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UDC 616.441-006.6-02:616-001.28:621.039.5.004.6-03622:614.1:313.13(477+47741) DOI: 10.22141/2224-0721.15.2.2019.166109
V.I. Tkachenko, Ya.Yu. Rimar
Shupyk National Medical Academy of Postgraduate Education, Kyiv, Ukraine
Morbidity and prevalence of malignant neoplasms of the thyroid gland in Ukraine and Kyiv region after the Chernobyl Nuclear Power Plant accident
For cite: Miznarodnij endokrinologicnij zurnal. 2019;15(2):152-157. doi: 10.22141/2224-0721.15.2.2019.166109
Abstract. Background. The annual increase in the number of newly diagnosed cases of malignant neoplasms of the thyroid gland (MNTG) is observed both in the territories most contaminated with radioiodine after the Chernobyl accident, and in other regions. The heterogeneous nature of the regional increase of this pathology requires a detailed analysis of the prevalence and the morbidity rate of MNTG, taking into account the possible influence of risk factors. The purpose was to analyze the morbidity rate and the prevalence of MNTG among the population of Ukraine and Kyiv region after the Chernobyl Nuclear Power Plant accident. Materials and methods. The analysis of the bulletins of the National Cancer Registry of Ukraine, the data of statistical reports of healthcare institutions of Kyiv region (2005-2016) and literature data since 1981, which contained relevant information on the subject was performed. Statistical analysis of indicators was carried out using software package Windows Office Excel 2016 and StatSoft Statistica 10.0.1011.0. Results. Since 1990 in Ukraine, there has been a sharp increase in the morbidity rate of MNTG compared with the pre-Chernobyl period. From 1989 to 2004, the all-Ukrainian rate of increase in the morbidity rate of thyroid cancer among male population was 90.28 %, and among females — 104.42 %; for Kyiv region — 65.6 and 156.9 %, respectively. In 2005-2016, in addition to increase in the share of MNTG in the structure of all cancer pathologies, there was also a significant increase in the morbidity rate: 1.7-fold in Ukraine (+70 %, p < 0.01) and 1.5-fold in the region (+52.6 %, p < 0.01), with higher incidence rates for this period in Kyiv region. Gender analysis (2005-2016) revealed the prevalence of thyroid cancer in the female population, and in terms of the age structure, the highest rate of increase in the morbidity rate was observed among men aged 40-44 and women aged 30-34 years. In addition, the heterogeneous nature of the regional distribution of the morbidity rate was clearly observed. The rate of increase in prevalence over the same period in Ukraine as a whole was 112.5 %, and in the region — 98.2 %, the predictive model showed its increase over at least next 5 years. Conclusions. The annual steady increase in the morbidity rate and prevalence of MNTG, as well as the heterogeneous gender, age and regional distribution of the studied parameters indicates the multifactoriality and relevance of studying this problem with the subsequent improvement of the system of preventive measures. Keywords: thyroid cancer; malignant neoplasms of the thyroid gland; epidemiology; morbidity rate; prevalence; risk factors; Ukraine; Kyiv region
Introduction
In recent decades, cancer has a tendency to increase both in the world and in Ukraine. The International Agency for Research on Cancer predicted 567,233 new cases of thyroid cancer (TC) in the world in 2018, representing 3.1 % of all cancer cases [1].
In Ukraine, the ratio of malignant neoplasms of the thyroid gland (MNTG) in the structure of cancer morbidity for 15 years has increased from 1.3 % in 2002 to 2.3 % in 2016, that is, by 1.8 times. As of 2016, MNTG rank fourth in the gender-age structure of malignant neoplasms among the Ukrainian female population aged
© «Ммнародний ендокринолопчний журнал» / «Международный эндокринологический журнал» / «International Journal of Endocrinology» («Miznarodnij endokrinologicnij zurnal»), 2019 © Видавець Заславський О.Ю. / Издатель Заславский А.Ю. / Publisher Zaslavsky O.Yu., 2019
Для листування: Ткаченко В.1., доктор медичних наук, професор, кафедра амейноТ медицини, Нацюнальна медична академiя тслядипломноТ освiти iM. П.Л. Шупика, вул. Дорогожиць-ка, 9, КиТв, 04112, УкраТна; факс: (044) 536-01-06; e-mail: [email protected]; тел. +38 (067) 7574596.
