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. Author manuscript; available in PMC: 2026 Oct 15.
Published in final edited form as: Lancet Diabetes Endocrinol. 2025 Feb 5;13(3):188–195. doi: 10.1016/S2213-8587(24)00310-3

Trends in incidence, metastasis, and mortality from thyroid cancer in the USA from 1975 to 2019: a population-based study of age, period, and cohort effects

Michelle M Chen 1, Michael Luu 2, Wendy L Sacks 3, Lisa Orloff 4, Lauren P Wallner 5,6, Jon Mallen-St Clair 7, Susan C Pitt 8, Allen S Ho 9, Zachary S Zumsteg 10
PMCID: PMC13664682  NIHMSID: NIHMS2212854  PMID: 39922210

Summary

Background

In the USA, the incidence of thyroid cancer increased rapidly for several decades, although some studies have suggested that it has now plateaued or even begun to decrease. We aimed to establish whether incidence in the USA has truly decreased or merely plateaued, and to understand some of the underlying factors driving these changes.

Methods

We conducted a retrospective, population-based study using the National Cancer Institute (NCI)’s Surveillance, Epidemiology, and End Results database and the National Center for Health Statistics database. We used incidence data from these registries obtained between 1975 and 2019, including patients with a diagnosis of thyroid cancer according to the third edition ICD for Oncology (site code C73.9) and malignant histology. We used the NCI’s Joinpoint Regression Program to estimate trends in the incidence over time and age-period-cohort modelling to identify the factors influencing these trends.

Findings

Our sample included 91 968 patients with thyroid cancer, of whom 23 467 (25·5%) were men and 68 501 (74·5%) were women. The annual incidence of thyroid cancer increased from 5·0 cases per 100 000 people in 1975 to 14·6 cases per 100 000 people in 2009, before plateauing until 2019. The age-period-cohort analysis suggests that the changes in incidence were primarily due to time period effects. Furthermore, the increase in incidence was most prominent among women aged 40–69 years and men aged 50–79 years. Throughout all time periods, incidence increased with each successive birth cohort among both women and men.

Interpretation

The rise and subsequent plateau in the incidence of thyroid cancer in the USA have been primarily driven by time period effects, likely due to changing patterns in diagnostic pressure. Variations in the incidence of thyroid cancer by age, which increased during the time frame of this study, seem to be driven predominantly by overdiagnosis. Although the incidence of thyroid cancer has plateaued, it remains at peak levels, suggesting that overdiagnosis remains a crucial unresolved public health issue. Further work is needed to help limit the current drivers of overdiagnosis and to implement novel solutions aimed at both physicians, patients, and policy makers.

Funding

None.

Introduction

Over the past several decades, the incidence of thyroid cancer has increased considerably worldwide.1–3 In 2006, Davies and Welch’s seminal paper showed that the increasing incidence in the USA was primarily due to an increase in tumours with a diameter of 2 cm or less, suggesting an increased detection of subclinical disease.4 It is well known from autopsy studies that there is a large reservoir of thyroid cancers that never become clinically relevant.5,6 Furthermore, countries that have initiated national cancer screening programmes, such as South Korea’s programme initiated in 1999, have had especially large surges in diagnoses of thyroid cancer.7

These data suggest a global epidemic of thyroid cancer overdiagnosis, particularly in countries with a high Human Development Index.2,8 Overdiagnosis is the diagnosis of a medical condition that would not cause any adverse consequences if left untreated. Given that the goal of treatment is to improve life expectancy, maintain quality of life, or both, overdiagnosing and treating thyroid cancers that will not affect life expectancy or quality of life is detrimental to patients. Over the past decade, several studies suggested that the incidence of thyroid cancer in the USA started to plateau around the mid-2010s, and might have started decreasing since.9,10 It has been postulated that this shift is due to changing practice guidelines, including those from Choosing Wisely and the US Preventive Services Task Force.11,12 However, the exact factors driving these changes in epidemiological patterns are unknown. Additionally, it is unclear if the possible recent reduction in the incidence of thyroid cancer proposed by these studies9,10 represents a robust change that will continue with more updated data. We aimed to investigate up-to-date trends in the incidence, metastasis at diagnosis, and mortality from thyroid cancer and to identify the factors influencing these trends in women and men in the USA between 1975 and 2019.

