trends in thyroid cancer incidence and mortality, arkansas

ARKANSAS DEPARTMENT OF HEALTH


Trends in Thyroid Cancer Incidence and Mortality,

Arkansas and United States, 2001-2015

Sarah O’Connor, MPH Student

Applied Practice Experience


Outline

• Purpose

• Background

– Types

– Risk factors

– Screening recommendations

• Incidence rates and trends AR and US (2001 – 2015)

• Mortality rates and trends AR and US (2001 – 2015)

• Discussion

• Conclusion


Purpose

• Addendum to Arkansas Cancer Facts & Figures 2017

• Describe national and state-specific incidence rates and trends of thyroid cancer

• Describe national and state-specific mortality rates and trends of thyroid cancer


Background

• Estimated to be twelfth most common malignancy in the United States in 2018

• SEER case projections estimate 53,990 new cases will be diagnosed in 2018

– 40,900 cases will occur in females

– 13,090 cases will occur in males

• National age-adjusted incidence rate

– 2001, 7.9 per 100,000

– 2015, 14.5 per 100,000

• National age-adjusted mortality rate

– 2001, 0.5 per 100,000

– 2015, 0.5 per 100,000


Types of Thyroid Cancer

• Differentiated

– Prognosis is favorable, infrequently fatal

• Papillary

– Slow growing, commonly develop in one lobe of gland

• Follicular

• Undifferentiated

– Prognosis is less favorable

– Difficult to detect, diagnose, and treat compared to differentiated types

• Medullary

• Anaplastic


Thyroid Cancers by Histology, Arkansas,

2001 - 2015

Papillary 3067, 81%

Follicular348, 9%

Medullary89, 2%

Anaplastic28, 1%

Other, 278, 7%

Note: Cancers were identified using the International Classification of Diseases for Oncology, 3rd Edition (ICD-O-3) for invasive thyroid cancer (C73.9) with histology codes for papillary tumors(8050, 8260, 8340-8344, 8504), medullary thyroid tumors (8345-8347, 8510), follicular tumors (8330-8332, 8335), and anaplastic tumors (8021). Data retrieved from the Arkansas Central CancerRegistry (ACCR) on 10/03/2018. Totals may not match NPCR dataset since reported cases are added, retrospectively, to the ACCR dataset.


Risk Factors

• Female sex

• History of goiter or nodules

• Family history of thyroid cancer

• Childhood or adolescent exposure to radiation

• Obesity

Source: CDC - https://www.cdc.gov/vitalsigns/obesity-cancer/infographic.html#graphic AND

https://www.cdc.gov/cancer/thyroid/index.htm

https://www.cdc.gov/vitalsigns/obesity-cancer/infographic.html#graphic

https://www.cdc.gov/cancer/thyroid/index.htm


Screening for Thyroid Cancer

• For high-risk individuals or those experiencing any symptoms, there are various methods used to detect thyroid cancer.

– The two primary methods to screen for thyroid cancer include neck

palpation and ultrasound.

• The United States Preventative Services Task Force (USPSTF) recommends against screening for thyroid cancer among adults who are asymptomatic.(USPSTF, 2017)

• The USPSTF concludes with sufficient certainty that screening for thyroid cancer in asymptomatic adults is potentially harmful, which outweighs the benefit, or has no net benefit.(USPSTF, 2017)


Technical Notes

Incidence data obtained from:National Program of Cancer Registries and Surveillance, Epidemiology, and End

Results SEER*Stat Database: NPCR and SEER Incidence – U.S. Cancer Statistics

2001–2015 Public Use Research Database, based on November 2017 submission.

Cases were identified based on “Site and Morphology Site Recode ICD-O-3/WHO

2008 = Thyroid”. Accessed at (https://www.cdc.gov/cancer/uscs/public-

use/index.htm?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcancer%2Fnp

cr%2Fpublic-use%2Findex.htm) on Oct. 3 2018.

Mortality data obtained from:United States Department of Health and Human Services, Centers for Disease

Control and Prevention and National Cancer Institute, Mortality WONDER Online

Database. Case deaths identified based on underlying cause of death ICD-10 code

C73 “Malignant neoplasm of the thyroid gland”. Accessed at

(http://wonder.cdc.gov/cancer-v2015.html) on Oct 3, 2018.


