Thyroid cancer pathology: Insights from a developing region.

[BACKGROUND] The South African (SA) health sector and laboratories comprise a dual system that includes public and private providers. SA studies illustrate diverse thyroid cancer incidence across provinces, with papillary thyroid cancer (PTC) more prevalent in urban provinces than follicular thyroid cancer (FTC) and anaplastic thyroid carcinoma.

[OBJECTIVES] To provide a deeper insight into the geographic intricacies of thyroid cancer types from public and private provider perspectives.

[METHODS] This study investigated thyroid cancer pathology in SA between 2015 and 2019, overall and by province and facility type (private, public). Laboratories provided data in different formats, requiring manual processing. The data extracted included date of birth, sex, province, specimen type and final histology results.

[RESULTS] A total of 14 157 reports were included, of which 3 235 were thyroid cancers. Multiple challenges were experienced in terms of data processing. The public sector contributed 53.6% of thyroid cancer cases. Preoperative cytology was performed in 19.8% of thyroid cancers, and was diagnostic in 23.6%. There was significantly more FTC in the public sector (20.8% v. 5.6%), and more PTC in the private sector (87.1% v. 55.2%). T3 tumours were most prevalent in the public sector (52.3%), and T1 tumours in the private (38.8%).

[CONCLUSION] The dual SA health system and the geographical distribution of the population appear to influence the pathological landscape of thyroid cancer. Standardised thyroid cancer reporting across all public and private laboratories in the form of a prospective national thyroid registry would allow for a more accurate evaluation of thyroid disease, ultimately improving thyroid cancer care in SA.