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An Executive Summary of The Philippine Interim Clinical Practice Guidelines for the Diagnosis and Management of Well Differentiated Thyroid Cancer 2021. ACTA MEDICA PHILIPPINA 2024; 58:5-30. [PMID: 38812767 PMCID: PMC11132293 DOI: 10.47895/amp.vi0.6535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/31/2024]
Abstract
Objectives Thyroid cancer is the most common endocrine cancer in the Philippines affecting primarily women in the reproductive age group. Considering the burden of thyroid cancer in the country, the Department of Health (DOH) called for the development of a national clinical practice guideline that would address patient needs, and aid physicians in clinical decision-making while considering therapeutic cost and availability in the local setting. The 2021 guidelines are aimed at providing optimal care to Filipino patients by assisting clinicians in the evaluation of thyroid nodules and management of well differentiated thyroid cancer. Methods A steering committee convened to formulate clinical questions pertaining to the screening and evaluation of thyroid nodules, surgical and post operative management of thyroid cancer, and palliative care for unresectable disease. A technical working group reviewed existing clinical guidelines, retrieved through a systematic literature search, synthesized clinical evidence, and drafted recommendations based on the ADAPTE process of clinical practice guideline development. The consensus panel reviewed evidence summaries and voted on recommendations for the final statements of the clinical practice guidelines. Results The guidelines consist of clinical questions and recommendations grouped into six key areas of management of well differentiated thyroid cancer: screening, diagnosis, surgical treatment, post operative management, surveillance, and palliative care. Conclusion The 2021 guidelines for well differentiated cancer could direct physicians in clinical decision making, and create better outcomes for Filipino patients afflicted with the disease. However, patient management should still be governed by sound clinical judgement and open physician-patient communication.
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Gillis A, Chen H, Wang TS, Dream S. Racial and Ethnic Disparities in the Diagnosis and Treatment of Thyroid Disease. J Clin Endocrinol Metab 2024; 109:e1336-e1344. [PMID: 37647887 PMCID: PMC10940267 DOI: 10.1210/clinem/dgad519] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 08/22/2023] [Accepted: 08/28/2023] [Indexed: 09/01/2023]
Abstract
CONTEXT There are differences in diagnosis, treatment, and outcomes for thyroid between racial and ethnic groups that contribute to disparities. Identifying these differences and their causes are the key to understanding and reducing disparities in presentation and outcomes in endocrine disorders. EVIDENCE ACQUISITION The present study reviews original studies identifying and exploring differences between benign and malignant thyroid diseases. A PubMed, Web of Science, and Scopus search was conducted for English-language studies using the terms "thyroid," "thyroid disease," "thyroid cancer," "race," "ethnicity," and "disparities" from inception to December 31, 2022. EVIDENCE SYNTHESIS Many racial and ethnic disparities in the diagnosis, presentation, treatment, and outcomes of thyroid disease were found. Non-White patients are more likely to have a later time to referral, to present with more advanced disease, to have more aggressive forms of thyroid cancer, and are less likely to receive the appropriate treatment than White patients. Overall and disease-specific survival rates are lower in Black and Hispanic populations when compared to White patients. CONCLUSIONS Extensive disparities exist in thyroid disease diagnosis, treatment, and outcomes that may have been overlooked. Further work is needed to identify the causes of these disparities to begin to work toward equity in the care of thyroid disease.
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Affiliation(s)
- Andrea Gillis
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Herbert Chen
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Tracy S Wang
- Department of Surgery, Medical College of Wisconsin, Milwaukee, WI 53266, USA
| | - Sophie Dream
- Department of Surgery, Medical College of Wisconsin, Milwaukee, WI 53266, USA
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Chen DW, Lang BHH, McLeod DSA, Newbold K, Haymart MR. Thyroid cancer. Lancet 2023; 401:1531-1544. [PMID: 37023783 DOI: 10.1016/s0140-6736(23)00020-x] [Citation(s) in RCA: 91] [Impact Index Per Article: 91.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 12/20/2022] [Accepted: 01/03/2023] [Indexed: 04/08/2023]
Abstract
The past 5-10 years have brought in a new era in the care of patients with thyroid cancer, with the introduction of transformative diagnostic and management options. Several international ultrasound-based thyroid nodule risk stratification systems have been developed with the goal of reducing unnecessary biopsies. Less invasive alternatives to surgery for low-risk thyroid cancer, such as active surveillance and minimally invasive interventions, are being explored. New systemic therapies are now available for patients with advanced thyroid cancer. However, in the setting of these advances, disparities exist in the diagnosis and management of thyroid cancer. As new management options are becoming available for thyroid cancer, it is essential to support population-based studies and randomised clinical trials that will inform evidence-based clinical practice guidelines on the management of thyroid cancer, and to include diverse patient populations in research to better understand and subsequently address existing barriers to equitable thyroid cancer care.
