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Impact of Overweight and Obesity on US Papillary Thyroid Cancer Incidence Trends (1995–2015)
Open accessAbstract
Background: Since the early 1980s, papillary thyroid cancer (PTC) incidence rates and the prevalence of obesity, a risk factor for PTC, have increased substantially in the United States. We estimated the proportion of PTC incidence in the United States attributable to overweight and obesity during 1995–2015. Methods: National Institutes of Health-AARP Diet and Health Study cohort data (n = 457 331 participants, 50–71 years and cancer-free at baseline) were used to estimate multivariable-adjusted hazard ratios (HRs) for PTC across body mass index categories. Population attributable fractions (PAFs) were calculated using estimated hazard ratios and annual overweight and obesity prevalence estimates from the National Health Interview Survey. PAF estimates were combined with Surveillance, Epidemiology, and End Results-13 data to calculate annual percent changes in PTC incidence rates attributable (and unrelated) to overweight and obesity. Results: Overweight (25.0–29.0 kg/m2) and obesity (≥30.0 kg/m2) were associated with 1.26-fold (95% confidence interval [CI] = 1.05- to 1.52-fold) and 1.30-fold (95% CI = 1.05- to 1.62-fold) increased risks of PTC, respectively, and nearly threefold (HR = 2.93, 95% CI = 1.25 to 6.87) and greater than fivefold (HR = 5.42, 95% CI = 2.24 to 13.1) increased risks of large (>4 cm) PTCs compared with normal weight (18.5–24.9 kg/m2). During 1995–2015, PAF estimates for overweight and obesity increased from 11.4% to 16.2% for all PTCs and from 51.4% to 63.2% for large PTCs. Overweight or obesity accounted for 13.6% and 57.8% of the annual percent changes in total (5.9%/y) and large (4.5%/y) PTC incidence rates, respectively, during 1995–2015. Conclusions: Overweight and obesity may have contributed importantly to the rapid rise in PTC incidence during 1995–2015. By 2015, we estimate that one of every six PTCs diagnosed among adults 60 years or older, including nearly two-thirds of large PTCs, were attributable to overweight and obesity.
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“a recent study estimated that 16% of the cancers overall and 63% of large tumors in the United States were attributable to obesity, 157”
From Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. (2024) · cites this paper as [157]
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“the relatively high proportion of obese patients among those receiving treatment could produce a bias, since excess weight is a risk factor for thyroid malignancies.22,63”
From Glucagon‐like peptide‐1 receptor agonists and risk of thyroid cancer: A systematic review and meta‐analysis of randomized controlled trials (2024) · cites this paper as [63]
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“org 2 A recent study in the US estimated that by 2015 one of every six PTCs diagnosed and two to three large PTCs diagnosed, among US adults over 60 years, were attributed to excessive weight (21).”
BackgroundUnravelling the rise in thyroid cancer incidence and addressing overdiagnosis
Chen, D., & Haymart, M. R. (2025) · Nature Reviews Endocrinology · doi:10.1038/s41574-025-01168-y · Cited by 46
“In this context, numerous studies have examined the relationship between increased BMI and thyroid cancer risk 50–52 (Table 2).”
Adiponectin and Thyroid Cancer: Insight into the Association between Adiponectin and Obesity
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InfluentialPasqual, E., O’Brien, K. M., Rinaldi, S., Sandler, D. P., & Kitahara, C. M. (2023) · The Lancet Regional Health - Americas · doi:10.1016/j.lana.2023.100537 · Cited by 32
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Du, B., Wang, F., Wu, L., Wang, Z., Zhang, D., Huang, Z., Gao, L., Li, Y., Liang, C., Li, P., et al. (2020) · Endocrine · doi:10.1007/s12020-020-02445-8 · Cited by 30
“Overweight and obesity are triggers for CVD and is considered a driving force of the rising PTC incidence in the US population over the last decades [46].”
BackgroundApproach to the patient with thyroid nodules: considering GLP-1 receptor agonists
Kelly, C. A., & Sipos, J. A. (2025) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/clinem/dgae722 · Cited by 30
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“Although this increase in incidence has predominantly been affected by the increased detection of early tumors, other risk factors, such as obesity, must have had an effect as well [2,4,5].”
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“In the United States from 1995 to 2015, one out of every six PTC and two thirds of PTC greater than 4 cm in size have been linked to being overweight or obesity, based on an analysis of data from three large national US databases [40].”
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“8% of PTC > 4cm during a period 1995-2015 (12).”
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“The causal relationship between TC and obesity had been proposed [17, 18].”
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“And other low risk factors include thyroid imaging with iodine 131 、 iodine deficiency 、 high thyroid stimulating hormone(TSH) 、 autoimmunity 、 thyroid nodule and obesity [6, 7].”
