EPIDEMIOLOGY of THYROID CANCER in Iran . Mssoud Amini Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences. Isfahan, Iran Sixth Isfahan Endocrine Update Congress, 19 April 2017

Prevalence of palpable thyroid nodule in the world Thyroid nodules are a common clinical problem. studies have shown the prevalence of palpable thyroid nodules to be approximately 5% in women and 1% in men living in iodine-sufficient parts of the world Volume 26, Number 1, 2016 THYROID

Prevalence of thyroid nodule by US in the world In contrast, high-resolution ultrasound (US) can detect thyroid nodules in 19%–68% of randomly selected individuals, with higher frequencies in women and the elderly Volume 26, Number 1, 2016 THYROID

Thyroid nodule size is inversely related to malignancy risk, as larger nodules have lower malignancy rates.

Prevalence of thyroid nodule in autopsy in the world Autopsy studies show a sizeable prevalence (5%-30%) of clinically occult thyroid cancer in asymptomatic persons. The rising diagnosis of thyroid cancer has been linked to increasing health care utilization and imaging practices,  

Thyroid nodules are very common Palpable nodules 5% of women 1% of men Ultrasound series 19-67% Autopsy series 37-57% The prevalence of nodules increases with age Prevalence in women 1.5-1.7 times higher than

Thyroid Cancer The clinical importance of thyroid nodules rests with the need to exclude thyroid cancer, which occurs in 7%–15% of cases depending on age, sex, radiation exposure history, family history, and other factors

Thyroid cancer is the most common endocrine cancer. Based on recent data, thyroid cancer is the fifth most common cancer in women ,

population-based study reported the doubling of thyroid cancer incidence from 2000 to 2012 compared to the prior decade as entirely attributable to clinically occult cancers detected incidentally on imaging or pathology THYROID Volume 26, Number 1, 2016

97.1% of the total increase was localized and regional 99.9% of the increased incidences of clinically detected cases over the same period were tumors <20 mm THYROID Volume 26, Number 1, 2016

Journal of Cancer Epidemiology

Journal of Cancer Epidemiology

85% of patients with DTC :disease-free after initial treatment 10–15% : recurrent disease 5%: distant metastases Distant metastases :lungs (50%), bones (25%), lungs and bones, (20%) 10-year-survival rates ranging from 25% to 42% THYROID Volume 26, Number 1, 2016

Risk factors of thyroid cancer Several known genetic Radiation exposure in childhood History of goiter or benign nodules/adenomas Air pollution Physician crowded is the next strongest risk factor Asian race Female gender Family history of thyroid diseases or MEN .

Deaths due to thyroid cancer are uncommon Deaths due to thyroid cancer are uncommon. It was estimated that there would be an estimated 1,890 deaths due to thyroid cancer in the U.S. in 2014. The more common cancers, such as breast and lung, lead to deaths in the hundreds of thousands each year

During 1994-2013, incidence-based mortality increased 1 During 1994-2013, incidence-based mortality increased 1.1% per year (from 0.40 per 100 000 person-years in 1994-1997 to 0.46 per 100 000 person-years in 2010-2013) overall and 2.9% per year for SEER distant stage papillary thyroid cancer JAMA. Published online March 31, 2017. doi:10.1001/jama.2017.2719

Iran population is equivalent to 1.08% of the total world population. The current population of the Islamic Republic of Iran is 80,729,207 as of Thursday, April 6, 2017, based on the latest United Nations estimates. Iran population is equivalent to 1.08% of the total world population. Iran ranks number 17 in the list of countries (and dependencies) by population.

The total land area is 1,630,207 Km2 (629,426 sq. miles) 74.8 % of the population is urban (60,552,800 people in 2017) The median age in Iran is 30.1 years.

Cancer registry in Iran The first activities in Iran aiming at organizing cancer reporting were initiated in 1955, by the establishment of Cancer Institute in University of Tehran (now the Institute is part of Tehran University of Medical Sciences). Cite the article as: Azizi MH, Bahadori M, Azizi F. History of Cancer in Iran. Arch Iran Med. 2013; 16(10): 613 – 622.

Thyroid incidentaloma in Iran (Isfahan) The prevalence of thyroid incidentaloma was 13.2%]. . It was more prevalent in females than in males (19% vs. 10%) Endokrynologia Polska/Polish Journal of Endocrinology 2008; 59 (4)

Thyroid Nodule in Iran We found one or more nodules in 210 (51.2%) of our patients. Among our patients, 61% had only one nodule The mean (±SD) age of patients with incidental thyroid nodules was 62.9±13.1 (range: 14–100) years. The nodules were unilateral in 56.5% and bilateral in 43.5% of the patients. Incidental thyroid nodules were detected in 46.9% of men and 58.8% of women (P=0.017).. Iran. J. Radiol., 2008, 5(1)

Common cancers in Iranian men The most common cancers in old men were prostatic cancer (61.3%), colon cancer (10.3%) cancer of the hematologic system, bladder cancer (9.6%), lung cancer (9.1%), thyroid cancer (3.9%) and brain tumors (1.3%).