For correspondence: V.I. Tkachenko, MD, PhD, Professor, Department of Family Medicine, Shupyk National Medical Academy of Postgraduate Education, Dorogozhytska str., 9, Kyiv, 04112, Ukraine; fax: (044) 536-01-06; e-mail: [email protected]; phone +38 (067) 7574596.
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KAiHiHHa TMpeoigoAorifl /Clinical Thyroidology/
0—17 and 30—54 years, and among women aged 1829 years, it ranks first [2].
High prevalence of TC in Ukraine is associated primarily with carcinogenic effect of ionizing radiation due to the Chernobyl accident, which led to a sharp increase in the number of radiation-induced tumors of the thyroid gland, starting from 4—5 years after the accident, and continuing its effect till now. It is reliably known that people who were 0—18 and especially 0—5 years old at the time of the accident, were most exposed to ionizing radiation [3, 4]. However, the number of newly diagnosed cases of TC annually increases not only in the most radioactive contaminated territories, but also in other regions. Thus, according to the latest information of 2017, the morbidity rates of MNTG were highest in Kirovohrad (14.6 %000), Vinnytsia (13.6 %000), Sumy (12.8 0/MM), Kyiv (12.1 0/0000) regions and in Kyiv (12.7 0/0000), whereas the lowest indicators were observed in Transcarpathi-an (1.8 %000), Chernivtsi (3.1 0/MM), Volyn (3.8 0/MM), Odesa (4.2 0/0000) and Ivano- Frankivsk (4.4 0/0000) regions [2]. This heterogeneous regional distribution indicates the possible influence of anthropogenic factor, micronutrient deficiency, concomitant diseases of the thyroid gland and various organs and systems, as well as a number of other risk factors that can provoke neoplastic process or directly modify carcinogenesis [5—9]. Referring to the above-mentioned and due to the disabling effects of this pathology, the analysis of the morbidity rate and the prevalence of MNTG in the regions of Ukraine taking into account possible risk factors is of current interest, as it will contribute to the development of measures for improving MNTG treatment in Ukraine.
The purpose: to analyze the morbidity rate and the prevalence of MNTG among the population of Ukraine and Kyiv region after the Chernobyl Nuclear Power Plant accident.
Materials and methods
To evaluate the morbidity rate and the prevalence of MNTG, there were used bulletins of the National Cancer Registry of Ukraine, data from statistic reports of the healthcare institutions of Kyiv region (2005—2016) and literature data since 1981, which contained relevant information on the subject.
Statistical analysis of indicators was carried out using software package Windows Office Excel 2016 and StatSoft Statistica 10.0.1011.0.
Results
The data of the retrospective analysis showed that in the pre-Chernobyl period, the morbidity of MNTG was episodic; the diagnostic capabilities, as well as the access to statistical indicators were limited at that time, but observation of A.D. Chernobrovyi (2001) shows rather low morbidity rate of TC among Ukrainian population before the Chernobyl accident. Thus, in 1981—1985, the morbidity of TC averaged 0.62 0/0000, and from 1986 to 1999, there was the clear annual increase in the morbidity rate of TC in Ukraine — up to 4 . 0 0/0000, it was especially intensive since 1990, in particular among the
population of Kyiv, Chernihiv and Zhytomyr regions, as well as in Kyiv residents [10, 11]. This is due to the start of the minimum latent period for the development of radiation-induced TC in a group of people who were 0—18 years old at the time of the accident, which is likely to continue until now [3, 12].
In addition, the research findings of M.M. Fuzik et al. over the period of 1989—2010 showed a significantly higher increase in the level of TC morbidity and its average annual rate in regions with high radiation exposure (> 35 mGy) compared to all other regions of Ukraine (< 35 mGy), both among those who were children and adolescents at the time of the Chernobyl accident and adult population [13].
