Growing incidence of thyroid carcinoma in recent years: Factors underlying overdiagnosis

There is an increasing incidence of well‐differentiated thyroid cancer worldwide. Much of the increase is secondary to increased detection of small, low‐risk tumors, with questionable clinical significance. This review addresses the factors that contribute to the increasing incidence and considers environmental, and patient‐based and clinician‐led influences. Articles addressing the causes of the increased incidence were critically reviewed. A complex interplay of environmental, medical, and social pressures has resulted in increased awareness of the thyroid disease risk, increased screening of thyroid cancers, and increased diagnosis of thyroid cancers. Although there is evidence to suggest that the true disease incidence may be changing slightly, most of the increase is related to factors that promote early diagnosis of low‐risk lesions, which is resulting in a significant phenomenon of overdiagnosis. An improved understanding of these pressures at a global level will enable healthcare policymakers to react appropriately to this challenge in the future.

[1]  A. Gill,et al.  Increasing incidence of thyroid cancer is due to increased pathologic detection. , 2008, Surgery.

[2]  F. Huang,et al.  Association of exposure to multiple metals with papillary thyroid cancer risk in China , 2019, Environmental Science and Pollution Research.

[3]  R. Mulić,et al.  Iodine intake and epidemiological characteristics of thyroid cancer: comparison between inland and littoral Croatia. , 2011, Acta clinica Croatica.

[4]  Sudhir Srivastava,et al.  Addressing overdiagnosis and overtreatment in cancer: a prescription for change. , 2014, The Lancet. Oncology.

[5]  Benjamin D. Smith,et al.  Projecting cancer incidence and deaths to 2030: the unexpected burden of thyroid, liver, and pancreas cancers in the United States. , 2014, Cancer research.

[6]  R. B. Davis,et al.  Utilization of outpatient diagnostic imaging. Does the physician's gender play a role? , 1997, Journal of general internal medicine.

[7]  Simin Liu,et al.  Diabetes, Diabetes Treatment, and Risk of Thyroid Cancer. , 2016, The Journal of clinical endocrinology and metabolism.

[8]  M. Zimmermann,et al.  Iodine deficiency and thyroid disorders. , 2015, The lancet. Diabetes & endocrinology.

[9]  P. Fu,et al.  Analysis of the rising incidence of thyroid cancer using the Surveillance, Epidemiology and End Results national cancer data registry. , 2010, Surgery.

[10]  K. Choi,et al.  Current status of thyroid cancer screening in Korea: results from a nationwide interview survey. , 2011, Asian Pacific journal of cancer prevention : APJCP.

[11]  P. BritoJuan,et al.  The Impact of Subclinical Disease and Mechanism of Detection on the Rise in Thyroid Cancer Incidence: A Population-Based Study in Olmsted County, Minnesota During 1935 Through 2012 , 2015 .

[12]  P. Rosenberg,et al.  Gender is an Age-Specific Effect Modifier for Papillary Cancers of the Thyroid Gland , 2009, Cancer Epidemiology Biomarkers & Prevention.

[13]  R. McNally,et al.  Increasing incidence of thyroid cancer in Great Britain, 1976–2005: age-period-cohort analysis , 2010, European Journal of Epidemiology.

[14]  P. Pezzotti,et al.  Increased incidence of thyroid cancer in Latina, Italy: a possible role of detection of subclinical disease. , 2013, Cancer epidemiology.

[15]  A. Miyauchi,et al.  Incidences of Unfavorable Events in the Management of Low-Risk Papillary Microcarcinoma of the Thyroid by Active Surveillance Versus Immediate Surgery , 2016, Thyroid : official journal of the American Thyroid Association.

[16]  M. Ward,et al.  Polybrominated diphenyl ethers and thyroid cancer risk in the Prostate, Colorectal, Lung, and Ovarian Cancer Screening Trial cohort. , 2015, American journal of epidemiology.

[17]  R J Telepak,et al.  Thyroid palpation versus high‐resolution thyroid ultrasonography in the detection of nodules. , 1998, Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine.

[18]  Loralie D. Ma Effects of Lead Time, Length Bias, and False-Negative Assurance on Screening for Breast Cancer; Decelerating Growth and Human Breast Cancer; Mammographic Assessment of Human Breast Cancer Growth and Duration , 1993 .

[19]  Eva Negri,et al.  Thyroid cancer mortality and incidence: A global overview , 2015, International journal of cancer.

[20]  A qualitative study of women’s views on overdiagnosis and screening for thyroid cancer in Korea , 2015, BMC Cancer.

