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Background: The advent and increased use of high-resolution ultrasonography has resulted in improved detection of thyroid nodules. Even with the use of various Thyroid Imaging–Reporting and Data System, accurate imaging diagnosis of malignant thyroid nodules has been suboptimal, which necessitated use of newer modalities like contrast-enhanced ultrasonography alone and in combination for this purpose. Although the combined use of various Thyroid Imaging–Reporting and Data System and contrast-enhanced ultrasonography has turned out to be accurate in many studies, the ideal way to integrate contrast-enhanced ultrasonography into the Thyroid Imaging–Reporting and Data System algorithm is under-investigated. Purpose: To estimate and compare the diagnostic accuracy of American College of Radiology Thyroid Imaging–Reporting and Data System and contrast-enhanced ultrasonography in differentiating benign and malignant nodules alone and in combination. To estimate the diagnostic accuracy of contrast-enhanced ultrasonography in re-categorisation of Thyroid Imaging–Reporting and Data System 3 and Thyroid Imaging–Reporting and Data System 4 thyroid nodules. Materials and methods: This was a prospective cohort study performed in a tertiary care university–based hospital for 3 years. Adult patients with clinical or previous sonographic diagnosis of thyroid nodules were selected. Each of the nodules were assessed using ultrasonography and categorised using American College of Radiology Thyroid Imaging–Reporting and Data System criteria. The lesion was then assessed for contrast-enhanced ultrasonography features. The final diagnosis of the nodules was made using fine needle aspiration cytology. The diagnostic accuracy in diagnosis of malignant thyroid nodules for each of the American College of Radiology Thyroid Imaging–Reporting and Data System and contrast-enhanced ultrasonography alone and in combination was assessed. The diagnostic accuracy of contrast-enhanced ultrasonography in diagnosis of malignant thyroid nodules categorised as Thyroid Imaging–Reporting and Data System 3 and Thyroid Imaging–Reporting and Data System 4 was also assessed. Results: American College of Radiology Thyroid Imaging–Reporting and Data System had a sensitivity, specificity, negative predictive value, positive predictive value and diagnostic accuracy of 86.6%, 54.5%, 17.4%, 97.3% and 57.7%, respectively, in diagnosis of malignant thyroid nodules. Contrast-enhanced ultrasonography had a sensitivity, specificity, negative predictive value, positive predictive value and diagnostic accuracy of 86.6%, 95.4%, 67.9%, 98.4% and 94.4%, respectively, in diagnosis of malignant thyroid nodules. Contrast-enhanced ultrasonography had sensitivity, specificity, negative predictive value, positive predictive value and diagnostic accuracy of 93.3%, 100.0%, 100.0%, 99.2% and 99.3%, respectively, in re-categorisation of Thyroid Imaging–Reporting and Data System 3 and Thyroid Imaging–Reporting and Data System 4 nodules. Conclusion: Contrast-enhanced ultrasonography can play a key role in diagnosis of malignant thyroid nodules which are categorised as indeterminate on grey-scale ultrasound. [ABSTRACT FROM AUTHOR]

Thyroid cancer is the most common endocrine malignancy in the pediatric population. A recent study has revealed a recent decline in overall US thyroid cancer incidence rates. The aim of this study is to assess whether there has been a corresponding decline in incidence rates in the pediatric population. We used the Surveillance, Epidemiology, and End Results (SEER) database to analyze the pediatric thyroid cancer incidence rate. The results demonstrate that the incidence rate of pediatric thyroid cancer continued to increase from 2000 to 2018. Future studies are needed to understand how recent changes in guidelines are affecting incidence rates. [ABSTRACT FROM AUTHOR]

Background Many different risk stratification systems have been formulated for thyroid nodules, differing in their fine-needle aspiration cytology (FNAC) indication, suggesting a lack of consensus around the world. Purpose This prospective study was conducted to find the best guideline for risk stratification, for a better malignancy yield, and with reduced rates of negative FNACs among three Thyroid Imaging, Reporting, and Data System (TIRADS) guidelines. Materials and Methods A total of 625 thyroid nodules with conclusive FNAC or histopathological diagnosis were included in the study. Various sonographic parameters were recorded. They were classified into categories as per the three guidelines and compared with FNAC diagnosis. The guidelines were evaluated in terms of sensitivity, specificity, predictive values, and diagnostic accuracy. Sensitivity and specificity were compared by McNemar's test. Results American College of Radiology (ACR) TIRADS had the highest diagnostic accuracy (56.8%), specificity (50.75%), positive predictive value (23.92%), lowest rates of negative FNACs (76.08%), and high negative predictive value (97.84 %). Korean (K) TIRADS had the maximum sensitivity (97.75%), highest negative predictive value (98.44%), and gross malignancy yield. European TIRADS was between the two other guidelines in most parameters with specificity like K TIRADS. Conclusion All the three guidelines are very good screening tools, with comparable high sensitivity. ACR TIRADS is better in terms of specificity and reduced rates of negative FNACs. Including the presence of a suspicious cervical lymph node as a criterion and more frequent follow-up might further improve the diagnostic performance of the guideline. [ABSTRACT FROM AUTHOR]

The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) is a standardized system which is used to classify results of thyroid fine-needle aspiration (FNA). This system is used to evaluate and determine which patients should get thyroid surgery. It was created in order to reduce the number of patients requiring surgery. The question remains as to whether this reporting system is accurate in determining those nodules that have malignant potential and those that do not. This study is a retrospective analysis of patients in one institution who have undergone FNA and then thyroid surgery based on TBSRTC. The outcome of the pathology reports after surgery was analyzed to determine the accuracy of TBSRTC in our institution (Lourdes Hospital, Binghamton, NY). The results from our institution were compared with similar studies in other institutions to determine accuracy and reproducibility. Our results indicated that the risk of malignancy in each Bethesda category was similar to the risk percentages described for most categories in the 2017 TBSRTC update. [ABSTRACT FROM AUTHOR]

Simple Summary: This study reports the clinical outcome of 704 papillary thyroid cancer (PTC) patients followed at our institution for a median time of 8 years. Currently, the long-term follow-up is based on the response to initial therapy (excellent response, indeterminate response, or biochemical or structural incomplete response) evaluated at 6–12 months after initial treatment. We assumed that the long-term follow-up of PTC patients might be better tailored by integrating the response to initial therapy with the American Thyroid Association (ATA) risk stratification system (low-, intermediate- and high-risk). This study confirmed that the initial response to therapy is predictive of the long-term outcome in PTC patients but also showed that the initial ATA risk class may be useful for improving the risk-adapted management of PTC patients based on the response to initial therapy. Background: In recent years, there has been a renewed interest in thyroid cancer management paradigms that use individualized risk assessments as the basis for treatment and follow-up recommendations. In this study, we assumed that the long-term follow-up of differentiated thyroid cancer patients might be better tailored by integrating the response to initial therapy with the America Thyroid Association (ATA) risk classes. Methods: This retrospective study included low- and intermediate-risk papillary thyroid cancer (PTC) patients followed up for a median time of 8 years and classified according to the response to initial therapy assessed 6–12 months after initial treatment. Results: After a median follow-up of 8 years, in the initial excellent response subgroup of PTC patients (n = 522), the rate of recurrent disease was significantly higher in intermediate-risk patients than in low-risk PTC patients (6.9% versus 1.2%, p = 0.0005). Similarly, in the initial biochemical incomplete response subgroup (n = 82), the rate of excellent response was significantly higher in low-risk PTC patients (58.0%) than in intermediate-risk PTC patients (33.3%) (p = 0.007). Finally, in the initial structural incomplete response subgroup (n = 66), the rate of excellent response was higher in low-risk patients (80.0%) than in intermediate-risk patients (46.4%) (p = 0.08). Moreover, all patients with initial indeterminate response had an excellent response at the last follow-up visit. ATA risk classes were independently associated with long-term outcome in each subgroup of patients classified dynamically after initial therapy and the overall prognostic performance, defined via ROC curve analysis, of response to initial therapy integrated with the ATA risk system (AUC: 0.89; 95% CI: 0.86–0.92) was significantly higher compared to the ATA risk stratification (AUC 0.69; 95% CI: 0.65–0.74, p < 0.001) or the dynamic risk stratification (DRS) systems alone (AUC: 0.86 95% CI: 0.82–0.90, p = 0.007). Conclusions: This study of a large cohort of PTC patients showed that the initial ATA risk criteria may be useful for improving the risk-adapted management of PTC patients based on the response to initial therapy. [ABSTRACT FROM AUTHOR]

