1 肿瘤防治科 Dept. of Cancer Ctr. & Prevention Pattern of the Incidence of Thyroid Cancer before and after Universal Salt Iodization in Shanghai Ying ZhengMD,

1

肿瘤防治科Dept. of Cancer

Ctr. & Prevention

Pattern of the Incidence of Thyroid Cancer before and after Universal Salt

Iodization in Shanghai

Ying Zheng MD, MScDepartment of Cancer Control and Prevention

Shanghai Municipal Center for Disease Control and Prevention

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Ctr. & Prevention

Thyroid Cancer

Risk factors Ionizing radiation

History of benign thyroid diseases

Iodine deficiency has been associated with follicular thyroid cancer

its pathogenesis is still unknown

Summarized in WHO/IARC --World Cancer Report 2008

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Ctr. & Prevention

Thyroid Cancer Worldwide

141,000 new cases in 2002 worldwide Rare malignancyMore common in females than in males (M:F sex

ratio, 0.36)2.1% of cancers in womenStable or slowly increasing in most countries

Global Cancer Statistics, 2002

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Ctr. & Prevention

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Ctr. & Prevention

Debate on Iodized Salt

July 31, 2009Southern Metropolis WeeklyDoubts about Iodized Salt : Over-supplement Causes Diseases?

August 13, 2009Ministry of Public Healthreplied:

Iodine Intake of Chinese Population is below the upper limit set by WHO

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Ctr. & Prevention

Objectives

Describe the incidence of thyroid cancer in Shanghai;

To study the 30 years time trend in urban area;

Internationally comparison;

Provide evidences for evaluate the health effect of universal salt iodization.

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Ctr. & Prevention

Methods

Data Resources: Shanghai Cancer Registry

Current pattern: Incidence by gender, age, district and histological types for the cases

diagnosed in 2002-2006

Time trend Diagnosed in the past 33 years APC (Annual Percent Change) joinpoint model

Compared with USA SEER .

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Ctr. & Prevention

Results

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Ctr. & Prevention

Current pattern

Crude incidence rate: 7.18 per 100 000

The ASR (W.) : 4.99 per 100 000

Ranks 6th in female, with 3.5 times higher than male

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Ctr. & Prevention

Incidence of Thyroid Cancerin Shanghai in 2002-2006

Gender CasesFrequency

%Crude rate1/100,000

ASR(W.)1/100,000　

TASR(35-64)

1/100,000

Cum. rate0-64

%

Cum. rate0-74

%M/I ratio

Urban and Rural

Male 1095 0.89 3.24 2.23 4.22 0.17 0.22 0.17

Female 3737 3.68 11.17 7.86 15.59 0.62 0.73 0.09

Total 4832 2.15 7.18 4.99 9.77 0.39 0.47 0.11

Urban

Male 548 0.94 3.51 2.36 4.58 0.18 0.23 0.18

Female 1764 3.35 11.49 7.78 16.19 0.63 0.74 0.10

Total 2312 2.09 7.46 5.00 10.21 0.40 0.48 0.12

Rural

Male 547 0.84 3.00 2.11 3.90 0.16 0.20 0.16

Female 1973 4.03 10.90 7.87 14.99 0.62 0.71 0.08

Total 2520 2.21 6.94 4.95 9.34 0.39 0.45 0.10

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Ctr. & Prevention

Age-specific Incidence of Thyroid Cancerin Shanghai in 2002-2006

0

200

400

600

800

0- 5- 10- 15- 20- 25- 30- 35- 40- 45- 50- 55- 60- 65- 70- 75- 80- 85-

age-group

case

s

0

2

4

6

8

10

12

14

16

18

20

rate

(1/1

00,0

00)

Male cases Female cases Male rate Female rate

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Ctr. & Prevention

Distribution of cases diagnosed by age groups

20.57%

20.58%

20.55%

45.05%

46.08%

41.55%

18.85%

18.22%

21.00%

0% 20% 40% 60% 80% 100%

Total

Female

Male

0-24 25-39 40-54 55-69 70+

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Ctr. & Prevention

The histological type of Thyroid cancer

Shanghai

Papillary 73.41%

Follicular 3.27%

Medullary 1.47%

World estimated

Papillary 50-80%

Follicular 10-40%

Medullary 5-15%

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Ctr. & Prevention

Pattern of Incidence 2002： Comparison Internationally

0

1

2

3

4

5

6

7

0-14 15-44 45-54 55-64 65+

1/10

0,00

0

World More developed countries

Less developed countries United States of America

China Shanghai（2002-2006）

0

4

8

12

16

20

0-14 15-44 45-54 55-64 65+

1/10

0,00

0

World More developed countries

Less developed countries United States of America

China Shanghai（2002-2006）

Male Female

GLOBOCAN 2002

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Ctr. & Prevention

Change of Age-specific Rate of Thyroid Cancer in Urban of Shanghai from 1973 to 2006

0

1

2

3

4

5

6

7

0- 5- 10- 15- 20- 25- 30- 35- 40- 45- 50- 55- 60- 65- 70- 75- 80-

1/10

0,00

0

1973-1977 1983-1987 1993-1997 2003-2006

0

4

8

12

16

20

24

0- 5- 10- 15- 20- 25- 30- 35- 40- 45- 50- 55- 60- 65- 70- 75- 80-

1/10

0,00

0

1973-1977 1983-1987 1993-1997 2003-2006

Male Female

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Ctr. & Prevention

Trends of Incidence of Thyroid Cancer among Male in Urban of Shanghai from 1973 to 2006

Segment Period APC t P

Cruderate

1973-2006 1.92 2.83 0.01

1 1973-1983 -8.7 -4.79 0.00

2 1983-2001 3.84 4.40 0.00

3 2001-2006 20.91 3.48 0.00

ASR (W.)

