Why Are Thyroid Cancer Rates Higher in Northern Georgia?

Thyroid cancer is the 12th most common cancer diagnosed in the United States, but accounts for just over 2% of all new cases each year. The states with the highest rates of thyroid cancer are clustered on the Northeast or scattered in the West or upper Midwest.

But while southern states have some of the lowest rates of thyroid cancer in the nation, counties in northern Georgia have rates that are close to or more than twice the state and national averages.

“The numbers and the comparison to the state and national averages is striking,” says Neal Lin, M.D. an expert in public health and epidemiology at the University of North Georgia tells television WXIA in a special report on high thyroid cancer levels. “Not just high, but it's exceptionally high.”

While the numbers of cases in some of these counties are small, the counties in which they are found are sparsely populated. For instance, Rabun County, Georgia, had 30 cases, an average of just six thyroid cancer cases a year, from 2017-2021. But the county has less than 18,000 residents. That’s a cancer rate of 24.7 per 100,000, more than twice the state average of 11.7. The U.S. rate is 12.9 per 100,000.

The chart below shows the Georgia counties with the highest incidence rates of thyroid cancer in the state. Many of these are rural counties and are adjacent to one another in the northern part of the state. The information comes from the National Cancer Institute State Cancer Profiles database.

In this article, we’ll explore: 

• Who’s at Risk for Developing Thyroid Cancer?
• Why Have Cases of Thyroid Cancer Increased?
• What is a Cancer Cluster?
• What Signs of Thyroid Cancer Should GA Residents Look for?
• Is Thyroid Cancer Treatable?
• Thyroid Cancer Care in Georgia

If you or a loved one has been diagnosed with cancer and are looking for a second opinion, call us 24/7 at 877-524-4673.

Who’s at Risk for Developing Thyroid Cancer?

Thyroid cancer is a bit of an outlier compared to other types of the disease. While most cancers are more common in men than women and are diagnosed in seniors, thyroid cancer is more common in young women. The average age of a patient diagnosed with thyroid cancer is 51, 15 years younger than the average age for most other cancers.

It should be noted, however, that most of the increase in new cases of thyroid cancers in women are small, papillary thyroid cancers (PTC) that are often less aggressive and rarely fatal. These cancers usually are slow-growing and may only need to be monitored and not treated. New research reported in JAMA Internal Medicine finds that women are four times more likely than men to be diagnosed with papillary thyroid cancer.

Conversely, aggressive and often deadly types of thyroid cancer are diagnosed equally among men and women. And poorly differentiated and anapestic thyroid cancers are diagnosed more often in elderly patients and account for most thyroid cancer deaths.

The average age of a patient who dies from thyroid cancer is 74 years old and 76% of deaths from the disease occur in patients 65 or older.

The potential causes of thyroid cancers also are different than for most other cancers. Smoking, obesity and alcohol intake are among the most common risk factors for cancer. Common causes of thyroid cancer are:

• Radiation exposure
• Family history
• Irregular iodine levels

“One place to start to consider whether there are high levels of radiation or radon in the area,” says Amy Y. Chen, M.D., M.P.H., M.B.A., F.A.C.S., chief of surgery and director of thyroid oncology at City of Hope^® Cancer Center Atlanta.

According to a WXIA report, state agencies have yet to do investigate the north Georgia cases because there is “no known source in northeast Georgia of radiation.”

Why Have Cases of Thyroid Cancer Increased?

Since the early 1990s, new diagnoses of thyroid cancer have more than doubled from about six per 100,000 people to nearly 15. Levels have especially spiked in women. But the mortality rate has stayed level.

Research indicates that the spike in new cases, especially in women, may be attributed to better diagnostic tools and, in many cases, overdiagnoses of PCT.

“So many more people are getting scanned these days, Dr. Chen says. “You might get scanned to determine if there’s a blockage in a carotid artery, or for any number of reasons. And if you scan that area of the neck, there’s a chance you may find a nodule in the thyroid.”