Simple Summary: Thyroid cancer is the most common endocrine cancer and is becoming increasingly prevalent. Although its prognosis is generally favorable, bone metastasis is a notable complication that significantly decreases survival rates. Currently, there is no definitive cure as most treatments are palliative to relieve patients of any pain or other symptoms. We assessed the incidence and influence of bone metastasis on thyroid cancer patients to understand the risk factors and outcomes which can improve clinical decision making and research endeavors. Bone is the second most common site of metastasis in patients with thyroid cancer (TC) and dramatically impacts overall survival and quality of life with no definitive cure, yet there is no extensive study of the demographic and clinical risk factors in the recent literature. Data regarding 120,754 TC patients with bone metastasis were retrieved from the Surveillance, Epidemiology, and End Results (SEER) database. Univariate and multivariate analyses were used to identify the risk factors of bone metastasis occurring in various histologies of TC. Cox regression was performed to analyze the influence of bone metastasis on overall survival. Hazard ratios were computed to analyze the association between bone metastasis and the primary outcomes. Of the 120,754 records collected from the SEER database from 2000 to 2019, 976 (0.8%) presented with bone metastasis, with occurrence being the greatest in patients of age ≥ 55 years (OR = 5.63, 95%CI = 4.72–6.71), males (OR = 2.60, 95%CI = 2.27–2.97), Blacks (OR = 2.38, 95%CI = 1.95–2.9) and Asian or Pacific Islanders (OR = 1.90, 95%CI = 1.58–2.27), and single marital status. TC patients presenting with bone metastasis (HR = 2.78, 95%CI = 2.34–3.3) or concurrent bone and brain metastases (HR = 1.62, 95%CI = 1.03–2.55) had a higher mortality risk. Older age, gender, race, and single marital status were associated with bone metastasis and poorer prognosis in TC patients at initial diagnosis. Understanding such risk factors can potentially assist clinicians in making early diagnoses and personalized treatment plans, as well as researchers in developing more therapeutic protocols. [ABSTRACT FROM AUTHOR]

Objective: To determine whether thyroid nodule surveillance compliance is influenced by patient demographics or plan type. Study Design: Retrospective case series from 2010 to 2018. Setting: United States Military Health System. Methods: There were 481 patients with a thyroid nodule fine-needle aspiration classified as atypia of undetermined significance for whom treatment and follow-up information were available. Demographic information and surveillance plan type were extracted from the medical record and statistical analysis was performed to determine whether these characteristics influenced compliance rates. Results: A total of 289 nodules were surveilled and 192 diagnostic lobectomies were performed. An initial surveillance plan was documented in 93% (268/289) and 86% (231/268) complied. The most common plans were repeat biopsy in 78% (210/268) or ultrasound in 20% (53/268). A second plan was documented in 88% (204/231) of those who complied with the first. The most common second plans were ultrasound in 87% (178/204) or repeat biopsy in 8% (17/204). Compliance with the second plan was 64% (130/204), significantly lower than with the first (OR 3.6, 95% CI: [2.3, 5.6], P <.0001). Only 45% (130/289) were surveilled twice. Age and gender did not significantly affect compliance rates. Compliance with primary care ultrasound surveillance was 40% (21/52), significantly lower than with a specialist (77% [137/179]; OR 4.8, 95% CI: [2.5, 9.3, P <.0001). Conclusion: Compliance with surveillance of thyroid nodules classified as atypia of undetermined significance was poor in this military cohort. Ultrasound surveillance by a specialist may be more reliable than with primary care. [ABSTRACT FROM AUTHOR]

Background: Describe the epidemiology and characteristics of patients with a history of mental illness undergoing otolaryngologic procedures. Methods: A retrospective cross-sectional analysis utilizing the Nationwide Readmissions Database, 2010 to 2015. The study sample included adult (≥18 years) patients undergoing otolaryngologic procedures. Results: A total of 146 182 patients were included, 18.3% with mental illness history. The prevalence of patients who required otolaryngologic surgeries with history of mental illness increased significantly from 14.9% in 2010 to 25.0% in 2015 (P <.001). Mental illness diagnoses included: depression (6.9%), anxiety (5.8%), alcohol dependence (4.2%), substance dependence (2.9%), bipolar disorder (1.4%), memory disorders (1.2%), delusional disorders (0.6%), self-harm (0.1%). Patients with a history of mental illness were more likely to be <65 years, female, and have multiple comorbidities (P <.05 each). Patients with history of mental illness had a higher risk of complications [OR:1.59, 95% CI:1.50,1.69, P <.001]. Conclusions: Patients with a history of mental illness are increasingly encountered in otolaryngology service. This study provides an epidemiological perspective that warrants increasing clinical investigation of this subpopulation. [ABSTRACT FROM AUTHOR]

Aims: To assess the application of American College of Radiology Thyroid Imaging Reporting and Data System (ACR‐TIRADS) guidelines and the potential reduction of unnecessary fine‐needle aspirate (FNA) and cost savings through examination of cytopathological correlation. Methods: All ultrasound‐guided thyroid FNA performed between December 2017 and July 2019 at our institution were included in this study. Prior to performing each FNA, the nodules were scored according to ACR‐TIRADS criteria with subsequent cytology scored according to Bethesda criteria. FNA request forms and preceding diagnostic ultrasound reports were analysed for clinical rationale behind each FNA. Collected data were applied to ACR‐TIRADS, American Thyroid Association (ATA) and Korean TIRADS (K‐TIRADS) criteria. Rate of reduction of unnecessary thyroid FNA and associated costs were subsequently calculated. Results: A total of 125 patients and 146 nodules were evaluated. A malignancy rate of 7.5% was obtained. Sensitivity and specificity for detection of malignancy were 75% and 41% for ACR‐TIRADS, 91% and 26% for ATA and 92% and 19% for K‐TIRADS. Reduction in the rate of unnecessary FNA was most superior for ACR‐TIRADS at 54.8%. Based on Australian Medicare Benefits Schedule item codes, a total of $18 452.70 might have been saved over the study period had ACR‐TIRADS guidelines been uniformly followed. Conclusions: This study highlights the strengths and limitations of guidelines in the investigative pathway of thyroid nodules, including superiority of ACR‐TIRADS in reducing the rate of unnecessary FNA. Continued education is needed towards application of guidelines among radiologists and referring clinicians, given the potential to reduce unnecessary FNA and achieve economic savings. [ABSTRACT FROM AUTHOR]

PURPOSE To examine the association between historic state Medicaid income eligibility limits and long-term survival among patients with cancer. METHODS 1,449,144 adults age 18-64 years newly diagnosed with 19 common cancers between 2010 and 2013 were identified from the National Cancer Database. States' Medicaid income eligibility limits were categorized as # 50%, 51%-137%, and $ 138% of federal poverty level (FPL). Survival time was measured from diagnosis date through December 31, 2017, for up to an 8-year follow-up. Multivariable Cox proportional hazards models with age as time scale were used to assess associations of eligibility limits and stage-specific survival, adjusting for the effects of sex, metropolitan statistical area, comorbidities, year of diagnosis, facility type and volume, and state. RESULTS Among patients with newly diagnosed cancer age 18-64 years, patients living in states with lower Medicaid income eligibility limits had worse survival for most cancers in both early and late stages, compared with those living in states with Medicaid income eligibility limits $ 138% FPL. A dose-response relationship was observed for most cancers with lower income limits associated with worse survival (13 of 17 cancers evaluated for early-stage cancers, and 11 of 17 cancers evaluated for late-stage cancers, and leukemia and brain tumors with P-trend < .05). CONCLUSION Lower Medicaid income eligibility limits were associated with worse long-term survival within stage; increasing Medicaid income eligibility may improve survival after cancer diagnosis. [ABSTRACT FROM AUTHOR]

Supplemental Digital Content is available in the text Objective: This study sought to clarify cancer risk in fighter aviators. Methods: US Air Force officers who served between 1970 and 2004 were followed through 2018 for incidence and mortality of 10 cancers: colon and rectum; pancreas; melanoma skin; prostate; testis; urinary bladder; kidney and renal pelvis; brain and other nervous system; thyroid; and non-Hodgkin lymphoma. Fighter aviators were compared with other officers and the general US population. Results: Compared with other officers, male fighter aviators had greater adjusted odds of developing testis, melanoma skin, and prostate cancers; mortality odds were similar for all cancers. When compared with the US population, male fighter aviators were more likely to develop and die from melanoma skin cancer, prostate cancer, and non-Hodgkin lymphoma. Conclusions: Military fighter aviation may be associated with slightly increased risk of certain cancers. [ABSTRACT FROM AUTHOR]

