| BackgroundThyroid cancer is the most common human endocrine malignant tumor. According to GLOBOCAN 2012 from International Agency for Research on Cancer (IARC) of World Health Organization, About 298,102 new cases of thyroid cancer were estimated in 2012 (229,923 in women and 68,179 in men, with an age-standardized (world population) rate of 4.0/100,000(6.10/100,000 in women and 1.90/100,000 in men), which accouted for 2.1% of all malignant tumor (3.5% in women and 0.9% in men).From the geographical distribution,there is an over tenfold difference in incidence across different parts of the world in women, high incidence areas (over 10/100,000 women) including selected countries of South Korea, Canada, the United States, Italy, Australia, Iceland; the absolute variation is substantial,but relatively smaller in men.Incidence rates are more than twofold higher in high-income countries as compared to low/middle-income ones both in women (11.10/100,000 and 4.70/100,000, respectively) and in men (3.60/100,000 and 1.40/100,000, respectively). At present, the growth of thyroid cancer incidence in global has caused the wide attention of the society. Thyroid cancer rates have increased from 1973-1977 to 1998-2002 for most of the populations except for Sweden. The average increase was 48.0% among males and 66.7% among females. At the same period, the incidence of thyroid cancer increased from 3.6 per 100 000 in 1973 to 8.7 per 100 000 in 2002-a 2.4-fold increase (95% CI,2.2-2.6) in United States. There was no significant change in the incidence of the less common histological types:follicular, medullary, and anaplastic. Virtually the entire increase is attributable to an increase in incidence of papillary thyroid cancer, which increased from 2.7 to 7.7 per 100000-a 2.9-fold increase (95% CI,2.6-3.2). Between 1988 and 2002,49%(95% CI,47%-51%) of the increase consisted of cancers measuring 1 cm or smaller; 87% (95% CI,85%-89%) consisted of cancers measuring 2 cm or smaller. South Korea has implemented cancer screening since 1999, the thyroid cancer incidence has increased rapidly from 2000, between 2002 to 2008 thyroid cancer incidence in women has rose by nearly 10 times, the annual increasing rate of 23.6% in 1999-2008.From 2014 south Korean cancer report,thyroid cancer ranked first in women, sixth in men.The thyroid cancer incidence was low in China. In 2008,21,833 new cases of thyroid cancer were registered (15,597 in women and 6,286 in men, with an age-standardized (world population) rate of 1.4/100,000(2.1/100,000 in women and 0.9/100,000 in men). But thyroid cancer incidence in 2003-2007 increased rapidly, with an annual rate of 14.51%.The growth in men (13.49%) was slower than in women (14.79%), faster in city (14.13%) than in rural areas (12.96%). The growth trend in Hong Kong, Beijing, Shanghai, Tianjing, Dalian and other regions.This study was designed to analyze thyroid cancer incidence data in Guangzhou in 2004-2013, including areas, population, time and pathological distribution, as well as the time trend changes, so as to understand the thyroid cancer incidence characteristics and growth and provide preliminary clues for the future thyroid cancer prevention and control in Guangzhou.MethodsThe incidence data of this study were obtained from the Cancer Registry office in Guangzhou Center for Disease Control and Prevetion. The original data in 2004-2009 were collected by manual excerpt report card and copy of electronic medical record home page from cancer diagnosis ability hospital.The data had been organized but needed to collect more information. The data in 2010-2013 were derived from Guangzhou Cancer Regesitred System,which organized according to leakage inspection prescribed, nonlocal cases rejecting, verify coding, rechecking, duplicate check and merge steps. A total of 6,394 cases of thyroid cancer were finally collected.Population data were from Guangzhou Municipal Public Security Bureau and Bureau of Statistics, covering the registered population,78,093,161 person-years in 2004-2013(39,731,128 in men and,38,362,033 in women).The thyroid cancer anatomical site were coded by International Classification of Diseases 10th Revision (ICD-10) and pathological histology were coded by International Classification of Diseases for Oncology Third Edition (ICD-O-3): papillary (8260,8340-8344,8450), follicular (8290,8330-8332,8335), medullary (8345-8346,8510), and anaplastic (8012,8020,8021,8030,8031,8032).Code consistency and validity inspection were according to "Guidline for Chinese Cancer Registration" of National Cancer Center and data were checked by IARCcrgTools software of the international association of cancer research center/international cancer registries (IARC/IACR).The rate of pathological diagnosis was 95.46%, the death replacement ratio was 0.35%, the