Accurate record of statistical indicators on MNTG morbidity in Ukraine has been started in 1989 with the help of the program information system of cancer registration by the National Cancer Institute when the Decree of the Ministry of Health of Ukraine No. 10 "About the creation of the National Cancer Registry of Ukraine" dated January 2, 1996 was approved [14]. According to the epidemiological research by V.M. Hor-benko et al. over the period of 1989—2004, the morbidity rate of TC in Ukraine among male population increased from 1.01 to 1.92 0/0000, and among women — from 3.54 to 7.24 0/0000, i.e., 90.28 and 104.42 %, respectively. The rate of increase in the morbidity rate in Kyiv region among male population was lower (65.6 %) than in other regions of the country, but among women it accounted for 156.9 % that was higher than the corresponding figures in Ukraine [15]. Regional analysis of the morbidity rate of TC in 1989-2004 showed that the highest increase among men was observed in Zhytomyr, Ivano-Frankivsk, Sumy and Zaporizhzhia regions, as well as in Kyiv; among women — in Cherkasy, Sumy, Zhytomyr, Poltava and Zaporizhzhia regions. Therefore, the researchers noted that an increase in the morbidity rate of TC in Ukraine is the highest among malignant neoplasms of other localization [15].
To continue studying the morbidity rate and the prevalence of MNTG in Ukrainian population as a whole and in Kyiv region in particular, we have analyzed statistical data for 2005-2016. It was found that in the structure of all cancers, the share of MNTG in Ukraine increased from 1.4 to 2.3 % (rate of increase +64.3 %), in Kyiv region — from 2.6 to 3.6 % (rate of increase +38.5 %). The morbidity rate of MNTG in Ukraine increased by 1.7 times — from 5 to 8 . 5 0/0000 (rate of increase +70 %, p < 0.01), in Kyiv region — by 1.5 times, from 9.5 to 14 . 5 0/0000 (rate of increase +52.6 %, p < 0.01) (Fig. 1).
However, along with morbidity rate of MNTG, which was higher in Ukraine than in Kyiv region, the mean morbidity rate in region (12 . 8 0/0000) was determined as more significant comparing to the nationwide (6 . 9 0/0000). In addition, the morbidity rates of MNTG among the population of Kyiv region for 2005-2016 were always statistically higher (p < 0.01) than the indicators in Ukraine, in the presence of certain fluctuations.
Kamnho TMpeoi'AOAorin /Clinical Thyroidology/
15 -|
10 -
5 -
# <F T? <F T?
Men and women
Men I Women
25 20 15 10 5 0
<F T? <F T? <T
Men and women
Men I Women
0
ft
B
Figure 1. The morbidity rate of MNTG in Ukraine (A) and in Kyiv region (B) for 2005-2016,0/00
Heterogeneous nature of the fluctuations in the morbidity rate of MNTG in Kyiv region needs further in-depth study. It can be assumed that one of the additional factors is the variable concentration of carcinogenic substances in the air. Thus, S.M. Tsymbaliuk et al. (2017) established a strong correlation (p < 0.05) between the levels of air pollution by chemical carcinogens, namely chromium IV, benzo[a]pyrene, formaldehyde and cadmium, in Kyiv and Cherkasy and the prevalence of TC. The authors also proved that the time lag of the greatest manifestation of the cumulative phenomenon for development of TC is 10 years [17]. The influence of anthropogenic chemical factors on the development of
Table 1. The rate of increase in the morbidity rate of MNTG in the regions of Ukraine for 2005-2016, %
Region Men Women
Vinnytsia 1325.0 106.7
Volyn 233.3 563.6
Dnipropetrovsk 21.4 19.8
Zhytomyr -10.5 72.0
Transcarpathian 50.0 86.4
Zaporizhzhia 87.5 51.0
Ivano-Frankivsk 17.6 124.3
Kyiv 0.0 67.4
Kirovohrad 54.5 242.7
Lviv 21.4 -10.5
Mykolaiv 62.5 15.8
Odesa 21.1 12.3
Poltava 28.6 27.1
Rivne 50.0 85.1
Sumy 104.8 151.3
Ternopil 46.7 189.3
Kharkiv 18.8 90.8
Kherson 60.9 74.5
Khmelnytskyi 266.7 152.2
Cherkasy 0.0 64.9
Chernivtsi -71.4 100.0
Chernihiv -29.2 19.4
Kyiv 52.4 34.7
Ukraine 57.9 69.2
TC was also studied by N.V. Balenko et al. [8, 17]. The authors concluded that some compounds, in particular pesticides of different chemical structures, perchlorates, and the socio-economic characteristics of the regions of Ukraine, determine the morbidity rate of TC, and the question of studying the ways and consequences of their effects remains unsettled until today [8, 17].
