美国 2007-2014 年甲状腺癌发病率的种族/民族差异。
Racial/ethnic differences in thyroid cancer incidence in the United States, 2007-2014.
机构信息
Medical Scientist Training Program, Carver College of Medicine, University of Iowa, Iowa City, Iowa.
Department of Epidemiology, University of Iowa College of Public Health, Iowa City, Iowa.
出版信息
Cancer. 2018 Apr 1;124(7):1483-1491. doi: 10.1002/cncr.31229. Epub 2018 Jan 16.
BACKGROUND
Small tumor diagnostic tools including ultrasound-guided fine needle aspiration (FNA) and computed tomography (CT) could be causing rising and racially/ethnically different thyroid cancer incidence rates due to variable overdiagnosis of indolent tumors. Papillary tumors and <40 mm tumors are most likely to be overdiagnosed as indolent tumors by FNA and CT.
METHODS
Age-adjusted incidence rates (AAIRs) for the years 2007-2014 were calculated for race/ethnicity (white, Hispanic, Asian, African American, Native American) by patient/tumor characteristics for microscopically confirmed malignant thyroid cancer cases in the Surveillance, Epidemiology, and End Results Program 18 database (SEER 18; N = 93,607). Multivariate analysis determined cancer patients' odds ratios of diagnosis with papillary thyroid carcinoma (vs other histologies) and tumors <40 mm (vs ≥40 mm).
RESULTS
For both males and females, there were statistically significant differences in incidence rates between race/ethnicity, with whites having the highest AAIRs and African Americans the lowest AAIRs. Among thyroid cancer patients, tumor size and histology differed significantly by race and insurance coverage after controlling for age, sex, stage, and tumor sequence. Non-whites with thyroid cancer (vs whites) were less associated with small tumors (odds ratio [OR], 0.51-0.79; P < .0001). Medicaid and uninsured patients with thyroid cancer were less associated with tumors <40 mm (OR, 0.55-0.71; 95% confidence interval [CI], 0.49-0.76) and papillary carcinoma (OR, 0.86; 95% CI, 0.80-0.93).
CONCLUSION
The diagnosis of small tumors is occurring at greater rates in whites (vs non-whites) and insured (vs Medicaid and uninsured) patients; consequently, these groups may be vulnerable to unnecessary tests and treatments or potentially aided by early detection. Guidelines that define postdetection interventions may be needed to limit the overtreatment of indolent and small papillary carcinomas. Cancer 2018;124:1483-91. © 2018 American Cancer Society.
背景
包括超声引导下细针抽吸（FNA）和计算机断层扫描（CT）在内的小肿瘤诊断工具，由于对惰性肿瘤的过度诊断，可能导致甲状腺癌发病率的上升和不同种族/民族之间的差异。FNA 和 CT 最有可能将乳头状肿瘤和<40mm 的肿瘤过度诊断为惰性肿瘤。
方法
通过对监测、流行病学和最终结果计划 18 数据库（SEER 18；N=93607）中经显微镜证实的恶性甲状腺癌病例的患者/肿瘤特征，计算 2007-2014 年期间按种族/民族（白人、西班牙裔、亚洲人、非裔美国人、美洲原住民）划分的年龄调整发病率（AAIR）。多变量分析确定了癌症患者被诊断为甲状腺乳头状癌（与其他组织学相比）和肿瘤<40mm（与≥40mm 相比）的优势比。
结果
无论男性还是女性，种族/民族之间的发病率都存在统计学差异，白人的 AAIR 最高，非裔美国人的 AAIR 最低。在甲状腺癌患者中，在控制年龄、性别、分期和肿瘤序列后，肿瘤大小和组织学在种族和保险覆盖范围方面存在显著差异。患有甲状腺癌的非白人（与白人相比）与小肿瘤的相关性较低（优势比[OR]，0.51-0.79；P<.0001）。患有甲状腺癌的医疗补助和无保险患者与肿瘤<40mm（OR，0.55-0.71；95%置信区间[CI]，0.49-0.76）和甲状腺乳头状癌（OR，0.86；95%CI，0.80-0.93）的相关性较低。
结论
白人（与非白人相比）和有保险（与医疗补助和无保险相比）患者中，小肿瘤的诊断率更高；因此，这些群体可能容易受到不必要的检查和治疗，或者可能通过早期发现而受益。可能需要制定定义检测后干预措施的指南，以限制对惰性和小的甲状腺乳头状癌的过度治疗。癌症 2018；124：1483-91。©2018 美国癌症协会。
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