title: Are there disparities in the presentation, treatment and outcomes of patients diagnosed with medullary thyroid cancer?-An analysis of 634 patients from the California Cancer Registry.
abstract: BACKGROUND
  Race, gender and socioeconomic disparities have been suggested to adversely influence stage at presentation, treatment options and outcomes in patients with cancer. Underserved minorities and those with a low socioeconomic status (SES) present with more advanced disease and have worse outcomes for differentiated thyroid cancer, but this relationship has never been evaluated for medullary thyroid cancer (MTC).
  
  
  METHODS
  We used the California Cancer Registry (CCR) to evaluate disparities in the presentation, treatment and outcomes of patients diagnosed with MTC.
  
  
  RESULTS
  We identified 634 patients with MTC diagnosed between 1988 and 2011. Almost everyone (85%) underwent thyroidectomy with 50% having a central lymph node dissection (CLND). There were no statistically significant differences by age, race or SES in mean tumor size or the proportion of patients diagnosed with localized disease, but men were diagnosed with larger tumors than women and were less likely to be diagnosed at a localized stage. Younger patients and women were more likely to be treated with a thyroidectomy. There were no statistically significant differences in surgical treatment by race or SES. Patients in the highest SES category had a better overall survival, but not disease specific survival, than those in the lowest SES (HR =0.3, CI =0.1-0.7). Patients treated with thyroidectomy had a better overall and cause specific survival, but the effect of CLND was not statistically significant after adjustment for other factors.
  
  
  CONCLUSIONS
  In MTC, we did not find that race, gender or SES influenced the presentation, treatment or outcomes of patients with MTC. Men with MTC present with larger tumors and are less likely to have localized disease. Half of the MTC patients in California do not undergo a CLND at the time of thyroidectomy, which may suggest a lack appropriate care across a range of healthcare systems.
authors: Department of Internal Medicine, Division of Endocrinology, University of California, Davis, USA ;
authors: Christine
authors: C
authors: Cox
authors: Department of Public Health Sciences, Division of Epidemiology, University of California, Davis, USA ;
authors: Yingjia
authors: Y
authors: Chen
authors: Department of Public Health Sciences, Division of Epidemiology, University of California, Davis, USA ;
authors: Rosemary
authors: R
authors: Cress
authors: Department of Internal Medicine, Division of Endocrinology, University of California, Davis, USA ;
authors: Alison M
authors: AM
authors: Semrad
authors: Department of Internal Medicine, Division of Hematology and Oncology, University of California, Davis, USA ;
authors: Thomas
authors: T
authors: Semrad
authors: Department of Surgery, Section of Endocrine Surgery, University of California, San Francisco, USA ;
authors: Jessica E
authors: JE
authors: Gosnell
authors: Department of Surgery, Section of Endocrine Surgery, University of California, Davis, USA.
authors: Michael J
authors: MJ
authors: Campbell
keywords: California Cancer Registry (CCR); Medullary thyroid cancer (MTC); central lymph node dissection (CLND); socioeconomic disparities