Epidemiology Of Thyroid Cancer Research Articles

Thyroid cancer epidemiology in Ireland from 1994 to 2019 – Rising diagnoses without mortality benefit

BackgroundThe epidemiology and management of thyroid cancer has changed radically in the recent past, with rising international incidence of early-stage papillary thyroid cancer (PTC) in particular. In this paper, we review the epidemiology of thyroid cancer in Ireland. MethodsA retrospective cohort study of National Cancer Registry of Ireland data, 1994–2019. ResultsRecords from 4158 patients were analysed. 73 % (n = 3040) were female. The average age was 50.4 years. Patient sex did not change over time (p = 0.662), while age decreased significantly (p < 0.0001). The most common diagnoses were PTC (n = 2,905, 70 %) and follicular thyroid carcinoma (n = 549, 13 %). Incidence rose over threefold (1.8–6.2 cases/100000 person-years). The incidence of T1 PTC rose over twelvefold (0.169–2.1 cases/100000 person-years), while the incidence of stage III and IV disease did not change significantly. Five-year disease-specific survival (DSS) was 85 % and varied significantly by diagnosis – 97 % for PTC versus 5 % for anaplastic thyroid carcinoma. Survival did not change significantly over time. Male sex was a risk factor for more advanced disease (p < 0.0001) but did not independently predict overall survival except in PTC (HR 1.6, p = 0.03). The use of radioactive iodine declined markedly from 49 % to 12.5 %. RAI improved DSS for PTC patients aged over 55 years (p = 0.02) without a notable effect on survival for those under 55 years (p = 0.99). ConclusionThe epidemiology and management of thyroid cancer in Ireland has changed dramatically in a manner reflective of international trends.

EPH178 Representing Thyroid Cancer Epidemiology in the US Over Time: A Microsimulation Modeling Approach Incorporating Temporal Differences in Thyroid Ultrasound Utilization by Sex and Age

EPH178 Representing Thyroid Cancer Epidemiology in the US Over Time: A Microsimulation Modeling Approach Incorporating Temporal Differences in Thyroid Ultrasound Utilization by Sex and Age

Changes in the Trend of Thyroid Cancer Epidemiology According to South Korean Nationwide Database, 1999–2020

Changes in the Trend of Thyroid Cancer Epidemiology According to South Korean Nationwide Database, 1999–2020

Thyroid cancer, risk factors, clinical features, prognosis, and its incidence preference in Saudi populations: review

Within the diverse cancers reported, the epidemiology of thyroid cancer increased 3-fold in the latest years which may be due lifestyle changes, lack of cancer awareness, lack of screening, and early cancer investigations and detection programs in addition to genetics and deficiency of iodine and vitamin D. The aim of this review was to discuss Thyroid cancer incidence, risk factors, and clinical features and prognosis. The cause of thyroid cancer is unknown, but because the thyroid gland is very sensitive to radiation, exposure to radiation can cause precancerous changes. For unclear reasons, thyroid cancer like almost all diseases of the thyroid, occurs about 3 times more often in women than in men at any age, but the risk peaks earlier for women at 40 to 50 years. Several inherited conditions have been linked to different types of thyroid cancer but some patients with thyroid cancer do not have inherited conditions or a family history of the disease. Four general types of thyroid cancer were explained, Papillary, Follicular, Medullary, and Anaplastic. Over the last decade, the incidence of Papillary and Follicular thyroid cancers increased at the same time.

Modeling Thyroid Cancer Epidemiology in the United States Using Papillary Thyroid Carcinoma Microsimulation Model

ObjectivesThyroid cancer incidence increased over 200% from 1992 to 2018, whereas mortality rates had not increased proportionately. The increased incidence has been attributed primarily to the detection of subclinical disease, raising important questions related to thyroid cancer control. We developed the Papillary Thyroid Carcinoma Microsimulation model (PATCAM) to answer them, including the impact of overdiagnosis on thyroid cancer incidence. MethodsPATCAM simulates individuals from age 15 until death in birth cohorts starting from 1975 using 4 inter-related components, including natural history, detection, post-diagnosis, and other-cause mortality. PATCAM was built using high-quality data and calibrated against observed age-, sex-, and stage-specific incidence in the United States as reported by the Surveillance, Epidemiology, and End Results database. PATCAM was validated against US thyroid cancer mortality and 3 active surveillance studies, including the largest and longest running thyroid cancer active surveillance cohort in the world (from Japan) and 2 from the United States. ResultsPATCAM successfully replicated age- and stage-specific papillary thyroid cancers (PTC) incidence and mean tumor size at diagnosis and PTC mortality in the United States between 1975 and 2015. PATCAM accurately predicted the proportion of tumors that grew more than 3 mm and 5 mm in 5 years and 10 years, aligning with the 95% confidence intervals of the reported rates from active surveillance studies in most cases. ConclusionsPATCAM successfully reproduced observed US thyroid cancer incidence and mortality over time and was externally validated. PATCAM can be used to identify factors that influence the detection of subclinical PTCs.

