E R N ES TO M O L AN E T WO R K WO N C A I TA L I A

Lecce - Italy

Preventing overmedicalization by listening

and sharingOvermediclization and Quaternary Prevention

Thiroid Cancer Epidemic

1

Presentation of

Hyeong Sik Ahn, MD, PhDKorea University School of Medicine

WHO 2015 International Workshop in Seoul

Use of CT in Asymptomatic People for Individual Health Assessment (IHA)

Korean Health Care System; Private Dominant,

Fee for Service. Competition by Higher Technology

Private hospital

2

Cancer Eligible Frequency Test / Procedure

40 & over

adultsevery 2 yrs endoscopy or UGI

Breast 40 & overwomen every 2 yrs mammography & CBE

Cervix 30 & over

womenevery 2 yrs Pap smear

Liver 40 & overhigh risk group every 6 mo sonography & AFP

Colorectal50 & over

adultsevery 1 yr FOBT colonoscopy or

barium enema

* 40 & over with HBsAg positive or anti-HCV positive or liver cirrhosis

7

National cancer screening program

Screening Recommendation

1999 - Add on Screening for Thyroid, Prostate

with Inexpensive Charge (30 USD)

The thyroid cancer

Differentiated thyroid cancer(> 90%) It includes papillary and follicular thyroid cancer, coming from thyroid cells. Not aggressive. The medullary thiroid cancer5% out of thiroid cancer. It comes from parafollicular cells which produce calcitonine.The anaplastic thyroid cancer<1%. Aggressive. It invades quickly organs and surroundings tissues.

CI5Plus - IARC

US(Whites)

US(Blacks)

India

China

France

Australia

UK

10

Incidence of Thyroid Cancer ; WorldwideFemale Male

Ahn HS et al. N Engl J Med2014;371:1765-1767.11

Korea's Thyroid-Cancer “Epidemic”

Begin a National Screening Program

Worldwide Thyroid-Cancer Epidemic? - NEJM 2016United States

Italy

France

England & Scotland

Nordic Countries

Japan

Australia

South Korea

13

14

Thyroid

Breast

Colon/rectum

StomachLung

Ulterine cervix

Liver

0

20

40

60

80

100

120

140

1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

Rat

e(P

er

100

,000

Pop

ula

tio

n)

Trend in Age-standardized Incidence Rates of Cancer

(Female)

Trend in Age-standardized Incidence Rates of Cancer (Male)

Lung

Liver

0

Colon/rectum

20

40

60

120

100

80

Stomach

Prostate

Thyroid

1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

Rat

e(P

er

10

0,0

00Po

pu

lati

on

)

15

Thyroid Cancer Mortality_Years(2000~2011)

0

0.2

0.6

Male0.4

0.8

1

1.2

Female

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

Mo

rtal

ity

Harms ; Thyroid cancer diagnosis and surgery

• diagnosed cases are surgeried

(radical bilateral thyroidectomy, everyday hormone

replacement medication)

• Surgical Complication ;

Hypoparathyroidism (10%)

Vocal cord paralysis ( 2%)

• (Radioactive iodine) ; relationship with leukemia?

•Sharply increased thyroid cancer incidence with screening

• No change in cancer related mortality

-> overdiagnosis

• Thyroid cancer screening are not recommended to generalpublic

• When studying on thyroid cancer epidemiology,

‘screening effect’ should be considered.

Summary; Thyroid Cancer Screening and Incidence

in Korea