Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

The changing incidence of thyroid cancer

Key Points

  • The incidence of thyroid cancer has increased over the past several decades, which, in many countries around the world, has been largely driven by new cases of papillary thyroid cancer

  • Increased opportunities for detection and diagnosis of small, indolent thyroid cancers seem to explain much, but not all, of the patterns in thyroid cancer incidence

  • Results from epidemiological studies suggest that a substantial proportion of thyroid cancer diagnoses (>40% in the USA) could be attributable to environmental factors, such as obesity and cigarette smoking

  • Clinical practice guidelines have recently changed in response to an increasing awareness of the potential for unnecessary diagnosis and treatment in a subset of patients

  • Large-scale, prospective epidemiological studies and laboratory-based investigations are needed to identify modifiable risk factors for thyroid cancer and promising targets for thyroid cancer prevention

Abstract

During the past few decades, the incidence of thyroid cancer has increased substantially in many countries, including the USA. The rise in incidence seems to be attributable both to the growing use of diagnostic imaging and fine-needle aspiration biopsy, which has led to enhanced detection and diagnosis of subclinical thyroid cancers, and environmental factors. The latest American Thyroid Association (ATA) practice guidelines for the management of adult patients with thyroid nodules and differentiated thyroid cancer differ substantially from the previous ATA guidelines published in 2009. Specifically, the problems of overdiagnosis and overtreatment of a disease that is typically indolent, where treatment-related morbidity might not be justified by a survival benefit, now seem to be acknowledged. As few modifiable risk factors for thyroid cancer have been established, the specific environmental factors that have contributed to the rising incidence of thyroid cancer remain speculative. However, the findings of several large, well-designed epidemiological studies have provided new information about exposures (such as obesity) that might influence the development of thyroid cancer. In this Review, we describe the changing incidence of thyroid cancer, suggest potential explanations for these trends, emphasize the implications for patients and highlight ongoing and potential strategies to combat this growing clinical and public health issue.

This is a preview of subscription content

Access options

Buy article

Get time limited or full article access on ReadCube.

$32.00

All prices are NET prices.

Figure 1: Trends in total and histology-specific thyroid cancer incidence (SEER 13) and total thyroid cancer mortality (USA) from 1993 to 2012.

References

  1. Ferlay, J. et al. GLOBOCAN 2012 v1.0, Cancer Incidence and Mortality Worldwide: IARC CancerBase No. 11. World Health Organization http://globocan.iarc.fr/Pages/summary_table_pop_prev_sel.aspx (2013).

    Google Scholar 

  2. Ron, E. & Schneider, A. B. in Cancer Epidemiology and Prevention (eds Schottenfeld, D. & Fraumeni, J. F. Jr) 975–994 (Oxford University Press, 2006).

    Book  Google Scholar 

  3. Kilfoy, B. A. et al. International patterns and trends in thyroid cancer incidence, 1973–2002. Cancer Causes Control 20, 525–531 (2009). This study found increases in the incidence of thyroid cancer in most of the countries with available, high-quality registry data; no differences were observed by region of the world or underlying thyroid cancer rates.

    Article  PubMed  Google Scholar 

  4. Enewold, L. et al. Rising thyroid cancer incidence in the United States by demographic and tumor characteristics, 1980–2005. Cancer Epidemiol. Biomarkers Prev. 18, 784–791 (2009). This comprehensive descriptive analysis of thyroid cancer trends in the USA described increases in the incidence of papillary thyroid cancer of all stages and sizes at diagnosis, including similar rates of increase for large (>5 cm) and small (≤ 1 cm) tumours, suggesting that medical surveillance cannot completely explain these patterns.

    PubMed  PubMed Central  Article  Google Scholar 

  5. Kent, W. D. et al. Increased incidence of differentiated thyroid carcinoma and detection of subclinical disease. CMAJ 177, 1357–1361 (2007). Pathology reports obtained from the Ontario Cancer Registry showed an increasing incidence of differentiated thyroid cancer and a disproportionate increase in the number of smaller (≤2 cm) versus larger tumours between 1990 and 2001.