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Affiliation(s)
- Debbie W Chen
- Division of Metabolism, Endocrinology, and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Brian H H Lang
- Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Hong Kong Special Administrative Region, China
| | - Donald S A McLeod
- Department of Endocrinology and Diabetes, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia; Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Kate Newbold
- Thyroid Unit, The Royal Marsden NHS Foundation Trust, London, UK
| | - Megan R Haymart
- Division of Metabolism, Endocrinology, and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA.
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Hsu R, Tsai KY, Chennapan K, Wojcik KY, Lee AW, Nieva JJ, Liu L. Characterization of mortality and high-risk characteristics of thyroid cancer in Filipinos using the California Cancer Registry. Front Public Health 2023; 10:1104607. [PMID: 36743179 PMCID: PMC9893642 DOI: 10.3389/fpubh.2022.1104607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 12/29/2022] [Indexed: 01/20/2023] Open
Abstract
Introduction Filipinos are the third largest Asian American subgroup and have the highest incidence of thyroid cancer among all races. To better understand this racial/ethnic disparity in thyroid cancer affecting Filipinos we analyzed the California Cancer Registry (CCR) data in Filipino thyroid cancer cases from 1988 to 2018. Methods 97,948 thyroid cancer cases in California from 1988 to 2018 (until 2015 for Asian subgroups) were evaluated. We examined the case distribution by sex, age at diagnosis, race/ethnicity including Asian ethnic subgroups, histology, TNM stage, tumor size, lymph node involvement, lymphovascular invasion, and multifocality. We also looked at treatment data including surgery and radiation including radioactive iodine therapy. We calculated age-adjusted mortality rates (AAMR) for each major racial group and each Asian ethnic subgroup. Binary logistic regression was used to determine the likelihood of high-risk characteristics and treatment when comparing Filipinos to other racial/ethnic groups. Kaplan-Meier Estimate was performed to evaluate thyroid cancer survival across all race/ethnicities. Multivariate Cox proportion hazards regression was performed to evaluate mortality risk from all causes of death by race. Results There were 5,243 (5.35%) Filipino thyroid cancer cases in California from 1988 to 2018. Filipinos had the highest AAMR (1.22 deaths per 100,000) in 2015. Filipinos had a higher likelihood of Stage IV thyroid cancer compared with Non-Hispanic Whites, Non-Hispanic Blacks, Hispanics and nearly all Asian subgroups. Filipinos had a worse 5-year and 10-year overall survival (OS) than the combination of all other Asian/Pacific Islanders. Filipinos compared to Non-Hispanic Whites had significant mortality risk in overall and papillary thyroid cancer cases (Overall HR: 1.10, 95% CI 1.07-1.13, p < 0.0001, Papillary HR: 1.11, 95% CI 1.07-1.14, p < 0.0001) when adjusted for race/ethnicity, age, gender, socioeconomic status, and stage. When stratified by Charlson comorbidity score, Filipinos compared to Non-Hispanic Whites still had significant mortality risk (Charlson 0 HR: 1.07, 95% CI 1.02-1.11, p = 0.0017, Charlson 1+ HR: 1.07 95% CI 1.002-1.14, p = 0.0434). Conclusions Filipino thyroid cancer patients have higher incidences of high-risk pathological features and greater AAMR and mortality risk. These findings warrant further investigation into better understanding the connection between the greater incidence of high-risk characteristics and increased mortality in Filipinos.
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Affiliation(s)
- Robert Hsu
- Division of Medical Oncology, Department of Internal Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States,Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States,*Correspondence: Robert Hsu ✉
| | - Kai-Ya Tsai
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States,Los Angeles Cancer Surveillance Program, Los Angeles, CA, United States
| | - Krithika Chennapan
- Department of Internal Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Katherine Y. Wojcik
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States,Los Angeles Cancer Surveillance Program, Los Angeles, CA, United States
| | - Alice W. Lee
- Department of Public Health, California State University, Fullerton, Fullerton, CA, United States
| | - Jorge J. Nieva
- Division of Medical Oncology, Department of Internal Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States,Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Lihua Liu
- Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States,Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States,Los Angeles Cancer Surveillance Program, Los Angeles, CA, United States
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Kruger E, Toraih EA, Hussein MH, Shehata SA, Waheed A, Fawzy MS, Kandil E. Thyroid Carcinoma: A Review for 25 Years of Environmental Risk Factors Studies. Cancers (Basel) 2022; 14:cancers14246172. [PMID: 36551665 PMCID: PMC9777404 DOI: 10.3390/cancers14246172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 12/07/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022] Open
Abstract
Environmental factors are established contributors to thyroid carcinomas. Due to their known ability to cause cancer, exposure to several organic and inorganic chemical toxicants and radiation from nuclear weapons, fallout, or medical radiation poses a threat to global public health. Halogenated substances like organochlorines and pesticides can interfere with thyroid function. Like phthalates and bisphenolates, polychlorinated biphenyls and their metabolites, along with polybrominated diethyl ethers, impact thyroid hormones biosynthesis, transport, binding to target organs, and impair thyroid function. A deeper understanding of environmental exposure is crucial for managing and preventing thyroid cancer. This review aims to investigate the relationship between environmental factors and the development of thyroid cancer.