Common cancers in Iranian women In the elderly women, the most common cancers were breast cancer (80.1%), colon cancer (5.1%), thyroid cancers (4.4%), bladder and hematologic system malignancies (3.6), lung cancer (2.9%) and brain tumors (0.7%). In addition

Thyroid Cancer in Iran In a survey by the Cancer Institute of Iran, 1.8% of all cancers and 76.1 % of all endocrine cancers were constituted by the neoplasias of the thyroid gland . Austral - Asian Journal of Cancer ISSN-0972-2556, Vol. 4, No.4, October 2005

91-100( مجله دیابت و متابولیسم ایران. آذر- دي 1394 ؛ دوره 15 (شماره

91-100( مجله دیابت و متابولیسم ایران. آذر- دي 1394 ؛ دوره 15 (شماره

91-100( مجله دیابت و متابولیسم ایران. آذر- دي 1394 ؛ دوره 15 (شماره

91-100( مجله دیابت و متابولیسم ایران. آذر- دي 1394 ؛ دوره 15 (شماره

91-100( مجله دیابت و متابولیسم ایران. آذر- دي 1394 ؛ دوره 15 (شماره

Thyroid Cancer in Iran A total of 9138 cases of thyroid cancer aged between 0 and 100 years have reported to the Iran Cancer Data System Registry during 2004 to 2009. The total annual incidence rate in the six years was 2.17 per 100000, most of whom were women (73.8%). Among the thyroid cancers, the most frequent type was Papillary Carcinoma Asian Pacific Journal of Cancer Prevention, Vol 17, 2016

Thyroid Cancer in Iran The highest rate of prevalence in thyroid cancer was observed at the age of 45 years at the time of diagnosis. We found a female-to-male ratio of 2 in Iran. Asian Pacific Journal of Cancer Prevention, Vol 17, 2016

Thyroid Cancer in Iran Mean of thyroid cancer prevalence displayed that prevalence increased with increase in years especially more rapidly from 2002-2010 the prevalence rates were estimated to be (0.0-0.25) and (4.2-13.7) per 100000 in 1990 and 2010 respectively and increased in both females and males. Asian Pacific Journal of Cancer Prevention, Vol 17, 2016

Thyroid Cancer in Iran The results indicated that, the incidence of thyroid cancer increased from 2003 to 2009 The age standardized rate . for women and men increased from 2.02 and 0.82 to4.2 and 1.36 per 100,000, respectively Asian Pacific Journal of Cancer Prevention, Vol 17, 2016

Thyroid Cancer in Iran The total incidence rate (per one year) was 2.20 per 100000 during 2004-2010 in Iran. A five-year worldwide prevalence of 667377 per 100000 (4.4%) has been reported Asian Pacific Journal of Cancer Prevention, Vol 17, 2016

International Journal of Epidemiologic Research, 2015; 2(1): 12-17.

Iranian Journal of Cancer Prevention Iran J Cancer Prev. 2014; 4:212-8

Asian Pac J Cancer Prev. 2016;17(1):407-12 Asian Pac J Cancer Prev. 2016;17(1):407-12. Thyroid Cancer Epidemiology in Iran: a Time Trend Study. Safavi A(1), Azizi F, Jafari R, Chaibakhsh S, Safavi AA.

Indian Journal of Cancer | April–June 2006 | Volume 43 | Issue 2

Iran J Cancer Prev. 2014; 4:212-8

Asian Pac J Cancer Prev, 17 (1), 407-412

Asian Pac J Cancer Prev, 17 (1), 407-412

Asian Pacific Journal of Cancer Prevention, Vol 17, 2016

Asian Pacific Journal of Cancer Prevention, Vol 12, 2011

A total of 1689 patients were enrolled in the study, of those 20 A total of 1689 patients were enrolled in the study, of those 20.8% were male, with a mean age of 41.98 ± 15.28 years (44.47 ± 16.21 years in male and 40.1 ± 14.9 in female patients). The history of goiter and HT was present in 18.2% and 9.5% of patients, respectively.

The female/male ratio was 3. 78. The mean size of tumors was 23. 35 mm The female/male ratio was 3.78. The mean size of tumors was 23.35 mm. Most patients had papillary thyroid cancer (PTC) followed by follicular thyroid cancer (FTC) (83% and 5.5%, respectively).

Lymph node involvement was seen in 27. 6% of patients, and 3 Lymph node involvement was seen in 27.6% of patients, and 3.6% of them had distant metastasis. Tumor recurrence was reported in 36.4% of patients

The frequencies of tumor types were as follows: 83% papillary, 5 The frequencies of tumor types were as follows: 83% papillary, 5.5% follicular, 1.3% medullary, and 0.7% for other tumor types, and the mean size of tumors was 23.35 ± 14.21 mm..

Most patients had stage 1 thyroid cancer (67 . Most patients had stage 1 thyroid cancer (67.5%), and stage 2, 3, and 4 were reported in 10.6%, 5.8%, and 4% of cases, respectively

: Female to male ratio was 2. 5 : Female to male ratio was 2.5. Highest prevalence thyroid cancer were in four provinces of Iran, Isfahan (mean rate 4.3 per 100000), Yazd (mean rate 4.1 per 100000), Tehran (mean rate 4 per 100000) and Qazvin (mean rate 3.1 per 100000) respectively.

Iranian Journal of Cancer Prevention

Iranian Journal of Cancer Prevention Iran J Cancer Prev. 2014; 4:212-8

International Journal of Epidemiologic Research, 2015; 2(1): 12-17.

. Patients should be advised of the benefits as well as harms that can occur with treatment of incidentally identified, small, asymptomatic thyroid cancers.

Isolation and anxiety characterize the current experience of patients with thyroid cancer who are living with the decision to not intervene. These patients are at risk of disengaging from health care. Successful de-escalation of intervention for patients who self-identify as having over diagnosed cancers requires explicit social and health system support and education.