Methods

Study design and participants

We conducted a retrospective, population-based study using the National Cancer Institute (NCI)’s Surveillance, Epidemiology, and End Results (SEER) database and the National Center for Health Statistics database. SEER is the only comprehensive source of population-based data on cancer staging at the time of diagnosis in the USA.13 We used incidence data from the SEER-8 registry obtained between 1975 and 2019. We included patients with a diagnosis of thyroid cancer according to the third edition ICD for Oncology (site code C73.9) and malignant histology (behaviour code 3). Due to the low number of patients younger than 25 years, this age group was excluded from the analysis. For patients aged 85 years and older, SEER does not provide exact ages; therefore, this age group was also excluded from the analysis. Metastasis rates referred to metastasis at diagnosis, which were determined by distant metastasis category in either the summary or the combined stage variable. Mortality data specific to thyroid cancer were obtained from the US Mortality Files from the National Center for Health Statistics database.14 This study was exempt from review by the Cedars-Sinai Medical Center investigational review board.

Statistical analysis

We calculated age-adjusted incidence rates using the 2000 US Standard Population from the US Census Bureau and SEER*Stat (NCI). We estimated trends in incidence, metastasis at diagnosis, and mortality using the NCI’s Joinpoint Regression Program (version 4.9.1.0). This programme estimates a piecewise log-linear regression model with so-called joinpoints identified at a timepoint with a change in the slope of incidence trends. The optimal number of joinpoints was based on a permutation test at an overall significance level of 0·05 and 4499 permutations.15 The estimated annual percentage change (APC) from the Joinpoint Regression Program is the slope of the change in incidence over the time period between two joinpoints. Using this approach, we assumed a log-linear change in rates from the previous year for each segment. We calculated the 95% CIs of the APC based on a t-distribution, with p values testing whether the APC was significantly different from 0.16 Residual plots were examined to visually detect deviations from randomness, including violations from assumptions of linearity.17 We assessed the normality assumption of the residuals using the Shapiro–Wilk test and evaluated autocorrelation using the Durbin–Watson test, both of which indicated no violations of model assumptions. Given the low rates of mortality and metastasis at diagnosis, which led to significant noise in the signal, joinpoint analysis was not performed for these endpoints.

We performed an age-period-cohort analysis using the NCI’s age-period-cohort web tool18 developed by Rosenberg and colleagues.19 This type of analysis allows for the assessment of the independent effect of the cohort (year of birth) and period (year of diagnosis) on overall incidence trends, adjusting for age. Although age, period, and cohort are inter-related and dependent variables, given that birth cohort is the difference between the time period of diagnosis and the patient’s age, analysing all three factors can provide insight into potential underlying sources driving epidemiological changes. Time period effects are caused by factors that change over time and affect a wide range of age groups more or less equally. Age variations in cancer incidence can be related to the accumulation of random mutations over a person’s lifespan, accumulated exposure to a carcinogen over time, or changes in detection in specific age groups. Birth cohort effects are produced by changes in underlying environmental or lifestyle risk factors that generally affect a specific age group starting in a specific period. These effects can be thought of as age-specific period effects.

Birth cohorts were derived from the data based on age and period, such that cohort=period – age. Age and period were included in the model based on 5-year age and period groupings. The tool uses reference points for age, period, and cohort to resolve the identifiability problem, enabling the model to estimate the independent effects of each factor. In our analysis, the reference age was set at 57·5 years, which is the midpoint of the reference age group, 55–59 years. The reference period was set at 1977·5, which is the midpoint of the reference period, 1975–79. The reference cohort was then derived by the following formula: reference cohort=reference period – reference age. The resulting reference cohort was 1920. Estimable parameters, such as net drift (estimated APC of age-adjusted rates over time), local drifts (estimated APC over time specific to age), period rate ratios (ratio of age-specific rates in periods relative to the reference period), and cohort rate ratios (ratio of age-specific rates in cohort relative to reference cohort), were used to describe the independent effects of period and cohort on incidence. We used the Wald test to estimate local drifts and compare these with the overall net drift. The Joinpoint Regression Program assumes constant variance and uncorrelated errors, and we inspected the residual plots generated by the software to visually confirm that the assumption of homoscedasticity was reasonable.17 Furthermore, we assessed the sex-stratified effects of age, time period, and cohort on incidence visually using line and bubble plots based on the classical rates plots observed in a Lexis diagram.20 Age-specific rates by period and cohort-specific rates by age were calculated based on 5-year groupings.

We performed all analyses with two-sided tests and a significance level of less than 0·05. We report 95% CIs in the text and figures and p values in the appendix (pp 2, 4). All analyses were performed with R (version 4.2.0), the NCI’s Joinpoint Regression Program (version 4.9.1.0),21 and NCI’s age-period-cohort web tool.18

Role of the funding source

There was no funding source for this study.