Background: The rising incidence of thyroid cancer has been attributed to increased detection of papillary thyroid microcarcinoma (PTMC). Although some PTMCs are thought to harbor aggressive pathologic features, the clinical significance of these features remains unclear. This study examines factors associated with survival in this patient population.Study Design: Adults with PTMC, defined as papillary thyroid carcinoma ≤ 1.0 cm, who underwent thyroidectomy between 2004 and 2016, were identified in the National Cancer Database. Demographic and clinical variables were analyzed. The primary aim was to identify factors associated with survival. The secondary aim was to assess the association of microscopic margins on survival and to identify factors associated with margin positivity. Overall survival was estimated using Kaplan-Meier methods and compared using log rank tests. Cox proportional hazards and binary logistic regression models identified factors associated with survival and margin positivity, respectively.Results: Of 77,817 patients with PTMC, 13,507 met inclusion criteria; 2,649 (20%) of these patients presented with advanced features: extrathyroidal extension (n = 916, 7%), lymphovascular invasion (n = 398, 3%), lymph node involvement (n = 2,003, 15%), and distant metastasis (n = 39, <1%). Microscopic margin positivity was present in 906 patients and associated with increased risk of death (hazard ratio 1.58, 95% CI 1.04-2.41). Academic facilities (odds ratio [OR] 0.75, 95% CI 0.59-0.95) and operative volume (OR 0.98, 95% CI 0.97-0.98) were associated with decreased margin positivity.Conclusions: Positive margin status was significantly associated with increased risk of death for PTMC. Higher operative volume and treatment at academic centers were associated with lower rates of margin positivity and may help improve survival outcomes in PTMC patients with aggressive features. [ABSTRACT FROM AUTHOR]

This study aimed to determine the diagnostic accuracy of the American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS) classification and shear-wave elastography (SWE) for the diagnosis of benign and malignant thyroid nodules. This retrospective study enrolled 141 patients (18-84 y of age) undergoing thyroidectomy between January 2015 and August 2020. All statistical analysis was based on pathologic results of patients. The cut-off value was found as category 4 for ACR TI-RADS classification and 5 m/s for shear-wave velocity (Vs) by the receiver operator characteristic curve analysis (area under the curve [AUC] = 0.684, p = 0.020 and AUC = 0.715, p = 0.005, respectively). SWE has higher diagnostic accuracy than the ACR TI-RADS classification system and can improve thyroid nodule discrimination in all sizes of the nodules. Also, the diagnostic performance decreases when the nodule diameter increases. [ABSTRACT FROM AUTHOR]

Background: Primary thyroid lymphoma (PTL) is a rare thyroid malignancy, there are few large sample studies on PTL and no standardized treatment regimen has been established due to the rarity. The aims of this study were to explore the incidence and prognostic factors of PTL and construct visual prognostic prediction models for post-chemotherapy and postoperative patients. Methods: The incidence of PTL in 1975–2017 was extracted from the US Surveillance, Epidemiology, and End Results (SEER) database, then assessed using joinpoint regression software. A total of 1616 eligible PTL patients diagnosed in 1998–2016 were brought into prognostic analysis. Multivariate Cox regression analyses were carried out to reveal independent prognostic elements for overall survival (OS) and cancer-specific survival (CSS). Results: PTL incidence showed a relatively steady increase in 1975–1994, which annual percent change (APC) was 4.0%, and steady decreasing in 1994–2017(APC − 2.4%). Age, marital status, lymphoma Ann Arbor stage, histological subtypes, surgery, chemotherapy, and radiation were significantly correlated to OS and CSS. Nomograms were constructed to predict OS and CSS in post-chemotherapy and postoperative PTL patients separately, and were verified to have good reliability. Conclusions: The incidence of PTL increased and subsequently decreased. We revealed the prognostic implications and constructed reliable nomograms for post-chemotherapy and postoperative PTL patients. [ABSTRACT FROM AUTHOR]

The release of radioactive iodine after a nuclear disaster, such as those that occurred at the Fukushima Daiichi Nuclear Power Plant in Japan 10 years ago and Three Mile Island in Pennsylvania in 1979, increases thyroid cancer risk among people who are exposed. Certain populations are especially vulnerable, including pregnant and breastfeeding women, children, and neonates. Potassium iodide (KI) can effectively block radioactive iodine from being absorbed by the thyroid gland if taken immediately after a radiation release. This article examines lessons learned from Fukushima to enhance disaster readiness and nursing actions. Nurses should be directly involved in vulnerability assessments, emergency planning, and in ensuring the availability, accessibility, and distribution of KI within U.S. nuclear power plant emergency planning zones before a crisis occurs. [ABSTRACT FROM AUTHOR]

Context: US papillary thyroid carcinoma (PTC) incidence recently declined for the first time in decades, for reasons that remain unclear.Objective: This work aims to evaluate PTC incidence trends, including by histologic subtype and size, and noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP).Design: This descriptive study uses US Surveillance, Epidemiology, and End Results-18 cancer registry data (2000-2017).Patients: Participants included individuals diagnosed with PTC (2000-2017) or NIFTP (2016-2017).Results: During 2000 to 2015, PTC incidence increased an average 7.3% per year, (95% CI, 6.9% to 7.8%) during 2000 to 2009, and 3.7% per year (95% CI, 0.2% to 7.3%) during 2009 to 2012, before stabilizing in 2012 to 2015 (annual percentage change [APC] = 1.4% per year, 95% CI, -1.8% to 4.7%) and declining in 2015 to 2017 (APC = -4.6% per year, 95% CI, -7.6% to -1.4%). The recent declines were observed for all sizes of PTC at diagnosis. Incidence of follicular variant of PTC (FVPTC) sharply declined in 2015 to 2017, overall (APC = -21.1% per year; 95% CI, -26.5% to -15.2%) and for all tumor sizes. Observed increases in encapsulated papillary carcinoma (classical PTC subtype) and NIFTP each accounted for 10% of the decline in FVPTC. Classical PTC incidence continuously increased (2000-2009, APC = 8.7% per year, 95% CI, 8.1% to 9.4%; 2009-2017, APC = 1.0% per year, 95% CI, 0.4% to 1.5%), overall and for all sizes except smaller than 1 cm, as did incidence of other PTC variants combined (2000-2017, APC = 5.9% per year, 95% CI, 4.0% to 7.9%).Conclusion: The reasons underlying PTC incidence trends were multifactorial. Sharp declines in FVPTC incidence during 2015 to 2017 coincided with clinical practice and diagnostic coding changes, including reclassification of noninvasive encapsulated FVPTC from a malignant to in situ neoplasm (NIFTP). Observed increases in NIFTP accounted for 10% of the decline in FVPTC. [ABSTRACT FROM AUTHOR]

Background: Since the early 1980s, papillary thyroid cancer (PTC) incidence rates and the prevalence of obesity, a risk factor for PTC, have increased substantially in the United States. We estimated the proportion of PTC incidence in the United States attributable to overweight and obesity during 1995-2015.Methods: National Institutes of Health-AARP Diet and Health Study cohort data (n = 457 331 participants, 50-71 years and cancer-free at baseline) were used to estimate multivariable-adjusted hazard ratios (HRs) for PTC across body mass index categories. Population attributable fractions (PAFs) were calculated using estimated hazard ratios and annual overweight and obesity prevalence estimates from the National Health Interview Survey. PAF estimates were combined with Surveillance, Epidemiology, and End Results-13 data to calculate annual percent changes in PTC incidence rates attributable (and unrelated) to overweight and obesity.Results: Overweight (25.0-29.0 kg/m2) and obesity (≥30.0 kg/m2) were associated with 1.26-fold (95% confidence interval [CI] = 1.05- to 1.52-fold) and 1.30-fold (95% CI = 1.05- to 1.62-fold) increased risks of PTC, respectively, and nearly threefold (HR = 2.93, 95% CI = 1.25 to 6.87) and greater than fivefold (HR = 5.42, 95% CI = 2.24 to 13.1) increased risks of large (>4 cm) PTCs compared with normal weight (18.5-24.9 kg/m2). During 1995-2015, PAF estimates for overweight and obesity increased from 11.4% to 16.2% for all PTCs and from 51.4% to 63.2% for large PTCs. Overweight or obesity accounted for 13.6% and 57.8% of the annual percent changes in total (5.9%/y) and large (4.5%/y) PTC incidence rates, respectively, during 1995-2015.Conclusions: Overweight and obesity may have contributed importantly to the rapid rise in PTC incidence during 1995-2015. By 2015, we estimate that one of every six PTCs diagnosed among adults 60 years or older, including nearly two-thirds of large PTCs, were attributable to overweight and obesity. [ABSTRACT FROM AUTHOR]