Moreover, a comparative analysis of the morbidity rate of MNTG in the regions of Ukraine over the relevant years has shown the highest increase among men in Vinnytsia, Khmelnytskyi, Volyn, Sumy and Zapori-zhzhia regions (Table 1). An increase in the morbidity rate among men in Vinnytsia region was surprisingly high - 1,325 % (from 0.4 to 5.7 0/0000). The most significant increase in the morbidity rate among women was in Volyn, Kirovohrad, Ternopil, Khmelnytskyi and Sumy regions. In Volyn region, the morbidity rate among women in 2005—2016 has increased from 1.1 to 7 . 3 0/0000 (rate of increase 563.6 %).
To provide a more detailed analysis of the dynamics of morbidity rate of MNTG, we divided the period from 1999 to 2013 into 5-year intervals: 1999-2003, 2004-2008, 2009-2013; since 2014, there are no data from Luhansk and Donetsk regions, Sevastopil and the Autonomous Republic of Crimea. It was found that the increase in the morbidity rate in Ukraine for the first period was 7.1 %, for the second - 22.9 %, for the third - 40.7 %, while in Kyiv region it was 9.4, 44.7 and 19.7 %, respectively.
The findings indicate that the rate of increase in the morbidity in Kyiv region was higher than in Ukraine during the first two periods (1999-2003 and 2004-2008), and it slows down in 2009-2013 that can be explained by a decrease in the stochastic effect of radiation pollution in the studied territory after the Chernobyl accident. On the other hand, according to the findings of S.M. Tsymbaliuk et al. [18], an increase in standardized indicators of the morbidity rate of MNTG (the Ukrainian standard) for 1991-2013 in the areas with high radiation control, which include Kyiv, Zhytomyr, Rivne, Volyn and Chernihiv regions, averaged 2.58 ± 0.14 times and was lower than in regions with high industrial development and in predominantly agricultural areas. It proves the possible influence of other carcinogens, in particular those of anthropogenic origin, except for the well-known
Kaîhîhho TMpeoÏAOAorin /Clinical Thyroidology/
influence of ionizing radiation, and combined effects of iodine deficiency of varying severity, which is observed in many regions of Ukraine, including Kyiv region, that must be taken into consideration [4, 5].
Discussion
Today, according to many national and foreign studies, it is known that the development of MNTG depends on gender. It has been found that women have TC on average 3—5 times more often than men [19]. Gender analysis of statistical indicators of the morbidity rate of MNTG among female population in 2005—2016 showed 1.7-fold increase, both in Ukraine as a whole (from 7.8 to 13 . 2 0/0000; rate of increase +69.2 %, p < 0.01), and in Kyiv region (from 14.1 to 23.6 0/0000; rate of increase +67.4 %, p < 0.01). The national index of morbidity among male population increased by 1.6 times (from 1.9 to 3 . 0 0/0000, rate of increase +57.9 %, p < 0.01), while in Kyiv region, there were observed heterogeneous fluctuations of indicators, but the average annual rate of morbidity increase among men (3.3 %) indicated a trend towards moderate growth. The men to women ratio in the total number of patients with MNTG in Ukraine in 2016 was 1 : 5, and in the region — 1 : 7. Over the whole analyzed period, the morbidity rate of MNTG among female population in Kyiv region was 2.7—6.3 times higher, and in Ukraine — 3.5—4.5 times higher than among men. This type of gender heterogeneity clearly shows the importance of certain hormonal factors, such as the age of menarche and menopause, the age of the first labor and their number, as well as the presence of some gynecological diseases, the effect of which has been actively studied recently [19—21].