[21]  T. Sobue,et al.  Incidence rate of thyroid cancer by histological type in Japan. , 2014, Japanese journal of clinical oncology.

[22]  L. Bastholt,et al.  Papillary thyroid carcinoma in Denmark 1996-2008: an investigation of changes in incidence. , 2013, Cancer epidemiology.

[23]  Ahmedin Jemal,et al.  Cancers with increasing incidence trends in the United States: 1999 through 2008 , 2012, CA: a cancer journal for clinicians.

[24]  Amy Y. Chen,et al.  Increasing incidence of thyroid cancer: is diagnostic scrutiny the sole explanation? , 2010, Future oncology.

[25]  A. Ugnat,et al.  Increasing thyroid cancer incidence in Canada, 1970–1996: time trends and age-period-cohort effects , 2001, British Journal of Cancer.

[26]  Shuangge Ma,et al.  A birth cohort analysis of the incidence of papillary thyroid cancer in the United States, 1973-2004. , 2009, Thyroid : official journal of the American Thyroid Association.

[27]  M. Knobel,et al.  Thyroid and the environment: exposure to excessive nutritional iodine increases the prevalence of thyroid disorders in Sao Paulo, Brazil. , 2008, European journal of endocrinology.

[28]  A. Sikora,et al.  The Basis of Racial Differences in the Incidence of Thyroid Cancer , 2008, Annals of Surgical Oncology.

[29]  N. Pearce,et al.  Temporal trends , 2005 .

[30]  R. Nelson,et al.  Trends in Incidentally Identified Thyroid Cancers Over a Decade: A Retrospective Analysis of 2,090 Surgical Patients , 2014, World Journal of Surgery.

[31]  J. Eastwood,et al.  An Exponential Growth in Incidence of Thyroid Cancer: Trends and Impact of CT Imaging , 2014, American Journal of Neuroradiology.

[32]  Amy Y. Chen,et al.  Increasing incidence of differentiated thyroid cancer in the United States, 1988–2005 , 2009, Cancer.

[33]  Kyu-Won Jung,et al.  Cancer Statistics in Korea: Incidence, Mortality, Survival, and Prevalence in 2013 , 2016, Cancer research and treatment : official journal of Korean Cancer Association.

[34]  E. D. Williams Chernobyl and thyroid cancer , 2006, Journal of surgical oncology.

[35]  V. Montori,et al.  The Impact of Subclinical Disease and Mechanism of Detection on the Rise in Thyroid Cancer Incidence: A Population-Based Study in Olmsted County, Minnesota During 1935 Through 2012. , 2015, Thyroid : official journal of the American Thyroid Association.

[36]  P. Arveux,et al.  Incidence of thyroid cancer in adults recorded by French cancer registries (1978-1997). , 2002, European journal of cancer.

[37]  N. Zarghami,et al.  Evaluating pre- and post-operation plasma miRNAs of papillary thyroid carcinoma (PTC) patients in comparison to benign nodules , 2019, BMC Cancer.

[38]  Rudolph P. Rull,et al.  Papillary thyroid cancer incidence rates vary significantly by birthplace in Asian American women , 2011, Cancer Causes & Control.

[39]  Q. Duh,et al.  Higher rate of BRAF mutation in papillary thyroid cancer over time , 2011, Cancer.

[40]  Nathaniel Rothman,et al.  International patterns and trends in thyroid cancer incidence, 1973–2002 , 2009, Cancer Causes & Control.

[41]  R. Meza,et al.  Multistage carcinogenesis and the incidence of thyroid cancer in the US by sex, race, stage and histology , 2015, BMC Public Health.

[42]  L. Akslen,et al.  Incidence pattern of thyroid cancer in norway: Influence of birth cohort and time period , 1993, International journal of cancer.

[43]  S. Franceschi,et al.  Changes in the incidence of thyroid cancer between 1991 and 2005 in Italy: a geographical analysis. , 2012, Thyroid : official journal of the American Thyroid Association.

[44]  E. Sturgis,et al.  Increased thyroid cancer incidence corresponds to increased use of thyroid ultrasound and fine‐needle aspiration: A study of the Veterans Affairs health care system , 2015, Cancer.

[45]  S. Ezzat,et al.  Cancer-related worry in Canadian thyroid cancer survivors. , 2015, The Journal of clinical endocrinology and metabolism.

[46]  J. Irish,et al.  Access, excess, and overdiagnosis: the case for thyroid cancer , 2014, Cancer medicine.