Background: Frailty is linked to perioperative morbidity and mortality. We evaluated the impact of preoperative frailty on inpatient outcomes of patients undergoing surgery for thyroid malignancy. Methods: This population-based, retrospective observational study extracted data of hospitalized patients who were 18 years and older with a primary diagnosis of thyroid cancer undergoing thyroidectomy from the US Nationwide Inpatient Sample (NIS) database (2005–2014). Participants were stratified into frail and non-frail using the Johns Hopkins (ACG) frailty-defining diagnosis indicator. Study endpoints were in-hospital mortality, incidence of surgical and medical complications and prolonged length of stay. Univariate and multivariate analysis were performed to determine associations between the endpoints and frailty. Results: Data of 38,202 patients were included. After adjusting for possible confounders, frailty remained significantly associated with higher odds of in-hospital mortality (OR: 3.839, 95% CI: 1.738–8.480), prolonged length of stay (OR: 5.420, 95% CI: 3.799–7.733), surgical complications (OR: 3.144, 95% CI: 2.443–4.045) and medical complications (OR: 6.734, 95% CI: 5.099–8.893) compared with non-frailty. In patients > age 65 years, adjusted odds ratio for frailty was 4.099 (95% CI: 1.736–9.679) for in-hospital mortality, 6.164 (95% CI: 3.514–10.812) for prolonged length of stay, 3.736 (95% CI: 2.620–5.328) for surgical complications, and 5.970, 95% CI: 4.088–8.720 for medical complications, all with significance. Conclusion: Frailty is associated with increased risk for adverse inpatient outcomes, including prolonged hospital stay, surgical and medical complications and mortality independent of age and comorbidities in thyroid cancer patients undergoing surgery. Study findings may provide valuable information for preoperative risk stratification. [ABSTRACT FROM AUTHOR]

Purpose: Thyroid cancer incidence is rising, possibly secondary to increased imaging and surveillance. Based on rural access to care disparities, we hypothesized that incidence would be greater in urban compared to rural counties with no significant difference in long‐term survival. Methods: An observational study was performed on thyroid cancer patients using Surveillance Epidemiology and End Results data (2000‐2012). Age‐adjusted incidence rates, incidence rate ratios, and survival rates were calculated across rural‐urban designations. Findings: Incidence rates were 11.2, 9.8, and 10.1 per 100,000 for urban, rural‐adjacent, and rural‐nonadjacent counties, respectively. Statistically significantly lower incidence was noted in rural‐adjacent and rural‐nonadjacent compared to urban areas. Five‐year and 10‐year survival was significantly lower in rural‐nonadjacent counties compared to urban counties. Conclusions: Higher incidence and increased long‐term survival for thyroid cancer were noted in urban areas compared to rural areas. It is uncertain if rural‐urban differences in long‐term survival reflect health care disparities, differences in therapy, or other origins. [ABSTRACT FROM AUTHOR]

Introduction: Lenvatinib has become the most commonly prescribed first-line (1L) agent for the treatment of radioactive iodine-refractory differentiated thyroid cancer (RAI-r DTC) since its approval in 2015. With no real-world studies describing clinical outcomes of 1L lenvatinib and subsequent therapy, the current study aimed to assess treatment sequencing and related clinical outcomes in patients treated with 1L lenvatinib in the USA METHODS: We conducted a multisite, retrospective chart review of US patients with a diagnosis of RAI-r DTC who had initiated 1L therapy with lenvatinib from January 1, 2016 through May 31, 2017 with follow-up through October 17, 2018. Physicians completed electronic case report forms for two patient cohorts: patients still receiving 1L lenvatinib (cohort 1) and those who had initiated second-line (2L) therapy prior to data cutoff (cohort 2). Real-world objective response rate (ORR) was assessed for both cohorts. Progression-free survival (PFS) and overall survival (OS) were assessed for cohort 2.Results: A total of 252 patients met the study criteria with 71 in cohort 1 and 181 in cohort 2. Patients were predominantly female, had papillary DTC, and had lung metastases. The ORR was 64.8% for cohort 1 and 53.6% for cohort 2. In cohort 2, median PFS from 1L lenvatinib initiation was 14.0 months (95% CI 12.7-15.0). Second-line treatments included sorafenib (49.7%), cabozantinib (19.3%), and other targeted/chemotherapy/immuno-oncology agents. The ORR in 2L therapy was 15.5%. For cohort 2, the 12-, 18-, and 24-month OS from initiation of 1L lenvatinib was 92.8%, 81.5%, and 66.9%, respectively.Conclusions: In this first real-world examination of clinical effectiveness of 1L lenvatinib and subsequent therapy among patients in the US, the results demonstrated that treatment with 1L lenvatinib followed by another 2L therapy may deliver a clinical benefit, thus allowing a number of potential 2L options following 1L lenvatinib for patients with RAI-r DTC. [ABSTRACT FROM AUTHOR]

Background: The presumptive overdiagnosis of papillary thyroid microcarcinoma (PTMC) has led to an emerging trend of less-extensive operation and an inclination toward active surveillance when possible. In this study, we aimed to examine the risk of advanced PTMC at presentation.Study Design: We conducted a retrospective analysis using the National Cancer Database (2010 to 2014). Patients with PTMC who underwent surgical intervention were included and patients with a history of any cancer were excluded.Results: A total of 30,180 adult patients with PTMC were identified; 5,628 patients (18.7%) presented with advanced features, including central lymph node (LN) metastasis (8.0%), lateral LN metastasis (4.4%), microscopic extrathyroidal extension (ETE; 6.7%), gross ETE (0.3%), lymphovascular invasion (LVI; 4.4%), and distant metastasis (0.4%). All of those features were associated with a significantly lower survival rate (p < 0.05 each) except for microscopic ETE and LVI. There was a significant interrelation among those features, distant metastasis was associated with central LN metastasis (odds ratio [OR] 2.44; 95% CI, 1.48 to 4.23; p < 0.001), lateral LN metastasis (OR 3.18; 95% CI, 1.77 to 5.71; p < 0.001), and gross ETE (OR 9.91; 95% Cl, 3.83 to 25.64; p < 0.001). In turn, nodal metastasis was associated with microscopic ETE (OR 4.23; 95% CI, 3.82 to 4.70; p < 0.001) and LVI (OR 7.17; 95% CI, 6.36 to 8.08; p < 0.001).Conclusions: PTMC could exhibit advanced features in 19% of patients who underwent operation and some of those, such as LVI and microscopic ETE, are undetectable with preoperative workup. Clinicians need to be cognizant of this considerable risk in the era of less-aggressive management of PTMC. [ABSTRACT FROM AUTHOR]

Background: Papillary thyroid carcinoma (PTC) is a common subtype of thyroid carcinoma with a rising incidence rate. The purpose of this study was to provide a better understanding of age and PTC using the Surveillance, Epidemiology, and End Results (SEER) Program. Methods: The study derived patients' information from the SEER Program (2010-2015). Chi-square or Fisher exact tests, and Kaplan-Meier method were used to analyze survival. Prognostic factors associated with survival were analyzed by Cox multivariate regression. Results: A total of 1738 records were included from SEER, with 1079 PTC in the age group <55 years, and 659 PTC in the age group ≥55 years. The 5-year survival rate was 94% and the overall survival (OS) curve in different age groups indicated that patients younger than 55yr have a longer survival time (P < 0.05). In multivariate Cox regression, age, M stage and surgery treatment were independent risk factors (P < 0.05). Regarding PTC-specific survival, age and surgery treatment were the two main independent prognostic factors in multivariate regression. However, AJCC and M stage were not in the disease specific survival. Conclusion: Age is a prognostic factor in OS and PCT specific survival. AJCC I stage and surgery treatment are also significant in predicting prognosis. [ABSTRACT FROM AUTHOR]

Purpose: Clinical trial enrollment is low among adolescents and young adults (AYAs) with cancer and may contribute to inferior survival gains in recent years in this population compared with other age groups. We investigated clinical trial participation among AYA women with cancer, and examined whether patients discussed clinical trial participation with their doctor and reasons for nonparticipation. Methods: Women with a diagnosis of breast cancer, thyroid cancer, melanoma, lymphoma, or gynecologic cancer at ages 15–39 years during 2004–2016 were identified from the North Carolina Central Cancer Registry and the Kaiser Permanente Southern California health system. During 2018–2019, a total of 1264 eligible women completed an online survey (response = 13%), which examined survivorship issues among AYAs. Results: Overall, 5% of participants reported that they had participated in a clinical trial. Most women reported that they had not discussed clinical trial participation with a medical provider (76%) and that they did not know whether a relevant trial was available for their cancer (73%). Among those who knew that a trial was available but did not participate, the most commonly reported reasons for nonparticipation included concerns about side effects of the treatment in the trial and concerns that the treatment had not been sufficiently tested. Conclusion: Only a small proportion of AYA women with cancer in our cohort reported discussing a clinical trial with a provider or knowing whether a relevant trial was available. Our findings point to opportunities to improve patient/provider communication to increase clinical trial enrollment among AYAs with cancer. [ABSTRACT FROM AUTHOR]

