Rising thyroid cancer incidence in Kerala: Is it real or over diagnosis?

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e17589-e17589
Author(s):  
Saadvik Raghuram ◽  
Bharadwaj Ponnada ◽  
Pavithran Keechilat
Keyword(s):  
Thyroid Cancer ◽  
Cancer Patients ◽  
Clinical Symptoms ◽  
P Value ◽  
Newly Diagnosed ◽  
Main Mode ◽  
Screening Programs ◽  
Cancer Registry Data ◽  
Initial Surgery ◽  
Mode Of Detection

e17589 Background: There has been an increase in the incidence of thyroid cancer in India and in high income countries. One of the reasons for this has been attributed to the large number of screening programs. Kerala state ranks second highest in the incidence of thyroid cancer in India. Screening provides the advantage of early detection of cancer and successful treatment but also tends to over diagnose. Methods: To study the trend of incidence of primary thyroid cancer among newly diagnosed cancer patients and its association with the mode of detection, we retrospectively reviewed hospital based cancer registry data of patients with thyroid cancer who were treated at AIMS (Amrita Institute of Medical Sciences), Kochi between 2004-2014. All patients who were newly diagnosed with primary thyroid cancer at our center or referred to us after initial surgery were included in this analysis. Patients with recurrent cancer/metastases were excluded. Results: We analyzed the records of 2,315 newly diagnosed thyroid cancer patients. Median age was 44.1yrs (range 13-90yrs). There were 619 males and 1696 females. Papillary type was the most common 85.8% followed by follicular type 7.4%. 1235 cases were operated at AIMS. 74 cases (3.2%) were diagnosed incidentally by Ultrasonography/PET scan/CT scan. All others (97% n = 2,245) presented with neck swelling. It was seen that the proportion of new cases of thyroid cancer among all new cancer cases was increasing serially from 4.6 % (n = 106, 95% 2004) to 7.4% (n = 195) to13.7% (n = 317, 2014). There was a significant increase in the number of cases of T1a and T1b at the time of diagnosis during the study period (n = 1235, p value < 0.001 and p value for trend < 0.001 respectively) which indicates that there was early diagnosis. 97% of the cases presented with thyroid related symptoms indicating that clinical presentation has still been the main mode of detection in our series. Conclusions: Our data shows that there may be a true increase in the number of cases of thyroid cancer as majority presented with clinical symptoms, except few detected incidentally. As it is a single institution based data we need further studies to see if over use of USG based imaging for any thyroid swelling is responsible for an apparent increase in the number of thyroid cancer cases.

Comorbidity in newly diagnosed thyroid cancer patients: a population-based study on prevalence and the impact on treatment and survival

2006 ◽  
Vol 64 (4) ◽  
pp. 450-455 ◽  
Author(s):  
Johannes L. P. Kuijpens ◽  
Maryska L. G. Janssen-Heijnen ◽  
Valery E. P. P. Lemmens ◽  
Harm R. Haak ◽  
A. Caroline Heijckmann ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Cancer Patients ◽  
Population Based ◽  
Newly Diagnosed ◽  
Population Based Study ◽  
Impact On Treatment ◽  
The Impact

scholarly journals Overdiagnosis of Juvenile Thyroid Cancer

2019 ◽  
Vol 9 (3) ◽  
pp. 124-131 ◽  
Author(s):  
Toru Takano
Keyword(s):  
Thyroid Cancer ◽  
Clinical Symptoms ◽  
Conflicts Of Interest ◽  
Steady Increase ◽  
Thyroid Ultrasound ◽  
Screening Programs ◽  
Incomplete Knowledge ◽  
Thyroid Screening ◽  
Future Harm ◽  
Cancer In Children