    PubMed  PubMed Central  Article  Google Scholar 

  6. Liu, S., Semenciw, R., Ugnat, A. M. & Mao, Y. Increasing thyroid cancer incidence in Canada, 1970–1996: time trends and age–period–cohort effects. Br. J. Cancer 85, 1335–1339 (2001).

    PubMed  PubMed Central  Article  CAS  Google Scholar 

  7. Uhry, Z. et al. Estimating infra-national and national thyroid cancer incidence in France from cancer registries data and national hospital discharge database. Eur. J. Epidemiol. 22, 607–614 (2007).

    Article  PubMed  Google Scholar 

  8. Colonna, M. et al. Recent trends in incidence, geographical distribution, and survival of papillary thyroid cancer in France. Cancer Epidemiol. 39, 511–518 (2015).

    Article  CAS  PubMed  Google Scholar 

  9. Reynolds, R. M. et al. Changing trends in incidence and mortality of thyroid cancer in Scotland. Clin. Endocrinol. (Oxf.) 62, 156–162 (2005).

    Article  Google Scholar 

  10. Smailyte, G., Miseikyte-Kaubriene, E. & Kurtinaitis, J. Increasing thyroid cancer incidence in Lithuania in 1978–2003. BMC Cancer 6, 284 (2006).

    PubMed  PubMed Central  Article  Google Scholar 

  11. Pandeya, N. et al. Increasing thyroid cancer incidence in Queensland, Australia 1982–2008 — true increase or overdiagnosis? Clin. Endocrinol. (Oxf.) http://dx.doi.org/10.1111/cen.12724 (2015).

  12. Keinan-Boker, L. & Silverman, B. G. Trends of thyroid cancer in Israel: 1980–2012. Rambam Maimonides Med. J. 7, e0001 (2016).

    PubMed Central  Article  Google Scholar 

  13. Lubina, A. et al. Time trends of incidence rates of thyroid cancer in Israel: what might explain the sharp increase. Thyroid 16, 1033–1040 (2006).

    Article  PubMed  Google Scholar 

  14. Wang, Y. & Wang, W. Increasing incidence of thyroid cancer in Shanghai, China, 1983–2007. Asia Pac. J. Public Health 27, NP223–NP229 (2015).

    Article  PubMed  Google Scholar 

  15. Ahn, H. S., Kim, H. J. & Welch, H. G. Korea's thyroid-cancer 'epidemic' — screening and overdiagnosis. N. Engl. J. Med. 371, 1765–1767 (2014). This commentary describes the rapid increase in thyroid cancer incidence in South Korea following a government-initiated national screening programme for cancer and other common diseases.

    Article  PubMed  Google Scholar 

  16. Veiga, L. H., Neta, G., Aschebrook-Kilfoy, B., Ron, E. & Devesa, S. S. Thyroid cancer incidence patterns in Sao Paulo, Brazil, and the U.S. SEER program, 1997–2008. Thyroid 23, 748–757 (2013).

    PubMed  PubMed Central  Article  Google Scholar 

  17. Howlader, N. et al. SEER Cancer Statistics Review, 1975–2012. National Cancer Institute http://seer.cancer.gov/csr/1975_2012 (2015). The SEER program is an authoritative source of information on cancer incidence and survival in the USA and includes data collected from population-based cancer registries that cover approximately 30% of the US population.

    Google Scholar 

  18. Ito, Y., Nikiforov, Y. E., Schlumberger, M. & Vigneri, R. Increasing incidence of thyroid cancer: controversies explored. Nat. Rev. Endocrinol. 9, 178–184 (2013). This article presents interview questions and answers with four experts regarding the potential reasons for the rising incidence of thyroid cancer in many regions of the world.

    Article  CAS  PubMed  Google Scholar 

  19. Brito, J. P. & Davies, L. Is there really an increased incidence of thyroid cancer? Curr. Opin. Endocrinol. Diabetes Obes. 21, 405–408 (2014).

    Article  PubMed  Google Scholar 

  20. Davies, L. & Welch, H. G. Increasing incidence of thyroid cancer in the United States, 1973–2002. JAMA 295, 2164–2167 (2006). In this descriptive analysis of thyroid cancer incidence in the USA, the authors report a marked increase in thyroid cancer incidence and a stable rate of thyroid cancer mortality over time and attribute these trends entirely to “increased diagnostic scrutiny.”.

