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 2017 are estimated at 56,870.1

Thyroid cancer now accounts for 3.4% of all new cancers in the United States.1 Among patients in the United States diagnosed with thyroid cancer from 1974-2013, the overall incidence of thyroid cancer increased 3% annually, with increases in the incidence rate and thyroid cancer mortality rate for advanced-stage papillary thyroid cancer.2

Thyroid cancer incidence and mortality1

Thyroid Cancer Types

Major types of thyroid cancer, approximate frequency3,4

Thyroid cancer staging

A New Approach to Staging5

The new 2017 AJCC staging approach focuses on age and provides adjusted 10 year DSS.

New 8th Edition Prognostic Staging by Age for Patients with Well-Differentiated Thyroid Cancer

When age at diagnosis is… And T is… And N is… And M is… Then the stage group is…

<55 years

Any T
Any T

Any N
Any N

M0
M1

I
II

>55 years

T1
T1
T2
T2
T3a/T3b
T4a
T4b
Any T

N0/NX
N1
N0/NX
N1
Any N
Any N
Any N
Any N

M0
M0
M0
M0
M0
M0
M0
M1

I
II
I
II
II
III
IVA
IVB

New 8th Edition Staging and 10 Year DSS

  Stage New Description Expected 10 year DSS

Younger Patients

I

< 55 years old
All patients without distant metastases regardless of tumor
size, lymph node status or extrathyroidal extension

98-100%

II

< 55 years old
Distant metastases

85-95%

Older Patients

I

≥ 55 years old
≤ 4 cm tumor
Confined to the thyroid

98-100%

II

≥ 55 years old
Tumors > 4cm,

Or tumors of any size with central or lateral neck lymph nodes,

Or gross extrathyroidal extension into strap muscles

85-95%

III

≥ 55 years old
Tumors of any size with gross
extrathyroidal extension into
subcutaneous tissue, larynx, trachea, esophagus, recurrent
laryngeal nerve

60-70%

IV

≥ 55 years old
Tumors of any size or lymph node status with gross extrathyroidal
extension into prevertebral fascia,
encasing major vessels

Or distant metastasis

< 50%

Thyroid Cancer Epidemiology

Through epidemiologic studies, various factors associated with increased risk for thyroid cancer have been identified, including6:

  • 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 20157

image

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 20157

image

References

  1. SEER. Cancer Stat Facts: Thyroid Cancer. 2017. https://seer.cancer.gov/statfacts/html/thyro.html. Accessed Oct 3, 2017.
  2. Lim H, et al. JAMA. 2017;317:1338-1348.
  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. Tuttle RM, Haugen B, Perrier ND. Thyroid. 2017;27:751-756.
  6. 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.
  7. American Cancer Society. Cancer Facts and Statistics, 2005-2015.  http://www.cancer.org/research/cancerfactsstatistics/.  Accessed Jan 8, 2015.

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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.