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Lack of an impact of education and income on the increase of thyroid cancer in Denmark

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Until recently, thyroid cancer was the fastest rising cancer in the United States. The reasons behind this increase is considered to be largely due to increased detection. Thyroid cancer is also the most common endocrine cancer. Overall the prognosis is excellent and, in the vast majority of patients, the concern is thyroid cancer recurrence rather than death from thyroid cancer. This because thyroid cancer is usually very slow growing and because we have excellent treatment options. There are different types of thyroid cancer based on how abnormal the cancer cells look under a microscope. The most frequent types are papillary thyroid cancer and follicular thyroid cancer.

Thyroid cancer also has been increasing in other parts of the world. Indeed, the occurrence of new cases of thyroid cancer in Denmark has increased considerably from 1980 to 2014. The goal of the study was specifically to evaluate how the level of education and income of adults in Denmark was associated with the increase in thyroid cancer.

Sørensen SM et al 2022 Temporal trends in papillary and follicular thyroid cancer incidence from 1995 to 2019 in adults in Denmark according to education and income. Thyroid. Epub 2022 Apr 22. PMID: 35459415.

Danish nationwide health registries hold validated and accurate information on cancer diagnoses, medical history, and socioeconomic variables, with virtually complete coverage of the population. The Danish Cancer Registry contains information on nearly all primary cancers diagnosed in Denmark since 1987. Information includes date of birth, sex, age at diagnosis, and cancer characteristics. Using these registries, all adult Danish citizens during a period of 25 years (from 1995-2004 and 2005-2019) with a diagnosis of papillary thyroid cancer and follicular thyroid cancer were studied.

A total of 3,454 cases of papillary thyroid cancer and 972 cases of follicular thyroid cancer were identified and placed in categories according to age, gender, size of the cancer, education and income. The study found that there was a similar increase in papillary thyroid cancer and follicular thyroid cancer among both men and women through all levels of education and income. There was no difference observed between small and large papillary thyroid cancers regarding socioeconomic status in either gender. These results may suggest a true increase in the incidence of papillary thyroid cancer and follicular thyroid cancer.

This study done in Denmark demonstrated an increased detection of papillary thyroid cancer and follicular thyroid cancer among all levels of education and income, but there were no significant relationships. This study is important as we are increasingly challenged with variability in health care coverage from insurance companies, in addition to the lack of access and support for health care services for many underserved groups of our population in the United States. Although these findings in Denmark may not be representative of other parts of the world (especially because of the universal health care system that is in place in that country), it does suggest to us that the increase in of papillary thyroid cancer and follicular thyroid cancer may be a result of many variables different than level of education and income.

— Juan Vasquez Mendez, MD
Maria del Pilar Brito, MD


Papillary thyroid cancer: the most common type of thyroid cancer. There are 4 variants of papillary thyroid cancer: classic, follicular, tall-cell and noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP).

Follicular thyroid cancer: is a tumor of the follicular cells that are lined by cuboidal epithelial cells and have capsular and vascular invasive properties.

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