Lancet Diabetes Endocrinol: Thyroid cancer incidence is rising rapidly because of overdiagnosis?

The incidence of thyroid cancer is on the rise globally, and according to the China Cancer Registry, thyroid cancer in China will continue to grow at a rate of 20% per yearHowever, the mortality rate from thyroid cancer remains relatively stable, even decliningThe increase inrates reflects advances in diagnostic techniques such as ultrasound examinations and raises concerns about overdiagnosisbecause it is a relative "lazy cancer" and progress is slow, and many patients have no symptoms or discomfortWithout a diagnostic and histological test, some patients may not be diagnosed with thyroid cancer for the rest of their livesin order to quantify the global trend and impact of overdiagnosis of thyroid cancer, the International Agency for Research on Cancer (IARC), aof the World Health Organization, analysed theof all thyroid cancer cases reported in 26 countries across four continents and among people aged 15-84 between 1998 and 2012The report is published in The Lancet - Diabetes and Endocrinologyscreenshotsource:theof heLancet Diabetes and EndocrinologyIARC researchers found that thyroid cancer rates continued to grow steadily in all high-income countries from 1998 to 2008-2012, and this trend was observed in low- and middle-income regions, particularlyChina,, Colombia, Lithuania and Belarus the incidence of the disease varies from country to country, but are particularly high among middle-aged women (35-64 years) in The most prominent of this trend is in South Korea: the incidence of thyroid cancer in women aged 50-59 in 2008-2012 (260 cases per 100,000 population), more than double (120 cases per 100,000 population) in 2003-2007 and more than seven times higher than in 1998-2002 (35 cases per 100,000 population) From the graph, the trend of China is also more obvious
the incidence of thyroid cancer in women of all ages in different countries from 1998 to 2012, the real line is the actual observation value, the dotted line is the prediction value without overdiagnosis (i.e advanced diagnostic technology and high-level detection screening) bits of assessment of the impact of overdiagnosis The researchers mapped a "historical-specific age curve" to comparing the incidence of symptomatic thyroid cancer before the introduction of ultrasound, and attributed the difference between actual and predicted values to overdiagnosis, an enhanced test of thyroid nodules that rarely lead to death in middle-aged people , the estimated proportion of thyroid cancer cases in women under overdiagnosis in 2008-2012, about 93% in South Korea, 91% in Belarus, 87% in in China, 84% in Italy and Croatia and 83% in Slovakia and France In other words, between 2008 and 2012, more than 830,000 female patients in these 26 countries were overdiagnosed, including about 390,000 women in China
, about 140,000 women in South Korea, 120,000 in the United States, 31,000 in Italy and 25,000 in France Denmark, Norway, Ireland, the UK, Japan and Thailand had a relatively low proportion of overdiagnosis, but it was almost half of all female patients observed a similar pattern in men, although at a slightly smaller rate , the proportion of overdiagnosed cases among men in each country was about 10 per cent lower than in women Overall, more than 220,000 men were overdiagnosed with thyroid cancer between 2008 and 2012 in 26 study countries research team believes that although radiation exposure, overweight and obesity and other risk factors may also increase the incidence of thyroid cancer, but from the above epidemiological characteristics, the increase in the incidence of adenocarcinoma is mainly due to the impact of overdiagnosis differences in morbidity between countries may also reflect local medical practices For example, South Korea's national screening program provides additional thyroid tests, while in other countries overdiagnosis may depend on the intensity of monitoring and the extent to which ultrasound and other diagnostic techniques are used Thyroid cancer is occasionally accidentally detected in imaging tests for other diseases overdiagnosis is more common in women and reflects the gender difference sexist thyroid disease, with a incidence rate of about 3:1 in 26 study countries the interaction of the thyroid gland with female reproductive hormones may lead to the development of thyroid disease and thyroid nodules, and due to factors such as reproduction and menopause, women generally have more medical treatment and more opportunities for potential thyroid examination however, thyroid cancer mortality rates are low for both men and women, with no gender difference in the prevalence of thyroid cancer found in autopsies report concludes, IARC researchers stress that while there is evidence that overdiagnosis is more harmful, more countries are increasingly offering thyroid cancer diagnosis techniques This increases the cost of care for individuals and the resource burden of the health care system, and, more importantly, this may turn healthy individuals into patients and receive that would otherwise be unnecessary for life most patients diagnosed with thyroid cancer receive additional treatments such as full thyroidectomy and radiotherapy, neck lymph node cleaning, and so on Although thyroid cancer surgery is effective, it can also cause injury , such as damage to the nerves that control the vocal cords, or damage to the glands that control blood calcium, although the risk is small In addition, patients who have had their thyroid removed need to take hormones for life to maintain their function currently top hospitals around the world, including the Mayo Clinic and Memorial Sloan Kettering Cancer Center, and a number of guidelines now recommend that thyroid cancer scant in asymptomatic individuals and promote active monitoring of micro-tumors rather than immediate treatment The Memorial Sloan-Kettering Cancer Center, which published research in the Journal of the American Medical Association, has shown that active monitoring is effective in the most common form of papilloma thyroid cancer in thyroid cancer According to the China Health and Health Commission's Thyroid Cancer Diagnostic And Treatment Code (2018 Edition), the high-risk groups that need to be monitored for screening for thyroid cancer include: (1) history of exposure to radiation from the head and neck in childhood or exposure to radioactive dust; (2) a history of systemic radiation therapy; (3) have a history of past or family histories of differentiated thyroid cancer, thyroid myelin cancer or multiple endocrine adenoma type 2 (MEN2), familial polyps, certain thyroid cancer syndromes (e.g., multiple dissocoma syndrome), Carney syndrome, Werner syndrome syndrome, and Gardner syndrome