A nested case-control study was carried out using data from the US Department of Defense cohort between 2000 and 2013 to investigate the associations of papillary thyroid cancer (PTC) with serum concentrations of polybrominated diphenyl ethers and polybrominated biphenyls. This study included 742 histologically confirmed PTC cases (in 341 women and 401 men) and 742 matched controls with prediagnostic serum samples from the Department of Defense Serum Repository. Lipid-corrected serum concentrations of 8 congeners were measured. Multivariate conditional logistic regression analyses were performed for classical PTC and follicular variant of PTC, respectively. We also examined effect modification by sex. BDE-28, a polybrominated diphenyl ether congener, was associated with significantly increased risk of classical PTC (for the third tertile vs. below the limit of detection, odds ratio = 2.09, 95% confidence interval: 1.05, 4.15; P for trend = 0.02), adjusting for other congeners, body mass index, and branch of military service. This association was observed mainly for larger classical PTC (tumor size > 10 mm), with a significantly stronger association among women than men (P for interaction = 0.004). No consistent associations were observed for other congeners, including those at higher concentrations. This study found a significantly increased risk of classical PTC associated with increasing levels of BDE-28. The risk varied by sex and tumor size. [ABSTRACT FROM AUTHOR]

Advances in cancer screening methods have opened avenues for incidental findings and cancer overdiagnosis. We performed a secondary analysis of the National Lung Screening Trial (enrollment from 2002–2004), a randomized controlled trial comparing low-dose computed tomography (LDCT; n  = 26,722) with chest radiography (CXR; n  = 26,732) for lung cancer detection, to examine incidental findings related to thyroid cancer (ThCa). Three screening rounds were included, and median follow-up was 6.6 years for LDCT and 6.5 years for CXR. Radiologists reported lung and non-lung-related abnormalities. In the LDCT arm, 5.7%, 4.7%, and 4.5% of participants had abnormalities above the diaphragm (AADs) detected at baseline, year 1, and year 2, respectively, compared with 2.3%, 1.5%, and 1.3% in the CXR arm. In the LDCT arm, 205 AADs (7.0%) were thyroid-related. Overall, 60 ThCas were reported, 35 in the LDCT arm and 25 in the CXR arm (P  = 0.2). In the LDCT arm, participants with a prior AAD had a 7.8-fold increased risk (95% confidence interval: 4.0, 15.1) of ThCa compared with those who did not have an AAD. Early and persistent excess of ThCas diagnosed earlier in the LDCT arm suggests overdiagnosis. The use of sensitive screening modalities for early detection of lung cancer might result in the discovery of thyroid incidentalomas. [ABSTRACT FROM AUTHOR]

Health problems arise when the thyroid gland, part of the endocrine system, generates hormone levels that are either too high or too low, affecting the body's ability to regulate metabolism and other essential functions, or becomes cancerous. According to the American Thyroid Association, over 10% of Americans will develop a thyroid condition during their lifetimes, however, as many as 60% of those with thyroid disease are unaware of their condition. This article covers major thyroid diseases, touching on common symptoms and treatment options as well as reputable web resources for further relevant information. Reassuringly, patients with thyroid disorders commonly thrive once their conditions are recognized and properly treated. [ABSTRACT FROM AUTHOR]

Background: Thyroid cancer is one of the most common cancers in women of reproductive age. Our purpose was to evaluate the association between thyroid cancer and maternal and neonatal outcomes of pregnancy. Methods: We conducted a retrospective cohort study using the Healthcare Cost and Utilization Project, Nationwide Inpatient Sample (HCUP-NIS) database from the US. A cohort consisting of women who delivered between 1999 and 2014 was created. Multivariate logistic regression, controlling for baseline maternal characteristics, was used to compare pregnancy complications and neonatal outcomes of pregnant women with thyroid cancer [International Classification of Diseases, ninth edition (ICD-9) code 193] diagnosed before or during pregnancy with those of the obstetric population without thyroid cancer. Results: The study included 14,513,587 pregnant women, of which 581 women had a diagnosis of thyroid cancer (4/100,000). During the observation period, there was an upward trend in the prevalence of thyroid cancer among pregnant women, though not statistically significant (P = 0.147). Women with thyroid cancer were more likely to be Caucasian, belong to a higher income quartile, have private insurance, to be discharged from an urban teaching hospital and to have pre-gestational hypertension. Women with thyroid cancer had a greater chance of delivering vaginally, requiring transfusion of blood and developing venous thromboembolism (VTE). Neonates of mothers with thyroid cancer were not found to be at increased risk for the adverse neonatal outcomes examined, specifically, congenital malformations, intrauterine growth restriction, fetal death and preterm labor. Conclusion: Pregnancies complicated by thyroid cancer have higher incidences of VTE and need for transfusions, with comparable overall newborn outcomes. [ABSTRACT FROM AUTHOR]

Background: Data on osteoporosis and fractures in patients with thyroid cancer, especially men, are conflicting. Our objective was to determine osteoporosis and fracture risk in U.S. veterans with thyroid cancer. Materials and Methods: This is a case‐control study using the Veterans Health Administration Corporate Data Warehouse (2004–2013). Patients with thyroid cancer (n = 10,370) and controls (n = 10,370) were matched by age, sex, weight, and steroid use. Generalized linear mixed‐effects regression model was used to compare the two groups in terms of osteoporosis and fracture risk. Next, subgroup analysis of the patients with thyroid cancer using longitudinal thyroid‐stimulating hormone (TSH) was performed to determine its effect on risk of osteoporosis and fractures. Other covariates included patient age, sex, median household income, comorbidities, and steroid and androgen use. Results: Compared with controls, osteoporosis, but not fractures, was more frequent in patients with thyroid cancer (7.3% vs. 5.3%; odds ratio [OR], 1.33; 95% confidence interval [CI], 1.18–1.49) when controlling for median household income, Charlson/Deyo comorbidity score, and androgen use. Subgroup analysis of patients with thyroid cancer demonstrated that lower TSH (OR, 0.93; 95% CI, 0.90–0.97), female sex (OR, 4.24; 95% CI, 3.53–5.10), older age (e.g., ≥85 years: OR, 17.18; 95% CI, 11.12–26.54 compared with <50 years), and androgen use (OR, 1.63; 95% CI, 1.18–2.23) were associated with osteoporosis. Serum TSH was not associated with fractures (OR, 1.01; 95% CI, 0.96–1.07). Conclusion: Osteoporosis, but not fractures, was more common in U.S. veterans with thyroid cancer than controls. Multiple factors may be contributory, with low TSH playing a small role. Implications for Practice: Data on osteoporosis and fragility fractures in patients with thyroid cancer, especially in men, are limited and conflicting. Because of excellent survival rates, the number of thyroid cancer survivors is growing and more individuals may experience long‐term effects from the cancer itself and its treatments, such as osteoporosis and fractures. The present study offers unique insight on the risk for osteoporosis and fractures in a largely male thyroid cancer cohort. Physicians who participate in the long‐term care of patients with thyroid cancer should take into consideration a variety of factors in addition to TSH level when considering risk for osteoporosis. Thyroid stimulating hormone suppression therapy may contribute to bone loss in patients with thyroid cancer, especially in postmenopausal women. The link between thyroid cancer treatment and osteoporosis and fractures in men is less certain. This article reports results of a study designed to address this knowledge gap. [ABSTRACT FROM AUTHOR]

