MINNEAPOLIS _ Overdiagnosis of thyroid cancer in the United States could be
causing thousands of patients to receive costly and unnecessary procedures that
won't increase the quality or length of their lives.
The findings, published Tuesday by doctors at the Mayo Clinic, have prompted the
researchers to recommend a new diagnostic term that could spare people with
small throat tumors from surgery, medication and radiation that they might not
The rapid expansion of high-tech imaging has identified thyroid lesions that
once went undetected _ and fueled a tripling in the diagnosis of thyroid cancer
in the U.S. over the past 30 years. But the increases in diagnoses and treatment
haven't changed the death rate from thyroid cancer, leading the researchers to
question whether the effort is wasted on patients who could lead healthy lives
without medical intervention.
"This is exposing patients to unnecessary and harmful treatments that are
inconsistent with their prognosis," said Dr. Juan P. Brito, a Mayo
endocrinologist in Rochester, Minn.
In a British Medical Journal article released Tuesday, Brito and colleagues
argued that people with common "papillary" thyroid tumors smaller than 20
millimeters and no family history of thyroid cancer should be diagnosed with a
new term _ "micropapillary lesions of indolent course," or microPLICs.
Giving these lesions a label other than cancer would lead more doctors and
patients to simply wait to see if they grow or cause symptoms. Absent those
problems, patients could avoid treatments that can include surgical removal of
some or all of the thyroid gland and the consumption of radioactive iodine that
targets and kills thyroid cells, including cancer cells.
Many patients who undergo surgery need lifelong medication to compensate for the
loss of the thyroid, a butterfly-shaped gland in the throat that regulates the
release of hormones that control growth, energy, mood, body temperature and
"Once you remove the label of cancer, you actually can reframe the care of these
patients," Brito said. "Many patients will still probably opt to have surgery,
but we feel a number of patients will be attracted to the option to just watch
it and wait."
While thyroid cancer isn't as common as cancers of the breast, lung or colon, it
is the third-fastest growing cancer in terms of the rate of diagnosis. The
problem is similar to the overdiagnosis of prostate cancer based on PSA blood
tests that can be misleading.
Autopsies have found patients who died of heart disease and other ailments with
tumors in their thyroid glands or prostates that never caused problems.
International variations in rates of thyroid cancer suggest that the disease is
overdiagnosed in the United States. There is no other ready explanation why the
rate would have increased in the United States from about 6 cases per 100,000
people in 1985 to 11 cases per 100,000 in 2002, when the rates stagnated in
Norway, Sweden and Japan.
A July study by New York cancer experts also found that diagnostic rates in the
U.S. were higher for people with wealth and health insurance. A real increase in
cancer would have likely transcended these economic demographics.
Doctors need to use more restraint in their use and interpretation of
ultrasounds and high-tech imaging scans, and learn to differentiate harmful
lesions from potentially harmless ones, said Dr. Otis Brawley, chief medical
officer of the American Cancer Society, a national advocacy group.
"I'm not ready to say it's time to start using that new term," he said of Mayo's
proposal, "but I am ready to say it's time to start considering it. Many doctors
don't realize this is a huge problem."
Apart from waiting and watching, doctors have alternatives such as surgically
removing lesions without radioiodine treatment, or laser ablation to shrink
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Susan Evans of St. Paul, who underwent treatment last year to remove a lesion in
her thyroid gland, said the overtreatment problem might, in part, reflect
doctors not talking enough with one another about options before passing along
test results or recommendations.
More coordination between the ear, nose and throat specialists, endocrinologists
and other physicians might produce a more cautious treatment plan, she said.
"If they were to work a little more hand in hand ... in these cases, I think
some people would be able to sit it out a little more," Evans said.
Removing the cancer label might encourage more conservative treatments, but
doctors would still need to be vigilant with small tumors, said Dr. Anders
Carlson, an endocrinologist with HealthPartners in St. Paul.
"There definitely are instances where papillary thyroid cancer is quite
aggressive and does spread and does cause quite a burden of disease," he said.
"So I think you have to be a little bit careful. You don't want the pendulum to
swing too far the other way."
(c)2013 Star Tribune (Minneapolis)
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