Thyroid Cancer Incidence Trends in the United States: Association with Changes in Professional Guidelines' recommendations.

Thyroid Cancer Incidence Trends in the United States: Association with Changes in Professional Guidelines' recommendations.:

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Thyroid Cancer Incidence Trends in the United States: Association with Changes in Professional Guidelines' recommendations.

Thyroid. 2020 Feb 26;:

Authors: Pereira MM, Williams VL, Hallanger-Johnson JE, Valderrabano P

Abstract

Background Overdiagnosis is the leading factor contributing to the rapid increase in thyroid cancer incidence of the last decades. During this period, however, thyroid cancer incidence has not been increasing at a constant pace. We hypothesized that changes in the slope of the incidence trends curve, called joinpoints, could be associated with changes in clinical practice guidelines' recommendations. Methods Data was obtained from the initial 9 registries of the Surveillance, Epidemiology, and End Results Program (SEER-9). Thyroid cancer incidence was analyzed from 1975 to 2016. Joinpoints in thyroid cancer incidence trends and clinical variables were correlated with significant changes in clinical practice recommendations. Results Incidence rate trends of Medullary and Anaplastic thyroid cancer were constant during the study period. Among papillary thyroid cancers, three main joinpoints were identified, mainly driven by changes in incidence trends of smaller cancers. First, acceleration followed by two deceleration periods in thyroid cancer incidence coincident in time with the release of American Thyroid Association guidelines in 1996, 2009, and 2015. In 1996, the use of thyroid ultrasound and fine needle aspiration biopsy for the evaluation of thyroid nodules was described; and in 2009 and 2015, higher size-thresholds for the biopsy of thyroid nodules were set. For the follicular variant of papillary thyroid carcinoma a joinpoint was observed around 1988, when the histological diagnosis of this entity was revised in the World Health Organization classification; and another one in 2015 coinciding with the proposal to remove the term carcinoma from non-invasive follicular-pattern tumors with papillary-like nuclear features which contributed to drive down the overall thyroid cancer incidence. Follicular thyroid cancer incidence was affected as well by changes in the guidelines but to a lesser extent; and it was fairly stable during the study period. Conclusions This study suggests that thyroid cancer incidence trends have been shaped in large part, but not completely, by changes in professional guidelines' recommendations.

PMID: 32098591 [PubMed - as supplied by publisher]