JAMA Sub-Journal: Are women more likely to get thyroid cancer?

We often hear this saying: Women are more likely to get thyroid cancer
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The results of various epidemiological investigations seem to support the above view.
However, does thyroid cancer really prefer women? Scientists from Dartmouth College in the United States expressed doubts about this.
They believed that judging whether there is a gender difference in a disease depends not only on morbidity but also on mortality.
So they conducted these two aspects of thyroid cancer.
Investigation
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The results show that although women are indeed higher in morbidity than men, the mortality rate is approximately equal
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The research was recently published in the journal JAMA Internal Medicine
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Screenshot source: JAMA Internal Medicine data source and research methods American adults (≥18 years old) thyroid cancer incidence and mortality data are from the National Cancer Institute's surveillance, epidemiology, and final results plan from 1975 to 2017 ( SEER) data
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A research article on the prevalence of subclinical thyroid cancer (published until May 31, 2021), from Embase, PubMed and Web of Science databases
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Researchers performed cohort analysis and meta-analysis on the above data
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Subclinical state, also known as "asymptomatic disease", refers to a certain degree of changes in the body's metabolism or function, but no obvious clinical symptoms and signs
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Papillary thyroid carcinoma (PTC) is usually in a subclinical state.
Autopsy results show that about 11% of people have one or more PTC lesions in the thyroid or nearby lymph nodes, and these people did not know that they had a thyroid before they were alive.
Cancer
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Research results The cohort study found that the current incidence of small and medium-sized (≤2 cm) PTC in women and men is 4.
39:1
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The meta-analysis found that based on the subclinical PTC data found in the autopsy, the PTC detection rate for women and men was 1.
07:1, and the mortality rate for thyroid cancer was 1.
02:1
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In other words, the gender differences in thyroid cancer are mainly limited to small and medium-sized PTCs, while there are no gender differences in the incidence of high-risk types of thyroid cancer, thyroid cancer mortality, and subclinical cancer prevalence
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Research motivation found the problem: the detection rate of thyroid cancer continued to increase, but the mortality rate did not decrease.
In the late 1970s and early 1980s, thyroid ultrasound and needle biopsy were introduced and used in the United States to assess thyroid nodules, both of which have a higher degree of visualization Technology has significantly improved the accuracy of detection and diagnosis, enabling doctors to better distinguish between benign and malignant lesions
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With the continuous popularization of the two technologies, the incidence of thyroid cancer in the United States has more than tripled since the early 1990s, but the mortality rate has not decreased, not only in the United States, but also in other countries
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Nowadays, in the United States, thyroid cancer is the fifth most common cancer among women and the ninth most common cancer among men.
It is expected to become the most common cancer among people aged 15 to 29 by 2021
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Analyzing the cause: Existing data suggests to clinicians that the incidence of some one-sided thyroid cancer in women has always been higher than that in men, and in recent years, with the increase in incidence in the United States and many other countries, this difference has become more obvious
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So why are the differences becoming more and more obvious? Judging from the available data, the diagnosis frequency of subclinical PTC in women is more than 4 times that of men, which gives people a hint: the incidence of thyroid cancer may be more common in women
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Then, clinicians formed such a thinking mode-to increase the screening of women for thyroid cancer
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As a result, this forms a feedback loop, with more detection-more discovery-more detection
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However, this cycle actually has an adverse effect on all genders, with over-examination of women and under-examination of men
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In the end, the detection rate continued to increase, but the mortality rate did not decrease
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Find a breakthrough: Statistics of thyroid cancer by gender.
So far, the investigation of the biological causes of gender-specific differences in thyroid cancer has not been conclusive
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This study analyzed the incidence and mortality data of major thyroid cancer histological types and tumor size categories for women and men in the United States, and conducted a meta-analysis by gender to investigate the prevalence of subclinical thyroid cancer in the total thyroid outcome
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Carry out autopsy on individuals without known thyroid disease, and count the status of thyroid cancer
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Discussion and Prospects In the face of disease, critical thinking is very important.
A large number of studies and epidemiological investigations have pointed to the fact that the prevalence of PTC in women is much higher than that of men, so it is natural to draw an inference-women are more likely It is not easy for men to get thyroid cancer, so we should increase the screening of women for thyroid cancer
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Studies have shown that women pay more attention to medical care than men, which provides more opportunities for finding thyroid nodules and diagnosing thyroid cancer
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Among the medical insurance population in the United States, from 2002 to 2013, the use of thyroid ultrasonography has greatly increased, which is related to the continuous increase in women's thyroid cancer screening
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In addition, women are also more likely than men to be referred by a doctor for thyroid ultrasound due to unexplained discomfort (such as fatigue, menstrual disorders)
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The whole society is paying more and more attention to women's thyroid cancer, which is naturally good for women, but at the same time, it may also neglect the screening of men's thyroid cancer, which brings health risks
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In the face of thyroid cancer, both men and women must be vigilant.
The analysis of this research shows that there is basically no difference between men and women in terms of thyroid cancer mortality.
Therefore, the argument that thyroid cancer prefers women is too one-sided
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A more reasonable action is that, on the one hand, we must actively screen and treat small, low-risk PTCs to reduce the harm it may bring
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On the other hand, thyroid cancer screening for women and men needs to be improved simultaneously
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Although the disease is tricky, over-treatment also needs to be vigilant.
Finally, the very important point is not to over-treatment
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We know that thyroid cancer is the common enemy of women and men, but many thyroid cancers exist in a subclinical state.
This shows that the treatment of the disease should be cautious and rational.
If the disease is mild but over-treated, new ones may be introduced.
Illness reduces the quality of life
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Related reading Why do women get more thyroid disease? JAMA elaborated on the physiological changes in women's life that affect too much iodized salt.
Will it increase thyroid nodules and thyroid cancer? The team of the Third Xiangya Hospital published the opinion of an authoritative endocrinologist with over 50,000 Chinese data: What should I eat to promote thyroid health? What shouldn't you eat? How high is the rate of overdiagnosis of thyroid cancer in various parts of China? Authoritative data published the "Lancet" sub-journal "Nature" review: more and more thyroid cancer, do you know the risk factors of Chinese "characteristic"? Text/Sheng Jie/Jane Title Picture Source: 123RF References: LeClair K, Bell KJL, Furuya-Kanamori L, Doi SA, Francis DO, Davies L.
(2021).
Evaluation of Gender Inequity in Thyroid Cancer Diagnosis: Differences by Sex in US Thyroid Cancer Incidence Compared With a Meta-analysis of Subclinical Thyroid Cancer Rates at Autopsy.
JAMA Intern Med, doi:10.
1001/jamainternmed.
2021.
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This article is for the purpose of information exchange only.
The opinions expressed in the article do not represent the position of WuXi AppTec, nor does it mean that WuXi AppTec supports or opposes the views in the article
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