Epidemiology of thyroid cancer in Tunisia

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Environmental and social determinants of thyroid cancer: A spatial analysis based on the Geographical Detector.

Thyroid cancer has increased sharply in China in recent years. This change may be attributable to multiple factors. The current study aimed to explore the environmental and social determinants of thyroid cancer. Incidence data from 487 cancer registries in 2016 were collected. Eight factors were considered, namely, air pollution, green space, ambient temperature, ultraviolet radiation, altitude, economic status, healthcare, and education level. A geographical detector (measured by q statistic) was used to evaluate the independent and interactive impact of the eight factors on thyroid cancer. Social factors, especially economic status and healthcare level (q>0.2), were most influential on thyroid cancer.Ultraviolet radiation, air pollution, and temperature had more impact on women, while green space and altitude had more influence on men. Enhanced effects were observed when two factors interacted. Spatially, economic status, healthcare, and air pollution were positively associated with thyroid cancer, while education level, green space, and altitude were negatively related to thyroid cancer. The socio-environmental determinants and spatial heterogeneity of thyroid cancer were observed in this study. These findings may improve our understanding of thyroid cancer epidemiology and help guide public health interventions.

Women and thyroid cancer incidence: overdiagnosis versus biological risk.

Our aim is to discuss the concepts of sex and gender in the context of thyroid cancer epidemiology. It has been long-established in global epidemiologic data that thyroid cancer incidence rates are higher in women than men. However, what has been less well understood is whether this reflects sex disparities in cancer susceptibility, gender disparities in detection, or a combination. A recent meta-analysis of autopsy data from individuals who were not known to have thyroid cancer in their lifetime demonstrated no difference in the prevalence of thyroid cancer in women and men, suggesting that gender differences may be the reason for gender-based differences in thyroid cancer detection. This finding, and sex differences in auto immunity and other factors that may affect cancer susceptibility are explored. Additional research to explore gender- and sex-specific data on thyroid cancer would inform our understanding of the differences and similarities between men and women in susceptibility and detection of thyroid cancer and help to optimize disease management for all genders and both sexes.

Епідеміологія та клініко-морфологічні особливості раку щитоподібної залози в осіб, які проживають у Вінницькій області

Актуальність. Рак щитоподібної залози (РЩЗ) є найбільш поширеною пухлиною ендокринних залоз. Проблема РЩЗ в Україні вийшла далеко за межі наслідків Чорнобильської катастрофи й характеризується зростанням захворюваності на цю патологію. Мета: вивчити захворюваність на РЩЗ у Він­ницькій області. Матеріали та методи. Прослідковано динаміку РЩЗ за останні 30 років (1986–2015 рр.) у жителів Вінницької області. Результати. Аналіз частоти РЩЗ за 30-річний період свідчить про постійний ріст цієї патології, особливо за останні 10 років. Захворюваність у дочорнобильський період перебувала в межах 1,0–1,2 випадку на 100 тис. населення, у перші 10 років після аварії вона виросла до 2,2–2,8 випадку на 100 тис. населення, у 2001–2005 рр. зросла до 4,4–5,5 випадку на 100 тис. населення, а в останні роки становила 9,9–11,3 випадку на 100 тис. населення. При порівнянні захворюваності в області з республіканськими даними виявлено, що показники в області більш високі, ніж загалом по Україні, але значно менші порівняно з регіонами, які найбільше постраждали внаслідок аварії на ЧАЕС (Київська область, м. Київ). По області спостерігається значне превалювання захворюваності жінок порівняно з показниками чоловічого населення. При аналізі динаміки захворюваності на РЩЗ у різних вікових групах статистично вірогідних розбіжностей не отримано. Висновки. Проведені дослідження структури захворюваності на РЩЗ серед жителів Вінницької області виявили значний ріст числа хворих серед дорослого населення. Рівень захворюваності в області перевищує республіканські показники й має тенденцію до збільшення, превалюють високодиференційовані форми, що мають малоагресивний перебіг, переважно в жінок, у солітарних вузлах, менших від 20 мм, що повинно викликати онконасторогу при виявленні цих хворих.

