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Abstract：
Background: Overdiagnosis is the leading factor contributing to the rapid increase in thyroid cancer incidence of the last decades. During this period, however, thyroid cancer incidence has not been increasing at a constant pace. We hypothesized that changes in the slope of the incidence trends curve, called joinpoints, could be associated with changes in clinical practice guideline recommendations. Methods: Data were obtained from the initial nine registries of the Surveillance, Epidemiology, and End Results (SEER) Program. Thyroid cancer incidence was analyzed from 1975 to 2016. Joinpoints in thyroid cancer incidence trends and clinical variables were correlated with significant changes in clinical practice recommendations. Results: Incidence rate trends of medullary and anaplastic thyroid cancer were constant during the study period. Among papillary thyroid cancers (PTCs), three main joinpoints were identified, mainly driven by changes in incidence trends of smaller cancers. First, acceleration followed by two deceleration periods in thyroid cancer incidence coincident in time with the release of American Thyroid Association guidelines in 1996, 2009, and 2015. In 1996, the use of thyroid ultrasound and fine needle aspiration biopsy for the evaluation of thyroid nodules was described; and in 2009 and 2015, higher size thresholds for the biopsy of thyroid nodules were set. For the follicular variant of PTC, a joinpoint was observed around 1988, when the histological diagnosis of this entity was revised in the World Health Organization classification; and another one in 2015 coinciding with the proposal to remove the term carcinoma from noninvasive follicular-pattern tumors with papillary-like nuclear features which contributed to drive down the overall thyroid cancer incidence. Follicular thyroid cancer incidence was affected as well by changes in the guidelines, but to a lesser extent, and it was fairly stable during the study period. Conclusions: This study suggests that thyroid cancer incidence trends have been shaped, in large part, but not completely, by changes in professional guideline recommendations.
摘要：
背景：过度诊断是导致近几十年来甲状腺癌发病率迅速增加的主要因素。在此期间,然而,甲状腺癌的发病率并没有持续增加。我们假设发病率趋势曲线的斜率变化，称为连接点，可能与临床实践指南建议的变化有关。方法：数据来自最初的九个监测登记册，流行病学,和最终结果（SEER）计划。分析1975年至2016年甲状腺癌发病率。甲状腺癌发病率趋势和临床变量的联合点与临床实践建议的显着变化相关。结果：在研究期间，髓样和间变性甲状腺癌的发病率趋势是恒定的。在乳头状甲状腺癌（PTC）中，确定了三个主要连接点，主要由较小癌症发病率趋势的变化驱动。首先,甲状腺癌发病率加速后出现两个减速期,这与美国甲状腺协会在1996年,2009年和2015年发布的指南一致.1996年，描述了使用甲状腺超声和细针穿刺活检评估甲状腺结节；2009年和2015年，为甲状腺结节的活检设定了更高的尺寸阈值。对于PTC的卵泡变体，在1988年前后,世界卫生组织对该实体的组织学诊断进行了修订,在2015年观察到了一个接合点;另一个接合点与从具有乳头状样核特征的非侵袭性滤泡型肿瘤中去除术语癌的提议相吻合,这有助于降低整体甲状腺癌的发病率.滤泡性甲状腺癌的发病率也受到指南变化的影响，但在较小程度上，在研究期间相当稳定。结论:本研究提示甲状腺癌发病趋势已经形成,在很大程度上,但不完全是,通过专业指南建议的变化。
