Increase in the Incidence of Differentiated Thyroid Carcinoma in Children, Adolescents, and Young Adults: A Population-Based Study

doi:10.1016/j.jpeds.2014.01.059

The Journal of Pediatrics

Volume 164, Issue 6, June 2014, Pages 1481-1485

Portions of the study were presented as a poster at the meeting of the American Society of Clinical Oncology, Chicago, IL, June 1-5, 2012.

https://doi.org/10.1016/j.jpeds.2014.01.059 Get rights and content

Objective

To investigate trends in incidence of differentiated thyroid carcinomas among children and adolescents and young adults.

Study design

In this ecological time-trends study, we selected cases of differentiated thyroid carcinomas (1984-2010) in patients <30 years from Surveillance, Epidemiology, and End Results 9 cancer registries by using International Classification of Diseases for Oncology, 3rd edition, codes for papillary and follicular cancers. Patients with multiple other primary diseases before differentiated thyroid carcinomas were excluded. SEER*Stat software, version 8.0.4 (National Cancer Institute, Bethesda, Maryland) was used to calculate age-standardized rates (estimated per 1 000 000/persons) and annual percentage changes (APCs) were calculated by the Joinpoint model (Joinpoint software, version 4.0.4; National Cancer Institute).

Results

Rates ranged from 2.77 (1990) to 9.63 (2009) and from 18.35 (1987) to 50.99 (2009), for male and female subjects, respectively. A significant increasing trend in incidence was observed for both male (APC 3.44; 95% CI 2.60-4.28) and female (APC 3.81; 95% CI 3.38-4.24) patients. When a stratified analysis on the basis of tumor size was performed, significant increasing trends were noted for the following categories: <0.5 cm (females: APC 5.09, 95% CI 3.54-6.65), 0.5-0.9 cm (females: APC 8.45, 95% CI 7.09-9.82), 1.0-1.9 cm (males: APC 5.09, 95% CI 3.20-7.01; females: APC 3.42, 95% CI 2.78-4.07), and ≥2 cm (males: APC 2.62, 95% CI 1.64-3.60; females: APC 2.96, 95% CI 2.34-3.59).

Conclusions

Incidence rates for differentiated thyroid carcinomas are increasing among children and adolescents and young adults in the US. The increasing trends for larger tumors rules out diagnostic scrutiny as the only explanation for the observed results. Environmental, dietary, and genetic influences should be investigated.

Section snippets

Methods

We selected cases of differentiated thyroid cancer diagnosed between 1984 and 2010 in patients <30 years of age from the National Cancer Institute's SEER 9 cancer registry (SEER*Stat Database: Incidence - SEER 9 Regs Research Data, Nov 2012 Sub [1973-2010] <Katrina/Rita Population Adjustment> - Linked To County Attributes - Total US, 1969-2011 Counties, National Cancer Institute, Division of Cancer Control and Population Sciences, Surveillance Research Program, Surveillance Systems Branch,

Results

Our series consisted of 6065 patients (5101 women) up to 29 years of age with differentiated thyroid carcinoma; 83.9% of cases occurred in white patients, and 96.8% occurred in adolescents and young adults (Table I). As reported in adult studies, incidence was lower in black patients (5.89 per million people vs 18.83 in white subjects). Tumors measuring 2.0 cm or more accounted for more than 50% of all tumors diagnosed in all age groups. There was an association between tumor size and age;

Discussion

Studies have shown an increase in the incidence of thyroid carcinoma in recent decades15, 16, 17, 18, 19, 20, 21; this increase does not appear to be geographically dependent.¹⁹ In this study we sought to investigate whether those same trends are seen at younger age through a population-based analysis encompassing the pediatric and older age groups. Although no changes in incidence trends were seen in children, similar trends seen in adults are occurring in adolescents and young adults.

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: L.V. was recipient of a scholarship from the program “Pesquisadores do Futuro”- Faculty of Medicine Sciences of Santa Casa of São Paulo, Brazil. The authors declare no conflicts of interest.

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Original ArticleIncrease in the Incidence of Differentiated Thyroid Carcinoma in Children, Adolescents, and Young Adults: A Population-Based Study

Objective

Study design

Results

Conclusions

Section snippets

Methods

Results

Discussion

J Adolesc Health

Ann Epidemiol

Eur J Cancer

J Am Coll Surg

Cancer statistics, 2012

CA Cancer J Clin

SEER Cancer Statistics Review, 1975-2006

Population-based outcomes for pediatric thyroid carcinoma

Laryngoscope

Thyroid cancer

Current controversies in the management of pediatric patients with well-differentiated nonmedullary thyroid cancer: a review

Thyroid

Prognostic factors in follicular carcinoma of the thyroid: a multivariate survival analysis

Eur J Oncol

Follicle-derived thyroid cancer in young people: the Duke experience

Pediatr Hematol Oncol

Differentiated thyroid cancer: determinants of disease progression in patients <21 years of age at diagnosis: a report from the Surgical Discipline Committee of the Children's Cancer Group

Ann Surg

Age is the major determinant of recurrence in pediatric differentiated thyroid carcinoma

Med Pediatr Oncol

Carcinomas and other malignant epithelial neoplasms

Differentiated thyroid cancer in children and adolescents: clinical outcome and mortality after long-term follow-up

Head Neck

Original Article
Increase in the Incidence of Differentiated Thyroid Carcinoma in Children, Adolescents, and Young Adults: A Population-Based Study