Incidence of Thyroid Cancer

Arkansas and the United States


Thyroid Cancer Incidence Rates, by

State, 2011-2015

Source: NPCR Data Visualization Tool: https://gis.cdc.gov/Cancer/USCS/DataViz.html

https://gis.cdc.gov/Cancer/USCS/DataViz.html


Age-Adjusted Thyroid Cancer Incidence

Rates, by County, Arkansas 2011 – 2015

Note: Incidence rates per 100,000 population; age-adjusted to the 2000 U.S. Standard Population. Arkansas Cancer Registry. Age-Adjusted Cancer Incidence Rates in Arkansas, 2011 - 2015.Accessed at http://cancer-rates.info/ar/. Retrieved on 10/08/2018.


Age-Standardized Thyroid Cancer Incidence Trends with 95 Percent

Confidence Intervals, Arkansas and United States, 2001 - 2015

4.9 4.65.5

6.1 6.3

7.7 7.88.3

99.7 10.1 10.1

9.1

12.513.6

7.78.3

8.89.5

10.310.9

11.812.8

13.5 13.7 14 14.4 14.7 14.5 14.4

0

2

4

6

8

10

12

14

16

2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Rat

e p

er

10

0,0

00

Year

Arkansas; AAPC = 7.2* United States; AAPC = 4.6*

N = 419

*The AAPC is significantly different from zero (p < 0.05).Note: Abbreviation: AAPC - Annual Average Percent Change. AAPCs were calculated using weighted least squares method. Incidence rates per 100,000 population; age-adjusted to the 2000 U.S.Standard Population. United States Department of Health and Human Services, Centers for Disease Control and Prevention and National Cancer Institute. National Program of Cancer Registriesand Surveillance, Epidemiology, and End Results SEER*Stat Database: NPCR and SEER Incidence – U.S. Cancer Statistics 2001–2015 Public Use Research Database, based on November 2017submission. Cases were identified based on “Site and Morphology Site Recode ICD-O-3/WHO 2008 = Thyroid”. Accessed at www.cdc.gov/cancer/npcr/public-use. Retrieved on 10/03/2018.

Arkansas = 3,767 cases, 2001-2015

N = 134


Age-Standardized Thyroid Cancer Incidence Rates with 95 Percent

Confidence Intervals by Sex, Arkansas, 2001 - 2015

12.2

4.7

0

2

4

6

8

10

12

14

Female (AR) Male (AR)

Rat

e p

er

10

0,0

00

The rate for females is nearly 3-times (RR = 2.6) that of males.

Note: Incidence rates per 100,000 population; age-adjusted to the 2000 U.S. Standard Population.United States Department of Health and Human Services, Centers for Disease Control and Prevention and National Cancer Institute. National Program of Cancer Registries and Surveillance,Epidemiology, and End Results SEER*Stat Database: NPCR and SEER Incidence – U.S. Cancer Statistics 2001–2015 Public Use Research Database, based on November 2017 submission. Caseswere identified based on “Site and Morphology Site Recode ICD-O-3/WHO 2008 = Thyroid”. Accessed at www.cdc.gov/cancer/npcr/public-use. Retrieved on 10/03/2018.


Age-Standardized Thyroid Cancer Incidence Trends with 95

Percent Confidence Intervals, By Sex, Arkansas, 2001 - 2015

3 2.63.5 3.2 3.4

4.7 4.7 4.7 4.9 5.2 5.1 4.6 4.86.2

7.9

6.9 6.47.5

9 9.110.5 10.8

11.813

14.2 14.9 15.3

13.1

18.8 19.3

0

2

4

6

8

10

12

14

16

18

20

22

24

2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Rat

e p

er

10

0,0

00

Year

Male Female

Incidence rates per 100,000 population; age-adjusted to the 2000 U.S. Standard Population. United States Department of Health and Human Services, Centers for Disease Control and Preventionand National Cancer Institute. National Program of Cancer Registries and Surveillance, Epidemiology, and End Results SEER*Stat Database: NPCR and SEER Incidence – U.S. Cancer Statistics 2001–2015 Public Use Research Database, based on November 2017 submission. Cases were identified based on “Site and Morphology Site Recode ICD-O-3/WHO 2008 = Thyroid”. Accessed atwww.cdc.gov/cancer/npcr/public-use. Retrieved on 11/26/2018.


