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  • Review Article
  • Published:

The changing incidence of thyroid cancer

Nature Reviews Endocrinology volume 12, pages 646–653 (2016)Cite this article

Subjects

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.

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

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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.

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Authors and Affiliations

  1. Division of Cancer Epidemiology and Genetics, Radiation Epidemiology Branch, National Cancer Institute, National Institutes of Health, 9609 Medical Center Drive, Room 7E-536, Bethesda, 20892–9778, Maryland, USA

    Cari M. Kitahara

  2. Department of Surgery, Section of Endocrine Surgery, Duke University, Seeley Mudd Building #484, 10 Searle Center Drive, DUMC #2945, Durham, 27710, North Carolina, USA

    Julie A. Sosa

  3. Duke Clinical Research Institute, North Pavilion, 2400 Pratt Street, Durham, 27705, North Carolina, USA

    Julie A. Sosa

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  1. Cari M. Kitahara
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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.

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Correspondence to Cari M. Kitahara.

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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.

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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

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