Results

Our sample included 91 968 patients, of whom 23 467 (25·5%) were men and 68 501 (74·5%) were women. Among all patients, the annual incidence of thyroid cancer increased gradually from 5·0 cases per 100 000 people in 1975 to 14·6 cases per 100 000 people in 2009 (figure 1). Incidence then plateaued until 2019, at which point 14·1 cases per 100 000 people were reported (appendix p 2). Overall, the absolute rate of metastasis at diagnosis remained stable from 0·4 cases per 100 000 people in 1975 to 0·4 cases per 100 000 people in 2019. Absolute mortality rates specific to thyroid cancer also remained unchanged at 0·5 deaths per 100 000 people in 1975 and 0·5 deaths per 100 000 people in 2019.

Figure 1: Trends in the incidence, metastasis at diagnosis, and mortality from thyroid cancer overall and by sex in the USA, 1975–2019.

Figure 1:

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Data taken from the National Cancer Institute’s SEER-8 registry.13 Numbers above each joinpoint segment are the annual percentage change. Shaded areas reflect 95% CIs. 95% CIs and exact p values are provided in the appendix (p 2). SEER=Surveillance, Epidemiology, and End Results. *p<0·05.

When sex-specific, age-adjusted incidence rates were evaluated, the incidence rate for women was 6·6 cases per 100 000 people in 1975 and reached a peak of 22·2 cases per 100 000 people in 2014, whereas the incidence rate for men was 3·4 cases per 100 000 people in 1975 and peaked at 8·1 cases per 100 000 people in 2012. Similar to the overall trends, rates for sex-specific mortality and metastasis remained relatively unchanged throughout the time period. For women, the metastasis rate was stable at 0·4 cases per 100 000 people in 1975 and in 2019 (appendix p 3). The mortality rate decreased slightly from 0·6 deaths per 100 000 people in 1975 to 0·5 deaths per 100 000 people in 2019. In men, the metastasis rate was also unchanged at 0·3 cases per 100 000 people in 1975 and in 2019. The mortality rate increased incrementally from 0·4 cases per 100 000 people in 1975 to 0·5 cases per 100 000 people in 2019.

Between 1975 and 2019, the net drift for thyroid cancer incidence was 3·56% (95% CI 3·42–3·71) for women and 2·87% (2·69–3·05) for men. The analysis of age-specific local drifts showed that all age groups in both men and women had significantly positive local drifts (figure 2). Among women, the peak rates of local drift were observed in individuals aged 55–59 years (4·03% [3·81–4·26]); however, among men, peak rates were observed in those aged 70–74 years (3·26% [2·86–3·67]; appendix p 4). Local drifts by age group were noted to be greater than net drifts among women aged 40–69 years and among men aged 50–79 years. Wald tests showed that all net drifts, local drifts, cohort effects, and period effects were significant for both sexes (appendix p 4).

Figure 2: Age-specific local drifts in the incidence of thyroid cancer in women and men in the USA, 1975–2019.

Figure 2:

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Local drifts for women and men obtained from age-period-cohort modelling. Data taken from the National Cancer Institute’s SEER-8 registry.13 Shaded areas reflect 95% CIs. The horizontal solid line represents the net drift of all age groups combined, with horizontal dashed lines representing corresponding 95% CIs. SEER=Surveillance, Epidemiology, and End Results.

Sex-specific period effects were observed across age groups (figure 3). For women, the incidence of thyroid cancer was relatively uniform across age groups before 1995 (figure 4). Thereafter, the relationship between age and incidence showed an increasingly inverted U shape with larger increases in incidence among middle-aged women. Incidence rates also increased across age groups over successive time periods for men (figure 4). However, compared with women, the increase over time was most pronounced in men aged 50 years and older.

Figure 3: Heat map of the incidence of thyroid cancer in women and men in the USA, 1975–2019.

Figure 3:

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Data taken from the National Cancer Institute’s SEER-8 registry13 and stratified by age and time period of diagnosis. SEER=Surveillance, Epidemiology, and End Results.

Figure 4: Incidence of thyroid cancer in women and men in the USA according to age group, 1975–2019.

Figure 4:

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Data taken from the National Cancer Institute’s SEER-8 registry13 and stratified by time period of diagnosis. SEER=Surveillance, Epidemiology, and End Results.