Age-Standardized Thyroid Cancer Incidence Rates with 95 Percent

Confidence Intervals by Race and Sex, Arkansas, 2001 - 2015

8.6

2.5

12.7

4.9

0

2

4

6

8

10

12

14

Black, F Black, M White, F White, M

Rat

e p

er

10

0,0

00

Note: Incidence rates per 100,000 population; age-adjusted to the 2000 U.S. Standard Population.United States Department of Health and Human Services, Centers for Disease Control and Prevention and National Cancer Institute. National Program of Cancer Registries and Surveillance,Epidemiology, and End Results SEER*Stat Database: NPCR and SEER Incidence – U.S. Cancer Statistics 2001–2015 Public Use Research Database, based on November 2017 submission. Caseswere identified based on “Site and Morphology Site Recode ICD-O-3/WHO 2008 = Thyroid”. Accessed at www.cdc.gov/cancer/npcr/public-use. Retrieved on 10/03/2018.


Age-Standardized Thyroid Cancer Incidence Trends with 95

Percent Confidence Intervals, By Race, Arkansas, 2001 - 2015

5 55.8

6.6 6.5 8.1 8.3 8.89.2 10.3 10.5 10.8

9.3

13.2 14.1

4.25.7 4.8 5.1 5.3 7.5 7.2 7.2

5.9 5.97.8

9.2

0

2

4

6

8

10

12

14

16

18

20

22

24

2001* 2002* 2003 2004* 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Rat

e p

er 1

00

,00

0

Year

White Black

Note: Incidence - Centers for Disease Control and Prevention and National Cancer Institute. National Program of Cancer Registries and Surveillance, Epidemiology, and End Results SEER*StatDatabase: NPCR and SEER Incidence – U.S. Cancer Statistics 2001–2015 Public Use Research Database, based on November 2017 submission. Cases were identified based on “Site andMorphology Site Recode ICD-O-3/WHO 2008 = Thyroid”. Accessed at www.cdc.gov/cancer/npcr/public-use. Retrieved on 10/03/2018.Mortality rates per 100,000 population; age-adjusted to the 2000 U.S. Standard Population. WONDER Online Database. Case deaths identified based on underlying cause of death ICD-10code C73 “Malignant neoplasm of the thyroid gland”.*For years 2001, 2002, and 2004 totals were not available due to suppression rules.


Age-Specific Thyroid Cancer Incidence Rates

by Race and Sex, Arkansas, 2001 – 2015

0

5

10

15

20

25

20-29* 30-39* 40-49* 50-59* 60-69 70-79* 80+^

Rat

e p

er

10

0,0

00

Age in Years at Diagnosis

Black, F

Black, M

White, F

White, M

Note: Incidence rates per 100,000 population; age-adjusted to the 2000 U.S. Standard Population.

* Rate for Black males not displayed due to fewer than 16 cases.^ Rate for Black females and males not displayed due to fewer than 16 cases.United States Department of Health and Human Services, Centers for Disease Control and Prevention and National Cancer Institute. National Program of Cancer Registries and Surveillance,Epidemiology, and End Results SEER*Stat Database: NPCR and SEER Incidence – U.S. Cancer Statistics 2001–2015 Public Use Research Database, based on November 2017 submission. Caseswere identified based on “Site and Morphology Site Recode ICD-O-3/WHO 2008 = Thyroid”. Accessed at www.cdc.gov/cancer/npcr/public-use. Retrieved on 10/03/2018.


Annual Median Age at Diagnosis, Arkansas, 2001 - 2015

0

10

20

30

40

50

60

70

80

90

100

2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Age

Median Age, 2001 – 2015 = 53

Source: Arkansas Central Cancer Registry, ADH


Thyroid Cancer, SEER 2000 Stage at Diagnosis,

by Race and Sex, Arkansas 2001 – 2015

76.8

20.4

2.8

69.7

24.3

6.1

74.5

23.4

2.2

63.2

33

3.8

0

10

20

30

40

50

60

70

80

90

Early Stage Late Stage Unstaged

Pe

rce

nt

Stage at Diagnosis

Black, F

Black, M

White, F

White, M

Note: United States Department of Health and Human Services, Centers for Disease Control and Prevention and National Cancer Institute. National Program of Cancer Registries andSurveillance, Epidemiology, and End Results SEER*Stat Database: NPCR and SEER Incidence – U.S. Cancer Statistics 2001–2015 Public Use Research Database, based on November 2017submission. Cases were identified based on “Site and Morphology Site Recode ICD-O-3/WHO 2008 = Thyroid”. Accessed at www.cdc.gov/cancer/npcr/public-use. Retrieved on 10/03/2018.


