The Increasing Incidence of Thyroid Cancer: The Influence of Access to Care

Abstract

Markers for higher levels of health care access, both sociodemographic and age-based, are associated with higher papillary thyroid cancer incidence rates. More papillary thyroid cancers are diagnosed among populations with wider access to healthcare. Despite the threefold increase in incidence over three decades, the mortality rate remains unchanged. Together with the large subclinical reservoir of occult papillary thyroid cancers, these data provide supportive evidence for the widespread overdiagnosis of this entity.

The Impact of Subclinical Disease and Mechanism of Detection on the Rise in Thyroid Cancer Incidence: A Population-Based Study in Olmsted County, Minnesota During 1935 Through 2012

“…Thus, a large pool of subclinical TC exists in the population. The discovery of this subclinical pool of TC lesions is directly associated with the access of individuals to health care, as has been demonstrated in a prior analysis of the SEER database (19). During the period 2000-2012, we have identified four important pathways for the detection of subclinical thyroid cancer, as shown in Figure 1.…”

The Epidemic of Thyroid Cancer in the United States: The Role of Endocrinologists and Ultrasounds

“…A recent ecologic study using the Surveillance, Epidemiology and End Results (SEER) data indicated that higher levels of healthcare access are associated with higher papillary thyroid cancer rates, which provided supportive evidence for the overdiagnosis of thyroid cancer (3). However, other studies offered divergent opinions (4,5).…”

Differentiated thyroid cancer incidentally detected by 18F-FDG PET/CT: patient’s future in a hot-spot?

“…An increasing number of thyroid incidentalomas is certainly one of the causes of the so-called "thyroid cancer epidemic", i.e. the increase in the number of differentiated thyroid cancers (DTC) [3]. The widespread use of ultrasonography (US) and subsequent fine-needle aspiration biopsy undoubtedly coincided with the larger number of small, clinically occult thyroid cancers [3].…”

“…the increase in the number of differentiated thyroid cancers (DTC) [3]. The widespread use of ultrasonography (US) and subsequent fine-needle aspiration biopsy undoubtedly coincided with the larger number of small, clinically occult thyroid cancers [3]. Another source of thyroid incidentalomas is the increasing rate of reporting of thyroid lesions during other nonthyroid imaging investigations (carotid US imaging, CT, 18 F-FDG PET [4].…”

“…In this context, incidentalomas discovered on US imaging have in particular been connected to possible overdiagnosis. In fact, the rising number of DTC may mainly refer to detection of cancers which would not have caused any relevant health problem if undetected [3,5]. In contrast, given the exquisite functional/metabolic nature of 18 F-FDG PET, incidental discovery of DTC by means of PET may not provide a simple unexpected diagnosis of cancer.…”