A birth cohort effect, with an increasing incidence of thyroid cancer for a given age group with each subsequent birth cohort, was also observed (figure 5). The cohort rate ratio, relative to the reference 1920 birth cohort, increased steadily for both women and men (appendix p 5). The rate ratio for developing thyroid cancer increased from a baseline of 1·00 in the 1920 birth cohort to 11·72 (95% CI 9·84–13·95) among women and 6·99 (5·44–8·98) among men in the most recent birth cohort (1990–94). Compared with the steady rise in the cohort rate ratio, the period rate ratio showed a rapid rise from 1975 to 2010, after which the ratio plateaued during the time periods 2010–14 and 2015–19 (appendix p 6).

Figure 5: Incidence of thyroid cancer in women and men in the USA according to birth cohort, 1975–2019.

Figure 5:

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Data taken from the National Cancer Institute’s SEER-8 registry13 and stratified by age at diagnosis of thyroid cancer. SEER=Surveillance, Epidemiology, and End Results.

Discussion

In the USA, the incidence of thyroid cancer increased substantially from at least 1975 to the time period between 2009 and 2019, during which time it plateaued but did not decrease significantly. Concurrently, mortality rates and the incidence of metastasis at diagnosis of thyroid cancer have remained stable. Separating out the age-period-cohort effects suggest that the sharp rise and then plateau in incidence have been primarily driven by a period effect, given that the changes in incidence were observed in broad age ranges of patients more or less simultaneously. This observation is consistent with what is known about these changes in clinical practice, with an increased use of medical imaging over time leading to the increased detection of thyroid nodules and subsequent diagnoses of thyroid cancer. Although an increasing incidence of thyroid cancer was observed with each subsequent birth cohort, this observation seemed to be secondary to period effects. If birth cohort effects were the dominant contributor, incidence would be relatively stable as a function of birth cohort until a specific birth cohort year and then rise for subsequent cohorts across age groups. By contrast, our findings indicate that older age groups had an increased incidence of thyroid cancer in earlier birth cohorts. This pattern is expected from a period effect, which influences a population across a wide range of age groups simultaneously.

Additionally, the effects of time period seem to be the primary factor driving the current variations in observed age-related incidence. In earlier periods, no significant age effects were seen, with a near constant incidence in thyroid cancer across age groups until approximately 1995. In periods after 1995, although an increase in incidence has been reported across all age groups, this increase was largest among women aged 40–69 years and men aged 50–79 years. These period-dependent age effects might be explained by the ages at which women and men most frequently interact with the health-care system, leading to an increased likelihood of receiving imaging that detects an incidental thyroid nodule. Increased health-care interactions might also explain, in part, the increased incidence of thyroid cancer in women in modern clinical practice. Across all ages, at least in the USA, women are more frequent users of health care than are men.22 Autopsy studies have shown that small subclinical papillary thyroid cancers are equally common in both sexes, despite being more frequently detected in life among women.23 Collectively, these data strongly suggest that both the age-specific and sex-specific variations seen in the incidence of thyroid cancer in current clinical practice are primarily driven by period-dependent increases in the overdiagnosis of clinically indolent thyroid cancers.

The recent plateau in period rate ratios suggests that shifts in clinical practice patterns are the primary factor behind the relative stability in thyroid cancer incidence observed in the USA since approximately 2009. A meta-analysis of autopsy studies reported that the prevalence of incidental thyroid cancer has been stable since 1970, providing strong evidence that the major driver of increased incidence over time is diagnostic detection of indolent subclinical cancers.24 Furthermore, a large series of patients with papillary thyroid microcarcinoma showed that over 99% of these patients were not at risk of distant metastases or cancer-specific mortality.25 As a result, there has been increased awareness of the negative impacts of overdiagnosis of thyroid cancer, and several practice guidelines have been implemented to help address this issue. In 2009, the American Thyroid Association altered its management guidelines for thyroid nodules by providing detailed recommendations for the nodule threshold for biopsy.26 In 2013 and again in 2017 and 2018, the Endocrine Society published its Choosing Wisely guidelines, which recommended against routine thyroid ultrasonography in patients with atypical thyroid function test results without any palpable abnormality.12 In 2017, the United States Preventive Services Task Force recommended against routine screening for thyroid cancer in asymptomatic adults.11 Additionally, a change in nomenclature reclassified the non-invasive encapsulated follicular variant of papillary thyroid carcinoma as a non-invasive follicular thyroid neoplasm with papillary-like nuclear features.27 Data on recent trends in thyroid ultrasonography practice in the USA are scarce. A study of ultrasound patterns in seven integrated US health-care systems suggested that there was increased use from 2000 to 2010, but then a plateau from 2010 to 2016 (APC −0·04% [95% CI −1·2 to 0·4]),28 mirroring the incidence data in our study.