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Affiliation(s)
- Eva Kruger
- School of Medicine, Tulane University, New Orleans, LA 70112, USA
| | - Eman A. Toraih
- Division of Endocrine and Oncologic Surgery, Department of Surgery, School of Medicine, Tulane University, New Orleans, LA 70112, USA
- Medical Genetics Unit, Department of Histology and Cell Biology, Faculty of Medicine, Suez Canal University, Ismailia 41522, Egypt
- Correspondence: (E.A.T.); (M.S.F.)
| | - Mohammad H. Hussein
- Division of Endocrine and Oncologic Surgery, Department of Surgery, School of Medicine, Tulane University, New Orleans, LA 70112, USA
| | - Shaimaa A. Shehata
- Department of Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Suez Canal University, Ismailia 41522, Egypt
| | - Amani Waheed
- Department of Community Medicine, Faculty of Medicine, Suez Canal University, Ismailia 41522, Egypt
| | - Manal S. Fawzy
- Department of Medical Biochemistry and Molecular Biology, Faculty of Medicine, Suez Canal University, Ismailia 41522, Egypt
- Department of Biochemistry, Faculty of Medicine, Northern Border University, Arar 1321, Saudi Arabia
- Correspondence: (E.A.T.); (M.S.F.)
| | - Emad Kandil
- Division of Endocrine and Oncologic Surgery, Department of Surgery, School of Medicine, Tulane University, New Orleans, LA 70112, USA
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Ghali MS, El Ansari W, Abdelaal A, Al Hassan MS. Behaviour and epidemiology of differentiated thyroid cancer among filipinos in and outside the Philippines: Comparison between Qatar, Canada and Philippines. Ann Med Surg (Lond) 2022; 81:104202. [PMID: 36147099 PMCID: PMC9486373 DOI: 10.1016/j.amsu.2022.104202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 07/12/2022] [Accepted: 07/12/2022] [Indexed: 12/02/2022] Open
Abstract
Background No study assessed the behaviour/epidemiology of differentiated thyroid cancer (DTC) among Filipinos in the Middle East/north Africa; or compared such behaviour with Filipino DTC patients in and outside the Philippines. Materials and methods Retrospective review of all adult Filipinos with DTC diagnosed between 2015 and 2020 at our institution [papillary TC (PTC, n = 110); follicular TC (FTC, n = 4)]. Chi-square or t-test compared the frequency, demography, history, ultrasound, laboratory and histopathology of PTC vs FTC; and compared the epidemiology of DTC among Filipinos in Qatar vs Canada (1 study) vs the Philippines (3 studies). Results DTC frequency was ≈43.84 cases/100,000 Filipinos in Qatar. Males had more aggressive disease in terms of lymphovascular invasion, number of nodules, stage IV disease and metastases. PTC and FTC were similar, but more PTC patients presented with solid tumors and higher number of involved lymph nodes. DTC behaviour among Filipinos in Qatar vs Canada was fairly homogenous. Conversely, DTC among Filipinos in Qatar vs Philippines exhibited many dissimilarities: Qatar had significantly younger patients, less hyperthyroid/thyrotoxicity symptoms and neck swelling at presentation, fewer solid nodules, micro-calcifications, and multi-nodular disease; smaller tumors; more stage I and less stage IV disease; and no distant metastasis (P 0.01 to < 0.0001). Conclusions DTC epidemiology among Filipinos in Qatar and Canada was fairly homogenous. Conversely, DTC in Qatar vs the Philippines was dissimilar. DTC among Filipinos in Qatar has presentations that could be misinterpreted as non-suspicious. This warrants additional practices for earlier detection among Filipinos. Epidemiology of differentiated thyroid cancer among Filipinos living Qatar vs Canada has considerable similarities. Epidemiology of differentiated thyroid cancer among Filipinos living Qatar vs the Philippines appears to be heterogenous. Differentiated thyroid cancer among Filipinos living in Qatar has presentations that could erroneously be misinterpreted as non-malignant by unsuspecting health worker, and seemingly lower tumor load compared to those living in the Philippines. Thyroid lesions among Filipinos in Qatar should be taken seriously, warranting additional practices for earlier detection among Filipinos.
