Cancers de la thyroïde en Italie : données épidémiologiques. F. Pacini

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1 Cancers de la thyroïde en Italie : données épidémiologiques F. Pacini

2 Recontres Nucléaire & Santé Janvier 2007 Neuilly Cancers de la thyroide en Italie: Données épidémiologiques Furio Pacini Dipartimento di Endocrinologia, Università di Siena

3 Reliable epidemiology of thyroid cancer in Italy is hampered by the lack of accurate national cancer registries. Italian Network of cancer registries (red spots)

4 Incidence of thyroid cancer in Italy

5 Trend of thyroid cancer incidence in ITALY

6

7

8 Thyroid cancer incidence and mortality in USA ( ) and Italy ( ) APC: USA 3.8% USA Italy Italy 4.0% Italian Network of Cancer Registries, 2006

9 Thyroid cancer incidence in USA ( ) and Italy ( ) Italy USA Italian Network of Cancer Registries, 2006

10 Trend incidence of papillary thyroid cancer by size in USA ( )

11 What about the incidence of childhood thyroid carcinoma in the European countries?

12 Time trend of age-specific incidence rate of thyroid carcinoma in european children and adolescent (excluding Belarus), , both sex. APC= 3.0 %

13 Thyroid cancer incidence in Italy from 1986: Summary 4 % annual increase Similar to the increase seen in USA Similar to that observed in western Europe in general Equal in children and adults

14 ANY RELATION WITH CHERNOBYL? CHERNOBYL APRIL 26, 1986

15 Increase in thyroid cancer incidence in young people 12 Incidence per in Belarus 11,3 Adolescents 10 8 Cases per Children (0-14) Adolescents (15-18) Adults (19-34) 4,2 4 3,8 3,4 3,5 3,1 2,9 3 3,8 2,3 3,2 2,6 2,9 2,1 1,9 1,4 1,2 1,4 1,0 0,8 9,5 9.7 Young adults 6,9 6,6 5,6 5,7 5,7 4,9 3,4 2,5 2,6 1,7 Children 0,7 0,3 0,3 0,2 0,4 0,8 0, Courtesy Yu. E. Demidchik

16

17 Estimates of equivalent dose to the thyroid from radioactive iodine (msv) for people in the Milan area and Belarus in May 1986 Protected Unprotected Belarus Adults Children (1-10 years) Infants (<1 year) Chiesa et al, Annals of Oncology, 2004

18 Ten years after the accident, the prevalence of thyroid disease in the cohort was indistinguishable from that of populations not exposed to radioactive population

19 Clinical diagnosis of 30 children with thyroid abnormalities Cases (n) Hurthle cell adenoma Thyroid cyst Thyroglossal cyst Thyroiditis No evidence of disease Chiesa et al, Annals of Oncology,

20 Epidemiological evidence does not favour any link with the Chernobyl accident and increased incidence of thyroid carcinoma in countries other than Belarus, Ukraine and Russia 10 years after there is no evidence of a major public health impact of the Chernobyl accident in the field of cancer in countries of Europe outside the former USSR. Sali D et al, Int J Cancer, 1996 The increased incidence of thyroid cancer in France is real (7.1% per year). Epidemiological evidence does not favour any link with the Chernobyl accident. Leenhardt L et al, Thyroid, 2004 results of time trends in cancer incidence and mortality in Europe do not indicate any increase in cancer rates that can be clearly attributed to radiation from the Chernobyl accident. Cardis E et al, Int J Cancer, 2006 Our results did not indicate any increase in thyroid cancer incidence in Filland related to exposure to radiation from the Chernobyl accident. But A et al, Europ J Cancer, 2006

21 If the Chernobyl accident is not responsable for the increased thyroid cancer incidence found in several European countries, what may be the explanation?

22 Several evidences point to the role of increased ascertainment From 1980 to 2000 Increased use of neck ultrasound, from 3% to 84.8% Increased use of FNAC, from 8% to 36% Extensiveness of thyroidectomies for benign conditions, from 30% to 80% Amelioration of pathological techniques Much of the increase is due to microcarcinomas Screening effect Leenhardt L et al, Thyroid, 2004

23 Several evidences point to the role of increased ascertainment The comparison with the Belarus epidemic Increased incidence tremendously greater than in Europe Increase much greater in children than adults Mainly large, metastatic tumor

24 Conclusions An increase in the incidence of thyroid cancer is observed in Italy and in many other countries in the world Most likely this increase is due to improved attention to the thyroid gland and its diseases Together with improved and diffuse use of powerful diagnostic techniques The responsability of other factors (genetic or environmental), although possible, is not envisage at this moment.

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