Rates of mortality and metastasis at diagnosis have remained relatively stable over time. However, due to the low absolute rates of mortality and metastasis, resulting in a low signal-to-noise ratio, we opted against performing joinpoint analysis for these two endpoints. Of note, we observed a slight numerical increase in mortality among men during the time period of our study, from 0·4 cases to 0·5 cases per 100 000 people. However, even if this was a true statistical signal, this increase could be due to attribution bias from the increase in overall diagnoses of thyroid cancer, whereby patients previously diagnosed with thyroid cancer who died of other or unknown causes might have thyroid cancer incorrectly listed as a potential contributing factor on their death certificates. More research is needed to establish if this possible rise in disease-specific mortality and its associated factors are real and persistent. However, if a slight rise in mortality among men exists, it does not diminish the issue of overdiagnosis of small indolent thyroid cancers, which continues to be a persistent and costly challenge for the US health-care system.

Given that our data suggest that the incidence in thyroid cancer has plateaued at peak levels rather than decreased, it is likely that overdiagnosis and overtreatment continue to be public health concerns. A multinational study on patients with thyroid cancer who had surgery in 2019 showed that 40% of thyroid cancers continued to be diagnosed in asymptomatic patients, with the most common mode of detection being radiographic serendipity.29 In the USA, the estimated rate of overdiagnosis from 2008 to 2012 was at least 76% in women and 55% in men.30 There are also significant economic and personal costs associated with overdiagnosis. The cumulative annual cost of care for thyroid cancer in the USA is currently estimated to be over US$1·5 billion and is expected to rise to $3·5 billion by 2030.31 Among all patients with cancer, bankruptcy incidence at 1 year after cancer diagnosis is highest for those with thyroid cancer and more than four times higher than individuals without cancer.32 Diagnosis and treatment of thyroid cancer involve risks, including those of cancer-related worry, vocal fold paralysis, hypoparathyroidism, the potential need for thyroid hormone supplementation, and side-effects related to radioactive iodine therapy. A survey of 2584 patients with thyroid cancer that was conducted 2–4 years after diagnosis reported that 38% of patients had worse energy and 51% had moderate to very severe fatigue.33 In a national survey of disease-free survivors of thyroid cancer, 41% of respondents reported worrying about death, 44% reported worrying about harms associated with treatment, and 63% reported worrying about recurrence.34 Guidelines and medical awareness have helped to reduce the rates of overdiagnosis, but further work is indicated to reduce and eliminate it entirely.

Although the most direct solution to addressing overdiagnosis is to limit the detection of indolent subclinical thyroid cancers, active surveillance is a complementary strategy to mitigate the downstream negative consequences of overdiagnosis-associated overtreatment.35–37 This approach seems to be safe and effective, with a meta-analysis of active surveillance studies in patients with small papillary thyroid cancers showing that only 5·3% of these cancers enlarged within 5 years, with a lymph node metastasis rate of 1·6%.38 Despite these results, active surveillance for thyroid cancer continues to have low acceptance in many countries. A survey of surgeons and endocrinologists reported that the main barriers to implementation of active surveillance included a lack of patient acceptance (80%), concerns regarding loss to follow-up (78%), patient worry (58%), and concerns regarding malpractice litigation (51%).39

We acknowledge several limitations to our study. To provide the most longitudinal data, we used the SEER-8 database (covering 9·4% of the US population) rather than SEER-13 or SEER-18, which contain more registries but cover fewer years. We do not have detailed data on patient comorbidities, such as obesity, or other risk factors for thyroid cancer. Absolute event rates for metastasis and mortality are relatively low, making them subject to statistical noise and uncertainty. Our data only capture metastasis at diagnosis, not metastasis at recurrence. Cancer-specific mortality in registry data can be potentially affected by attribution bias. We limited our dataset to patients diagnosed either in or before 2019 because there were considerable temporary changes in routine health-care use in 2020 due to the COVID-19 pandemic. We note that patients with confirmed thyroid cancer on cytology who underwent active surveillance would have been included in the dataset used to calculate apparent incidence; however, those with suspected thyroid cancer on ultrasonography without a cytological diagnosis would not have been included. Nevertheless, the number of patients undergoing active surveillance in the USA is relatively small; therefore, this factor is unlikely to meaningfully influence our results or conclusions.40 Furthermore, the Joinpoint Regression Model assumes a piecewise log-linear relationship between incidence and time, which might not fully capture the true data structure, potentially leading to mis-specification bias in the model.