Background: Pediatric differentiated thyroid cancer (DTC) rates have increased over time in the United States and worldwide. Improvements in imaging for the diagnosis of DTC have been hypothesized as a potential driver of these increases. This study stratifies temporal trends in pediatric DTC by stage and tumor size to assess whether rates of large, late-stage cancers, which are likely to be clinically meaningful, are increasing over time.Methods: Age-standardized incidence rates (ASRs) of DTC and annual percent changes (APCs) in primary DTC rates were estimated for 0- to 19-year-olds with data from 39 US cancer registries during 1998-2013.Results: During 1998-2013, 7296 cases of DTC were diagnosed (6652 papillary cases and 644 follicular cases). APCs of pediatric DTCs significantly increased by 4.43%/y [95% CI, 3.74%/y-5.13%/y], primarily because of increases in papillary histologies. Increasing trends were observed for children aged 10 to 19 years for both sexes and for non-Hispanic whites, non-Hispanic blacks, and Hispanics. Rates increased significantly over the time period for all tumor stages (APClocalized , +4.06%/y [95% CI, 2.84%/y-5.29%/y]; APCregional , +5.68%/y [95% CI, 4.64%/y-6.73%/y]; APCdistant , +8.55%/y [95% CI, 5.03%/y-12.19%/y]) and across tumor sizes (APC<1 cm , +9.46%/y [95% CI, 6.13%/y-12.90%/y]; APC1-2 cm , +6.92%/y [95% CI, 4.31%/y-9.60%/y]; APC>2 cm , +4.69%/y [95% CI, 2.75%/y-6.67%/y]).Conclusions: Significantly increasing rates of DTC over time among 10- to 19-year-olds in the United States are unlikely to be entirely explained by increases in medical surveillance during childhood because rates of large and late-stage DTC are increasing over time. Future studies should examine environmental and other factors that may be contributing to rising DTC rates. [ABSTRACT FROM AUTHOR]

Background: Image-guided fine needle aspiration cytology (FNAC) is emerging as an important diagnostic tool in the evaluation of thyroid swellings. Aim: This study aims to assess the efficacy of ultrasound (US)-guided FNAC combined with "The Bethesda system' of reporting as a primary screening test for all thyroid lesions. Settings and Design: A prospective cohort study was made and all the US-guided FNACs done were followed up to find out the histopathological diagnoses wherever surgery was done. Materials and Methods: In all, 1050 patients who underwent US-guided FNAC were studied during a period of 1 year. Age, sex, cytological features, and histological diagnoses were analyzed. Statistical analyses of all the findings were done to derive conclusions. Results: Of the 1050 patients, only 10.5% underwent surgery. Higher than expected rate (as per the Bethesda system) of malignancy was noted with the so-called grey zone lesions. The test results revealed a high level of sensitivity, specificity, and diagnostic accuracy. Conclusion: The study showed that The Bethesda System of Reporting Thyroid Cytology provides effective communication between clinician and pathologists thereby enabling clear management strategies. We also concluded that US-guided FNACs offer better results compared with palpation-guided FNACs. [ABSTRACT FROM AUTHOR]

Background Sepsis is an important cause of mortality among older adults in the United States. The association between sepsis and subsequent risk of cancer is poorly understood. Methods Using the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database, we conducted a case-control study in US adults. We included 1801156 cases with a first cancer diagnosis in SEER during 1992–2013 (ages 66–115 years) and 200000 cancer-free controls from a 5% random sample of Medicare beneficiaries. Sepsis was identified using inpatient Medicare claims. Associations with sepsis were estimated using logistic regression. Results After correction for multiple comparisons, sepsis was significantly associated with increased risk for cancers of the colon (adjusted odds ratio [aOR] = 1.12), rectum (1.13), liver (1.47), lung (1.17), and cervix (1.52), as well as acute myeloid leukemia (AML, 1.19), chronic myeloid leukemia (1.54), and myelodysplastic syndrome (1.30). Inverse associations were observed for cancers of the breast (aOR = 0.86), prostate (0.75), kidney (0.90), and thyroid (0.68) and for melanoma (0.83), diffuse large B-cell lymphoma (0.89), and follicular lymphoma (0.65). Sepsis was significantly associated with the following 9 types of cancer in the period >5 years following sepsis diagnosis: thyroid, prostate, colon, rectum, lung, and liver and follicular lymphoma, melanoma, and AML. Conclusions Sepsis is associated with increased or decreased risks for a small group of cancers. Factors that may explain these associations include etiologic effects. Other associations may reflect the presence of precursor conditions or patterns in ascertainment of cancer and screening. [ABSTRACT FROM AUTHOR]

In July 1973, a study at the University of Chicago linked radiation treatment during childhood to a variety of diseases, including thyroid cancer. A few months later, a worker at Michael Reese Hospital in Chicago, Illinois found a registry of 5266 former patients who had been treated with radiation during the 1950s and 1960s. Hospital officials decided to contact these patients and arrange for follow-up medical examinations. Media coverage of the hospital's campaign had a snowball effect that prompted more medical institutions to follow suit, resulting in the National Cancer Institute (NCI) launching a nationwide campaign to warn the public and medical community about the late health effects of ionizing radiation. This study describes how the single action of a hospital in Chicago and the media attention it attracted led to a national campaign to warn those who underwent radiation treatment during childhood. [ABSTRACT FROM AUTHOR]

Background: The incidence of pregnancy-associated cancer (PAC) is expected to increase as more women delay childbearing until later ages. However, information on frequency and incidence of PAC is scarce in the United States. Methods: We identified pregnancies among women aged 10–54 years during 2001–2013 from five U.S. health plans participating in the Cancer Research Network (CRN) and the Medication Exposure in Pregnancy Risk Evaluation Program (MEPREP). We extracted information from the health plans' administrative claims and electronic health record databases, tumor registries, and infants' birth certificate files to estimate the frequency and incidence of PAC, defined as cancer diagnosed during pregnancy and up to 1 year postpartum. Results: We identified 846 PAC events among 775,709 pregnancies from 2001 to 2013. The overall incidence estimate was 109.1 (95% confidence interval [CI] = 101.8–116.7) per 100,000 pregnancies. There was an increase in the incidence between 2002 and 2012 (the period during which complete data were available), from 75.0 (95% CI = 54.9–100.0) per 100,000 pregnancies in 2002 to 138.5 (95% CI = 109.1–173.3) per 100,000 pregnancies in 2012. The most common invasive cancers diagnosed were breast (n = 208, 24.6%), thyroid (n = 168, 19.9%), melanoma (n = 93, 11.0%), hematologic (n = 87, 10.3%), and cervix/uterus (n = 74, 8.7%). Conclusions: Our study provides contemporary incidence estimates of PAC from a population-based cohort of U.S. women. These estimates provide the data needed to help develop clinical and public health policies aimed at diagnosing PAC at an early stage and initiating appropriate therapeutic interventions in a timely manner. [ABSTRACT FROM AUTHOR]

Abstract Objective To determine the incidence of malignancy, follow-up ultrasound (US), and repeat fine needle aspiration (FNA) in thyroid nodules that have been previously biopsied as benign. Methods This is a retrospective, descriptive study of benign thyroid nodules evaluated by US between 2010-2011. We determined the frequency of follow-up ultrasounds and FNAs, mean years of follow-up, interval between follow-up US, change in nodule size, reasons for repeat FNA (rFNA), frequency of thyroidectomy, and thyroid malignancy during 5 years of follow-up. Results A total of 733 benign thyroid nodules were reviewed in 615 patients. Mean years of US follow-up was 3.47 ± 1.65 years; 275 (37.5%) had no follow-up US; 109 (14.9%) had 1 follow-up US; 93 (12.7%) had 2 follow-up US; and 256 (34.9%) had 3 or more follow-up US. Assessment of thyroid nodule size showed that 215 (28.8%) nodules decreased in size, 145 (19.4%) increased in size by less than 50%, and 91 (12.1%) increased in size by more than 50%. Of the 733 nodules, 17 nodules (2.3%) underwent thyroidectomy for which the pathology result of 9 (1.2%) showed malignancy, and 65 (8.9%) thyroid nodules underwent rFNA. When applying the 2015 recommendations for repeat FNA, 35% were done unnecessarily. Conclusion In our sample of initially benign thyroid nodules, only 9 patients (1.2%) had pathology-proven malignancy after a mean follow-up of 3.5 years. Over 30% of patients had more than 3 rUSs. Decreased interval and frequency of rUS should be considered in future guidelines for thyroid management. [ABSTRACT FROM AUTHOR]

The American Academy of Oral and Maxillofacial Radiology established an ad hoc committee to draft evidence-based recommendations and clinical guidance for the application of patient contact shielding during dentomaxillofacial imaging. The committee reviewed monographs and reports from radiation protection organizations and studies that reported radiation dose to gonads, breasts, and thyroid gland from dentomaxillofacial imaging. Considering the absence of radiation-induced heritable effects in humans and the negligible dose to the gonads and fetus from dentomaxillofacial imaging, the committee recommends discontinuing shielding of the gonads, pelvic structures, and fetuses during all dentomaxillofacial radiographic imaging procedures. On the basis of radiation doses from contemporaneous maxillofacial imaging, the committee considered that the risks from thyroid cancer are negligible and recommends that thyroid shielding not be used during intraoral, panoramic, cephalometric, and cone-beam computed tomographic imaging. This position statement informs and educates the reader on evolving radiation protection practices and provides simple, unequivocal guidance to dental personnel to implement these guidelines. State and local authorities should be contacted to update regulations to reflect these recommendations. [ABSTRACT FROM AUTHOR]

