Abstract
Background
Over the past few decades, an increase in the incidence of thyroid cancer has been recorded in many countries around the world including Australia. Heightened medical surveillance and increased technological sensitivity could be contributing to greater detection of asymptomatic disease.
Objectives
To describe the pathways to diagnosis of thyroid cancer for a cohort of newly diagnosed patients in New South Wales (NSW), Australia, and compare these pathways by age, sex, place of residence, ethnic background, medical insurance status, and disease characteristics.
Methods
A total of 452 newly diagnosed cases of thyroid cancer were recruited through the population-based NSW Central Cancer Registry. Participants completed a questionnaire and diary of doctor visits and investigations that led to their diagnosis. Tumor characteristics were obtained from pathology reports.
Results
Forty percent of patients initially presented to their doctor with a lump or symptom specific to thyroid cancer and 60% had their cancer detected incidentally during a medical encounter. Men were more likely than women to be diagnosed after imaging for another health concern versus reporting a thyroid lump or symptom (p = 0.001). Thyroid cancer diagnosis after imaging for another health concern increased with age (p = 0.023), and larger tumors were less likely to be diagnosed after treatment for a benign thyroid disease (p = 0.040).
Conclusion
As the majority of participants had incidental diagnoses, the reported incidence of thyroid cancer is likely to be influenced by diagnostic technology and medical surveillance practices. This, however, probably only partly explains the observed rise in the incidence of thyroid cancer in NSW.
Similar content being viewed by others
References
Burgess JR (2002) Temporal trends for thyroid carcinoma in Australia: an increasing incidence of papillary thyroid carcinoma (1982–1997). Thyroid 12(2):141–149
Chen AY, Jemal A, Ward EM (2009) Increasing incidence of differentiated thyroid cancer in the United States, 1988–2005. Cancer 115(16):3801–3807
Colonna M, Grosclaude P, Remontet L et al (2002) Incidence of thyroid cancer in adults recorded by French cancer registries (1978–1997). Eur J Cancer 38(13):1762–1768
Davies L, Welch HG (2006) Increasing incidence of thyroid cancer in the United States, 1973–2002. JAMA 295(18):2164–2167
Kilfoy BA, Zheng T, Holford TR et al (2009) International patterns and trends in thyroid cancer incidence, 1973–2002. Cancer Causes Control 20(5):525–531
Colonna M, Guizard AV, Schvartz C et al (2007) A time trend analysis of papillary and follicular cancers as a function of tumour size: a study of data from six cancer registries in France (1983–2000). Eur J Cancer 43(5):891–900
Leenhardt L, Grosclaude P, Cherie-Challine L (2004) Increased incidence of thyroid carcinoma in France: a true epidemic or thyroid nodule management effects? Report from the French Thyroid Cancer Committee. Thyroid 14(12):1056–1060
Verkooijen HM, Fioretta G, Pache J-C et al (2003) Diagnostic changes as a reason for the increase in papillary thyroid cancer incidence in Geneva, Switzerland. Cancer Causes Control 14(1):13–17
Kovacs GL, Gonda G, Vadasz G et al (2005) Epidemiology of thyroid microcarcinoma found in autopsy series conducted in areas of different iodine intake. Thyroid 15(2):152–157
Welch HG, Black WC (2010) Overdiagnosis in cancer. J Natl Cancer Inst 102(9):605–613
Kent WDT, Hall SF, Isotalo PA, Houlden RL, George RL, Groome PA (2007) Increased incidence of differentiated thyroid carcinoma and detection of subclinical disease. CMAJ 177(11):1357–1361
Scheiden R, Keipes M, Bock C, Dippel W, Kieffer N, Capesius C (2006) Thyroid cancer in Luxembourg: a national population-based data report (1983–1999). BMC Cancer 6:102
Yu GP, Li JC, Branovan D, McCormick S, Schantz SP (2010) Thyroid cancer incidence and survival in the National Cancer Institute Surveillance, Epidemiology, and End Results race/ethnicity groups. Thyroid 20:465–473
Zhu C, Zheng T, Kilfoy BA et al (2009) A birth cohort analysis of the incidence of papillary thyroid cancer in the United States, 1973–2004. Thyroid 19(10):1061–1066
Ward EM, Jemal A, Chen A (2010) Increasing incidence of thyroid cancer: is diagnostic scrutiny the sole explanation? Fut Oncol 6:185–188
Enewold L, Zhu K, Ron E et al (2009) Rising thyroid cancer incidence in the United States by demographic and tumor characteristics, 1980–2005. Cancer Epidemiol Biomarkers Prev 18(3):784–791
Preston-Martin S, Franceschi S, Ron E, Negri E (2003) Thyroid cancer pooled analysis from 14 case–control studies: what have we learned? Cancer Causes Control 14:787–789
Zivaljevic V, Vlajinac H, Jankovic R et al (2003) Case–control study of female thyroid cancer—menstrual, reproductive and hormonal factors. Eur J Cancer Prev 12:63–66
Dal ML, Bosetti C, La VC, Franceschi S (2009) Risk factors for thyroid cancer: an epidemiological review focused on nutritional factors. Cancer Causes Control 20:75–86
Stavrou E, Baker D, McElroy H, Bishop J (2008) Thyroid cancer in New South Wales. Cancer Institute NSW, Sydney
Tracey EA, Supramaniam R, Chen W (2003) Cancer in New South Wales: incidence and mortality 2001. The Cancer Council NSW, Sydney
Smith DP, Supramaniam R, King MT, Ward J, Berry M, Armstrong BK (2007) Age, health, and education determine supportive care needs of men younger than 70 years with prostate cancer. J Clin Oncol 20:2560–2566
Royston P, Ambler G, Sauerbrei W (1999) The use of fractional polynomials to model continuous risk variables in epidemiology. Int J Epidemiol 28:964–974
New South Wales Central Cancer Registry (1986) Cancer in New South Wales: incidence and mortality 1980. Department of Health NSW, Sydney
Tracey E, Alam N, Chen W, Bishop J (2008) Cancer in New South Wales: incidence and mortality 2006. Cancer Institute NSW, Sydney
Burgess JR, Tucker P (2006) Incidence trends for papillary thyroid carcinoma and their correlation with thyroid surgery and thyroid fine-needle aspirate cytology. Thyroid 16(1):47–53
Leennhardt L, Bernier MO, Boin-Pineau MH et al (2004) Advances in diagnostic practices affect thyroid cancer incidence in France. Eur J Endocrinol 150(2):133–139
Hall SF, Walker H, Siemens R, Schneeberg A (2009) Increasing detection and increasing incidence in thyroid cancer. World J Surg 33(12):2567–2571
Li M, Eastman CJ, Waite KV et al (2006) Are Australian children iodine deficient? Results of the Australian National Iodine Nutrition Study. Med J Aust 184:165–169
Grodski S, Brown T, Sidhu S et al (2008) Increasing incidence of thyroid cancer is due to increased pathologic detection. Surgery 144(6):1038–1043
Acknowledgments
We are very grateful to the NSW Central Cancer Registry at the Cancer Institute NSW for all their help with recruitment, data extraction from the pathology forms and for providing data for participants and non-participants. We would like to thank Leighna Carmichael and Sam Egger (Cancer Council NSW) for their assistance with statistical analyses. Cancer Council NSW funded the study.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Kahn, C., Simonella, L., Sywak, M. et al. Pathways to the diagnosis of thyroid cancer in New South Wales: a population-based cross-sectional study. Cancer Causes Control 23, 35–44 (2012). https://doi.org/10.1007/s10552-011-9852-2
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10552-011-9852-2