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Original Investigation
May 23, 2019

Pediatric Thyroid Cancer Incidence and Mortality Trends in the United States, 1973-2013

Author Affiliations
  • 1Department of Otolaryngology–Head and Neck Surgery, Stanford University School of Medicine, Stanford, California
  • 2Children’s Thyroid Center, Stanford Children’s Health, Lucile Packard Children’s Hospital, Stanford, California
JAMA Otolaryngol Head Neck Surg. 2019;145(7):617-623. doi:10.1001/jamaoto.2019.0898
Key Points

Question  What are the trends in US pediatric thyroid cancer incidence rates?

Findings  In this cross-sectional study of 1806 pediatric patients with thyroid cancer diagnosed from 1973 to 2013, the annual percent change in pediatric thyroid cancer incidence increased from 1.1% per year from 1973 to 2006 to 9.5% per year from 2006 to 2013.

Meaning  The findings suggest that the marked increase in pediatric thyroid cancer between 2006 and 2013 was not solely attributable to enhanced detection.


Importance  The incidence of thyroid cancer is increasing by 3% annually. This increase is often thought to be attributable to overdiagnosis in adults. A previous study reported a 1.1% annual increase in the incidence of pediatric thyroid cancer. However, the analysis was limited to the period from 1973 to 2004 and was performed in a linear fashion, which does not account for changes in incidence trends over time.

Objective  To analyze trends in pediatric thyroid cancer incidence based on demographic and tumor characteristics at diagnosis.

Design, Setting, and Participants  This cross-sectional study included individuals younger than 20 years who had a diagnosis of thyroid cancer in the Surveillance, Epidemiology, and End Results (SEER) 9 database from 1973 to 2013. Cases of thyroid cancer were identified using the International Classification of Diseases for Oncology, Third Edition and were categorized by histologic type, stage, and tumor size.

Main Outcomes and Measures  Annual percent change (APC) in the incidence rates was calculated using joinpoint regression analysis.

Results  Among 1806 patients included in the analysis, 1454 (80.5%) were female and 1503 (83.2%) were white; most patients were aged 15 to 19 years. The overall incidence rates of thyroid cancer increased annually from 0.48 per 100 000 person-years in 1973 to 1.14 per 100 000 person-years in 2013. Incidence rates gradually increased from 1973 to 2006 (APC, 1.11%; 95% CI, 0.56%-1.67%) and then markedly increased from 2006 to 2013 (APC, 9.56%; 95% CI, 5.09%-14.22%). The incidence rates of large tumors (>20 mm) gradually increased from 1983 to 2006 (APC, 2.23%; 95% CI, 0.93%-3.54%) and then markedly increased from 2006 to 2013 (APC, 8.84%; 95% CI, 3.20%-14.79%); these rates were not significantly different from incidence rates of small (1-20 mm) tumors. The incidence rates of regionally extended thyroid cancer gradually increased from 1973 to 2006 (APC, 1.44%; 95% CI, 0.68%-2.21%) and then markedly increased from 2006 to 2013 (APC, 11.16%; 95% CI, 5.26%-17.40%); these rates were not significantly different from the incidence rates of localized disease.

Conclusions and Relevance  The incidence rates of pediatric thyroid cancer increased more rapidly from 2006 to 2013 than from 1973 to 2006. The findings suggest that there may be a co-occurring increase in thyroid cancer in the pediatric population in addition to enhanced detection.