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. 2020 Aug;9(4):968-984.
doi: 10.21037/gs-20-97.

A rapidly increasing trend of thyroid cancer incidence in selected East Asian countries: Joinpoint regression and age-period-cohort analyses

Runhua Li  1   2 , Youqing Wang  1   2 , Lingbin Du  1   2
Affiliations

A rapidly increasing trend of thyroid cancer incidence in selected East Asian countries: Joinpoint regression and age-period-cohort analyses

Runhua Li et al. Gland Surg. 2020 Aug.

Abstract

Background: This study described the incidence and mortality trends and analyzed age-period-cohort effects on incidences in China, Japan, and Korea.

Methods: Data were extracted from the Cancer Incidence in Five Continents series and the World Health Organization Cancer Mortality Database, and the age-standardized incidence and mortality rates by Segi's world population were calculated. Joinpoint regression analysis was used to evaluate the time trend of age-standardized incidence and mortality rates and the age-period-cohort model with intrinsic estimator was applied for estimating the effects of age, period, and cohort on thyroid cancer (TC) incidence in individuals between 20 and 84 years of age.

Results: An increasing trend in TC incidence rates was observed among males from China (10.3%), Japan (4.7%), and Korea (20.8%) and among females from China (9.4%), Japan (3.5%), and Korea (20.5%). TC incidence rates in females were much higher than those in males. A downward trend of TC mortality rates was observed, especially in both sexes of Japan and Chinese females. The slope of the age effect curve peaked at an earlier age in females than males in Japan and Korea. A strong period effect and remarkedly increasing rate ratios were observed in all regions and for both sexes. The cohort effect had a declining tendency on TC incidence in males and females in these areas.

Conclusions: The rapidly upward incidence trend and strong period effect suggest that overdiagnosis caused by higher diagnostic intensity might be an explanation for the upward trend, and some environmental risk factor exposures are also not excluded. In addition, the discrepant trends of TC incidence and mortality reveal the need to identify the few high-risk patients who needed further treatment from those patients who may not need treatment.

Keywords: Joinpoint regression; Thyroid cancer (TC); age-period-cohort model; incidence; mortality.

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/gs-20-97). The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Age-standardized incidence and mortality rates in three East Asian countries.
Figure 2
Figure 2
The Joinpoint analysis of age-standardized incidence rates in males and females for TC in three East Asian countries.
Figure 3
Figure 3
The Joinpoint analysis of age-standardized mortality rates in males and females for TC in three East Asian countries.
Figure 4
Figure 4
Age-specific incidence rates of TC by period of diagnosis and birth cohort in males and females in (A) China, (B) Japan and (C) Korea.
Figure 5
Figure 5
Relative risk (RR) of age, period, and cohort on TC incidence in females and males in three East Asian countries.
See this image and copyright information in PMC

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