Purpose: In an effort to counteract the differences in improvement in survival rates of adolescents and young adults (AYA), compared to other age groups with cancer, the University of Iowa Hospitals and Clinics established an AYA cancer program. This study was conducted to gather feedback from AYAs in an effort to generate actionable data for program development. Methods: The target population included patients aged 13–31 treated for malignancy in one of the following disease sites: central nervous system, leukemia, lymphoma, neuroendocrine, sarcoma, and thyroid. A series of four focus groups was held to identify and describe gaps in care and provide suggestions for program development. A convergent parallel mixed-methods design was used. Qualitative data were derived from focus group discussion and free-response survey questions, while quantitative data were derived from objective survey questions and electronic medical record data. Results: Across the four focus groups, 24 different AYAs participated, ranging from 8 to 19 individuals per session. Topics discussed included the following: communication, treatment experience, and overall AYA program; finances, work and school, and late effects; relationships, emotions, and spirituality; and body image, infertility, sexuality, risky behavior, and suicide. The results of the analyses corroborated what makes AYAs different from other age groups. The primary theme identified was the unique relationships of AYAs, which can be thought of along a continuum. Conclusions: Information obtained from these analyses has been used to inform specific projects within the development of the AYA program to address patient-identified gaps. For AYAs, the importance of relationships along a continuum should be considered when developing an AYA program, in addition to potential policy or health service research utilization in the future. [ABSTRACT FROM AUTHOR]

Radioactive iodine (RAI) is not routinely recommended for the adjuvant treatment of micropapillary thyroid carcinoma (MPTC). We aimed to report on clinical and pathologic factors associated with the use of RAI in these patients. We queried the Surveillance, Epidemiology, and End Results database for patients who underwent surgery for MPTC (tumor size ≤1 cm) from 1988 to 2009. We excluded patients without a biopsy-proven diagnosis, those diagnosed at autopsy, and patients with documented extra-thyroidal extension. Multivariate logistic regression models predicted the use of RAI based on patient, tumor, and treatment-related factors. We identified 24,076 patients with MPTC that were eligible for study inclusion. Of these, 6,172 (25.6%) received RAI. Lymph node metastases were present in 23.8 per cent of those for whom lymph node status was known. On multivariate analysis, an increasing number of positive nodes, increasing tumor size, Asian race, and male gender predicted the use of RAI. RAI use was less likely in those with advancing age, an increasing number of lymph nodes examined and patients that received less than a total thyroidectomy. Among node-negative patients, Asian race and increasing tumor size predicted the use of RAI. Factors predicting decreased use of RAI were an increasing number of lymph nodes examined, unknown race, less than a total thyroidectomy, and advancing age. A significant number of MPTC patients receive potentially unnecessary RAI. [ABSTRACT FROM AUTHOR]

Thyroid cancer is an endocrine malignancy whose prevalence is increasing in the United States. Nearly 57,000 new cases of thyroid cancer are estimated to be diagnosed in 2017. The standard of care for differentiated thyroid cancer is thyroidectomy followed by ablation of thyroid remnants with high‐dose radioactive iodine (131I). Apart from thyroid glands, 131I accumulates in cells of salivary glands and compromises its function. Xerostomia is, therefore, a frequent and often persistent complaint of patients. Despite adoption of standard preventive measures, parenchymal damage and chronic salivary dysfunction are observed in a substantial number of patients. Saliva is important for oral homeostasis, and its reduction increases the risk of oral morbidity. As differentiated thyroid cancer patients have an excellent survival rate, preservation of salivary gland function carries added significance. A focus on treatments that preserve or restore long‐term salivary flow can significantly improve the quality of life of thyroid cancer survivors. [ABSTRACT FROM AUTHOR]

Background: There is considerable scientific interest in associations between protracted low-dose exposure to ionizing radiation and the occurrence of specific types of cancer.Methods: Associations between ionizing radiation and site-specific solid cancer mortality were examined among 308,297 nuclear workers employed in France, the United Kingdom, and the United States. Workers were monitored for external radiation exposure and follow-up encompassed 8.2 million person-years. Radiation-mortality associations were estimated using a maximum-likelihood method and using a Markov chain Monte Carlo method, the latter used to fit a hierarchical regression model to stabilize estimates of association.Results: The analysis included 17,957 deaths attributable to solid cancer, the most common being lung, prostate, and colon cancer. Using a maximum-likelihood method to quantify associations between radiation dose- and site-specific cancer, we obtained positive point estimates for oral, esophagus, stomach, colon, rectum, pancreas, peritoneum, larynx, lung, pleura, bone and connective tissue, skin, ovary, testis, and thyroid cancer; in addition, we obtained negative point estimates for cancer of the liver and gallbladder, prostate, bladder, kidney, and brain. Most of these estimated coefficients exhibited substantial imprecision. Employing a hierarchical model for stabilization had little impact on the estimated associations for the most commonly observed outcomes, but for less frequent cancer types, the stabilized estimates tended to take less extreme values and have greater precision than estimates obtained without such stabilization.Conclusions: The results provide further evidence regarding associations between low-dose radiation exposure and cancer. [ABSTRACT FROM AUTHOR]

Background: Well-differentiated thyroid carcinoma has a favorable prognosis, but patients with multiple recurrences have drastically lower survival. Filipinos in the United States are known to have high rates of thyroid cancer incidence and disease recurrence. To the authors' knowledge, it is unknown whether Filipinos also have higher thyroid cancer mortality rates.Methods: The authors studied thyroid cancer mortality in Filipino, non-Filipino Asian (NFA), and non-Hispanic white (NHW) adults using US death records (2003-2012) and US Census data. Age-adjusted mortality rates and proportional mortality ratios (PMRs) were calculated. Sex, nativity status, age at death, and educational attainment also were examined.Results: The authors examined 19,940,952 deaths. The age-adjusted mortality rates due to thyroid cancer were highest in Filipinos (1.72 deaths per 100,000 population; 95% confidence interval [95% CI], 1.51-1.95) compared with NFAs (1.03 per 100,000 population; 95% CI, 0.95-1.12) and NHWs (1.17 per 100,000 population; 95% CI, 1.16-1.18). Compared with NHWs, higher proportionate mortality was observed in Filipino women (3-5 times higher) across all age groups, and among Filipino men, the PMR was 2 to 3 times higher in the subgroup aged >55 years. Filipinos who completed a higher educational level had a notably higher PMR (5.0) compared with their counterparts who had not (3.5).Conclusions: Negative prognostic factors for thyroid cancer traditionally include age >45 years and male sex. The results of the current study demonstrate that Filipinos die of thyroid cancer at higher rates than NFA and NHW individuals of similar ages. Highly educated Filipinos and Filipino women may be especially at risk of poor thyroid cancer outcomes. Filipino ethnicity should be factored into clinical decision making in the management of patients with thyroid cancer. Cancer 2017;123:4860-7. © 2017 American Cancer Society. [ABSTRACT FROM AUTHOR]

Background: Sub-Saharan African-born blacks (ABs) are one of the fastest-growing populations in the United States. However, to the authors' knowledge, data regarding the cancer burden in this group are lacking, which would inform targeted cancer prevention and control.Methods: The authors calculated age-standardized proportional incidence ratios (PIRs) comparing the frequency of the top 15 cancers in ABs with that of US-born non-Hispanic blacks (USBs) by sex and region of birth using incidence data for 2000 through 2012 from the Surveillance, Epidemiology, and End Results (SEER 17) program.Results: Compared with USBs, ABs had significantly higher PIRs of infection-related cancers (liver, stomach, and Kaposi sarcoma), blood cancers (leukemia and non-Hodgkin lymphoma), prostate cancer, and thyroid cancers (females only). For example, the PIR for Kaposi sarcoma in AB versus USB women was 12.06 (95% confidence interval [95% CI], 5.23-18.90). In contrast, ABs had lower PIRs for smoking-related and colorectal cancers (eg, for lung cancer among men, the PIR was 0.30 [95% CI, 0.27-0.34]). Furthermore, cancer occurrence in ABs versus USBs varied by region of birth. For example, the higher PIRs for liver cancer noted among male ABs (PIR, 3.57; 95% CI, 1.79-5.35) and for thyroid cancer in female ABs (PIR, 3.03; 95% CI, 2.03-4.02) were confined to Eastern African-born blacks, whereas the higher PIR for prostate cancer (PIR, 1.90; 95% CI, 1.78, 2.02) was confined to Western African-born blacks.Conclusions: The cancer incidence profile of ABs is different from that of USBs and varies by region of birth, suggesting differences in environmental, cultural, social, and genetic factors. The findings of the current study could stimulate etiologic research and help to inform targeted interventions. Cancer 2017;123:3116-24. © 2017 American Cancer Society. [ABSTRACT FROM AUTHOR]