Epidemiology of Thyroid Cancer: Incidence and Mortality in China, 2015.

Objective: Using data from cancer registries to estimate thyroid cancer incidence and mortality in China, 2015.Methods: Data submitted from local cancer registries were checked and evaluated according to the criteria of data quality control, a total of 368 cancer registries' data were qualified for the final analysis. Data were stratified by area (urban/rural, eastern/central/western), sex and age, combined with national population data to estimate thyroid cancer incidence and mortality in China, 2015.Results: Approximately 200,700 new cases were diagnosed in 2015, accounting for 5.11% of all cancer cases. The crude incidence rate was 14.60/100,000. Age-standardized incidence rates by Chinese standard population (ASIRC) and world standard population (ASIRW) were 12.05/100,000 and 10.44/100,000, with the cumulative incidence rate (0–74 years old) of 1.00%. About 7,900 deaths of thyroid cancer were reported in 2015, accounting for 0.34% of all cancer deaths. The crude mortality rate was 0.58/100,000, age-standardized mortality rates by Chinese standard population (ASMRC) and world standard population (ASMRW) were 0.37/100,000 and 0.36/100,000. The age-standardized incidence and mortality in females were significantly higher than those in males (P < 0.001). The rates in urban areas were higher than those in rural areas (P < 0.001). The ASIRC in eastern areas was higher than that in central and western areas (P < 0.001), while the ASMRC in central areas was higher than that in eastern and western areas (P < 0.001).Conclusions: The burden of thyroid cancer was heavy in China, cancer control faces the problem of the disparity between geographic areas, and the incidence and mortality rates were varied by sex and age. Targeted cancer preventive measures should be put into practice.

EPIDEMIOLOGICAL CHARACTERISTICS OF THYROID CANCER IN THE DEVELOPED INDUSTRIAL REGION

The purpose of the study was to assess thyroid cancer epidemiology in the Udmurt Republic during 2008–18 and to estimate thyroid cancer raetes until 2023.Material and Methods. The incidence of thyroid cancer in the Udmurt Republic was studied over a 10-year period (2008–18) according to state statistical accounting and reporting documentation.Results. The age-standardized incidence rate of thyroid cancer in the Udmurt Republic for both sexes increased from 2.57 ± 0.36 per 100,000 population in 2008 to 6.60 ± 0.61 per 100,000 population in 2018, with an average annual percentage change of 9.9 %. The mortality rate from thyroid cancer decreased from 0.39 ± 0.12 per 100,000 population in 2008 to 0.36 ± 0.14 per 100,000 population in 2018.The incidence of thyroid cancer in the Udmurt Republic in 2023 was estimated to be 10.24 per 100,000 population.Conclusion. In the Udmurt Republic, the increase in the incidence of thyroid cancer is significantly higher than in the Volga Federal District and Russia. The obtained estimates of thyroid cancer incidence until 2023 can be used in developing programs for early detection and prevention of this disease.

Epidemiology and Surgical Characteristics of Thyroid Cancer in United Arab Emirates: Review of 100 Consecutive Patients

