ESPE Yearbook of Paediatric Endocrinology

To read the full abstract: JAMA Otolaryngol Head Neck Surg. 2019 Jul 1;145(7):617–623

Differentiated thyroid cancer represents 2–4% of all pediatric malignancies. In adults, increasing incidence rates have been reported over the last decades. Data on trends in pediatric patients are scarce. This paper reports the 40-year incidence rate of differentiated thyroid cancer in patients younger than 20 years and calculated annual % changes to detect trends most accurately.

The key finding was a marked change in annual % change of differentiated thyroid cancer from 1.1% (1973–2006) to 9.56% (2006–2013). This change was evident for small (<20 mm) and large (>20 mm) tumours as well as for extended and localized disease, suggesting that enhanced diagnosis of thyroid cancer was not the only reason for this trend. In contrast to the steep rise in rates of papillary histology, the incidence of follicular histology remained at low and stable rates over 40 years. There was a higher incidence in female than male patients. White patients represented 83.2% and the age group of 15–20 years represented 76.6% of all affected patients. Mortality was very low.

In summary, the authors describe a significant increase in incidence rate of differentiated thyroid cancer from before versus after 2006. These results are in accordance with a second study of trends of pediatric thyroid cancer incidence from 1998–2013 published in 2019 [1]. However, neither study provides any explanation for this trend.

As a consequence of these data, and despite the discussion of over-diagnosis of thyroid cancer in adults and children, we as clinicians need to develop an appropriate clinical awareness and suspicion for thyroid cancer in pediatric patients.

Reference: 1. Bernier MO, Withrow DR, Berrington de Gonzalez A, Lam CJK, Linet MS, Kitahara CM, Shiels MS. Trends in pediatric thyroid cancer incidence in the United States, 1998–2013. Cancer 2019; doi:10.1002/cncr.32125 [Epub ahead of print].