Differentiated Thyroid carcinoma 1631 Epidemiology

In childhood, thyroid carcinoma is more a disease of teenagers, with the approximate median age of diagnosis being 15 years [4]. The incidence of DTC varies from 0.5-1.5 cases/million/year in children less than 15 years of age to 14.6, 36.1, and 53.2 cases per million per year in the 15-19, 20-24, and 25-29 year age groups, respectively [2, 5]. DTC is more common in females, and the female:male incidence is greater than 5:1 in adolescents and young adults [1, 2]. This sex difference is not pronounced in children younger than 10 years. Although a definite increase in thyroid cancer cases has been identified in females age 20-40 years between the years 1975 and 2000, the same has not been found in males or in females less than age 20 years [2].

DTC is among the most curable of malignancies, particularly if identified early and treated appropriately. The overall prognosis of pediatric DTC is favorable even for patients with disseminated disease at diagnosis [6, 7]. However, some of these individuals may succumb to their disease or die from treatment-related complications decades after diagnosis, which under

Epidemiology Thyroid Cancer
Figure 16.1

Incidence of thyroid cancer among males (blue) and females (pink) as a function of age at diagnosis. United States SEER 1975-2000 [1]

scores the importance of life-long follow up in these cases [6]. Children diagnosed prior to age 10 years may have a higher chance of dying from their disease, albeit still many years to decades after diagnosis [5, 78].

Although several prognostic scoring systems have been described for thyroid carcinoma, a thorough discussion of these is beyond the scope of the current chapter. The pathological tumor-node-metastasis (TNM) classification is used as the international reference staging system and may be superior, given that it takes into account the prognostic effects of lymph node metastases at presentation [9]. By definition, however, the highest TNM stage that anyone less than age 45 years can achieve is stage II, even with distant metastases. Therefore, utilizing the TNM staging system as an indicator of prognosis or how aggressive treatment should be is not very useful in managing children and young adults with DTC.

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