Background and Objectives: Thyroid cancer incidence is increasing globally. There is limited data regarding the epidemiology of thyroid cancer in the Middle East and North Africa region. This region has also experienced socioeconomic changes recently that have influenced the histopathological and epidemiological pattern of thyroid cancer. The aim of this study is to evaluate the histological, epidemiologic, and surgical factors of thyroid cancer patients who underwent thyroidectomy at Cleveland Clinic Abu Dhabi. Materials and Methods: A retrospective review of patients who underwent thyroidectomy and found to have thyroid cancer over a 2-year period from July 2015 - July 2017. The histopathological data were reviewed based on the College of American Pathologists Protocol for Carcinomas of Thyroid Gland (American Joint Committee on Cancer, 7th edition, 2010). Results: One hundred patients underwent surgery for thyroid carcinoma in our patient population. In these cancer patients, the female to male ratio was 5.25:1 and 71 patients (71%) were below 45 years of age. The most common surgery performed was total thyroidectomy at 75.7%. Papillary thyroid carcinoma (PTC) was the most common pathology in 89%, followed by follicular thyroid carcinoma (FTC) in 9%, one case of mixed papillary follicular carcinoma, and one case of Hurthle cell carcinoma. Hypocalcemia was the most common postoperative complication (20.6%). Conclusion: PTC, traditionally seen in iodine sufficient regions, is the most common histologic subtype of thyroid cancer and its rates are increasing in the United Arab Emirates (UAE). Female gender and age &lt;45 were associated with thyroid carcinoma in our UAE patient cohort.

Thyroid cancer in Brazil: a descriptive study of cases held on hospital-based cancer registries, 2000-2016.

Objective To describe the clinical and epidemiological profile of primary thyroid cancer hospital cases in Brazil. Methods This is a descriptive study of cases held on hospital cancer records who had their first consultation for treatment in the period 2000-2016 and who were monitored by the hospitals providing those records. Results Of the 52,912 cases, 83.4% were female and 96.9% were differentiated carcinoma cases. The median time to diagnosis was shorter for anaplastic cases (11 days) and for those living in Brazil's Southern region (5 days). Treatment was initiated within 60 days in 88.8% of cases that arrived at the hospitals without diagnosis and in 34.9% of those who arrived with diagnosis. Conclusion The findings are consistent with thyroid cancer epidemiology, with a predominance of female cases and differentiated carcinomas. Analysis of time-to-treatment suggests access difficulties for those who already had diagnosis when they arrived at the hospitals.

Thyroid cancer in the world: An epidemiological review

BackgroundThyroid cancer is the most common malignancy of the endocrine glands at any age and sex. The present study was designed to comprehensively identify the epidemiological status of thyroid cancer using the results of similar studies.MethodsThe present study was an epidemiological review study. Studies on the epidemiology of thyroid cancer between March 2020 and April 2020 were searched by two researchers at four Latin scientific databases (Google Scholar, PubMed / Medline, Scopus, ISI Web of Science). Persian and Latin articles about the epidemiology of thyroid cancer were included in the study.ResultsThe incidence of thyroid cancer is increasing worldwide; however, this type of cancer has a good survival rate. The most important risk factors for thyroid cancer include Ionizing radiation, diet, female gender, age, genetic background and race and ethnicity.ConclusionThe incidence of thyroid cancer in the world is increasing. Therefore, preventive and protective measures to reduce the risk factors of this cancer are recommended to reduce the incidence of the disease.

Increasing Thyroid Cancer Incidence in Oman: A Joinpoint Trend Analysis.

ObjectivesWe sought to investigate the epidemiology of thyroid cancer and its trends in Oman over a 20-year period.MethodsWe analyzed all cases of primary thyroid cancer reported to the Oman National Cancer Registry between 1996 and 2015. Age-standardized incidence rates (ASR) were calculated using the World Standard Population. Joinpoint regression was used to assess trends and obtain annual percentage changes (APC) in incidence rates with 95% confidence intervals (95% CI) and p-values at the alpha = 0.050 level. Gender-specific APC was used to project thyroid cancer incidence rates in Oman over the next 20 years. Population attributable fraction was calculated for obesity and current non-smoking.ResultsA total of 1285 cases of primary thyroid cancer cases were registered in Oman between 1996 and 2015, with a female to male ratio of 4:1. In men, the ASR was 2.0 per 100 000 while in females it was 7.6 per 100 000 (p < 0.010). Over 80.0% of thyroid tumors were of a papillary type and 19.0% follicular type. Statistically significant trends for thyroid cancer were detected in women from 2008–2015 (APC = 14.3%, 95% CI: 8.0–20.9, p < 0.010) and among both genders (APC = 16.7%, 95% CI: 4.9–29.9, p < 0.010). If current trends continue, thyroid cancer incidence will increase to 3.1, 16.6, and 11.8 per 100 000 by 2040 in men, women, and both genders, respectively. Nearly 10.0% of thyroid cancer can be prevented by controlling obesity in the Omani population.ConclusionsOman has had moderate incidence rates of thyroid cancer with an increasing trend among women. Since projections estimate that the rates of this disease will double in women over the next 20 years, health authorities should consider providing sufficient resources to manage this condition and establish prevention programs that address obesity as part of the strategy for the prevention and control of noncommunicable diseases.