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Affiliation(s)
- Mohamed Said Ghali
- Department of Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
- Department of General Surgery, Ain Shams University, Cairo, Egypt
| | - Walid El Ansari
- Department of Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
- College of Medicine, Qatar University, Doha, Qatar
- Weill Cornell Medicine – Qatar, Doha, Qatar
- Corresponding author. Department of Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, 3050, Qatar.
| | - Abdelrahman Abdelaal
- Department of Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Mohamed S. Al Hassan
- Department of Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
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Santamaria-Barria JA, Graff-Baker AN, Chang SC, Khader A, Scholer AJ, Garland-Kledzik M, Goldfarb M. Disparities in the impact of the AJCC 8th edition staging system on differentiated thyroid cancer outcomes. Head Neck 2022; 44:2129-2141. [PMID: 35766292 DOI: 10.1002/hed.27122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 05/15/2022] [Accepted: 06/01/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND The impact of AJCC8 among self-reported racial/ethnic groups on differentiated thyroid cancer (DTC) outcomes is unknown. METHODS Multivariate-regression evaluated the association between AJCC7 to AJCC8 stage change and race/ethnicity in patients with DTC in the NCDB. Cox-proportional-regression evaluated whether AJCC7 to AJCC8 stage change affects overall survival (OS) differently based on reported race/ethnicity. RESULTS After adjusting for confounders, Hispanics and Asian-Pacific-Islanders (APIs) were 27% and 12% less likely to be down-staged compared to white-non-Hispanics (WNHs) (p < 0.001); black-non-Hispanics (BNHs) had no significant down-staging difference. Down-staged patients had an increased risk of death compared to patients with unchanged staging, regardless of race/ethnicity. However, based on two-way interaction, the magnitude of this negative change on survival from down-staging was only different between WNHs (HR = 2.64) and BNHs (HR = 1.77), (p = 0.04). CONCLUSIONS Outcome disparities persist among self-reported racial/ethnic groups with AJCC8. Down-staged patients across all racial/ethnic groups had decreased survival compared to those with unchanged stage, with the least impact in BNHs.
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Affiliation(s)
- Juan A Santamaria-Barria
- Department of Surgical Oncology, Saint John's Cancer Institute at Providence Saint John's Health Center, Santa Monica, California, USA
| | | | - Shu-Ching Chang
- Medical Data Research Center, Providence St. Joseph Health, Portland, Oregon, USA
| | - Adam Khader
- Department of Surgical Oncology, Saint John's Cancer Institute at Providence Saint John's Health Center, Santa Monica, California, USA
| | - Anthony J Scholer
- Department of Surgical Oncology, Saint John's Cancer Institute at Providence Saint John's Health Center, Santa Monica, California, USA
| | - Mary Garland-Kledzik
- Department of Surgical Oncology, Saint John's Cancer Institute at Providence Saint John's Health Center, Santa Monica, California, USA
| | - Melanie Goldfarb
- Department of Surgical Oncology, Saint John's Cancer Institute at Providence Saint John's Health Center, Santa Monica, California, USA
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Megwalu UC, Osazuwa-Peters N, Moon P, Palaniappan LP. Thyroid Cancer Incidence Trends Among Filipinos in the United States. Laryngoscope 2021; 132:1495-1502. [PMID: 34910822 DOI: 10.1002/lary.29986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 11/22/2021] [Accepted: 12/04/2021] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To analyze thyroid cancer incidence trends among Filipinos relative to non-Filipino Asians and non-Hispanic Whites in the US. STUDY DESIGN Population-based analysis of cancer incidence data. METHODS Population-based analysis of cancer incidence data from Surveillance, Epidemiology, and End Results 9 detailed Asian/Pacific Islander subgroup incidence and population datasets. Adult patients aged 20 and older with thyroid cancer diagnosed in 2004 to 2014 were included. Annual percent change (APC) of the incidence rates were calculated using joinpoint regression analysis. RESULTS The incidence rates were 19.57 (95% CI 19.03-20.12) per 100,000 for Filipinos, 10.45 (95% CI 10.22-10.68) per 100,000 for non-Filipino Asians, and 13.94 (95% CI 13.85-14.02) per 100,000 for non-Hispanic Whites. The highest increase was seen among non-Hispanic Whites (average APC 5.04, 95% CI 4.61-5.46). Incidence rates of tumors ≤ 2 cm remained stable among Filipinos but increased in non-Filipino Asians (average APC 5.38, 95% CI 2.51-8.34) and non-Hispanic Whites (average APC 5.81 95% CI 4.52-7.11). CONCLUSION Filipinos have high incidence of thyroid cancer compared with other racial/ethnic groups. However, non-Hispanic Whites have the highest increase in incidence rates, resulting in a significant narrowing of the gap in incidence rates between Filipinos and non-Hispanic Whites. This is most likely due to enhanced detection of small tumors in non-Hispanic Whites. Laryngoscope, 2021.
