Thyroid cancer in the United States: Recent increases

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1 Thyroid cancer in the United States: Recent increases Meg Watson Epidemiology and Applied Research Branch Division of Cancer Prevention and Control CDC NAACCR Annual Conference June 22, 2011 National Center for Chronic Disease Prevention and Health Promotion Division of Cancer Prevention and Control

2 Background Increasing rates of thyroid cancer since 1980 s Improved surveillance often cited as cause Increased detection Definition of papillary thyroid cancer expanded in 1988 However, rates continue to increase in more recent years Combined NPCR/SEER dataset allows for detailed analysis, more information

3 Methods NPCR/SEER combined data, States meeting USCS criteria for all years 89.4% population coverage Invasive, microscopically confirmed cancers only Incidence rates Expressed per 100,000 persons Age-adjusted to 2000 US Standard Population Calculated using SEER*Stat % Confidence Intervals Annual Percent Change (APC) Least squares regression Variables Age, Race, Hispanic ethnicity, Sex, US Census Region

4 RESULTS: RACE/ETHNICITY

5 Average annual incidence rates and counts of thyroid cancer by sex & race/ethnicity, US, Average annual count Rate per 100,000 95% C.I. All cases 23, (9.11, 9.18) Sex Male (4.61, 4.69) Female 18, * (13.45, 13.58) Race White 20, (9.43, 9.51) Black * (5.57, 5.76) AI/AN * (4.35, 4.96) API (9.20, 9.58) Ethnicity Non-Hispanic 21, (9.26, 9.35) Hispanic * (8.33, 8.57) AI/AN=American Indian/Alaska Native API=Asian/Pacific Islander Data from NPCR/SEER covering 89.4% of US population * Indicates statistical significance (p<0.05; top row referent group)

6 Thyroid cancer trends by race/ethnicity, males, US, White APC 6.16* Black APC 5.37* API APC 4.70* Hispanic APC 4.22* Rate per 100, Data from NPCR/SEER covering 89.4% of US population Hispanic ethnicity and race are not mutually exclusive. *APC statistically significant (p<0.05).

7 Thyroid cancer trends by race/ethnicity, females, US, Rate per 100, White APC 7.12* Black APC 6.49* AI/AN APC 6.44* API APC 5.99* Hispanic APC 6.30* Data from NPCR/SEER covering 89.4% of US population Hispanic ethnicity and race are not mutually exclusive. *APC statistically significant (p<0.05).

8 RESULTS: AGE

9 Age-specific incidence rates of thyroid cancer by sex, US, Male Female 47 Rate per 100, Age at diagnosis Data from NPCR/SEER covering 89.4% of US population

10 Thyroid cancer trends by age, males, US, Rate per 100, APC APC 3.81* APC 5.71* APC 7.69* 80+ APC 7.11* Year of diagnosis Data from NPCR/SEER covering 89.4% of US population *APC statistically significant (p<0.05).

11 Thyroid cancer trends by age, females, US, Rate per 100, APC 2.53* APC 5.26* APC 7.67* APC 9.54* 80+ APC 5.42* Year of diagnosis Data from NPCR/SEER covering 89.4% of US population *APC statistically significant (p<0.05).

12 RESULTS: US CENSUS REGION

13 Incidence rates of thyroid cancer by US Census Region, US, Northeast Midwest South West 17.1 Rate per 100, * 8.1* 8.8* * 4.2* 4.5* 13.2* 12.6* 11.9* 2 0 Male and female Male Female Data from NPCR/SEER covering 89.4% of US population. * Indicates statistical significance (p<0.05; Northeast referent group).

14 Thyroid cancer trends by US Census Region, US, Male Female 9 NE APC 7.91* MW APC 6.05* S APC 5.29* W APC 5.02* 25 NE APC 8.75* MW APC 6.77* S APC 6.41* W APC 6.35* Rate per 100, Rate per 100, Year of diagnosis Year of diagnosis Data from NPCR/SEER covering 89.4% of US population *APC statistically significant (p<0.05).

15 SUMMARY OF RESULTS Rates of thyroid cancer higher: Females White, API Northeast Younger age distribution for women, older for men Increases among virtually all groups

16 CONCLUSION

17 Conclusions Analysis expands previous findings, with greater precision Thyroid cancer continuing to increase among nearly all groups Increased diagnosis unlikely to be sole reason for increases Survivors require lifelong thyroid replacement therapy, also at increased risk of other cancers Etiologic research needed

18 Co-authors: Dawn Holman, MPH Mary C. White, ScD Hannah Weir, PhD Katrina Trivers, PhD Acknowledgements For more information please contact Centers for Disease Control and Prevention 1600 Clifton Road NE, Atlanta, GA Telephone, CDC-INFO ( )/TTY: Web: The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. National Center for Chronic Disease Prevention and Health Promotion Division of Cancer Prevention and Control