AN ANALYTICAL, STATISTICAL STUDY OF THYROID CANCER INCIDENCE IN SUDAN DURING 2005-2015

Introduction: Sudan, the most diverse country in the African continent, is experiencing growing cancers problems. However, little is known about thyroid cancer epidemiology and patterns. the study aimed to analyse and describe the epidemiological characteristics and trends of thyroid cancer in, in the period1st January 2005 and 31st December 2015. Methods: This is retrospective population and hospital-based study. We analysed epidemiological data for digital medical records at both Radiation and Isotope Centre Khartoum (RICK), and Soba University Hospital, Khartoum, Sudan were reviewed. Results: In total, 1,062 cases were reported during 1st January 2005 and 31st December 2015. Of these, (360; 33.9%) were male and (702; 66.1%) were female. The highest number of cases was in the 25-54-year-old age group (451; 42.5%), and more than 65-year-old age (331; 31.2%). The most predominant type of thyroid cancer among the Sudanese population was Papillary carcinoma (734; 69.1%) followed by Follicular carcinoma 178(16.8%) and Medullary carcinoma (150; 14.1%). There were significant differences in gender, age groups and types of thyroid cancer (P=0.001). Based on geographical distribution thyroid cancer showed high prevalence in Khartoum, North Kurdufan, River Nile, Kassala, North Darfur, Northern, and south Kurdufan. Whereas, low distribution is seen in Red sea, West Darfur, West Kurdufan, East Darfur, Al Gadarif, and the Blue Nile. Conclusion: our results suggest that thyroid cancer continuous presenting alarming challenge with an increasing the prevalence in females. Papillary carcinoma is the most common type among Sudanese populations. Further epidemiological studies are required in policy strategies for control and prevention strategies of thyroid cancer in Sudan.

National trends in prevalence and mortality rates of thyroid cancer using data from the Ministry of Health of Peru

The incidence of thyroid cancer has increased worldwide. Peru has few reports describing the national and regional epidemiology of thyroid cancer. The incidence of thyroid cancer has increased worldwide. Peru has few reports describing the national and regional epidemiology of thyroid cancer. A descriptive study of trends was conducted with secondary data obtained from a public information source in Peru. The ICD 10: C73.0 coding record was evaluated, by age group, year and region. The age-standardized prevalence (period 2005 to 2016) and mortality (period 2005 to 2015) were calculated by region and year of study. In the 2005-2016 period, 19 513 cases of thyroid cancer were recorded. The age group with the highest frequency was 30 to 59 years (57.7%). The prevalence increased from 4.7 to 15.2 cases per 100 000 inhabitants in the period 2005-2016, with the coastal region showing the greatest increase. Likewise, 1596 deaths from thyroid cancer (period 2005 to 2015) were recorded, more frequently in those older than 60 years (75.5%). The age-standardized mortality rate increased from 0.67 in 2005 to 0.72 in 2015, being the highlands the one with the greatest increase. The prevalence of thyroid cancer increased and mortality remained constant in the period studied. These results suggest exploring social and population factors that may have influenced these results. Likewise, population records of this and other neoplasms in Peru should be improved.

Thyroid Cancer in Ecuador, a 16\u2009years population-based analysis (2001\u20132016)

