thiroid cancer epidemic - coordinamentowoncaitalia.iternesto mola network wonca italia ......
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E R N ES TO M O L AN E T WO R K WO N C A I TA L I A
Lecce - Italy
Preventing overmedicalization by listening
and sharingOvermediclization and Quaternary Prevention
Thiroid Cancer Epidemic
1
Presentation of
Hyeong Sik Ahn, MD, PhDKorea University School of Medicine
WHO 2015 International Workshop in Seoul
Use of CT in Asymptomatic People for Individual Health Assessment (IHA)
Korean Health Care System; Private Dominant,
Fee for Service. Competition by Higher Technology
Private hospital
2
Cancer Eligible Frequency Test / Procedure
40 & over
adultsevery 2 yrs endoscopy or UGI
Breast 40 & overwomen every 2 yrs mammography & CBE
Cervix 30 & over
womenevery 2 yrs Pap smear
Liver 40 & overhigh risk group every 6 mo sonography & AFP
Colorectal50 & over
adultsevery 1 yr FOBT colonoscopy or
barium enema
* 40 & over with HBsAg positive or anti-HCV positive or liver cirrhosis
7
National cancer screening program
Screening Recommendation
1999 - Add on Screening for Thyroid, Prostate
with Inexpensive Charge (30 USD)
The thyroid cancer
Differentiated thyroid cancer(> 90%) It includes papillary and follicular thyroid cancer, coming from thyroid cells. Not aggressive. The medullary thiroid cancer5% out of thiroid cancer. It comes from parafollicular cells which produce calcitonine.The anaplastic thyroid cancer<1%. Aggressive. It invades quickly organs and surroundings tissues.
CI5Plus - IARC
US(Whites)
US(Blacks)
India
China
France
Australia
UK
10
Incidence of Thyroid Cancer ; WorldwideFemale Male
Ahn HS et al. N Engl J Med2014;371:1765-1767.11
Korea's Thyroid-Cancer “Epidemic”
Begin a National Screening Program
Worldwide Thyroid-Cancer Epidemic? - NEJM 2016United States
Italy
France
England & Scotland
Nordic Countries
Japan
Australia
South Korea
13
14
Thyroid
Breast
Colon/rectum
StomachLung
Ulterine cervix
Liver
0
20
40
60
80
100
120
140
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
Rat
e(P
er
100
,000
Pop
ula
tio
n)
Trend in Age-standardized Incidence Rates of Cancer
(Female)
Trend in Age-standardized Incidence Rates of Cancer (Male)
Lung
Liver
0
Colon/rectum
20
40
60
120
100
80
Stomach
Prostate
Thyroid
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
Rat
e(P
er
10
0,0
00Po
pu
lati
on
)
15
Thyroid Cancer Mortality_Years(2000~2011)
0
0.2
0.6
Male0.4
0.8
1
1.2
Female
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
Mo
rtal
ity
Harms ; Thyroid cancer diagnosis and surgery
• diagnosed cases are surgeried
(radical bilateral thyroidectomy, everyday hormone
replacement medication)
• Surgical Complication ;
Hypoparathyroidism (10%)
Vocal cord paralysis ( 2%)
• (Radioactive iodine) ; relationship with leukemia?
•Sharply increased thyroid cancer incidence with screening
• No change in cancer related mortality
-> overdiagnosis
• Thyroid cancer screening are not recommended to generalpublic
• When studying on thyroid cancer epidemiology,
‘screening effect’ should be considered.
Summary; Thyroid Cancer Screening and Incidence
in Korea