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Affiliation(s)
- Uchechukwu C Megwalu
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, U.S.A
| | - Nosayaba Osazuwa-Peters
- Department of Head and Neck Surgery and Communication Sciences, Duke University School of Medicine, Durham, North Carolina, U.S.A.,Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, U.S.A.,Duke Cancer Institute, Duke University, Durham, North Carolina, U.S.A.,Duke Global Health Institute, Durham, North Carolina, U.S.A
| | - Peter Moon
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, U.S.A
| | - Latha P Palaniappan
- Division of General Medical Disciplines, Stanford University School of Medicine, Stanford, California, U.S.A
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Lee AW, Mendoza RA, Aman S, Hsu R, Liu L. Thyroid cancer incidence disparities among ethnic Asian American populations, 1990-2014. Ann Epidemiol 2021; 66:28-36. [PMID: 34774744 DOI: 10.1016/j.annepidem.2021.11.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 10/27/2021] [Accepted: 11/02/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE Asian/Pacific Islanders (APIs) are at high risk of thyroid cancer, hence we examined thyroid cancer's incidence among disaggregated API subgroups in the United States (U.S.) to identify potential ethnic-specific disparities. METHODS Data from 1990 to 2014 in the Surveillance, Epidemiology, and End Results Program (SEER) were used to compare age-adjusted incidence rates (AAIRs) of thyroid cancer for seven API ethnic subgroups to non-Hispanic whites (NHWs) using incidence rate ratios (IRRs) and 95% confidence intervals (CIs). Sex, age, tumor histotype, and year of diagnosis were considered. Trends were evaluated using average annual percent change (AAPC) statistics. RESULTS The highest AAIRs (per 100,000 person-years) were among Filipinos (female AAIR=20.49, male AAIR=7.06) and the lowest among Japanese (female AAIR=8.36, male AAIR=3.20). However, Filipinos showed significantly lower incidence of medullary tumors when compared to NHWs (female IRR=0.60, 95% CI 0.40-0.87, male IRR=0.26, 95% CI 0.26-0.51). The largest increasing trends were among Asian Indian/Pakistanis for females (AAPC=5.19, 95% CI 3.81 to 6.58) and Koreans for males (AAPC=4.57, 95% CI 3.14 to 6.03). CONCLUSIONS There are clear differences in thyroid cancer incidence and trends when U.S. API ethnic subgroups are examined separately. Disaggregating APIs in research can provide critical information for understanding thyroid cancer risk.
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Key Words
- average annual percent change, APC, annual percent change, API, Asian/Pacific Islander, ASIR, age-specific incidence rate, CI, confidence interval, ICD-O-3, International Classification of Diseases for Oncology, Third Edition, IRR, incidence rate ratio, NHW, non-Hispanic white, NOS, not otherwise specified002C SEER, Surveillance, Epidemiology, and End Results Program, U.S., United States
- thyroid cancer, Asian Americans, racial/ethnic disparities, AAIR, age-adjusted incidence rate, AAPC
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Affiliation(s)
- Alice W Lee
- Department of Public Health, California State University, Fullerton, 800 N. State College Blvd., KHS-127, Fullerton, CA, 92831, USA.
