Radiation Safety in the Treatment of Patients with Thyroid Diseases by Radioiodine 131I: Practice Recommendations of the American Thyroid Association

James C. Sisson, John Freitas, Iain Ross McDougall, Lawrence T. Dauer, James R. Hurley, James D. Brierley, Charlotte H. Edinboro, David Rosenthal, Michael J. Thomas, Jason A Wexler, Ernest Asamoah, Anca M. Avram, Mira Milas, Carol Greenlee

Thyroid. April 2011, 21(4): 335-346.

The Most Commonly Occurring Papillary Thyroid Cancer in the United States Is Now a Microcarcinoma in a Patient Older than 45 Years

Thyroid 21;231-236,2011

David T. Hughes, Megan R. Haymart, Barbra S. Miller, Paul G. Gauger,3 and Gerard M. Doherty.

The incidence of papillary thyroid cancer (PTC) is growing at a faster rate than any other malignancy.. With the goal of understanding the role of age in thyroid cancer incidence, this study analyzes the changing demographics of patients with PTC over the past three decades, via a retrospective evaluation of the incidence rates of PTC from 1973 to 2006 reported by the National Cancer Institute’s Surveillance, Epidemiology, and End Results database.

From 1973 -2006 the age group most commonly found to have PTC has shifted from patients in their 30s to patients in the 40 -50-year-old age group. In 1973 60% of PTC cases were found in patients younger than 45, and the majority of cases continued to occur in younger patients until 1999. After 1999 PTC became more common in patients older than 45 years, and in 2006, 61% of PTC cases were in patients older than 45 years. From 1988 to 2003 there has been an increasing incidence of all sizes of PTC in all age groups with the largest increase in tumors <1 cm in patients older than 45. Forty-three percent of tumors in patients older than 45 are now <1 cm, whereas only 34% are <1 cm in patients younger than 45. Of the nearly 20,000 thyroid cancer cases in 2003, 24% were microcarcinomas in patients over the age of 45.

The incidence of PTC is increasing disproportionally in patients older than 45 years. The number of PTC tumors smaller than 1 cm is increasing in all age groups, and now the most commonly found PTC tumor in the United States is a microcarcinoma in a patient older than 45 years. These changes have important treatment implications for patients with PTC.

Comment

The striking 5 fold increased incidence of PTC (largely under 1cm) between 1999 and 2006 in individuals over age 45 is suggested by the authors to be due to increased detection by imaging studies and more common use of total thyroidectomy. However tumors of all sizes have increased in incidence in individuals both over and under age 45, and the increase is both sudden and dramatic. These factors suggest concern that other yet- unidentified factors may account for this phenomenon. LDeG