In conclusion, our findings suggest that the rise and subsequent plateau in the incidence of thyroid cancer in the USA since 1975 have been primarily driven by period effects as a result of shifts in clinical practice. The variations in incidence by age seen in current clinical practice seem to be driven largely by overdiagnosis. Despite some progress in reducing the progressively increasing rate of overdiagnosis of thyroid cancer in the USA, its incidence has largely plateaued near peak levels. If these trends persist, there will be a long-term persistence in a vast number of thyroid cancer cases that have been overdiagnosed, representing an area of utmost public health concern. Novel imaging strategies to better identify thyroid nodules that require biopsy, along with advancements in molecular testing to decrease the rate of indeterminate thyroid biopsies, are needed. Furthermore, overcoming barriers to widespread adoption of active surveillance will require high-level studies, including prospective randomised controlled trials. There is a crucial need for further research to mitigate factors contributing to overdiagnosis and to implement novel solutions aimed at both physicians and patients.

Supplementary Material

supplemental appendix

Research in context.

Evidence before this study

In the USA, the incidence of thyroid cancer increased rapidly for several decades, but recent studies have suggested that incidence has now plateaued or even started to decrease. We searched PubMed for studies in English from database inception to April 10, 2024, on the incidence, metastasis at diagnosis, and mortality from thyroid cancer in the USA using the search terms “thyroid” AND (cancer OR neoplasm* OR carcinoma*) AND “United States”. We also searched the reference lists of these articles to identify additional studies. In particular, we searched for any study that captured data from 2009 onwards to understand the most recent trends in the incidence of thyroid cancer in the USA. The overdiagnosis of thyroid cancer has become a global epidemic, especially in countries with a high Human Development Index. Previous studies have shown that the incidence of thyroid cancer in the USA has started to decrease, but noted that more years of data are needed to understand whether this observation is a true decrease or merely a plateau in overdiagnosis of the condition.

Added value of this study

We provide a comprehensive, longitudinal, and up-to-date perspective on the trends in incidence, metastasis at diagnosis, and mortality from thyroid cancer in the USA using data from the Surveillance, Epidemiology, and End Results database. The data show a plateau in incidence starting in 2009, whereas mortality rates remained stable. Additionally, we used an age-period-cohort analysis to identify the factors driving these changes in trends. Our analysis shows that this plateau in incidence has been primarily driven by a period effect. Furthermore, the period effects seem to be the primary factor behind the observed variations in age-related incidence of thyroid cancer in the USA.

Implications of all the available evidence

Altogether there is evidence that previous efforts to decrease the overdiagnosis of thyroid cancer in the USA have created a plateau rather than reduction in incidence. Therefore, substantial concerns about overdiagnosis remain. It is crucial that we continue to actively work on novel strategies to reduce the drivers of overdiagnosis.

Declaration of interests

SCP has a K08 grant and R03 grant from the NCI, and a Society of University Surgeons Mid-Career Award. SCP is also the chair of the Surgical Affairs Committee for the American Thyroid Association. ZSZ’s spouse did legal work previously for Merck, Allergan, Johnson & Johnson, and Boehringer Ingelheim through her law firm. All other authors declare no competing interests.

Contributor Information

Michelle M Chen, Department of Otolaryngology-Head and Neck Surgery, Stanford University, Palo Alto, CA, USA.

Michael Luu, Department of Biostatistics and Bioinformatics, Cedars-Sinai Medical Center, Los Angeles, CA, USA.

Wendy L Sacks, Division of Endocrinology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA.

Lisa Orloff, Department of Otolaryngology-Head and Neck Surgery, Stanford University, Palo Alto, CA, USA.

Lauren P Wallner, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA.

Jon Mallen-St Clair, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA.

Susan C Pitt, Department of Surgery, University of Michigan Medical School, Ann Arbor, MI, USA.

Allen S Ho, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA.

Zachary S Zumsteg, Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, CA, USA.

Data sharing

The data are publicly available through the SEER registry and the National Center for Health Statistics.