Describing the age structure of the first diagnosed cases of MNTG in Ukraine for 2005—2016, we can distinguish a certain "rejuvenation" of the period with highest rates of morbidity, especially among women (Fig. 2). For example, if in 2005 the morbidity rate was maximal among women aged 55—59 years and men aged 80—84, then in 2016, a significant increase begins with the age of 30—34, and the maximum values correspond to 55—59 years in the structure of both genders. When assessing the rate of increase in the morbidity rate of MNTG, this trend was also observed in the form of the highest percentage values for the following age intervals: 40—44 years among men and 30—34 years among women. In addition, from the age of 80 years and over, the morbidity was characterized by a decline both among male and female population, which may indicate a need for more careful monitoring of thyroid neoplasms in young people.
When analyzing the prevalence of the studied on-cologic pathology from 2005 to 2016, a similar epide-miological situation was observed: regional indicators for each year almost twice exceeded the corresponding national figures and were statistically higher (p < 0.01). An increase in the prevalence of MNTG for this period in Kyiv region among the overall population was 98.2 % (from 114.3 to 226.5 0/0000; p < 0.01), and in Ukraine it was 112.5 % (from 50.2 to 106.7 0/0000; p < 0.01).
Using the trend line to further evaluate the epidemio-logical situation, we predicted the prevalence of TC in
30 i 2520151050
2005 men 2016 men
2005 women 2016 women
Figure 2. The gender-age structure of the morbidity rate of MNTG in Ukraine for 2005-2016, °/0000
2017—2021 in Kyiv region and in Ukraine (Fig. 3). In the prognostic calculation of the dynamics of the TC prevalence for 5 years, the regression analysis demonstrated a polynomial (2-level) long-term trend line with high determinants (R2). Thus, in Kyiv region, the calculated R2 accounted for 0.9851 and was close to 1, which demonstrates the high accuracy of the selected regression equation and the adequacy of the model. The polynomial trend of the TC prevalence in Ukraine was also characterized by a significant R2 index (0.9791), which, in turn, shows that the chosen prediction model (97.9 %) indicates an adequate selection of the trend equation to the initial data. Thus, the prognosis of the TC prevalence shows its growth over the next 5 years, both in Kyiv region and in Ukraine, which clearly demonstrates the need to improve primary and secondary prevention at different levels of health care provision.
Conclusions
The retrospective analysis of statistical data showed that after the Chernobyl accident, the morbidity rates of MNTG were characterized by constant growth since 1986, with greater intensity after 1990, with the onset of the ionizing radiation effects, especially in the most affected regions.
Over the period of 2005—2016, the morbidity rates of MNTG increased in Ukraine and in Kyiv region by 1.7 and 1.5 times, and in Kyiv region, the rates were statistically significantly higher than in Ukraine (p < 0.01) and were characterized by certain fluctuations. The revealed
300 250 200 150 100 50 0
y = -0.2 124x2 + 864. 76x - 87979 4
R2 = 0.98 51
0 108 5x2 - 4 31.18 8275
y = R2 = 0.9791
2004 2006 2008 2010 2012 2014 2016 2018 2020 2022
Kyiv region Ukraine
Polynomial (Kyiv region) Polynomial (Ukraine)
Figure 3. Predictive model of TC prevalence in 2005-2016, °/0000
Kaïhnho tmpeoïaoaorifl /Clinical Thyroidology/
heterogeneous rates of increase in the morbidity of MNTG in various age groups and the highest morbidity among young people also indicate the influence of age factors on oncogenesis and "rejuvenation" of MNTG. A significant increase (3-6-fold) in the morbidity rate of MNTG among female population as compared to male population during all the time both in Kyiv region and in Ukraine indicates the contribution of certain gender factors. The highest rate of increase in the morbidity rate of MNTG among male population was observed in Vinnytsia (1,325 %), Khmelnytskyi (266.7 %), Volyn (233.3 %), Sumy (104.8 %), and Zaporizhzhia (87.5 %) regions, and among women — in Volyn (563.6 %), Kiro-vohrad (242.7 %), Ternopil (189.3 %), Khmelnytskyi (152.2 %) and Sumy (151.3 %) regions, indicating not only carcinogenic and stochastic effect of ionizing radiation, but also the influence of other factors.
