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
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
Methods NPCR/SEER combined data, 1999-2007 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 7.0.4 95% Confidence Intervals Annual Percent Change (APC) Least squares regression Variables Age, Race, Hispanic ethnicity, Sex, US Census Region
RESULTS: RACE/ETHNICITY
Average annual incidence rates and counts of thyroid cancer by sex & race/ethnicity, US, 1999-2007 Average annual count Rate per 100,000 95% C.I. All cases 23,895 9.14 (9.11, 9.18) Sex Male 5771 4.65 (4.61, 4.69) Female 18,124 13.51* (13.45, 13.58) Race White 20,682 9.47 (9.43, 9.51) Black 1543 5.67* (5.57, 5.76) AI/AN 111 4.64* (4.35, 4.96) API 1117 9.38 (9.20, 9.58) Ethnicity Non-Hispanic 21,450 9.30 (9.26, 9.35) Hispanic 2446 8.45* (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)
Thyroid cancer trends by race/ethnicity, males, US, 1999-2007 7 6 White APC 6.16* Black APC 5.37* API APC 4.70* Hispanic APC 4.22* Rate per 100,000 5 4 3 2 1 0 1999 2000 2001 2002 2003 2004 2005 2006 2007 Data from NPCR/SEER covering 89.4% of US population Hispanic ethnicity and race are not mutually exclusive. *APC statistically significant (p<0.05).
Thyroid cancer trends by race/ethnicity, females, US, 1999-2007 Rate per 100,000 20 18 16 14 12 10 8 6 4 2 0 White APC 7.12* Black APC 6.49* AI/AN APC 6.44* API APC 5.99* Hispanic APC 6.30* 1999 2000 2001 2002 2003 2004 2005 2006 2007 Data from NPCR/SEER covering 89.4% of US population Hispanic ethnicity and race are not mutually exclusive. *APC statistically significant (p<0.05).
RESULTS: AGE
Age-specific incidence rates of thyroid cancer by sex, US, 1999-2007 25 Male Female 47 Rate per 100,000 20 15 10 5 53 0 Age at diagnosis Data from NPCR/SEER covering 89.4% of US population
Thyroid cancer trends by age, males, US, 1999-2007 Rate per 100,000 18 16 14 12 10 8 6 4 2 0-19 APC 3.98 20-39 APC 3.81* 40-59 APC 5.71* 60-79 APC 7.69* 80+ APC 7.11* 0 1999 2000 2001 2002 2003 2004 2005 2006 2007 Year of diagnosis Data from NPCR/SEER covering 89.4% of US population *APC statistically significant (p<0.05).
Thyroid cancer trends by age, females, US, 1999-2007 35 30 Rate per 100,000 25 20 15 10 0-19 APC 2.53* 20-39 APC 5.26* 40-59 APC 7.67* 60-79 APC 9.54* 80+ APC 5.42* 5 0 1999 2000 2001 2002 2003 2004 2005 2006 2007 Year of diagnosis Data from NPCR/SEER covering 89.4% of US population *APC statistically significant (p<0.05).
RESULTS: US CENSUS REGION
Incidence rates of thyroid cancer by US Census Region, US, 1999-2007 18 16 Northeast Midwest South West 17.1 Rate per 100,000 14 12 10 8 6 4 11.6 8.5* 8.1* 8.8* 5.8 4.4* 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).
Thyroid cancer trends by US Census Region, US, 1999-2007 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 100,000 8 7 6 5 4 3 2 1 Rate per 100,000 20 15 10 5 0 0 1999 2000 2001 2002 2003 2004 2005 Year of diagnosis 2006 2007 1999 2000 2001 2002 2003 2004 2005 Year of diagnosis 2006 2007 Data from NPCR/SEER covering 89.4% of US population *APC statistically significant (p<0.05).
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
CONCLUSION
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
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 30333 Telephone, 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348 E-mail: cdcinfo@cdc.gov Web: www.cdc.gov 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