    Article  CAS  PubMed  Google Scholar 

  21. Franceschi, S. & Vaccarella, S. Thyroid cancer: an epidemic of disease or an epidemic of diagnosis? Int. J. Cancer 136, 2738–2739 (2015).

    Article  CAS  PubMed  Google Scholar 

  22. Morris, L. G., Tuttle, R. M. & Davies, L. Changing trends in the incidence of thyroid cancer in the United States. JAMA Otolaryngol. Head Neck Surg. http://dx.doi.org/10.1001/jamaoto.2016.0230 (2016).

  23. Aschebrook-Kilfoy, B. & Grogan, R. H. Re: Brito et al. overdiagnosis of thyroid cancer and Graves' disease. Thyroid 24, 403–404 (2014).

    Article  PubMed  Google Scholar 

  24. Sosa, J. A., Hanna, J. W., Robinson, K. A. & Lanman, R. B. Increases in thyroid nodule fine-needle aspirations, operations, and diagnoses of thyroid cancer in the United States. Surgery 154, 1420–1426; discussion 1426–1427 (2013). This study demonstrated the rapid increase in the use of thyroid fine-needle aspiration biopsies in the USA between 2006 and 2011, and showed that thyroidectomies were more commonly performed than lobectomies and that the use of thyroidectomies increased at a faster rate.

    Article  PubMed  Google Scholar 

  25. Guth, S., Theune, U., Aberle, J., Galach, A. & Bamberger, C. M. Very high prevalence of thyroid nodules detected by high frequency (13 MHz) ultrasound examination. Eur. J. Clin. Invest. 39, 699–706 (2009).

    Article  CAS  PubMed  Google Scholar 

  26. Uppal, A. et al. Benign and malignant thyroid incidentalomas are rare in routine clinical practice: a review of 97,908 imaging studies. Cancer Epidemiol. Biomarkers Prev. 24, 1327–1331 (2015). A retrospective chart review of all reports for scans of the head, neck and chest at a single tertiary care centre revealed a much lower rate of incidental thyroid nodule reporting than was found on dedicated review, suggesting that the contribution of incidentalomas to the rising incidence of thyroid cancer in the USA has been greatly overestimated.

    PubMed  PubMed Central  Article  Google Scholar 

  27. Burgess, J. R. Temporal trends for thyroid carcinoma in Australia: an increasing incidence of papillary thyroid carcinoma (1982–1997). Thyroid 12, 141–149 (2002).

    Article  PubMed  Google Scholar 

  28. Piersanti, M., Ezzat, S. & Asa, S. L. Controversies in papillary microcarcinoma of the thyroid. Endocr. Pathol. 14, 183–191 (2003).

    Article  PubMed  Google Scholar 

  29. Martinez-Tello, F. J., Martinez-Cabruja, R., Fernandez-Martin, J., Lasso-Oria, C. & Ballestin-Carcavilla, C. Occult carcinoma of the thyroid. A systematic autopsy study from Spain of two series performed with two different methods. Cancer 71, 4022–4029 (1993).

    Article  CAS  PubMed  Google Scholar 

  30. Ross, D. S. & Tuttle, R. M. Observing micopapillary thyroid cancers. Thyroid 24, 3–6 (2014).

    Article  PubMed  Google Scholar 

  31. Schneider, A. B. et al. Thyroid nodules in the follow-up of irradiated individuals: comparison of thyroid ultrasound with scanning and palpation. J. Clin. Endocrinol. Metab. 82, 4020–4027 (1997).

    CAS  PubMed  Google Scholar 

  32. Zhu, C. et al. A birth cohort analysis of the incidence of papillary thyroid cancer in the United States, 1973–2004. Thyroid 19, 1061–1066 (2009).

    PubMed  PubMed Central  Article  Google Scholar 

  33. Horn-Ross, P. L. et al. Continued rapid increase in thyroid cancer incidence in California: trends by patient, tumor, and neighborhood characteristics. Cancer Epidemiol. Biomarkers Prev. 23, 1067–1079 (2014).

    PubMed  PubMed Central  Article  Google Scholar 

  34. Meinhold, C. L. et al. Nonradiation risk factors for thyroid cancer in the US Radiologic Technologists Study. Am. J. Epidemiol. 171, 242–253 (2010).

