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      International patterns and trends in thyroid cancer incidence, 1973–2002

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          Abstract

          During the past several decades, an increasing incidence of thyroid cancer has been reported in many parts of the world. To date, no study has compared the trends in thyroid cancer incidence across continents. We examined incidence data from cancer incidence in five continents (CI5) over the 30-year period 1973-2002 from 19 populations in the Americas, Asia, Europe, and Oceania. Thyroid cancer rates have increased from 1973-1977 to 1998-2002 for most of the populations except Sweden, in which the incidence rates decreased about 18% for both males and females. The average increase was 48.0% among males and 66.7% among females. More recently, the age-adjusted international thyroid cancer incidence rates from 1998 to 2002 varied 5-fold for males and nearly 10-fold for females by geographic region. Considerable variation in thyroid cancer incidence was present for every continent but Africa, in which the incidence rates were generally low. Our analysis of published CI5 data suggests that thyroid cancer rates increased between 1973 and 2002 in most populations worldwide, and that the increase does not appear to be restricted to a particular region of the world or by the underlying rates of thyroid cancer.

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          Increasing incidence of thyroid cancer in the United States, 1973-2002.

          Increasing cancer incidence is typically interpreted as an increase in the true occurrence of disease but may also reflect changing pathological criteria or increased diagnostic scrutiny. Changes in the diagnostic approach to thyroid nodules may have resulted in an increase in the apparent incidence of thyroid cancer. To examine trends in thyroid cancer incidence, histology, size distribution, and mortality in the United States. Retrospective cohort evaluation of patients with thyroid cancer, 1973-2002, using the Surveillance, Epidemiology, and End Results (SEER) program and data on thyroid cancer mortality from the National Vital Statistics System. Thyroid cancer incidence, histology, size distribution, and mortality. The incidence of thyroid cancer increased from 3.6 per 100,000 in 1973 to 8.7 per 100,000 in 2002-a 2.4-fold increase (95% confidence interval [CI], 2.2-2.6; P .20 for trend). Virtually the entire increase is attributable to an increase in incidence of papillary thyroid cancer, which increased from 2.7 to 7.7 per 100,000-a 2.9-fold increase (95% CI, 2.6-3.2; P<.001 for trend). Between 1988 (the first year SEER collected data on tumor size) and 2002, 49% (95% CI, 47%-51%) of the increase consisted of cancers measuring 1 cm or smaller; 87% (95% CI, 85%-89%) consisted of cancers measuring 2 cm or smaller. Mortality from thyroid cancer was stable between 1973 and 2002 (approximately 0.5 deaths per 100,000). The increasing incidence of thyroid cancer in the United States is predominantly due to the increased detection of small papillary cancers. These trends, combined with the known existence of a substantial reservoir of subclinical cancer and stable overall mortality, suggest that increasing incidence reflects increased detection of subclinical disease, not an increase in the true occurrence of thyroid cancer.
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            Polybrominated diphenyl ether flame retardants in the U.S. population: current levels, temporal trends, and comparison with dioxins, dibenzofurans, and polychlorinated biphenyls.

            Brominated flame retardants have come into common use in the United States during the past 3 decades. This study reports levels of polybrominated diphenyl ether (PBDE) flame retardants in blood from the U.S. population at the present time and 30 years previously and also current human milk levels. This is also the first study to report measured congeners and dioxin toxic equivalents (TEQs) of dioxins, dibenzofurans, and dioxin-like polychlorinated biphenyls (PCBs) from archived, 1973, blood and compare them with current levels. The findings indicate there have been significant changes in levels of each class of these persistent organic pollutants (POPs) in U.S. human blood. Although dioxin, dibenzofuran, and PCB levels are markedly higher in the 1973 blood, the opposite is true for PBDEs. Furthermore, unlike dioxins, dibenzofurans, and PCBs, which increase with age, there was no significant correlation found in our study between PBDE levels and age. Current total PBDE levels in U.S. blood are the highest reported worldwide to date, with 2 pooled samples (N = 100 each) measuring 61.7 and 79.7 parts per billion (ppb) lipid, and in a series of 39 individual analyses, the range was 4.6 to 365.5 ppb with a median of 29 ppb and a mean of 52.6 ppb. The median for women in this study was 43.3 ppb, and for men it was 25.1 ppb. Although women have a higher level of PBDEs in blood than men, in our study, this is not statistically significant. Blood levels are similar to levels in U.S. human milk from 59 women, 6.2 to 418.8 ppb lipid. Levels of PBDE in pooled 2003 serum are far higher at 61.7 ppb than in 1973 archived pooled serum in which almost no PBDEs were quantified, although the estimated level using half the detection limit for nondetects was 0.77 ppb. Although no human health studies have been conducted on PBDEs, they are of concern because in vivo and in vitro animal studies show nervous system, reproductive, developmental, and endocrine effects, as well as cancer in high-dose studies.
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              Human prenatal and postnatal exposure to polybrominated diphenyl ethers, polychlorinated biphenyls, polychlorobiphenylols, and pentachlorophenol.

              The aim of this study was to determine human prenatal and postnatal exposures to polybrominated diphenyl ethers (PBDEs), polychlorinated biphenyls (PCBs), hydroxylated metabolites of PCBs (polychlorobiphenylols; OH-PCBs), and pentachlorophenol (PCP). The median PBDE fresh-weight concentrations in maternal and cord blood plasma and in breast milk were 24, 4.3, and 75 pg/g, respectively. The PCB concentrations were approximately 60 times higher in each compartment (1,560, 277, and 4,310 pg/g, respectively). Calculated on a lipid weight basis, the levels were comparable in maternal blood plasma and breast milk. In contrast to PCBs, differences were found between PBDE congener distribution in maternal and cord blood plasma. The OH-PCBs constituted up to 26% of the PCB levels in maternal blood plasma and 53% in cord blood plasma, with levels of 120 and 88 pg/g fresh weight, respectively, and in breast milk 3 pg/g. The corresponding concentrations for PCP were 2,830, 1,960, and 20 pg/g. The ratios of PCB to OH-PCB were 13, 3, and 1,400 in maternal, cord plasma, and breast milk, respectively. It is evident that prenatal exposures occur for all the analytes. Moreover, the exposure continues after birth via breast milk. However, levels of OH-PCBs and PCP in breast milk are low compared with levels in blood plasma. Exposures to both PCBs and PBDEs, and in particular to the endocrine-active halogenated phenolic compounds, are of concern and implicate a potential risk for developmental disturbances.
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                Author and article information

                Journal
                Cancer Causes & Control
                Cancer Causes Control
                Springer Science and Business Media LLC
                0957-5243
                1573-7225
                July 2009
                November 19 2008
                July 2009
                : 20
                : 5
                : 525-531
                Article
                10.1007/s10552-008-9260-4
                2788231
                19016336
                0060e7e1-fccb-4e2c-898c-c7e8cee52485
                © 2009

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