death incidence ratio (M:I) was 0.05.Excel 2013 and SPSS 19.0 were adopted to establish the database and perform statistical analysis. According to "Guidline for Chinese Cancer Registration" recommended method, crude incidence, the age-adjusted incidence (China’s 1982 population structure as to calculate Chinese standardized incidence and the Segi’s world standard population as to calculate world standardized incidence), the standard deviation of standardized rate, median were calculated. The annual percentage change (APC) and 95% CI value were calculated by Jointpont Regression Program 4.0.4 software of American National Cancer Institute, selecting the Grid Search method to judge the statistically significant trend of standardized.The trend of adjacent differences were carried on the statistical test, with P< 0.05 for the statistically significant difference.Results1.6,394 new cases of thyroid cancer(4,926 in female and 468 in males) had reported in Guangzhou in 2004-2013, with a crud incidence of 8.19/100,00 (12.84/100,000 in females and 3.69/100,000 in males) and world standardized incidence of 6.32/100,000(9.82/100,000 in females and 6.32/100,000 in males),which accounted for 5.04% of all cancer.2. The sex ratio of male and female thyroid incidence was 1:3.48 in2004-2013. The incidence median age of thyroid cancer was 45 (46 in men and 45 in women).The median age was 46 for males and 45 for females.The median age for males and females had a downward trend.3. The age thyroid cancer incidence increased with age, reaching peak at the 50-54 age group and declining gradually from 55-59 age group.In different gender, male thyroid cancer incidence increased with age, reaching peak at 55-59 age group (the rate was 7.23/100,000) and then falling slightly, but still maintaining at a high level;female thyroid cancer incidence increased with age, maintaining at a higher level at 30-64 age group (the rates were greater than 15.00/100,000), reaching peak at 50-54 age group (the rate was 22.50/100,000), declining from 65-66 age group and decreasing to 8.52/100,000 at>85 age group.4. Thyroid cancer incidence increased in both men and women from 2004 to 2013.The APC of world standardized incidence were 15.85%(P< 0.001) in males and 13.15% in females,which resulted in a total increase of 244.38%(from 1.6/100,00 to 5.82/100,000) in males and 189.31%(from 5.8/100,00 to 16.78/100,000) in females.5. The increase was not significant at 0-19 and>60 age group, but significant at 20-59 age group in males, with the APC of incidence 20.81%(P< 0.001),which result in a total increase of 415.87%(from 1.89/100,000 to 9.75/100,000). The increase were significant in all age groups in female.The APC were 15.14%(P< 0.001) at 0-19 age group.14.90%(P< 0.001) at 20-59 age group and 6.34%(P< 0.001) at>60 age group,which resulted in a total increase of 206.17%(from 0.81/100,000 to 2.48/100,000) at 0-19 age group.231.95%(from 8.67/100,000 to 28.78/100,000) at 20-59 age group and 88.33%(from 11.74/100,000 to 22.11/100,000) at>60 age group.6. The world standardized incidence rate of thyroid cancer was 4.21 times more in Tianhe district (the highest,9.09/100,000 in) than in Conghua (the lowest 2.16/100,000). The cluster analysis results of incidence were divided into three categories for 12 districts. The first category included Haizhu, Tianhe, Yuexiu,; The second category was Baiyun,Panyu,Nansha,Luogang,Liwan,Huangpu.The third category was Huadu,Zengcheng,Conghua.7. The world standardized incidence rate of thyroid cancer in urban (9.97/100,000) was higher than in suburb (5.52/100,000), but the growth in urban (APC-15.14%) was slightly lower than in suburb (APC= 14.12%).8. The sex difference between men and women was 1:3.71 in papillary thyroid cancer,1:2.88 in follicular and 1:1.73 in medullary.The pathological types of gender differences were statistically significant.The growth of papillary was statistically significant. The APC was 15.57%(P< 0.001), which resulted in a total increase of 274.70%(from the rising of 4.15/100,000 to 4.15/100,000).The changes were no statistically significant in follicular, medullary, anaplastic from 2004 to 2013.Conclusions1. The world standardized incidence rates in Guangzhou were higher than the average levels of Chinese city and world, close to Beijing and United States.The incidence increased rapidly. The prevention and control of thyroid carcinoma should be strengthened.2. Thyroid cancer incidence in females and urban areas was higher than in males and suburb areas, suggesting thyroid cancer prevention and control should focus on females and urban areas.3. The increase of thyroid cancer in Guangzhou was mainly due to papillary carcinoma suggesting strengthening the prevention and treatment of papillary carcinoma. |
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