    Article  PubMed  Google Scholar 

  35. Sen, A. et al. Baseline and lifetime alcohol consumption and risk of differentiated thyroid carcinoma in the EPIC study. Br. J. Cancer 113, 840–847 (2015).

    PubMed  PubMed Central  Article  CAS  Google Scholar 

  36. Zamora-Ros, R. et al. Energy and macronutrient intake and risk of differentiated thyroid carcinoma in the European Prospective Investigation into Cancer and Nutrition study. Int. J. Cancer 138, 65–73 (2016).

    Article  CAS  PubMed  Google Scholar 

  37. Rinaldi, S. et al. Thyroid-stimulating hormone, thyroglobulin, and thyroid hormones and risk of differentiated thyroid carcinoma: the EPIC study. J. Natl Cancer Inst. 106, dj097 (2014).

    Article  CAS  Google Scholar 

  38. Braganza, M. Z. et al. Adolescent and mid-life diet and subsequent risk of thyroid cancer in the NIH-AARP Diet and Health Study. Int. J. Cancer 137, 2413–2423 (2015).

    PubMed  PubMed Central  Article  CAS  Google Scholar 

  39. Balasubramaniam, S., Ron, E., Gridley, G., Schneider, A. B. & Brenner, A. V. Association between benign thyroid and endocrine disorders and subsequent risk of thyroid cancer among 4.5 million U.S. male veterans. J. Clin. Endocrinol. Metab. 97, 2661–2669 (2012).

    PubMed  PubMed Central  Article  CAS  Google Scholar 

  40. Almquist, M. et al. Metabolic factors and risk of thyroid cancer in the Metabolic syndrome and Cancer project (Me-Can). Cancer Causes Control 22, 743–751 (2011).

    Article  PubMed  Google Scholar 

  41. Luo, J., Phillips, L., Liu, S., Wactawski-Wende, J. & Margolis, K. L. Diabetes, diabetes treatment, and risk of thyroid cancer. J. Clin. Endocrinol. Metab. 101, 1243–1248 (2016).

    PubMed  PubMed Central  Article  CAS  Google Scholar 

  42. Schmid, D., Behrens, G., Jochem, C., Keimling, M. & Leitzmann, M. Physical activity, diabetes, and risk of thyroid cancer: a systematic review and meta-analysis. Eur. J. Epidemiol. 28, 945–958 (2013).

    Article  PubMed  Google Scholar 

  43. Cho, Y. A. & Kim, J. Thyroid cancer risk and smoking status: a meta-analysis. Cancer Causes Control 25, 1187–1195 (2014).

    Article  PubMed  Google Scholar 

  44. Caini, S. et al. Menstrual and reproductive history and use of exogenous sex hormones and risk of thyroid cancer among women: a meta-analysis of prospective studies. Cancer Causes Control 26, 511–518 (2015).

    Article  PubMed  Google Scholar 

  45. Jing, Z. et al. Association between height and thyroid cancer risk: a meta-analysis of prospective cohort studies. Int. J. Cancer 137, 1484–1490 (2015).

    Article  CAS  PubMed  Google Scholar 

  46. Schmid, D., Ricci, C., Behrens, G. & Leitzmann, M. F. Adiposity and risk of thyroid cancer: a systematic review and meta-analysis. Obes. Rev. 16, 1042–1054 (2015).

    Article  CAS  PubMed  Google Scholar 

  47. Patel, D. et al. Thyroid cancer and nonsteroidal anti-inflammatory drug use: a pooled analysis of patients older than 40 years of age. Thyroid 25, 1355–1362 (2015).

    PubMed  PubMed Central  Article  CAS  Google Scholar 

  48. Kitahara, C. M. et al. Physical activity, diabetes, and thyroid cancer risk: a pooled analysis of five prospective studies. Cancer Causes Control http://dx.doi.org/10.1007/s10552-012-9896-y (2012).

    Google Scholar 

  49. Kitahara, C. M. et al. Cigarette smoking, alcohol intake, and thyroid cancer risk: a pooled analysis of five prospective studies in the United States. Cancer Causes Control 23, 1615–1624 (2012).

