Incidence and Mortality

Incidence and Deaths

According to the National Institutes of Health SEER (Surveillance, Epidemiology, and End Results) Database, the incidence of thyroid cancer has increased in the past 20 years. New cases in 2015 are estimated at 62,450.

Thyroid cancer now accounts for nearly 4% of all new cancers in the United States.1

Early detection and effective therapy has kept mortality from thyroid cancer low.However, despite advances in the diagnosis and treatment of thyroid cancer, the total number of deaths due to thyroid cancer has not decreased.1

Thyroid cancer incidence and mortality1

Thyroid Cancer Types and Staging

Major types of thyroid cancer, approximate frequency3,4

Thyroid cancer staging

Staging in well-differentiated thyroid cancer is the process of finding out if and how far a cancer has spread. The stage of a cancer is one of the most important factors in choosing treatment options and establishing a prognosis. Staging is based on the size and spread of the primary tumor, extent of lymph node involvement, and the presence or absence of distant metastases (or spreading outside of the neck).5

  • In Stage I disease, the tumor is <2 cm and there is no spread to lymph nodes outside the neck
  • In Stage II disease, the tumor is 2-4 cm and there is no spread of cancer
  • Stage III disease is characterized by a larger tumor or spread to lymph nodes in the neck
  • Stage IV disease includes tumors that have grown beyond thyroid, in which there is nodal involvement, and/or cancer outside the neck

Thyroid Cancer Survival Is Affected by Stage and Type of Cancer

The survival of patients with thyroid cancer survival is affected by both the type and stage of cancer, and the degree to which it has spread at diagnosis.

The degree to which cancer has spread at diagnosis also influences survival, regardless of thyroid cancer type.  Based on data from the SEER database, the 5-year survival for localized thyroid cancer is >99% while that for cancer with distant metastases is 54.1%.1

Papillary and follicular thyroid cancers generally have a good outcome. As noted in the table below, approximately 100% of patients diagnosed at stage I survive to 5 years. The 5-year survival rate decreases as the stages progress.  Similarly, the 5-year survival for medullary cancer is estimated at 100%, with decreasing survival as stage progresses. The outlook can be very poor for anaplastic thyroid cancer, with only a 7% survival rate for patients (stage IV).6

Combination of Information about Cancer Type and Stage Provides the Clearest Picture Regarding Prognosis

5-year survival with different types of thyroid cancer6

American Joint Committee on Cancer Staging Types of Thyroid Cancer
Papillary1a Follicular1a Medullary2b Anaplastic2b
I ~100% ~100% ~100% -
II ~100% ~100% 98% -
III 93% 71% 81% -
IV 51% 50% 28% 7%c

a Based on patients diagnosed from 1998 to 1999.
b Based on patients diagnosed between 1985 and 1991.
c All anaplastic thyroid cancer is considered Stage IV.

Thyroid Cancer Epidemiology

Through epidemiologic studies, various factors associated with increased risk for thyroid cancer have been identified, including7:

  • Age 40-60 in women, and age 60-80 in men
  • Female sex
  • Diet low in iodine
  • Exposure to radiation to the head and neck as a child or being exposed to radioactive fallout
  • Family history of thyroid disease or thyroid cancer

Percentage of new cases of thyroid cancer by age group1

Estimated number of new cases of thyroid cancer, 2005 to 20158

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Thyroid Cancer Deaths

Similar factors also impact mortality rates.

