Global patterns and trends in incidence and mortality of thyroid cancer in children and adolescents: a population-based study
Menée à partir de données d'incidence de 49 pays et de mortalité de 27 pays, cette étude analyse les facteurs associés à l'évolution, sur la période 1998-2012, de l'incidence du cancer de la thyroïde chez les enfants et adolescents (âge : inférieur ou égal à 19 ans) ainsi que la mortalité spécifique
Background : There has been a considerable increase in thyroid cancer incidence among adults inseveral 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 Volume3 study database, the WHO mortality database, and the cancer incidence in five continentsdatabase (CI5plus; for adult data [age 20–74 years]). We analysed temporal trendsin incidence rates, including absolute changes in rates, and the strength of the correlationbetween incidence rates in children and adolescents and in adults. We calculated theaverage annual number of thyroid cancer deaths and the age-standardised mortalityrates for children and adolescents.
Findings : Age-standardised incidence rates of thyroid cancer among children and adolescentsaged 0–19 years ranged from 0·4 (in Uganda and Kenya) to 13·4 (in Belarus) cancersper 1 million person-years in 2008–12. The variability in the incidence rates wasmostly accounted for by the papillary tumour subtype. Incidence rates were almostalways higher in girls than in boys and increased with age in both sexes. Rapid increasesin 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 incidencerates ( r>0·6). Thyroid cancer deaths in those aged younger than 20 years were less than 0·1per 10 million person-years in each country.
Interpretation : The pattern of thyroid cancer incidence in children and adolescents mirrors the patternseen in adults, suggesting a major role for overdiagnosis, which, in turn, can leadto overtreatment, lifelong medical care, and side effects that can negatively affectquality of life. We suggest that the existing recommendation against screening forthyroid cancer in the asymptomatic adult population who are free from specific riskfactors should be extended to explicitly recommend against screening for thyroid cancerin similar populations of children and adolescents.
The Lancet Diabetes & Endocrinology , résumé, 2020