    PubMed  PubMed Central  Article  Google Scholar 

  50. Kitahara, C. M. et al. Anthropometric factors and thyroid cancer risk by histological subtype: pooled analysis of 22 prospective studies. Thyroid 26, 306–318 (2016). This study is a comprehensive evaluation of the associations of height and several indicators of adiposity, including BMI in younger and middle-to-older adulthood, with thyroid cancer risk by histologic type and thyroid-cancer-specific mortality using a compilation of data from 22 large prospective studies from North America, Europe, Australia and Asia. The findings support aetiologic differences in thyroid cancer according to histologic type and tumour aggressiveness.

    PubMed  PubMed Central  Article  Google Scholar 

  51. Aschebrook-Kilfoy, B., Kaplan, E. L., Chiu, B. C., Angelos, P. & Grogan, R. H. The acceleration in papillary thyroid cancer incidence rates is similar among racial and ethnic groups in the United States. Ann. Surg. Oncol. 20, 2746–2753 (2013).

    Article  PubMed  Google Scholar 

  52. Dal Maso, L., Bosetti, C., La Vecchia, C. & Franceschi, S. Risk factors for thyroid cancer: an epidemiological review focused on nutritional factors. Cancer Causes Control 20, 75–86 (2009).

    Article  PubMed  Google Scholar 

  53. Furukawa, K. et al. Long-term trend of thyroid cancer risk among Japanese atomic-bomb survivors: 60 years after exposure. Int. J. Cancer 132, 1222–1226 (2013).

    Article  CAS  PubMed  Google Scholar 

  54. Sinnott, B., Ron, E. & Schneider, A. B. Exposing the thyroid to radiation: a review of its current extent, risks, and implications. Endocr. Rev. 31, 756–773 (2010).

    PubMed  PubMed Central  Article  Google Scholar 

  55. Ron, E. et al. Thyroid cancer after exposure to external radiation: a pooled analysis of seven studies. Radiat. Res. 141, 259–277 (1995). Data from five cohort studies and two case–control studies were pooled to quantify the radiation dose-response association for thyroid cancer and revealed a much stronger association for radiation exposure at younger (particularly <5 years) versus older ages.

    Article  CAS  PubMed  Google Scholar 

  56. National Council on Radiation Protection and Measurements. NCRP Report No. 160, Ionizing Radiation Exposure of the Population of the United States (NCRP, 2009).

  57. Pellegriti, G., Frasca, F., Regalbuto, C., Squatrito, S. & Vigneri, R. Worldwide increasing incidence of thyroid cancer: update on epidemiology and risk factors. J. Cancer Epidemiol. 2013, 965212 (2013).

    PubMed  PubMed Central  Article  Google Scholar 

  58. Schonfeld, S. J., Lee, C. & Berrington de Gonzalez, A. Medical exposure to radiation and thyroid cancer. Clin. Oncol. (R. Coll. Radiol.) 23, 244–250 (2011).

    Article  CAS  Google Scholar 

  59. Hamatani, K. et al. RET/PTC rearrangements preferentially occurred in papillary thyroid cancer among atomic bomb survivors exposed to high radiation dose. Cancer Res. 68, 7176–7182 (2008).

    Article  CAS  PubMed  Google Scholar 

  60. Nikiforov, Y. E., Rowland, J. M., Bove, K. E., Monforte-Munoz, H. & Fagin, J. A. Distinct pattern of ret oncogene rearrangements in morphological variants of radiation-induced and sporadic thyroid papillary carcinomas in children. Cancer Res. 57, 1690–1694 (1997).

    CAS  PubMed  Google Scholar 

  61. Ciampi, R. & Nikiforov, Y. E. RET/PTC rearrangements and BRAF mutations in thyroid tumorigenesis. Endocrinology 148, 936–941 (2007).

    Article  CAS  PubMed  Google Scholar 

  62. Fugazzola, L. et al. Oncogenic rearrangements of the RET proto-oncogene in papillary thyroid carcinomas from children exposed to the Chernobyl nuclear accident. Cancer Res. 55, 5617–5620 (1995).