Thyroid Cancer Incidence by Tumor

Sequence*, Arkansas, 2001-2015

0

50

100

150

200

250

300

350

400

450

2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Co

un

t

Year

All Cases

First Primary

Second of 2+ Primaries^

* First Primary includes only 1 primary and first of 2 or more primaries.^ Data suppressed before 2006 due to <16 cases per year for multiple years.United States Department of Health and Human Services, Centers for Disease Control and Prevention and National Cancer Institute. National Program of Cancer Registries and Surveillance,Epidemiology, and End Results SEER*Stat Database: NPCR and SEER Incidence – U.S. Cancer Statistics 2001–2015 Public Use Research Database, based on November 2017 submission. Caseswere identified based on “Site and Morphology Site Recode ICD-O-3/WHO 2008 = Thyroid”. Accessed at www.cdc.gov/cancer/npcr/public-use. Retrieved on 11/26/2018.

2001-2015 (AR)

First primary: 3,397

Subsequent primaries: 370

Total: 3,767


Mortality of Thyroid Cancer

Arkansas and the United States


Age-Standardized Thyroid Cancer Incidence and Mortality Trends

with 95 Percent Confidence Intervals, United States, 2001 – 2015

0.5 0.5 0.5 0.5 0.5 0.5 0.5 0.5 0.5 0.5 0.5 0.5 0.5 0.5 0.5

7.78.3

8.89.5

10.310.9

11.812.8

13.5 13.7 14 14.4 14.7 14.5 14.4

0

2

4

6

8

10

12

14

16

2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Rat

e p

er

10

0,0

00

Mortality Incidence

Note: Mortality rates per 100,000 population; age-adjusted to the 2000 U.S. Standard Population. United States Department of Health and Human Services, Centers for Disease Control and Prevention and NationalCancer Institute, Mortality WONDER Online Database. Case deaths identified based on underlying cause of death ICD-10 code C73 “Malignant neoplasm of the thyroid gland”. Accessed athttp://wonder.cdc.gov/cancer-v2015.html on Oct 3, 2018. Incidence rates per 100,000 population; age-adjusted to the 2000 U.S. Standard Population. United States Department of Health and Human Services, Centersfor Disease Control and Prevention and National Cancer Institute. National Program of Cancer Registries and Surveillance, Epidemiology, and End Results SEER*Stat Database: NPCR and SEER Incidence – U.S. CancerStatistics 2001–2015 Public Use Research Database, based on November 2017 submission. Cases were identified based on “Site Recode ICD-O-3/WHO 2008 = Thyroid”. Accessed at www.cdc.gov/cancer/npcr/public-use. Retrieved on 10/03/2018.


Age-Standardized Thyroid Cancer Incidence and Mortality Trends with 95

Percent Confidence Intervals, Arkansas, 2001 – 2015

4.9 4.65.5

6.1 6.3

7.7 7.88.3

99.7 10.1 10.1

9.1

12.513.6

0.7 0.5 0.3 0.6 0.4 0.3 0.6 0.7 0.5 0.4 0.3 0.4 0.7 0.6

0

2

4

6

8

10

12

14

16

2001 2002 2003 2004 2005 2006 2007* 2008 2009 2010 2011 2012 2013 2014 2015

Rat

e p

er

10

0,0

00

Year

Arkansas Incidence Arkansas Mortality

Note: Incidence - Centers for Disease Control and Prevention and National Cancer Institute. National Program of Cancer Registries and Surveillance, Epidemiology, and End Results SEER*StatDatabase: NPCR and SEER Incidence – U.S. Cancer Statistics 2001–2015 Public Use Research Database, based on November 2017 submission. Cases were identified based on “Site andMorphology Site Recode ICD-O-3/WHO 2008 = Thyroid”. Accessed at www.cdc.gov/cancer/npcr/public-use. Retrieved on 10/03/2018.Mortality rates per 100,000 population; age-adjusted to the 2000 U.S. Standard Population. WONDER Online Database. Case deaths identified based on underlying cause of death ICD-10 codeC73 “Malignant neoplasm of the thyroid gland”.

*For year 2007, totals were not available due to suppression rules. Age-adjusted rates for years 2002-2008 , 2010-2013 were unreliable due to small numbers.

……………

N=20 N=20Arkansas = 233 deaths, 2001 - 2015

http://www.cdc.gov/cancer/npcr/public-use. Retrieved on 10/03/2018


Age-Standardized Thyroid Cancer Mortality Rates with 95 Percent

Confidence Interval by Sex, Arkansas, 2001 – 2015

0.5 0.5

0

2

4

6

8

10

12

14

Female Male

Rat

e p

er

10

0,0

00

Note: Mortality rates per 100,000 population; age-adjusted to the 2000 U.S. Standard Population. Centers for Disease Control and Prevention Wide-ranging Online Data for EpidemiologicResearch [CDC WONDER]. Case deaths identified based on underlying cause of death ICD-10 code C73 “Malignant neoplasm of the thyroid gland”. Accessed at http://wonder.cdc.gov/cancer-v2015.html on Oct 3, 2018.