Percentage of deaths by age group1

Estimated number of deaths due to thyroid cancer, 2005 to 20158

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References

  1. SEER. Thyroid cancer. 2015. http://seer.cancer.gov/statfacts/html/thyro.html. Accessed Nov 1, 2015.
  2. National Comprehensive Cancer Network (NCCN) Clinical Practice Guidelines in Oncology. Thyroid Carcinoma, version 2.20.2015. NCCN.org. Accessed Nov 4, 2015.
  3. Neoplasms of the Thyroid. 2015. http://jpck.zju.edu.cn/jcyxjp/files/ge/011/MT/0113.pdf. Accessed Nov 4, 2015.
  4. Katoh H, Yamashita K, Enonoto T, Watanabe M. Classification and general considerations of thyroid cancer. Ann Clin Pathol. 2015;3:1-9.
  5. American Cancer Society. Thyroid Cancer – What is Cancer? 2015. http://www.cancer.org/cancer/thyroidcancer/detailedguide. Accessed Jan 8,2016.
  6. American Cancer Society. 2015. http://www.cancer.org/acs/groups/cid/documents/webcontent/003144-pdf.pdf Accessed Oct 29, 2015.
  7. American Cancer Society. What are the risk factors for thyroid cancer? 2015. http://www.cancer.org/cancer/thyroidcancer/detailedguide/thyroid-cancer-risk-factors. Accessed Oct 26, 2015.
  8. American Cancer Society. Cancer Facts and Statistics, 2005-2015.  http://www.cancer.org/research/cancerfactsstatistics/.  Accessed Jan 8, 2015.

Thyrogen® (thyrotropin alfa for injection) 0.9 mg/mL after reconstitution

IMPORTANT SAFETY INFORMATION

WARNINGS AND PRECAUTIONS

There have been reports of death in non-thyroidectomized patients and in patients with distant metastatic thyroid cancer in which events leading to death occurred within 24 hours after administration of Thyrogen.

Caution should be exercised in patients who have substantial thyroid tissue still in situ or functional thyroid cancer metastases, specifically in the elderly and those with a known history of heart disease.

Hospitalization for administration of Thyrogen and post-administration observation in patients at risk should be considered.

There are post marketing reports of stroke in young women with risk factors for stroke, and neurological findings suggestive of stroke (e.g., unilateral weakness) occurring within 72 hours of Thyrogen administration in patients without known central nervous system metastases.

Patients should be well-hydrated prior to treatment with Thyrogen.

Sudden, rapid and painful enlargement of residual thyroid tissue or distant metastases can occur following treatment with Thyrogen.

Pretreatment with glucocorticoids should be considered for patients in whom tumor expansion may compromise vital anatomic structures.

ADVERSE REACTIONS

The most common adverse reactions reported in clinical trials were nausea and headache.

USE IN SPECIFIC POPULATIONS

Pregnancy Category C: Animal reproduction studies have not been conducted with Thyrogen. It is also not known whether Thyrogen can cause fetal harm when administered to a pregnant woman or can affect reproductive capacity. Thyrogen should be given to a pregnant woman only if clearly needed.

Nursing Mothers: It is not known whether the drug is excreted in human milk. Because many drugs are excreted in human milk, caution should be exercised when Thyrogen is administered to a nursing woman.

Pediatric Use: Safety and effectiveness in pediatric patients have not been established.

Geriatric Use: Results from controlled trials do not indicate a difference in the safety and efficacy of Thyrogen between adult patients less than 65 years and those over 65 years of age.

Renal Impairment: Elimination of Thyrogen is significantly slower in dialysis-dependent end stage renal disease patients, resulting in prolonged elevation of TSH levels.

INDICATIONS AND USAGE

Thyrogen is a thyroid stimulating hormone indicated for:

Diagnostic: Use as an adjunctive diagnostic tool for serum thyroglobulin (Tg) testing with or without radioiodine imaging in the follow-up of patients with well-differentiated thyroid cancer who have previously undergone thyroidectomy.

Limitations of Use:

  • Thyrogen -stimulated Tg levels are generally lower than, and do not correlate with Tg levels after thyroid hormone withdrawal.
  • Even when Thyrogen -Tg testing is performed in combination with radioiodine imaging, there remains a risk of missing a diagnosis of thyroid cancer or underestimating the extent of the disease.
  • Anti-Tg Antibodies may confound the Tg assay and render Tg levels uninterpretable.

Ablation: Use as an adjunctive treatment for radioiodine ablation of thyroid tissue remnants in patients who have undergone a near-total or total thyroidectomy for well-differentiated thyroid cancer and who do not have evidence of distant metastatic thyroid cancer.

Limitations of Use:

  • The effect of Thyrogen on long term thyroid cancer outcomes has not been determined.

See full Prescribing Information for more details.