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Cancers & Neoplasias CANCERS & NEOPLASIAS THYROID CANCER COST BURDEN SEX DIFFERENCES $1.6 $3.1 – 3.5 BILLION BILLION 22.23 7.68 ESTIMATED OVERALL EXPECTED COST COST OF CARE IN 2013 IN 2019 (PATIENTS DIAGNOSED (90,000 NEW CASES)3 AFTER 1985)2 INCIDENCE IN THE US IN 20141 PREVALENCE PREVALENCE BY SUBTYPE (2008-2012) IN THE US1 726,646 APPROXIMATE NUMBER OF AMERICANS WITH FOLLICULAR THYROID THYROID CANCER PAPILLARY CANCER 5.0% IN 20141 THYROID MEDULLARY THYROID CANCER CANCER 1.7% 88.5% ANAPLASTIC THYROID CANCER 0.8% UNSPECIFIED 4% INCIDENCE Source: 1 Howlander et al. SEER Cancer Statistics Review, 1975-2014, National Cancer Institute. 2 Lubitz et al. 2014. 15.04 3 Ascherbrook-Kilfor et al. 2013; Lubitz et al. 2014. US CASES PER 100,000 IN 20141 © 2017 The Endocrine Society. All rights reserved. Endocrine Society 2055 L Street NW, Suite 600 Washington, DC 20036 USA Phone: 202.971.3636 Fax: 202.736.9705 endocrine.org Mission Statement of the Acknowledgements We also acknowledge the Endocrine Society The production of Endocrine Facts contributions of Nikki Deoudes, The mission of the Endocrine and Figures would not have been Beryl Roda, and Sukhi Mahal. Society is to advance excellence possible without the guidance of: in endocrinology and promote For More Information its essential and integrative role Advisory Panel For more information, updates, and in scientific discovery, medical Robert A. Vigersky, MD (Chair) the online version of this report, visit: practice, and human health. Walter Reed National Military endocrinefacts.org Medical Center About Endocrine Facts Suggested Citation and Figures Ursula B. Kaiser, MD The Endocrine Society requests that Endocrine Facts and Figures is a Brigham and Women’s Hospital this document be cited as follows: compendium of epidemiological The Endocrine Society. Endocrine data and trends related to a Sherita H. Golden, MD, MHS Facts and Figures: Cancers and spectrum of endocrine diseases. Johns Hopkins University Neoplasias. First Edition. 2017. The data is organized into nine chapters covering the breadth Joanna L. Spencer-Segal, MD, PhD Disclaimer of endocrinology: Adrenal, University of Michigan This publication summarizes Bone and Mineral, Cancers and current scientific information Neoplasias, Cardiovascular and R. Michael Tuttle, MD about epidemiology and trends Lipids, Diabetes, Hypothalamic- Memorial Sloan Kettering data related to a spectrum of Pituitary, Obesity, Thyroid, and Cancer Center endocrine diseases. It is not a Reproduction and Development. practice guideline or systematic William F. Young, Jr., MD, MSc review. Except when specified, All data is sourced from peer- Mayo Clinic this publication does not represent reviewed publications, with an the official policy of the Endocrine additional round of review by a Cancers & Neoplasias Society. group of world-renowned experts in Expert Reviewers the field. Additional oversight from Tobias Else, MD © 2017 The Endocrine Society. the Endocrine Facts and Figures University of Michigan All rights reserved. This is an Advisory Panel ensured fair and official publication of The Endocrine balanced coverage of data across Anthony Heaney, MD Society. No part of this publication the therapeutic areas. University of California, Los Angeles may be reproduced, translated, modified, enhanced, and/or The first edition ofEndocrine Facts Constantine Stratakis, MD, DSc transmitted in any form or by and Figures emphasizes data on the Eunice Kennedy Shriver National any means without the prior United States. Future updates to the Institute of Child Health and written permission of The report will include additional data for Human Development, National Endocrine Society. To other countries. Institutes of Health purchase additional reprints or obtain permissions, e-mail Endocrine Society Staff [email protected]. Lucia D. Tejada, PhD © 2017 The Endocrine Society. All rights reserved. Importantly, the most common forms of thyroid cancer, I OVERVIEW papillary thyroid cancer (PTC) and follicular thyroid cancer This chapter presents data on Endocrine Cancers and (FTC) (together also referred to as differentiated thyroid Neoplasias, including thyroid cancer, adrenal adenomas cancer), have a better prognosis than the rarer anaplastic and carcinomas, familial neoplasia syndromes, thyroid cancer (ATC).4,5 The prevalence of thyroid cancer, parathyroid carcinomas, pheochromocytomas and by histological subtype, is shown in Table 2.1. paragangliomas, and pancreatic neuroendocrine tumors. Due to the rare nature of some of these disorders, some A 2013 study by Aschebrook-Kilfoy and colleagues using data is not available. In addition, in instance when United data from 1992 to 2009 SEER registries (n=59,611), States (US)-based data are limited, we present data from reported an incidence (per 100,000) of 7.3 for PTC, 0.9 for international studies. FTC, 0.2 for MTC, and 0.1 for ATC.6 In a follow-up study, PTC was reported to have the highest annual increase II THYROID CANCER among all thyroid cancer subtypes in the US (Table 2.2).7 According to the National Cancer Institute (NCI), thyroid