    CAS  PubMed  Google Scholar 

  63. Elisei, R. et al. BRAFV600E mutation and outcome of patients with papillary thyroid carcinoma: a 15-year median follow-up study. J. Clin. Endocrinol. Metab. 93, 3943–3949 (2008).

    Article  CAS  PubMed  Google Scholar 

  64. Collins, B. J., Schneider, A. B., Prinz, R. A. & Xu, X. Low frequency of BRAF mutations in adult patients with papillary thyroid cancers following childhood radiation exposure. Thyroid 16, 61–66 (2006).

    Article  CAS  PubMed  Google Scholar 

  65. Xing, M. BRAF mutation in thyroid cancer. Endocr. Relat. Cancer 12, 245–262 (2005).

    Article  CAS  PubMed  Google Scholar 

  66. Romei, C. et al. Modifications in the papillary thyroid cancer gene profile over the last 15 years. J. Clin. Endocrinol. Metab. 97, E1758–E1765 (2012). This study demonstrated changes in the molecular profile of PTC, with increases in BRAF mutations and decreases in RET/PTC rearrangements. The authors discuss several possible explanations, including environmental exposures that could account for these trends.

    Article  CAS  PubMed  Google Scholar 

  67. Jung, C. K. et al. The increase in thyroid cancer incidence during the last four decades is accompanied by a high frequency of BRAF mutations and a sharp increase in RAS mutations. J. Clin. Endocrinol. Metab. 99, E276–E285 (2014). This study demonstrated changes in the molecular profile of PTC, with increases in RAS mutations and decreases in RET/PTC rearrangements. The authors discuss several possible explanations, including environmental exposures that could account for these trends.

    Article  CAS  PubMed  Google Scholar 

  68. Kebebew, E. et al. The prevalence and prognostic value of BRAF mutation in thyroid cancer. Ann. Surg. 246, 466–470; discussion 470–471 (2007).

    PubMed  PubMed Central  Article  Google Scholar 

  69. Mathur, A. et al. Higher rate of BRAF mutation in papillary thyroid cancer over time: a single-institution study. Cancer 117, 4390–4395 (2011). This study demonstrated changes in the molecular profile of PTC, with increases in BRAF V600E mutations over time. The authors discuss several possible explanations, including environmental exposures that could account for this trend.

    PubMed  Article  CAS  Google Scholar 

  70. Brignardello, E. et al. Ultrasound screening for thyroid carcinoma in childhood cancer survivors: a case series. J. Clin. Endocrinol. Metab. 93, 4840–4843 (2008).

    Article  CAS  PubMed  Google Scholar 

  71. Acharya, S. et al. Thyroid neoplasms after therapeutic radiation for malignancies during childhood or adolescence. Cancer 97, 2397–2403 (2003).

    Article  PubMed  Google Scholar 

  72. Crom, D. B. et al. Ultrasonography for thyroid screening after head and neck irradiation in childhood cancer survivors. Med. Pediatr. Oncol. 28, 15–21 (1997).

    Article  CAS  PubMed  Google Scholar 

  73. Ng, M. et al. Global, regional, and national prevalence of overweight and obesity in children and adults during 1980–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 384, 766–781 (2014).

    PubMed  PubMed Central  Article  Google Scholar 

  74. Tresallet, C. et al. The incidence of papillary thyroid carcinoma and outcomes in operative patients according to their body mass indices. Surgery 156, 1145–1152 (2014).

    Article  PubMed  Google Scholar 

  75. Kim, H. J. et al. Associations between body mass index and clinico-pathological characteristics of papillary thyroid cancer. Clin. Endocrinol. (Oxf.) 78, 134–140 (2013).

    Article  Google Scholar 

  76. Choi, J. S., Kim, E. K., Moon, H. J. & Kwak, J. Y. Higher body mass index may be a predictor of extrathyroidal extension in patients with papillary thyroid microcarcinoma. Endocrine 48, 264–271 (2015).

    Article  CAS  PubMed  Google Scholar 

  77. Kitahara, C. M., Gamborg, M., Berrington de Gonzalez, A., Sorensen, T. I. & Baker, J. L. Childhood height and body mass index were associated with risk of adult thyroid cancer in a large cohort study. Cancer Res. 74, 235–242 (2014).