| | - Roy A Mendoza
- Department of Biological Sciences, California State University, Fullerton, 800 N. State College Blvd., MH-112, Fullerton, CA, 92831, USA
| | - Shehla Aman
- Department of Public Health, California State University, Fullerton, 800 N. State College Blvd., KHS-127, Fullerton, CA, 92831, USA
| | - Robert Hsu
- Department of Oncology, Keck School of Medicine, University of Southern California, 1975 Zonal Ave., Los Angeles, CA, 90033, USA
| | - Lihua Liu
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, 2001 N. Soto St., Los Angeles, CA, 90033, USA; Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, 1441 Eastlake Ave., Los Angeles, CA, 90033, USA
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10
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Megwalu UC, Ma Y, Osazuwa‐Peters N, Orloff LA. Clinical presentation and survival outcomes of well-differentiated thyroid cancer in Filipinos. Cancer Med 2021; 10:5964-5973. [PMID: 34288520 PMCID: PMC8419748 DOI: 10.1002/cam4.4149] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 06/09/2021] [Accepted: 06/10/2021] [Indexed: 12/25/2022] Open
Abstract
Background Filipinos have higher recurrence rates compared to other racial/ethnic groups, which might suggest a higher propensity for aggressive disease. The goal of this study was to perform a population‐based analysis of disease extent at diagnosis and survival outcomes in Filipino patients with well‐differentiated thyroid cancer relative to other racial/ethnic groups. Methods The study cohort comprised adult patients with well‐differentiated thyroid cancer diagnosed between 2004 and 2015, identified in the California Cancer Registry. Rates of extrathyroidal extension, nodal metastasis, and distant metastasis were compared between Filipinos, Non‐Filipino Asians, and Non‐Asians using multilevel logistic regression models. Survival outcomes were compared using Cox regression models, utilizing a sequential modeling approach. Results Filipino ethnicity was associated with extrathyroidal extension (OR 1.35, 95% CI 1.11–1.63) compared with non‐Asians and non‐Filipino Asians. Filipino ethnicity was also associated with nodal metastasis (OR 1.32, 95% CI 1.18–1.46), and with worse OS (Hazard Ratio [HR] 1.45, 95% CI 1.20–1.75) and DSS (HR 1.51, 95% CI 1.12–2.04). After adjusting for demographic and clinical factors, Filipino ethnicity was no longer associated with OS (HR 1.03, 95% CI 0.84–1.25) or DSS (HR 0.93, 95% CI 0.68–1.28). Conclusion Filipino patients with thyroid cancer are more likely to present with locoregionally advanced disease compared with non‐Filipino Asians and non‐Asians. Furthermore, Filipino patients have worse survival outcomes compared with non‐Filipino Asians and non‐Asians. However, this appears to be driven by the higher rates of locoregionally advanced disease in Filipino patients.
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Affiliation(s)
- Uchechukwu C. Megwalu
- Department of Otolaryngology—Head and Neck SurgeryStanford University School of MedicineStanfordCaliforniaUSA
| | - Yifei Ma
- Department of Otolaryngology—Head and Neck SurgeryStanford University School of MedicineStanfordCaliforniaUSA
| | - Nosayaba Osazuwa‐Peters
- Department of Head and Neck Surgery and Communication SciencesDuke University School of MedicineDurhamNorth CarolinaUSA
| | - Lisa A. Orloff
- Department of Otolaryngology—Head and Neck SurgeryStanford University School of MedicineStanfordCaliforniaUSA
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Patel S, Pappoppula L, Guddati AK, Annamaraju P. Analysis of Race and Gender Disparities in Incidence-Based Mortality in Patients Diagnosed with Thyroid Cancer from 2000 to 2016. Int J Gen Med 2020; 13:1589-1594. [PMID: 33364821 PMCID: PMC7751731 DOI: 10.2147/ijgm.s280986] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 12/01/2020] [Indexed: 01/01/2023] Open
Abstract
Background Well-differentiated thyroid cancer has better outcomes compared to undifferentiated/anaplastic thyroid cancer. The incidence of well-differentiated thyroid cancer is known to be more in women whereas it is approximately the same in both genders for anaplastic thyroid cancer. The variability of incidence-based mortality across gender in the context of race has not been studied. This study analyzes the rates of incidence-based mortality from the years 2000 to 2016 amongst both the genders in four racial groups. Methods The Surveillance, Epidemiology, and End Results (SEER) database was utilized to conduct a nation-wide analysis for the years 2000 to 2016. Incidence-based mortality for all stages of well-differentiated and undifferentiated thyroid cancer was queried and the results were grouped by race (Caucasian/White, African American/Black, American Indian/Alaskan Native and Asian/Pacific Islander) and gender. All stages and ages were included in the analysis. Two sample t-test was used to determine statistically significant difference between various subgroups. Results Incidence-based mortality rates (per 100,000) for well-differentiated and undifferentiated thyroid cancer for all races and both the genders were calculated. The incidence-based mortality rates for both genders are approximately the same despite a 2–3:1 difference in incidence. Anaplastic thyroid cancer has a higher mortality rate in Caucasian and Asian/Pacific Islander women compared to men despite an equal ratio in incidence. As expected, the mortality rates of anaplastic thyroid cancer were significantly higher compared to well-differentiated cancer across all races and genders. Also, Asian/Pacific Islander women have a higher rate of mortality compared to both the genders of Caucasian and African American races. Conclusion Incidence-based mortality for anaplastic thyroid cancer is higher in women in all races whereas there is no difference in mortality between men and women for well-differentiated thyroid cancer. This is divergent from the incidence ratios noted in these malignancies. In the context of increasing incidence of thyroid cancer for the past few decades, this data suggests that additional resources may be devoted to decreasing the disparity of mortality in this gender.