Research also shows that women are more likely than men to attend to their health. That may result in more testing, including scans, in women that may result in the discovery of a PTC, even though the patient is asymptomatic.

“The gender disparity is mostly confined to the detection of small subclinical PTCs, which are equally common in both sexes at autopsy but identified during life much more often in women than men,” reads a report from researchers at the National Cancer Institute.

According to the WXIA report, most of the more than 50 patients diagnosed with thyroid cancer in north Georgia are women. In most cases, their specific types of thyroid cancers were not detailed.

What is a Cancer Cluster?

Are the high rates of thyroid cancer found in adjacent north Georgia counties a cancer cluster?

It may seem like a possibility, given the proximity of the patients and their type of cancer. But the official determination of a cancer cluster is never that simple.

“There’s a big difference between association and causation, when determining if cancer diagnoses are related,” Dr. Chen says.

According to the National Cancer Institute: “A cancer cluster refers to the occurrence of a greater than expected number of cancer cases among a group of people in a defined geographic area over a specific time period. A cancer cluster may be suspected when people report that several family members, friends, neighbors or coworkers have been diagnosed with the same or related types of cancer.”

But just because several people who live close by are diagnosed with the same type of cancer, it doesn’t mean their disease was caused by the same factor. Cancers take years or even decades to grow before they are diagnosed, so patients’ exposure may have occurred when they lived in a different area. Or they may have inherited a high risk of disease that has nothing to do with exposures or their environment.

“It’s often difficult to scientifically prove the presence of a cancer cluster,” says Anthony Perre, M.D., F.A.C.P., a new patient intake physician at City of Hope Atlanta. “It’s very possible that the cancer cluster does exist. It just can’t be proven. Many reported cancer clusters just don’t include enough cases to allow investigators to prove that there is a statistical difference from the expected number of cases.”

Members of the Georgia Legislature who represent the state’s northern counties are calling on health agencies to investigate the high incidence rates among their constituents.

What Signs of Thyroid Cancer Should GA Residents Look for?

The thyroid is a wing-shaped gland in the front of the neck. It secretes hormones that help manage the body’s growth and metabolism.

Many thyroid cancers are indolent — they are slow growing and produce no symptoms. These cancers often require monitoring, but no treatment.

If the cancer becomes advanced, patients may experience symptoms, such as:

• A lump or nodule in the neck
• Swelling, soreness or pain in the neck
• Fatigue
• Hoarseness or voice changes
• Difficulty breathing

Is Thyroid Cancer Treatable?

When caught locally, the five-year survival rate for thyroid cancer is more than 98% — one of the highest of all cancers.

But even after it has spread, thyroid cancer may often be treated with positive outcomes. The five-year survival rate for metastatic thyroid cancer is more than 50%.

Treatments for thyroid cancer include:

• Surgery to remove all or part of the thyroid
• Radiation therapy
• Chemotherapy

Thyroid Cancer Care in Georgia

Most of the patients diagnosed with thyroid cancer in north Georgia live in rural counties, where access to specialized care may be limited. Good health care may be found anywhere, including rural areas, where knowledgeable and compassionate doctors practice medicine. But in such areas, doctors may not have the training or equipment to deal with specific diseases, such as thyroid cancer.

Patients who have been diagnosed with thyroid cancer or are experiencing symptoms should seek out an expert with training and experience in diagnosing and treating the disease.

City of Hope Atlanta is just a two- to three-hour drive south of the north Georgia counties with high thyroid cancer rates. At City of Hope, Dr. Chen teams up with endocrinologist Sabrina Rene, M.D. to diagnose and treat patients with thyroid cancer.

“I like to say we are a one-two punch in the fight against thyroid cancer,” Dr. Chen says.

Dr. Chen also refers patients to the Thyroid Cancer Survivors Association website, which offers:

• News on the latest research
• Links to support groups
• Handbooks in multiple languages
• Recipes for low-iodine meals

If you or a loved one has been diagnosed with cancer and are looking for a second opinion, call us 24/7 at 877-524-4673.