O. Picado1, A. R. Marcadis1, E. N. Kobetz2, R. R. Balise3, J. I. Lew1 1University Of Miami Leonard M. Miller School Of Medicine,Division Of Endocrine Surgery, DeWitt Daughtry Family Department Of Surgery,Miami, FL, USA 2University Of Miami Leonard M. Miller School Of Medicine,Department Of Medicine,Miami, FL, USA 3University Of Miami Leonard M. Miller School Of Medicine,Division Of Biostatistics, Department Of Public Health Sciences,Miami, FL, USA
Introduction: Recent trends suggest increasing incidence of thyroid cancer among all racial/ethnic groups in the United States. Hispanics are the largest racial/ethnic group in the country, representing 17% of the population. South Florida has an exceptionally high concentration (41%) of Hispanics composed primarily of Cubans, South and Central Americans. This study examines the differences in thyroid cancer rates and disease burden of Hispanics in South Florida.
Methods: A retrospective review of 1012 patients who underwent thyroidectomy from 2010 to 2016 at a single academic institution was performed. Demographics including age, sex, race/ethnicity, and country of origin were reviewed. Racial/ethnic groups were defined as white (non-Hispanic), black (non-Hispanic) and Hispanic. All patients underwent pre-operative thyroid ultrasound and fine needle aspiration (FNA). Pathologic characteristics of thyroid cancer including histology, tumor size, multifocality, extrathyroidal and lymphovascular invasion were reviewed. Descriptive statistics and subgroup analysis were performed among Hispanic patients in relation to country of origin.
Results: Of 529 patients with thyroid cancer, 63% were Hispanic (n=335), 28% white (n=147) and 9% black (n=47). Hispanic patients were more likely to be foreign-born compared to white and black patients (61% vs 28% vs 31%, p<0.01). Hispanics with thyroid cancer were younger than their white and black counterparts (respectively, 45 vs 47 vs 51 years, p<0.001), had smaller nodules (2.1 vs 2.1 vs 2.8 cm, p<0.01), and more worrisome ultrasound features including irregular borders (41% vs 36% vs 19%, p<0.05) and microcalcifications (45% vs 46% vs 19%, p<0.05). FNA results were more commonly malignant in Hispanic and white patients compared to black patients where FNA results were mostly benign (p<0.01). While papillary thyroid carcinoma (PTC) was the most common thyroid cancer in all groups, foreign-born Hispanics had more diffuse (7% vs 4%) and tall cell (9% vs 3%) variants of PTC compared to native born Hispanics. There was also a higher proportion of follicular thyroid cancer (5% vs 2%) among foreign-born Hispanics. Stratified analysis of foreign-born Hispanics by region showed lower rates of PTC among Cubans (88%) and South Americans (86%) with higher rates of follicular carcinoma and medullary thyroid cancer, respectively.
Conclusion: South Florida encompasses a diverse patient population as demonstrated by a varied presentation of thyroid cancer among different racial/ethnic groups including Hispanics. Differing thyroid cancer incidence, clinical presentation and tumor histopathology among Hispanic patients may be associated with environmental or behavioral factors, especially among those that are foreign-born. Clinicians should be prepared and culturally competent to provide care to this fastest growing racial/ethnic group in the United States.