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Affiliation(s)
- Sunny Patel
- Department of Hematology/Oncology, Medical College of Georgia, Augusta University, Augusta, GA 30909, USA
| | - Lakshmi Pappoppula
- Division of Hematology/Oncology, Georgia Cancer Center, Augusta University, Augusta, GA 30909, USA
| | - Achuta Kumar Guddati
- Department of Hematology/Oncology, Georgia Cancer Center, Augusta University, Augusta, GA 30909, USA
| | - Pavan Annamaraju
- Johnston Memorial Hospital Ballad Health System, Abingdon, VA 24211, USA
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Jacomina LE, Jacinto JKM, Co LBA, Yu KKL, Agas RAF, Co JL, Mejia MBA. The Role of postoperative external beam radiotherapy for differentiated thyroid carcinoma: A Systematic review and meta-analysis. Head Neck 2020; 42:2181-2193. [PMID: 32129545 DOI: 10.1002/hed.26133] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 02/07/2020] [Accepted: 02/20/2020] [Indexed: 11/11/2022] Open
Abstract
The indications for external beam radiotherapy (RT) in differentiated thyroid carcinomas (DTC) are still undefined. The objective of this study was to synthesize current evidence defining the role of postoperative RT in patients with DTC. A systematic review and meta-analysis were done. Included studies compared oncologic outcomes and toxicity of RT vs no RT in patients with DTC. Nine studies were included, two prospective and seven retrospective cohorts. RT improved 5-year locoregional recurrence-free survival but not overall survival and distant metastasis failure-free survival. The locoregional control benefit was seen in patients at increased risk for recurrence, including those with advanced age, locoregionally advanced disease, gross or microscopic residual tumor, and structural invasion. Serious RT-related acute and late toxicities were rare. Available evidence suggests that postoperative RT can improve locoregional control in high-risk DTC with acceptable toxicity. Further prospective studies are warranted.
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Affiliation(s)
- Luisa E Jacomina
- Department of Radiation Oncology, Benavides Cancer Institute, University of Santo Tomas Hospital, Manila, Philippines
| | - Jc Kennetth M Jacinto
- Department of Radiation Oncology, Benavides Cancer Institute, University of Santo Tomas Hospital, Manila, Philippines
| | - Lester Bryan A Co
- Department of Radiation Oncology, Benavides Cancer Institute, University of Santo Tomas Hospital, Manila, Philippines
| | - Kelvin Ken L Yu
- Department of Radiation Oncology, Benavides Cancer Institute, University of Santo Tomas Hospital, Manila, Philippines
| | - Ryan Anthony F Agas
- Department of Radiation Oncology, Benavides Cancer Institute, University of Santo Tomas Hospital, Manila, Philippines
| | - Jayson L Co
- Department of Radiation Oncology, Benavides Cancer Institute, University of Santo Tomas Hospital, Manila, Philippines
| | - Michael Benedict A Mejia
- Department of Radiation Oncology, Benavides Cancer Institute, University of Santo Tomas Hospital, Manila, Philippines
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13
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Badhey AK, Moshier E, Jategaonkar A, Wong A, Echanique K, Chai RL. Unexpected high-risk pathologic features following thyroidectomy in the chinese immigrant population. Laryngoscope 2019; 130:1844-1849. [PMID: 31593307 DOI: 10.1002/lary.28319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Revised: 08/11/2019] [Accepted: 09/05/2019] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To compare rates of unexpected high-risk pathologic features between Chinese and non-Asian patients who underwent thyroidectomy for papillary thyroid cancer. METHODS This was a retrospective cohort study at a tertiary academic urban medical center. Patients who underwent thyroidectomy for papillary carcinoma from 2015 to 2017 were included. Patient demographics, tumor characteristics, and tumor histopathology were analyzed. Primary outcome was the presence of adverse histopathologic features such as lymphovascular invasion (LVI) or microscopic/minimal extrathyroidal extension (mETE). Differences between the groups were analyzed using multivariate logistical regression analysis and propensity score-weighted analysis. RESULTS One hundred seventy-nine patients were included: 58 Chinese-born and 121 non-Asian. The median age of the cohort was 47 years old (36-58). Twenty-nine percent of patients were male, and 71% were female. There was no statistically significant difference between the two cohorts in rates of LVI, multifocality, extent of surgery, or presence of thyroiditis. Patients with mETE were more likely to have larger tumors (P = 0.00247). Both the multivariate and propensity-weighted models demonstrated that Chinese ancestry was independently associated with an increased rate of unexpected mETE (adjusted prevalence ratio, 2.52; 95% confidence interval, 1.82-3.48). CONCLUSION mETE is significantly higher in the immigrant Chinese compared to the non-Asian population. Given the high prevalence of unexpected mETE in the Chinese population, the added risk of this finding should be brought into the discussion during initial surgical planning. LEVEL OF EVIDENCE 3 Laryngoscope, 130:1844-1849, 2020.