[47]  P. Guénel,et al.  Risk factors of thyroid tumors: role of environmental and occupational exposures to chemical pollutants. , 2010, Revue d'epidemiologie et de sante publique.

[48]  F. Frasca,et al.  Worldwide Increasing Incidence of Thyroid Cancer: Update on Epidemiology and Risk Factors , 2013, Journal of cancer epidemiology.

[49]  E. Kaplan,et al.  The Acceleration in Papillary Thyroid Cancer Incidence Rates is Similar Among Racial and Ethnic Groups in the United States , 2013, Annals of Surgical Oncology.

[50]  K. Mabuchi,et al.  Thyroid cancer incidence in Chornobyl liquidators in Ukraine: SIR analysis, 1986–2010 , 2014, European Journal of Epidemiology.

[51]  M. Porta A Dictionary of Epidemiology, Fifth Edition , 2009 .

[52]  S. Devesa,et al.  Rising Thyroid Cancer Incidence in the United States by Demographic and Tumor Characteristics, 1980-2005 , 2009, Cancer Epidemiology Biomarkers & Prevention.

[53]  L. Morrissey,et al.  Geospatial and Temporal Analysis of Thyroid Cancer Incidence in a Rural Population. , 2015, Thyroid : official journal of the American Thyroid Association.

[54]  J. Burgess Temporal trends for thyroid carcinoma in Australia: an increasing incidence of papillary thyroid carcinoma (1982-1997). , 2002, Thyroid : official journal of the American Thyroid Association.

[55]  R. Luoto,et al.  Increased risk of thyroid cancer among women with hysterectomies. , 2003, American journal of obstetrics and gynecology.

[56]  P. Grosclaude,et al.  [Time trends in the geographic variation of thyroid cancer incidence by tumor size from 1983 to 2000 in France]. , 2009, Revue d'epidemiologie et de sante publique.

[57]  D. Myssiorek,et al.  Improved detection does not fully explain the rising incidence of well-differentiated thyroid cancer: a population-based analysis. , 2010, American journal of surgery.

[58]  C. Reiners,et al.  Major Factors Affecting Incidence of Childhood Thyroid Cancer in Belarus after the Chernobyl Accident: Do Nitrates in Drinking Water Play a Role? , 2015, PloS one.

[59]  G. Stuart,et al.  Cytopathology , 2012, Definitions.

[60]  S. Franceschi,et al.  Diagnostic changes as a reason for the increase in papillary thyroid cancer incidence in Geneva, Switzerland , 2003, Cancer Causes & Control.

[61]  C. Kahn,et al.  Pathways to the diagnosis of thyroid cancer in New South Wales: a population-based cross-sectional study , 2011, Cancer Causes & Control.

[62]  K. Bollaerts,et al.  Thyroid cancer incidence around the Belgian nuclear sites: surrogate exposure modelling. , 2015, Cancer epidemiology.

[63]  Louise Davies,et al.  Current thyroid cancer trends in the United States. , 2014, JAMA otolaryngology-- head & neck surgery.

[64]  J. Freeman,et al.  Diminishing diagnosis of follicular thyroid carcinoma , 2010, Head & neck.

[65]  S. Hall,et al.  Increasing Detection and Increasing Incidence in Thyroid Cancer , 2009, World Journal of Surgery.

[66]  Katheryn R. Christy,et al.  Public Estimates of Cancer Frequency: Cancer Incidence Perceptions Mirror Distorted Media Depictions , 2014, Journal of health communication.

[67]  P. Glasziou,et al.  Prevalence of Differentiated Thyroid Cancer in Autopsy Studies Over Six Decades: A Meta-Analysis. , 2016, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[68]  I. Dos Santos Silva,et al.  Thyroid cancer epidemiology in England and Wales: time trends and geographical distribution. , 1993, British Journal of Cancer.

[69]  S. Johnson-Obaseki,et al.  Incidence of differentiated thyroid cancer in Canada by City of residence , 2015, Journal of Otolaryngology - Head & Neck Surgery.

[70]  B. Franc,et al.  A time trend analysis of papillary and follicular cancers as a function of tumour size: a study of data from six cancer registries in France (1983-2000). , 2007, European journal of cancer.

[71]  H. Karim-Kos,et al.  Rising incidence, no change in survival and decreasing mortality from thyroid cancer in The Netherlands since 1989. , 2013, Endocrine-related cancer.

[72]  J. Boissin,et al.  Dietary iodine and thyroid cancer risk in French Polynesia: a case-control study. , 2012, Thyroid : official journal of the American Thyroid Association.