Overdiagnosis is the detection of a disease that does not do any harm to the patient throughout the lifetime. Thyroid cancer in children is a rare disease; however, since 2011, many children in Fukushima, Japan, have been diagnosed with it, and the number has shown a steady increase to over 200 cases at present. Some experts have stated that this phenomenon is due to overdiagnosis caused by thyroid ultrasound (US)-based thyroid screening detecting self-limiting thyroid cancer, which will not lead to clinical symptoms in the future. Harm caused by overdiagnosis of thyroid cancer is more serious in the young, since it is difficult to perform active surveillance and children diagnosed with cancer are likely to suffer from stigma. Thus, overdiagnosis of thyroid cancer in the young is not only a health problem but also a problem of human rights. Conflicts of interest among people related to screening programs and some experts with incomplete knowledge on overdiagnosis help to spread misleading opinions together with fear of radiation exposure among residents, which has led to their erroneous understanding of the nature of US-based thyroid screening. Scientific and honest discussions among experts to enhance education of residents and consideration of medical ethics are crucial to prevent the expansion of overdiagnosis.

scholarly journals Assessing the relationship between institutional cancer and diabetes mortality rates using National Death Index data

2020 ◽  
Vol 6 (10) ◽  
pp. FSO633
Author(s):  
Nina J Karlin ◽  
Matthew R Buras ◽  
Heidi E Kosiorek ◽  
Kyle E Coppola ◽  
Patricia M Verona ◽  
...  
Keyword(s):  
Glycemic Control ◽  
Cancer Patients ◽  
Matched Pairs ◽  
Newly Diagnosed ◽  
National Death Index ◽  
Vital Status ◽  
Diabetes Mortality ◽  
Cancer Registry Data ◽  
Pancreatic Cancers ◽  
The Relationship

Aim: To evaluate overall survival (OS), glycemic control in cancer patients with and without diabetes mellitus (DM). Patients & methods: Patients (2010–2015) with newly diagnosed prostate, breast, lung, colorectal and pancreatic cancers were identified in institutional cancer registry. Data linked to National Death Index for vital status. 5-year OS estimated; glucose and hemoglobin A1c assessed during year postdiagnosis. Results: We identified 1404 patients (non-DM, n = 936; DM, n = 468). DM cohort had 168 deaths (36%); non-DM, 267 (29%). 5-year OS estimated at 58% (95% CI: 53–64%) for DM and 67% (95% CI: 64–71%) for controls; for matched pairs, hazard ratio: 1.35 (95% CI: 1.02–1.79). Cancer did not harm glycemic control. Conclusion: OS among cancer patients with DM was lower than without DM.

scholarly journals Impact of routine screening on detection, severity and outcome of pulmonary arterial hypertension in systemic sclerosis

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
H Fayed ◽  
B E Schreiber ◽  
C P Denton ◽  
J G Coghlan ◽  
Keyword(s):  
Pulmonary Hypertension ◽  
P Value ◽  
Newly Diagnosed ◽  
Referral Centre ◽  
Screening Programs ◽  
Pulmonary Arterial ◽  
The Impact ◽  
Current Screening ◽  
Risk Categories ◽  
Group 1

Abstract Introduction It has been reported that up to 20% of systemic sclerosis (SSc) patients can be asymptomatic at the time of pulmonary arterial hypertension (PAH) diagnosis. The significant prevalence rate, lack of symptoms and high morbidity and mortality from SSc-PAH as well as the potential benefit from early intervention with the more widely available therapeutic options provide a strong rationale for active screening programs. The DETECT algorithm was developed in 2013 from a large prospective and multicentre study in SSc patients with higher risk of PAH. The objective of this study was to examine the impact of a screening program on the early detection of SSc-PAH. We looked at serial patients diagnosed with SSc associated PAH (SSC-PAH) in a large national pulmonary hypertension referral centre. Patients and methods All newly diagnosed adult patients with SSc-PAH prospectively enrolled in a large national pulmonary hypertension referral centre. The current study included newly diagnosed patients between January 2006 and January 2018. Results Three-hundred and five patients were diagnosed with SSc-PAH in our centre between 2006 and 2018. Of these, 164 patients were diagnosed before 2013 (January 2006 - December 2012) and 141 after 2013 (January 2013 - January 2018). Demographics were similar at presentation between the two groups. The non-invasive (WHO-FC, 6-MWD and NT-proBNP) and haemodynamic measurements (RAP, CI and SvO2) were used to calculate the ESC guidelines risk score. It was noted that higher proportion of patients in the post-2013 were in the higher risk categories than the pre 213 group (84.4% vs. 78%) but this was not found to be statistically significant (p value 0.356). There was no statistically significant difference in survival between the two groups (Post 2013 group, 1-, 3- year and 5-year survival was 87.9%, 60.4% and 52.1%, respectively and pre-2013 group 1-, 3- year and 5-year survival 89.6%, 65.2% and 49%, respectively) with a log rank p value of 0.869. Applying Cox regression analysis of proportional hazard and adjusting for ESC risk score at baseline, predicted survival was not found to be statistically different between the two groups. The ESC risk category at baseline was a highly significant predictor of survival as expected. Conclusion There remains a strong rationale for active screening for PAH in SSc patients which has a poor prognosis despite advances in therapeutic strategies. However, the current screening programme does not seem to have resulted in significantly earlier detection in this cohort. It would be important to analyse other patient populations in order to understand the impact of screening programmes. The current screening programs limitations may explain why we have not been able to detect more patients in the lower risk categories. Further development of these programs in order to overcome their shortfalls is direly needed. FUNDunding Acknowledgement Type of funding sources: Public Institution(s). Main funding source(s): National Health ServiceRoyal Free NHS Trust Survival analysis