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Hisan, U. K., Myung, S., & Nguyen, G. V. (2024) · Nutrition and Cancer · doi:10.1080/01635581.2024.2419488 · Cited by 13
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“Several studies have estimated the thyroid cancer burden attributable to overweight/obesity.(12,17-20) However, these estimates are based on past overweight and obesity prevalences, and therefore likely underestimate the currently preventable thyroid cancer burden.”
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“…epidemiological studies could be sustained by the fact that T2DM and TC could share some common risk factors, such as obesity and increasing age (Kitahara et al., 2020), and TC is often diagnosed incidentally in patients with T2DM due to the performance of screening imaging (such as carotid…”
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“A large populat ion-based study of US showed overweight and obesity were associated threefold and fivefold increased risks of large (>4 cm) PTCs compared with normal weight (23).”
BackgroundObesity and thyroid cancer risk
Burrage, L., McLeod, D. S. A., & Jordan, S. J. (2023) · Current Opinion in Endocrinology Diabetes and Obesity · doi:10.1097/med.0000000000000825 · Cited by 11
Prediction Model of Pathologic Central Lymph Node Negativity in cN0 Papillary Thyroid Carcinoma
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“org 9 The incidence of being overweight increased synchronously with the morbidity of PTC (42), but the relationship between BMI and PTC is not clear.”
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“There is consistent evidence that twelve cancer types (15) – ovarian (16), breast (17, 18), endometrial (19), thyroid (20), gallbladder (21), colorectal (22), pancreatic (23), gastric (24), esophageal (25), liver (26), kidney (27) and multiple myeloma (28), are related to excessive body fat.”
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“The existing data concerning the relationship between these two conditions have yielded conflicting results [ 8, 9 ].”
Yin, Y., Xu, X. M., Shen, L., Zhao, W., Diao, H., & Li, C. (2021) · Frontiers in Oncology · doi:10.3389/fonc.2021.644645 · Cited by 10
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“8% of the annual percent changes in all and large PTC incidence, respectively [22].”
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“[31,32] This association may be attributed to the fact that obese and overweight people are at greater health risk due to their lifestyle, nutrition, and physical activity.”
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“CI, confidence interval; DTC, differentiated thyroid cancer; HR, hazard ratio; PTC, papillary thyroid cancer; WHO, World Health Organization.”
Current and emerging medications for the management of obesity in adults
Walmsley, R., & Sumithran, P. (2023) · The Medical Journal of Australia · doi:10.5694/mja2.52031 · Cited by 8
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“Moreover, the number of obese individuals has increased in recent decades, and obesity has been reported to be positively associated with increased risk for both thyroid and breast cancer [14,15].”
BackgroundLuo, H., Tobey, A., Auh, S., Cochran, C. S., Behairy, N. H. E. D., Merino, M. J., Zemskova, M., & Kłubo-Gwieździńska, J. (2022) · Frontiers in Pharmacology · doi:10.3389/fphar.2022.791710 · Cited by 7
“Thyroid cancer is an endocrine malignancy characterized by a multifactorial etiology consisting of contribution from somatic drivers such as BRAF-like and RAS-like molecular signatures, combined with a contribution from environmental factors such as the increased prevalence of obesity and presence of chemical thyroid…”
BackgroundCapezzone, M., Balducci, M. T., Morabito, E. M., Durante, C., Piacentini, P., Torregrossa, L., Materazzi, G., Giubbolini, G., Mancini, V., Rossi, M., et al. (2023) · Biomedicines · doi:10.3390/biomedicines11020298 · Cited by 9
The growing global burden of thyroid cancer overdiagnosis
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“A study by Kitahara et al. [44] suggests that excess weight significantly contributes to thyroid cancer diagnoses in older adults.”
Chen, R., Liang, F., Wang, M., Han, P., Lin, P., Zhang, L., & Huang, X. (2022) · Sleep Medicine · doi:10.1016/j.sleep.2022.04.015 · Cited by 7
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Luo, Q., Hofmann, J. N., Pfeiffer, R. M., Kitahara, C. M., Song, M., & Shiels, M. S. (2023) · International Journal of Cancer · doi:10.1002/ijc.34516 · Cited by 7
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“overweight/obesity (6, 7) are the mostwell-established risk factors for TC.”
BackgroundBody Mass Index, Physical Activity, and Subsequent Neoplasm Risk Among Childhood Cancer Survivors
Joffe, L., Mirzaei, S., Bhatia, S., Darji, H., Ness, K. K., Onerup, A., Ladas, E. J., Im, C., Lupo, P. J., Oeffinger, K. C., et al. (2025) · JAMA Oncology · doi:10.1001/jamaoncol.2025.1340 · Cited by 7
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“Although the pathogenesis and etiology of PTMC remain unclear, possible causes include radiation [5] and obesity [6], among others.”