[73]  E. Mazzaferri,et al.  Increasing Incidence of Thyroid Cancer in the United States, 1973–2002Davies L, Welch HG (Dept of Veterans Affairs Med Ctr, White River Junction, Vt; Darmouth Med School, Hanover, NH) JAMA 295:2164–2167, 2006§ , 2007 .

[74]  K. Hemminki,et al.  Risks of papillary and follicular thyroid cancer among immigrants to Sweden , 2011, International journal of cancer.

[75]  David O Nelson,et al.  Continued Rapid Increase in Thyroid Cancer Incidence in California: Trends by Patient, Tumor, and Neighborhood Characteristics , 2014, Cancer Epidemiology, Biomarkers & Prevention.

[76]  M. Schlumberger,et al.  Advances in diagnostic practices affect thyroid cancer incidence in France. , 2004, European journal of endocrinology.

[77]  J. Burgess,et al.  The changing incidence and spectrum of thyroid carcinoma in Tasmania (1978-1998) during a transition from iodine sufficiency to iodine deficiency. , 2000, The Journal of clinical endocrinology and metabolism.

[78]  S. Filetti Faculty of 1000 evaluation for Incidences of Unfavorable Events in the Management of Low-Risk Papillary Microcarcinoma of the Thyroid by Active Surveillance Versus Immediate Surgery. , 2018 .

[79]  Rudolph P. Rull,et al.  Nativity and papillary thyroid cancer incidence rates among Hispanic women in California , 2012, Cancer.

[80]  P. Horn-Ross,et al.  Risk of second primary malignancies in women with papillary thyroid cancer. , 2006, American journal of epidemiology.

[81]  Laurence Leenhardt,et al.  Increased incidence of thyroid carcinoma in france: a true epidemic or thyroid nodule management effects? Report from the French Thyroid Cancer Committee. , 2004, Thyroid : official journal of the American Thyroid Association.

[82]  J. Burgess,et al.  Incidence trends for papillary thyroid carcinoma and their correlation with thyroid surgery and thyroid fine-needle aspirate cytology. , 2006, Thyroid : official journal of the American Thyroid Association.

[83]  Mark Hachey,et al.  A New Method of Estimating United States and State‐level Cancer Incidence Counts for the Current Calendar Year , 2007, CA: a cancer journal for clinicians.

[84]  E. Cibas,et al.  The Bethesda System for Reporting Thyroid Cytopathology , 2009, Springer International Publishing.

[85]  E. Ron,et al.  Exposing the thyroid to radiation: a review of its current extent, risks, and implications. , 2010, Endocrine reviews.

[86]  K. Katanoda,et al.  Quantification of the increase in thyroid cancer prevalence in Fukushima after the nuclear disaster in 2011—a potential overdiagnosis? , 2016, Japanese journal of clinical oncology.

[87]  S. Franceschi,et al.  Incidence of thyroid cancer in Italy, 1991-2005: time trends and age-period-cohort effects. , 2011, Annals of oncology : official journal of the European Society for Medical Oncology.

[88]  S. Stordeur,et al.  Regional variation in thyroid cancer incidence in Belgium is associated with variation in thyroid imaging and thyroid disease management. , 2013, The Journal of clinical endocrinology and metabolism.

[89]  T. Tosteson,et al.  The increasing incidence of thyroid cancer: the influence of access to care. , 2013, Thyroid : official journal of the American Thyroid Association.

[90]  S. Chevret,et al.  Interobserver and intraobserver reproducibility in the histopathology of follicular thyroid carcinoma. , 2003, Human pathology.

[91]  G. Tortolero-Luna,et al.  Incidence of thyroid cancer in Puerto Rico and the US by racial/ethnic group, 2011–2015 , 2019, BMC Cancer.

[92]  A. Karasik,et al.  Time trends of incidence rates of thyroid cancer in Israel: what might explain the sharp increase. , 2006, Thyroid : official journal of the American Thyroid Association.

[93]  Carol C Wu,et al.  Managing incidental thyroid nodules detected on imaging: white paper of the ACR Incidental Thyroid Findings Committee. , 2015, Journal of the American College of Radiology : JACR.

[94]  R. Payne,et al.  Obesity and thyroid cancer. , 2011, Frontiers in bioscience.

[95]  E. Faerstein,et al.  A DICTIONARY OF EPIDEMIOLOGY , 2016 .

