Volume 89, April 2024, 102539Author links open overlay panel, , , AbstractBackground

A previous study found higher papillary thyroid cancer incidence in the US military than the general population with larger differences among Black than White individuals. This study compared the two populations in the incidence by sex, race, tumor stage, and size to assess possible factors related to identified differences.

Methods

Subjects were aged 18–59 in the military and general populations. Papillary thyroid cancer patients diagnosed during 1990–2013 were identified from the Department of Defense’s Automated Central Tumor Registry (ACTUR) and the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) program. Age-adjusted rates and incidence rate ratios (IRR) comparing ACTUR to SEER were calculated.

Results

Higher incidence rates in ACTUR than SEER were more obvious for Black (IRR=2.07, 95%CI=1.56–2.70) than White men (IRR=1.17, 95%CI=1.07–1.26) and for Black (IRR=2.30, 95%CI=1.91–2.71) than White women (IRR=1.50, 95%CI=1.38–1.64). Population differences by race were observed for localized tumors among both men and women and were larger for Black individuals. Differences were observed regardless of tumor size among Black men and White women, and in smaller tumors among Black women.

Conclusion

Higher incidence in the military than general population primarily in localized tumors suggests universal healthcare in the military may lead to earlier detection. The differences were larger among Blacks than Whites, suggesting universal access in the military may be more impactful among Black persons, who are less likely to have timely care than White persons in the general population. Nevertheless, observed differences for tumors > 2 cm suggest other factors may also play a role.

Section snippetsBackground

Thyroid cancer incidence has increased by almost 300% since 1975, accompanied by a much smaller increase in mortality [1]. An estimated 43,720 thyroid cancer patients will be diagnosed in 2023 with over 70% of them among women [2]. Incidence is also higher among White women than Black women [3], [4], [5], [6]. This is in contrast to many other cancers that often have higher incidence and mortality rates among Black persons compared with their White counterparts [7].

Incidence rates are

Data sources and study populations

Data for active military servicemembers were obtained from the Department of Defense’s (DoD) Automated Central Tumor Registry (ACTUR). ACTUR, which began in 1986, collected demographic, tumor, treatment, and outcome variables for cancers among Department of Defense beneficiaries treated or diagnosed in the Military Health System (MHS). This study included active-duty Black and White servicemembers in the Army, Navy, Marine Corps, and Air Force aged 18 to 59 years, who were pathologically

Results

In this study, White persons comprised 82% of men and 66% of women in the active-duty military population examined and 87% of men and 85% of women in the SEER population. There were 770 and 94 cases of papillary thyroid cancer among White and Black men in ACTUR, respectively. Among White and Black women in ACTUR, there were 561 and 165 papillary thyroid cancer cases, respectively. The corresponding numbers for White and Black men in SEER were 7102 and 347 respectively and for White and Black

Discussion

This study found higher age-adjusted incidence rates of papillary thyroid cancer in the active-duty military than in the general population. These differences were more obvious for Black men and women than White men and women. Further analysis by tumor stage revealed that the difference between the two populations by race were observed for localized tumors among both men and women, with larger differences in Black individuals. The analysis by tumor size showed that the difference between the

CRediT authorship contribution statement

Bytnar Julie A: Conceptualization, Formal analysis, Investigation, Methodology, Visualization, Writing – original draft, Writing – review & editing. Zhu Kangmin: Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Supervision, Writing – review & editing. Shriver Craig D: Conceptualization, Funding acquisition, Investigation, Methodology, Writing – review & editing. Enewold Lindsey: Conceptualization, Investigation, Methodology, Writing – review & editing.

Declaration of Competing Interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Acknowledgments

This project was supported by the John P. Murtha Cancer Research Program, Department of Surgery, Uniformed Services University of the Health Sciences under the auspices of the Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc. The authors thank the Joint Pathology Center for providing the ACTUR data.

Financial support

This project was supported by the Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences under the auspices of the

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