Global Thyroid Cancer Trends, 1990–2021 (GBD 2021)

Thyroid cancer is among the most common endocrine malignancies. The authors used the Global Burden of Disease (GBD) 2021 dataset to deliver an updated picture of thyroid cancer worldwide—tracking prevalence, incidence, deaths, and disability-adjusted life years (DALYs) across 204 countries from 1990 to 2021, with projections to 2040. Analyses were stratified by sex, age, world region, and Socio-demographic Index (SDI) quintiles; trends were summarized with estimated annual percentage change and Joinpoint methods, and future rates were modeled with a Bayesian age-period-cohort approach.

Background: what to know about thyroid cancer

Thyroid cancer incidence has been rising globally and ranked tenth among cancers in 2020, with higher prevalence in women. The most common types are papillary carcinoma (≈84%), follicular carcinoma (≈4%, more common in iodine-deficient settings), and anaplastic carcinoma (highly aggressive). Many well-differentiated tumors are asymptomatic and found incidentally during routine exams or imaging, though hoarseness, difficulty swallowing, and shortness of breath can occur. Geographic differences are pronounced: Asia accounts for over half of cases; the United States recorded an average 2000–2019 incidence of ~13.22 per 100,000; and Eastern Europe shows higher incidence and mortality than Western Europe. The study aims to provide a comprehensive update using the newest GBD data.

What the study did

• Data: GBD 2021 estimates for prevalence, incidence, deaths, and DALYs, plus SDI and population data for 21 regions and 204 countries.

• Methods: EAPC and Joinpoint analyses summarized trends; a Bayesian age-period-cohort model projected burden to 2040; high body-mass index (BMI) was assessed as a risk factor using population-attributable fractions.

Key messages (results in plain language)

1) Cases and rates: up for incidence and prevalence; mortality/DALYs: down slightly

In 2021 there were ~1.99 million people living with thyroid cancer globally—a 193.7% increase since 1990. Age-standardized prevalence rose from 14.9 to 23.1 per 100,000 (EAPC 1.58). New cases reached ~249,538 (↑177.6%); age-standardized incidence climbed from 2.1 to 2.9 per 100,000 (EAPC 1.25). Deaths totaled ~44,799 in 2021; the age-standardized death rate declined slightly (EAPC −0.24). DALYs reached ~1.25 million in 2021, with an age-standardized DALY rate of 14.6 and a modest negative trend (EAPC −0.14).

2) The SDI picture: divergence across development levels

High-SDI regions had the highest prevalence and incidence in 2021, but their growth slowed and both indicators declined sharply after 2009. In contrast, low and low-middle SDI regions showed marked increases in prevalence, incidence, deaths, and DALYs.

3) Regional standouts and country shifts

Central Europe was the only region with a decline in prevalence since 1990. Highest 2021 prevalence appeared in High-income North America and Australasia; highest incidence in High-income North America, Australasia, and High-income Asia Pacific. Incidence growth was fastest in North Africa and the Middle East, Australasia, and Andean Latin America. Countries with >300% prevalence increases included Cape Verde, Saudi Arabia, Qatar, the United Arab Emirates, Equatorial Guinea, Iran, Ecuador, and Belize, while Poland, Croatia, and Hungary saw notable incidence declines. Mortality rose most in Cape Verde, Qatar, Iran, Ecuador, and the UAE and fell most in Hungary and Poland.

4) Sex and age patterns

Women carry a higher burden: in 2021, prevalence was 31.33 per 100,000 in women vs 14.79 in men; incidence, 3.83 vs 1.98 per 100,000. The burden increases through mid-life, with prevalence peaking at ages 55–59 and incidence peaking later (70–79), followed by decline. The sharpest incidence rise occurred during 2003–2009, then stabilized.

5) Risk factor signal

High BMI emerged as a major modeled risk contributor to deaths and DALYs. The highest death burden attributable to high BMI was observed in North Africa and the Middle East (17.4%); the largest DALY impact appeared in High-income North America (17.4%). Across SDI strata, deaths and DALYs attributable to high BMI were higher in high and high-middle SDI regions.

6) What’s ahead: projections to 2040

The authors project further increases in global age-standardized prevalence (to about 26.12 per 100,000 in 2040; wide uncertainty) and incidence (to 3.34 per 100,000), while age-standardized DALYs may continue a gradual decline. Women are projected to maintain higher rates than men.