1973-2006 0.98 1.46 0.15

1 1973-1984 -8.43 -5.21 0.00

2 1984-2001 3.21 3.28 0.00

3 2001-2006 19.11 3.12 0.00

2001

1984

0

1

2

3

4

5

6

1973 1976 1979 1982 1985 1988 1991 1994 1997 2000 2003 2006

1/10

0,00

0

Crude rate Observed Modelled joinpoint

ASR Observed Modelled joinpoint

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Ctr. & Prevention

Trends of Incidence of Thyroid Cancer among Female in Urban of Shanghai from 1973 to 2006

Segment Period APC t P

Cruderate

1973-2006 2.61 3.72 0.00

1 1973-1985 -7.80 -7.47 0.00

2 1985-2003 6.84 10.28 0.00

3 2003-2006 25.46 2.47 0.02

ASR(W.)

1973-2006 1.81 2.6 0.01

1 1973-1984 -9.56 -8.28 0.00

2 1984-2003 5.52 9.3 0.00

3 2003-2006 25.91 2.56 0.02

2003

1984

0

2

4

6

8

10

12

14

16

18

1973 1976 1979 1982 1985 1988 1991 1994 1997 2000 2003 2006

1/10

0,00

0



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Ctr. & Prevention

Universal Salt Iodization in China

The Act for the management of salt iodization for avoiding iodine deficiency

State Department Act No.163 P.R.C.

Signed and issued on August 23, 1994 by Premier Li Peng

Enforced began from October 1, 1994

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Ctr. & Prevention

Take 1995 as a cut point

Male Seg. Period APC t P

Cruderate

1 1973-1983 -8.43 -4.06 0.00

2 1983-1995 3.22 1.92 0.07

3 1995-2001 4.03 1.70 0.13

4 2001-2006 20.29 6.02 0.00

ASR (W.)

1 1973-1983 -8.87 -4.13 0.00

2 1983-1995 1.73 1.00 0.33

3 1995-2001 3.86 1.64 0.14

4 2001-2006 18.33 5.52 0.00

Female Seg. Period APC t P

Cruderate

1 1973-1985 -8.27 -7.05 0.00

2 1985-1995 8.34 4.97 0.00

3 1995-2002 4.01 4.54 0.00

4 2001-2006 23.01 10.10 0.00

ASR (W.)

1 1973-1985 -8.97 -7.93 0.00

2 1985-1995 7.53 4.65 0.00

3 1995-2003 4.30 3.78 0.01

4 2003-2006 28.22 4.87 0.00

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Ctr. & Prevention

Trends of Incidence of Thyroid Cancerin USA SEER from 1973 to 2006

1982

1993

0

2

4

6

8

10

12

14

16

18

1973 1976 1979 1982 1985 1988 1991 1994 1997 2000 2003 2006

1/10

0,00

0



1989

0

1

2

3

4

5

6

1973 1976 1979 1982 1985 1988 1991 1994 1997 2000 2003 2006

1/10

0,00

0



Male Female

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Ctr. & Prevention

Comparison: Shanghai Vs. US

2001

1984

1989

0

1

2

3

4

5

6

1973 1976 1979 1982 1985 1988 1991 1994 1997 2000 2003 2006

1/10

0,00

0

上海市区粗率观察值拟合值 joinpoint点

上海市区标率观察值拟合值 joinpoint点

美国SEER 粗率观察值拟合值 joinpoint点

美国SEER 标率观察值拟合值 joinpoint点

Male Female

20031982

1993

1984

0

2

4

6

8

10

12

14

16

18

1973 1976 1979 1982 1985 1988 1991 1994 1997 2000 2003 2006

1/10

0,00

0

上海市区粗率观察值拟合值 joinpoint点

上海市区标率观察值拟合值 joinpoint点

美国SEER 粗率观察值拟合值 joinpoint点

美国SEER 标率观察值拟合值 joinpoint点

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Ctr. & Prevention

Conclusions

Shanghai is among the areas with the highest incidence of thyroid cancer in the world. Compared to more developed countries.

The incidence of male is at the average levelThe incidence of female is above the average level

Continual increase in past 33 years Similar to US which has compulsory salt iodization for over 80

years Synchronous with the improvement of Ultrasonic and Biopsy

There is no solid evidence to suggest a relationship between the rise of thyroid cancer incidence and universal salt iodization

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Ctr. & Prevention

Next Steps

Short term： Case-control Study

Long term： Risk Factors

Collect and analyze the long-term incidence pattern

Study on interaction on iodin exposure and other environment factors

Genetic factors

Documents

1 肿瘤防治科 Dept. of Cancer Ctr. & Prevention Pattern of the Incidence of Thyroid Cancer before and after Universal Salt Iodization in Shanghai Ying ZhengMD,