[96]  K. McGlynn,et al.  Thyroid Cancer Incidence among Active Duty U.S. Military Personnel, 1990–2004 , 2011, Cancer Epidemiology, Biomarkers & Prevention.

[97]  Xianglin L. Du,et al.  Impact of enhanced detection on the increase in thyroid cancer incidence in the United States: review of incidence trends by socioeconomic status within the surveillance, epidemiology, and end results registry, 1980-2008. , 2013, Thyroid : official journal of the American Thyroid Association.

[98]  D. Stockton,et al.  Changing trends in incidence and mortality of thyroid cancer in Scotland , 2005, Clinical endocrinology.

[99]  Jae‐Ho Lee,et al.  The Incidence of Thyroid Cancer Is Affected by the Characteristics of a Healthcare System , 2012, Journal of Korean medical science.

[100]  U. Ekrikpo,et al.  Increasing incidence of differentiated thyroid cancer in South East England: 1987–2006 , 2011, European Archives of Oto-Rhino-Laryngology.

[101]  R. Udelsman,et al.  The epidemic of thyroid cancer in the United States: the role of endocrinologists and ultrasounds. , 2014, Thyroid : official journal of the American Thyroid Association.

[102]  E. Sturgis,et al.  Trends in thyroid cancer incidence in Texas from 1995 to 2008 by socioeconomic status and race/ethnicity. , 2014, Thyroid : official journal of the American Thyroid Association.

[103]  E. Kaplan,et al.  Benign and Malignant Thyroid Incidentalomas Are Rare in Routine Clinical Practice: A Review of 97,908 Imaging Studies , 2015, Cancer Epidemiology, Biomarkers & Prevention.

[104]  R. Jeffrey,et al.  Management of thyroid nodules detected at US: Society of Radiologists in Ultrasound consensus conference statement. , 2005, Ultrasound quarterly.

[105]  Amy Y. Chen,et al.  AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS AND AMERICAN COLLEGE OF ENDOCRINOLOGY DISEASE STATE CLINICAL REVIEW: THE INCREASING INCIDENCE OF THYROID CANCER. , 2015, Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists.

[106]  S. Baker,et al.  The thyroid cancer epidemic: is it the dark side of the CT revolution? , 2006, European journal of radiology.

[107]  Diana M Eccles,et al.  The Angelina Jolie effect: how high celebrity profile can have a major impact on provision of cancer related services , 2014, Breast Cancer Research.

[108]  A. Renshaw,et al.  Why there is the tendency to "overdiagnose" the follicular variant of papillary thyroid carcinoma. , 2002, American journal of clinical pathology.

[109]  J. Domingo,et al.  Human exposure to PBDE and critical evaluation of health hazards , 2015, Archives of Toxicology.

[110]  E. Kaplan,et al.  Follicular thyroid cancer incidence patterns in the United States, 1980-2009. , 2013, Thyroid : official journal of the American Thyroid Association.

[111]  S. Devesa,et al.  Thyroid cancer incidence patterns in Sao Paulo, Brazil, and the U.S. SEER program, 1997-2008. , 2013, Thyroid : official journal of the American Thyroid Association.

[112]  A. Bordoni,et al.  Unexpected additional increase in the incidence of thyroid cancer among a recent birth cohort in Switzerland , 2006, European journal of cancer prevention : the official journal of the European Cancer Prevention Organisation.

[113]  F. Boscoe,et al.  Thyroid cancer incidence attributable to overdiagnosis in the United States 1981–2011 , 2015, International journal of cancer.

[114]  Hyeong Sik Ahn,et al.  Korea's thyroid-cancer "epidemic"--screening and overdiagnosis. , 2014, The New England journal of medicine.

[115]  Age of diagnosing physician impacts the incidence of thyroid cancer in a population , 2014, Cancer Causes & Control.

[116]  Youxin Wang,et al.  Increasing Incidence of Thyroid Cancer in Shanghai, China, 1983-2007 , 2011, Asia-Pacific journal of public health.

[117]  Darrin V Bann,et al.  The effects of race and ethnicity on thyroid cancer incidence. , 2015, JAMA otolaryngology-- head & neck surgery.

[118]  M. Spitz,et al.  Ethnic patterns of thyroid cancer incidence in the United States, 1973‐1981 , 1988, International journal of cancer.

[119]  K. Mabuchi,et al.  Thyroid cancer in Ukraine after the Chernobyl accident (in the framework of the Ukraine–US Thyroid Project) , 2012, Journal of radiological protection : official journal of the Society for Radiological Protection.

