Overdiagnosis and Overtreatment of Thyroid Cancer, a Single City Experience in the Kurdistan Region/Iraq.
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BACKGROUND AND AIMS: The incidence of thyroid cancer (TC) has increased globally over the last three decades. Overdiagnosis appears to be the primary factor driving an increasing number of TC diagnoses. Most documented TC cases involve small, well-differentiated lesions. This study aimed to evaluate the changing trends in TC diagnoses and mortality over the last 10 years. METHODS: This retrospective study included patients registered between January 2013 and December 2022. Data on the number of patients diagnosed over 10 years were presented, and data on the types of treatment used were analyzed. This study aimed to investigate possible overdiagnosis and the approach to treatment of TC. RESULTS: The total number of registered cases was 342; the majority of cases were females (295, 86%), and only 47 cases were males (14%), with a female-to-male ratio of 6:1. The age-standardized rate (ASR) has increased over 10 years, from 47 cases to 621 per 1,000,000 people. Between 2013 and 2022, the ASR of TC increased from 58 to 1030 cases/1,000,000 and from 30 to 212 cases among women and men, respectively. Among the 184 patients with micropapillary TC, 173 (94%) underwent total thyroidectomy, whereas only 11 (6%) underwent lobectomy. In 2022, TC became the third most common cancer in this region, following breast and colorectal cancers in females. Of the 80 new cases diagnosed in 2022, only 47% had adjuvant radioactive iodine. The mortality rate over the 10-year period from 2013 to 2022 did not increase and remained relatively stable, with minor variations between 0 and 2 cases per year. CONCLUSIONS: This study demonstrated a significant increase in TC diagnosis, especially in early-stage disease, without a corresponding increase in the mortality rate. This finding suggests that the current incidence of TC may be an example of overdiagnosis and overtreatment.