How to interpret the trends

The study notes that improving diagnostic technology and broad uptake of health check-ups likely raised detection, helping explain rising prevalence and incidence alongside falling mortality and DALYs. Overdiagnosis and overtreatment are recognized concerns; international guidance has moved to avoid screening in asymptomatic people. High-SDI regions—with early diagnostic capacity and more resources—show slowing or declining rates after 2009, while other regions still face rising burden, including mortality and DALYs.

Practical implications for the field

For health systems and researchers, the results point to several immediate priorities the authors emphasize:

• Balance detection with harm reduction. The data support careful use of screening to prevent overtreatment while sustaining early diagnosis where it improves outcomes.

• Target prevention where it matters. The high-BMI signal suggests opportunities for population-level prevention strategies aligned with broader noncommunicable-disease efforts, especially in higher-SDI settings where attributable burden is largest.

• Address inequities. The authors highlight the need for stronger health systems and reduced socioeconomic polarization to narrow regional gaps. As they write, “Improving health systems, reducing socioeconomic polarization, and strengthening early screening and prevention are all critical measures.”

• Communicate clearly. “Equally important are raising public awareness of the disease and avoiding overtreatment.”

What’s new here

• An up-to-date, GBD 2021–based global, regional, and national mapping of thyroid cancer burden through 2021, with standardized trend metrics and projections to 2040.

• Identification of 2009 as a turning point for high-SDI regions, where prevalence and incidence began to decline after prior increases.

• A sex- and age-resolved profile, showing higher burden in women and late-life incidence peaks, useful for study design and service planning.

• A risk-attribution lens focusing on high BMI, enabling region-specific prevention discussions using GBD methods and TMREL-based PAFs.

Limitations to keep in view

The authors note variability in data quality and availability across sources and acknowledge uncertainty from modeling assumptions. Their estimates represent the best synthesis of current evidence.

One-sentence takeaway

As the authors conclude, “The burden of TC remains significant and is steadily increasing,” with wide regional differences—calling for better systems, calibrated screening, prevention that includes weight management, and communication that avoids overtreatment.

The translation of the preceding English text in Chinese:

甲状腺癌是最常见的内分泌恶性肿瘤之一。作者使用《全球疾病负担》（GBD）2021 数据集，提供了全球甲状腺癌的最新概况——追踪 1990–2021 年间 204 个国家的患病人数、发病数、死亡数和伤残调整寿命年（DALY），并预测至 2040 年。分析按性别、年龄、世界区域和社会人口学指数（SDI）五分位分层；趋势采用估计年均百分比变化（EAPC）与 Joinpoint 折点回归方法总结，未来率以贝叶斯年龄–时期–队列（APC）模型进行预测。

背景：关于甲状腺癌需要了解的要点

甲状腺癌发病率在全球范围持续上升，2020 年位列所有癌症的第十位，女性患病率更高。最常见的类型为乳头状癌（约 84%）、滤泡状癌（约 4%，在碘缺乏地区更常见）和未分化癌（高度侵袭）。许多高分化肿瘤无症状，常在常规体检或影像学检查中偶然发现，但也可出现声音嘶哑、吞咽困难和呼吸困难。地域差异显著：亚洲占病例总数的一半以上；美国在 2000–2019 年的平均发病率约为每 10 万人 13.22 例；东欧的发病率和死亡率均高于西欧。本研究旨在利用最新的 GBD 数据给出全面更新。

研究做了什么

数据：GBD 2021 关于患病、发病、死亡和 DALY 的估计，以及 21 个区域、204 个国家的 SDI 与人口数据。

方法：用 EAPC 和 Joinpoint 分析总结趋势；用贝叶斯 APC 模型预测至 2040 年的疾病负担；并以人群归因分值（PAF）评估高体重指数（BMI）作为危险因素的贡献。

关键信息（通俗表述）

1）病例与率：发病与患病上升；死亡与 DALY 略降

2021 年全球约有 199 万人带病生存（较 1990 年 ↑193.7%）。年龄标化患病率由每 10 万人 14.9 例升至 23.1 例（EAPC 1.58）。新发病例约 249,538 例（↑177.6%）；年龄标化发病率由每 10 万人 2.1 例升至 2.9 例（EAPC 1.25）。2021 年死亡约 44,799 例；年龄标化死亡率略有下降（EAPC −0.24）。2021 年 DALY 约 125 万；年龄标化 DALY 率为 14.6（每 10 万人），总体呈温和下降趋势（EAPC −0.14）。

