analysis of epidemiological studies. Cancer Med. 2016 Apr;5(4):739–52. https://doi.org/10.1002/cam4.604
- Yi X, Zhu J, Zhu X, Liu GJ, Wu L. Breastfeeding and thyroid cancer risk in women: A dose-response meta-analysis of epidemiological studies. Clin Nutr. 2016 Oct;35(5):1039–46. https://doi.org/10.1016/j.clnu.2015.12.005
- Baker SR, Bhatti WA. The thyroid cancer epidemic: is it the dark side of the CT revolution? Eur J Radiol. 2006 Oct;60(1):67–9. https://doi.org/10.1016/j.ejrad.2006.04.022
- Brito JP, Morris JC, Montori VM. Thyroid cancer: zealous imaging has increased detection and treatment of low risk tumours. BMJ. 2013 Aug;347 aug27 4:f4706. https://doi.org/10.1136/bmj.f4706
- Jegerlehner S, Bulliard JL, Aujesky D, Rodondi N, Germann S, Konzelmann I, et al.; NICER Working Group. Overdiagnosis and overtreatment of thyroid cancer: A population-based temporal trend study. PLoS One. 2017 Jun;12(6):e0179387. https://doi.org/10.1371/journal.pone.0179387
- Brito JP, Davies L. Is there really an increased incidence of thyroid cancer? Curr Opin Endocrinol Diabetes Obes. 2014 Oct;21(5):405–8. https://doi.org/10.1097/MED.0000000000000094
- Vaccarella S, Dal Maso L, Laversanne M, Bray F, Plummer M, Franceschi S. The Impact of Diagnostic Changes on the Rise in Thyroid Cancer Incidence: A Population-Based Study in Selected High-Resource Countries. Thyroid. 2015 Oct;25(10):1127–36. https://doi.org/10.1089/thy.2015.0116
- Morris LG, Tuttle RM, Davies L. Changing Trends in the Incidence of Thyroid Cancer in the United States. JAMA Otolaryngol Head Neck Surg. 2016 Jul;142(7):709–11. https://doi.org/10.1001/jamaoto.2016.0230
- Davies L. Overdiagnosis of thyroid cancer. BMJ. 2016 Nov;355:i6312. https://doi.org/10.1136/bmj.i6312
- Brito JP, Davies L, Zeballos-Palacios C, Morris JC, Montori VM. Papillary lesions of indolent course: reducing the overdiagnosis of indolent papillary thyroid cancer and unnecessary treatment. Future Oncol. 2014 Jan;10(1):1–4. https://doi.org/10.2217/fon.13.240
- Iñiguez-Ariza NM, Brito JP. Management of Low-Risk Papillary Thyroid Cancer. Endocrinol Metab (Seoul). 2018 Jun;33(2):185–94. https://doi.org/10.3803/EnM.2018.33.2.185
- Welch HG, Black WC. Overdiagnosis in cancer. J Natl Cancer Inst. 2010 May;102(9):605–13. https://doi.org/10.1093/jnci/djq099
- Morris LG, Sikora AG, Tosteson TD, Davies L. The increasing incidence of thyroid cancer: the influence of access to care. Thyroid. 2013 Jul;23(7):885–91. https://doi.org/10.1089/thy.2013.0045
- Ulyte A, Wei W, Dressel H, Gruebner O, von Wyl V, Bähler C, et al. Variation of colorectal, breast and prostate cancer screening activity in Switzerland: influence of insurance, policy and guidelines. PLoS One. 2020 Apr;15(4):e0231409. https://doi.org/10.1371/journal.pone.0231409
- Nguyen QT, Lee EJ, Huang MG, Park YI, Khullar A, Plodkowski RA. Diagnosis and treatment of patients with thyroid cancer. Am Health Drug Benefits. 2015 Feb;8(1):30–40.
- Lorez M, Bordoni A, Bouchardy C, Bulliard JL, Camey B, Dehler S, et al. Evaluation of completeness of case ascertainment in Swiss cancer registration. Eur J Cancer Prev. 2017;26 Joining forces for better cancer registration in Europe:S139-S46.
- Bulliard JL, Chiolero A. Screening and overdiagnosis: public health implications. Public Health Rev. 2015 Nov;36(1):8. https://doi.org/10.1186/s40985-015-0012-1
- Chiolero A, Paccaud F, Aujesky D, Santschi V, Rodondi N. How to prevent overdiagnosis. Swiss Med Wkly. 2015 Jan;145:w14060.