BackgroundThyroid cancer is the most frequent endocrine neoplasia worldwide. Information from Andean countries is scarce. In Ecuador there is no reports available of the epidemiology of this type of cancer. The aim of this study is to present the epidemiology and the burden of disease of thyroid cancer.MethodsThis is a cross-sectional population-based analysis of thyroid cancer epidemiology in Ecuador from 2001 to 2016. The variables studied were the overall mortality rate, socio-demographics characteristics of the hospitalized patients, geographical trends and the burden of thyroid cancer in Ecuador. All the data was obtained from the official records reported by the Ministry of Public Health’s and retrieved from the public databases of the Vital Statistics Deaths and Births Databases and the National Institute of Census and Statistics (INEC).ResultsIn Ecuador, over a period of 16 years from 2001 to 2016 a total of 23,632 hospital admissions were reported, which caused 1539 deaths due thyroid cancer. Data demonstrated an annual mean of 1477 cases, which caused 96 deaths per year in average. The annual incidence fluctuated from 3 in 2001 to 22 in 2016 per 100,000 inhabitants. Women were 5 times more likely than men to have thyroid cancer. The average length of stay for both sexes were 4 days. The mortality attributable to thyroid cancer represent less than 0.3% of all cancer deaths.ConclusionEcuador has one of the highest rates of thyroid cancer in Latin America, ranking first among women in Latin America. Although this cancer is frequent, mortality rate is relatively low. As this is the first national report of thyroid cancer in the country, a further analysis of the pathological variants and the grading of this neoplasia is needed.

Epidemiology of Thyroid Cancer: A Review of the National Cancer Database, 2000-2013.

Objective To show the recent trends in thyroid cancer in the United States, elucidate the characteristics of stage IV thyroid cancer, and consider the effects of diagnostic testing on the rising incidence of thyroid cancer.Design A retrospective population-based study conducted using the National Cancer Database from 2000-2013 (NCDB). Demographics of patients presenting with stage IV thyroid cancer were compared to patients presenting with all other stages using the chi-square testing. The incidence rates were examined with the trend graphs.Results When compared to stages I-III, there was an increased incidence of stage IV thyroid cancer in: Medicare, lower level of education, lower income, advanced age, male sex, increased number of comorbidities, further distance from a treatment facility, and medullary/anaplastic histology. The incidence of thyroid cancer increased from 7.1 per 100,000 in 2000 to 17.6 per 100,000 in 2013. During this same time period, stage IV disease increased 1 per 100,000. The increase in the incidence of thyroid cancer was almost entirely due to an increase in papillary cancer.Conclusions The United States has continued to see a rise in the incidence of thyroid cancer over the last decade, largely due to the detection of papillary cancers. During this same time, the incidence of stage IV thyroid cancer increased as well. Because early diagnosis and treatment of an increasing number of potentially lethal cancers should lead to a decrease in metastatic disease, we suggest that the increasing incidence of thyroid cancer in the United States is due to overdiagnosis and that more aggressive disease is not being removed by early detection.

The epidemiology of thyroid cancer in the twentieth and early twenty-first century in Ukraine and Zaporizhzhia region

Objective. To study the dynamics of incidence and mortality from thyroid cancer in Ukraine and Zaporizhzhia region in the twentieth and early twenty-first century. Materials and methods. Review of specialized literature was performed; statistical reporting forms were analyzed. Results. Statistical record of thyroid cancer in Ukraine has been conducted since 1989. Thus, in 1989, the incidence among men was 1.01, and in 2004 it was already 1.92, for women these rates were 3.54 and 7.24 per 100 thousand population, respectively. The total incidence of thyroid cancer in Ukraine in 2012 was 5.5 per 100 thousand population, among men – 2.2, and among women – 8.3 per 100 thousand population. The total incidence of thyroid cancer in 2002 in the Zaporizhzhia region was 2.1 per 100 thousand population, among men and women – 1.3 and 2.9 per 100 thousand population, respectively. The total incidence of thyroid cancer in 2002 in the Zaporizhzhia region was 2.1 per 100 thousand population, among men and women – 1.3 and 2.9 per 100 thousand population, respectively. Conclusions . There is an increase in the incidence of thyroid cancer in Ukraine, especially among women. So, for the period 1989–2012, the incidence of thyroid cancer in men and women increased by 115 % and 137 %, respectively. The annual incidence of thyroid cancer in males and females was 5 % and 6 %, respectively. In the Zaporizhzhia region, for the past 14 years, the incidence of thyroid cancer in males and females has increased by 100 % and 310 %, respectively. The annual increase in the incidence of thyroid cancer for men and women in the Zaporizhzhia region was 7.1 % and 22 %, respectively. Mortality from cancer of the thyroid gland in the Zaporizhzhia region in men and women increased by 50 % and 57 %, respectively. The highest incidence of thyroid cancer in the studied period is observed in the city of Kyiv, Kyiv region, Vinnytsia region, and the lowest – in the Zakarpattіa region, Ivano-Frankivsk region and Ternopil region.