Role of the Mechanisms of Detection in the Increased Risk of Thyroid Cancer: A Retrospective Cohort Study in an HMO in Buenos Aires

Abstract

Background. Two hypotheses attempt to explain the increase of thyroid cancer (TC) incidence: overdetection by excessive diagnostic scrutiny and a true increase in new cases brought about by environmental factors. Changes in the mechanism of detection and the risk of incidentally diagnosed TC could result in an increase of TC incidence. Methods. Retrospective cohort study. We identified incident cases of TC from the pathological reports of patients in a HMO and review of clinical records. The results were analyzed in two periods: 2003-2007 and 2008-2012. Incidence rates expressed per 100,000 person-years (with 95% CI) and relative risk of incidence rates of incidental and nonincidental TC were estimated. Results. The relative risk of incidentally detecting a thyroid cancer in 2008-2012 compared to 2003-2007 was 6.06 (95%CI 1.84-20.04). Clinical evaluations detected 31 (75.6%) cancers in the period 2003-2007 and 70 (51.8%) cancers in the period 2008-2012 (p<0.007). Although tumor median size was significantly lower in the period 2008-2012 (10 vs. 14 mm, p<0.03), tumors greater than 40 mm (4.3%) were only present in 2008-2012. The female/male ratio decreased between analyzed periods from 8 (3-21) to 4 (3-7). Conclusions. Our findings partially support the hypothesis of increased incidence due to overdetection but do not explain the changes in the increase of larger tumors and decrease in the female/male ratio, which could be secondary to the influence of unidentified environmental factors.