2）SDI 视角：不同发展水平出现分化

高 SDI 地区在 2021 年具有最高的患病率和发病率，但增速放缓，且两项指标在 2009 年后明显下降。相反，低和中低 SDI 地区的患病、发病、死亡和 DALY 均显著上升。

3）区域亮点与国家层面的变化

自 1990 年以来，仅中欧地区的患病率出现下降。2021 年患病率最高的是高收入北美和澳大拉西亚；发病率最高的是高收入北美、澳大拉西亚和高收入亚太。发病增长最快的区域是北非与中东、澳大拉西亚以及安第斯拉丁美洲。患病率增幅超过 300% 的国家包括：佛得角、沙特阿拉伯、卡塔尔、阿拉伯联合酋长国、赤道几内亚、伊朗、厄瓜多尔和伯利兹；而波兰、克罗地亚和匈牙利的发病率则出现显著下降。死亡率上升最明显的是佛得角、卡塔尔、伊朗、厄瓜多尔和阿联酋，下降最明显的是匈牙利和波兰。

4）性别与年龄模式

女性负担更高：2021 年女性的患病率为每 10 万人 31.33 例，男性为 14.79 例；发病率女性为 3.83、男性为 1.98（每 10 万人）。负担在中年之前逐步增加，患病率在 55–59 岁达到峰值，发病率在更晚（70–79 岁）达到峰值，随后下降。发病率增长最陡的阶段为 2003–2009 年，此后趋于稳定。

5）危险因素信号

高 BMI 是死亡和 DALY 的主要模型化风险贡献者。归因于高 BMI 的死亡负担最高见于北非与中东（17.4%）；归因 DALY 影响最大见于高收入北美（17.4%）。在各 SDI 阶层中，高和中高 SDI 地区的高 BMI 归因死亡与 DALY 更高。

6）展望：至 2040 年的预测

模型预测全球年龄标化患病率将进一步上升（至约每 10 万人 26.12 例，区间不确定性较大），年龄标化发病率升至每 10 万人 3.34 例；而年龄标化 DALY 可能继续缓慢下降。女性的各项率预计仍高于男性。

如何解读这些趋势

研究指出，诊断技术的改进与健康体检的广泛开展可能提高了检出率，从而出现“患病/发病上升而死亡/DALY 下降”的组合。过度诊断与过度治疗是公认问题；国际指南已转向不对无症状人群进行筛查。具备更早期诊断能力与更丰富资源的高 SDI 地区在 2009 年后出现增速放缓甚至下降；而其他地区仍面临负担上升，包括死亡和 DALY 的增加。

对临床与公共卫生的启示

— 在发现与减害之间取得平衡。证据支持谨慎使用筛查，避免过度治疗，同时在确有获益处保持早诊早治。
— 把预防聚焦于关键环节。高 BMI 的信号提示可与更广泛的慢病防控对齐，尤其在高 SDI 地区，归因负担更大。
— 解决不平等。需要更强的卫生系统并减少社会经济两极化，以缩小区域差距。正如作者所言：“改善卫生系统、减少社会经济两极化、强化早期筛查与预防，都是关键举措。”
— 加强沟通。 “同样重要的是提升公众对疾病的认知并避免过度治疗。”

本研究的新意

— 基于 GBD 2021 的全球、区域和国家层面的甲状腺癌负担最新地图，覆盖至 2021 年，并提供标准化的趋势指标与至 2040 年的预测。
— 识别出 2009 年是高 SDI 地区的拐点：在此前上升后，患病率与发病率开始下降。
— 给出按性别与年龄分层的画像：女性负担更高、老年段发病峰值更晚，可用于研究设计与服务规划。
— 引入以高 BMI 为重点的风险归因视角，基于 GBD 方法与 TMREL（理论最小风险暴露水平）计算的 PAF，支持因地制宜的预防讨论。

需要注意的局限

作者指出，不同来源数据的质量与可得性存在差异，且模型假设带来不确定性。这些估计代表了对现有证据的最佳综合。

一句话结论

正如作者总结的那样：“甲状腺癌（TC）的负担仍然显著并在稳步上升”，且地区差异很大——这呼吁建立更完善的卫生体系、实施校准的筛查、将体重管理纳入预防，并通过沟通避免过度治疗。

Reference:

Ming Tang, Jiarui Li, Mingxiu Sun, Xin Song, Kaize Zheng, Xiaoting Luo, Zhirui Xue, Likun Du