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Affiliation(s)
- Arvind K Badhey
- Department of Otolaryngology, Institute for Healthcare Delivery Science, Tisch Cancer Institute (TCI), Icahn School of Medicine at Mount Sinai, New York, New York
| | - Erin Moshier
- Department of Population Health Science and Policy, Institute for Healthcare Delivery Science, Tisch Cancer Institute (TCI), Icahn School of Medicine at Mount Sinai, New York, New York
| | - Ameya Jategaonkar
- Department of Otolaryngology, Institute for Healthcare Delivery Science, Tisch Cancer Institute (TCI), Icahn School of Medicine at Mount Sinai, New York, New York
| | - Anni Wong
- Department of Otolaryngology, Institute for Healthcare Delivery Science, Tisch Cancer Institute (TCI), Icahn School of Medicine at Mount Sinai, New York, New York
| | - Kristen Echanique
- Department of Head and Neck Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, U.S.A
| | - Raymond L Chai
- Department of Otolaryngology, Institute for Healthcare Delivery Science, Tisch Cancer Institute (TCI), Icahn School of Medicine at Mount Sinai, New York, New York
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Rodriguez F, Chung S, Blum MR, Coulet A, Basu S, Palaniappan LP. Atherosclerotic Cardiovascular Disease Risk Prediction in Disaggregated Asian and Hispanic Subgroups Using Electronic Health Records. J Am Heart Assoc 2019; 8:e011874. [PMID: 31291803 PMCID: PMC6662141 DOI: 10.1161/jaha.118.011874] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Background Risk assessment is the cornerstone for atherosclerotic cardiovascular disease ( ASCVD ) treatment decisions. The Pooled Cohort Equations ( PCE ) have not been validated in disaggregated Asian or Hispanic populations, who have heterogeneous cardiovascular risk and outcomes. Methods and Results We used electronic health record data from adults aged 40 to 79 years from a community-based, outpatient healthcare system in northern California between January 1, 2006 and December 31, 2015, without ASCVD and not on statins. We examined the calibration and discrimination of the PCE and recalibrated the equations for disaggregated race/ethnic subgroups. The cohort included 231 622 adults with a mean age of 53.1 (SD 9.7) years and 54.3% women. There were 56 130 Asian (Chinese, Asian Indian, Filipino, Japanese, Vietnamese, and other Asian) and 19 760 Hispanic (Mexican, Puerto Rican, and other Hispanic) patients. There were 2703 events (332 and 189 in Asian and Hispanic patients, respectively) during an average of 3.9 (SD 1.5) years of follow-up. The PCE overestimated risk for NHW s, African Americans, Asians, and Hispanics by 20% to 60%. The extent of overestimation of ASCVD risk varied by disaggregated racial/ethnic subgroups, with a predicted-to-observed ratio of ASCVD events ranging from 1.1 for Puerto Rican patients to 1.9 for Chinese patients. The PCE had adequate discrimination, although it varied significantly by race/ethnic subgroups (C-indices 0.66-0.83). Recalibration of the PCE did not significantly improve its performance. Conclusions Using electronic health record data from a large, real-world population, we found that the PCE generally overestimated ASCVD risk, with marked heterogeneity by disaggregated Asian and Hispanic subgroups.
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Affiliation(s)
- Fatima Rodriguez
- 1 Division of Cardiovascular Medicine Stanford University School of Medicine Stanford CA
| | - Sukyung Chung
- 2 Palo Alto Foundation Research Institute Palo Alto CA.,3 Division of Primary Care and Population Health Stanford University School of Medicine Stanford CA
| | - Manuel R Blum
- 1 Division of Cardiovascular Medicine Stanford University School of Medicine Stanford CA.,4 Department of General Internal Medicine Inselspital Bern University Hospital University of Bern Switzerland
| | - Adrien Coulet
- 5 Université de Lorraine CNRS Inria LORIA Nancy France.,6 Stanford Center for Biomedical Informatics Research Stanford University Stanford CA
| | - Sanjay Basu
- 7 Departments of Medicine and of Health Research and Policy Centers for Primary Care and Outcomes Research and Center for Population Health Sciences Stanford University Stanford CA
| | - Latha P Palaniappan
- 3 Division of Primary Care and Population Health Stanford University School of Medicine Stanford CA
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