    Article  CAS  PubMed  Google Scholar 

  78. Pazaitou-Panayiotou, K., Polyzos, S. A. & Mantzoros, C. S. Obesity and thyroid cancer: epidemiologic associations and underlying mechanisms. Obes. Rev. 14, 1006–1022 (2013).

    Article  CAS  PubMed  Google Scholar 

  79. Kim, W. G., Park, J. W., Willingham, M. C. & Cheng, S. Y. Diet-induced obesity increases tumor growth and promotes anaplastic change in thyroid cancer in a mouse model. Endocrinology 154, 2 936–2947 (2013).

    Google Scholar 

  80. Ng, M. et al. Smoking prevalence and cigarette consumption in 187 countries, 1980–2012. JAMA 311, 183–192 (2014).

    Article  CAS  PubMed  Google Scholar 

  81. Wiersinga, W. M. Smoking and thyroid. Clin. Endocrinol. (Oxf.) 79, 145–151 (2013).

    Article  CAS  Google Scholar 

  82. Zimmermann, M. B. & Galetti, V. Iodine intake as a risk factor for thyroid cancer: a comprehensive review of animal and human studies. Thyroid Res. 8, 8 (2015).

    PubMed  PubMed Central  Article  CAS  Google Scholar 

  83. Blomberg, M., Feldt-Rasmussen, U., Andersen, K. K. & Kjaer, S. K. Thyroid cancer in Denmark 1943–2008, before and after iodine supplementation. Int. J. Cancer 131, 2360–2366 (2012).

    Article  CAS  PubMed  Google Scholar 

  84. Levin, M. L. The occurrence of lung cancer in man. Acta Unio Int. Contra Cancrum 9, 531–541 (1953).

    CAS  PubMed  Google Scholar 

  85. Ogden, C. L., Carroll, M. D., Kit, B. K. & Flegal, K. M. Prevalence of childhood and adult obesity in the United States, 2011–2012. JAMA 311, 806–814 (2014).

    PubMed  PubMed Central  Article  CAS  Google Scholar 

  86. National Center for Health Statistics. Early release of selected estimates based on data from the National Health Interview Survey, 2014. Centers for Disease Control and Prevention http://www.cdc.gov/nchs/fastats/smoking.htm (2016).

  87. Zagzag, J. et al. Method of detection of well-differentiated thyroid cancers in obese and non-obese patients. PLoS ONE 11, e0152768 (2016).

    PubMed  PubMed Central  Article  CAS  Google Scholar 

  88. Loeb, S. et al. Overdiagnosis and overtreatment of prostate cancer. Eur. Urol. 65, 1046–1055 (2014).

    PubMed  PubMed Central  Article  Google Scholar 

  89. Sugitani, I. et al. Three distinctly different kinds of papillary thyroid microcarcinoma should be recognized: our treatment strategies and outcomes. World J. Surg. 34, 1222–1231 (2010).

    Article  PubMed  Google Scholar 

  90. Wang, T. S., Goffredo, P., Sosa, J. A. & Roman, S. A. Papillary thyroid microcarcinoma: an over-treated malignancy? World J. Surg. 38, 2297–2303 (2014).

    Article  PubMed  Google Scholar 

  91. Giordano, D. et al. Complications of central neck dissection in patients with papillary thyroid carcinoma: results of a study on 1087 patients and review of the literature. Thyroid 22, 911–917 (2012).

    Article  PubMed  Google Scholar 

  92. Applewhite, M. K. et al. Quality of life in thyroid cancer is similar to that of other cancers with worse survival. World J. Surg. 40, 551–561 (2016).

    Article  PubMed  Google Scholar 

  93. Ramsey, S. et al. Washington State cancer patients found to be at greater risk for bankruptcy than people without a cancer diagnosis. Health Aff. (Millwood) 32, 1143–1152 (2013).

    Article  Google Scholar 

  94. Lubitz, C. C. et al. Annual financial impact of well-differentiated thyroid cancer care in the United States. Cancer 120, 1345–1352 (2014).

    PubMed  Article  Google Scholar 

  95. Aschebrook-Kilfoy, B. et al. The clinical and economic burden of a sustained increase in thyroid cancer incidence. Cancer Epidemiol. Biomarkers Prev. 22, 1252–1259 (2013).