Assessment of the impact of the Hospital Anxiety and Depression Scale on the initiation of treatment in newly diagnosed cancer patients in a safety-net hospital.

2017 ◽  
Vol 35 (31_suppl) ◽  
pp. 250-250
Author(s):  
Daulath Singh ◽  
Annapoorna Singh ◽  
Punita Grover ◽  
Mahathi Indaram ◽  
Nikki Malomo ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Poisson Regression ◽  
Treatment Initiation ◽  
Depression Scale ◽  
Anxiety And Depression ◽  
P Value ◽  
Newly Diagnosed ◽  
Hospital Anxiety ◽  
Poisson Regression Analysis ◽  
The Impact

250 Background: Distress is a universal symptom in oncologic patients which negatively impact the quality of life and survival. It interferes with the ability to cope with the diagnosis and is a risk factor for non-adherence with treatment. The Hospital Anxiety and Depression Scale (HADS), is used at our institution for distress screening. The aim of our study is to assess the impact of distress, measured by the HADS score, on initiation of treatment in newly diagnosed cancer patients. Methods: We conducted a retrospective chart review of patients with a new diagnosis of cancer, between March 1st, 2014 and December 31st, 2015; who had been evaluated for distress at their first oncology clinic visit. We included only patients who were treated with chemotherapy or chemoradiation, with curative intent. Poisson regression analysis was conducted to investigate the relationship between HADS to treatment initiation while including age, sex, race, insurance status, cancer type, and stage as covariates in the model. Results: A total of 101 patients met the inclusion criteria. The mean age was 54 years, 63% were female and 37% were male. The majority were Caucasians (53%), followed by African-Americans (36%). 56% of the population had Medicaid, and 26% had Medicare and private insurance. The most common cancers were – breast (30%), gastrointestinal (20%), gynecologic (15%) and lung (11%). 64% received chemotherapy and 36% were treated with chemoradiation. We grouped patients into 3 categories based on the HADS score – category 1 with score ≤7 (28%), category 2 with score 8-10 (17%) and category 3 with score ≥11 (55%). The median time to treatment initiation was 28 days. Multivariate Poisson regression analysis did not show any correlation between the HADS score and treatment initiation. Subscales analyses showed that higher depression scores correlate with a delay in treatment initiation (p-value 0.01), while the anxiety scores had no influence (p-value 0.57). Conclusions: In our study, the initial total HADS score did not affect the treatment initiation. Interestingly, depression had an influence on the initiation of treatment in newly diagnosed cancer patients.

scholarly journals Prevalence of Alpha(α)-Thalassemia in Southeast Asia (2010–2020): A Meta-Analysis Involving 83,674 Subjects