References

  • 1.Lim H, Devesa SS, Sosa JA, Check D, Kitahara CM. Trends in thyroid cancer incidence and mortality in the United States, 1974–2013. JAMA 2017; 317: 1338–48. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 2.Pizzato M, Li M, Vignat J, et al. The epidemiological landscape of thyroid cancer worldwide: GLOBOCAN estimates for incidence and mortality rates in 2020. Lancet Diabetes Endocrinol 2022; 10: 264–72. [DOI] [PubMed] [Google Scholar]
  • 3.Zhou GQ, Wu CF, Deng B, et al. An optimal posttreatment surveillance strategy for cancer survivors based on an individualized risk-based approach. Nat Commun 2020; 11: 3872. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 4.Davies L, Welch HG. Increasing incidence of thyroid cancer in the United States, 1973–2002. JAMA 2006; 295: 2164–67. [DOI] [PubMed] [Google Scholar]
  • 5.Vanderlaan WP. The occurrence of carcinoma of the thyroid gland in autopsy material. N Engl J Med 1947; 237: 221–22. [DOI] [PubMed] [Google Scholar]
  • 6.Harach HR, Franssila KO, Wasenius VM. Occult papillary carcinoma of the thyroid. A “normal” finding in Finland. A systematic autopsy study. Cancer 1985; 56: 531–38. [DOI] [PubMed] [Google Scholar]
  • 7.Ahn HS, Kim HJ, Welch HG. Korea’s thyroid-cancer “epidemic”–screening and overdiagnosis. N Engl J Med 2014; 371: 1765–67. [DOI] [PubMed] [Google Scholar]
  • 8.Miranda-Filho A, Lortet-Tieulent J, Bray F, et al. Thyroid cancer incidence trends by histology in 25 countries: a population-based study. Lancet Diabetes Endocrinol 2021; 9: 225–34. [DOI] [PubMed] [Google Scholar]
  • 9.Powers AE, Marcadis AR, Lee M, Morris LGT, Marti JL. Changes in trends in thyroid cancer incidence in the United States, 1992 to 2016. JAMA 2019; 322: 2440–41. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 10.Li Y, Che W, Yu Z, et al. The incidence trend of papillary thyroid carcinoma in the United States during 2003–2017. Cancer Control 2022; 29: 10732748221135447. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 11.Bibbins-Domingo K, Grossman DC, Curry SJ, et al. Screening for thyroid cancer: US Preventive Services Task Force recommendation statement. JAMA 2017; 317: 1882–87. [DOI] [PubMed] [Google Scholar]
  • 12.American Academy of Family Physicians. Choosing Wisely recommendations: don’t routinely order a thyroid ultrasound in patients with abnormal thyroid function tests if there is no palpable abnormality of the thyroid gland.https://www.aafp.org/pubs/afp/collections/choosing-wisely/141.html (accessed Aug 10, 2024).
  • 13.National Cancer Institute Surveillance, Epidemiology, and End Results Program. Overview of the SEER Program. https://seer.cancer.gov/about/overview.html (accessed Aug 10, 2024). [Google Scholar]
  • 14.National Cancer Institute Surveillance, Epidemiology, and End Results Program. U.S. mortality data, 1969–2022. https://seer.cancer.gov/mortality/index.html (accessed Sept 11, 2024). [Google Scholar]
  • 15.Kim HJ, Fay MP, Feuer EJ, Midthune DN. Permutation tests for joinpoint regression with applications to cancer rates. Stat Med 2000; 19: 335–51. [DOI] [PubMed] [Google Scholar]
  • 16.National Cancer Institute Division of Cancer Control and Population Sciences. Annual percent change (APC) and confidence interval. https://surveillance.cancer.gov/help/joinpoint/setting-parameters/method-and-parameters-tab/apc-aapc-tau-confidence-intervals/estimate-average-percent-change-apc-and-confidence-interval (accessed Sept 8, 2024). [Google Scholar]
  • 17.Harrell FE. Regression modeling strategies: with applications to linear models, logistic and ordinal regression, and survival analysis. Cham: Springer International Publishing, 2015. [Google Scholar]
  • 18.National Cancer Institute Division of Cancer Epidemiology & Genetics. Biostatistics branch. https://analysistools.cancer.gov/apc/ (accessed Sept 8, 2024). [Google Scholar]
  • 19.Rosenberg PS, Check DP, Anderson WF. A web tool for age-period-cohort analysis of cancer incidence and mortality rates. Cancer Epidemiol Biomarkers Prev 2014; 23: 2296–302. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 20.Carstensen B Age-period-cohort models for the Lexis diagram. Stat Med 2007; 26: 3018–45. [DOI] [PubMed] [Google Scholar]
  • 21.National Cancer Institute Division of Cancer Control and Population Sciences. Joinpoint trend analysis software. https://surveillance.cancer.gov/joinpoint/ (accessed Sept 8, 2024). [Google Scholar]
  • 22.Brett KM, Burt CW. Utilization of ambulatory medical care by women: United States, 1997–98. Vital Health Stat 13 2001; 149: 1–46. [DOI] [PubMed] [Google Scholar]