    Article  PubMed  Google Scholar 

  96. Cooper, D. S. et al. Management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid 16, 109–142 (2006).

    Article  PubMed  Google Scholar 

  97. Hoang, J. K. et al. Managing incidental thyroid nodules detected on imaging: white paper of the ACR Incidental Thyroid Findings Committee. J. Am. Coll. Radiol. 12, 143–150 (2015).

    Article  PubMed  Google Scholar 

  98. Haugen, B. R. et al. 2015 American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: the American Thyroid Association guidelines task force on thyroid nodules and differentiated thyroid cancer. Thyroid 26, 1–133 (2016). This article describes the most recent set of evidence-based guidelines from the American Thyroid Association for clinical decision-making in the management of thyroid nodules and differentiated thyroid cancer.

    PubMed  PubMed Central  Article  Google Scholar 

  99. Cooper, D. S. et al. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid 19, 1167–1214 (2009).

    Article  PubMed  Google Scholar 

  100. Ito, Y. et al. An observational trial for papillary thyroid microcarcinoma in Japanese patients. World J. Surg. 34, 28–35 (2010). The results of this study provide support for observation as a viable treatment option for patients with papillary thyroid microcarcinomas without unfavourable features.

    Article  PubMed  Google Scholar 

  101. Ito, Y. et al. Patient age is significantly related to the progression of papillary microcarcinoma of the thyroid under observation. Thyroid 24, 27–34 (2014).

    PubMed  PubMed Central  Article  CAS  Google Scholar 

  102. Shrestha, R. T., Karunamurthy, A., Amin, K., Nikiforov, Y. E. & Caramori, M. L. Multiple mutations detected preoperatively may predict aggressive behavior of papillary thyroid cancer and guide management — a case report. Thyroid 25, 1375–1378 (2015).

    Article  CAS  PubMed  Google Scholar 

  103. Nikiforova, M. N., Wald, A. I., Roy, S., Durso, M. B. & Nikiforov, Y. E. Targeted next-generation sequencing panel (ThyroSeq) for detection of mutations in thyroid cancer. J. Clin. Endocrinol. Metab. 98, E1852–E1860 (2013).

    PubMed  PubMed Central  Article  CAS  Google Scholar 

  104. Edge, S. B. et al. (eds) AJCC Cancer Staging Manual 7th edn 59–64 (Springer-Verlag, 2010).

    Google Scholar 

  105. Adam, M. A. et al. Presence and number of lymph node metastases are associated with compromised survival for patients younger than age 45 years with papillary thyroid cancer. J. Clin. Oncol. 33, 2370–2375 (2015).

    Article  PubMed  Google Scholar 

  106. Nikiforov, Y. E. et al. Nomenclature revision for encapsulated follicular variant of papillary thyroid carcinoma: a paradigm shift to reduce overtreatment of indolent tumors. JAMA Oncol. http://dx.doi.org/10.1001/jamaoncol.2016.0386 (2016).

Download references

Acknowledgements

C.M.K. and J.A.S. acknowledge S. Devesa and D. Check of the Biostatistics Branch and H. Lim of the Radiation Epidemiology Branch of the Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, for assistance with the figure in the article and analysis of SEER and US mortality data.

Author information

Authors and Affiliations

Authors

Contributions

C.M.K. and J.A.S. researched data for the article, made substantial contributions to discussion of the content, wrote the article and reviewed and/or edited the manuscript before submission.

Corresponding author

Correspondence to Cari M. Kitahara.

Ethics declarations

Competing interests

C.M.K. declares no competing interests. J.A.S. is on the Data Monitoring Committee of the Medullary Thyroid Cancer Consortium Registry, which is sponsored by Astra Zeneca, Eli Lilly, GlaxoSmithKline and Novo Nordisk.

PowerPoint slides

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Kitahara, C., Sosa, J. The changing incidence of thyroid cancer. Nat Rev Endocrinol 12, 646–653 (2016). https://doi.org/10.1038/nrendo.2016.110

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/nrendo.2016.110

Further reading

Search

Quick links

Nature Briefing

Sign up for the Nature Briefing newsletter — what matters in science, free to your inbox daily.

Get the most important science stories of the day, free in your inbox. Sign up for Nature Briefing