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Cited by 1Thyroid Cancer Diagnosis and TreatmentGlobal Cancer Incidence and ScreeningThyroid and Parathyroid Surgery

Sex-specific trends in thyroid cancer incidence and histological patterns in Northern Tunisia: a population-based study with implications for cancer control and prevention

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Khiari, Hyem, Henchiri, Soumaya, Dergaa, Ismail, Ceylan, Halil İbrahim, Stefanica, Valentina, Sakhri, Saida, Zarraa, Semia, Ben Mansour, Hajer +6 more·2026·Cancers
DOI 10.3390/cancers18091472PMC PMC13162613
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Abstract

Background: Thyroid cancer (TC) represents the most common endocrine malignancy worldwide, with incidence increasing rapidly across diverse geographic regions. However, population-based evidence from North Africa remains limited, and comprehensive longitudinal analyses examining sex-specific incidence patterns, histological subtypes, and trends in tumor extension are lacking in Tunisia. Aim: This study aimed to (i) quantify TC incidence trends by sex and age group, (ii) characterize histological subtype-specific temporal patterns and tumor extension at diagnosis in northern Tunisia between 2000 and 2018, and (iii) to address projections in incidence by sex until 2040. Methods: A retrospective, population-based registry study was conducted using data from the Northern Tunisia Cancer Registry (NTCR), covering 11 governorates with a population of 5,233,700 in 2018. All primary invasive TC cases diagnosed between 2000 and 2018 were included (n = 3639). Age-standardized incidence rates (ASIRs) were calculated using the WHO standard population. Temporal trends were assessed using Joinpoint regression to estimate average annual percentage change (AAPC) with 95% confidence intervals. Projections of TC incidence to 2040 were generated using Bayesian autoregressive age–period–cohort models. Results: TC incidence increased significantly between 2000 and 2018, with overall ASIR rising from 2.8 to 5.0 per 100,000 person-years (AAPC = 3.8%, p < 0.001). In males, ASIR increased from 0.9 to 2.4 (AAPC = 3.0%, p < 0.001), while in females it rose from 3.7 to 7.8 (AAPC = 4.3%, 95% CI: 3.0–5.7; p < 0.001). The increase was predominantly driven by papillary thyroid carcinoma (PTC) (AAPC = 6.4% in males; 5.8% in females; both p < 0.001), whereas follicular thyroid carcinoma (FTC) remained stable. Notably, the proportion of metastatic cases decreased significantly in females (AAPC = −7.2%, p = 0.033), and the proportion of regionally advanced disease decreased in males (AAPC = −5.0%, p = 0.034). Conclusions: This population-based study demonstrates a sustained rise in TC incidence in northern Tunisia, disproportionately affecting women and largely driven by papillary histology. The concurrent increase in TC incidence alongside a reduction in regional and metastatic extension at diagnosis occurred. These findings have important implications for cancer prevention and control, highlighting the need for risk-adapted screening strategies and rationalized diagnostic practices.

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  • The thyroid cancer incidence data from Northern Tunisia, combined with regional epidemiological context, indicates the importance of validation in non-Western populations where cancer risk factor profiles and healthcare system characteristics may differ substantially from populations dominating existing XAI oncology research.

    “The thyroid cancer incidence data from Northern Tunisia generated by the research team (Khiari et al., 2026), combined with the regional epidemiological context it provides, indicates the importance of validation in non-Western populations where cancer risk factor profiles and healthcare system characteristics may differ substantially from the populations that dominate existing XAI oncology”

    From A generative AI multi-agent framework with integrated XAI governance for cancer diagnostics: from multi-omics interpretation to lifestyle risk stratification (2026) · cites this paper as Khiari et al., 2026

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Research works printed but not linked: 5

  1. [16]Zoghlami N. Chihaoui N. Letaief A. Aounallah-Skhiri H. Ben Mansour N. Skhiri A. Ben Slama F. Hsairi M. Jing L. Health State of the Tunisian Population Evaluated by the Tunisian Health Examination Survey (THES-2016) DataSuds 2024 10.23708/PRDTYS · DOI
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Authors
Khiari, H., Henchiri, S., Dergaa, I., Ceylan, H. İ., Stefanica, V., Sakhri, S., Zarraa, S., Ben Mansour, H., Zenzri, Y., Dziri, H., Mansour, N. B., Mahjoub, N., Muntean, R. I., & Hsairi, M.
Affiliations
  • Department of Epidemiology, Salah Azaiez Institute of Cancer, Bab Saadoun, Tunis 1006, Tunisia
  • Directorate of Basic Healthcare, Tunis 1002, Tunisia
  • University of Jendouba (TN)
  • Physical Education and Sports Teaching Department, Faculty of Sports Sciences, Atatürk University, Erzurum 25240, Türkiye
  • Department of Physical Education and Sport, Faculty of Sciences, Physical Education and Informatics, Pitesti University Center, National University of Science and Technology Politehnica Bucharest, 060042 Pitesti, Romania
  • Institut Salah-Azaïz (TN)
  • Department of Radiotherapy, Salah Azaiez Institute of Cancer, Tunis 1007, Tunisia
  • Department of Medical Oncology, Salah Azaiez Institute of Cancer, Tunis 1007, Tunisia
  • Hôpital Charles-Nicolle (TN)
  • 1 Decembrie 1918 University (RO)
Corresponding author
Muntean, Raul Ioan
ORCID
Venue
Cancers
Publisher
MDPI AG
Published
2026-05-03
Volume
18
Issue
9
Pages
1472
ISSN
2072-6694 (ISSN-L)
DOI
10.3390/cancers18091472
PMC
PMC13162613
OpenAlex
W7160056227
Cited by
1
References
28
Citations by year
2026: 1
FWCI
5.01
Type
journal article
Language
en
Open access
Licence
Locations
  • Cancers (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • PubMed Central (publishedVersion, cc-by)
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Cancer Diagnosis and Treatment
  • Health Sciences › Medicine › Oncology › Global Cancer Incidence and Screening
  • Health Sciences › Medicine › Surgery › Thyroid and Parathyroid Surgery
Keywords
thyroid cancer, incidence trends, sex differences, papillary thyroid carcinoma, follicular thyroid carcinoma, histological subtypes, metastasis, metastatic disease, regional lymph node metastasis, age-standardized incidence rate, incidence projections, cancer control, Tunisia, North Africa, cancer registry data, age-period-cohort model, joinpoint regression

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