2020 ◽  
Vol 17 (20) ◽  
pp. 7354
Author(s):  
Lucky Poh Wah Goh ◽  
Eric Tzyy Jiann Chong ◽  
Ping-Chin Lee
Keyword(s):  
Southeast Asia ◽  
Publication Bias ◽  
Clinical Symptoms ◽  
Meta Analysis ◽  
Globin Gene ◽  
Random Effect ◽  
Analysis Data ◽  
P Value ◽  
Screening Programs ◽  
Blood Disorder

Alpha(α)-thalassemia is a blood disorder caused by many types of inheritable α-globin gene mutations which causes no-to-severe clinical symptoms, such as Hb Bart’s hydrops fetalis that leads to early foetal death. Therefore, the aim of this meta-analysis was to provide an update from year 2010 to 2020 on the prevalence of α-thalassemia in Southeast Asia. A systematic literature search was performed using PubMed and SCOPUS databases for related studies published from 2010 to 2020, based on specified inclusion and exclusion criteria. Heterogeneity of included studies was examined with the I2 index and Q-test. Funnel plots and Egger’s tests were performed in order to determine publication bias in this meta-analysis. Twenty-nine studies with 83,674 subjects were included and pooled prevalence rates in this meta-analysis were calculated using random effect models based on high observed heterogeneity (I2 > 99.5, p-value < 0.1). Overall, the prevalence of α-thalassemia is 22.6%. The highest α-thalassemia prevalence was observed in Vietnam (51.5%) followed by Cambodia (39.5%), Laos (26.8%), Thailand (20.1%), and Malaysia (17.3%). No publication bias was detected. Conclusions: This meta-analysis suggested that a high prevalence of α-thalassemia occurred in selected Southeast Asia countries. This meta-analysis data are useful for designing thalassemia screening programs and improve the disease management.

598: Increased Risk of Newly Diagnosed Comorbidities in Prostate Cancer Patients Treated with Androgen Deprivation Therapy

2007 ◽  
Vol 177 (4S) ◽  
pp. 200-200 ◽  
Author(s):  
Andrea Gallina ◽  
Pierre I. Karakiewicz ◽  
Jochen Walz ◽  
Claudio Jeldres ◽  
Quoc-Dien Trinh ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Cancer Patients ◽  
Androgen Deprivation Therapy ◽  
Androgen Deprivation ◽  
Newly Diagnosed ◽  
Increased Risk

289: Assessment of Indirect Costs of Newly Diagnosed Prostate Cancer Patients

2007 ◽  
Vol 177 (4S) ◽  
pp. 97-97
Author(s):  
Ravishankar Jayavedappa ◽  
Sumedha Chhatre ◽  
Richard Whittington ◽  
Alan J. Wein ◽  
S. Bruce Malkowicz
Keyword(s):  
Prostate Cancer ◽  
Cancer Patients ◽  
Indirect Costs ◽  
Newly Diagnosed

Quality Control of Data in a Large-Scale Cancer Register Program

1966 ◽  
Vol 05 (02) ◽  
pp. 67-74 ◽  
Author(s):  
W. I. Lourie ◽  
W. Haenszeland
Keyword(s):  
United States ◽  
Quality Control ◽  
Cancer Patients ◽  
Large Scale ◽  
The United States ◽  
Newly Diagnosed ◽  
Related Data ◽  
Cancer Register ◽  
Independent Review ◽  
End Results

Quality control of data collected in the United States by the Cancer End Results Program utilizing punchcards prepared by participating registries in accordance with a Uniform Punchcard Code is discussed. Existing arrangements decentralize responsibility for editing and related data processing to the local registries with centralization of tabulating and statistical services in the End Results Section, National Cancer Institute. The most recent deck of punchcards represented over 600,000 cancer patients; approximately 50,000 newly diagnosed cases are added annually.Mechanical editing and inspection of punchcards and field audits are the principal tools for quality control. Mechanical editing of the punchcards includes testing for blank entries and detection of in-admissable or inconsistent codes. Highly improbable codes are subjected to special scrutiny. Field audits include the drawing of a 1-10 percent random sample of punchcards submitted by a registry; the charts are .then reabstracted and recoded by a NCI staff member and differences between the punchcard and the results of independent review are noted.

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