Global patterns and trends in incidence and mortality of thyroid cancer in children and adolescents: a population-based study

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Abstract

Background: There has been a considerable increase in thyroid cancer incidence among adults in several countries in the past three decades, attributed primarily to overdiagnosis. We aimed to assess global patterns and trends in incidence and mortality of thyroid cancer in children and adolescents, in view of the increased incidence among adults. Methods: We did a population-based study of the observed incidence (in 49 countries and territories) and mortality (in 27 countries) of thyroid cancer in children and adolescents aged 0–19 years using data from the International Incidence of Childhood Cancer Volume 3 study database, the WHO mortality database, and the cancer incidence in five continents database (CI5plus; for adult data [age 20–74 years]). We analysed temporal trends in incidence rates, including absolute changes in rates, and the strength of the correlation between incidence rates in children and adolescents and in adults. We calculated the average annual number of thyroid cancer deaths and the age-standardised mortality rates for children and adolescents. Findings: Age-standardised incidence rates of thyroid cancer among children and adolescents aged 0–19 years ranged from 0·4 (in Uganda and Kenya) to 13·4 (in Belarus) cancers per 1 million person-years in 2008–12. The variability in the incidence rates was mostly accounted for by the papillary tumour subtype. Incidence rates were almost always higher in girls than in boys and increased with age in both sexes. Rapid increases in incidence between 1998–2002 and 2008–12 were observed in almost all countries. Country-specific incidence rates in children and adolescents were strongly correlated (r>0·8) with rates in adults, as were the temporal changes in the respective incidence rates (r>0·6). Thyroid cancer deaths in those aged younger than 20 years were less than 0·1 per 10 million person-years in each country. Interpretation: The pattern of thyroid cancer incidence in children and adolescents mirrors the pattern seen in adults, suggesting a major role for overdiagnosis, which, in turn, can lead to overtreatment, lifelong medical care, and side effects that can negatively affect quality of life. We suggest that the existing recommendation against screening for thyroid cancer in the asymptomatic adult population who are free from specific risk factors should be extended to explicitly recommend against screening for thyroid cancer in similar populations of children and adolescents. Funding: International Agency for Research on Cancer and the Union for International Cancer Control; French Institut National du Cancer; Italian Association of Cancer Research; and Italian Ministry of Health.

Original languageEnglish
Pages (from-to)144-152
Number of pages9
JournalThe Lancet Diabetes and Endocrinology
Volume9
Issue number3
DOIs
Publication statusPublished - Mar 2021

Bibliographical note

Funding Information:
This study results from a coordinated effort of all data providers, the staff in the named registries and the registries' funders as specified in the IICC-3 publication, which we gratefully acknowledge. IICC-3 has been supported by the International Agency for Research on Cancer and by the Union for International Cancer Control. This study was supported by the French Institut National du Cancer (grant number 2018-116), the Italian Association of Cancer Research (AIRC, number 21879), and the Italian Ministry of Health (2013, 5X1000). The authors alone are responsible for the views expressed in this Article and these views do not necessarily represent the decisions, policy, or views of the International Agency for Research on Cancer or WHO. Selected preliminary results from this study were presented orally at the 51st congress of the International Society of Paediatric Oncology and the abstract of this communication was published previously.

Publisher Copyright:
© 2021 World Health Organization. Published by Elsevier Ltd. All rights reserved.

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