The prevalence of TC in 2005-2016 has the following rates of increase: in the region — 98.2 % (p < 0.01), in Ukraine — 112.5 % (p < 0.01), and further increase is expected.
The obtained results indicate the multifactoriality and urgency of the problem that requires further systematic study, as well as demonstrate the need for a directed system of preventive measures to improve the cancer situation in Ukraine.
Conflicts of interests. Authors declare no conflicts of interests that might be construed to influence the results or interpretation of their manuscript.
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Received 04.02.2019 ■
IEI
Клiнiчна тиреоíдологiя /Clinical Thyroidology/
Ткаченко В.И., Римар Я.Ю.
Национальная медицинская академия последипломного образования имени П.Л. Шупика, г. Киев, Украина
Заболеваемость и распространенность злокачественных новообразований щитовидной железы в Украине и Киевской области после аварии на Чернобыльской атомной электростанции
Резюме. Актуальность. Ежегодный прирост количества впервые диагностированных случаев злокачественных новообразований щитовидной железы (ЗНЩЖ) отмечается как на территориях, наиболее загрязненных радиойодом после аварии на Чернобыльской атомной электростанции (ЧАЭС), так и в других регионах. Неоднородный характер регионального роста данной патологии требует детального анализа распространенности и заболеваемости ЗНЩЖ с учетом возможного влияния факторов риска. Цель: провести анализ динамики заболеваемости и распространенности ЗНЩЖ среди населения Украины и Киевской области после аварии на ЧАЭС. Материалы и методы. Проведен анализ бюллетеней Национального канцер-реестра Украины, данных статистических отчетов учреждений здравоохранения Киевской области (2005—2016) и данных литературы начиная с 1981 г., которая содержит актуальную информацию по текущей теме. Статистический анализ показателей выполнен с помощью пакета программ Windows Office Ехсе1 2016 и StatSoft Statistica 10.0.1011.0. Результаты. Начиная с 1990 г. в Украине прослеживается резкий рост заболеваемости ЗНЩЖ по сравнению с до-чернобыльским периодом. С 1989 по 2004 г. увеличение заболеваемости раком щитовидной железы в целом по Украине среди мужского населения составило 90,28 %, а среди женского — 104,42 %; в Киевской области — 65,6 и 156,9 % соответственно. За период 2005—2016 гг., помимо
увеличения доли ЗНЩЖ в структуре всех онкопатологий, также отмечен значительный прирост заболеваемости: по Украине — в 1,7 раза (+70 %, р < 0,01), по области — в 1,5 раза (+52,6 %, р < 0,01), с более высокими показателями заболеваемости за данный период в Киевской области. При проведении гендерного анализа (2005—2016) обнаружено преобладание ЗНЩЖ в женской популяции, а в возрастной структуре самый высокий прирост заболеваемости отмечался среди мужчин 40—44 и женщин 30—34 лет. Кроме того, четко прослеживался неоднородный характер регионального распределения заболеваемости ЗНЩЖ. Увеличение распространенности за аналогичный период по Украине в целом составило 112,5 %, а по области — 98,2 %, прогностическая модель свидетельствует о ее повышении в течение по меньшей мере следующих 5 лет. Выводы. Ежегодный постоянный рост заболеваемости и распространенности ЗНЩЖ, а также неоднородное гендерное, возрастное и региональное распределение исследуемых показателей свидетельствует о многофакторности и актуальности изучения данной проблемы с последующим улучшением системы профилактических мероприятий.