cancer is the most common malignant disease of the In the US, thyroid cancer (mainly PTC) is the fastest endocrine system, and in 2015 it was reported as the increasing cancer, with an estimated 9-fold increase eighth most common cancer in the US.1 Thyroid cancer since the 1930s, 3-fold since the 1970s, and almost 2,5,8,9 comprises four major histological subtypes, based on 2-fold since the start of the millennium (Table 2.3). whether the cancer arises in follicular (papillary, follicular, Aschebrook-Kilfoy and colleagues projected that, if and anaplastic) or non-follicular (medullary) cell types. current trends continue, by 2019, the incidence rate per 100,000 of the US population would reach 23.8 for PTC, 6 2.1 1.5 for FTC, 0.26 for MTC, and 0.12 for ATC. However, PREVALENCE AND INCIDENCE it has been suggested that the rapid increase in thyroid cancer observed in the US over the last three decades Based on NCI data from 2000-2012, on January 1 2012, may be partially due to overdiagnosis as a result of there were 601,789 thyroid cancer cases, comprising improved imaging technologies.10,11 Furthermore, recent 4.37% of all diagnosed cancers (13,776,251 cases) in data suggests that rising trends in thyroid cancer may be the US.2 According to the National Institute of Health’s slowing down.12 SEER 18 registries database, in 2012, the US incidence of thyroid cancer was 14.25 cases per 100,000.3 Periods of marked acceleration in thyroid cancer incidence are shown in Table 2.4.2. Table 2.1 Prevalence of thyroid cancer by subtypes from 1992-2012, in the US. DATA SOURCE POPULATION HISTOLOGICAL TYPE PREVALENCE (%) REFERENCES SEER 13 database US (n=59,611) PTC 84.6 Aschebrook-Kilfoy et al. 20136 1992-2009 FTC 9.8 MTC 2.1 ATC 0.9 Unspecified 2.6 SEER 18 registries US, all races, both sexes PTC 88.5 Howlander et al. 20142 2008-2012 FTC 5.1 MTC 1.7 ATC 0.8 Unspecified 4 Abbreviations: SEER, Surveillance, Epidemiology, and End Results; US, United States; PTC, Papillary thyroid cancer; FTC, Follicular thyroid cancer; MTC, Medullary thyroid cancer; ATC Anaplastic thyroid cancer. © 2017 The Endocrine Society. All rights reserved. ENDOCRINE SOCIETY | 1 Table 2.2 Annual percentage change in the 4 subtypes of thyroid cancer in the US. DATA SOURCE POPULATION THYROID CANCER SUBTYPE ANNUAL PERCENTAGE CHANGE (%) SEER database, 1992-2009 US (n=59,611) PTC +7.0 FTC +1.0 MTC +2.0 ATC +1.0 Source: Aschebrook-Kilfoy et al. 20137 Abbreviations: US, United States; SEER, Surveillance, Epidemiology, and End Results; PTC, Papillary thyroid cancer; FTC, Follicular thyroid cancer; MTC, Medullary thyroid cancer; ATC Anaplastic thyroid cancer. Table 2.3 Temporal increase in the incidence of thyroid (papillary) cancer from 1935 to 2012 in the US. INCIDENCE (PER 100,000) DATA SOURCE POPULATION THYROID CANCER TYPE 1935-1939 1990-1992 FOLD-INCREASE REFERENCE Connecticut US, incident thyroid cancer cases, Thyroid cancer 1.6 8.55 5.3 Zheng et al. Tumor both sexes (72% females, 28% 19968 Registry males), age-adjusted (n=4,315) 1973 2002 SEER 9 US, new cases of thyroid cancer, Thyroid cancer 3.6 8.7 2.4 Davies Registries median age 46 years, 2002 Papillary thyroid cancer 2.7 7.7 2.9 and Welch. database (n=2,400) 20065 2000 2012 SEER 18 US, age-adjusted to 2000 US Thyroid cancer 7.4 14.3 1.9 Howlader et program population al. 20142 Abbreviations: SEER, Surveillance, Epidemiology, and End Results. Note: SEER program presents population-based data collected from 9 cancer registries in distinct areas of the United States, covers 10% of the US population in 5 states: Connecticut, Hawaii, Iowa, New Mexico, and Utah; and 4 metropolitan areas: Atlanta, Detroit, San Francisco, and Seattle. Table 2.4 Annual percentage change in invasive thyroid cancer from 1975 to 2012, in the US. DATA SOURCE POPULATION TIME FRAME ANNUAL PERCENTAGE CHANGE (%) SEER 9 Delay-Adjusted Incidence US, all races, 1975-1977 +6.3 1975-2012 both sexes 1977-1980 -6.6 1980-1997 +2.4 1997-2009 +6.7 2009-2012 +2.3 Source: National Cancer Institute. 20123 Note: + denotes an increase and - denotes a decrease. Data are based on rates age-adjusted to the 2000 US standard population, from SEER 9 registries (San Francisco, Connecticut, Detroit, Hawaii, Iowa, New Mexico, Seattle, Utah, and Atlanta). 2 | CANCERS AND NEOPLASIAS © 2017 The Endocrine Society. All rights reserved. The increase in the 1970s is attributed to an increase The first report of thyroid carcinomas as a common in head and neck ionizing radiation treatment of benign feature at autopsy, by VanderLaan in 1947, was followed childhood conditions.8 The increase around the turn of by other reports of subclinical thyroid carcinomas in the the century is thought to be due to multiple factors, the general population.20,21,22 In 1994, Ezzat and colleagues major one being improved diagnostics (thyroid ultrasound reported identifying more asymptomatic subjects with and fine-needle aspiration technology in the 1980s) and thyroid nodules by high-resolution ultrasonography improved detection sensitivity of subclinical small-size (67%) and by palpation alone (21%) (Table 2.6).
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