title: Improved detection does not fully explain the rising incidence of well-differentiated thyroid cancer: a population-based analysis.
abstract: BACKGROUND
  The increasing incidence of thyroid cancer may be an artifact of increased diagnostic scrutiny, permitting detection of smaller, subclinical thyroid cancers. Our objective was to examine trends in the incidence of well-differentiated thyroid cancers with large size and adverse pathological features.
  
  
  METHODS
  Detailed population-based analysis of incidence trends in well-differentiated thyroid carcinoma (1973-2006) in the Surveillance Epidemiology and End Results (SEER) cancer registry, using weighted least squares and Joinpoint regression models.
  
  
  RESULTS
  The incidence of well-differentiated thyroid cancer (WDTC) in the United States has tripled since 1973 (P < .0001). Incidence trends differ significantly between geographic regions and racial groups. Large WDTCs, including those >4 cm or >6 cm, have more than doubled in incidence (P < .0001). Cancers with extrathyroidal extension and with cervical metastases have also more than doubled in incidence (P < .0001).
  
  
  CONCLUSIONS
  While the model of improving screening does explain increased diagnoses of small thyroid cancers, significant rises in the incidence of large cancers, and cancers with clinically significant pathological adverse features, are harder to explain. Alternative hypotheses, including a true increase in cancer incidence, would seem to merit exploration.
authors.affiliation: Head and Neck Service, New York University Cancer Institute, New York, NY, USA. morrisl@mskcc.org
authors.forename: Luc G T
authors.initials: LG
authors.lastname: Morris
authors.forename: David
authors.initials: D
authors.lastname: Myssiorek
mesh_terms: D003937:Diagnosis, Differential; D018450:Disease Progression; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods*; D011159:Population Surveillance / Q000379:methods*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D018426:SEER Program; D017678:Sex Distribution; D013964:Thyroid Neoplasms / Q000175:diagnosis* / Q000453:epidemiology*; D014481:United States / Q000453:epidemiology