Ключевые слова: рак щитовидной железы; злокачественные новообразования щитовидной железы; эпидемиология; заболеваемость; распространенность; факторы риска; Украина; Киевская область
Ткаченко В.1., Рмар Я.Ю.
Нацюнальна медична академiя пслядипломноi освти iMeHi П.Л. Шупика, м. Кив, Украина
Захворюванють та поширенють злоякюних новоутворень
щитоподiбноi залози в Укра'ГН та Кшвсьюй облает пюля аварм на Чорнобильсьюй атомнм електростанцм
Резюме. Актуальтсть. Щорiчний прирют кшькосл вперше дiaгностовaних випадшв злоякюних новоутворень щитоподiбноi залози (ЗНЩЗ) вщзначаеться як на територiях, найбшьш забруднених радюйодом тсля ава-ри на Чорнобильськш атомнш електростанци (ЧАЕС), так i в шших регюнах. Неоднорщний характер регюналь-ного зростання ^ei патологи потребуе детального аналь зу поширеносл i захворюваносл на ЗНЩЗ з урахуван-ням можливого впливу фактс^в ризику. Мета: провести aнaлiз динaмiки захворюваносл та поширеносл ЗНЩЗ серед населення Украши та ки'всько' обласл пюля ава-ри на ЧАЕС. Матерiалu та методи. Проведено aнaлiз бюлетешв Нацюнального канцер-реестру Украши, да-них статистичних звтв зaклaдiв охорони здоров'я Кшв-сько' обласл (2005—2016) та даних лггератури починаючи з 1981 р., що мютить актуальну шформацш з поточно' теми. Статистичний aнaлiз показнишв було проведено за допомогою пакета програм Windows Office Ехсе1 2016 та StatSoft Statistica 10.0.1011.0. Результати. Починаючи з 1990 р. в Укра'ш простежуеться рiзке зростання захворюваносл на ЗНЩЗ порiвняно з дочорнобильським перюдом. З 1989 по 2004 р. збшьшення захворюваносл на рак щитоподiбноi залози в цiлому по Укра'ш серед чоловiчого населення становило 90,28 %, а серед жшо-чого — 104,42 %; у Кшвськш обласл — 65,6 та 156,9 %
вщповщно. За перюд 2005—2016 рр., окрiм збiльшення частки ЗНЩЗ в структурi всiх онкопатологш, також вщ-бувся значний прирют захворюваносл: по Укра'ш — в 1,7 раза (+70 %, p < 0,01), по обласл — в 1,5 раза (+52,6 %, p < 0,01), з бшьш високими показниками захворюваносл за цей перюд у Кшвськш область При проведенш гендерного aнaлiзу (2005—2016) виявлене переважання ЗНЩЗ в жшочш популяци, а у вiковiй структурi найви-щий прирiст зaхворювaностi вiдмiчaвся серед чоловiкiв 40—44 i жшок 30—34 рокiв. Крiм того, чпко простежував-ся неоднорiдний характер регюнального розподiлення зaхворювaностi на ЗНЩЗ. Прирют поширеносл за ана-логiчний перюд по Укра'ш в цiлому дорiвнювaв 112,5 %, а по обласл — 98,2 %, прогностична модель свщчить про ii збiльшення протягом щонайменше наступних 5 рокiв. Висновки. Щорiчне невпинне зростання зaхворювaностi та поширеносл ЗНЩЗ, а також неоднорщне гендерне, вшове та регiонaльне розподшення дослщжуваних по-казниыв свiдчить про багатофакторнють та aктуaльнiсть вивчення щы проблеми з подальшим покращанням сис-теми профiлaктичних зaходiв.
Ключовi слова: рак щитоподiбноi залози; злоякiснi но-воутворення щитоподiбноi залози; епiдемiологiя; захворюванють; поширенють; фактори ризику; Украша; Кшв-ська область
