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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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Zweifler RS, Medina Mora LA, Sanchez Escobar JG, Liao E, Kuriloff D, Poretsky L. Recognizing the Impact of Ethnicity: Thyroid Neoplasia in Hispanic Americans. Endocr Pract 2023; 29:1017-1019. [PMID: 37633412 DOI: 10.1016/j.eprac.2023.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 08/17/2023] [Accepted: 08/18/2023] [Indexed: 08/28/2023]
Affiliation(s)
- Rebecca Susan Zweifler
- Division of Endocrinology and Metabolism, Lenox Hill Hospital, Northwell Health, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, New York
| | - Luis Augusto Medina Mora
- Division of Endocrinology and Metabolism, Lenox Hill Hospital, Northwell Health, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, New York
| | - Jose Gonzalo Sanchez Escobar
- Division of Endocrinology and Metabolism, Lenox Hill Hospital, Northwell Health, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, New York
| | - Emilia Liao
- Division of Endocrinology and Metabolism, Lenox Hill Hospital, Northwell Health, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, New York
| | - Daniel Kuriloff
- Division of Otolaryngology, Lenox Hill Hospital, Northwell Health, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, New York
| | - Leonid Poretsky
- Division of Endocrinology and Metabolism, Lenox Hill Hospital, Northwell Health, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, New York.
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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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Kerr CE, Ferrell J, Kitano M, Koek W, Dahia PLM, Velez J, Francis G. Thyroid nodules of indeterminate cytology in Hispanic/Latinx patients. Head Neck 2022; 44:1842-1848. [PMID: 35583054 DOI: 10.1002/hed.27100] [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: 12/16/2021] [Revised: 04/01/2022] [Accepted: 05/05/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Behavior of differentiated thyroid cancer (DTC) varies among ethnic groups. Recommended management of thyroid nodules with indeterminate cytology (TN-IC) is based on molecular analysis from predominantly non-Hispanic white patients. We hypothesized that TN-IC in Hispanic/Latinx patients would have different features, management, and outcomes and that molecular testing might perform differently in Hispanic/Latinx patients. METHODS Retrospective chart review was performed on 127 TN-IC analyzed with Afirma. Patient characteristics were compared using linear model ANOVA and Fisher's exact test. RESULTS Out of 127 TN-IC, 71 (56%) were Hispanic/Latinx. Hispanic/Latinx had a greater prevalence of diabetes, but Afirma results (benign or suspicious) were similar between ethnic groups. Fourteen patients had malignant pathology. Their management and outcomes were similar across groups. The negative predictive value for our cohort (97.9%) was similar to published data. CONCLUSIONS Data from our predominantly-Hispanic/Latinx cohort suggest that Afirma performs similarly in Hispanic/Latinx and non-Hispanic white patients with TN-IC.
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Affiliation(s)
- Catherine E Kerr
- Department of Pediatric Endocrinology, University of Texas Health Science Center San Antonio, San Antonio, TX, United States
| | - Jay Ferrell
- Department of Otolaryngology, University of Texas Health Science Center San Antonio, San Antonio, Texas, USA
| | - Mio Kitano
- Department of Surgery, University of Texas Health Science Center San Antonio, San Antonio, Texas, USA
| | - Wouter Koek
- Department of Cell Systems and Anatomy, University of Texas Health Science Center San Antonio, San Antonio, Texas, USA
| | - Patricia L M Dahia
- Division of Hematology and Medical Oncology, Department of Medicine, University of Texas Health Science Center San Antonio, San Antonio, Texas, USA
| | - Jorge Velez
- Department of Endocrinology, University Health System, San Antonio, Texas, USA
| | - Gary Francis
- Department of Pediatric Endocrinology, University of Texas Health Science Center San Antonio, San Antonio, TX, United States
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Richard MA, Lupo PJ, Morton LM, Yasui YA, Sapkota YA, Arnold MA, Aubert G, Neglia JP, Turcotte LM, Leisenring WM, Sampson JN, Chanock SJ, Hudson MM, Armstrong GT, Robison LL, Bhatia S, Gramatges MM. Genetic variation in POT1 and risk of thyroid subsequent malignant neoplasm: A report from the Childhood Cancer Survivor Study. PLoS One 2020; 15:e0228887. [PMID: 32040538 PMCID: PMC7010302 DOI: 10.1371/journal.pone.0228887] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Accepted: 01/24/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Telomere length is associated with risk for thyroid subsequent malignant neoplasm in survivors of childhood cancer. Here, we investigated associations between thyroid subsequent malignant neoplasm and inherited variation in telomere maintenance genes. METHODS We used RegulomeDB to annotate the functional impact of variants mapping to 14 telomere maintenance genes among 5,066 five-or-more year survivors who participate in the Childhood Cancer Survivor Study (CCSS) and who are longitudinally followed for incidence of subsequent cancers. Hazard ratios for thyroid subsequent malignant neoplasm were calculated for 60 putatively functional variants with minor allele frequency ≥1% in or near telomere maintenance genes. Functional impact was further assessed by measuring telomere length in leukocyte subsets. RESULTS The minor allele at Protection of Telomeres-1 (POT1) rs58722976 was associated with increased risk for thyroid subsequent malignant neoplasm (adjusted HR = 6.1, 95% CI: 2.4, 15.5, P = 0.0001; Fisher's exact P = 0.001). This imputed SNP was present in three out of 110 survivors who developed thyroid cancer vs. 14 out of 4,956 survivors who did not develop thyroid cancer. In a subset of 83 survivors with leukocyte telomere length data available, this variant was associated with longer telomeres in B lymphocytes (P = 0.004). CONCLUSIONS Using a functional variant approach, we identified and confirmed an association between a low frequency intronic regulatory POT1 variant and thyroid subsequent malignant neoplasm in survivors of childhood cancer. These results suggest that intronic variation in POT1 may affect key protein binding interactions that impact telomere maintenance and genomic integrity.
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Affiliation(s)
- Melissa A. Richard
- Department of Pediatrics, Baylor College of Medicine and Dan L. Duncan Cancer Center, Houston, TX, United States of America
| | - Philip J. Lupo
- Department of Pediatrics, Baylor College of Medicine and Dan L. Duncan Cancer Center, Houston, TX, United States of America
| | - Lindsay M. Morton
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, United States of America
| | - Yutaka A. Yasui
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN, United States of America
| | - Yadav A. Sapkota
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN, United States of America
| | - Michael A. Arnold
- Department of Pathology and Laboratory Medicine, Nationwide Children’s Hospital, Columbus, Ohio, United States of America
| | - Geraldine Aubert
- Terry Fox Laboratory, British Columbia Cancer Agency, Vancouver, BC, Canada
| | - Joseph P. Neglia
- Department of Pediatrics, University of Minnesota, Minneapolis, MN, United States of America
| | - Lucie M. Turcotte
- Department of Pediatrics, University of Minnesota, Minneapolis, MN, United States of America
| | - Wendy M. Leisenring
- Division of Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, WA, United States of America
| | - Joshua N. Sampson
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, United States of America
| | - Stephen J. Chanock
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, United States of America
- Cancer Genomics Research Laboratory, Leidos Biomedical Research, Inc., Frederick National Laboratory for Cancer Research, Frederick, Maryland, United States of America
| | - Melissa M. Hudson
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN, United States of America
| | - Gregory T. Armstrong
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN, United States of America
| | - Leslie L. Robison
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN, United States of America
| | - Smita Bhatia
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL, England
| | - Maria Monica Gramatges
- Department of Pediatrics, Baylor College of Medicine and Dan L. Duncan Cancer Center, Houston, TX, United States of America
- * E-mail:
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