Background: Cancer incidence rates and trends for cases diagnosed through 2014 using data reported to the Surveillance, Epidemiology, and End Results (SEER) program in February 2016 and a validation of rates and trends for cases diagnosed through 2013 and submitted in February 2015 using the November 2015 submission are reported. New cancer sites include the pancreas, kidney and renal pelvis, corpus and uterus, and childhood cancer sites for ages birth to 19 years inclusive.Methods: A new reporting delay model is presented for these estimates for more consistent results with the model used for the usual November SEER submissions, adjusting for the large case undercount in the February submission. Joinpoint regression methodology was used to assess trends. Delay-adjusted rates and trends were checked for validity between the February 2016 and November 2016 submissions.Results: Validation revealed that the delay model provides similar estimates of eventual counts using either February or November submission data. Trends declined through 2014 for prostate and colon and rectum cancer for males and females, male and female lung cancer, and cervical cancer. Thyroid cancer and liver and intrahepatic bile duct cancer increased. Pancreas (male and female) and corpus and uterus cancer demonstrated a modest increase. Slight increases occurred for male kidney and renal pelvis, and for all childhood cancer sites for ages birth to 19 years.Conclusions: Evaluating early cancer data submissions, adjusted for reporting delay, produces timely and valid incidence rates and trends. The results of the current study support using delay-adjusted February submission data for valid incidence rate and trend estimates over several data cycles. Cancer 2017;123:2524-34. © 2017 American Cancer Society. [ABSTRACT FROM AUTHOR]

Despite the increase in thyroid cancer incidence among adolescents and young adults (AYAs), this group has received limited attention. We reviewed the epidemiology and challenges of thyroid cancer care among AYAs, and proposed a research agenda to improve their care. Thyroid cancer is the most common cancer in American adults 16-33 years of age. AYAs with thyroid cancer face challenges including overdiagnosis reduced healthcare access and inconsistent care. Successful treatment of these patients results in additional challenges due to ongoing side effects of treatment as well as lasting impacts on their quality of life. These challenges should fuel a collaborative research agenda aimed at improving the quality of care for AYAs with thyroid cancer across the spectrum of diagnosis, treatment and survivorship. [ABSTRACT FROM AUTHOR]

Background: Thyroid cancer incidence is increasing in the United States (US) and many other countries. The objective of this study was to develop and evaluate algorithms using administrative medical claims data for identification of incident thyroid cancer.Methods: This effort was part of a prospective cohort study of adults initiating therapy on antidiabetic drugs and used administrative data from a large commercial health insurer in the US. Patients had at least 6 months of continuous enrollment prior to initiation during 2009-2013, with follow-up through March, 2014 or until disenrollment. Potential incident thyroid cancers were identified using International Classification of Diseases, 9th Revision (ICD-9) diagnosis code 193 (malignant neoplasm of the thyroid gland). Medical records were adjudicated by a thyroid cancer specialist. Several clinical variables (e.g., hospitalization, treatments) were considered as predictors of case status. Positive predictive values (PPVs) and 95% confidence intervals (CIs) were calculated to evaluate the performance of two primary algorithms.Results: Charts were requested for 170 patients, 150 (88%) were received and 141 (80%) had sufficient information to adjudicate. Of the 141 potential cases identified using ≥1 ICD-9 diagnosis code 193, 72 were confirmed as incident thyroid cancer (PPV of 51% (95% CI 43-60%)). Adding the requirement for thyroid surgery increased the PPV to 68% (95% CI 58-77%); including the presence of other therapies (chemotherapy, radio-iodine therapy) had no impact. When cases were required to have thyroid surgery during follow-up and ≥2 ICD-9 193 codes within 90 days of this surgery, the PPV was 91% (95% CI 81-96%); 62 (82%) of the true cases were identified and 63 (91%) of the non-cases were removed from consideration by the algorithm as potential cases.Conclusions: These findings suggest a significant degree of misclassification results from relying only on ICD-9 diagnosis codes to detect thyroid cancer. An administrative claims-based algorithm was developed that performed well to identify true incident thyroid cancer cases. [ABSTRACT FROM AUTHOR]

A review is provided for an article about mass media's reaction to a link between radiotherapy and thyroid cancer in the 1970s which was written by Bavli and Shvarts and appears in the same issue of the journal, and it mentions a study conducted by the Michael Reese Hospital in Chicago, Illinois.

The article presents information on the role of the U.S. Nuclear Regulatory Commission (NRC) in devising a strategy to protect the children affected from nuclear radiation caused by the nuclear tests. The nuclear weapon test conducted by the U.S. on March 1, 1954 in Bikini Atoll in Marshall Island caused thyroid tumors to the children living in the area. The children began one after another to develop thyroid tumors. The cause of the damage to the children's thyroids was the radioactive iodine in the fallout. In order to protect these children, a study group recommended to the NRC in 1975 that a national policy of stockpiling thyroid-blocking chemicals for possible emergency distribution should be established.

During the past few decades, the incidence of thyroid cancer has increased substantially in many countries, including the USA. The rise in incidence seems to be attributable both to the growing use of diagnostic imaging and fine-needle aspiration biopsy, which has led to enhanced detection and diagnosis of subclinical thyroid cancers, and environmental factors. The latest American Thyroid Association (ATA) practice guidelines for the management of adult patients with thyroid nodules and differentiated thyroid cancer differ substantially from the previous ATA guidelines published in 2009. Specifically, the problems of overdiagnosis and overtreatment of a disease that is typically indolent, where treatment-related morbidity might not be justified by a survival benefit, now seem to be acknowledged. As few modifiable risk factors for thyroid cancer have been established, the specific environmental factors that have contributed to the rising incidence of thyroid cancer remain speculative. However, the findings of several large, well-designed epidemiological studies have provided new information about exposures (such as obesity) that might influence the development of thyroid cancer. In this Review, we describe the changing incidence of thyroid cancer, suggest potential explanations for these trends, emphasize the implications for patients and highlight ongoing and potential strategies to combat this growing clinical and public health issue. [ABSTRACT FROM AUTHOR]

Background. Mutations in the BRCA1 and BRCA2 genes are associated with increased risk of breast, ovarian, and several other cancers. The purpose of the present study was to evaluate the incidence of cancer in first- and second-degree relatives of BRCA mutation carriers compared with the general population. Materials and Methods. A total of 1,086 pedigrees of BRCA mutation carriers was obtained from a prospectively maintained, internal review board-approved study of persons referred for clinical genetic counseling at the University of Texas MD Anderson Cancer Center. We identified 9,032 first-and second-degree relatives from 784 pedigrees that had demonstrated a clear indication of parental origin of mutation. Standardized incidence ratios (SIRs) were used to compare the observed incidence of 20 primary cancer sites to the expected incidence of each cancer based on the calculated risk estimates according to each subject's age, sex, and ethnicity. Results. BRCA1 families had increased SIRs for breast and ovarian cancer (p < .001) and decreased SIRs for kidney, lung, prostate, and thyroid cancer and non-Hodgkin's lymphoma (p < .001). BRCA2 families had increased SIRs for breast, ovarian, and pancreatic cancer (p <.001) and decreased SIRs for kidney, lung, thyroid, and uterine cancer and non-Hodgkin's lymphoma (p < .0025). Analysis of only first-degree relatives (n = 4,099) identified no decreased SIRs and agreed with the increased SIRs observed in the overall study population. Conclusion. We have confirmed previous reports of an association between breast, ovarian, and pancreatic cancers with BRCA mutations. Additional research to quantify the relative risks of these cancers for BRCA mutation carriers can help tailor recommendations for risk reduction and enhance genetic counseling. [ABSTRACT FROM AUTHOR]

Long‐term survival is an expected outcome for children diagnosed with retinoblastoma and low‐grade astroglial tumors. Studies examining health‐related outcomes in long‐term survivors of these malignancies can help inform the next‐generation therapeutic studies aimed at decreasing long‐term morbidity without compromising survival. [ABSTRACT FROM AUTHOR]