BackgroundToluidine blue for the detection of sentinel lymph nodes in patients with thyroid cancer
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“Both obesity and overweight have been identified as risk factors for the development of TC [7], and the involvement of obesity has been reported in the occurrence and progression of TC and benign nodular thyroid disease [8].”
BackgroundJammah, A. A., Alsadhan, I., Alyusuf, E. Y., Alajmi, M., Alhamoudi, A., & Al‐Sofiani, M. E. (2023) · Frontiers in Endocrinology · doi:10.3389/fendo.2023.1256232 · Cited by 5
Thyroid Cancer Identified After Positron Emission Tomography (PET) Shows Aggressive Histopathology
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Exposure to GLP-1RA and Risk of Structural Progression in Differentiated Thyroid Cancer
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Sex-specific Associations between Body Mass Index and Thyroid Cancer Incidence among Korean Adults
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Low-Glycemic Load Diets and Thyroid Function: A Narrative Review and Future Perspectives
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“Additionally, emerging evidence suggests a potential association between obesity and thyroid cancer development [73].”
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“14 Using national population ‐ based health survey and cancer registry data, the authors estimated that 15% of papillary thyroid cancers (and 60% of large papillary thyroid cancers) diagnosed in the United States are attributable to overweight and obesity.”
BackgroundSelf-citationRisk factors in thyroid cancer: is the obesity pandemic an important factor?
Matrone, A. (2022) · Expert Review of Endocrinology & Metabolism · doi:10.1080/17446651.2022.2144832 · Cited by 4
“exclusively due to overweight and obesity [15].”
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Sex-dependent impact of obesity on aggressiveness of papillary thyroid cancer
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“Thyroid cancer (TC) is the most common endocrine tumor worldwide and papillary thyroid cancer (PTC) is the most common histologic type [1].”
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“Consistent with our study, a large US study (27) of 457,331 cases indicated that obesity was a signi fi cant contributor to the rapid increase in the incidence of papillary thyroid carcinoma between 1995-2015, both overweight and obese were signi fi cantly associated with papillary thyroid carcinoma…”
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“Thyroid cancer is closely related to obesity and metabolic disorders [31, 32].”
Environmental and lifestyle factors and risk of thyroid carcinoma: a cross-sectional study
Sada, V., Cozzolino, A., Neri, I., Lorenzo, R. D., Barba, L., Modica, R., Dolce, P., Achour, O., Pozza, C., Giannetta, E., et al. (2025) · Endocrine · doi:10.1007/s12020-025-04441-2 · Cited by 2
“WC is considered the best parameter of android obesity and visceral fat, and it is preferred to BMI, which does not discriminate lean from fat mass [39].”
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“Most studies, 10,11 but not all, 12,13 suggest that obesity [measured by body mass index (BMI)] is associated with an increased incidence of thyroid cancer.”
Metadata
- Authors
- Kitahara, C. M., Pfeiffer, R. M., Sosa, J. A., & Shiels, M. S.
- Affiliations
- Division of Cancer Epidemiology and Genetics (US)
- University of California, San Francisco (US)
- Corresponding author
- Kitahara, Cari M
- Venue
- JNCI: Journal of the National Cancer Institute
- Publisher
- Oxford University Press (OUP)
- Published
- 2019-12-05
- Volume
- 112
- Issue
- 8
- Pages
- 810-817
- ISSN
- 0027-8874 (ISSN-L)
- 1460-2105
- PMC
- PMC7825478
- OpenAlex
- W2981876570
- Cited by
- 142
- References
- 55
- Citations by year
- 2026: 11 · 2025: 18 · 2024: 22 · 2023: 25 · 2022: 32 · 2021: 20 · 2020: 13
- FWCI
- 13.59
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- JNCI Journal of the National Cancer Institute (publishedVersion, cc-by-nc)
- Europe PMC (PubMed Central) (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- eScholarship (California Digital Library) (submittedVersion, cc-by-nc)
- Funders
- Intramural Research Program of the National Cancer Institute at the National Institutes of Health
- NIH
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Cancer Diagnosis and Treatment
- Health Sciences › Medicine › Oncology › Cancer Risks and Factors
- Health Sciences › Medicine › Oncology › Global Cancer Incidence and Screening
- Keywords
- papillary thyroid carcinoma, overweight, obesity, body mass index, cancer incidence trends, population attributable fraction, obesity as cancer risk factor, AARP Diet and Health Study
- MeSH terms
- Thyroid Cancer, Papillary, Aged, Female, Humans, Male, Middle Aged, Obesity, Risk Factors, Thyroid Neoplasms, United States, Cohort Studies, Body Mass Index, Incidence, Prevalence, SEER Program, Overweight
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