  • 23.LeClair K, Bell KJL, Furuya-Kanamori L, Doi SA, Francis DO, Davies L. Evaluation of gender inequity in thyroid cancer diagnosis: differences by sex in US thyroid cancer incidence compared with a meta-analysis of subclinical thyroid cancer rates at autopsy. JAMA Intern Med 2021; 181: 1351–58. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 24.Furuya-Kanamori L, Bell KJL, Clark J, Glasziou P, Doi SAR. Prevalence of differentiated thyroid cancer in autopsy studies over six decades: a meta-analysis. J Clin Oncol 2016; 34: 3672–79. [DOI] [PubMed] [Google Scholar]
  • 25.Hay ID, Hutchinson ME, Gonzalez-Losada T, et al. Papillary thyroid microcarcinoma: a study of 900 cases observed in a 60-year period. Surgery 2008; 144: 980–87, discussion 987–88. [DOI] [PubMed] [Google Scholar]
  • 26.Cooper DS, Doherty GM, Haugen BR, et al. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid 2009; 19: 1167–214. [DOI] [PubMed] [Google Scholar]
  • 27.Nikiforov YE, Seethala RR, Tallini G, et al. Nomenclature revision for encapsulated follicular variant of papillary thyroid carcinoma: a paradigm shift to reduce overtreatment of indolent tumors. JAMA Oncol 2016; 2: 1023–29. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 28.Smith-Bindman R, Kwan ML, Marlow EC, et al. Trends in use of medical imaging in US health care systems and in Ontario, Canada, 2000–2016. JAMA 2019; 322: 843–56. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 29.Sajisevi M, Caulley L, Eskander A, et al. Evaluating the rising incidence of thyroid cancer and thyroid nodule detection modes: a multinational, multi-institutional analysis. JAMA Otolaryngol Head Neck Surg 2022; 148: 811–18. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 30.Li M, Dal Maso L, Vaccarella S. Global trends in thyroid cancer incidence and the impact of overdiagnosis. Lancet Diabetes Endocrinol 2020; 8: 468–70. [DOI] [PubMed] [Google Scholar]
  • 31.Lubitz CC, Kong CY, McMahon PM, et al. Annual financial impact of well-differentiated thyroid cancer care in the United States. Cancer 2014; 120: 1345–52. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 32.Uppal N, Cunningham Nee Lubitz C, James B. The cost and financial burden of thyroid cancer on patients in the US: a review and directions for future research. JAMA Otolaryngol Head Neck Surg 2022; 148: 568–75. [DOI] [PubMed] [Google Scholar]
  • 33.Hughes DT, Reyes-Gastelum D, Kovatch KJ, Hamilton AS, Ward KC, Haymart MR. Energy level and fatigue after surgery for thyroid cancer: a population-based study of patient-reported outcomes. Surgery 2020; 167: 102–09. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 34.Papaleontiou M, Reyes-Gastelum D, Gay BL, et al. Worry in thyroid cancer survivors with a favorable prognosis. Thyroid 2019; 29: 1080–88. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 35.Lamartina L, Leboulleux S, Borget I, Schlumberger M. Global thyroid estimates in 2020. Lancet Diabetes Endocrinol 2022; 10: 235–36. [DOI] [PubMed] [Google Scholar]
  • 36.Davies L, Hoang JK. Thyroid cancer in the USA: current trends and outstanding questions. Lancet Diabetes Endocrinol 2021; 9: 11–12. [DOI] [PubMed] [Google Scholar]
  • 37.Leboulleux S, Tuttle RM, Pacini F, Schlumberger M. Papillary thyroid microcarcinoma: time to shift from surgery to active surveillance? Lancet Diabetes Endocrinol 2016; 4: 933–42. [DOI] [PubMed] [Google Scholar]
  • 38.Jin C, Hyun S, Hwan B, et al. Active surveillance for small papillary thyroid cancer: a systematic review and meta-analysis. Thyroid 2019; 29: 1399–1408. [DOI] [PubMed] [Google Scholar]
  • 39.Hughes DT, Reyes-Gastelum D, Ward KC, Hamilton AS, Haymart MR. Barriers to the use of active surveillance for thyroid cancer results of a physician survey. Ann Surg 2022; 276: e40–47. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 40.Levyn H, Scholfield DW, Eagan A, et al. Outcomes of conversion surgery for patients with low-risk papillary thyroid carcinoma. JAMA Otolaryngol Head Neck Surg 2024; published online May 15. 10.1001/jamaoto.2024.1699. [DOI] [PMC free article] [PubMed] [Google Scholar]

Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Supplementary Materials

supplemental appendix
NIHMS2212854-supplement-supplemental_appendix.pdf (164.3KB, pdf)

Data Availability Statement

The data are publicly available through the SEER registry and the National Center for Health Statistics.

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