[120]  H. Welch,et al.  South Korea's Thyroid-Cancer "Epidemic"--Turning the Tide. , 2015, The New England journal of medicine.

[121]  K. Choi,et al.  A qualitative study of women’s views on overdiagnosis and screening for thyroid cancer in Korea , 2015, BMC Cancer.

[122]  Guo-Pei Yu,et al.  Thyroid cancer incidence and survival in the national cancer institute surveillance, epidemiology, and end results race/ethnicity groups. , 2010, Thyroid : official journal of the American Thyroid Association.

[123]  R. Tiwari,et al.  (www.interscience.wiley.com) DOI: 10.1002/sim.3733 Estimating average annual per cent change in trend analysis , 2022 .

[124]  M. Leitzmann,et al.  Adiposity and risk of thyroid cancer: a systematic review and meta‐analysis , 2015, Obesity reviews : an official journal of the International Association for the Study of Obesity.

[125]  S. Devesa,et al.  Trends in Thyroid Cancer Incidence and Mortality in the United States, 1974-2013 , 2017, JAMA.

[126]  S. Jargin,et al.  VALIDITY OF THYROID CANCER INCIDENCE DATA FOLLOWING THE CHERNOBYL ACCIDENT , 2011, Health physics.

[127]  S. Asa,et al.  Interobserver and intraobserver variation among experts in the diagnosis of thyroid follicular lesions with borderline nuclear features of papillary carcinoma. , 2008, American journal of clinical pathology.

[128]  J. Shah,et al.  The impact of family history on non-medullary thyroid cancer. , 2016, European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology.

[129]  Donald L. Miller,et al.  Cancer risks associated with external radiation from diagnostic imaging procedures , 2012, CA: a cancer journal for clinicians.

[130]  Mary H Ward,et al.  Nitrate Intake and the Risk of Thyroid Cancer and Thyroid Disease , 2010, Epidemiology.

[131]  H. Welch,et al.  Overdiagnosis in cancer. , 2010, Journal of the National Cancer Institute.

[132]  S. Hall,et al.  Increased incidence of differentiated thyroid carcinoma and detection of subclinical disease , 2007, Canadian Medical Association Journal.

[133]  L. Kivisaari,et al.  Clinical versus ultrasound examination of the thyroid gland in common clinical practice , 1992, Journal of clinical ultrasound : JCU.

[134]  M. Plummer,et al.  The Impact of Diagnostic Changes on the Rise in Thyroid Cancer Incidence: A Population-Based Study in Selected High-Resource Countries. , 2015, Thyroid : official journal of the American Thyroid Association.

[135]  Louise Davies,et al.  Increasing incidence of thyroid cancer in the United States, 1973-2002. , 2006, JAMA.

[136]  I. Sugitani,et al.  Three Distinctly Different Kinds of Papillary Thyroid Microcarcinoma should be Recognized: Our Treatment Strategies and Outcomes , 2010, World Journal of Surgery.

[137]  A. Trentham-Dietz,et al.  Thyroid cancer incidence and socioeconomic indicators of health care access , 2008, Cancer Causes & Control.

[138]  P. Giardina,et al.  A Review of Joseph J. Mangano’s Study on the Variation in Thyroid Cancer Incidence , 2015, Health physics.

[139]  Ji Man Kim,et al.  The association between cancer incidence and family income: analysis of Korean National Health Insurance cancer registration data. , 2012, Asian Pacific journal of cancer prevention : APJCP.

[140]  P. Boyle,et al.  Time trend and age‐period‐cohort effect on incidence of thyroid cancer in Connecticut, 1935–1992 , 1996, International journal of cancer.

[141]  L. Fonseca,et al.  Cancer incidence in eighteen cities of the State of São Paulo, Brazil. , 2001, Revista de saude publica.

[142]  B. Zhang,et al.  Time trends and age-period-cohort analyses on incidence rates of thyroid cancer in Shanghai and Hong Kong , 2014, BMC Cancer.

[143]  J. S. Lee,et al.  Cancer Statistics in Korea: Incidence, Mortality, Survival, and Prevalence in 2011 , 2014, Cancer research and treatment : official journal of Korean Cancer Association.

[144]  G. Sakorafas,et al.  Microscopic papillary thyroid cancer as an incidental finding in patients treated surgically for presumably benign thyroid disease. , 2007, Journal of postgraduate medicine.

[145]  Joseph G. Allen,et al.  PBDE flame retardants, thyroid disease, and menopausal status in U.S. women , 2016, Environmental Health.