10 Year Survival by SEER Summary

Stage, Arkansas, 2001 – 2015P

erc

en

t Su

rviv

ing

Years after Diagnosis

Note: Arkansas Central Cancer Registry, Survival estimates are based on passive follow-up of mortality from all causes among incident cases using death certificates from Arkansas Departmentof Health and linkage results from the National Death Index.

StageLocal

Regional

Distant

Thyroid cancer 10-year survival depends on stage at diagnosis.• Localized = 84%• Regional = 77%• Distant = 40%


Discussion

Incidence-Mortality Discrepancy

Indicative of enhanced disease detection and

overdiagnosis

Overdiagnosis

1973

Development of real-time scanning device which

produced 2-dimensional images(Woo, 2001)

Increase in the diagnostic capabilities of

ultrasonography

Subsequent increase in detection of thyroid

cancer, which included cases of

overdiagnosis(ACS, 2018)

The rise in detection was confined to papillary

thyroid cancer, the least aggressive and most

common type

Cohort Effect

1930s – 1960s

Children routinely treated with external radiation therapy for

benign conditions of the head and neck such as cystic acne

or enlarged tonsils(ACS, 2017, Haugen et al., 2015, Iglesias et al., 2017)

Minimum latency period after exposure to radiation before

development of radiation-related thyroid cancers is 5 to 10

years(Iglesias et al., 2017)

Risk increases and peaks at 20-35 years post-exposure(Iglesias et al., 2017)

Persons treated with radiation as children would be in the

peak risk post-exposure age range around 1950 through

1995

Threefold increase in age-adjusted incidence rates during

1975 through 2005 lends support to this suggested cohort

effect


Conclusion

Even with the increase in thyroid cancer diagnosis in Arkansas, incidence remains low compared to other cancers.

– 1.7% (n=3,767) of all cancer cases, 2001-2015

Risk reduction, especially in young children, is stressed for thyroid cancer prevention.

– Avoid unnecessary exposure to radiation of head and

neck

– Maintain normal body weight


References

Arkansas Central Cancer Registry. (2018). Age-Adjusted Cancer Incidence Rates in Arkansas, 2001 - 2015. Retrieved from http://cancer-rates.info/ar/

American Cancer Society. (2018). Cancer Facts & Figures 2018. Retrieved from https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/annual-cancer-facts-and-figures/2018/cancer-facts-and-figures-2018.pdf

Centers for Disease Control and Prevention, National Center for Health Statistics. Compressed Mortality File 1999-2016 on CDC WONDER Online Database,released June 2017. Data are from the Compressed Mortality File 1999-2016 Series 20 No. 2U, 2016, as compiled from data provided bythe 57 vital statistics jurisdictions through the Vital Statistics Cooperative Program. Accessed at http://wonder.cdc.gov/cmf-icd10.html

Haugen, B.R., Alexander, E.K., Bible, K.C., Doherty, G.M., Mandel, S.J., Nikiforov, Y.E., Pacini, F., Randolph, G.W., Sawka, A.M., Schlumberger, M., Schuff,K.G., Sherman, S.I., Sosa, J.A., Steward, D.L., Tuttle, R.M., Wartofsky, L. (2016). 2015 American Thyroid Association ManagementGuidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines TaskForce on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid, 26(1), 1-133. doi:10.1089/thy.2015.0020

Kitahara CM, McCullough ML, Franceschi S, et al. Anthropometric factors and thyroid cancer risk by histological subtype: Pooled analysis of 22 prospectivestudies. Thyroid 2016; 26(2):306-318.

Iglesias, M.L., Schmidt, A., Ghuzlan, A.A., LACCRoix, L., Vathaire, F., Chevillard, S., Schlumberger, M. (2017). Radiation exposure and thyroid cancer: a review.Archives of Endocrinology and Metabolism, 61(2), 180-187. doi:1590/2359-3997000000257

United States Preventive Services Task Force. (2017). Final Recommendation Statement: Thyroid Cancer: Screening. Rockville, MD: USPSTF. Retrieved fromhttps://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/thyroid-cancer-screening1

Woo, J. (2001). A short history of the real-time ultrasound scanner. Retrieved from http://www.ob-ultrasound.net/history-realtime.html

trends in thyroid cancer incidence and mortality, arkansas

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